TABLE OF CONTENTS

2020 PHSA/COBRA BENEFITS ENROLLMENT

02 | Before You Enroll & How to Enroll

03 | Need Help? & FAQ’s

04 | Optima Health Plan Premiums

05 | Optima Health Plan Comparison

06 | Additional Optima Health Plan Services

07 | HealthEquity HSA Coverage

08 | MetLife Dental Coverage & Premiums

09 | MetLife Dental Plan Comparison

10 | WageWorks Health Care FSA Coverage

11 | Individual Coverage Options & Community Resources

12 | CBO Contact Information

The City of Virginia Beach (COVB) and Virginia Beach City Public Schools (VBCPS) may extend temporary benefit coverage to you and members of your family for certain benefit plans when coverage would otherwise end. The Consolidated Benefits Office (CBO) administers PHSA (Public Health Service Act) continuation of coverage (also referred to as COBRA), to each qualified beneficiary giving them an independent right to elect.

This guide provides information about the benefits available to you if you are offered PHSA/COBRA continuation of coverage, how to enroll, deadlines to be aware of, as well as community resources you may choose to take advantage of.

To access this guide, forms, and additional resources online, visit vbgov.com/benefits (click on PHSA Participants).

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BEFORE YOU ENROLL

HOW TO ENROLL

Gather all required dependent documentation for health plan enrollment.• Social Security Number (SSN) - will be required for all dependents you wish to cover on your health plan. This is a

requirement for health plans under the Patient Protection and Affordable Care Act (PPACA) for 1095-C reporting and therefore required when submitting enrollment forms.

• Marriage License (spouse) Birth or Adoption Certificate (children) - You will be required to provide proof of legal dependent status for dependents with a different last name from yours.

Review your plans.• Read this guide and check out the resources available to you on vbgov.com/benefits (by selecting PHSA Participants),

websites/mobile applications listed in this guide, etc.

Submit your completed PHSA/COBRA Summary & Election form along with any corresponding benefit enrollment form(s) to the Consolidated Benefits Office.• Completed forms sent via email, fax, by US mail1, in-person at the CBO, or placed in the secure Drop Box (available

24/7 outside Plaza Annex) are accepted.

Need to cancel coverage?• You can cancel PHSA/COBRA health and/or dental coverage at any time by submitting the PHSA Benefits Cancellation

Form.2 An electronic copy can be found online. You may also cancel coverage by submitting a payment coupon indicating that you are terminating coverage to the Consolidated Benefits Office.3

Use the chart below for required forms and information on how to enroll in PHSA/COBRA coverage. Electronic copies of enrollment forms can be found online.

BENEFIT FORM(S) / DOCUMENT(S) NEEDED ENROLLMENT PERIOD/DEADLINE

Any PHSA/COBRA Summary & Election Form (This form is mailed to your home upon qualification for coverage.)

Eligibility for coverage continuation,

enrollment periods and deadlines (including

Open Enrollment) are communicated directly to qualified beneficiaries via

home mailings.

HEALTHOptima Health

PHSA 2020 Optima Health Enrollment Form

Disabled Adult Dependent Certification Form (Required annually with enrollment of disabled adult dependent on health plan.)

DENTALMetLife

PHSA MetLife Dental Enrollment Form

Disabled Adult Dependent Certification Form (Required annually with enrollment of disabled adult dependent on dental plan.)

HEALTH SAVINGS ACCOUNT (HSA)

HealthEquity

PHSA 2020 Health Savings Account (HSA) Election Form (Eligibility limitations apply - You must be enrolled in the POS Basic or POS Standard plan to participate in a HealthEquity HSA.)

HEALTH CARE FLEXIBLE SPENDING

ACCOUNT (FSA)WageWorks

PHSA/COBRA Summary & Election Form (If you participated in the Health Care FSA as an active employee, you may have the option to continue participation on an after-tax basis, if a balance remained at the time of separation from coverage. See page 10.)

