2013|2014 EMPLOYEE BENEFIT HIGHLIGHTS
PINELLAS SUNCOAST TRANSIT AUTHORITY — 2013-2014 EMPLOYEE BENEFIT HIGHLIGHTS
IMPORTANT CONTACT INFORMATION
Pinellas Suncoast Transit Authority Contact Name Contact Information
Director of Human Resources
Larry Longenecker, PHR
Phone: (727) 540-1854
Email: [email protected]
Human Resources Associates
Trish Collins, PHR
Phone: (727) 540-1855
Email: [email protected]
Marty Murray
Phone: (727) 540-1808
Email: mmurray@psta.net
Service Provider Contact Information
Medical Insurance
Cigna
Customer Service: (800) 244-6224
www.cigna.com
Prescription Mail-Order Program
Cigna Home Delivery
Customer Service: (800) 285-4812
www.mycigna.com
Dental Insurance
Cigna
Customer Service: (800) 244-6224
www.cigna.com
Vision Insurance
Advantica
Customer Service: (866) 425-2323
www.advanticabenets.com
Basic Life and AD&D Insurance
Minnesota Life
Customer Service: (800) 392-7295
www.minnesotalife.com
Voluntary Life and AD&D Insurance
Minnesota Life
Customer Service: (800) 392-7295
www.minnesotalife.com
Long Term Disability Insurance
Lincoln Financial Group
Customer Service: (800) 423-2765
www.lfg.com
Supplemental Insurance
Aac
www.aac.com
Agent: John Domeier
Phone: (727) 398-4396
Email: [email protected]ac.com
Agent: Rodney Willis
Phone: (727) 204-5396
Email: [email protected]
Employee Assistance Program
Bensinger, DuPont & Associates (BDA)
Customer Service: (800) 272-2727
www.bdaeap.com
Password: connect
Legal Insurance & Identity Theft Protection
Legal Shield
Agent: Craig & Virginia Miller
Phone: (386) 689-1010
Emaill: [email protected]
www.greatbenetsplus.com
PINELLAS SUNCOAST TRANSIT AUTHORITY — 2013-2014 EMPLOYEE BENEFIT HIGHLIGHTS
Table of Contents
Introduction .............................................................................1
Notices .................................................................................1
Medical Insurance ........................................................................2
Group Insurance Eligibility ..................................................................3
Qualifying Events and IRS Code Section 125 ....................................................4
Medical Insurance Premiums ................................................................5
How to Locate A Provider ...................................................................5
Other Available Plan Resources ..............................................................5
Medical Insurance: Cigna Open Access Plus In Network Only Plan At-A-Glance .........................6
Dental Insurance: Cigna Dental Care DHMO Plan ................................................7
Dental Insurance: Cigna Dental Care DHMO Plan At-A-Glance ......................................8
Dental Insurance: Cigna Dental Care PPO Core Plan ..............................................9
Dental Insurance: Cigna Dental Care PPO Core Plan At-A-Glance ...................................10
Vision Insurance: Advantica Select Plus 150 Plan ................................................11
Vision Insurance: Advantica Select Plus 150 Plan At-A-Glance ......................................12
Basic Life and AD&D Insurance .............................................................13
Voluntary Life and AD&D Insurance ..........................................................13
Long Term Disability Insurance ..............................................................14
Employee Assistance Program ...............................................................14
Legal Insurance & Identity Theft Protection .....................................................15
Supplemental Insurance ...................................................................15
Authority Programs .......................................................................16
1
All benets in this booklet are subject to change. This is an Employee Benets Highlights Summary and not a contract. All benets are subject to the provisions and exclusions of the master contract.
PINELLAS SUNCOAST TRANSIT AUTHORITY — 2013-2014 EMPLOYEE BENEFIT HIGHLIGHTS
Introduction
Pinellas Suncoast Transit Authority (PSTA) provides a comprehensive compensation package including group insurance benets. The
Employee Benet Highlights Booklet provides a general summary of these benet options as a convenient reference. Please refer
to PSTA’s Personnel Policies, applicable Union Contracts and/or Certicates of Coverage for detailed descriptions of all available
employee benet programs and stipulations therein. If you require further explanation or need assistance regarding claims processing,
please refer to the customer service phone numbers under each benet description heading or contact Human Resources for further
information.
Notices
COBRA Continuation of Medical Coverage Benets
Under the Consolidated Omnibus Budget Reconciliation
Act (COBRA), employees and/or dependents may be able
to continue their enrollment in certain health plans such as
medical and dental, if such coverage is terminated or changed
due to a qualifying event.
Medicare Part D Creditable Coverage
PSTA’s prescription drug coverage(s) is considered Creditable
Coverage under Medicare Part D. If you or your dependents
are or will be eligible for Medicare, you may obtain more
information by requesting a Medicare Part D Disclosure of
Creditable Coverage Notice.
More information is available on the above notices by contacting Human Resources.
2
All benets in this booklet are subject to change. This is an Employee Benets Highlights Summary and not a contract. All benets are subject to the provisions and exclusions of the master contract.
