View
1
Download
0
Category
Preview:
Citation preview
Benefits Wise
2019‐2020 Plan Year April 1, 2019 through March 31, 2020
2 | Florida Institute of Technology 2019 Benefit Guide
Welcome to Your 2019‐2020 ICUBA Benefits Guide! As a member of the Independent Colleges and Universities Benefits Association (ICUBA), Florida Institute of Technology
offers a comprehensive range of benefits to promote overall wellbeing for you and your family. This booklet provides
a summary of your benefits. Official plan and insurance documents govern your rights and benefits under each plan.
For more details about your benefits, including covered expenses, exclusions, and limitations, please refer to the
summary plan descriptions, plan document, or certificate of coverage. If any discrepancy exists between this
brochure and the official documents, the official documents will prevail.
Please review this brochure carefully so you can choose the coverage that’s right for you! It’s time to make your
benefit decisions for April 1, 2019 – March 31, 2020!
Contents
Welcome 2
Who’s Eligible 3
Enrolling with ICUBABenefits.org 4‐5
Quick Reference: Medical Plan Perks and Additional Details 6‐7
Wellbeing for Our Members! 8
Teladoc 9
SurgeryPlus 10‐11
ICUBA Medical Plan Option ‐ Preferred Provider Organization (PPO) 12
ICUBA Medical Plan Option ‐ Premier Copay Plan (PPO) 13
ICUBA Medical Plan Option ‐ $4000/$8000 Deductible PPO Plan 14
ICUBA Prescription Plan 15
ICUBA Employee Assistance Program (EAP) 16
Spending Accounts 17
Understanding Health Care Accounts 18
ICUBA Dental Benefit Options from Humana 19
ICUBA Vision Benefit Options from EyeMed 20
Income Protection 21
Additional Voluntary Benefits 22
Important Contacts 23
3 | Florida Institute of Technology 2019 Benefit Guide
Who’s Eligible
As long as you are a full‐time employee of Florida Institute of Technology, you and your legal dependents are eligible
for the benefits described in this booklet. As a newly‐hired employee, coverage for your elected benefits will be
effective on the first day of the month following or coinciding with the date of hire.
Dependent Eligibility
You may enroll your eligible dependents for coverage once you are eligible.
Your eligible dependents include: your legally recognized spouse or qualified domestic partner and your legal child
dependent(s) including natural child, legally adopted child, stepchild, child required to be covered pursuant to a Qualified
Medical Child Support Order, child with proof of legal guardianship who resides with you, or a foster child.
It is your responsibility to provide Human Resources with proof of your dependents’ eligibility.
Status Change/Qualifying Events
Once your benefit elections become effective, they remain in effect until the end of the plan year (March 31). You may
only change coverage due to a qualifying event. You must notify Human Resources and complete your enrollment
changes within 30 days of the event occurring.
The following list highlights these qualifying events, which include but are not limited to:
• Change in marital status (marriage, death of spouse, divorce, legal separation);
• Change in number of dependents (birth, death, adoption, eligibility status, child support order);
• Change in employment status for you or your spouse (commencement, termination, leave of absence, full‐time to
part‐time or vice versa);
• Special enrollment rights under HIPAA; or
• You, your spouse or child gains or loses Medicare or Medicaid coverage.
For further information on eligible qualifying events, please refer to the Plan Document or contact your Human
Resources Department.
4 | Florida Institute of Technology 2019 Benefit Guide
Enrolling with ICUBABenefits.org
Let’s Get Started! Your 2019‐2020 enrollment can be completed on line at http://ICUBAbenefits.org. Be sure to review your benefits,
confirm and submit.
Go to http://ICUBAbenefits.org. From the log on
screen, enter your username & password.
If this is your first time logging on we’ve set your
default login information as follows:
USERNAME: Your user name is the First Initial of your
First Name + Last Name + Last Four Digits of SSN
(e.g. JSmith6789)
PASSWORD: Your Date of Birth (mmddyyyy).
Please note: You will be asked to change your
password after your initial login.
If you do not remember your password, select
Forgot Password and answer your security
question. After three failed login attempts,
your account will be locked and you will
need to contact Human Resources or bswift
at 1‐866‐524‐5063.
Upon logging in, you will be able to access your
benefits information, work through enrollments
and access our Single Sign‐On section under
My Carrier Accounts. From the top task bar or
side panel you can:
• Verify your personal information. If you
need to make any updates or changes, you
may do so by contacting the Human
Resources office.
• Update contact information. Please make sure
your phone number and email address are up
to date. This is how we can contact you about
exciting benefits updates and wellbeing
communication opportunities.
• If applicable, confirm dependent eligibility
based on the plan document rules.
• Access ICUBA's insurance carrier sites throughour Single Sign‐On section. Approximately48 hours after you've successfully electedyour ICUBA benefits, you will gain access tothe insurance carrier portals. Upon your firstconnection attempt you'll register with thecarriers, however, each subsequent visit willmake the connection automatically withoutneeding to remember a ton of differentusernames and passwords.
5 | Florida Institute of Technology 2019 Benefit Guide
Enrolling with ICUBABenefits.org (continued)
Enroll in your benefit selections. When you are in
an active enrollment period, Click the Start Your
Enrollment button located on your home page.