EMAIL

Benefits@vbschools.com

FAX

757.263.1123

MAILING ADDRESS1

2512 George Mason DriveVirginia Beach, VA 23456

PHYSICAL ADDRESSPlaza Annex (Drop Box available)641 Carriage Hill RoadVirginia Beach, VA 23452

1 The CBO cannot be responsible for mail that is received in our office after enrollment deadlines if sent by U.S. Postal Service.2 Once your continuation of coverage terminates for any reason, it cannot be reinstated.3 All PHSA/COBRA Participants are mailed payment coupons upon enrollment and/or at the beginning of the benefit plan year.

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NEED HELP?

Consolidated Benefits Office• Email: Benefits@vbschools.com (This mailbox is routinely checked

throughout the day during business hours.)

• Call: 757.263.1060 (To speak to staff members and to confirm our office hours and holiday observance schedule.)

• Visit: 641 Carriage Hill Road, Virginia Beach, VA 23452 (We are located at Plaza Annex and staff will be able to answer your benefit questions as well as provide assistance so you can complete your enrollment.)

FREQUENTLY ASKED QUESTIONS

Q: Once enrolled, how do I pay for my PHSA/COBRA benefits?

A: Once your benefit(s) enrollment has been processed, the Consolidated Benefits Office will mail you an election confirmation letter with monthly payment coupons. These coupons will reflect your plan(s), monthly premium(s), payment due date and check payable information.

Q: Can I use a credit or debit card to pay for my PHSA/COBRA benefits?

A: No. At this time, only checks or money orders are accepted forms of payment.

Q: Can I prorate my monthly premium if I gain new coverage somewhere else?

A: No. Unfortunately, there is not an option to pay a prorated amount or have coverage for only a portion of the month.Monthly premiums must be paid in full within the designated timeframe.

Q: Do I have to stay with the same plan(s) for my entire PHSA/COBRA term?

A: No. Each fall, we mail information to all PHSA/COBRA participants to notify them of their annual Open Enrollment, which allows them the opportunity to change plans and/or tiers for the new plan year (January 1). The only other opportunity to make changes to coverage is within 30 days following an eligible qualifying life event, such as marriage, divorce, birth of a child, etc. Please contact the CBO for additional information.

Q: Can I use the same Optima Health insurance card I had as an active employee?

A: No. Once your PHSA/COBRA Optima Health insurance enrollment has been processed, Optima will mail you a newinsurance card with your new group number. If you need your new insurance information sooner, you may access your member card by logging in to your Optima Health member account online at OptimaHealth.com and in their mobile app, Optima Health.

CBO staff is available to assist you with enrolling and understanding your benefits!

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2020 OPTIMA HEALTH PLAN PREMIUMS

HEALTH PLAN PREMIUMS (OPTIMA HEALTH) - Monthly premiums listed below

PREVIOUS ACTIVE EMPLOYEES PREVIOUS RETIREESLEVEL OF COVERAGE POS BASIC POS STANDARD POS PREMIER POS BASIC POS STANDARD POS PREMIER

Subscriber Only $528.58 $568.23 $628.10 $726.39 $781.11 $863.73

Subscriber + 1 Child $854.67 $918.89 $1,015.86 $1,053.20 $1,132.54 $1,252.34

Subscriber + Children $1,287.42 $1,384.25 $1,530.47 $1,488.91 $1,601.09 $1,770.47

Subscriber + Spouse $1,225.30 $1,317.74 $1,457.32 $1,684.94 $1,812.44 $2,004.94

Family $1,715.71 $1,845.11 $2,040.47 $2,178.77 $2,343.46 $2,592.15

OPEN ENROLLMENT is offered annually in the Fall, and allows PHSA/COBRA participants the opportunity to change or cancel health and/or dental plan coverage, as well as add or remove dependents. The only other opportunity to make changes to coverage is when you are experiencing a qualifying life event.

Health Tip:Don't forget to keep your

Primary Care Physician (PCP) up to date!