PINELLAS SUNCOAST TRANSIT AUTHORITY — 2013-2014 EMPLOYEE BENEFIT HIGHLIGHTS
Medical Insurance
Summary of Benets and Coverage
A Summary of Benets & Coverage (SBC) for the Medical Plan is provided as a
supplement to this booklet which is being distributed to New Hires and Existing Employees
during open enrollment. The summary is an important item in understanding your benet
options. A copy of the SBC document is available as follows:
From: The Human Resources Department
Address: 3201 Scherer Drive N.
St. Petersburg, FL 33716
Phone: (727) 540-1808
The SBC is only a summary of the plan’s coverage. A copy of the plan document, policy, or
certicate of coverage should be consulted to determine the governing contractual provisions
of the coverage. A copy of the actual group certicate of coverage can be reviewed and
obtained by contacting Human Resources.
If you have any questions about the plan offerings or coverage options, please contact the
Human Resources Department at (727) 540-1808.
3
All benets in this booklet are subject to change. This is an Employee Benets Highlights Summary and not a contract. All benets are subject to the provisions and exclusions of the master contract.
PINELLAS SUNCOAST TRANSIT AUTHORITY — 2013-2014 EMPLOYEE BENEFIT HIGHLIGHTS
Group Insurance Eligibility
Disabled Dependents
Coverage for an unmarried dependent child may be continued beyond age 26 if:
1. The dependent is physically or mentally disabled and incapable of self-sustaining employment; AND
2. The dependent is otherwise eligible for coverage under the group medical plan; AND
3. The dependent has been continuously insured; AND
4. Coverage began prior to the age of 19.
Proof of disability will be required upon request. Please contact Human Resources if further clarication is required.
Taxable Dependents
Employees covering adult children under their medical insurance plan may continue to have the related coverage premiums payroll
deducted on a pre-tax basis through the end of the calendar year in which the child reaches age 26. Beginning January 1st of the
calendar year in which the child reaches age 27 through the end of the calendar year in which the child reaches age 30, imputed
income for the value of the applicable adult child’s coverage for the coverage period must be reported on the employee’s W-2.
Imputed income is the dollar value of insurance coverage attributable to covering the adult child. There is no imputed income if an
adult child is eligible to be claimed as a dependent for federal income tax purposes on the employees tax return. Check with Human
Resources for further details if you are covering an adult child who will turn 27 any time in the upcoming calendar year or for more
information.
Dependent Eligibility Age Requirements
Eligibility requirements for eligible Over-age Dependents have been eliminated for group medical insurance. Over-age Dependents
may be covered by the medical plan through the end of the Calendar Year in which the child turns age 26.
Medical coverage may continue to the end of the Calendar Year in which the dependent reaches the age of 30, if the dependent is:
• Unmarried with no dependents; AND
• A Florida resident, or full-time or part-time student; AND
• Otherwise uninsured; AND
• Not entitled to Medicare benets under Title XVIII of the Social Security Act, unless the child is handicapped.
Pinellas Suncoast Transit Authority’s group insurance plan year is October 1st through September 30th.
Employee Eligibility
Employees are eligible to participate in PSTA’s insurance plans if they are designated full-time employees and are regularly scheduled
to work over 30 hours or more per week. Coverage will be effective the rst day of the month following 30 days of employment.
For example: If you are hired on June 15th, your coverage will be effective on August 1st.
Dependent Eligibility
A dependent is dened as the legal spouse and/or a dependent child(ren) of the participant or the spouse. Dependent children
may be covered through the end of the Calendar Year in which the child reaches age 26 for medical, dental, and vision. The term
“child” includes any of the following:
• A natural child • A foster child • A child for whom legal guardianship has been
awarded to the participant or the participant’s
spouse
• A stepchild • A newborn (up to age 18 months) of
a covered dependent (Florida)
• A legally adopted child
4
All benets in this booklet are subject to change. This is an Employee Benets Highlights Summary and not a contract. All benets are subject to the provisions and exclusions of the master contract.
PINELLAS SUNCOAST TRANSIT AUTHORITY — 2013-2014 EMPLOYEE BENEFIT HIGHLIGHTS
Qualifying Events and IRS Code Section 125
IRS Code Section 125
Premiums for medical, dental, vision insurance, and/or certain supplemental policies and contributions to FSA accounts (Health
Care and Dependent Care FSAs) are deducted through a Cafeteria Plan established under Section 125 of the Internal Revenue Code
(IRC) and are pre-tax to the extent permitted. Under Section 125, changes to your pre-tax benets can be made ONLY during the
Open Enrollment period unless you or your qualied dependents experience a qualifying event and the request to make a change
is made within 30 days of the qualifying event.
Under certain circumstances, you may be allowed to make changes to your benets elections during the plan year, if the event
affects your own, your spouse’s, or your dependent’s coverage eligibility. An “eligible” qualifying event is determined by the
Internal Revenue Service (IRS) Code, Section 125.
