leon county benefit booklet
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Leon County Benefit Booklet
Board of County Commissioners Clerk of Courts
Supervisor of Elections
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Board of County Commissioners
Clerk of Courts Supervisor of Elections
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Welcome to your Employee Benefits!
This Benefit Booklet describes the many benefits that are
available to you as an eligible Leon County employee. These
benefits are an important part of your compensation package.
You are encouraged to read this booklet, which provides a brief
summary of your benefits. Keep this Benefits Booklet for
reference throughout the year. Should you have any questions
concerning the benefits or eligibility described in this booklet,
refer to the insurance certificates, policies, or other benefit
brochures provided to you.
If you have further questions, please contact your
Human Resources office:
Board of County Commissioners at 606-2400
Supervisor of Elections at 606-8613
Clerk of Courts at 577-4230
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TABLE OF CONTENTS
Benefits Summary
HIPPA Notice
Service Directory
Monthly Premiums
Medical Insurance
Medicare Drug Coverage
Dental Insurance
Vision Insurance
Term Life Insurance
Long Term Disability
Legal Services
Long Term Care
Colonial Supplemental Insurance
5
8
13
14
15
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25
27
28
30
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36
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Benefits Summary The following is a brief summary of the Benefits that are available at Leon County: Eligibility:
All regular full- time employees Leon County Board of County Commissioners and Supervisor of Elections regular
part-time employees who have been employed for at least two years are eligible only for health insurance and participation in the Colonial Insurance programs.
Part time employees with less than 2 years of service & OPS employees are not eligible to participate
Pre-Tax Advantage: Medical, dental & vision premiums deducted from your pay can be made from pre-tax dollars. This means that the premiums deducted from your paycheck are before Federal taxes and Social Security taxes are withheld. That’s a tax savings for you. Pre-tax payments allowed under the IRS regulations do not allow you to change your coverage during the year except for certain change in status events.
Benefit Options Medical
You can choose to participate in Capital Health Plan or United Healthcare. If you are a regular full time or eligible part time employee, you can also choose to
Opt-Out of medical insurance coverage if you can provide proof that you have medical insurance coverage elsewhere. You can receive $300 per month in a payment for opting out of coverage. This is taxable income to you. If a husband & wife both work for Leon County, they are not eligible for the Opt-Out Program.
Dental
You can choose to participate in one of 2 Managed Care Plans (DHMO) which requires you to use a dentist from a Network of Participating Dentists or you can choose to participate in 2 Preferred Provider Plan (PPO) which allows you to obtain services from a Network of Participating Dentists or from any Dentist.
Vision
This plan provides for coverage for eye exams, glasses, lenses & frames. You can choose to have your eye care provided by a Network Doctor (which provides you the least out-of-pocket expenses) or a Non-Network Doctor.
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Group Term Life Insurance Basic Life
Leon County pays for basic term life insurance coverage in an amount equal to your annual salary if you are a Career Service or Executive Support Employee or an amount of two times your annual salary if you are in Executive or Senior Management.
Supplemental Life
You can purchase additional life insurance in the amount of two times your annual earnings if you are a Career Service or Executive Support Employee or one times your annual salary if you are in Executive or Senior Management.
You will need to complete an “Evidence of Insurability” form & approval is subject to the underwriting requirements of the insurance company. You could be declined coverage.
Dependent Life
You can apply for coverage for your spouse and/or dependent children You can choose from the following coverage amounts:
Spouse: $20,000 $10,000 $5,000
Children: $ 5,000 $ 2,500 $1,500 You will need to complete an “Evidence of Insurability” form & approval is
subject to the underwriting requirements of the insurance company. Your spouse & or children could be declined coverage.
Long Term Disability Insurance ( Leon County Board and Supervisor of Elections )
You can apply for coverage that could pay you 60% of pay up to age 65 after you have been disabled for 90 days.
You will need to complete an “Evidence of Insurability” form & approval is subject to the underwriting requirements of the insurance company. You could be declined coverage.
Flexible Reimbursement Accounts
You can choose to participate in this program which allows you to pay for certain health care & dependent care expenses through payroll deduction with pre-tax dollars.
You can contribute a maximum of $5,000 to the health care account and $5,000 to the dependent care account.
Careful planning of expenses is essential because IRS regulations require that participants forfeit any money left in the account at the end of the year.
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Voluntary Plans Opportunity to participate in ARAG-Legal Plan which provides coverage for
legal services that you may need. Opportunity to apply for coverage with Colonial Life which provides
insurance coverage for: Cancer, Intensive Care, Accident & Disability & Hospital Indemnity; or for Long Term Care Insurance with Blue Cross/Blue Shield. You may need to provide “Evidence of Insurability” & approval of your application is subject to the underwriting requirements of the Insurance Company. You could be declined coverage.
Opportunity to enroll in limited additional Life Insurance with Reliance Standard Life without Evidence of Insurability.
Retirement (Contact Human Resources for information)
Automatic participation in the Florida Retirement System. No contributions are required. You can choose to participate in the Pension Plan or the Investment Plan
Opportunity for you to save for retirement through payroll deduction with pre-tax dollars in Deferred Compensation Plans through VALIC, ICMA or NACO. You can choose to participate any time during the year.
Other Benefits Available (Contact Human Resources for information)
Sick Leave Pool (BOCC) Tuition Assistance Employee Assistance Program (EAP) and Mediation Program (BOCC & Clerk) Florida PrePaid College Savings Program Annual & Sick Leave Accruals Volunteer Service-Project Lead (BOCC) Parking (Cost deducted Pre-Tax)
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LEON COUNTY BOARD OF COUNTY COMMISSIONERS,
CLERK OF COURTS AND THE SUPERVISOR OF ELECTIONS
Notice of Privacy Practices (NPP)
LEON COUNTY FLEXIBLE BENEFITS PLAN NOTICE OF PRIVACY PRACTICES
This Notice is effective January 1, 2005
This notice will describe how medical information about you may be used and disclosed and how you can get access to this information.
PLEASE REVIEW IT CAREFULLY
If you have any questions about this Notice, or you would like to make a request concerning your rights, please contact the Privacy Officer through the Leon County Human Resources Division. This Notice applies to all records about your health care that we complete or have access to and relate to your eligibility or method of payment for such care.
OUR RESPONSIBILITIES
This privacy notice will tell you about the lawful ways in which we may use and disclose your Protected Health Information (PHI). It also describes your rights and the responsibilities we have regarding the use and disclosure of your PHI. PHI is information that may identify you (including your name, address, and social security number), that relates to your past, present, or future physical or mental health condition, your health care services, and payment for your health care services. Leon County Human Resources Division is required by law to maintain the security and privacy of your PHI and to provide you with this Notice of our Privacy Practices and legal duties. We are required to follow the terms of this Notice. We reserve the right to change the terms of this notice and to make any new provisions effective to the entire PHI that we maintain about you. If we revise this notice, we will provide you with a revised notice upon request. We will also make any revised Notice available in our reception area and on our website at http://www.co.leon.fl.us/ .
USES and DISCLOSURES of PHI
To comply with the law only the individual’s "Minimum and Necessary" PHI will be used or disclosed to accomplish the intended purpose of the use, disclosure, or request. It is the Leon County Human Resources Division policy to limit the use or disclosure of an individual’s PHI on a "need to know" basis. The following categories describe some of the different ways we may use and disclose your PHI.
Payment:
We may use and disclose your PHI for payment activities. For example, we may use and disclose your PHI to process and pay your bill for health care services, when your health care provider requests information regarding your eligibility for coverage under our health plan, or in reviewing the medical necessity of the treatment you received, or in coordinating payment with other insurance carriers or facilities, or in coordinating reimbursement under our Flexible Benefits Plan.
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LEON COUNTY BOARD OF COUNTY COMMISSIONERS,
CLERK OF COURTS AND THE SUPERVISOR OF ELECTIONS Business Associates:
We may disclose your PHI to third party "business associates" that perform various services for us.
Individuals Involved in Your Care:
We may use and disclose your PHI to a family member or other person’s you identify involved in your care. We will disclose only PHI relevant to that person’s involvement in your care or payment for your care. We may use and disclose your PHI for locating and notifying a family member, a personal representative, or another person responsible for your care. If you are unable to agree or object to this disclosure, we may disclose such information as we deem is in your best interest based on our professional judgment.
State of Florida Monitors and Other Auditors:
We may disclose your PHI to State of Florida monitors and other auditors determining our compliance with the law, other state and federal regulations, and Generally Accepted Accounting Procedures.
Research:
We may use and disclose your PHI for research purposes in certain limited circumstances.
Required By Law: We will disclose your PHI as required by federal or state law including:
Military and National Security. We may disclose your PHI to authorized federal officials for conducting national security and intelligence activities who have appropriate authorization in writing citing the relevant Law, U.S. Code, Code of Federal Regulations,
Florida Statute, and / or Florida Administrative Code. We may also be required to disclose your PHI to authorized members of the Armed Forces for activities deemed necessary, and described and justified in writing by appropriate military authorities.
Public Health. We may disclose your PHI for public health activities. For example, we may disclose your PHI when necessary to prevent a serious threat to you or others health and safety. Public health activities generally include: (1) to prevent or control disease,
injury or disability; (2) to report births and deaths; (3) to report child abuse or neglect; (4) to report reactions to medications or problems with products; (5) to notify people of recalls of products they may be using; (6) to notify a person who may have been exposed to a disease or may be at risk for contracting or spreading a disease or condition; and (7) to notify the appropriate government authority if we believe the individual has been the victim of abuse, neglect, or domestic violence.
Health Oversight Activities. We may disclose your PHI to a health oversight agency for activities authorized by law such as audits, investigations, inspections, and licensure. Government oversight agencies include those agencies that oversee government benefit
programs, government regulatory programs, and civil rights laws.
Legal Proceedings. We may disclose your PHI in the course of any judicial or administrative proceeding to the extent expressly authorized by a court or administrative order. We may disclose your PHI in response to a subpoena, discovery request, or other
lawful process, but only if efforts have been made to tell you or your attorney representative about the request or to obtain an order protecting the information requested.
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LEON COUNTY BOARD OF COUNTY COMMISSIONERS,
CLERK OF COURTS AND THE SUPERVISOR OF ELECTIONS
Law Enforcement. We may disclose your PHI to law enforcement officials for law enforcement, including: (1) in response to a court order, subpoena, warrant, summons, or similar process; (2) to identify or locate a suspect, fugitive, material witness, or missing
person; (3) pertaining to a victim of a crime if, under certain limited circumstances, we are unable to obtain the person’s agreement; (4) about a death we believe may be the result of criminal conduct; (5) about criminal conduct that occurs on our premises; and (6) in emergency circumstances to report a crime, the location of the crime or victims, or the identity , description, or location of the person who committed the crime.
Coroners, Medical Examiners, and Funeral Directors. We may disclose your PHI to a coroner or medical examiner for purposes of identifying a deceased person or determine cause of death. We may also disclose your PHI to a funeral director, as authorized by
law, in order for the director to carry out assigned duties.
Inmates. If you are an inmate of a correctional institution, we may disclose your PHI to the correctional institution or law enforcement official holding you in custody in order for:
(1) the institution to provide you with health care; (2) your health and safety and the health and safety of others; or (3) the safety and security of the correctional institution.
OTHER USES and DISCLOSURE OF YOUR PHI
Other disclosures of your PHI not covered by this notice or laws that apply to our use and disclosure will be made only with your written authorization. You may revoke your authorization, in writing, at anytime. If you revoke your authorization we will no longer use or disclose your PHI for the reasons covered by your written authorization. We are unable to take back any use or disclosure that has already been made with your authorization or that has been made as described in this notice.
YOUR RIGHTS
The following is a description of your rights with respect to your Protected Health Information.
