2021 Jones County School System Benefits Enrollment Guide

2021

Jones County School System

Benefits Enrollment Guide

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Welcome to your new Benefits Enrollment Guide. This guide is your summary of the benefitoptions that are available to eligible employees of Jones County Schools. Each benefit isdesigned to protect your health and well-being as well as provide valuable financialprotection.

Each section of the Benefits Enrollment Guide is structured to provide you with planhighlights as well as detailed, descriptive instructions to assist you in navigating through theweb-based enrollment portal.

While the Benefits Enrollment Guide is an important component in the benefitcommunication process, your dedicated NFP service team continues to provide annualenrollment meetings in addition to being available for questions and concerns regardingbenefits throughout the plan year.

Please review the plans contained in the Benefits Enrollment Guide and see how these planscan work for you and your eligible dependents. Your participation in the plans is voluntary.The benefit plans have been chosen to provide a continuation of protection thatcomplements Jones County Schools leave policies and retirement plans. The plan year is ineffect from January 1, 2021 to December 31, 2021.

This Benefits Enrollment Guide is intended for orientation purposes only. It is an abbreviatedoverview of the plan documents. Please refer to the Certificate Booklet (the contract)available from the plan carriers for complete details. Your Certificate Booklet will providedetailed information regarding copayments, coinsurance, deductibles, exclusions and otherbenefits. The certificate booklet will govern should a conflict arise relating to the informationcontained in this summary. This summary does not establish eligibility to participate in orreceive benefits from any benefit plan.

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Topic Page

Before You Enroll 4

How To Enroll 5

State Health Coverage 6

Dental Coverage 12

Dental Providers 14

Vision Coverage 15

Vision Providers 16

Life and AD&D Coverage 17

Disability Coverage 19

Flexible Spending Accounts (FSA) 20

Espyr 22

Accident 24

Critical Illness 26

Whole Life 28

Disclosure Notices 29

NFP Service Center 30

Contact Information 31

Table of Contents

This guide describes the benefit plans available to you as an eligible Employee of Jones County Schools. Thedetails of these plans are contained in the official Plan Documents, including some insurance contracts. This guideis meant only to cover the major points of each plan. It does not contain all of the details that are included inyour Summary Plan Descriptions (SPD) (as described by the Employee Retirement Income Security Act).

If there is ever a question about one of these plans, or if there is a conflict between the information in this guideand the formal language of the Plan Documents, the formal wording in the Plan Documents will govern.

Please note the benefits described in this guide may be changed at any time and do not represent a contractualobligation on the part of Jones County Schools and NFP.

You are REQUIRED to provide the following information and documentation for all dependents/beneficiaries:

• Name• Date of Birth• Social Security number

Annual Enrollment period opens on October 19, 2020 and ends at midnight on November 6, 2020.

• Please go online and make your elections during the open enrollment period by thedeadline provided.

• Please contact NFP at 800-994-7429 to speak with a benefit consultant if you needassistance with your enrollment.

Failure to enroll within the enrollment time period will result in the forfeiture of youreligibility for enrollment until the next annual enrollment period unless you experiencean eligible qualifying event.

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Before You Enroll – Things to Know

HOW TO ENROLL

Go to www.jonescountyschoolsys.bswift.com.

At this time, make sure to disable your pop-up blocker.

At the enrollment website enter your Username and Password.

• Username is the first letter of your first name, your last name, and last 4 digits of your Social Security number (ex. jdoe4567).

• Password is the last 4 digits of your Social Security number (ex. 4567).

You will then be prompted to create a permanent password.

To Begin:1) From the “Home Page” click on the “Start Your Enrollment” link, to begin the election

process.2) On the “Employee Information Page”, verify your information is accurate and “Add” all

eligible dependents you wish to cover under any benefits.

3) To make a plan selection, select “View Plan Options”. If you are covering dependents,make sure to “Select” them by checking off next to their name under “Who will becovered by this plan?” Then press “Continue” at the bottom of the screen.

4) Once you have reviewed and completed your enrollment, click on “I Agree, and I amfinished with my enrollment,” then click on “Complete My Enrollment.”

5) You will now be taken to the final confirmation page to either print or email.

Note: The enrollment images within this guide are for illustrative purposes only.

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How To Enroll

2021 Plan OptionsA basic overview of the health care options available to employees is provided here. Please refer tothe SHBP Decision Guide at http://shbp.Georgia.gov/ for additional details. The enrollment site toenroll in State Health is http://myshbpga.adp.com.

Anthem Blue Cross Blue Shield, United Healthcare and Kaiser Permanente will continue to offerState Health Benefit Plan (SHBP) members the below plan options for 2021.

Anthem BlueCross BlueShield of Georgia (now called Anthem)• Health Reimbursement Arrangement (HRA) without copays

• Gold• Silver• Bronze

• Statewide Health Maintenance Organization (HMO)

United Healthcare- UHC• High Deductible Health Plan (HDHP)• Statewide Health Maintenance Organization (HMO)

Kaiser Permanente- KPThe KP Regional HMO (Metro Atlanta Service Area only) offers medical, wellness and pharmacybenefits. You must live or work in one of the below 27 counties within the Metro Atlanta ServiceArea to be eligible to enroll in KP:

Medicare Advantage Preferred Provider Organization (PPO) Standard and Premium• United Healthcare• Anthem

PharmacyFor 2021, the State Health Benefit Plan will continue to use CVS Caremark as administrator for thepharmacy benefit. This does not mean members must go to a CVS Pharmacy location for theirprescriptions.

The TRICARE Supplement will continue to be available for those members enrolled in TRICARE.

Peach Care for Kids will continue to be available for those members enrolled in Peach Care for Kids.