Examples of Qualifying Events
• You get married or divorced
• You have a child, gain legal custody or adopt a child
• Your spouse and/or other dependent(s) die(s)
• You, your spouse, or dependent(s) terminate or start employment
• An increase or decrease in your work hours causes eligibility or ineligibility
• A covered dependent no longer meets eligibility criteria for coverage
• A child gains or loses coverage with an ex-spouse
• Gain or loss of Medicare coverage
• Enrollment only - Eligibility for premium assistance under Medicaid or CHIP, as long as you/dependents are eligible but not
already enrolled in employer plan (60 day notication period) Note: Check with the Medicaid Ofce for additional information
regarding eligibility.
• Enrollment only - Loss of Medicaid or CHIP eligibility, as long as you/dependents are eligible but not already enrolled in
employer plan (60 day notication period)
IMPORTANT
If you experience a qualifying event, you must contact Human Resources within 30 days of the qualifying event
to make the appropriate changes to your coverage. Beyond 30 days, requests will be denied and the employee
may be responsible both legally and nancially for any claim and/or expense incurred as a result of the employee
or a dependent who continues to be enrolled but no longer meets eligibility requirements. If approved, changes
will take place on the rst of the month following the qualifying event, except for newborns which are effective on
the date of birth. Any cancellations will be processed at the end of the month, except coverage following a death
which terminates the subsequent day. You will be required to furnish valid documentation supporting a change in
status or “Qualifying Event.”
5
All benets in this booklet are subject to change. This is an Employee Benets Highlights Summary and not a contract. All benets are subject to the provisions and exclusions of the master contract.
PINELLAS SUNCOAST TRANSIT AUTHORITY — 2013-2014 EMPLOYEE BENEFIT HIGHLIGHTS
Medical Insurance Premiums
PSTA offers medical insurance through Cigna to benet eligible employees. The costs per pay period for coverage are listed in the
premium table below. For information about your medical plan please refer to the Summary of Benets and Coverage (SBC)
provided.
Other Available Plan Resources
Cigna offers all enrolled members and dependents additional services and discounts through value added programs. For more
details regarding other available plan resources, please refer to your Summary of Benets and Coverage (SBC).
24 Hour Help Information Hotline (800) CIGNA-24
The Cigna 24-Hour Health Information Line provides you access to helpful, reliable information and assistance from qualied health
information nurses on a wide range of health topics 24 hours a day, any day of the year. Not sure what to do when your child has a
fever in the middle of the night? Have you injured yourself and are not sure if you should seek treatment or go see a doctor? There
are over 1,000 topics in the Health Information Library that include FREE audio, video and printed information on aging, women’s
health, nutrition, surgery and specic medical conditions to help you weigh the risks and advantages of treatment options. The call
is FREE and is strictly condential.
Healthy Rewards
Cigna’s Healthy Rewards is provided to you automatically at no additional cost and offers access to discounted health and wellness
programs at participating providers. Members can log on to www.mycigna.com and select Healthy Rewards to learn more about
these programs or call (800) 870-3470.
• Vision Care
• Lasik Vision Correction Services
• Fitness Club Discounts
• Nutrition Discounts
• Hearing Care
• Tobacco Cessation
• Alternative Medicine
The myCigna Mobile App
The myCigna Mobile App gives you an easy way to organize and access your important health information. Anytime. Anywhere.
Download it today from the App Store
SM
or Google Play
TM
.
Tier of Coverage Employee Cost
Employee Only
$0.00
Employee + Spouse $368.04
Employee + Child(ren) $197.91
Employee + Family $469.42
Medical Insurance – Cigna Open Access Plus
In Network Only Plan
Monthly Payroll Deductions
How to Locate A Provider
To search for a participating provider, contact Customer Service or go to www.cigna.com, select “Find a Doctor,” then click on
“Select a Plan For Your Search” and choose “Open Access Plus Network,” then “Select.” Fill in the rest of your search criteria and
click “Search.”
The Summary of Benets and Coverage (SBC), provided in addition to this Employee Benets Highlights Booklet, is your primary source of information
regarding your Cigna medical plan. The information contained in this Booklet regarding your medical plan is intended to supplement your SBC and
accompanying denitions. If any information in this booklet unintentionally conicts with the SBC or accompanying denitions, the SBC information
prevails. If you have any additional questions regarding the plan please contact Cigna’s Customer Service at (800) 244-6224.
6
All benets in this booklet are subject to change. This is an Employee Benets Highlights Summary and not a contract. All benets are subject to the provisions and exclusions of the master contract.
PINELLAS SUNCOAST TRANSIT AUTHORITY — 2013-2014 EMPLOYEE BENEFIT HIGHLIGHTS
The Summary of Benets and Coverage (SBC), provided in addition to this Employee Benets Highlights Booklet, is your primary source of information
regarding your Cigna medical plan. The information contained in this Booklet regarding your medical plan is intended to supplement your SBC and
accompanying denitions. If any information in this booklet unintentionally conicts with the SBC or accompanying denitions, the SBC information
prevails. If you have any additional questions regarding the plan please contact Cigna’s Customer Service at (800) 244-6224.