Right to a Request A Restriction. You have the right to request a restriction on certain uses and disclosures of your PHI, including that for treatment, payment, or health care operations. You also have the right to request a restriction on the disclosure of your
information to individuals involved in your care or payment for your care. Leon County Human Resources Division will give serious consideration to your request but is not required to agree to any such restrictions. If we do agree, we will comply with the restriction unless the information is needed under exceptional circumstances. If we are unable to notify you of these exceptional circumstances prior to the fact, we will notify you of those circumstances as soon as reasonably possible. To request a restriction please contact the Privacy Officer. Your request must specify (1) the information you want to limit; (2) whether you want to limit our use, disclosure, or both; and (3) to whom you want the limits to apply.
Right to Access, Inspect, And Copy. You have the right to access, inspect, and obtain a copy of your PHI that may be used to make decisions about your health care benefits. This includes your medical and billing records, but may not include information that is
subject to laws that prohibit access. We may deny your request to access, inspect, and copy in certain limited circumstances. If you are denied access, you may request that the
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LEON COUNTY BOARD OF COUNTY COMMISSIONERS,
CLERK OF COURTS AND THE SUPERVISOR OF ELECTIONS denial be reviewed. A licensed health care provider chosen by us will review your request and denial. The person performing this request will not be the person who denied your initial request. We will comply with the outcome of that review. To inspect and copy your PHI, please contact the Privacy Officer. A fee may be charged for the cost of copying, mailing, or other supplies associated with your request.
Right to Amend - If you believe any of your information in our possession is inaccurate you may request, in writing, that we amend or correct the information that you believe to be erroneous. To request an amendment, contact the Privacy Officer. You will be
required to provide a reason that supports your request. We may deny your request if you ask us to amend information that: (1) was not created by us, unless the person or entity that created the information is no longer available to make the amendment; (2) is not part of the Protected Health Information kept by or for us; (3) is not part of the information which you would be permitted to inspect or copy; or (4) is accurate and complete. If we deny your request you may submit a short statement of dispute, which will be included in any future disclosure of your information.
Right to an Accounting of Disclosures. You have the right to receive an accounting of disclosures of your PHI. This is a list of the disclosures of your PHI that we made to others. The list does not include disclosures made: (1) for treatment, payment and any
other health plan operations; (2) to you; (3) that are incidental disclosures; (4) in accordance with an authorization; (5) for national security or intelligence purposes; and (6) to correctional institutions or law enforcement officials for the provision of health care, safety of individual, other inmates, and officers and employees. To request an accounting contact the Privacy Officer. You may request an accounting for disclosure made up to 6 years before the date of your request but not for disclosures made before January 1, 2005. The first accounting you request within a 12-month period will be free. For additional accountings, we may charge you the cost of providing the list. We will notify you of the fee before any costs are incurred.
Right to Confidential Communications. You have the right to request that you receive communication of your Protected Health Information in a certain time or manner (for example, by e-mail rather than by regular mail, or never by telephone). For example, you
may ask that we only contact you at work or by U.S. Mail. We must agree to your request as long as it would not be disruptive to our operations to do so. You must make any such request in writing, addressed to our Privacy Officer. Your request must specify how or where you wish to be contacted.
Right to a Paper Copy of This Notice. You have the right to a paper copy of this notice. You may request a paper copy by contacting the Privacy Officer. In addition, you may obtain a copy of this notice on the Leon County website: http://www.co.leon.fl.us/
COMPLAINTS
If you believe your privacy rights have been violated, please send your complaint, in writing, to the Privacy Officer. All complaints will be resolved in a timely manner. If we cannot resolve your concern, you have the right to file a written complaint with the Secretary of the United States Department of Health and Human Services. You will not be retaliated against in any way for filing a complaint.
If you would like to discuss the privacy of your Protected Health Information in detail, or if you have any concerns, please feel free to contact the Privacy Officer. For additional information please visit the Leon County website at: http://www.co.leon.fl.us/ or the Leon County Human
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LEON COUNTY BOARD OF COUNTY COMMISSIONERS,
CLERK OF COURTS AND THE SUPERVISOR OF ELECTIONS Human Resources Division contact person at:
315 South Calhoun Street, Tallahassee, Florida 32301
Leon County Board of County Commissioners
Suite 502
850-487-2220
Clerk of Courts
Suite 450
850-577-4230
Supervisor of Elections
Suite 110
850-606-8613
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Service Directory
For all service related issues please call:
Brown & Brown, Inc 3520 Thomasville Rd. Suite 500
Tallahassee, FL 32309 850.656.3747
Fringe Benefits Management Company
3101 Sessions Road Tallahassee, FL 32303
800.342.8017
LEON COUNTY BOARD OF COUNTY COMMISSIONERS LEON COUNTY CLERK OF COURTS MEDICAL MEDICAL
Capital Health Plan 850.383.3311
Capital Health Plan 850.383.3311
United Healthcare 1.800.411.1147
United Healthcare 1.800.411.1147
DENTAL DENTAL CompBenefits 1.800.342.5209
CompBenefits 1800.342.5209
United Healthcare 1.877.816.3596
United Healthcare 1.877.816.3596
VISION VISION Vision Care 1.800.865.3676
Vision Care 1.800.865.3676
TERM LIFE INSURANCE TERM LIFE INSURANCE Florida Combined Life 1.800.333.3256
Florida Combined Life 1800.333.3256
Reliance Standard Life 1.800.644.1103
Reliance Standard Life 1.800.644.1103
LONG TERM DISABILITY LONG TERM DISABILITY Michael J. Milton North Florida Insurance Service, Inc. 4356 Lafayette St. Marianna, FL 32446 1.800.652.5032
Michael J. Milton North Florida Insurance Service, Inc. 4356 Lafayette St. Marianna, FL 32446 1.800.652.5032
LONG TERM CARE LONG TERM CARE Blue Cross/Blue Shield 1.888.202.3393
Blue Cross/Blue Shield 1.888.202.3393
LEGAL ARAG Group 1.800.523.5299
LEGAL ARAG Group 1.800.523.5299
Supplemental Products Colonial Supplemental Insurance 850.962.2600 850.962.2500
Supplemental Products Colonial Supplemental Insurance 850.962.2600 850.962.2500
AFLAC (Brown & Brown, Inc.) 850.656.3747
Flexible Spending Account, Medical Reimbursement Account, Dependent Daycare
Flexible Spending Account, Medical Reimbursement Account, Dependent Daycare
Fringe Benefits Management Company 3101 Sessions Road Tallahassee, FL 32303 Customer Service: 800.342.8017
Fringe Benefits Management Company 3101 Sessions Road Tallahassee, FL 32303 Customer Service: 800.342.8017
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2008 EMPLOYEE CONTRIBUTIONS PER PAY CHECK
Your employee contributions are deducted from your paycheck 24 times per year. The rates below reflect what you would
pay for your benefits each paycheck. Coverage Type Employee Employee + 1 Family Only Dependent MEDICAL PLANS Capital Health Plan $15.56 $32.21 $41.23 United $20.31 $42.04 $53.82 Full Time Employees (If both spouses employed by LCBCC or by LCBCC and a Constitutional Office, then no
employee contribution required for Family coverage ) Part Time Employees Capital Health Plan $15.56 $237.36 $357.81 United $20.31 $310.07 $467.14 DENTAL PLANS CompBenefits DHMO (Managed Care) $10.55 $17.86 $28.15 Advantage $7.62 $14.78 $24.50 PPO (Preferred Provider) $12.67 $24.21 $40.18 United PPO Plan $15.42 $30.57 $54.23 VISIONCARE PLAN $2.99 $8.55 SUPPLEMENTAL TERM LIFE INSURANCE $0.43 cents per thousand dollars of coverage DEPENDENT LIFE Coverage Type INSURANCE Spouse Children Premium $20,000 $5,000 $3.12 $10,000 $2,500 $1.58 $ 5,000 $1,500 $0.86 LONG TERM Monthly rates are based on age and $100 of pay. DISABILITY Age Band Rate 29 or less $0.46 30-34 $0.60 35-39 $0.67 40-44 $0.97 45-49 $1.20 50-54 $1.73 55-59 $2.56 60-64 $3.31 65 or over $3.38
ARAG LEGAL PLAN $8.75
Colonial Voluntary Plans Rates are based on the type of Plan. Contact Colonial Representative for plans and rates.
*Please contact a Brown & Brown Representative for information on Reliance Standard Life Voluntary Group Life and Blue Cross Blue Shield Long Term Care plan and rates.
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to a
ge 1
7$1
0/vi
sit u
p to
age
17
- 18 -
CA
PIT
AL
HE
AL
TH
PL
AN
UN
ITE
D H
EA
LT
H C
AR
ED
IRE
CT
AC
CE
SS
SE
RV
ICE
S
Der
mat
olog
y$1
0/vi
sit;
limit
of 5
vis
its/y
ear
No
limits
; thi
s on
ly a
pplie
s to
H
MO
's w
here
ref
erra
ls a
re r
equi
red
O
B/G
YN
Exa
m$1
0/vi
sit f
or w
ell w
oman
exa
m$1
0/vi
sit f
or w
ell w
oman
exa
m
V
isio
n S
cree
ning
$10/
visi
t for
rou
tine
eye
exam
s$1
0/vi
sit f
or r
outin
e ey
e ex
ams
(g
lass
es &
con
tact
lens
es n
ot c
over
ed)
P
odia
try
$10/
visi
t; $1
0/vi
sit;
whe
n m
edic
ally
nec
essa
ryw
hen
med
ical
ly n
eces
sary
S
pine
& B
ack
Dis
orde
r T
reat
men
t$1
0/vi
sit;
$10/
visi
t; fo
r ac
ute
& d
iagn
ostic
con
ditio
nsfo
r ac
ute
& d
iagn
ostic
con
ditio
nsD
IAB
ET
ES
TR
EA
TM
EN
T
In P
hysi
cian
Offi
ce$1
0/vi
sit;
$10/
visi
t;se
e m
embe
r ha
ndbo
ok fo
r de
tails
see
mem
ber
hand
book
for
deta
ilsIN
-HO
SP
ITA
L S
ER
VIC
ES
S
emi-P
rivat
e R
oom
& B
oard
No
Cha
rge
No
Cha
rge
A
ncill
ary
& P
rofe
ssio
nal S
ervi
ces
No
Cha
rge
No
Cha
rge
M
edic
al S
ervi
ces
No
Cha
rge
No
Cha
rge
A
nest
hesi
aN
o C
harg
eN
o C
harg
e
M
ater
nity
(P
re &
Pos
t Car
e)N
o C
harg
eN
o C
harg
e
D
iagn
ostic
Ser
vice
sN
o C
harg
eN
o C
harg
e
In
tens
ive
Cor
onar
y C
are
No
Cha
rge;
No
Cha
rge
whe
n m
edic
ally
nec
essa
ry
S
urgi
cal P
roce
dure
sN
o C
harg
e;N
o C
harg
esu
bjec
t to
appr
oval
- 19 -
CA
PIT
AL
HE
AL
TH
PL
AN
UN
ITE
D H
EA
LT
H C
AR
E
Ope
ratin
g &
Rec
over
y R
oom
No
Cha
rge
No
Cha
rge
A
cute
& C
hron
ic D
ialy
sis
No
Cha
rge
No
Cha
rge
D
rugs
, Med
icat
ions
& R
adio
ther
apy
No
Cha
rge
No
Cha
rge
S
peci
alty
Car
e &
Con
sulta
nts
No
Cha
rge;
No
Cha
rge
whe
n m
edic
ally
nec
essa
ry
S
peci
al D
uty
Nur
sing
No
Cha
rge;
No
Cha
rge
whe
n m
edic
ally
nec
essa
ry
OU
TP
AT
IEN
T H
OS
PIT
AL
SE
RV
ICE
S
Out
patie
nt S
urge
ryN
o C
harg
eN
o C
harg
e
R
adio
logy
& D
iagn
ostic
Tes
ting
Mam
mog
ram
No
Cha
rge
No
Cha
rge
Rou
tine:
Che
st x
-ray
, EK
G, e
tcN
o C
harg
eN
o C
harg
e
Spe
cial
ized
: Ultr
asou
nd, E
EG
,N
o C
harg
e; $
10 c
opay
N
o C
harg
e; $
10 c
opay
al
lerg
y te
stin
g, e
tc.