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State Health Benefit Plan

BarrowBartowButts

CarrollCherokeeClayton

CobbCowetaDawson

DeKalbDouglasFayetteForsythFulton

GwinnettHaralson

HeardHenry

LamarMeriwether

NewtonPauldingPickens

PikeRockdaleSpaldingWalton

To Enroll go to the SHBP Enrollment Portal at www.mySHBPga.adp.com• Click “Forgot Your Password”• Enter your User ID• Follow the instructions and answer the security questions• Create a new password• Click “Continue”Note: Your account will be locked after three incorrect login attempts and you must call SHBP to unlock the account.

If You Take No Action During Open Enrollment for SHBP Coverage:• If you are currently enrolled in a Commercial Plan Option for 2020, you will remain in your current

option and tier with your current Medical Claims Administrator for 2021.• If you are currently enrolled in the Tricare Supplement for 2020, you will remain enrolled in the Tricare

Supplement for 2021.• If you are paying a Tobacco Surcharge for 2020, you will continue to pay the surcharge for 2021. If you

did not pay a Tobacco Surcharge in 2020, you will not pay one in 2021.Note: It is your responsibility to notify SHBP immediately if you and/or your covered dependents change tobacco use status, eitherstarting or stopping use.

To Make a 2021 Health Benefit Election with SHBP:➢ Login to your SHBP Enrollment Portal as explained above. If you are a first-time user, click on “Register”

and use the code SHBP-GA and set up a password. If you are a returning user but have not used thewebsite since 09/15/20, then you MUST reset your password.

➢ At the Open Enrollment window, click on “Continue” to proceed with your 2021 enrollment.➢ On the Welcome page, you must click “Accept Terms and Conditions” to continue.➢ Click “Go to Review Your Current Elections” to see your current coverage.➢ Click “Go to Review Your Dependents (if applicable)” to see any dependents that you have currently

covered. Please confirm the correct Social Security number or Taxpayer ID.➢ Click “Go to Make Your Elections” to start the election process for 2021 coverage.➢ Click “Go to Tobacco Surcharge Question” and answer the surcharge question.➢ You will have the chance to accept or decline the opportunity to use the Decision Support Benefit

Option Comparison Tool which is personalized, easy-to-understand information to assist you in makingyour health coverage election. (This Tool is not available for the Tricare Supplement or MedicareAdvantage options.)

➢ Click on “Go to Health Benefits” to choose your Medical Claims Administrator, Plan Option andcoverage tier.

➢ Make your elections. If you are NOT enrolling in a Plan Option, you MUST click the radio button for “NoCoverage” and then you MUST select the appropriate “Reason for Waive” from the drop-down menulist.

➢ Click “Go to Review and Confirm Changes” to carefully review the elections you made for 2021.➢ Click “Finish.”

Making Changes During the Plan Year When You Experience a Qualifying EventThe SHBP coverage you elect during Open Enrollment will be the coverage you have for the entire 2021 planyear, unless you have a Qualifying Event (QE) that allows you to make a change and you notify SHBP within 31days after the QE (or 90 days to add a newly eligible dependent child).

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If you need any assistancewith enrollment, contactSHBP at 800-610-1863.

REMEMBER – Your newly added dependents will be placed in “Pending” status until (a) you submit the required documentationof eligibility to SHBP within 45 days of the election, or (b) the deadline for submitting the documentation passes, whicheveroccurs first. If the deadline passes without providing the documentation, the dependents will not have coverage.

QEs include but are not limited to:• Marriage or divorce• Birth, adoption, or legal guardianship of a child• Death of currently enrolled spouse or child• Dependent’s loss or gain of eligibility for other group

health coverage• Medicare eligibility• Loss of Medicaid eligibility (excluding voluntary loss)

Eligible Dependents for SHBP may include:• Spouse• Dependent Child

- Natural child- Adopted child- Stepchild- Child due to Guardianship

Go to www.shbp.georgia.gov for more information.

http://www.myshbpga.adp.com/

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SHBP - HRA Benefit Summary

Anthem Gold HRA Option

Anthem Silver HRA Option

Anthem BronzeHRA Option

In-Network Out-of-Network In-NetworkOut-of-

NetworkIn-Network

Out-of-Network

Covered Services You Pay You Pay You Pay

DeductibleYou $1,500 $3,000 $2,000 $4,000 $2,500 $5,000

You + Spouse $2,250 $4,500 $3,000 $6,000 $3,750 $7,500

You + Child(ren) $2,250 $4,500 $3,000 $6,000 $3,750 $7,500

You + Family $3,000 $6,000 $4,000 $8,000 $5,000 $10,000

HRA credits will reduce “You Pay” amounts

Out-of-Pocket Maximum

You $4,000 $8,000 $5,000 $10,000 $6,000 $12,000

You + Spouse $6,000 $12,000 $7,500 $15,000 $9,000 $18,000

You + Child(ren) $6,000 $12,000 $7,500 $15,000 $9,000 $18,000

You + Family $8,000 $16,000 $10,000 $20,000 $12,000 $24,000

HRA credits will reduce “You Pay” amounts

HRA The Plan Pays The Plan Pays The Plan Pays

You $400 $200 $100

You & Spouse $600 $300 $150

You + Child(ren) $600 $300 $150

You + Family $800 $400 $200

Physicians' Services The Plan Pays The Plan Pays The Plan Pays

Primary Care Physician or Specialist Office or Clinic Visits (illness or injury)

85% coverage; subject to deductible






Maternity Care (non-routine, prenatal, delivery & postpartum)







Primary Care Physician or Specialist Office or Clinic Visits (Wellness/preventive, prenatal care coded as preventive)

100% coverage;

not subject to deductible

Not Covered

100% coverage;