The City of Virginia Beach and Virginia Beach City Public Schools offer three health plan options through Optima Health: POS Basic, POS Standard, and POS Premier. Enrolling in health insurance protects you from paying the full cost of medical services when you’re injured, sick, or have other medical costs. Health insurance provides coverage for preventive care, treatment, pharmacy, and other medical services. If you elect continuation of health coverage, you must keep the same plan you were enrolled in prior to loss of coverage for the remainder of the plan year unless you experience a Qualifying Life Event (QLE) (see bottom of page for more information). Please note: PHSA/COBRA participants will receive new Optima Health insurance card(s) mailed to their home address. It is encouraged that new participants enroll in a timely manner to account for the time it takes for forms to be received, processed and new Optima card(s) mailed.

Primary Care Physician You can view or change your Primary Care Physician (PCP) at any time online on OptimaHealth.com. Select:

• "Employer Plans"• "POS"• "POS with PHCS Network"

As a friendly reminder, you may see a cost savings (see the Summary of Benefits on page 5) if you elect a physician in the Sentara Quality Care Network (SQCN). Information on SQCN can be found here: SentaraQualityCareNetwork.com.

QUALIFYING LIFE EVENTS... Certain events in your life (i.e. marriage, divorce, birth of a child, etc.) allow you to make changes to your benefit plan(s). If you experience a qualifying life event during the plan year it is important thatall required forms are received in the Consolidated Benefits Office (CBO) within 30 calendar days following the qualifying life event date, even if the supporting documentation is not yet available.Please contact the CBO for more information.

!

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HEALTH PLAN PREMIUMS (OPTIMA HEALTH) - Monthly premiums listed below

PREVIOUS ACTIVE EMPLOYEES PREVIOUS RETIREESLEVEL OF COVERAGE POS BASIC POS STANDARD POS PREMIER POS BASIC POS STANDARD POS PREMIER

Subscriber Only $528.58 $568.23 $628.10 $726.39 $781.11 $863.73

Subscriber + 1 Child $854.67 $918.89 $1,015.86 $1,053.20 $1,132.54 $1,252.34

Subscriber + Children $1,287.42 $1,384.25 $1,530.47 $1,488.91 $1,601.09 $1,770.47

Subscriber + Spouse $1,225.30 $1,317.74 $1,457.32 $1,684.94 $1,812.44 $2,004.94

Family $1,715.71 $1,845.11 $2,040.47 $2,178.77 $2,343.46 $2,592.15

PLAN FEATURES

OPTIMA POS BASIC OPTIMA POS STANDARD OPTIMA POS PREMIER*Must meet the Family Deductible/Out-of-Pocket Max

if enrolled in any tier other than Subscriber OnlyOptima Network/

PHCS Network Out-of-Network

Optima Network/PHCS Network

Out-of-Network Optima Network/PHCS Network Out-of-Network

Deductibles (per calendar year)

$2,000 per individual*

$4,000 per Family*

$4,000 per individual*

$8,000 per Family*

$1,400 per individual*

$2,800 per Family*

$2,800 per individual*

$5,600 per Family*

$850 per individual$1,700 per Family

$1,700 per individual$3,400 per Family

HSA Eligible5 Yes Yes No

Maximum Out-of-Pocket (MOOP) (per calendar year)

$4,000 per individual*

$8,000 per family*

$6,500 per individual*

$13,000 per family*

$3,500 per individual*

$7,000 per family*

$5,500 per individual*

$11,000 per family*

$3,000 per individual$6,000 per family $4,500 per individual

$9,000 per family

Preventive Care 100%1 Covered at 50%AD 100%1 Covered at 50%AD 100%1 Covered at 60%AD

MDLIVE2 Covered at 100%AD Covered at 100%AD Covered at 100%1

SQCN3 PCP Covered at 85%AD Covered at 50%AD Covered at 90%AD Covered at 50%AD $20 Co-pay1 Covered at 60%AD