Network Open Access Plus
Calendar Year Deductible (CYD)
In Network
Single
$500
Family
$1,000
Coinsurance In Network
Member Responsibility
20%
Plan Year Out-of-Pocket Limit In Network
Single
$3,500
Family
$7,000
What Applies to the Out-of-Pocket Limit?
Deductibles, Coinsurance and Copays
Physician Services In Network
Physician Ofce Visit
$20 Copay
Specialist Ofce Visit
$30 Copay
Diagnostic Services In Network
Clinical Lab (Blood Work) at Independent Facility*
No Charge
X-rays at Independent Facility*
Advanced Imaging (MRI, PET, CT) at Independent Facility* 20% After Deductible
Hospital Services In Network
Inpatient 20% After CYD
Outpatient 20% After CYD
Physician Services at Hospital
20% After CYD
Emergency Room (Waived if Admitted)
$100 Copay
Urgent Care (Waived if Admitted) $50 Copay
Mental Health / Alcohol & Substance Abuse In Network
Inpatient 20% After CYD
Outpatient
20% After CYD
Physician Ofce Visit $20 Copay
Prescription Drugs (Rx) In Network
Generic
$10 Copay
Preferred Brand Name $30 Copay
Non-Preferred Brand Name $50 Copay
Mail-Order Drug (90 Day Supply)
2.5x Copay
Medical Insurance: Cigna Open Access Plus In Network Only Plan At-A-Glance
* Costs may differ depending on location where services are rendered.
7
All benets in this booklet are subject to change. This is an Employee Benets Highlights Summary and not a contract. All benets are subject to the provisions and exclusions of the master contract.
PINELLAS SUNCOAST TRANSIT AUTHORITY — 2013-2014 EMPLOYEE BENEFIT HIGHLIGHTS
Dental Insurance: Cigna Dental Care DHMO Plan
PSTA offers two dental plans through Cigna. A brief description
of the DHMO Plan is provided below, and the employee costs
per pay period are shown on the premium table to the right.
A summary of benets is provided on the following page. For
detailed coverages, exclusions and stipulations, please refer
to the carrier’s benet summary or contact Cigna‘s Customer
Service.
In-Network Benets
The Dental Care DHMO Plan is a managed care dental plan.
It requires you to select a Primary Dental Provider who participates in the Cigna Dental Care Network to coordinate your care.
You will only be subject to copays from in-network dental providers. The Dental Care DHMO Plan’s copays are based on Cigna’s
discounted fee schedule.
Out-of-Network Benets
The Dental Care DHMO Plan does not offer coverage for services from providers not in the network (out of network). If you utilize
a provider not in the Cigna Dental Care Network, you will pay out of pocket and will not be reimbursed.
How To Locate a Provider
To search for a participating provider, contact Customer Service or go to www.cigna.com, select “Find a Doctor,” then click on
“Select a Plan For Your Search” and choose “Cigna Dental Care,” then “Select.” Fill in the rest of your search criteria and click
“Search.”
Calendar Year Deductible
The Dental Care DHMO Plan does not require you to meet a Plan Year Deductible before benets begin.
Calendar Year Benet Maximum
There is no Out-of-Pocket Maximum with the Dental Care DHMO Plan.
Please Note the Following:
• Each covered family member may receive up to 2 FREE cleanings per plan year. Members can also receive 2 additional cleanings
at the charge of a $55 copay.
• Coverage and age limitations may apply.
Cigna
Customer Service: (800) 244-6224
www.cigna.com
Tier of Coverage Employee Cost
Employee Only $0.00
Employee + 1 $9.09
Employee + Family $24.41
Dental Insurance – Cigna Dental Care DHMO Plan
Monthly Payroll Deductions
8
All benets in this booklet are subject to change. This is an Employee Benets Highlights Summary and not a contract. All benets are subject to the provisions and exclusions of the master contract.
PINELLAS SUNCOAST TRANSIT AUTHORITY — 2013-2014 EMPLOYEE BENEFIT HIGHLIGHTS
Dental Insurance: Cigna Dental Care DHMO Plan At-A-Glance
Network
Cigna Dental Care DHMO
Calendar Year Deductible (CYD)
In Network Only
Per Member
Does Not ApplyPer Family
Plan Year Maximum
Class I Services: Diagnostic & Preventative Code
In Network Copay
Ofce Visit 9430
$6
Routine Oral Exam 0150 $0
Routine Cleanings (2 Per Calendar Year) 1110/1120
$0
Bitewing X-rays (2 Films) 0272 $0
Complete X-rays (1 Every 3 Years) 0210 $0
Fluoride Treatments to Age 19 (2 Per Calendar Year)
1203 $0
Sealants (Per Tooth)
1351
$12
Emergency Care to Relieve Pain (Minor Procedure)
9110
$6
Class II Services: Basic Restorative Code
In Network Copay
Fillings (Amalgam) 2140 $0
Fillings (Composite, Anterior) 2330 $0
Fillings (Composite, Posterior) 2391 $70
Simple Extractions 7140 $12
Root Canal Therapy (Molar; Excluding Final Restoration)
3330
$305
Deep Cleaning (1 Per Lifetime) 4355
$50
Periodontal Scaling (1 to 3 Teeth Per Quadrant; Limit 4 Quadrants Per 12 Months)
4342
$40
Periodontal Scaling (4 or More Teeth; Limit 4 Quadrants Per 12 Months)
4341
$50
General Anesthesia (First 30 Minutes; Per Visit) 9220
$160
Class III Services: Major Restorative*
Code
In Network Copay
Crowns (Porcelain Fused to Metal) 6752
$250
Bridges 5213/5214 $240
Dentures 5110/5120 $225
Class IV Services: Orthodontia - 24 Month Treatment Fee*
Code
In Network Copay
Benet — Child to Age 19 8670
$1,600
Benet — Adult 8670
$2,600
* Additional charges may apply for some services. Please see your plan summary or contact Cigna’s Customer Service
for details, specic to your procedure.