Not covered

100% coverage;


Not Covered

Physician Services Furnished in a Hospital







Telemedicine/Virtual Visit

85% coverage;


Not Covered

80% coverage;


Not Covered

75% coverage;


Not Covered

Refer to your Summary Plan Description and Policy Certificate for full details on the plan

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SHBP - HRA Benefit Summary - continued

HRA Pharmacy You Pay

Tier 1 Coinsurance 15% ($20 min/$50 max); not subject to deductible

Tier 2 Coinsurance Preferred Brand

25% ($50 min/$80 max); not subject to deductible

Tier 3 Coinsurance Non-Preferred Brand

25% ($80 min/$125 max); not subject to deductible

Participating 90-day Voluntary Mail Order or Retail 90-day Network

Tier 1 - 15% ($50 min/$125 max)

Tier 2 - 25% ($125 min/$200 max)

Tier 3 - 25% ($200 min/$313 max)

Note: Amounts you pay for Rx go toward the out-of-pocket maximum.


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SHBP- HMO & HDHP Benefit Summary

Anthem /United Healthcare Statewide

HMOUnited Healthcare HDHP KP Regional HMO

Covered Services Deductible In-Network only In-NetworkOut-of-

NetworkNot Available

You Pay You Pay

You $1,300 $3,500 $7,000

You + Spouse $1,950 $7,000 $14,000

You + Child(ren) $1,950 $7,000 $14,000

You + Family $2,600 $7,000 $14,000

Out-of-Pocket Maximum

You $4,000 $6,450 $12,900

You + Spouse $6,500 $12,900 $25,800

You + Child(ren) $6,500 $12,900 $25,800

You + Family $9,000 $12,900 $25,800

HRA The Plan Pays The Plan Pays

You

N/A N/AYou + Spouse

You + Child(ren)

You + Family

Physicians' Services The Plan Pays The Plan Pays

Primary Care Physician or Specialist Office or Clinic Visits (illness or injury)

100% coverage after$35 PCP copay$45 SPC copay



Maternity Care (non-routine, prenatal, delivery & postpartum)

100% coverage after$35 PCP copay$45 SPC copay



Primary Care Physician or Specialist Office or Clinic Visits (Wellness/preventive)

100% coverage; not subject to deductible, in-

network only

100% coverage; not

subject to deductible

Not covered

Physician Services Furnished in a Hospital




Telemedicine/Virtual Visit100% coverage after $35

PCP copay

70% coverage, subject to deductible

Not Covered

HMO HDHP Pharmacy You Pay

In-Network

Out-of-Network

In-NetworkOut-of-

Network

Tier 1 Coinsurance $20 copay

70% coverage; after deductible is met*

Tier 2 Coinsurance Preferred Brand

$50 copay

Tier 3 Coinsurance Non-Preferred Brand

$90 copay

Participating 90-day Voluntary Mail Order or Retail 90-day Network

Tier 1 - $5070% coverage; after deductible is met*

Tier 2 - $125

Tier 3 - $225

Note: Amounts you pay for Rx go toward the out-of-pocket maximum.

*For HDHP out-of-network, pharmacy expenses are paid at 70% of the contracted rate, after the deductible has been satisfied.

Note: If you request a Brand-name Prescription Drug Product in place of the chemically equivalent Prescription Drug Product (Generic equivalent), you will pay the applicable Generic copayment or coinsurance in addition to the difference between the Brand and Generic Drug costs. This differential will not apply towards your out of pocket maximum.


Basic information on the health care options available to employees is given here. Pleaserefer to the SHBP Decision Guide at http://shbp.Georgia.gov/. The enrollment site to enrollin State Health is http://myshbpga.adp.com/shbp/.

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State Health Benefit Plan – Monthly Premiums for Active EmployeesJanuary 1 – December 31, 2021

EmployeeEmployee +

ChildrenEmployee +

SpouseFamily

Anthem Gold $175.68 $320.11 $436.33 $580.76

Anthem Silver $114.32 $215.80 $307.47 $408.95

Anthem Bronze $76.58 $151.64 $228.22 $303.28

Anthem HMO $143.03 $264.61 $367.76 $489.34

UHC HMO $174.49 $318.09 $433.83 $577.43

UHC HDHP $61.83 $126.57 $197.24 $261.98

Tricare Supplement $60.50 $119.50 $119.50 $160.50

NOTES: An additional $80 will be added to the monthly premium shown above when you orany of your covered dependents use tobacco products. Premiums are deducted in advance.

Special note about calling Anthem BlueCross BlueShield, UHC or Kaiser: If you contact your insurance carrier about a coverage or eligibility question and they ask you to contact “your employer”, they are intending for you to contact SHBP directly. The Benefits

Office does not have access to the information necessary to answer these questions. SHBP’s telephone number is 800.610.1863.


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Dental

Dental coverage is provided through Anthem.Keep in mind that you will pay less if you use an in-network dentist. For a complete list ofproviders, use the Provider Locator on www.anthem.com and choose the Dental Completenetwork or call 800-627-0004.

In-Network: If an In-Network Dentist performs a covered service, benefit will be based onthe percentage of the maximum allowed charge.

Out-of-Network: If an Out-of-Network Dentist performs a covered service, benefit will bebased on the maximum allowable charge for the low plan and the percentage of thereasonable and customary charges for the high plan, and you may be charged more for theservice from the out-of-network dentist.

Pretreatment: While we don’t require a pretreatment authorization form for any procedure,we recommend them for any work you consider expensive. As a smart consumer, it’s bestfor you to know your share of the cost up front. Simply ask your dentist to submit theinformation for a pretreatment estimate. Your dentist will be informed of the exact amountyour insurance will cover and the amount you will be responsible for.