for
alle
rgy
test
ing
for
alle
rgy
test
ing
Ext
ensi
ve: C
at s
can,
MR
I, et
c.N
o C
harg
e;N
o C
harg
e;m
ay r
equi
re p
rior
auth
oriz
atio
nm
ay r
equi
re p
rior
auth
oriz
atio
n
La
b W
ork
No
Cha
rge
No
Cha
rge
C
hem
othe
rapy
No
Cha
rge
No
Cha
rge
D
ialy
sis
Ser
vice
sN
o C
harg
eN
o C
harg
e
S
hort
Ter
m T
hera
py
O
ccup
atio
nal,
Phy
sica
l, S
peec
h,$1
0/vi
sit;
for
cond
ition
s$1
0/vi
sit;
for
cond
ition
s
In
hala
tion
sub
ject
to s
igni
fican
t s
ubje
ct to
sig
nific
ant
impr
ovem
ent i
n 62
day
sim
prov
emen
t in
62 d
ays
- 20 -
CA
PIT
AL
HE
AL
TH
PL
AN
UN
ITE
D H
EA
LT
H C
AR
E
EM
ER
GE
NC
Y C
AR
E S
ER
VIC
ES
H
ospi
tal E
R R
oom
$100
/epi
sode
, wai
ved
if ad
mitt
ed$1
00/e
piso
de, w
aive
d if
adm
itted
P
hysi
cian
Cha
rges
Incl
uded
in a
bove
$10
0 co
pay
Incl
uded
in a
bove
$10
0 co
pay
U
gent
Car
e F
acili
ty$1
5/vi
sit
$15/
visi
t
EX
TE
ND
ED
CA
RE
SE
RV
ICE
S
Ski
lled
Nur
sing
Fac
ility
No
Cha
rge;
No
Cha
rge;
u
p to
60
days
per
adm
issi
on u
p to
60
days
per
adm
issi
on
H
ospi
ce C
are
No
Cha
rge
No
Cha
rge
H
ome
Hea
lth C
are
No
Cha
rge
No
Cha
rge
ME
NT
AL
HE
AL
TH
In
patie
nt F
acili
tyN
o C
harg
e; u
p to
31
days
/yea
rN
o C
harg
e; u
p to
30
days
/yea
r
O
utpa
tient
Fac
ility
& P
hysi
cian
Offi
ce$2
0/vi
sit;
up to
20
visi
ts/y
ear
$20/
visi
t; up
to 2
0 vi
sits
/yea
r
D
ay T
reat
men
t Fac
ility
Not
Cov
ered
Not
Cov
ered
P
artia
l Hos
pita
lizat
ion
No
Cha
rge;
2 d
ays
of p
artia
l N
o C
harg
e; 2
day
s of
par
tial
hosp
italiz
atio
n co
unts
as
1 da
yho
spita
lizat
ion
coun
ts a
s 1
day
tow
ards
men
tal/n
ervo
us b
enef
itto
war
ds m
enta
l/ner
vous
ben
efit
SU
BS
TA
NC
E A
BU
SE
In
patie
nt F
acili
tyN
o C
harg
e; d
etox
ifica
tion
only
No
Cha
rge;
det
oxifi
catio
n on
ly
Out
patie
nt F
acili
ty$2
0/vi
sit;
up to
20
visi
ts/y
ear
$20/
visi
t; up
to 2
0 vi
sits
/yea
r (C
ombi
ned
with
men
tal h
ealth
(C
ombi
ned
with
men
tal h
ealth
ou
tpat
ient
vis
its)
outp
atie
nt v
isits
)N
o C
harg
e fo
r di
agno
stic
med
ical
N
o C
harg
e fo
r di
agno
stic
med
ical
tr
eatm
ent f
or d
rugs
and
trea
tmen
t for
dru
gs a
ndal
coho
l det
oxifi
catio
nal
coho
l det
oxifi
catio
n
- 21 -
CA
PIT
AL
HE
AL
TH
PL
AN
UN
ITE
D H
EA
LT
H C
AR
E
OT
HE
R S
ER
VIC
ES
D
ME
No
Cha
rge;
up
to
No
Cha
rge;
up
to
$2,5
00 p
er m
embe
r pe
r ye
ar$2
,500
per
mem
ber
per
cale
ndar
yea
r
P
rost
hetic
sN
o C
harg
eN
o C
harg
e; $
2500
per
cal
enda
r ye
ar
O
rtho
tics
Not
Cov
ered
Not
Cov
ered
T
MJ/
Ort
hogn
atic
No
Cha
rge;
Not
Cov
ered
whe
n m
edic
ally
nec
essa
ry
O
rgan
Tra
nspl
ants
No
Cha
rge;
sub
ject
to li
mita
tions
No
Cha
rge;
sub
ject
to li
mita
tions
A
mbu
lanc
eN
o C
harg
e; w
hen
med
ical
y N
o C
harg
ene
cess
ary
M
edic
al S
uppl
ies
No
Cha
rge;
whe
n pa
rt o
fN
o C
harg
e;m
edic
al tr
eatm
ent
whe
n pa
rt o
f med
ical
trea
tmen
t
S
teril
izat
ion
Ser
vice
sN
o C
harg
e; s
urgi
cal s
teril
izat
ion
No
Cha
rge;
sur
gica
l ste
riliz
atio
n in
clud
ing
tuba
l lig
atio
ns a
nd in
clud
ing
tuba
l lig
atio
ns a
ndva
sect
omie
sva
sect
omie
s
F
ertil
ity S
ervi
ces
$10/
visi
t; $2
,000
Life
time
Max
$10/
visi
t; fa
mily
pla
nnin
g se
rvic
es
othe
r th
an th
ose
serv
ices
othe
r th
an th
ose
serv
ices
spec
ifica
lly d
escr
ibed
in th
e sp
ecifi
cally
des
crib
ed in
the
Cov
ered
Ser
vice
s se
ctio
n of
the
Cov
ered
Ser
vice
s se
ctio
n of
the
Mem
ber
Han
dboo
k ar
e ex
clud
edM
embe
r H
andb
ook
are
excl
uded
In
fert
ility
Ser
vice
s$1
0 fo
r en
dom
etria
l bio
psy,
$1
0 fo
r en
dom
etria
l bio
psy,
sp
erm
cou
nt &
sp
erm
cou
nt &
hy
ster
osal
ping
ogra
phy
hyst
eros
alpi
ngog
raph
y
- 22 -
CA
PIT
AL
HE
AL
TH
PL
AN
UN
ITE
D H
EA
LT
H C
AR
EP
RE
SC
RIP
TIO
N D
RU
GS
(fo
r 30
day
su
pp
ly)
G
ener
ic$7
$7
Pre
ferr
ed B
rand
$20
$20
N
on-P
refe
rred
Bra
nd$3
5$3
5
Mai
l Ord
erC
o-pa
ys in
boo
klet
New
em
ploy
ees
wis
hing
to e
nrol
l in
med
ical
insu
ranc
e m
ust s
ubm
it an
enr
ollm
ent a
pplic
atio
n w
ithin
30
days
of e
mpl
oym
ent.
It m
ay b
e ne
cess
ary
to c
onta
ct th
e ph
ysic
ian'
s of
fice
befo
re m
akin
g yo
ur s
elec
tion
in C
HP
to d
eter
min
e if
the
phys
icia
n is
acc
eptin
gne
w p
atie
nts.
Em
ploy
ees
who
hav
e m
edic
al in
sura
nce
thro
ugh
anot
her
plan
out
side
of L
CB
CC
may
ele
ct to
par
ticip
ate
in th
e M
edic
al In
sura
nce
Op
t-O
ut P
rogr
aman
d re
ceiv
e $3
00/m
onth
. E
mpl
oyee
s m
ust p
rovi
de w
ritte
n pr
oof o
f oth
er m
edic
al c
over
age,
with
in 3
0 da
ys o
f em
ploy
men
t, in
ord
er to
par
ticip
ate.
SP
EC
IAL
NO
TIC
ES
:D
EC
LIN
ING
EN
RO
LL
ME
NT
IN T
HE
ME
DIC
AL
PL
AN
If yo
u ar
e de
clin
ing
enro
llmen
t for
you
rsel
f or
your
dep
ende
nts
beca
use
of o
ther
med
ical
insu
ranc
e co
vera
ge, y
ou m
ay in
the
futu
re b
e ab
le to
enr
oll
your
self
of y
our
depe
nden
ts in
one
of t
he m
edic
al p
lans
, pro
vide
d th
at y
ou r
eque
st e
nrol
lmen
t with
in 3
1 da
ys a
fter
your
cov
erag
e en
ds.
In a
dditi
on, i
f you
hav
e a
new
dep
ende
nt a
s a
resu
lt of
mar
riage
, birt
h, a
dopt
ion/
plac
emen
t for
ado
ptio
n, y
ou m
ay b
e ab
le to
enr
oll y
ours
elf &
your
dep
ende
nts,
pro
vide
d th
at y
ou r
eque
st e
nrol
lmen
t with
in 3
1 da
ys a
fter
the
mar
riage
, birt
h, a
dopt
ion/
plac
emen
t for
ado
ptio
n.
WO
ME
N'S
HE
AL
TH
& C
AN
CE
R R
IGH
TS
AC
T O
F 1
998
Mas
tect
omie
s &
rel
ated
rec
onst
ruct
ive
surg
ery
are
cove
red
bene
fits
for
mem
bers
in th
e m
edic
al p
lans
. T
his
incl
udes
bot
h re
cons
truc
tion
of th
e br
east
on w
hich
sur
gery
was
per
form
ed a
s w
ell a
s su
rger
y &
rec
onst
ruct
ion
of th
e ot
her
brea
st to
pro
duce
a s
ymm
etric
al a
ppea
ranc
e. C
ove
rage
is a
lso
avai
labl
e fo
r br
east
pro
sthe
sis
& fo
r th
e ph
ysic
al c
ompl
icat
ions
of m
aste
ctom
y, in
clud
ing
lym
phed
emas
.
- 23 -
-
16 -
Imp
ort
ant
No
tice
fro
m L
eon
Co
un
ty A
bo
ut
Yo
ur
Pre
scri
pti
on
Dru
g C
ove
rag
e an
d M
edic
are
Ple
ase
read
th
is n
oti
ce c
aref
ully
an
d k
eep
it w
her
e yo
u c
an f
ind
it. T
his
no
tice
has
info
rmat
ion
ab
ou
t yo
ur
curr
ent
pre
scri
pti
on
dru
g c
ove
rag
e w
ith
Leo
n C
ou
nty
an
d a
bo
ut
you
r o
pti
on
s u
nd
er M
edic
are’
s p
resc
rip
tio
n d
rug
co
vera
ge.
T
his
in
form
atio
n c
an h
elp
yo
u d
ecid
e w
het
her
or
no
t yo
u w
ant
to j
oin
a M
edic
are
dru
g p
lan
. In
form
atio
n a
bo
ut
wh
ere
you
can
get
hel
p t
o m
ake
dec
isio
ns
abo
ut
you
r p
resc
rip
tio
n d
rug
co
vera
ge
is a
t th
e en
d
of
this
no
tice
. 1.
M
edic
are
pre
scri
pti
on
dru
g c
ove
rag
e b
ecam
e av
aila
ble
in
200
6 to
eve
ryo
ne
wit
h M
edic
are.
Yo
u c
an g
et t
his
co
vera
ge
if y
ou
jo
in a
Med
icar
e P
resc
rip
tio
n D
rug
Pla
n o
r jo
in a
Med
icar
e A
dva
nta
ge
Pla
n (
like
an H
MO
or
PP
O)
that
off
ers
pre
scri
pti
on
dru
g c
ove
rag
e. A
ll M
edic
are
dru
g p
lan
s p
rovi
de
at l
east
a s
tan
dar
d l
evel
of
cove
rag
e se
t b
y M
edic
are.