9
All benets in this booklet are subject to change. This is an Employee Benets Highlights Summary and not a contract. All benets are subject to the provisions and exclusions of the master contract.
PINELLAS SUNCOAST TRANSIT AUTHORITY — 2013-2014 EMPLOYEE BENEFIT HIGHLIGHTS
Cigna
Customer Service: (800) 244-6224 PPO
www.cigna.com
Dental Insurance: Cigna Dental Care PPO Core Plan
PSTA offers two dental plans through Cigna. A brief description
of the PPO Core Plan is provided below, and the employee
costs per pay period are shown on the premium table to the
right. A summary of benets is provided on the following
page. For detailed coverages, exclusions and stipulations,
please refer to the carrier’s benet summary or contact Cigna’s
Customer Service.
In-Network Benets
The Dental PPO Core Plan is “open access” and allows you
to receive services from any dental provider without selecting a Primary Dental Provider (PDP) and does not require referrals
to specialists. The network of participating dental providers the plan utilizes is the PPO Core Network. The PPO plan provides
benets for services received from in- and out-of-network providers. You are responsible for a Plan Year Deductible (PYD) and then
coinsurance based on the plan’s Usual, Customary and Reasonable (UCR) charge limitations.
Out-of-Network Benets
Providers who do not contract with insurance carriers because they do not accept their discounted rates are referred to as “non-
participating” or “out of network.” Understanding how your insurance company pays for out-of-network services is important
because you will usually pay more.
The insurance company processes charges based on what it determines the “Usual, Customary and Reasonable (UCR)” charge is
for a specic service. UCR or the “allowed amount” can be dened as the most common charge for a particular dental procedure
performed in a specic geographic area. Since there is no contract in place between the insurance company and out-of-network
provider, the dentist may charge an amount higher than the UCR. The difference between the UCR amount and the dentist’s higher
charge is called “balance billing.” Balance billing is in addition to your deductible and coinsurance responsibility.
How to Locate a Provider
To search for a participating provider, contact Customer Service or go to www.cigna.com, select “Find a Doctor,” then click on
“Select a Plan For Your Search” and choose “Cigna Dental PPO” then “Core Network,” and “Select.” Fill in the rest of your search
criteria and click “Search.”
Calendar Year Deductible
This plan’s benets begin once each covered member satises the deductible. The deductible is applied collectively for either in-
network or out-of-network services or any combination of both. There is $50 individual and $150 family Calendar Year Deductible.
Once you satisfy your Calendar Year Deductible, your coinsurance responsibility will be based on the plan’s discounted fee
schedule and will be determined by the type of services you receive as summarized in the table on the following page. The
Deductible is waived for Preventive Services.
Calendar Year Benet Maximum
The maximum benet the Dental PPO Plan will pay for each covered member is $1,000 for in-network and out-of-network services
combined. All services, including Preventive Services, accumulate towards the benet maximum.
Please Note the Following:
• Each covered family member may receive up to 2 cleanings per plan year. Each cleaning has to be 6 months apart from one
another.
• Coverage and age limitations may apply.
• Teeth missing prior to coverage with Cigna are not covered.
• Pre-treatment review is recommended when dental services are expected to exceed $500.
Tier of Coverage Employee Cost
Employee Only $10.05
Employee + 1 $32.25
Employee + Family $66.36
Dental Insurance – Cigna Dental PPO Core Plan
Monthly Payroll Deductions
10
All benets in this booklet are subject to change. This is an Employee Benets Highlights Summary and not a contract. All benets are subject to the provisions and exclusions of the master contract.
PINELLAS SUNCOAST TRANSIT AUTHORITY — 2013-2014 EMPLOYEE BENEFIT HIGHLIGHTS
*Out-Of-Network Balance Billing
For information regarding Out-Of-Network Balance Billing that may be charged by an out-of-network provider for services rendered,
please refer to the Out-of-Network Benets section on the previous page.