12 Month Waiting Period: Anyone hired after the initial enrollment or selects the dental at a later date, will have a waiting period for the Orthodontia Benefit.

Dependent Children can be covered to the age of 26.


Benefit Low Dental Plan High Dental Plan

Annual DeductibleSingleFamily Maximum

$35 No Family Maximum

$35 No Family Maximum

Annual Benefit Maximum $1,200 calendar year $1,200 calendar year

Preventive Services (Type 1)80%

No Deductible100 %

No Deductible

Basic Treatment (Type 2)50%

Subject to Deductible80%

Subject to Deductible

Major Treatment (Type 3)40%

Subject to Deductible50%

Subject to Deductible

Orthodontia (Child Only) Not covered50% to a Lifetime

Maximum of $1,000


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Dental

Tier of CoverageLow Plan Cost

Per Month

Employee Only $19.05

Employee + 1 $34.98

Employee + 2 or more $53.57

Tier of CoverageHigh Plan Cost

Per Month

Employee Only $37.70

Employee + Spouse $72.12

Employee + Child(ren) $78.11

Employee+ Family $112.62

Dental Services

Type 1

Routine Exam (2 per 12 months), Bitewing X-rays (1 per 12 months),Cleaning (2 per 12 months), Fluoride for Children 18 and under (1 per 12months), Full Mouth/Panoramic X-rays (1 per 60 months), Sealants forChildren 16 and under (1 per 60 months).

Type 2

Second Opinion Consultation (1 per 12 month), Space Maintainer forChildren 18 and under (1 per lifetime for posterior teeth), Fillings (1 pertooth per 12 months), Brush Biopsy (cancer test – 1 per 12 months), OralSurgery – Simple or Complex (1 per tooth per lifetime), Crowns, Denture,Bridge Repairs (1 per 12 months; 6 months after placement), Denture andBridge Adjustments (2 per 12 months; 6 months after placement).

Type 3

Endodontics: Root Canal and Retreatments; Apicoectomy andApexification) (1 per tooth per lifetime).Periodontics: Periodontal Maintenance (4 per 12 months; w/teethcleaning), Scaling and root planning (1 per quadrant per 24 months),Periodontal Surgery (1 per quadrant per 36 months).Major Services & Prosthodontics: Crowns, Veneers, Dentures, and Bridges(1 per tooth per 60 months).Dental Implants and Cosmetic Teeth Whitening are Not Covered.

The same dental services are covered under the low and high dental plan. The onlydifference is the percentage amount paid out under each plan. See chart on the previouspage for the percentage paid under each plan.

For a complete list of providers, use the Provider Locator on www.anthem.com and choosethe Dental Complete network or call 800-627-0004. Anthem does not contract with a groupfor dentists (ex. Kool Smiles), they contract with the dentist. Not all dentists in a group maybe contracted with Anthem BCBS. Please verify with the dental group if your particulardentist is in-network before scheduling an appointment.

Not all providers offer all services. Please confirm what services are offered with theprovider when making your appointment.

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Dental Providers

.

List of Participating Dentist List of Participating Dentist

KARA G MOORE242 W Clinton St.Gray, GA 31032(478) 986-6821

KENNETH E KAY250 W Clinton St.

Suite # 5Gray, GA 31032(478) 986-1830

KOOL SMILES1386 Gray Hwy.

Suite 1380Macon, GA 31211

(478) 745-5239

JOHN S BENDER797 Poplar St.

Macon, GA 31210(478) 342-0555

JAMES LEE STOCKSLAGER4020 Elnora Dr.

Macon, GA 31210(478) 477-1228

Ashley D. Walker2700 Northside Dr.Macon, GA 31210

(478) 477-2761

PAUL JASON MANN225 N Macon St.

Macon, GA 31210(478) 733-0857

Candace L Lauderdale5005 Riverside Dr. Unit A

Macon, GA 31210(478-405-0664

RODNEY CLARK1918 Forsyth St.

Macon, GA 31201(478) 474-9980

SHARON S JORDAN2614 Cherokee Ave.Macon, GA 31204

(478) 743-3583

DENTAL CARE CENTER OF MACON3432 Mercer University Dr.

Macon, GA 31204(478) 746-0046

CHARLES A ROSS3706 Mercer University Dr.


(478) 474-2557

LAWRENCE MARABLE3661 Eisenhower Pkwy.


(478) 474-8037

STEVEN N GOLUBOW6443 Zebulon Rd.

Suite 3A-BMacon, GA 31220

(478) 238-4460

JANET H HARRISON108 Fieldstone Dr.

Milledgeville, GA 31061(478) 453-7535

DEVON WATSON, ENDODONTICS5019 Riverside Dr. Unit A

Macon, GA 31210(478) 405-0664

Benefit In-Network Out-of-Network Frequency

Vision ExamRetinal Imaging

Contact Lens Fit & Follow-up

$10 CopayUp to $39

Standard: Up to $55 Premium: 10% off retail price

Up to $40N/AN/AN/A

Once every 12 months

Contact Lenses Allowance Max Amount


Conventional

Disposables

Medically Necessary

$0 Copay; $120 allowance, 15% off balance over $120

$0 Copay; $120 allowance plus balance over $120

$0 Copay; Paid-in-Full

$120

$120

$210

Standard Plastic Lenses Copayment Max Amount


Single Vision

Bifocal

Trifocal

Standard Progressive

$25

$25

$25

$90

$30

$50

$70

$50

Frames$0 Copay; $120 allowance, 20% off balance over $120 $84 Once every 24 months

Lasik Surgery15% off the retail price or 5%

off the promotional price N/A

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Vision

Vision is provided directly through EyeMed.To receive the full benefit of the plan, it is best to use an In-Network Provider. Note: The plan covers either contact lenses OR lenses for your glasses once every 12 months.

