2019 FIT Benefits Guide v3-RM · 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

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


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.


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.


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.


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.


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.


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!


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


SurgeryPlus


SurgeryPlus (continued)


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)


Benefits Summary

Premier Copay Plan


EMPLOYEE PAYS


Coinsurance 20% 40%


coinsurance

$4,000/$8,000 $7,500/$15,000

Physician Office Visits $25 Copay 40% after deductible


$0 Not applicable

Specialist Office Visits $50 Copay 40% after deductible




Preventive Care 0% Not covered



Emergency Room Services 0% after $300 Copay (waived if admitted)






Employee $120.00 $471.10 $201.90

Employee & Spouse $240.00 $1,001.70 $429.30


Family $260.00 $1,320.20 $565.80

ICUBA Medical Plan Option – Premier Copay Plan (PPO)


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


EMPLOYEE PAYS


Coinsurance 30% 50%


coinsurance

$5,350/$10,700 $10,700/$21,400

Physician Office Visits $35 Copay 50% after deductible


$0 Not applicable

Specialist Office Visits $70 Copay 50% after deductible




Preventive Care $0 Not covered



Emergency Room Services $500 Copay (waived if admitted)






Employee $120.00 $536.25 $99.75

Employee & Spouse $240.00 $1,017.75 $339.25


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


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)


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.


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.


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


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.


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


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.


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.


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)


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: [email protected]

Online: http://ICUBAbenefits.org

Symetra Life and Disability

(Always contact HR before Symetra!)

Customer Service: 877‐377‐6773

Online: www.symetra.com


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.

Documents

2019 FIT Benefits Guide v3-RM · 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