**Restrictions apply to composite llings.
Network
PPO Core
Calendar Year Deductible (CYD)
In Network Out of Network
Per Member $50
Per Family $150
Waived for Class I Services? Yes
Plan Year Benet Maximum In Network Out of Network
Per Member $1,000
Class I Services: Diagnostic & Preventative In Network Out of Network*
Routine Oral Exam
Plan Pays: 90%
Deductible Waived
Plan Pays: 90%
Deductible Waived
(Subject to Balance Billing)
Routine Cleanings
Bitewing X-rays
Class II Services: Basic Restorative In Network Out of Network*
Fillings (Amalgam and Composite)**
Plan Pays: 70%
After Deductible
Plan Pays: 70%
After Deductible
(Subject to Balance Billing)
Complete X-rays
Simple Extractions
Root Canal Therapy/Endodontics
Periodontics
Emergency Care to Relieve Pain
Oral Surgery (Except Simple Extractions)
Plan Pays: 50%
After Deductible
Plan Pays: 50%
After Deductible
(Subject to Balance Billing)
Anesthetics
Crowns
Bridges
Dentures
Class IV Services: Orthodontia In Network Out of Network*
Lifetime Maximum $1,000
Benet (Dependent Children to Age 19)
50%
50% After Deductible
(Subject to Balance Billing)
Dental Insurance: Cigna Dental Care PPO Core Plan At-A-Glance
11
All benets in this booklet are subject to change. This is an Employee Benets Highlights Summary and not a contract. All benets are subject to the provisions and exclusions of the master contract.
PINELLAS SUNCOAST TRANSIT AUTHORITY — 2013-2014 EMPLOYEE BENEFIT HIGHLIGHTS
PSTA offers vision insurance through Advantica. A brief
description of the Select Plus 150 Plan is provided below and
the premium payroll deductions are shown on the table to the
right. A summary of benets is provided on the following page.
For detailed coverages, exclusions and stipulations, please refer
to the carrier’s benet summary or contact Advantica’s Customer
Service.
In-Network Benets
The vision plan offers you and your covered dependents coverage for routine eye care, including eye exams, eyeglasses (lenses and
frames) or contact lenses. To schedule an appointment, covered members can select any network provider that participates in the
Advantica Network. At the time of service, routine vision examinations and basic optical needs will be covered as shown on the
plan’s schedule of benets. Cosmetic services and upgrades will be additional if chosen at the time of your appointment.
Out-of-Network Benets
You may also choose to receive services from vision providers who do not participate in the vision network. If you go out of network
you would be required to make payment at the time of your appointment. Advantica will then reimburse you based on the plan’s
out-of-network reimbursement schedule upon receipt of proof of services rendered.
How to Locate a Provider
To search for a participating provider, call Customer Service or go to www.advanticabenets.com. Choose “Provider Search,” then
click “Vision Care Provider.” Fill in the rest of your search criteria and click “Submit.”
Calendar Year Deductible
There is no Plan Year Deductible.
Calendar Year Benet Maximum
There is no Out-of-Pocket Maximum. However, there are benet reimbursement maximums for certain services per year.
Please Note: Member options, such as Lasik, UV coating, progressive lenses, etc. are not covered in full, but may be available at a
discount.
Vision Insurance: Advantica Select Plus 150 Plan
Advantica
Customer Service: (866) 423-2323
www.advanticabenets.com
Tier of Coverage Employee Cost
Employee Only $0.00
Employee + Family $7. 5 4
Vision Insurance – Advantica Select Plus 150 Plan
Monthly Payroll Deductions
12
All benets in this booklet are subject to change. This is an Employee Benets Highlights Summary and not a contract. All benets are subject to the provisions and exclusions of the master contract.
PINELLAS SUNCOAST TRANSIT AUTHORITY — 2013-2014 EMPLOYEE BENEFIT HIGHLIGHTS
Vision Insurance: Advantica Select Plus 150 Plan At-A-Glance
Services In Network Out of Network
Eye Exam No Charge
Up to $40 Reimbursement
After $10 Copay
Contact Lense Exam (Fitting and Follow-up) $40 Allowance No Reimbursement
Frequency of Services In Network Out of Network
Examination 12 Months
Lenses 12 Months
Frames 24 Months
Contact Lenses 12 Months
Lenses In Network Out of Network
Single
Covered in Full
After $10 Copay
Up to $20 Reimbursement
After $10 Copay
Bifocal
Up to $40 Reimbursement
After $10 Copay
Trifocal
Up to $60 Reimbursement
After $10 Copay
Frames In Network Out of Network
Special Frame Selection
$10 Copay
(Paid in Full with Lenses)
Up to $60 Reimbursement
After $10 Copay
(No Copay if Included with Lenses)
Non-Special Frame Selection
Up to $150 Allowance
(Less $10 Copay)
Contact Lenses* In Network Out of Network
Non-Elective (Medically Necessary)
Prior Authorization Required
$250 Allowance
After $10 Copay
Up to $250 Reimbursement
After $10 Copay
Elective
$150 Allowance
After $10 Copay
Up to $80 Reimbursement
After $10 Copay
* Contact lenses are in lieu of spectacle lenses and a frame
13
All benets in this booklet are subject to change. This is an Employee Benets Highlights Summary and not a contract. All benets are subject to the provisions and exclusions of the master contract.