Tier of Coverage Employee Monthly Cost

Employee Only $5.38


Employee + Child(ren) $10.72

Family $15.78

To locate a provider, please visit www.eyemedvisioncare.com and click on the ACCESS Network.For Lasik providers, call 1-877-5LASER6 or visit www.eyemedlasik.com.

Dependent Children can be covered to the age of 26


Not all providers offer all services. Please confirm what services are offered with theprovider when making your appointment. For a complete list of providers use the providerlocator at www.eyemed.com and chose the “Access” network.

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Vision Providers

CATHYS EYE CARE1841 N. Columbia St. Ste B


Dr. David H Ritchie150 S Jefferson St.


The Vision Center in Wal-Mart2592 N Columbia St.


LENSCRAFTERS - RIVERSIDE5080 Riverside Drive

Space 400Macon, GA 31210

(478) 474-3720

DOWNTOWN OPTICIANS – GRAY1376 Gray HighwayMacon, GA 31211

(478) 743-6006

DOWNTOWN OPTICIANS INC –TOM HILL

236 Tom Hill Sr BoulevardMacon, GA 31210

(478) 471-7686

DOWNTOWN OPTICIANS INC - NORTHSIDE3780 Northside Drive


(478) 471-7686

PIERRE K VINH6443 Zebulon Rd. Ste 3c

Macon, GA 31220(478) 254-4373

MYEYEDR3801 Northside Dr.Macon, GA 31210

(478) 475-1600

DEPOE EYE CENTER5451 Bowman Road


(478) 741-3960

GEORGIA EYE CARE CENTER1870 Hardeman Avenue

Macon, GA 31201(478) 743-2000

BROWN’S EYE CENTER4445 Forsyth RoadMacon, GA 31210

(478) 757-8600

MIDTOWNE VISION CENTER635 Pio Nono Ave.Macon, GA 31204

(478) 803-0001

Oldham Opticians518 Mulberry St.Macon, Ga 30201

(478) 746-4866

VISION SAVER, MACON MALL3661 Eisenhower Pkwy Ste 46

Macon, GA 31206(478) 475-4555

http://www.eyemed.com/

The Life Coverage is with Standard LifeJones County Schools pays the full cost for $10,000 in Basic Life with Accidental Death andDismemberment (AD&D) coverage for all benefits-eligible employees.

Addition life insurance is made available that will provide additional financial protection foryour family. Jones County School System is pleased to offer life insurance coverage optionsas a solution. This enrollment period is an annual opportunity to increase coverage or electlife insurance if you do not already have coverage. Your premium will be based on thecoverage amount you elect and your age.

Current Employees WITHOUT Life Coverage: If you currently do not have this coverage youmay select up to $20,000 for yourself and $10,000 for you spouse without answering healthquestions. Any amounts above the Guarantee Issue (GI) will require health questions throughan evidence of insurability and approved by Standard Life.

Important Terms to UnderstandEvidence of Insurability: Evidence of Insurability is a request to verify good health and is often in the form of aquestionnaire. This is required when you are requesting insurance that is over the guarantee issue amount or ifyou are enrolling after your initial enrollment.

Guarantee Issue: Guarantee Issue is the amount of life insurance that you can elect without having to provideevidence of insurability. The guarantee issue period is 31 days from the date you first become eligible for theplan from your date of hire. If you choose not to enroll when you are first eligible and enroll at a later date, theentire amount of insurance will be subject to evidence of insurability, but this is waived during this initialenrollment only.


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Basic Life and Voluntary Life Insurance

Benefit Coverage

Employee Voluntary Life & AD&D

You can purchase coverage in increments of $10,000 up to the max of $300,000, rounded to the next higher multiple of $10,000.

New Hires: You will have a guaranteed issue amount of $150,000.

Current Employees: If you are currently enrolled with minimum coverage, you may increase coverage by $20,000 with no medical questions to a maximum of $150,000.

Spouse Voluntary Life

You can purchase coverage in increments of $5,000 to a maximum of $300,000 not to exceed 100% of employee’s coverage, rounded to the next higher multiple of $5,000.

New Hires: Spouse elections over $25,000 will require Evidence of Insurability.

Current Employees: If you are currently enrolled with minimum coverage, you may increase coverage by $10,000 with no medical questions to a maximum of $25,000.

Child(ren) Voluntary Life

You can purchase coverage in increments of $2,000 to a maximum of $10,000 not to exceed 100% of employee’s coverage. Dependent children are covered from live birth to age 26.No Health questions are required for Child coverage.

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Child Life rate is $2.00 for $10,000 andcovers all children.

Additional Information: For completecoverage outline and other informationsee the certificate booklet and/or benefitsummary on the bswift website.

Reduction of Coverage: The VoluntaryLife benefits will reduce by 50% at age 70.

Living Benefit: Your policy has a livingbenefit which allows you a portion of youor your dependent’s life insurance benefitone time in the case of a terminal illness.The payment will be based on 75% of youor your dependent’s life insuranceamount. A terminal illness means lifeexpectancy has been reduced to less than12 months that is determined by yourphysician. Please see policy certificate foradditional information.

Voluntary Life Insurance

Rate per $1,000

Age EE Rate Spouse Rate

<25 0.20 0.056

25-29 0.20 0.056

30-34 0.20 0.060

35-39 0.20 0.075

40-44 0.20 0.099

45-49 0.20 0.149

50-54 0.20 0.229

55-59 0.20 0.377

60-64 0.20 0.584

65-69 0.20 1.145

70-74 0.20 1.964

75+ 0.20 2.060


The Long Term Disability is with Standard LifeJones County School System provides you the opportunity to elect Long Term Disability (LTD)income benefits through convenient payroll deductions. Long Term Disability (LTD) insurance isanother valuable benefit that protects your financial well-being in the event you are unable towork. If you currently have the LTD coverage, your coverage will automatically roll over to thenew carrier.