So
me
pla
ns
may
als
o o
ffer
mo
re c
ove
rag
e fo
r a
hig
her
mo
nth
ly p
rem
ium
.
2.
Leo
n C
ou
nty
has
det
erm
ined
th
at t
he
pre
scri
pti
on
dru
g c
ove
rag
e o
ffer
ed b
y th
e L
eon
Co
un
ty m
edic
al
insu
ran
ce v
end
ors
(C
apit
al H
ealt
h P
lan
an
d U
nit
ed)
is,
on
ave
rag
e fo
r al
l p
lan
par
tici
pan
ts,
exp
ecte
d t
o p
ay
ou
t as
mu
ch a
s st
and
ard
Med
icar
e p
resc
rip
tio
n d
rug
co
vera
ge
pay
s an
d is
co
nsi
der
ed C
red
itab
le C
ove
rag
e.
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
__
Bec
ause
yo
ur
exis
tin
g c
ove
rag
e is
, o
n a
vera
ge,
at
leas
t as
go
od
as
stan
dar
d M
edic
are
pre
scri
pti
on
dru
g
cove
rag
e, y
ou
can
kee
p t
his
co
vera
ge
and
no
t p
ay a
hig
her
pre
miu
m (
a p
enal
ty)
if y
ou
lat
er d
ecid
e to
jo
in a
M
edic
are
dru
g p
lan
. Y
ou c
an j
oin
a M
edic
are
drug
pla
n w
hen
you
first
bec
ome
elig
ible
for
Med
icar
e an
d ea
ch y
ear
from
Nov
embe
r 15
th
thro
ugh
Dec
embe
r 31
st.
Thi
s m
ay m
ean
that
you
may
hav
e to
wai
t to
join
a M
edic
are
drug
pla
n an
d th
at y
ou m
ay p
ay a
hi
gher
pre
miu
m (
a pe
nalty
) if
you
join
late
r.
You
may
pay
tha
t hi
gher
pre
miu
m (
a pe
nalty
) as
long
as
you
have
Med
icar
e pr
escr
iptio
n dr
ug c
over
age.
H
owev
er, i
f you
lose
cre
dita
ble
pres
crip
tion
drug
cov
erag
e, th
roug
h no
faul
t of y
our
own,
you
w
ill b
e el
igib
le f
or a
six
ty (
60)
day
Spe
cial
Enr
ollm
ent
Per
iod
(SE
P)
beca
use
you
lost
cre
dita
ble
cove
rage
to
join
a P
art
D
plan
. I
n ad
ditio
n, if
you
lose
or
deci
de t
o le
ave
empl
oyer
/uni
on s
pons
ored
cov
erag
e; y
ou w
ill b
e el
igib
le t
o jo
in a
Par
t D
pl
an a
t th
at t
ime
usin
g an
Em
ploy
er G
roup
Spe
cial
Enr
ollm
ent
Per
iod.
Y
ou s
houl
d co
mpa
re y
our
curr
ent
cove
rage
, in
clud
ing
whi
ch d
rugs
are
cov
ered
at
wha
t co
st,
with
the
cov
erag
e an
d co
sts
of t
he p
lans
offe
ring
Med
icar
e pr
escr
iptio
n dr
ug c
over
age
in y
our
area
.
If y
ou
dec
ide
to j
oin
a M
edic
are
dru
g p
lan
, yo
ur
Leo
n C
ou
nty
co
vera
ge
will
be
affe
cted
. S
ee b
elo
w f
or
mo
re
info
rmat
ion
ab
ou
t w
hat
hap
pen
s to
yo
ur
curr
ent
cove
rag
e if
yo
u jo
in a
Med
icar
e d
rug
pla
n.
If yo
u en
roll
in a
Med
icar
e pr
escr
iptio
n dr
ug p
lan,
you
and
you
r de
pend
ents
will
no
long
er b
e el
igib
le f
or L
eon
Cou
nty’
s re
tiree
med
ical
or
pres
crip
tion
drug
cov
erag
e an
d yo
u w
ill n
ot b
e ab
le t
o ha
ve t
hat
cove
rage
rei
nsta
ted
if yo
u la
ter
dise
nrol
l fro
m t
he M
edic
are
pres
crip
tion
dru
g pl
an.
Bef
ore
you
deci
de t
o en
roll
in a
Med
icar
e pr
escr
iptio
n dr
ug p
lan,
you
sh
ould
com
pare
you
r Le
on C
ount
y m
edic
al p
lan
optio
ns—
incl
udin
g w
hich
dru
gs a
re c
over
ed—
with
the
cove
rage
and
cos
t of
the
plan
s of
ferin
g M
edic
are
med
ical
and
pre
scrip
tion
drug
cov
erag
e in
you
r ar
ea.
- 24 -
-
17 -
If y
ou
do
dec
ide
to j
oin
a M
edic
are
dru
g p
lan
an
d d
rop
yo
ur
Leo
n C
ou
nty
pre
scri
pti
on
dru
g c
ove
rag
e, b
e aw
are
that
yo
u a
nd
yo
ur
dep
end
ents
may
no
t b
e ab
le t
o g
et t
his
co
vera
ge
bac
k.
You
sho
uld
also
kno
w t
hat
if yo
u dr
op o
r lo
se y
our
cove
rage
with
Leo
n C
ount
y an
d do
n’t
join
a M
edic
are
drug
pla
n w
ithin
63
con
tinuo
us d
ays
afte
r yo
ur c
urre
nt c
over
age
ends
, yo
u m
ay p
ay a
hig
her
prem
ium
(a
pena
lty)
to jo
in a
Med
icar
e dr
ug
plan
late
r.
If yo
u go
63
cont
inuo
us d
ays
or l
onge
r w
ithou
t pr
escr
iptio
n dr
ug c
over
age
that
’s a
t le
ast
as g
ood
as M
edic
are’
s pr
escr
iptio
n dr
ug c
over
age,
you
r m
onth
ly p
rem
ium
may
go
up b
y at
leas
t 1%
of
the
base
ben
efic
iary
pre
miu
m p
er m
onth
fo
r ev
ery
mon
th t
hat
you
did
not
have
tha
t co
vera
ge.
For
exa
mpl
e, i
f yo
u go
nin
etee
n m
onth
s w
ithou
t co
vera
ge,
your
pr
emiu
m m
ay c
onsi
sten
tly b
e at
lea
st 1
9% h
ighe
r th
an t
he b
ase
bene
ficia
ry p
rem
ium
. Y
ou m
ay h
ave
to p
ay t
his
high
er
prem
ium
(a
pena
lty)
as lo
ng a
s yo
u ha
ve M
edic
are
pres
crip
tion
drug
cov
erag
e. In
add
ition
, you
may
hav
e to
wai
t unt
il th
e fo
llow
ing
Nov
embe
r to
join
. F
or m
ore
info
rmat
ion
abou
t thi
s no
tice
or y
our
curr
ent p
resc
ript
ion
drug
cov
erag
e…
Con
tact
the
per
son
liste
d be
low
for
fur
ther
info
rmat
ion.
N
OT
E:
You
’ll g
et t
his
notic
e ea
ch y
ear.
You
will
als
o ge
t it
befo
re
the
next
per
iod
you
can
join
a M
edic
are
drug
pla
n, a
nd i
f th
is c
over
age
thro
ugh
Leon
Cou
nty
chan
ges.
You
als
o m
ay
requ
est a
cop
y.
For
mor
e in
form
atio
n ab
out y
our
optio
ns u
nder
Med
icar
e pr
escr
iptio
n dr
ug c
over
age…
M
ore
deta
iled
info
rmat
ion
abou
t M
edic
are
plan
s th
at o
ffer
pres
crip
tion
drug
cov
erag
e is
in
the
“Med
icar
e &
You
” ha
ndbo
ok.
You
’ll g
et a
cop
y of
the
han
dboo
k in
the
mai
l eve
ry y
ear
from
Med
icar
e.
You
may
als
o be
con
tact
ed d
irect
ly
by M
edic
are
drug
pla
ns.
For
mor
e in
form
atio
n ab
out M
edic
are
pres
crip
tion
drug
cov
erag
e:
V
isit
ww
w.m
edic
are.
gov
Cal
l you
r S
tate
Hea
lth In
sura
nce
Ass
ista
nce
Pro
gram
(se
e th
e in
side
bac
k co
ver
of y
our
copy
of t
he “
Med
icar
e &
Y
ou”
hand
book
for
thei
r te
leph
one
num
ber)
for
pers
onal
ized
hel
p,
C
all 1
-800
-ME
DIC
AR
E (
1-80
0-63
3-42
27).
TT
Y u
sers
sho
uld
call
1-87
7-48
6-20
48.
If yo
u ha
ve l
imite
d in
com
e an
d re
sour
ces,
ext
ra h
elp
payi
ng f
or M
edic
are
pres
crip
tion
drug
cov
erag
e is
ava
ilabl
e. F
or
info
rmat
ion
abou
t th
is e
xtra
hel
p, v
isit
Soc
ial
Sec
urity
on
the
web
at
ww
w.s
ocia
lsec
urity
.gov
, or
cal
l th
em a
t 1-
800-
772-
1213
(T
TY
1-8
00-3
25-0
778)
. R
emem
ber
: K
eep
th
is C
red
itab
le C
ove
rag
e n
oti
ce.
If y
ou
dec
ide
to jo
in o
ne
of
the
Med
icar
e d
rug
pla
ns,
yo
u m
ay
be
req
uir
ed t
o p
rovi
de
a co
py
of
this
no
tice
wh
en y
ou
join
to
sh
ow
wh
eth
er o
r n
ot
you
hav
e m
ain
tain
ed c
red
itab
le
cove
rag
e an
d w
het
her
or
no
t yo
u a
re r
equ
ired
to
pay
a h
igh
er p
rem
ium
(a
pen
alty
).
D
ate:
11
/01/
07
N
ame
of E
ntity
/Sen
der:
Le
on C
ount
y
Con
tact
--P
ositi
on/O
ffice
: E
rnie
Poi
rier(
BO
CC
)/S
haro
n F
erre
ll(C
lerk
of C
ourt
s)/C
indy
Kel
ly (
Sup
ervi
sor
of E
lect
ions
)
A
ddre
ss:
315
S. C
alho
un S
t., T
alla
hass
ee, F
L 32
301
S
uite
502
(B
OC
C),
Sui
te 4
50 (
Cle
rk o
f Cou
rts)
, Sui
te 1
10(S
uper
viso
r of
Ele
ctio
ns)
P
hone
Num
bers
: (8
50)
- 60
6-24
17 (
BO
CC
), 5
77-4
230
(Cle
rk o
f Cou
rts)
, 606
-861
3 (S
uper
viso
r of
Ele
ctio
ns)
DH
MO
Pla
nA
dva
nta
ge
Pla
nC
S150
AV
N1
In N
etw
ork
Out
of N
etw
ork
Co
pa
yme
ntC
op
aym
ent
Reim
bur
sem
ent
Reim
bur
sem
ent
9430
Offi
ce V
isit
(Nor
mal
Hou
rs)
$5.0
0$0
.00
120
Per
iodi
c or
al e
valu
atio
n N
o C
harg
eN
o C
harg
e14
0Li
mite
d or
al e
valu
atio
nN
o C
harg
eN
o C
harg
e15
0C
ompr
ehen
sive
ora
l eva
luat
ion
No
Cha
rge
No
Cha
rge
210
Intr
aora
l-com
plet
e se
ries
(incl
udin
g bi
tew
ings
) N
o C
harg
eN
o C
harg
e22
0In
trao
ral-p
eria
pica
l-firs
t film
N
o C
harg
eN
o C
harg
e27
4B
itew
ings
-fou
r fil
ms
No
Cha
rge
No
Cha
rge
330
Pan
oram
ic fi
lm
No
Cha
rge
No
Cha
rge
1110
Pro
phyl
axis
-adu
lt (o
nce
ever
y si
x m
onth
s)N
o C
harg
eN
o C
harg
e11
20P
roph
ylax
is-c
hild
(on
ce e
very
six
mon
ths)
No
Cha
rge
No
Cha
rge
1203
Top
ical
app
licat
ion
of fl
uorid
e (u
p to
16
year
s of
age
) N
o C
harg
eN
o C
harg
e
1351
Sea
lant
-per
toot
h $1
0.00
No
Cha
rge
2140
Am
alga
m-o
ne s
urfa
ce, p
rimar
y or
per
man
ent
No
Cha
rge
$24.