Non-SQCN PCP Covered at 75%AD Covered at 50%AD Covered at 80%AD Covered at 50%AD $40 Co-pay1 Covered at 60%AD

SQCN3 Specialist Covered at 85%AD Covered at 50%AD Covered at 90%AD Covered at 50%AD $40 Co-pay1 Covered at 60%AD

Non-SQCN Specialist Covered at 75%AD Covered at 50%AD Covered at 80%AD Covered at 50%AD $60 Co-pay1 Covered at 60%AD

SQCN3 Maternity Care Covered at 85%AD Covered at 50%AD Covered at 90%AD Covered at 50%AD $350 Co-pay1 Covered at 60%AD

Non-SQCN Maternity Care Covered at 75%AD Covered at 50%AD Covered at 80%AD Covered at 50%AD $500 Co-pay1 Covered at 60%AD

Diagnostic (x-ray, lab work) and Imaging (CT/PET/MRI)

Covered at 75%AD Covered at 50%AD Covered at 80%AD Covered at 50%AD Covered at 85%AD Covered at 60%AD

Inpatient and Outpatient Hospital

Covered at 75%AD Covered at 50%AD Covered at 80%AD Covered at 50%AD Covered at 85%AD Covered at 60%AD

Preferred Pharmacy4 (Walgreens, Walmart/Sams Club)

Tier 16 $10 Co-payAD,7 $10 Co-payAD,7 $10 Co-pay1

Tier 26 $25 Co-payAD,7 $25 Co-payAD,7 $25 Co-pay1

Tier 3 Covered at 75%AD,7 (Max $50) Covered at 75%AD,7 (Max $50) Covered at 75%1 (Max $50)

Non-Preferred Pharmacy4

Tier 16 $25 Co-payAD,7 $25 Co-payAD,7 $25 Co-pay1

Tier 26 $45 Co-payAD,7 $45 Co-payAD,7 $45 Co-pay1

Tier 3 Covered at 75%AD,7 (Max $75) Covered at 75%AD,7 (Max $75) Covered at 75%1 (Max $75)

Specialty Pharmacy4

Covered at 75%AD ,7(Max $200) Covered at 75%AD,7 (Max $200) Covered at 75%1 (Max $200)

2020 OPTIMA HEALTH PLAN COMPARISON SUMMARY OF BENEFITS

Health Tip:Don't forget to keep your

Primary Care Physician (PCP) up to date!

AD After Deductible (deductible must be paid first before the plan will provide coverage as indicated)1 Deductible does not apply to this service (plan will provide coverage as indicated and before the

deductible has been met) 2 MDLIVE telemedicine services available with health plan enrollment. For Basic and Standard plans

the cost is $39 before you meet your deductible and 100%AD.3 Sentara Quality Care Network (to see if your doctors are part of SQCN visit OptimaHealth.com

and click on doctor search. Look for doctors with a “CIN” symbol next to his or her name)

4 Closed Formulary Prescription Drug Benefit (contains specific drugs in each drug class. Non-formulary medications must meet medical necessity criteria through an exception process to be covered)

5 You may not be enrolled in an HSA and a Health Care FSA6 Or the plan’s negotiated cost of the drug, if less7 Please note: Prescription medications used to prevent any of the following medical conditions are

not subject to the deductible including medications for hypertension, high cholesterol, diabetes, asthma, osterporosis, stroke, prenatal nutrient deficiency.

The City of Virginia Beach and Virginia Beach City Public Schools offer three health plan options through Optima Health: POS Basic, POS Standard, and POS Premier. Enrolling in health insurance protects you from paying the full cost of medical services when you’re injured, sick, or have other medical costs. Health insurance provides coverage for preventive care, treatment, pharmacy, and other medical services. If you elect continuation of health coverage, you must keep the same plan you were enrolled in prior to loss of coverage for the remainder of the plan year unless you experience a Qualifying Life Event (QLE) (see bottom of page for more information). Please note: PHSA/COBRA participants will receive new Optima Health insurance card(s) mailed to their home address. It is encouraged that new participants enroll in a timely manner to account for the time it takes for forms to be received, processed and new Optima card(s) mailed.