Enrollment: Employees have two opportunities to elect disability coverage; within 30 days ofbeing newly hired, or during the annual open enrollment. Pre-Existing conditions will apply inboth cases. No health questions will be asked.

Limitations• Outpatient Mental/Nervous Illness Limitation based primarily on self-reported symptoms –

24 month lifetime combined pay out• Pre‐Existing Condition Limitation – Not Covered• Intentional Self-inflicted Injuries – Not Covered• Disability Due to War – Not Covered• Substance Abuse Limitation – 24 months

Pre-Existing Condition: In general, if you received medical treatment, consultation, care orservices including diagnostic measures, or took prescribed drugs or medicines in the 6 monthsjust prior to your effective date of coverage and the disability begins in the first 12 monthsafter your effective date of coverage.

Please Note: In the event that you experience a disability, your disability benefit will not beoffset by any accrued sick leave.


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Disability

Benefits Option A Option B

Percentage of Income

You may elect a monthly benefit amount in $100

increments not to exceed 66.67% of your monthly

earnings.

You may elect a monthly benefit amount in $100

increments not to exceed 66.67% of your monthly

earnings.

Benefits Begin After

(Elimination Period)Accidental

InjuryOther

DisabilitiesAccidental

InjuryOther

Disabilities

0 Days

14 Days

30 Days

60 Days

90 Days

180 Days

3 Days

14 Days

30 Days

60 Days

90 Days

180 Days

0 Days

14 Days

30 Days

60 Days

90 Days

180 Days

3 Days

14 Days

30 Days

60 Days

90 Days

180 Days

Maximum Benefit Duration SSNRA SSNRA 5 YR ADEA 5 YR ADEA

Benefit Maximum $8,000

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Reenrollment is required during openenrollment. Last year’s election will notcontinue unless you make electionagain.

FlexSystem FSA increases your take-home pay by reducing your taxableincome. A Flexible Spending Account(FSA) allows you to save up to 30% oneligible healthcare and/or dependentcare expenses every year by using pre-tax dollars.

Consider how much you spend onhealthcare and/or dependent careexpenses for you and your qualifieddependents in one year:

• Prescription drugs/Medications• Medical/Dental office visit co-

pays• Eye Exams and prescription

glasses/lenses• Vaccinations• Daycare tuition

Why not reduce these expenses by usingpre-tax dollars instead of after-taxdollars? With rising healthcare costs,every penny counts!

By using pre-tax dollars, you are taxedon a lower gross salary, thereby savingmoney that would otherwise be spenton federal, state and FICA taxes, andthereby you increase your take homepay! See example ---->>

How FlexSystem WorksFlexSystem FSA is offered through youremployer and is administered by TASCFlexSystem. When you choose to enrollin a FlexSystem FSA Healthcare and/orDependent Care, you choose the dollaramount you want to contribute to eachaccount based on your estimatedexpenses for the upcoming Plan Year.Your Contributions will be deducted inequal amounts from each paycheck, pre-tax, throughout the Plan Year. The moreyou contribute to these accounts, themore you save by paying less in taxes!

Reimbursements and the TASC CardAs you incur eligible expenses, simplysubmit a request for reimbursement toTASC in order to receive reimbursementfrom your FlexSystem FSA, up to theamount of your annual contribution.FlexSystem offers multiple methods forrequesting a reimbursement: Online, TextMessage, Mobile App, Fax, or Mail.

For additional convenience, you will beissued a TASC Card to directly access yourFlexSystem funds when paying for eligiblemedical and/or dependent care expensesat the point of purchase, which eliminatesthe need for requesting a reimbursement.

The TASC Card also offers the MyCashAccount feature that allows you to auto-deposit your reimbursements into aseparate cash account and directly accessthose funds with your TASC Card for anypurchase. Your benefits card also becomesa VISA cash card.

Pre-Tax Savings Example

Without FSA

With FSA

Gross Monthly Pay: $3,500 $3,500

Pre-Tax Contributions

Medical Expenses (FSA) $0 -$200

Dependent Care Expenses

$0 -$400

TOTAL: $0 -$600

Taxable Monthly Income

$3,500 $2,900

Taxes (federal, state, FICA):

-$968 -$802

Out-of-pocket Expenses: -$600 $0

Monthly Take-home Pay:

$1,932 $2,098

Net Increase in Take-Home Pay = $166/mo! For illustration only. Actual dollar amounts may vary.

Maximum Annual ElectionHealthCare: $2,400 Dependent Day Care $5,000

Flexible Spending Accounts (FSA)

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The Group Accident plan from Aflac means that your family has access to added financial resources to help with the cost of follow-up care as well.

The Aflac Group Accident plan benefits:• A Wellness Benefit for covered preventive screenings• Transportation and Lodging benefits• An Emergency Room Treatment Benefit• Hospital Confinement• Fractures, Dislocations, and Burns• A Rehabilitation Unit Benefit• An Accidental Death Benefit• A Dismemberment Benefit

Features:• Coverage is guaranteed-issue (which means you may qualify for coverage without having

to answer health questions).• Coverage is 24 hours.• Benefits are paid directly to you unless you choose otherwise.• Coverage is available for you, your spouse, and dependent children under age 26.• Coverage is fully portable when you leave employment. That means you can take it with

you if you change jobs or retire.• No reduction in benefits with age.• There is no waiting period.