0021
50A
mal
gam
-tw
o su
rfac
es, p
rimar
y or
per
man
ent
No
Cha
rge
$31.
0023
30R
esin
-bas
ed c
ompo
site
-one
sur
face
, ant
erio
r $3
5.00
$24.
0023
31R
esin
-bas
ed c
ompo
site
-tw
o su
rfac
es, a
nter
ior
$40.
00$3
1.00
2391
Res
in-b
ased
com
posi
te-o
ne s
urfa
ce, p
oste
rior
$60.
00$2
8.00
2750
Cro
wn-
porc
elai
n fu
sed
to h
igh
nobl
e m
etal
$2
80.0
0+up
to $
125
per
unit
for
high
no
ble
met
al$4
66.0
033
30M
olar
Roo
t Can
al$2
50.0
0$4
97.0
043
41P
erio
dont
al s
calin
g an
d ro
ot p
lani
ng-
per
quad
rant
$5
0.00
$39.
0049
10P
erio
dont
al m
aint
enan
ce
$50.
00$2
3.00
7140
Ext
ract
ion,
eru
pted
toot
h or
exp
osed
roo
tN
o C
harg
e$2
6.00
Typ
e IV
- O
rtho
do
ntic
s
8070
/808
0C
ompr
ehen
sive
ort
hodo
ntic
trea
tmen
t of t
he tr
ansi
tiona
l/ado
lesc
ent d
entit
ion.
Chi
ldre
n up
to
19 y
ears
of a
ge; u
p to
24
mon
ths
of r
outin
e or
thod
ontic
trea
tmen
t for
Cla
ss I
& C
lass
II c
ases
.C
onsu
ltatio
nN
o C
harg
eN
o C
harg
eE
valu
atio
n$3
5.00
$35.
00R
ecor
ds/T
reat
men
t Pla
nnin
g$2
50.0
0$2
50.0
0O
rtho
dont
ic T
reat
men
t$1
,800
.00
$2,1
00.0
0
8090
Com
preh
ensi
ve o
rtho
dont
ic tr
eatm
ent o
f the
adu
lt de
ntiti
on.
Adu
lts19
yea
rs o
f age
and
ove
r;
up to
24
mon
ths
of r
outin
e or
thod
ontic
trea
tmen
t for
Cla
ss I
& C
lass
II c
ases
.C
onsu
ltatio
nN
o C
harg
eN
o C
harg
eE
valu
atio
n$3
5.00
$35.
00R
ecor
ds/T
reat
men
t Pla
nnin
g$2
50.0
0$2
50.0
0O
rtho
dont
ic T
reat
men
t$2
,000
.00
$2,3
00.0
0
Max
imu
m B
enef
its
Life
time
Max
imum
- T
ype
I, II,
III
Unl
imite
dU
nlim
ited
Cal
enda
r Y
ear
Max
imum
- T
ype
I, II,
III
$1,0
00$1
,000
Ded
uctib
le (
thre
e tim
es p
er fa
mily
max
imum
) -
Typ
e I
Wai
ved
Wai
ved
Typ
e II,
III
$50
$50
Th
is s
ched
ule
sh
ow
s o
nly
a f
ew o
f th
e co
vere
d p
roce
du
res.
Th
is s
ched
ule
is in
ten
ded
fo
r co
mp
aris
on
pu
rpo
ses
on
ly.
Th
e b
enef
its
for
each
pla
n w
ill b
e d
eter
min
ed b
y th
e co
ntr
act.
Fo
r a
com
ple
te li
stin
g o
f b
enef
its
and
exc
lusi
on
s an
d li
mit
atio
ns,
ple
ase
refe
ren
ce t
he
cert
ific
ate
of
cove
rag
e.
Typ
e I
- D
iag
nost
ic &
Pre
vent
ive
Se
rvic
es
Typ
e II
- B
asi
c S
erv
ice
s
Typ
e II
I - M
ajo
r Se
rvic
es
(12
mo
nth
wa
iting
pe
riod
. Ti
me
se
rve
d o
n th
e e
mp
loye
r's im
me
dia
tley
pre
ce
din
g g
roup
de
nta
l pla
n m
ay
be
cre
dite
d to
wa
rds
this
wa
iting
pe
riod
.)
Par
ticip
atin
g P
rovi
ders
will
red
uce
thei
r fe
es b
y 25
%.
Not
Cov
ered
.
80%
of P
PO
Pro
vide
r's fe
e80
% o
f PP
O S
ched
ule;
bal
ance
bill
ing
appl
icab
le
50%
of P
PO
Pro
vide
r's fe
e50
% o
f PP
O S
ched
ule;
bal
ance
bill
ing
appl
icab
le
No
clai
m fo
rms
to fi
le; n
o an
nual
m
axim
um b
enef
its;
no
wai
ting
perio
ds,
no c
alen
dar
year
ded
uctib
les
No
clai
m fo
rms
to fi
le; n
o an
nual
m
axim
um b
enef
its;
no
wai
ting
perio
ds,
no c
alen
dar
year
ded
uctib
les
Wit
h t
he
CS
150
pla
n, i
n o
rder
to
rec
eive
ben
efit
s yo
u m
ust
co
nta
ct t
he
den
tal o
ffic
e yo
u h
ave
sele
cted
. W
ith
th
e A
dva
nta
ge
pla
n, n
o p
rese
lect
ion
of
den
tist
is r
equ
ired
, yo
u m
ay b
e tr
eate
d b
y an
y d
enti
st w
ith
in t
he
net
wo
rk.
Wit
h b
oth
th
e C
S15
0 an
d A
dva
nta
ge
Pla
ns,
co
pay
men
ts a
nd
ben
efit
s ar
e av
aila
ble
wit
h n
etw
ork
pro
vid
ers
on
ly.
2008
SU
MM
AR
Y O
F C
OM
PB
EN
EF
ITS
DE
NT
AL
OP
TIO
NS
100%
of P
PO
Pro
vide
r's fe
e10
0% o
f PP
O S
ched
ule;
bal
ance
bill
ing
appl
icab
le
PPO
EP7
00 P
lan
Parti
al L
istin
g o
f Co
vere
d S
erv
ice
s
- 26 -
In
and
Out
of
Net
wor
k
I
n an
d O
ut o
f N
etw
ork
N
on-O
rtho
dont
ics
Ort
hodo
ntic
s In
divi
dual
Ann
ual D
educ
tible
$5
0
Fam
ily A
nnua
l Ded
uctib
le
$150
Max
imum
(co
mbi
ned
for
both
In-
Net
wor
k an
d O
ut-o
f-N
etw
ork
serv
ices
) $1
500
per
pers
on p
er c
alen
dar
year
$1
000
per
pers
on p
er li
fetim
e
In-N
etw
ork
Out
-of-
Net
wor
k A
nnua
l ded
uctib
le a
pplie
s to
pre
vent
ativ
e an
d di
agno
stic
se
rvic
es
No
No
For
new
enr
olle
es, t
here
will
be
a w
aitin
g pe
riod
of:
E
mpl
oyee
s al
read
y en
rolle
d in
den
tal w
ill b
e gi
ven
prio
r cr
edit
12 m
onth
s fo
r M
ajor
12
Mon
ths
for
Maj
or
12
mon
ths
for
Ort
ho
12 m
onth
s fo
r O
rtho
O
rtho
dont
ic e
ligib
ility
req
uire
men
t C
hild
up
to a
ge 1
9 C
hild
up
to a
ge 1
9
C
over
ed S
ervi
ces
In-
Net
wor
k
O
ut-o
f-N
etw
ork
Pre
vent
ativ
e an
d D
iagn
osti
c D
enta
l Ser
vice
s Pe
riod
ic O
ral E
xam
inat
ions
10
0%
100%
B
itew
ing
X-r
ays
100%
10
0%
Com
plet
e Se
ries
or
Pano
rex
X-r
ays
100%
10
0%
Den
tal P
roph
ylax
is (
Cle
anin
gs)
100%
10
0%
Fluo
ride
Tre
atm
ents
10
0%
100%
Se
alan
ts
100%
10
0%
Bas
ic D
enta
l Ser
vice
s A
mal
gam
Res
tora
tions
(Fi
lling
s)
80%
80
%
Com
posi
te R
esin
(Fi
lling
s)
80%
80
%
Spac
e M
aint
aine
rs
80%
80
%
Sim
ple
Ext
ract
ion
80%
80
%
Surg
ical
Ext
ract
ion
incl
udin
g im
pact
ed W
isdo
m T
eeth
80
%
80%
Gen
eral
Ane
sthe
sia
80%
80
%
Palli
ativ
e T
reat
men
t (R
elie
f of
Pai
n)
80%
80
%
Roo
t Can
al T
reat
men
t 80
%
80%
R
oot P
lani
ng
80%
80
%
Peri
odon
tal S
urge
ry
80%
80
%
Maj
or D
enta
l Ser
vice
s
C
row
ns
50%
50
%
Fixe
d B
ridg
es
50%
50
%
Full
Den
ture
s 50
%
50%
In
lays
and
Onl
ays
50%
50
%
Part
ial D
entu
res
50%
50
%
Rec
emen
t Bri
dges
, Cro
wns
, Inl
ays
50%
50
%
Rel
inin
g D
entu
res
50%
50
%
Rep
airs
to F
ull D
entu
res,
Par
tial D
entu
res,
Bri
dges
50
%
50%
O
rtho
dont
ic S
ervi
ces
Dia
gnos
e or
cor
rect
mis
alig
nmen
t of
the
teet
h or
bite
in
clud
ing
Phas
e I
and
Phas
e II
50
%
50%
*The
in-n
etw
ork
perc
enta
ge o
f be
nefi
ts is
bas
ed o
n th
e di
scou
nted
fee
neg
otia
ted
with
the
prov
ider
. **
The
out
-of-
netw
ork
perc
enta
ge o
f be
nefi
ts is
pai
d at
85th
per
cent
ile o
f th
e us
ual a
nd c
usto
mar
y ra
tes
prev
ailin
g in
the
geog
raph
ic a
rea
in w
hich
the
expe
nses
are
incu
rred
.
SUM
MA
RY
OF
UN
ITE
D H
EA
LT
HC
AR
E’S
DE
NT
AL
OP
TIO
NS
- 27 - -
21 -
N
ET
WO
RK
DO
CT
OR
N
ON
-NE
TW
OR
K D
OC
TO
R
BE
NE
FIT
S
Eye
Exa
ms
$10
copa
y; th
en p
aid
in fu
ll $3
5 al
low
ance
E
xam
eve
ry 1
2 m
onth
s
L
ense
s (p
er p
air)
$1
5 co
pay;
then
pai
d in
full
See
bel
ow
Lens
es e
very
12
mon
ths
Sin
gle
$2
5 al
low
ance
Bifo
cal
$4
0 al
low
ance
Trif
ocal
$60
allo
wan
ce
Le
ntic
al
$1
00 a
llow
ance
Co
nta
ct L
ense
s
Ele
ctiv
e (e
xam
+ le
nses
) $1
0 co
pay
for
exam
and
$10
5 al
low
ance
for
lens
es (
incl
udin
g fit
ting,
fo
llow
up
exam
and
lens
es)
$35
allo
wan
ce fo
r ex
am a
nd $
105
allo
wan
ce fo
r le
nses
(in
clud
ing
fittin
g,
follo
w u
p ex
am, a
nd le
nses
)
Thi
s al
low
ance
is p
aid
with
the
sam
e fr
eque
ncy
as le
nses
. T
he p
lan
prov
ides
an
allo
wan
ce fo
r co
ntac
ts in
stea
d of
le
nses
and
fram
es.