First you will be asked to confirm your personal
information. Next, you have the option to enroll or
waive coverage for the various benefits offered to you.
Please make your way through each benefit category
shown below until the plan image shows green and
says completed! You may “View Plan Options” to find
out more about each plan and your other available
options (if applicable). Once completed, select the
orange Continue button on the right panel to review
your selections and complete your enrollment.
Have you Asked Emma?
If you’re thinking, which plan is best for me — Ask Emma! If you have questions while you are enrolling for benefits, we encourage you to use our Ask Emma decision support tool.
Review all your benefit selections. Complete your
benefit enrollment by checking the “I agree and I’m
finished with my enrollment” box and click the
submit button.
Finally, be sure to Save your new benefit elections. You’ll be directed to your final confirmation statement. You have the option of emailing, printing or viewing a confirmation of your elections. This will submit your elections to Human Resources for approval.
Emma can help you make smart, cost‐effective benefits
decisions to fit your individual needs by estimating your
annual costs, using real‐life scenarios from your personal
experiences. She will ask you a few questions for a
personalized “walk through” to guide you in the right
direction.
Bonus: She can assist with benefits selections in English
and Spanish. In addition to her personal walk through,
various benefit information and FAQs are available in the
Ask Emma toolbar. Please use this resource to educate
yourself on your options.
6 | Florida Institute of Technology 2019 Benefit Guide
Quick Reference: Medical Plan Perks and Additional Details
NEW! SurgeryPlus
We are excited to announce a new supplemental benefit through SurgeryPlus which will accompany your ICUBA medical plan
effective 04/01/2019. This is a surgical concierge benefit which focuses on medically necessary, non‐emergent surgical cases
including but not limited to knee, hip, shoulder, foot & ankle, spine, wrist & elbow, general surgery, GI, GYN, bariatric, cardiac and ENT.
We know the surgery process can be very overwhelming and stressful. With the help of SurgeryPlus, your dedicated Care Advocate
will manage the entire procedure including helping you select the right surgeon, coordinating travel, scheduling appointments and
managing medical expenses. SurgeryPlus takes care of it all with a distinct group of High Quality Surgeons of Excellence.
Procedures coordinated through SurgeryPlus will benefit from lower cost because the deductible and coinsurance will be waived,
eliminating all out‐of‐pocket costs including consultation and surgical procedure. To learn more about SurgeryPlus, please call
855‐200‐2119 or register online at https://ICUBA.SurgeryPlus.com, access code: surgery plus. (Remember, this benefit is effective
04/01/2019!)
Deductibles Only Apply to Major Services!
Please familiarize yourself with what our plan covers. Many services are free and not subject to the deductible. ICUBA Medical Plan
Deductibles only apply to Major Services!
No Member Cost Share for: Annual Wellness Visits, ALL Immunizations, Allergy Injections, Venipuncture/Conveyance fees, Quest
Diagnostic Labs, Primary Care Visits to a Blue Distinction Total Care Provider, Electrocardiograms, Echocardiograms, Bone Mineral
Density Tests, Colonoscopies, Sigmoidoscopies, Mammograms and Ultrasounds of the Breast.
Deductible DOES NOT Apply to: Physician, Specialist & Therapy visits; Convenient Care & Urgent Care; Emergency Room &
Emergency Transportation, Prescription Drugs, and Advanced Imaging (precertification required for advanced imaging).
Health Management and Care Consultants
We are calling because we care! Health management and care consultant services are available to ICUBA medical plan members at
no additional cost. These trained health advisors and registered nurses provide tools, education and advocacy to help you manage
chronic health conditions. They can assist with goal setting, help you better understand your doctor’s treatment plan and support
you with referrals, transition of care and assistance addressing gaps in care. ICUBA Members with specific health challenges may
receive a call from one of our Care Consultants from BCBS, Optum, ICUBAcares or Aetna. We highly recommend you take
advantage of this valuable service if a health advisor calls you! Working together with an advisor to manage your health will help
you live life to the fullest.
In‐Network Outpatient Hospital Labs
In‐Network Outpatient Hospital Labs are not subject to deductible. These laboratory tests (which are recommended through Quest
Diagnostics) can be performed during an evaluation and management visit to an in‐network outpatient hospital/office in places
like Moffitt Cancer Center or the Mayo Clinic. Employees will only be responsible for the coinsurance.
Advanced Imaging
Advanced imaging (such as an MRI or CT scan) is not subject to the deductible. ICUBA Members are only responsible for the
allowable charges up to $500. If your imaging is less than $500, you are only responsible for the cost of the image.
Please note: Prior Authorization is still required for all advanced imaging services.
Engaged Rally ICUBA Private Sweepstakes Winners
ICUBA is giving away $50 Amazon Gift Cards every 14 days for participation in City Walks. When you complete a cross city challenge
milestone, not only will you earn coins as you sync your tracking device, but you will be entered EVERY. SINGLE. TIME. a milestone is
reached! There is no limit on entries or winners – and we did have a DOUBLE winner in 2018‐2019! Keep moving! In addition to the
Amazon winners within Rally, ICUBA also draws winners monthly for participation in all the challenges, missions and survey
completions through your engagement in Rally. Learn more about the BlueRewards powered by Rally program on page 8.