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Accident - Administered by AFLAC

Tier of Coverage Cost Per Month

Employee $11.72


Employee + Children $26.75

Family $34.65


Benefit Description Benefit Amount

Hospital emergency room with X-Ray / without X-Ray $250/$200

Urgent care facility with X-Ray / without X-Ray $250/$200

Doctor’s office or facility (other than a hospital emergency room or urgent care) with X-Ray /without X-Ray $125/$100

AMBULANCE (within 90 days after the accident) Payable when an insured receivestransportation by a professional ambulance service due to a covered accidental injury.

$200 Ground $1,000 Air

ACCIDENT FOLLOW-UP TREATMENT (maximum of 6 per accident, within 6 months after theaccident provided initial treatment is within 7 days of the accident) Payable for doctor-prescribed follow-up treatment for injuries received in a covered accident. Follow-uptreatments do not include physical, occupational or speech therapy. Chiropractic oracupuncture procedures are also not considered follow-up treatment.

$30

HOSPITAL ADMISSION (once per accident, within 6 months after the accident) Payable whenan insured is admitted to a hospital and confined as an inpatient because of a coveredaccidental injury. This benefit is not payable for confinement to an observation unit, foremergency room treatment or for outpatient treatment.

$200 per day

HOSPITAL CONFINEMENT (maximum of 365 days per accident, within 6 months after theaccident) Payable for each day that an insured is confined to a hospital as an inpatientbecause of a covered accidental injury. If we pay benefits for confinement and the insured isconfined again within 6 months because of the same accidental injury, we will treat thisconfinement as the same period of confinement. This benefit is payable for only one hospitalconfinement at a time even if caused by more than one covered accidental injury. Thisbenefit is not payable for confinement to an observation unit or a rehabilitation facility.

$200 per day

HOSPITAL INTENSIVE CARE (maximum of 30 days per accident, within 6 months after theaccident) Payable for each day an insured is confined in a hospital intensive care unitbecause of a covered accidental injury. We will pay benefits for only one confinement in ahospital intensive care unit at a time, even if it is caused by more than one coveredaccidental injury. If we pay benefits for confinement in a hospital intensive care unit and aninsured becomes confined to a hospital intensive care unit again within 6 months because ofthe same accidental injury, we will treat this confinement as the same period ofconfinement.

$400 per day

FAMILY MEMBER LODGING (greater than 100 miles from the insured’s residence, maximumof 30 days per accident, within 6 months after the accident) Payable for each night’s lodgingin a motel/hotel/rental property for an adult member of the insured’s immediate family. Forthis benefit to be payable: • The insured must be confined to a hospital for treatment of acovered accidental injury; • The hospital and motel/hotel must be more than 100 miles fromthe insured’s residence; and • The treatment must be prescribed by the insured’s treatingdoctor.

$100 per day

WELLNESS BENEFIT (once per calendar year) Payable for wellness testsperformed as the result of preventive care, including tests and diagnosticprocedures ordered in connection with routine examinations.First year of certificate Second year of certificate and thereafter

$25$50

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Accident - Administered by AFLAC

Sample of the Schedule of Benefits (the full schedule is available online):INITIAL TREATMENT (once per accident, within 7 days after the accident, not payable for telemedicine services) Payable when an insured receives initial treatment for a covered accidental injury. This benefit is payable for initial treatment received under the care of a doctor when an insured visits the following:


Critical Illness Benefits are payable for specified conditions and can help to cover the costs of your treatments and related expenses, regardless of your major medical insurance coverage.

1 All covered conditions are subject to the definitions found in your certificate.This brochure is a brief description of coverage and is not a contract. Read your certificate carefully for exact terms and conditions. Definitions, waiting period, pre-existing condition limitation, limitations and exclusions, benefits, termination, portability, etc., may vary based on your employer's home office. Please see your agent for the plan details specific to youremployer.

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Critical Illness with Cancer - Administered by AFLAC

BENEFITS This brochure is a brief description of coverage and is not a contract. Read your certificate carefully for exact terms and conditions.

COVERED CRITICAL ILLNESSES:1

Cancer (Internal or Invasive)Heart Attack (Myocardial Infarction)Stroke(Ischemic or Hemorrhagic)Major Organ TransplantKidney Failure (End Stage Renal Failure)Bone Marrow Transplant (Stem Cell)Sudden cardiac Arrest

Additional covered critical illnesses:Severe Burn, Coma, Paralysis, Loss ofSight, Loss of Hearing, Loss of Speech.The following are covered at 25%:Non-Invasive Cancer, Coronary ArteryBypass Surgery2, Benign Brain Tumor

INITIAL DIAGNOSIS Aflac will pay a lump sum benefit upon initial diagnosis of a covered critical illnesswhen such diagnosis is caused by or solely attributed to an underlying disease.Cancer diagnoses are subject to the cancer diagnosis limitation. Benefits will bebased on the face amount chosen. Employee benefit amounts available from $5,000to $30,000. Spouse coverage is also available in benefit amounts up to $15,000.

ADDITIONAL DIAGNOSIS Aflac will pay benefits for each different critical illness after the first when the twodates of diagnoses are separated by at least 6 consecutive months. Cancerdiagnoses are subject to the cancer diagnosis limitation.

RE-OCCURRENCE BENEFIT

Aflac will pay benefits for the same critical illness after the first when the two datesof diagnoses are separated by at least 6 consecutive months. Cancer diagnoses aresubject to the cancer diagnosis limitation.

CANCER DIAGNOSIS LIMITATION

Benefits are payable for cancer and/or noninvasive cancer as long as the insured istreatment free from cancer for at least 12 months before the diagnosis date; and isin complete remission prior to the date of a subsequent diagnosis.