QUALIFYING LIFE EVENTS... Certain events in your life (i.e. marriage, divorce, birth of a child, etc.) allow you to make changes to your benefit plan(s). If you experience a qualifying life event during the plan year it is important thatall required forms are received in the Consolidated Benefits Office (CBO) within 30 calendar days following the qualifying life event date, even if the supporting documentation is not yet available.Please contact the CBO for more information.

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ADDITIONAL OPTIMA HEALTH PLAN SERVICES

EyeMed Vision Care• As part of your Optima POS Health Plan coverage, you have a benefit for vision care services and materials provided by

EyeMed. Below is a brief summary of your vision benefit (for detailed plan information please see the Optima Health Benefit Information Guide online). To locate a provider visit OptimaHealth.com and select “Preventive Vision Network (non-Medicaid).”

EyeMed Vision Care In-Network CoverageSERVICE MEMBER COST

Spectacle Exam or $20 Co-payStandard Contact Lens Exam $40 Co-payLenses (single vision, bifocal, trifocal) Covered at 100%

Frames Covered in full up to $150 retailContact Lens - Conventional (in lieu of glasses) Covered in full up to $150 retail (in lieu of glasses)

Did you know? Your Optima member card is also your EyeMed member card.

For detailed plan information, please visit vbgov.com/benefits and download the Optima Health Benefits Information Guide (BIG). If you have any questions or need additional information on

plan design, contact Optima Member Services at 757.687.6141 or 866.509.7567.

OptumRx - Prescription Drug Coverage• Prescription drug coverage managed by OptumRx is provided when you are enrolled in the Optima Health Plan. Your Prescription Drug Benefit is a closed formulary, which means it contains specific drugs in each drug class, and non-formulary medications must meet medical necessity criteria through an exception process to be covered.

MDLIVE Virtual CareReceive virtual care, anywhere! • As part of your Optima POS Health Plan coverage, you have a benefit for telemedicine services provided by MDLIVE. With MDLIVE, you can visit a doctor 24/7 from your home, office or on the go. MDLIVE's network of Board Certified doctors is available by phone 866.648.3638 or secure video to assist with non-emergency medical conditions. • To access this benefit, log in to your Optima Health member

account on OptimaHealth.com or the Optima Health mobile app.

•Allergies •Depression•Addictions •Infections•Bronchitis •Rashes•Cold & Flu •Urinary Tract Infections

COMMON CONDITIONS THEY TREAT:

Check out the Optima Health Mobile App for Additional Resources!Download Optima Health from the App Store (Apple) or Google Play (Android).Optima Health members must be registered on OptimaHealth.com to use the secure features of the mobile app.

• Find doctors and urgent care centers • View and email member ID cards • Access claims information• View your user prof ile and update your email address• Access MDLIVE services

Limited to one pair of frames, lenses (single vision, bifocal, trifocal) OR contact lenses from a participating EyeMed Vision Care Provider (once every 12 months from the date of last exam). Copayments or Coinsurance payments made for vision care services are not applied toward the annual maximum-out-of pocket (MOOP). This means that you will continue to pay when seeking services after the MOOP has been met.

$39 before the annual deductible is met, and then covered at 100%

Covered at 100%

POS BASIC PLAN

POS STANDARD PLAN

POS PREMIER PLAN

HEALTH PLAN ENROLLMENT OUT-OF-POCKET COST

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1 If you are age 55 or older you may contribute an additional $1,000 on top of the allowed contribution limits post-tax directly with HealthEquity. 2 HSAs are never taxed at a federal income tax level when used appropriately for qualified medical expenses. Also, most states recognize HSA funds as tax-free with very few

exceptions. Please consult a tax advisor regarding your state’s specific rules.3 Investments available to HSA holders are subject to risk, including the possible loss of the principal invested and are not federally-insured or guaranteed by HealthEquity.