7 | Florida Institute of Technology 2019 Benefit Guide
Quick Reference: Medical Plan Perks and Additional Details (continued)
Teladoc rave reviews for $5!
Talk to a Doctor anytime! Teladoc gives you 24/7/365 access to a U.S.‐based board‐certified doctor through the convenience of a
phone or video chat consultations. It’s an affordable alternative to costly urgent care and ER visits when you need care now. You
can find additional information about Teladoc on page 9.
Blue Distinction Total Care (BDTC)
Doctors with the Blue Distinction Total Care (BDTC) recognition are dedicated to improving the quality of care for their patients. By
selecting one of the BDTC providers, your cost is $0 for all medically necessary services with a family practice, internal medicine,
and/or pediatric physician. These physicians specialize in care for people with chronic conditions, like diabetes, asthma, COPD and
heart problems, to ensure each person receives preventive screenings and follow‐up care.
BDTC designation does not necessarily mean they provide a higher standard of care than other doctors. It means these doctors
take part in a quality improvement program recognized by BCBS of Florida.
Use the online Doctor and Hospital finder to locate these preferred physicians by filtering for BDTC designations. Simply log in to
your member account through the single sign‐on section at ICUBAbenefits.org. (If applicable: Dependents can visit the BCBS
website directly at www.MyHealthToolKitFL.com.)
BlueCross BlueShield of Florida Member Website
ICUBA health insurance members can access the BlueCross BlueShield of Florida member website through the single sign‐on
section in the center of your http://ICUBAbenefits.org home page. By using this website, you can view your claim information,
access your Rally wellbeing tools, look up doctors in your network and so much more. Spouses will need to visit the BCBS site
directly by visiting at http://MyHealthToolkitFL.com and enter his/her own name, DOB and ID number to create an account.
Download the BCBS of Florida Mobile App Now you can enjoy the making‐your‐life‐easier utility of the MyHealthToolkit in an app! With the app you can use your digital medical
ID card from your phone and smart wallet feature, check the status of your claims, view benefits and what’s covered by your medical
plan and find local providers quickly! Available for Apple and Android devices.
Free Generic Statin Prescription Drugs
If you meet certain criteria as outlined by the Affordable Care Act (ACA), you may be eligible for Free Generic Statin prescription
drugs. Talk to your doctor or call the ICUBAcares Pharmacist Advocate Program to find out more!
ICUBAcares Pharmacist Advocate Program
Now you can speak with a pharmacist directly and have your personal questions answered over the telephone. Our pharmacists
are ready to answer medication management questions, assist with prior authorization, or troubleshoot your personal side effects.
They’ll even coordinate with your doctor and the insurance company to advocate on your behalf! Learn more on page 15.
Aetna Behavioral Health and Substance Abuse
Behavioral health and substance abuse benefits through Aetna supplement the Medical benefits provided by BCBS. A few
examples of Behavioral Health services include psychologists, therapists, psychiatrists, substance abuse treatments and much
more! Inpatient and outpatient services are available through this valuable benefit.
8 | Florida Institute of Technology 2019 Benefit Guide
Wellbeing for Our Members!
BlueRewards powered by Rally
Rally is our digital health engagement experience that will help you stay engaged in improving your health and wellbeing
while incentivizing you for healthy activities along the way! While we want the focus to be on you actively engaging in your
health for your own reasons, a small incentive is always a good motivator. Remember, taking care of yourself and being a
wise consumer helps lower premiums for everyone. Preventive Care is the most important care you can receive!
ACTIVITY INCENTIVES
Rally Survey Required for incentives + 400 Coins
& ICUBA Private Sweepstakes
Biometric Screenings $25
Onsite/Campus Events $10 each (up to $50)
Wellness Exams $25
Colonoscopy $50
Mammogram/PSA $50
ICUBAcares $50
Missions Unlimited Coins & ICUBA Private Sweepstakes
City Challenges Unlimited Coins & ICUBA Private Sweepstakes every 14 days!
Teladoc Registration 400 Rally Coins
Tobacco Attestation 400 Rally Coins
Clinical Rewards for Chronic Conditions*
500 Rally Coins per Quarter = 2,000 Coins per year
INCENTIVE TOTAL $250
*The Clinical Rewards program will provide 2,000 coins (500 coins per quarter) and targets high cost conditions
including: Asthma, Chronic Obstructive Pulmonary Disease, Congestive Heart Failure, Coronary Artery Disease,
Diabetes, Hyperlipidemia and Hypertension.
Enrolled medical plan members will have access to the Rally portal by visiting http://ICUBAbenefits.org and utilizing
the single sign‐on feature for BCBS MyHealthToolkit. The site features an innovative health survey, personalized
activity recommendations, individual goals, and supportive online communities. Members can link wearable activity
tracking devices to your Rally account to make it easy to track your steps, check your progress, and compete against
others in challenges. As you work toward your goals, you’ll earn Rally coins and ICUBA dollars that can be redeemed
through the Rally Marketplace. Coins can be used for a variety of discounts and ICUBA dollars can be used for
electronic gift cards. Each employee and spouse enrolled in the medical plan is eligible to participate in this WellBeing
incentive. (As applicable, enrolled spouses should visit BCBS website directly at www.MyHealthToolKitFL.com.)