Med
ical
ly N
eces
sary
$1
5 co
pay;
then
pai
d in
full
$210
allo
wan
ce
Prio
r au
thor
izat
ion
is r
equi
red
for
Med
ical
ly N
eces
sary
con
tact
lens
es a
s in
dica
ted
in th
e C
ertif
icat
e of
Cov
erag
e.
Fra
me
$15
copa
y; th
en p
aid
in fu
ll $4
0 al
low
ance
E
very
24
mon
ths.
The
pla
n co
vers
fram
es
base
d on
the
man
ufac
ture
rs w
hole
sale
pr
ice.
Pric
e of
cov
ered
fram
es m
ay v
ary
amon
g pl
an d
octo
rs, t
houg
h th
e va
lue
of
your
cov
ered
fram
e st
ays
the
sam
e. Y
ou
may
be
requ
ired
to p
ay e
xtra
onl
y if
you
choo
se a
fram
e th
at e
xcee
ds th
e co
vere
d w
hole
sale
pric
e.
LA
SIK
Pro
ced
ure
s T
he p
lan
has
cont
ract
ed w
ith m
any
of
the
fines
t LA
SIK
faci
litie
s an
d ey
e do
ctor
s to
offe
r th
is p
roce
dure
at
subs
tant
ially
red
uced
fees
. T
he
netw
ork
of L
AS
IK c
ente
rs fe
atur
es a
ll T
LC L
aser
Cen
ter
(TLC
Vis
ion)
fa
cilit
ies
as w
ell a
s m
any
of th
e le
adin
g in
depe
nden
t cen
ters
in th
e co
untr
y.
No
bene
fit a
vaila
ble
To
rece
ive
$180
0 re
duce
d fe
e, m
embe
r m
ust u
se th
e La
ser
Cen
ter’s
faci
litie
s.
Mem
ber
rece
ives
a 1
0% d
isco
unt f
or
usin
g ou
t of n
etw
ork
doct
ors,
with
the
max
imum
allo
wab
le a
mou
nt $
1800
.
Ou
t o
f S
tate
Ser
vice
s T
hrou
gh N
atio
nwid
e ne
twor
k S
ame
bene
fits
In-n
etw
ork
serv
ices
are
ava
ilabl
e th
roug
h a
natio
nwid
e ne
twor
k of
par
ticip
atin
g do
ctor
s. I
f pla
n m
embe
rs tr
avel
or
mov
e to
ano
ther
sta
te, t
heir
plan
goe
s w
ith
them
. T
hey
can
sim
ply
requ
est a
list
of
Mem
ber
Doc
tors
for
that
are
a al
ong
with
a
bene
fit fo
rm, a
nd a
s lo
ng a
s th
ey a
re
elig
ible
, the
y w
ill r
ecei
ve th
e sa
me
bene
fits
as th
ey w
ould
in th
eir
hom
e st
ate.
The
am
ount
s sh
own
are
max
imum
ben
efits
. The
act
ual b
enef
it am
ount
the
plan
will
rei
mbu
rse
to a
pla
n m
embe
r fo
r no
n-ne
twor
k do
ctor
s w
ill b
e th
e le
ast o
f: th
e m
axim
um s
how
n in
the
sche
dule
; the
am
ount
act
ually
cha
rged
; or
the
amou
nt a
doc
tor
usua
lly c
harg
es a
priv
ate
patie
nt.
The
ava
ilabi
lity
of s
ervi
ces
unde
r th
e no
n-ne
twor
k re
imbu
rsem
ent s
ched
ule
is s
ubje
ct
to th
e sa
me
time
limits
and
cop
aym
ents
as
thos
e fo
r ne
twor
k se
rvic
es.
The
pla
n pa
ys n
on-n
etw
ork
bene
fits
in p
lace
of s
ervi
ces
from
a n
etw
ork
doct
or.
- 28 -
-
22 -
T
ER
M L
IFE
IN
SU
RA
NC
E
FLO
RID
A C
OM
BIN
ED
LIF
E
B
AS
IC L
IFE
S
UPPLE
ME
NT
AL L
IFE
D
EPE
ND
EN
T L
IFE
E
LIG
IBIL
ITY
Fu
ll T
ime
Em
plo
yee
Fu
ll T
ime
Em
plo
yee
Fu
ll T
ime
Em
plo
yee
WA
ITIN
G P
ER
IOD
1
st D
ay
of t
he
Mon
th
1
st D
ay
of t
he
Mon
th
1
st D
ay
of t
he
Mon
th
FO
R N
EW
HIR
ES
Fol
low
ing
Date
of
Hir
e Fol
low
ing
Rec
eipt
of
Fol
low
ing
Rec
eipt
of
A
pplica
tion
(M
ust
su
bm
it
Applica
tion
(M
ust
su
bm
it
A
pplica
tion
wit
hin
30 d
ays
of
A
pplica
tion
wit
hin
30 d
ays
of
D
ate
of
hir
e)
date
of
hir
e)
WA
ITIN
G P
ER
IOD
1
st D
ay
of t
he
Mon
th
1
st D
ay
of t
he
Mon
th
FO
R C
UR
RE
NT
Fol
low
ing
Evi
den
ce o
f
Fol
low
ing
Evi
den
ce o
f E
MPLO
YE
ES
Insu
rabilit
y A
ppro
val by
Insu
rabilit
y A
ppro
val by
In
sura
nce
Com
pan
y
Insu
ran
ce C
ompan
y W
HO
PA
YS
FO
R
Leo
n C
oun
ty
Em
plo
yee
Em
plo
yee
TH
E P
LA
N
CO
VE
RA
GE
AM
OU
NT
E
XE
CU
TIV
E &
2 x
Basi
c A
nn
ual S
ala
ry
1 x
Basi
c A
nn
ual S
ala
ry
Opti
ons:
S
R. M
AN
AG
EM
EN
T
S
pou
se a
nd D
epen
den
ts
$20,0
00 a
nd $
5,0
00
Applies
to
Boa
rd a
nd S
uper
viso
r of
Ele
ctio
n o
nly
$10,0
00 a
nd $
2,5
00
$ 5
,000 a
nd $
1,5
00
E
XE
CU
TIV
E S
UPPT
.
1 x
Basi
c A
nn
ual S
ala
ry
1 o
r 2 x
Basi
c A
nn
ual S
ala
ry
O
pti
ons:
&
CA
RE
ER
SE
RVIC
E
S
pou
se a
nd D
epen
den
ts
$20,0
00 a
nd $
5,0
00
$10,0
00 a
nd $
2,5
00
$ 5
,000 a
nd $
1,5
00
AD
DIT
ION
AL I
NFO
RM
AT
ION
M
axi
mu
m c
over
age
am
oun
t is
$250,0
00 f
or B
asi
c an
d S
upple
men
tal Life
Insu
ran
ce
C
over
age
am
oun
t re
du
ces
to 6
5%
at
Age
65
D
epen
den
t Life
Insu
ran
ce a
mou
nt
can
not
exc
eed 5
0%
of
the
emplo
yee’
s B
asi
c an
d S
upple
men
tal life
com
bin
ed a
mou
nts
In
sura
nce
pro
vided
by
Flo
rida C
ombin
ed L
ife
Insu
ran
ce C
ompan
y
C
omple
te b
enef
it p
rovi
sion
s are
ava
ilable
in
th
e m
ast
er c
ontr
act
an
d c
erti
fica
te o
f life
in
sura
nce
cov
erage
.
- 29 -
-
23 -
TE
RM
LIF
E I
NS
UR
AN
CE
R
ELIA
NC
E S
TA
ND
AR
D L
IFE
S
UPPLE
ME
NT
AL L
IFE
DE
PE
ND
EN
T L
IFE
E
LIG
IBIL
ITY
A
ny
emplo
yee
wor
kin
g 30
A
ny
emplo
yee
wor
kin
g 30
Or
mor
e h
ours
O
r m
ore
hou
rs
WA
ITIN
G P
ER
IOD
1st D
ay
of t
he
Mon
th
1st D
ay
of t
he
Mon
th
FO
R N
EW
HIR
ES
Fol
low
ing
Date
of
Hir
e
W
AIT
ING
PE
RIO
D
1
st d
ay
of t
he
mon
th f
ollo
win
g
1
st d
ay
of t
he
mon
th f
ollo
win
g
FO
R C
UR
RE
NT
rece
ipt
of a
pplica
tion
rece
ipt
of a
pplica
tion
E
MPLO
YE
ES
WH
O P
AYS
FO
R
E
mplo
yee
Em
plo
yee
T
HE
PLA
N
CO
VE
RA
GE
AM
OU
NT
E
mplo
yee
S
pou
se
Opti
on o
f $10,
000 t
o $500,
000 in
in
crem
ents
of
$10,0
00
Opti
on o
f $10,
000 t
o $500,
000 in
in
crem
ents
of
$10,0
00
Gu
ara
nte
e Is
sue
am
oun
t u
nder
Age
60-
$100,0
00
Gu
ara
nte
e Is
sue
Am
oun
t u
nder
Age
60 -
$40,0
00
Gu
ara
nte
e Is
sue
Am
oun
t A
ge 6
0 t
o 70 -
$10,0
00
subje
ct t
o em
plo
yee
cove
rage
of
at
least
$50,0
00
C
hildre
n
C
over
age
opti
ons
1
2
3
4
14 d
ays
up t
o 6 m
onth
s
$1000
$1000
$1000
$1000
6 m
onth
s u
p t
o age
20*
$2500
$5000
$7500
$
10,0
00
*
26 if
Fu
ll-T
ime
Stu
den
t
A
DD
ITIO
NA
L I
NFO
RM
AT
ION
C
hoi
ces
of lif
e in
sura
nce
in
in
crem
ents
of
$1
0,0
00
to
$5
00
,00
0
D
epen
den
t C
over
age
Ava
ilab
le
G
ua
ran
teed
Acc
epta
nce
Am
oun
ts f
or E
mp
loy
ee,
Sp
ouse
an
d D
epen
den
t C
hild
ren
Gu
ara
nte
e Is
sue
for
Em
plo
yee
s u
nd
er a
ge 6
0 is
$1
00
,00
0
G
ua
ran
tee
Issu
e fo
r E
mp
loy
ees
age
60
to
70
is
$1
0,0
00
Gu
ara
nte
e Is
sue
for
Sp
ouse
un
der
age
60
is
$4
0,0
00
, p
rovi
ded
th
e em
plo
yee
ap
plie
s fo
r a
t le
ast
$5
0,0
00
No
Med
ica
l E
vid
ence
is
requ
ired
on
dep
end
ent
child
ren
Lib
era
l C
onve
rsio
n a
nd
Por
tab
ility
Pro
visi
ons
Liv
ing
Ben
efit
- 30 -
LONG T
ERM
DIS
ABIL
ITY
UNUM
PROVI
DENT
ELI
GIB
ILIT
Y
Al
l ful
l tim
e em
ploy
ees
wor
king
30
hour
s or
mor
e pe
r w
eek
WAIT
ING P
ERIO
D
1s
t of t
he m
onth
coi
ncid
ing
with
or
next
follo
win
g 30
con
secu
tive
days
of e
mpl
oym
ent
FO
R N
EW
HIR
ES
WHO P
AYS
FOR
Em
ploy
ee
THE P
LAN
BENEFI
T PE
RCE
NTA
GE
60%
to
a m
axim
um o
f $60
00 a
mon
th
M
AXIM
UM
BENEFI
T PE
RIO
D
TO
AG
E 6
5 DEFI
NIT
ION O
F BM
E
Cur
rent
bas
e m
onth
ly s
alar
y
DEFI
NIT
ION O
F DIS
ABIL
ITY
Your
ow
n oc
cupa
tion
for
two
year
s, a
ny o
ccup
atio
n th
erea
fter
ELI
MIN
ATI
ON P
ERIO
D
3 M
onth
s
PRE-E
XIS
TING C
ONDIT
ION P
ERIO
D
The
3 m
onth
s pr
ior
to y
our
cove
rage
effe
ctiv
e da
te
PRE-E
XIS
TING C
ONDIT
ION E
XCL
USI
ON P
ERIO
D
The
first
12
mon
ths
as a
cov
ered
per
son
ADDIT
IONAL
INFO
RM
ATI
ON
Indi
vidu
al G
uara
ntee
d Ren
ewab
ility
Pol
icy
Ear
ning
s m
eans
bas
e m
onth
ly s
alar
y bu
t ex
clud
es b
onus
es, o
vert
ime
pay,
and
any
oth
er e
xtra
com
pens
atio
n re
ceiv
ed fr
om the
Em
ploy
er.