PINELLAS SUNCOAST TRANSIT AUTHORITY — 2013-2014 EMPLOYEE BENEFIT HIGHLIGHTS
Basic Life and AD&D Insurance
Minnesota Life
Customer Service: (800) 392-7295
www.minnesotalife.com
Basic Term Life
PSTA provides Basic Life insurance for all benet-eligible employees through Minnesota Life, at no cost to the employee. All eligible
employees are covered for an amount equal to one times your annual earnings, rounded to the next higher $1,000, not to exceed
$200,000. Coverage is reduced to 75% at age 75. Age reductions occur based on your age at the beginning of the Calendar Year.
Accidental Death & Dismemberment
Also at no cost to the employee, PSTA provides Accidental Death & Dismemberment (AD&D) insurance, which pays in addition to
the Basic Life benet when death occurs as a result of an accident. The AD&D benet amount equals the Basic Term Life benet
and follows the same age reduction age reduction schedule.
Always remember to keep your beneciary forms updated.
You may update your beneciary at anytime through Human Resources.
Minnesota Life
Customer Service: (800) 392-7295
www.minnesotalife.com
Eligible employees may elect to purchase additional life insurance on a voluntary basis through Minnesota Life. This coverage may
be purchased in addition to the Basic Term Life and AD&D coverages. Voluntary Life Insurance offers coverage for yourself, spouse
or child(ren) at different benet levels.
Voluntary Employee Life Insurance
• Units can be purchased in increments of 1x or 2x your annual earnings, not to exceed
$300,000.
• All increases in Voluntary Life require Evidence of Insurability.
Dependent Term Life Insurance
• Dependent Term Life covers your spouse and any eligible child(ren) for $1.78 per month.
• Spouse Coverage: $5,000
• A spouse is not eligible if they are eligible as an employee.
• Eligible unmarried children, from 6 months up to age 20, or up to age 24 if a full-time
student: $2,500
• Children under 6 months: $250
New Hires can purchase Voluntary Employee Life insurance without having to go
through Medical Underwriting, also known as Evidence of Insurability (EOI), up to the
Guaranteed Issue amount of $150,000.
Voluntary Life and AD&D Insurance
Voluntary Life/AD&D
Monthly Rates
Age Bracket
Employee
per $1,000
Under 35 $0.145
35-39 $0.165
40-44 $0.205
45-49 $0.285
50-54 $0.425
55-59 $0.715
60-64 $0.955
65-69 $1.465
70-74 $1.905
75 $1.905
14
All benets in this booklet are subject to change. This is an Employee Benets Highlights Summary and not a contract. All benets are subject to the provisions and exclusions of the master contract.
PINELLAS SUNCOAST TRANSIT AUTHORITY — 2013-2014 EMPLOYEE BENEFIT HIGHLIGHTS
Long Term Disability Insurance
All benet-eligible PSTA employees can purchase Long-Term Disability (LTD) through Lincoln Financial Group (LFG). The LTD
benet pays you a percentage of your gross monthly earnings if you become disabled due to an illness or non-work related injury.
Please see Human Resources for more information or to enroll in the plan. A summary of the plan’s benets is provided below.
LTD Plan Summary
• The LTD benet pays 60% of your monthly earnings up to a monthly maximum of $10,000.
• An employee must be disabled for 60 days prior to becoming eligible for the LTD benet (Benets would begin on the 61st day).
• If you return to work on a part-time basis, you may continue to be eligible for partial benets.
• Periodic evaluations will occur at the discretion of LFG.
• The duration of the LTD benet payable is based on your age at the time the disabling event occurs.
• Benets may be reduced by other income.
Lincoln Financial Group
Customer Service: (800) 423-2765
www.lfg.com
Employee Assistance Program
Bensinger, DuPont & Associates (BDA)
Phone: (800) 272-2727
www.bdaeap.com
Password: connect
A comprehensive Employee Assistance Program (EAP) is available to you and each member of your family through Bensinger,
Dupont & Associates (BDA) at no cost. BDA offers access to licensed mental health professionals through a condential program
that is protected by state and federal laws. The EAP program is available to help you gain a better understanding of problems that
affect you, locate the best professional help for your particular problem, and decide upon a plan of action. All EAP counselors are
professionally trained and are certied and licensed in their elds. The EAP Plan provides up to ve condential (5) face-to-face
counseling sessions with a Master’s Level Clinician in your local area. If you or a family member require long term therapy, you will
be referred to a qualied local resource to continue care. Master-level counselors are available 24 hours a day, 7 days a week.
What is an Employee Assistance Program?
An Employee Assistance Program (EAP) offers covered employees and their family members free and convenient access to a range
of condential and professional services to help them address a variety of problems that can negatively affect their well-being such
as:
• Anxiety
• Child & Elder Care
• Depression
• Life Improvement
• Family and/or Marriage Problems
• Stress
• Grief and Bereavement
• Substance Abuse
• Legal & Financial Consultation
Are your services condential?
Yes. Receipt of EAP services is completely condential. If, however, participation in the EAP is the direct result of a Management
Referral (a referral initiated by a supervisor or manager), we will ask permission to communicate certain aspects of the employee’s
care (attendance at sessions, adherence to treatment plans, etc.) to the referring supervisor/manager. The referring supervisor will
not, however, receive specic information regarding the referred employee’s case. The supervisor will only receive reports on
whether the referred employee is complying with the prescribed treatment plan.