Rally is also available as a mobile app for Apple and Android users. With the mobile app you will be able to stay
engaged anytime or any place! The Rally mobile app will allow users to quickly and securely login with a password or
thumb print, easily check in to Challenges for entry into ICUBA Private Sweepstakes, earn Rally Coins, set and receive
daily reminders and notifications to build healthy habits, participate in daily Missions and much more!
Did you know… Florida Institute of Technology has an active Wellbeing Committee on campus that plans ways for faculty and staff to reach their wellbeing goals? Visit the Human Resources office for more information on how to get involved and get healthy!
9 | Florida Institute of Technology 2019 Benefit Guide
Teladoc® gives you 24/7/365 access to U.S. board‐certified doctors through the convenience of phone or video consults. It’s an
affordable alternative to costly urgent care and ER visits when you need care now. Talk to a doctor any time for a low $5 copay.
Please note: Restrictions apply as it relates to number of consults during the year and severity of condition for consultation.
When Can I Use Teladoc? Teladoc does not replace your primary care physician. It is a convenient and affordable option for quality care.
When you need care now
If you’re considering the ERor urgent care center for anon‐emergency issue
On vacation, on a business trip,or away from home
For short‐term prescriptionrefills
Get The Care You Need Teladoc doctors can treat many medical conditions, including:
Cold & flu symptoms
Allergies
Bronchitis
Urinary tract infection
Respiratory Infection
Sinus Problems
And more!
Doctor Requirements Teladoc is simply a new way to access qualified doctors. All Teladoc doctors:
Are practicing PCPs, pediatricians,and family medicine physicians
Average 15 years experience
Are U.S. board certificate andlicensed in your state
Are credentialed every threeyears, meeting NCQA standards
With your consent, Teladoc is happy to provide information about your Teladoc consult to your primary care physician. For first
time registration with Teladoc there is a single sign‐on feature through BCBS MyHealthToolkit or you may visit www.teladoc.com
directly. If you experience any difficulties, call 1‐800‐Teladoc, and a customer service representative will be more than happy to
walk you through getting your account setup.
Teladoc
10 | Florida Institute of Technology 2019 Benefit Guide
SurgeryPlus
11 | Florida Institute of Technology 2019 Benefit Guide
SurgeryPlus (continued)
12 | Florida Institute of Technology 2019 Benefit Guide
Benefits Summary
Preferred PPO
In‐Network Out‐of‐Network
EMPLOYEE PAYS
Deductible (Individual/Family) $2,500/$5,000 $4,000/$10,750
Coinsurance 20% 40%
Out‐of‐Pocket Maximum (Individual/Family) Includes all medical copays, deductibles &
coinsurance
$4,000/$8,000 $7,500/$15,000
Physician Office Visits 20% 40% after deductible
Blue Distinction Total Care (Family Practice, Internal Medicine, Pediatrics)
$0 Not Applicable
Specialist Office Visits 20% 40% after deductible
Convenient Care Clinics $10 Copay
Independent Clinical Labs* (free standing facilities & office visits)
0%* 40% after deductible
Preventive Care 0% Not covered
Teladoc Visit $5 Copay Not covered
Urgent Care Center $30 Copay
Emergency Room Services 0% after $300 Copay (waived if admitted)
Ambulance $250 Copay
Hospital Inpatient 20% after deductible 40% after deductible
*Quest Diagnostic Labs is the In‐Network Lab for BlueCross BlueShield of Florida.
Monthly Employee Premium Amount
Employer HRA Contribution Employer Cost Employee Premium
Employee $120.00 $541.25 $99.75
Employee & Spouse $240.00 $1,023.00 $341.00
Employee & Child(ren) $260.00 $865.50 $288.50
Family $260.00 $1,347.75 $449.25
ICUBA Medical Plan Option – Preferred Provider Organization (PPO)
13 | Florida Institute of Technology 2019 Benefit Guide
Benefits Summary
Premier Copay Plan
In‐Network Out‐of‐Network
EMPLOYEE PAYS
Deductible (Individual/Family) $2,500/$5,000 $4,000/$10,750
Coinsurance 20% 40%
Out‐of‐Pocket Maximum (Individual/Family) Includes all medical copays, deductibles &
coinsurance
$4,000/$8,000 $7,500/$15,000
Physician Office Visits $25 Copay 40% after deductible
Blue Distinction Total Care (Family Practice, Internal Medicine, Pediatrics)
$0 Not applicable
Specialist Office Visits $50 Copay 40% after deductible
Convenient Care Clinics $10 Copay
Independent Clinical Labs* (free standing facilities & office visits)
0%* 40% after deductible
Preventive Care 0% Not covered
Teladoc Visit $5 Copay Not covered
Urgent Care Center $50 Copay
Emergency Room Services 0% after $300 Copay (waived if admitted)
Ambulance $250 Copay
Hospital Inpatient 20% after deductible 40% after deductible
*Quest Diagnostic Labs is the In‐Network Lab for BlueCross BlueShield of Florida.