- 31 -
28
UA_Workbook_Copy_0504
UltimateAdvisor – Full-
Time Legal Protection At Your Fingertips For only $17.50, UltimateAdvisor provides legal protection and financial services on most covered matters without receiving an invoice for attorney’s fees. UltimateAdvisor offers a full network of legal and financial services providing you with the support you need, regardless of the size of your matter. Online Legal Services Law Guide – Helps you
learn about your legal situation and become a better-informed legal consumer
Do-It-Yourself Legal Documents™ – Allows you to create your own legal documents
Telephone Legal Services Unlimited advice about
personal legal matters Follow-up calls and letters
Specific document preparation
Specific document review (up to four pages)
Standard will preparation including testamentary support trusts for minor children, durable powers of attorney, health care powers of attorney, living wills, advanced health care directives
In-Office Legal Benefits For situations like your underage
child getting in trouble with the law
or uncontested divorce, sometimes
only face-to-face counsel from an
attorney will do. UltimateAdvisor
can protect your world by
providing attorney representation to
help resolve a number of legal
issues. Benefits include:
Standard will preparation
Complex will
reimbursement (partial)
Codicil (amendment to a
will)
Living will
Power of attorney IRS audit protection
reimbursements (partial)
IRS collection defense reimbursements
Court adoption proceedings
Divorce, legal separation or annulment (Uncontested)
Divorce, legal separation or annulment (Contested – up to 15 hours paid) Plus ARAG contract rate for any additional hours needed
Guardianship or conservatorship – Uncontested and contested
Name change proceedings
Juvenile court proceedings
Loss of driving privilege (except DWI)
Review of documents
Preparation of final contract
Attendance at closing
Preparation and review of deeds and mortgages
Preparation and review of promissory notes and affidavits
Preparation and review of a lease contract (lessee only)
Enforcement of tenants rights for primary residence (lessee only)
Enforcement of personal property rights
Representation in disputes regarding the transfer of personal property
Tenant eviction defense for primary residence (lessee only)
Consumer protection
Consumer debt collection
Criminal misdemeanor
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Reduced Fee Benefit
Reduced Fee Attorney Network - If you have a legal issue that is not covered by your plan, a Reduced Fee Network Attorney will provide a rate of 25% off for personal legal needs such as representation and other legal issues for most non-covered, non-excluded matters.
Reduced Contingency Fees – A Network Attorney will represent you under a contingent fee arrangement. The fee paid to the attorney is based on the success of your case and is a percentage of the amount of money rewarded. The contingent fee cannot exceed 25% of the amount awarded before or after trial, or cannot exceed 30% of the amount successfully resolved only after an appeal.
Value-Added Services Financial Planning To Enrich Your Life
Unlimited toll-free confidential telephone access to an experienced and objective financial planner for advice and
personal planning reports
Unlimited access to an interactive financial planning Web site that includes calculators, a library of content, planning
resources and more
Online financial information record keeper and financial modeling tools
Identity Theft Protection Explain what identity theft is and how to prevent it Provide you assistance from our Identity Theft Case Managers who will walk you through the recovery
process Assist you in finding available legal assistance from our network of attorneys Provide an identity theft victim action kit
Immigration Assistance If you are required to utilize the United States Immigration Process, UltimateAdvisor will help you by: Providing toll-free access to an Immigration Case Manager who can give information on the immigration
process Providing access to In-Office Network Attorneys at a reduced fee for covered matters
How To Enroll Enrolling in UltimateAdvisor is easy. Just fill out an enrollment form in your HR office and your premium is payroll deducted!
For more information on UltimateAdvisor: Visit http://members.ARAGgroup.com/sglcp to view detailed information on plan benefits, how to use the plan and
FAQs.
Talk to an ARAG Customer Care Counselor toll-free from 7 a.m. to 7 p.m. Central time, Monday through Friday at 800-247-4184.
E-mail an ARAG Customer Care Counselor at service@ARAGgroup.com.
Insurance products are underwritten by ARAG® Insurance Company of Des Moines, Iowa or GuideOne® Mutual Insurance Company of West Des Moines, Iowa or GuideOne Specialty Mutual Insurance Of West Des Moines Iowa. Additional services may be provided by ARAG LLC, ARAG Services LLC, or Advisory Communication Systems Inc. Some products are only available through membership in the ARAG Association LC. This document is for illustrative purposes only and is not a contract. For terms, benefits or exclusions, visit our web site or call our toll-free number.
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SUPPLEMENTAL PRODUCTS
ACCIDENT
CANCER SECURITY COVERAGE
DISABILITY INCOME COVERAGE
CRITICAL ILLNESS
HOSPITAL CONFINEMENT
LIFE INSURANCE
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What’s a part of your everyday life? Little League...weekend sports...leisure hobbies…exercising... gardening...chores...fix-up projects around the house? Going to work every day? These are just a few of the routine, everyday activities we all enjoy.
Unfortunately, accidents are also a part of everyday life. And we often don’t think about the accidental injuries, or even the accidental deaths, which may happen during the course of a day.
Colonial's accident insurance can help. This composite rated, guaranteed renewable product pays specific benefit amounts for injuries received in a covered accident occurring on or off the job.
Plus, your Colonial accident policy is designed for you: Benefits are paid directly to you, unless you specify otherwise. Benefits are paid regardless of any other insurance you may have with other insurance
companies. The coverage is portable; you can take it with you if you change jobs or retire. Family Coverage available. Worldwide Coverage. 4 Levels of Rates
Named Insured for Employee, Spouse or Child $ 9.00 per pay period Employee & Spouse $12.00 per pay period 1 Parent Family $15.00 per pay period 2-Parent Family $18.00 per pay period
Offers Rider Options At An Additional Cost: Off-Job Only Accident/Sickness Disability Income for Employee or Spouse Sickness Hospital Confinement Rider Health Screening Rider HELP PREPARE YOURSELF FOR THE UNEXPECTED WITH COLONIAL’S ACCIDENT INSURANCE.
Policies have exclusions and limitations that may affect benefits payable.
For cost and complete details, please see your sales representative. Policies or provisions may vary or be unavailable in some states.
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What’s a part of your everyday life? Little League...weekend sports...leisure hobbies…exercising... gardening...chores...fix-up projects around the house? Going to work every day? These are just a few of the routine, everyday activities we all enjoy.
Unfortunately, accidents are also a part of everyday life. And we often don’t think about the accidental injuries, or even the accidental deaths, which may happen during the course of a day.
Colonial's accident insurance can help. This composite rated, guaranteed renewable product pays specific benefit amounts for injuries received in a covered accident occurring on or off the job.
Plus, your Colonial accident policy is designed for you: Benefits are paid directly to you, unless you specify otherwise. Benefits are paid regardless of any other insurance you may have with other insurance
companies. The coverage is portable; you can take it with you if you change jobs or retire. Family Coverage available. Worldwide Coverage. 4 Levels of Rates
Named Insured for Employee, Spouse or Child $ 9.00 per pay period Employee & Spouse $12.00 per pay period 1 Parent Family $15.00 per pay period 2-Parent Family $18.00 per pay period
Offers Rider Options At An Additional Cost: Off-Job Only Accident/Sickness Disability Income for Employee or Spouse Sickness Hospital Confinement Rider Health Screening Rider HELP PREPARE YOURSELF FOR THE UNEXPECTED WITH COLONIAL’S ACCIDENT INSURANCE.
Policies have exclusions and limitations that may affect benefits payable.
For cost and complete details, please see your sales representative. Policies or provisions may vary or be unavailable in some states.
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What’s a part of your everyday life? Little League...weekend sports...leisure hobbies…exercising... gardening...chores...fix-up projects around the house? Going to work every day? These are just a few of the routine, everyday activities we all enjoy.
Unfortunately, accidents are also a part of everyday life. And we often don’t think about the accidental injuries, or even the accidental deaths, which may happen during the course of a day.
Colonial's accident insurance can help. This composite rated, guaranteed renewable product pays specific benefit amounts for injuries received in a covered accident occurring on or off the job.
Plus, your Colonial accident policy is designed for you: Benefits are paid directly to you, unless you specify otherwise. Benefits are paid regardless of any other insurance you may have with other insurance
companies. The coverage is portable; you can take it with you if you change jobs or retire. Family Coverage available. Worldwide Coverage. 4 Levels of Rates
Named Insured for Employee, Spouse or Child $ 9.00 per pay period Employee & Spouse $12.00 per pay period 1 Parent Family $15.00 per pay period 2-Parent Family $18.00 per pay period
Offers Rider Options At An Additional Cost: Off-Job Only Accident/Sickness Disability Income for Employee or Spouse Sickness Hospital Confinement Rider Health Screening Rider HELP PREPARE YOURSELF FOR THE UNEXPECTED WITH COLONIAL’S ACCIDENT INSURANCE.
Policies have exclusions and limitations that may affect benefits payable.
For cost and complete details, please see your sales representative. Policies or provisions may vary or be unavailable in some states.
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The need for cancer insurance is very real. According to statistics, in the U.S., men have a one-in-two
lifetime risk of developing cancer, and for women the risk is one in three.* Everybody knows somebody
who has had cancer, and this disease affects all age groups.
As serious as the threat of cancer may be, new and improved treatments are being introduced, and studies
are showing that regular screening tests can detect some cancers in the early stages. But with high
technology come high costs. The American Cancer Society reports that cancer costs Americans more than
$107 billion.* And much of that amount is considered indirect or hidden costs not covered by major
medical plans.
Colonial's cancer insurance can help. It helps you deal with the financial problems that may be associated with cancer detection and treatment. Plus, your Colonial cancer policy is designed for you:
4 Levels of Coverage 3 Optional Riders
Initial Diagnosis Rider – Pays $1,000 to $5,000 Progressive Payment Rider – Builds $50 Per Month & Pays At Time of Diagnosis Specified Disease Rider – Pays Up To $125,000 During Lifetime
Benefits are paid directly to you, unless you specify otherwise. Benefits are paid regardless of any other insurance you may have with other insurance companies. The coverage is portable; you can take it with you if you change jobs or retire. Guaranteed
Renewable. Key Features and Benefits of Colonial’s most updated cancer plan addresses the changing needs of insureds by staying abreast of changing treatment trends.
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What’s a part of your everyday life? Little League...weekend sports...leisure hobbies…exercising... gardening...chores...fix-up projects around the house? Going to work every day? These are just a few of the routine, everyday activities we all enjoy.
Unfortunately, accidents are also a part of everyday life. And we often don’t think about the accidental injuries, or even the accidental deaths, which may happen during the course of a day.
Colonial's accident insurance can help. This composite rated, guaranteed renewable product pays specific benefit amounts for injuries received in a covered accident occurring on or off the job.