HealthEquity does not provide financial advice.

HEALTHEQUITY HEALTH SAVINGS ACCOUNT COVERAGE

If you enroll in the POS Basic or POS Standard health plan, you may have the opportunity to set aside money that can earn tax-free interest on balances and can be used to pay for your out-of-pocket medical expenses. There are investment opportunities with an HSA after you reach a balance of $2,000, and the account can be used to help save for retirement. The account is not pre-funded and there is a $1.45 monthly administration fee.

For comprehensive detailed plan information, please visit HealthEquity.com. If you have questions or need further information on HSAs, you can contact HealthEquity Member Services at 866.346.5800.

HSA Eligibility:The IRS requires that you:• Are covered by an HSA-qualified health plan

(POS Basic or POS Standard);• Have no other health coverage (such as other health plan,

Medicaid, Medicare (Part A and/or B), military health benefits, or medical FSAs);

• Cannot be claimed as a dependent on another person’s tax return.

Here is how you get started with an HSA:

1. Add money to your HSA• Fund your HSA by transfering money into your account through

the HealthEquity member portal. To take full advantage of tax savings and to build a reserve for the future, it is suggested that you maximize your contributions as set by the IRS (listed below).

2. Watch your HSA grow• Your federally-insured HSA earns tax-free2 interest. Maximize your tax-free earning potential by investing HSA

funds using the convenient online investment tool.3

3. Use your HSA for qualified medical expenses• After enrollment you will receive a welcome kit with a HealthEquity debit card for easy access to your funds.• HSA funds can be used for a variety of qualified medical, dental, and vision expenses.

(Please note, HSA funds cannot be used for PHSA/COBRA premium payments.)

HealthEquity Mobile AppDownload mobile app from the

App Store (Apple) or Google Play (Android).

• Access to your account on-the-go• Take a photo of receipts with

your device to start claims and payments.

• Send payments and request reimbursements

Website: HealthEquity.com Phone: 866.346.5800

EXAMPLES OF ELIGIBLE EXPENSES

Acupuncture • Birth control • Chiropractor • Contact lensesDental treatment • Fertility enhancement • Hearing aids

Lab Work • Medical supplies • Physical exams • PrescriptionsPrescription eyeglasses • Orthodontia • Radiology

Stop-smoking programs • Surgery (non-cosmetic) • Therapy

2020 HSA CONTRIBUTION LIMITS1:$3,550 - Single Subscriber (subscriber only) $7,100 - Family Coverage (subscriber + one or more individuals)

HEALTH SAVINGS ACCOUNT (HEALTHEQUITY)

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Familiarize yourself with your dental plan before you visit the dentist.

Request a pretreatment estimate for more costly procedures before dental services are performed.

MetLife member cards are not provided. Use your name and member number (SSN for all covered dependents) to seek dental services.

DENTAL PLAN PREMIUMS (METLIFE) - Monthly premiums listed below

LEVEL OF COVERAGE SILVER GOLD

Subscriber Only $20.45 $33.59

Subscriber + 1 Child $32.72 $53.28

Subscriber + Children $43.29 $70.57

Subscriber + Spouse $43.29 $70.57

Family $65.29 $106.97

METLIFE DENTAL COVERAGEThe City of Virginia Beach and Virginia Beach City Public Schools offer two different PDP (Preferred Dentist Program) plans through MetLife Dental that provide coverage for cleanings, x-rays, fillings, bridges, and many other dental procedures.

MetLife Silver plan allows you to receive in-network and out-of-network services at lower coverage levels than the Gold Plan. No orthodontic coverage is provided under this plan.

MetLife Gold plan allows you to receive in-network and out-of-network services as well as orthodontic care.