Monthly Employee Premium Amount
Employer HRA Contribution Employer Cost Employee Premium
Employee $120.00 $471.10 $201.90
Employee & Spouse $240.00 $1,001.70 $429.30
Employee & Child(ren) $260.00 $848.40 $363.60
Family $260.00 $1,320.20 $565.80
ICUBA Medical Plan Option – Premier Copay Plan (PPO)
14 | Florida Institute of Technology 2019 Benefit Guide
ICUBA Medical Plan Option – $4,000/$8,000 Deductible PPO Plan
Benefits Summary
This plan provides premium cost savings for healthy families with children! This plan offers the same great value‐based benefits as
ICUBA’s Preferred PPO Plan at a lower cost. However, this plan is designed as ICUBA’s first silver plan equivalent with a higher
deductible, out‐of‐pocket maximum and higher employee cost share.
$4,000/$8,000 Deductible Plan
In‐Network Out‐of‐Network
EMPLOYEE PAYS
Deductible (Individual/Family) $4,000/$8,000 $8,000/$16,000
Coinsurance 30% 50%
Out‐of‐Pocket Maximum (Individual/Family) Includes all medical copays, deductibles &
coinsurance
$5,350/$10,700 $10,700/$21,400
Physician Office Visits $35 Copay 50% after deductible
Blue Distinction Total Care (Family Practice, Internal Medicine, Pediatrics)
$0 Not applicable
Specialist Office Visits $70 Copay 50% after deductible
Convenient Care Clinics $10 Copay
Independent Clinical Labs* (free standing facilities & office visits)
0%* 50% after deductible
Preventive Care $0 Not covered
Teladoc Visit $5 Copay Not covered
Urgent Care Center $70 Copay
Emergency Room Services $500 Copay (waived if admitted)
Ambulance $250 Copay
Hospital Inpatient 30% after deductible 50% after deductible
*Quest Diagnostic Labs is the In‐Network Lab for BlueCross BlueShield of Florida.
Monthly Employee Premium Amount
Employer HRA Contribution Employer Cost Employee Premium
Employee $120.00 $536.25 $99.75
Employee & Spouse $240.00 $1,017.75 $339.25
Employee & Child(ren) $260.00 $724.50 $241.50
Family $260.00 $1,213.50 $404.50
Benefits Summary
Copayments Prescription‐Fill Methods*
Tier Retail: Up to a 30‐day supply
90‐Day at Retail Program Up to a 90‐day supply
Mail: Up to a 90‐day supply
Preferred generics at the Nova Southeastern University (NSU) pharmacy $0 $0 N/A
Preferred generics at other network pharmacies $5 $10 $10
Non‐Preferred generics $10 $20 $20
Preferred brands: brand‐name medications on the Preferred Medication List (PML)** $40 $80 $80
Non‐Preferred brands: brand‐name medications not on the Preferred Medication List $75 $150 $150
Preferred specialty at Briova Specialty Pharmacy $75*** N/A N/A
Non‐Preferred specialty at Briova Specialty Pharmacy $75*** N/A N/A
*Preferred Specialty medications are eligible for copay card usage.
Out‐of‐Pocket Maximum
In‐Network Rx copays will be applied toward an individual maximum out‐of‐pocket of $2,000/single and $4,000/family. Once
you reach your out‐of‐pocket maximum, your prescriptions will be paid for at 100% by the plan and no cost to you ($0 copay).
If you have a question about your pharmacy benefit, call the OptumRx Customer Care Center, 24 hours a day, 7 days a week.
The toll‐free number can be found on the back of your Optum ID card.
Tobacco Cessation Benefit Are you ready to quit smoking? We are here to help! Tobacco cessation medications are covered—up to two cycles each year—
$0 copay when you participate in coaching or counseling options though local Area Health Education Centers, BCBS telephonic
coaching or Resources for Living counseling.
Free Over the Counter Items and Diabetic Supplies Did you know you can get certain over the counter items at no cost with a prescription from your doctor! That’s right – as long as
you have a prescription from your provider you can received FREE prescribed diabetic supplies including meters, lancing devices,
lancets, test strips, control solution, needles, and syringes; prescribed Aspirin for adults; prescribed generic folic acid and generic
prenatal vitamins for pregnancy. Simply take the prescription to the pharmacy counter and your local pharmacist can assist you.
ICUBAcares Pharmacist Advocate Program • Real Pharmacists • Real Advocates • Real Solutions
The ICUBAcares team can review your prescriptions and answer questions. Call for a free prescription check‐up at 1‐877‐286‐3967,
Monday to Friday 9 AM‐5 PM!
Our ICUBAcares Pharmacist Team is ready to:
• Serve as a liaison between your doctor, the pharmacy and the insurance company—taking the burden off of you!
• Answer questions on a medication you are taking or considering—providing useful information on side effects and
drug interactions.
• Discuss preferred and non‐preferred tier options to save you money.
• Provide assistance for a prior authorization from your provider.
Our ICUBAcares Pharmacist Advocates will make outbound phone calls to members identified for specific services and assistance.