Plus, your Colonial accident policy is designed for you: Benefits are paid directly to you, unless you specify otherwise. Benefits are paid regardless of any other insurance you may have with other insurance
companies. The coverage is portable; you can take it with you if you change jobs or retire. Family Coverage available. Worldwide Coverage. 4 Levels of Rates
Named Insured for Employee, Spouse or Child $ 9.00 per pay period Employee & Spouse $12.00 per pay period 1 Parent Family $15.00 per pay period 2-Parent Family $18.00 per pay period
Offers Rider Options At An Additional Cost: Off-Job Only Accident/Sickness Disability Income for Employee or Spouse Sickness Hospital Confinement Rider Health Screening Rider HELP PREPARE YOURSELF FOR THE UNEXPECTED WITH COLONIAL’S ACCIDENT INSURANCE.
Policies have exclusions and limitations that may affect benefits payable.
For cost and complete details, please see your sales representative. Policies or provisions may vary or be unavailable in some states.
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What’s a part of your everyday life? Little League...weekend sports...leisure hobbies…exercising... gardening...chores...fix-up projects around the house? Going to work every day? These are just a few of the routine, everyday activities we all enjoy.
Unfortunately, accidents are also a part of everyday life. And we often don’t think about the accidental injuries, or even the accidental deaths, which may happen during the course of a day.
Colonial's accident insurance can help. This composite rated, guaranteed renewable product pays specific benefit amounts for injuries received in a covered accident occurring on or off the job.
Plus, your Colonial accident policy is designed for you: Benefits are paid directly to you, unless you specify otherwise. Benefits are paid regardless of any other insurance you may have with other insurance
companies. The coverage is portable; you can take it with you if you change jobs or retire. Family Coverage available. Worldwide Coverage. 4 Levels of Rates
Named Insured for Employee, Spouse or Child $ 9.00 per pay period Employee & Spouse $12.00 per pay period 1 Parent Family $15.00 per pay period 2-Parent Family $18.00 per pay period
Offers Rider Options At An Additional Cost: Off-Job Only Accident/Sickness Disability Income for Employee or Spouse Sickness Hospital Confinement Rider Health Screening Rider HELP PREPARE YOURSELF FOR THE UNEXPECTED WITH COLONIAL’S ACCIDENT INSURANCE.
Policies have exclusions and limitations that may affect benefits payable.
For cost and complete details, please see your sales representative. Policies or provisions may vary or be unavailable in some states.
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Chances are you know someone who has faced a critical illness, so you know the physical and emotional drain such an illness can impose. But have you thought about the financial problems a critical illness can bring? Fortunately, the odds of surviving a critical illness are in your favor, but would you be prepared for the many expenses that can accompany a critical illness, such as coinsurance, deductibles, caregivers, special medical equipment, household renovations and extra living expenses? Colonial's Critical Illness insurance can help. It pays a lump-sum benefit upon diagnosis of a covered
critical illness for you to use where it’s needed most. Face amount for Employee up to $50,000 and up to
$30,000 for Spouse. Colonial pays 100 percent of the policy’s face amount for the following conditions,
unless otherwise specified:
Cancer (if purchased) Heart attack (myocardial infarction) Stroke Major organ transplant (surgery required) End stage renal (kidney) failure Coronary artery bypass surgery (payable once at 25 percent of face amount) Carcinoma in situ (payable if cancer coverage is purchased at 25 percent of policy’s face amount)
Plus, your Colonial Critical Illness policy is designed for you:
Benefits are paid directly to you, unless you specify otherwise. Benefits are paid regardless of any other insurance you may have with other insurance companies. The coverage is portable; you can take it with you if you change jobs or retire. Compliments Major Medical coverage, pays deductibles and coinsurance; replaces lost income;
benefits can be sued for travel to any treatment center or for childcare and unexpected household expenses, etc. No survival period required.
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What’s a part of your everyday life? Little League...weekend sports...leisure hobbies…exercising... gardening...chores...fix-up projects around the house? Going to work every day? These are just a few of the routine, everyday activities we all enjoy.
Unfortunately, accidents are also a part of everyday life. And we often don’t think about the accidental injuries, or even the accidental deaths, which may happen during the course of a day.
Colonial's accident insurance can help. This composite rated, guaranteed renewable product pays specific benefit amounts for injuries received in a covered accident occurring on or off the job.
Plus, your Colonial accident policy is designed for you: Benefits are paid directly to you, unless you specify otherwise. Benefits are paid regardless of any other insurance you may have with other insurance
companies. The coverage is portable; you can take it with you if you change jobs or retire. Family Coverage available. Worldwide Coverage. 4 Levels of Rates
Named Insured for Employee, Spouse or Child $ 9.00 per pay period Employee & Spouse $12.00 per pay period 1 Parent Family $15.00 per pay period 2-Parent Family $18.00 per pay period
Offers Rider Options At An Additional Cost: Off-Job Only Accident/Sickness Disability Income for Employee or Spouse Sickness Hospital Confinement Rider Health Screening Rider HELP PREPARE YOURSELF FOR THE UNEXPECTED WITH COLONIAL’S ACCIDENT INSURANCE.
Policies have exclusions and limitations that may affect benefits payable.
For cost and complete details, please see your sales representative. Policies or provisions may vary or be unavailable in some states.
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What’s a part of your everyday life? Little League...weekend sports...leisure hobbies…exercising... gardening...chores...fix-up projects around the house? Going to work every day? These are just a few of the routine, everyday activities we all enjoy.
Unfortunately, accidents are also a part of everyday life. And we often don’t think about the accidental injuries, or even the accidental deaths, which may happen during the course of a day.
Colonial's accident insurance can help. This composite rated, guaranteed renewable product pays specific benefit amounts for injuries received in a covered accident occurring on or off the job.
Plus, your Colonial accident policy is designed for you: Benefits are paid directly to you, unless you specify otherwise. Benefits are paid regardless of any other insurance you may have with other insurance
companies. The coverage is portable; you can take it with you if you change jobs or retire. Family Coverage available. Worldwide Coverage. 4 Levels of Rates
Named Insured for Employee, Spouse or Child $ 9.00 per pay period Employee & Spouse $12.00 per pay period 1 Parent Family $15.00 per pay period 2-Parent Family $18.00 per pay period
Offers Rider Options At An Additional Cost: Off-Job Only Accident/Sickness Disability Income for Employee or Spouse Sickness Hospital Confinement Rider Health Screening Rider HELP PREPARE YOURSELF FOR THE UNEXPECTED WITH COLONIAL’S ACCIDENT INSURANCE.
Policies have exclusions and limitations that may affect benefits payable.
For cost and complete details, please see your sales representative. Policies or provisions may vary or be unavailable in some states.
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Your income is the financial security that helps protect your family and lifestyle. But if a serious accident or illness suddenly stopped your income, how would you get by? Do you have other sources of income? If you were unable to work, would you be able to continue covering everyday living expenses? Colonial's Short-Term Disability Insurance can help. It replaces a portion of your income if you become
disabled because of a covered illness or injury.
Elimination Period (accident/sickness) Benefit Periods 0/7, 7/7, 0/14, 14/14 3, 6, 12 and 24 months 0/30, 30/30 6, 12, and 24 months 60/60, 90/90 12 and 24 months 180/180 24 months
Plus, your Colonial Short-Term Disability policy is designed for you: Benefits are paid directly to you, unless you specify otherwise. Benefits are paid regardless of any other insurance you may have with other insurance companies. You may choose the amount of disability benefits to meet your needs, subject to income. The coverage is portable; you can take it with you if you change jobs or retire.
The Colonial Advantage
“Your Job” definition for Total Disability. Partial Disability available if insured returns to his job or any other job working less than 20 hours per
week, after being paid disability for at least one month. Partial disability pays up to 3 months at 50% of Total Disability benefit.
Worldwide Coverage Waiver of Premium after 90 continuous days of disability. Guaranteed Renewable to age 70. Up to $5,000 in monthly benefits. An optional Health Screening Rider that pays $50/calendar year is available at an additional cost.
HELP PROTECT YOUR INCOME WITH COLONIAL’S SHORT-TERM DISABILITY INSURANCE. FIND OUT MORE WITH YOUR COLONIAL REPRESENTATIVE:
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What’s a part of your everyday life? Little League...weekend sports...leisure hobbies…exercising... gardening...chores...fix-up projects around the house? Going to work every day? These are just a few of the routine, everyday activities we all enjoy.
Unfortunately, accidents are also a part of everyday life. And we often don’t think about the accidental injuries, or even the accidental deaths, which may happen during the course of a day.
Colonial's accident insurance can help. This composite rated, guaranteed renewable product pays specific benefit amounts for injuries received in a covered accident occurring on or off the job.
Plus, your Colonial accident policy is designed for you: Benefits are paid directly to you, unless you specify otherwise. Benefits are paid regardless of any other insurance you may have with other insurance
companies. The coverage is portable; you can take it with you if you change jobs or retire. Family Coverage available. Worldwide Coverage. 4 Levels of Rates
Named Insured for Employee, Spouse or Child $ 9.00 per pay period Employee & Spouse $12.00 per pay period 1 Parent Family $15.00 per pay period 2-Parent Family $18.00 per pay period
Offers Rider Options At An Additional Cost: Off-Job Only Accident/Sickness Disability Income for Employee or Spouse Sickness Hospital Confinement Rider Health Screening Rider HELP PREPARE YOURSELF FOR THE UNEXPECTED WITH COLONIAL’S ACCIDENT INSURANCE.
Policies have exclusions and limitations that may affect benefits payable.
For cost and complete details, please see your sales representative. Policies or provisions may vary or be unavailable in some states.
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What’s a part of your everyday life? Little League...weekend sports...leisure hobbies…exercising... gardening...chores...fix-up projects around the house? Going to work every day? These are just a few of the routine, everyday activities we all enjoy.
Unfortunately, accidents are also a part of everyday life. And we often don’t think about the accidental injuries, or even the accidental deaths, which may happen during the course of a day.
Colonial's accident insurance can help. This composite rated, guaranteed renewable product pays specific benefit amounts for injuries received in a covered accident occurring on or off the job.
Plus, your Colonial accident policy is designed for you: Benefits are paid directly to you, unless you specify otherwise. Benefits are paid regardless of any other insurance you may have with other insurance
companies. The coverage is portable; you can take it with you if you change jobs or retire. Family Coverage available. Worldwide Coverage. 4 Levels of Rates
Named Insured for Employee, Spouse or Child $ 9.00 per pay period Employee & Spouse $12.00 per pay period 1 Parent Family $15.00 per pay period 2-Parent Family $18.00 per pay period
Offers Rider Options At An Additional Cost: Off-Job Only Accident/Sickness Disability Income for Employee or Spouse Sickness Hospital Confinement Rider Health Screening Rider HELP PREPARE YOURSELF FOR THE UNEXPECTED WITH COLONIAL’S ACCIDENT INSURANCE.
Policies have exclusions and limitations that may affect benefits payable.
For cost and complete details, please see your sales representative. Policies or provisions may vary or be unavailable in some states.
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The materials contained in this booklet do not constitute an insurance
certificate or policy. The information provided is intended only as a
summary to assist in the selection of benefits. Final determination of
benefits, exact terms, and exclusions of coverage for each benefit plan are
contained in certificates of insurance issued by the participating insurance
companies. Leon County Board of County Commissioners, Clerk of Courts,
and Supervisor of Elections reserve the right to amend, reduce, or terminate
the plans described in this booklet at any time.
The materials contained in this booklet do not constitute an insurance
certificate or policy. The information provided is intended only as a
summary to assist in the selection of benefits. Final determination of
benefit, exact terms and exclusions of coverage for each benefit plan are
contained in certificates of insurance issued by the participating insurance
companies. Leon County Board of County Commissioners, Clerk of Courts
and Supervisor of Elections reserves the right to amend, reduce or
terminate the plans described in this booklet at any time.
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