2020 METLIFE DENTAL PLAN PREMIUMS

METLIFE DENTAL TIPS & HOW TO LOCATE A PROVIDER

• Visit MetLife.com• Choose the option to search for a dentist• Your network is “PDP Plus”

HOW TO LOCATE A METLIFE PDP PLUS PROVIDER

For detailed plan information, please visit vbgov.com/benefits and download the MetLife Dental Guide. If you have questions, or need further information on dental benefits, contact MetLife at 800.942.0854.

Check out the MetLife Mobile App for Additional Resources!Download MetLife US App from the App Store (Apple) or Google Play (Android).

• Search for providers • View member ID cards • View plan and claim summary

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METLIFE SILVERIn-Network

METLIFE GOLDIn-Network

Deductible (applies only to type B & C services) $75 Individual $225 Family

$50 Individual$150 Family

Annual Maximum Benefit per calendar year $1,000 $1,300

Type A – Prophylaxis/cleanings, oral examinations, topical fluoride applications, space maintainers, x-rays (bitewings), brush biopsies

100% of Negotiated Fee1 100% of Negotiated Fee1

Type B – Fillings, simple extractions, repair of crown, denture and bridge, oral surgery, pulp caps/pulpotomy, periodontics (nonsurgical), sealants, x-rays (full mouth)

60% of Negotiated Fee1 80% of Negotiated Fee1

Type C – Bridges, dentures, endontics (other than pulp caps/pulpotomy), crowns, inlays/onlays, implants, periodontics (surgical)

30% of Negotiated Fee1 50% of Negotiated Fee1

Type D – Orthodontic Diagnostics, orthodontic treatment No Coverage 50% of Negotiated Fee1

Orthodontia Lifetime Maximum Per Person (Orthodontia maximum includes maximum history from prior employer sponsored dental plan)

No Coverage $1,000

1Negotiated Fee refers to the fees that participating dentists have agreed to accept as payment in full, subject to any co-payments, deductibles, cost sharing and benefits maximums. Negotiated fees are subject to change.

Deductibles and coverage levels listed below reflect the Preferred Dentist Program (PDP) in-network care. Plan frequency limitations apply (for example, two cleanings per calendar year, etc.).

2020 METLIFE DENTAL PLAN COMPARISON SUMMARY OF BENEFITS

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WAGEWORKS HEALTH CARE FLEXIBLE SPENDING ACCOUNT COVERAGE

A Health Care Flexible Spending Account (FSA) allows participating active employees to set aside pre-tax dollars to pay for certain out-of-pocket expenses. If you participated as an active employee, you may take one of the following actions:

Option 1: Elect to continue participation for the remainder of the current benefit plan year, if funds remain in your account. By electing to continue on an after-tax basis, through PHSA, you may get reimbursed for eligible medical expenses with any remaining funds through the end of the benefit plan year in which you were separated from coverage as an active employee. Eligible participants may select to continue participation using the PHSA/COBRA Summary & Election Form (mailed to homes upon initial qualification for PHSA/COBRA coverage). If eligible, use the PHSA/COBRA Summary & Election Form to enroll: • Under "Insurance Plan", select the listed Flexible Spending Account (FSA)

(If you do not see one listed, you are not eligible.) • Complete the "PHSA/COBRA Election Form Information" section • Sign and date the bottom portion of the form • Submit the form to the Consolidated Benefits Office.

Option 2: Submit claims incurred for the calendar year prior to separation of coverage to WageWorks withoutenrolling in a Health Care FSA as a PHSA participant.All claims must be submitted by the end of the month following 90 calendar days after your coverage end date by using the Pay Me Back Claims Form found on WageWorks.com. Any funds remaining after that time will be forfeited.

For comprehensive detailed plan information, access the WageWorks member site at participant.WageWorks.com. If you have questions, or need further information on WageWorks FSAs, you may contact WageWorks at 877.924.3967.

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INDIVIDUAL COVERAGE OPTIONS:• THE HEALTH INSURANCE MARKETPLACE

If you choose not to elect coverage on the COVB or VBCPS health plan, exhaust PHSA/COBRA continuation coverage, or have another qualifying event (such as marriage or birth of a child), you may want to explore your other coverage options with the Health Insurance Marketplace. Visit HealthCare.gov to find the latest, most accurate information about the Marketplace and available plans.