Our members can also call our Pharmacist Advocates directly and speak to a real pharmacist if a question arises.
ICUBAcares Rally Incentive: If you are a candidate for a qualified medication change, the ICUBAcares team will assist with your
transition to a medication less costly to the plan and reward once complete. Call for a prescription check‐up to find out more!
ICUBA Prescription Plan
15 | Florida Institute of Technology 2019 Benefit Guide
There isn’t a person on this planet who doesn’t have problems. Some problems are easier to handle than others. Then there are
times when these problems seem overwhelming. Well, you don’t have to go through it alone. Resources For Living EAP services
are available to you, all members of your household and your adult children up to the age of 26, regardless of your medical
insurance coverage. Services are confidential and are available 24 hours a day, 7 days a week.
For access to services, simply call 1‐877‐398‐5816 and select Option 1 for EAP.
Online: www.resourcesforliving.com
Username: ICUBA
Password: 8773985816
This resource includes six free counseling sessions per issue per plan year. If additional services are needed, you may utilize the
Aetna behavioral health benefits through the ICUBA medical plan.
EAP services include counseling and relationship support; worklife balance services for child care, parenting, special needs, legal
services, document preparation, financial services, will preparation, urgent/daily living needs, convenience/personal services,
pet/elder care, caregiver support, temporary back‐up care, and so much more!
Our EAP goes digital – Download Talkspace and text a therapist!!
Talkspace is an online therapy platform that makes mental healthcare more convenient and accessible by connecting users with
a network of 2,500+ licensed therapists. With Talkspace, you can send unlimited multimedia messages to a therapist via web
browser or the Talkspace mobile app — anywhere, anytime. You can reach out to your therapist as often as you need to (and at
any time of day) and expect to hear back from your therapist within one working day, during their business hours, five days per
week. Six (6) weeks of Talkspace messaging is included per issue per year within the EAP benefit.
Talkspace is currently provided to adults* who are 18 or older. Similar to the face‐to‐face therapy experience, prior authorization
from Resources for Living is required to begin therapy. Your household dependents and spouse (18+) have access to Talkspace.
Register your account at talkspace.com/RFL then download the app from your device’s app store. Enter your employer’s name
when prompted for Organization name.
*Non‐California residents only. If you are a resident of California and need support, please contact your EAP, 877‐398‐5816.
ICUBA Employee Assistance Program (EAP)
16 | Florida Institute of Technology 2019 Benefit Guide
Spending Accounts
Health Reimbursement Account (HRA) When you enroll in an ICUBA medical plan, Florida Institute of Technology contributes funds to an HRA for you at the end of each
month. The HRA contributions will be available on your ICUBA MasterCard for eligible health care expenses for ICUBA medical plan
participants and covered dependents such as deductibles, copays, dental & vision care, and other eligible expenses not paid for by
your plan.
The funds in your account earn interest on a quarterly basis. Unused funds roll over tax‐free from year to year, allowing you to
save for future health care expenses. Employees with 36 continuous months of employer contributions become vested in their
HRA. This means the funds are yours to keep for life to use for eligible expenses, although fees apply if you stop working for an
ICUBA employer.
Flexible Spending Account (FSA) Flexible Spending Accounts (FSAs), such as our Health Care Spending Account (HCSA) and Dependent Care Spending Account
(DCSA), allow you to pay for certain eligible health and/or dependent care expenses using pre‐tax dollars. IRS rules allow you to
contribute to your account(s) through payroll deduction on a pre‐tax basis—before federal income tax and Social Security taxes
are deducted—reducing you taxable income. FSA dollars can be used for all qualified, taxable dependents. Flexible spending
amounts are subject to discrimination testing. Highly compensated employees may be asked to adjust flexible spending dollars
based on results.
Florida Institute of Technology honors a grace period for the HCSA/DCSA’s. You will have additional time to incur and submit
claims so that you don’t forfeit your funds. For the current plan year ending March 31, 2020, you can continue to incur eligible
expenses until June 15, 2020, but will need to be sure to submit your request for reimbursement before June 30, 2020. Unused
dollars at the end of the grace period will be forfeited.
Using Your ICUBA Benefits MasterCard When you enroll in an ICUBA medical plan you will receive an ICUBA MasterCard to pay for eligible health care expenses such as
deductibles, copays, dental, and vision care, and other eligible expenses not paid for by your plan. This card may only be used for
participant(s) covered by the ICUBA Medical Plan.
View your ICUBA Benefits MasterCard account information online! Log in to ICUBAbenefits.org to access our single sign‐on feature!
Once logged in, look for the MasterCard image and click on it. From here you can access account balances and submit claims for
reimbursement. You also have access from the single sign‐on section in the middle of your ICUBAbenefits.org home page.
17 | Florida Institute of Technology 2019 Benefit Guide
Understanding Health Care Accounts
Health Care
Reimbursement Account (HRA)
Health Care
Flexible Spending Account (FSA)
Funding Contribution Funded by your employer.
Funded by employee pre‐tax dollars.
The maximum amount you can
contribute to the Health Care Spending
Account is $2,700.