15
All benets in this booklet are subject to change. This is an Employee Benets Highlights Summary and not a contract. All benets are subject to the provisions and exclusions of the master contract.
PINELLAS SUNCOAST TRANSIT AUTHORITY — 2013-2014 EMPLOYEE BENEFIT HIGHLIGHTS
Legal Insurance & Identity Theft Protection
LegalShield
Customer Service: (800) 729-7998
www.greatbenetsplus.com
Supplemental Insurance
Aac
Customer Service: (800) 992-3522
www.aac.com
Agent: John Domeier
Phone: (727) 398-4396
Email: [email protected]ac.com
Aac offers a variety of voluntary supplemental insurance plans that may be purchased separately on a voluntary basis and
premiums paid by payroll deduction on a post-tax basis. Aac pays money directly to you, regardless of what other insurance plans
you may have. Dependents up to age 26 may be included on any plan. To learn more about these Aac plans and/or to schedule a
personal appointment, contact your local Aac agent. Details regarding available Aac plans and services are also available online
at www.aac.com.
Available Aac plans include coverages for:
• Accident Indemnity
• Cancer Care
• Hospital Care
• Critical Illness
• Intensive Care
• Disability Income Protector
• Term and Whole Life Insurance
Agent: Craig & Virginia Miller
Phone: (386) 689-1010
Emaill: millercr2010@hotmail.com
Agent: Rodney Willis
Phone: (727) 204-5396
Email: [email protected]
Life Events Family Legal Plan
PSTA employees have the opportunity to enroll in a voluntary pre-paid legal program provided by LegalShield. By enrolling in this
plan, a participant will have direct access to attorneys who will provide legal assistance, 24 hours a day, 7 days a week, for a variety
of situations that include:
• Divorce
• Child Custody & Support
• Adoption
• Civil Litigation
• Bankruptcy
• Name Changes
• Criminal Defense
• Trafc Tickets
• Wills & Living trusts
• Real Estate
• Credit Report Issues
• Contract Review
The cost to the employee to participate in this legal plan is $15.95 per month. This includes coverage for the entire household
including your spouse and dependent children regardless of the number of eligible dependents enrolled in the plan. Plan benets
include unlimited phone consultations.
Identity Theft Shield
LegalShield has also teamed up with Kroll Background America to offer comprehensive Identity Theft Monitoring AND Restoration
Service. This plan will give you and your spouse access to your credit report, plus daily monitoring of your credit report. If you
are a victim of identity theft, this membership will provide an investigator to help you with the restoration process. This includes
contacting the State DMV, the Medical Information Bureau, all 3 Credit Repositories, your Financial Institutions, the Social Security
Administration, and even Criminal Records. This plan can be added to your legal plan for only $9.95 per month. To learn more,
about the benets of this plan, contact Craig & Virginia Miller by using the contact information provided above.
16
All benets in this booklet are subject to change. This is an Employee Benets Highlights Summary and not a contract. All benets are subject to the provisions and exclusions of the master contract.
PINELLAS SUNCOAST TRANSIT AUTHORITY — 2013-2014 EMPLOYEE BENEFIT HIGHLIGHTS
Authority Programs
Direct Deposit
PSTA operates a direct deposit payroll system, which allows employees to authorize automatic payroll deposits into their checking
or savings accounts. To enroll in direct deposit, complete an Enrollment Authorization form, available at the Human Resources
department. Once your account information has been veried, your pay will automatically be deposited, and you will receive a
non-negotiable pay stub via email summarizing your payroll information for that period.
Your pay may be deposited into three different nancial institutions if you so choose; however, the entire amount of your pay will be
direct deposited with no portion presented in check form.
Changes to your direct deposit can be made at any time, by visiting the Human Resources Department.
Fitness Center
PSTA employees may join our on-site Fitness Center, where staying in shape is convenient and inexpensive. Our Fitness Center is
located on the second oor of the Operations Building, and includes various machines, free weights, and other exercise equipment.
It also has a television and current selection of tness magazines to keep you entertained and provide information on workouts and
tness strategies.
Membership is available to employees only, for a cost of $10.00 per month. There is no contract term, so you may start or stop your
membership at any time. Visit the Human Resources department to learn more, or to join.
YMCA Partnership
PSTA has partnered with YMCA of Pinellas County to offer a special membership deal for our employees. Join YMCA, bring proof
of PSTA employment (ID badge or paystub), and they will waive the join fee, and give you 10% off your monthly membership fees. If
you are already a YMCA member, go to your local branch and ask to be added to the corporate member group under PSTA to start
receiving your 10% discount. Visit www.ymcatampabay.org for locations and hours of operation.
11505 Fairchild Gardens Ave., Suite 202
Palm Beach Gardens, Florida 33410
Toll Free: (800) 244-3696; Fax: (561) 626-6970
www.gehringgroup.com
FINAL – Last Modied:
August 27, 2013 5:19 PM