For more information, you can also call the Marketplace Call Center toll-free at 800.318.2596 (TTY users should call 855.889.4325) or find help in your area by visiting Localhelp.healthcare.gov.

• COVER VIRGINIA - CONNECTING VIRGINIANS TO AFFORDABLE HEALTH CARE * FAMIS is Virginia’s health insurance program for children. It makes health care affordable for children of eligible families. FAMIS covers all the medical care growing children need to avoid getting sick, plus the medical care that will help them if they do get sick or get hurt. Dental services for children enrolled in FAMIS are provided through Smiles For Children program.

* MEDICAID enables states to provide medical care for public assistance recipients and medically needy persons (i.e. persons of low income who can meet their maintenance needs but have insufficient income to provide the cost of medical care). The program is financed by state and federal funds.

For additional information and eligibility requirements for the Cover Virginia programs, contact: Cover Virginia 855.242.8282 or visit coverva.org.

• METLIFE TAKEALONG DENTAL PLAN If you choose not to elect your current dental coverage through PHSA/COBRA continuation of coverage or are no longer eligible for coverage through COVB or VBCPS, the MetLife TakeAlong Dental Plan may be a great option for you. This is an individual dental insurance policy that is purchased independently and provides continuous coverage for you and/or your family. MetLife offers three great plans to select from with various dental benefit coverage levels to help you choose the best plan that suits you and/or your family’s needs!

For more information or to enroll, call MetLife at 1.844.2METDEN (1.844.263.8336) or visit metlifetakealongdental.com. When prompted, provide MetLife with the following referral code: VBTAD65.

LOCAL HEALTH/DENTAL CLINICSA Free Clinic is a private, nonprofit, community-based or faith-based organization that provides quality health care at little or no charge to low income, uninsured people through heavy use of volunteer health professionals and partnerships with other

health-related organizations.

BEACH HEALTH CLINIC (Virginia Beach)757.428.5601 | beachhealthclinic.org

CHESAPEAKE CARE CLINIC (Chesapeake) 757.545.5700 | chesapeakecare.org

H.E.L.P Inc. (Hampton)757.727.2577 | helpushelpu.org

PARK PLACE DENTAL CLINIC757.965.4224 | parkplaceclinic.org

For additional clinic locations, please visit vafreeclinics.org.

SENIOR RESOURCESThe following agencies and organizations are available to help plan, administer, and provide services and advocates for senior

citizens and their caregivers. These organizations can help assist with counseling for Medicare, Medicaid, long term care

insurance, legal and financial information.

SENIOR SERVICES OF SOUTHEASTERN VIRGINIA757.461.9481 | ssseva.org

SENIOR NAVIGATOR866.393.0957 | seniornavigator.org

CITIZENS’ COMMITTEE TO PROTECT THE ELDERLYcitizenscommittee.org

INDIVIDUAL COVERAGE OPTIONS & COMMUNITY RESOURCES

COMMUNITY RESOURCES:

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CONTACT INFORMATION

PHONE757.263.1060

FAX757.263.1123

EMAILBenef its@vbschools.com

PHYSICAL ADDRESS(Plaza Annex) or Drop Box641 Carriage Hill RoadVirginia Beach, VA 23452

MAILING ADDRESS2512 George Mason DriveVirginia Beach, VA 23456

WEB ACCESS www.vbgov.com/benef its

Please note: This guide does not represent a contractual agreement. The City of Virginia Beach and Virginia Beach City Public Schools reserve the right to modify, amend, or terminate health and retirement benef its as they apply to all future, current, and/or retired employees. The Administrator of each benef it plan has the discretionary authority to determine eligibility for benef its and to interpret the plan’s terms.

CITY OF VIRGINIA BEACH / VIRGINIA BEACH CITY PUBLIC SCHOOLS