The maximum amount you can
contribute to the Dependent Care
Spending Account is $5,000.
Flexible spending amounts are subject to
discrimination testing. Highly compensated
employees may be asked to adjust flexible
spending dollars based on results.
Roll Over of Funds Funds roll over at the end of each plan
year indefinitely.
Have to spend funds by 6/15 and
claim by 6/30 of the following plan
year (Use‐it‐or‐lose‐it).
Medical Plan Enrollment Must be enrolled in ICUBA medical
plan to be eligible. Enrollment in medical plan not required.
Dependent Eligibility Only if covered on medical plan. All qualified dependents are eligible, even if
not enrolled in medical plan.
Availability of Funds Can withdraw up to what has been deposited. Annual election amount available the 1st
business day of plan year.
Portability
Can continue after 36 months of
continuous participation in an ICUBA
medical plan.
Available for remainder of plan year
through COBRA.
Remember: Each time you use your Health Reimbursement Account (HRA) or Flexible Spending Account (FSA) debit card, you
should be keeping your receipts in a safe place. You’ll want to keep those receipts in case you are asked to prove dollars you
spent from the account(s) were eligible health‐related expenses.
18 | Florida Institute of Technology 2019 Benefit Guide
ICUBA Dental Benefit Options from Humana
Benefits Summary
The dental coverage is offered so you and your family can receive the important dental care you need for good health. You can
choose from three different fully insured dental plans that best fit your needs. Humana offers a Dental Health Maintenance
Organization (DHMO) and Preferred Provider Organization (PPO) plans.
High Option PPO Preventive Plus DHMO Prepaid 250CS
Plan Year Maximum $2,000 $1,000 Unlimited
Providers In‐ & Out‐of‐Network
Providers In‐ & Out‐of‐Network
Providers Network Providers/ Assignment Providers
Deductible $50 Individual/ $150 Family
$50 Individual/ $150 Family
Not Applicable
In‐Network Out‐of‐Network
Plan Pays In‐ & Out‐of‐Network Patient Pays Assigned
Network Provider Benefit/Service EMPLOYEE PAYS
Preventive Services 0% 20% 0% You pay a pre‐set copay
Basic Services 20% after deductible
50% after deductible
20% after deductible You pay a pre‐set copay
Major Services 50% after deductible
70% after deductible
Discount available for In‐Network only*
You pay a pre‐set copay
Orthodontia (Adult and/or
Child) 50%
Discount available for In‐Network only*
You pay a pre‐set copay
Orthodontia Lifetime
Maximum for each member $2,000 Not Covered
No Maximum, Member pays pre‐set copay
*Discount is subject to provider discretion and does not count toward the deductible or maximum out‐of‐pocket.
Monthly Employee Premium Amount
Higher Option PPO Preventive Plus DHMO 250CS
Employee Only $40.81 $19.67 $11.83
Employee + 1 $81.29 $45.72 $23.73
Employee & Family $136.71 $75.69 $36.85
19 | Florida Institute of Technology 2019 Benefit Guide
ICUBA Vision Benefit Options from EyeMed
Benefits Summary
ICUBA offers one voluntary vision plan through EyeMed. The Base Vision Plan allows you and your covered family members one
routine exam every 12 months, plus lenses once every 12 months, and new frames every 24 months.
To view the entire provider network, please visit the EyeMed website at www.eyemed.com or contact the Vison Service Center at
(866) 800‐5457. Please review the complete summary of benefits for full coverage details.
Base Plan
In‐Network Out‐of‐Network Reimbursement
Exam (Once every 12 months)
$5 copay up to $35
Frames
$0 copay; $100 allowance; 20% off
balance over $100; (Once every 24 mos.)
up to $50
Single Vision Lenses (Once every 12 months)
$15 copay up to $20
Contacts
(Once every 12 months)
$0 copay; $100 allowance; plus balance over
$100
up to $80
Monthly Employee Premium
Base Plan
Employee $3.91
Employee & Family $10.02
Download the EyeMed Members App
Get the scoop on the EyeMed Members App! Members may download our App for Apple
and Android, at iTunes or the Google Playstore. The app allows you to easily view your ID
card, see benefit details, set eye exam reminders, and find a provider near you.
20 | Florida Institute of Technology 2019 Benefit Guide
Income Protection Benefit Options from Symetra
Short‐Term Disability
All benefit eligible employees are provided Short‐Term Disability coverage at no cost. You will receive 66 2/3% of weekly earnings,
to a maximum benefit of $2,000 per week. The elimination period of this coverage is 14 calendar days for disability due to an injury
or sickness. Short‐Term Disability is provided for 11 weeks before an employee converts to Long‐Term Disability.
Long‐Term Disability
All benefit‐eligible employees are provided salary continuance insurance. There are two options to choose from:
• Option A: Base Level ‐ This plan provides a benefit of 60% of weekly earnings, to a maximum of $2,000 per month, and is provided
by Florida Institute of Technology at no cost to all benefit‐eligible employees.
• Option B: Buy‐Up Level ‐ This plan provides a benefit of 66 2/3% of weekly earnings, to a maximum of $14,000 per month. You and
Florida Institute of Technology share the cost of this coverage. Benefit cost is based on your age and salary level.
Life Insurance and AD&D Plan
Florida Institute of Technology provides group life insurance at no cost to all active full‐time, benefit eligible employees.
Employees receive one times their annual earnings. All amounts are rounded to the next higher multiple of $1,000, if not
already an exact multiple thereof. Age reductions may apply.
Employee Voluntary Supplemental Life Insurance and AD&D Plan
You may purchase this coverage in $10,000 benefit units up to 5 times your annual salary not to exceed $500,000. Evidence of
Insurability is required for amounts above $150,000 and must be approved by Symetra. All amounts are rounded to the next
higher multiple of $10,000, if not already an exact multiple thereof. Age reductions may apply.
Dependent Voluntary Life Insurance
In order to purchase life insurance for your spouse and/or child, you must purchase Supplemental Life coverage for yourself.
The spouse value can be purchased up to 50% of employee amount in increments of $5,000, not to exceed $250,000. Evidence
of Insurability is required for amounts above $50,000 and requires approval by Symetra. Child life insurance can be purchased
in increments of $2,000 up to $10,000 if less than 50% of the employee coverage amount. Age reductions may apply.
21 | Florida Institute of Technology 2019 Benefit Guide
Additional Voluntary Benefits
LegalShield
This pre‐paid legal services provides protection, peace of mind and security for you and your family while saving you time and
money. You can purchase this coverage with after‐tax dollars. LegalShield is available at 407‐657‐1940 or online at
www.prepaidlegal.com. Please contact Human Resources if you are interested.
AFLAC
Florida Institute of Technology offers three separate plans with Aflac. These are portable individual policies that you pay for with after‐tax dollars. Policy options include: Personal Cancer, Personal Accident, Hospital Indemnity. Aflac is available at 1‐800‐992‐3522 or online at www.aflac.com. Please contact Human Resources if you are interested.
Nationwide Pet Insurance
Nationwide Pet Insurance is available to the employees at Florida Institute of Technology. There are multiple plans to choose from
including: Major Medical, Injury, Emergency, Feline Plans, Wellness and more. There are no pre‐authorizations or hoops to jump
through. Please contact Human Resources if you are interested!
Paycheck Calculator
Do you want to know what your benefits will cost each paycheck? Use this handy paycheck calculator tool to help determine the exact amount. You can repeat this process for each monthly benefit cost shown in this brochure!
Equation
[monthly amount] x 12 months =
÷ [paychecks per year] = total cost per paycheck
20 Pay Employees
x 12 months =
÷ 20 paychecks per year =
total cost per paycheck (benefit amount)
26 Pay Employees
x 12 months =
÷ 26 paychecks per year =
total cost per paycheck (benefit amount)
22 | Florida Institute of Technology 2019 Benefit Guide
Important Contacts
BCBS Medical Insurance Customer Service: 855‐258‐9029
24/7 Essential Advocate: 888‐521‐2583
Online: http://myhealthtoolkitfl.com
Teladoc Request a Consult: 800‐TELADOC (835‐2362)
Online: www.teladoc.com
SurgeryPlus
Surgical Care Advocate: 855‐200‐2119
Aetna Behavioral Health & Resources for Living EAP Customer Service: 877‐398‐5816
Option 1: Employee Assistance Program
Option 2: Behavioral Health
Online: www.resourcesforliving.com
Username: ICUBA
Password: 8773985816
OptumRx Prescription Drugs HealthCare Advisor: 855‐811‐2213
Online: www.optumrx.com
ICUBAcares Pharmacist Advocate Program Pharmacist Help Line: 877‐286‐3967
Humana Dental Insurance Customer Service: DHMO: 800‐979‐4760
PPO: 800‐233‐4013
Online: www.humanadental.com
EyeMed Vision Insurance Customer Service: 866‐800‐5457
Online: www.eyemed.com (network: Insight)
ICUBA Benefits MasterCard Customer Service: 866‐377‐5102
Email: benefitsadministration@icuba.org
Online: http://ICUBAbenefits.org
Symetra Life and Disability
(Always contact HR before Symetra!)
Customer Service: 877‐377‐6773
Online: www.symetra.com
23 | Florida Institute of Technology 2019 Benefit Guide
Remember to visit our website http://ICUBAbenefits.org! This user‐friendly site is your one stop shop
for all things benefits! Visit our single sign‐
on section located below the scrolling
banner and gain access to ICUBA’s Brand
Partners including BCBS MyHealthToolkit
and Rally, OptumRx Prescription Portal,
Resources for Living and Aetna Navigator
and, of course, the ICUBA MasterCard, as
applicable and when enrolled!
MESSAGE: This summary of benefits does not create a contract between the Institute and any employee. Details of these plans can be found in official plan documents that govern the plans. In the event of a discrepancy between the plan documents and this document, the plan documents govern. While care has been taken to ensure the accuracy of this information, the plan documents and Florida Institute of Technology policies will govern in all cases. Although it is Florida Institute of Technology's intention to continue the plans, the Institute reserves the right to modify, amend or terminate the plans at any time. All rates are based on current of participation and are subject to change. Revised 4/1/19.
Recommended