CHILD COVERAGE AT NO ADDITIONAL COST

Each Dependent Child is covered at 50 percent of the primary insured amount at noadditional charge.

SKIN CANCER BENEFIT Aflac will pay $250 for the diagnosis of skin cancer. This payment will only pay onceper calendar year.

$50 HEALTH SCREENING BENEFIT

Aflac will pay $50 for health screening tests performed while an insured’s coverageis in force. This benefit will pay once per calendar year. This benefit is only payablefor health screening tests performed as the result of preventive care, including testsand diagnostic procedures ordered in connection with routine examinations. Thisbenefit is payable for the covered employee and spouse. This benefit is not paid forDependent Children.

COVERED HEALTH SCREENING TESTS INCLUDE:

• Mammography • Colonoscopy • Pap smear• Breast ultrasound • Chest X-ray • PSA(blood test for prostate cancer) • Stress teston a bicycle or treadmill • Bone marrowtesting • CA 15-3 (blood test for breastcancer) • CA 125 (blood test for ovariancancer) • Blood test for triglycerides • DNAstool analysis • Spiral CT screening for Lung

Cancer • Flexible sigmoidoscopy •Hemocult stool analysis • Serumprotein electrophoresis (blood testfor myeloma) • Thermography •Fasting blood glucose test• Serum cholesterol test todetermine level of HDL and LDL •CEA (blood test for colon cancer)


27

Critical Illness with Cancer Rates - Administered by AFLAC

28

Whole Life Insurance offers protection, cash accumulation, and cash value loan privileges –allin one policy. Whole Life Insurance is also portable. If you ever leave employment, you cantake your insurance coverage with you and your premium amounts and cash value areguaranteed as long as you meet the required premium payments.

Benefits Amounts• Up to $300,000 for Employee• Up to $100,000 for Spouse• Up to $25,000 for Dependent Children

Guaranteed Issue Amounts• Employee: Up to $100,000• Spouse: Up to $50,000• Child: $10,000 Child Term Life Rider

Children’s Term Insurance (CTR) Rider: CTR provides insurance coverage to dependentchildren for $10,000 up to the child’s 26th birthday. Coverage an be converted to a whole lifepolicy at that age.

Additional benefits to the whole life policy:• Cash Value• Loans and Repayment• Accidental Death Benefit Rider

Face amounts based on monthly premium $13.00

Face amounts based on monthly premium $47.67

Whole Life – Administered by AFLAC

Non-Tobacco Tobacco

Issue age Face Amount Cash Value Face Amount Cash Value

25 $17,910 $7,049 $10,277 $4,598

35 $11,650 $4,124 $7,072 $2,835

45 $6,949 $1,985 $4,101 $1,311

55 $3,640 $599 $2,182 $388

Non-Tobacco Tobacco

Issue age Face Amount Cash Value Face Amount Cash Value

25 $65,672 $25,847 $37,681 $16,860

35 $42,718 $15,123 $25,929 $10,395

45 $25,479 $7,277 $15,037 $4,807

55 $13,346 $2,196 $8,000 $1,421


Unless otherwise noted, a paper copy of these notices are available, free of charge, by calling NFP at800-994-7429.

NOTICE OF YOUR HIPAA SPECIAL ENROLLMENT RIGHTS:If you are declining enrollment for yourself or your dependents (including your spouse) because ofother health insurance or group health plan coverage, you may be able to enroll yourself and yourdependents in this plan if you or your dependents lose eligibility for that other coverage (or if theemployer stops contributing towards you or your dependents’ other coverage). However, you mustrequest enrollment within 30 days after you or your dependents’ other coverage ends (or after theemployer stops contribution toward the other coverage). In addition, if you have a new dependent asa result of marriage, birth, adoption, or placement for adoption, you may be able to enroll yourself oryour dependents. However, you must request enrollment within 30 days after the marriage, birth,adoption, or placement for adoption.

SECTION 125 PRE-TAX BENEFIT AUTHORIZATION NOTICE:Before-tax deductions will lower the amount of income reported to the federal government. This mayresult in slightly reduced Social Security benefits. If you do not enroll eligible dependents at this time,you may not enroll them until the next open enrollment period. You may not drop the coverage youelected until the next open enrollment period. You may only make a change or drop coverageelections before the next open enrollment period under the following circumstances:A change in marital status, orA change in the number of dependents due to birth, adoption, placement for adoption or death of adependent, orA change in employment status for myself or my spouse, orOpen enrollment elections for my spouse, orA change in dependents eligibility, orA change in residence or worksite.Any change being made must be appropriate and consistent with the event and must be made within30 days of when the event occurred. All changes are subject to approval by your Employer/Plan.

NOTICE OF PRIVACY PRACTICES FOR PROTECTED HEALTH INFORMATION: This Notice describes howthe Plan(s) may use and disclose your protected health information ("PHI”) and how you can get accessto your information. The privacy of your protected health information that is created, received, usedor disclosed by the Plan(s) is protected by the Health Insurance Portability and Accountability Act of1996 ("HIPAA"). This Notice is available on the web at: www.jonescountyschoolsys.bswift.com. Apaper copy is also available, free of charge, by calling your Employer or NFP at 800-994-7429. Pleasenote the participant is responsible for providing a copy to their dependents covered under the grouphealth plan."

GENERAL NOTICE OF COBRA CONTINUATION COVERAGE RIGHTS: On April 7, 1986, a federal law wasenacted (Public Law 99272, Title X) requiring that most employers sponsoring group health plans offeremployees and their families the opportunity for a temporary extension of health coverage (called"continuation coverage") at group rates in certain instances where coverage under the plan wouldotherwise end. If you or your eligible dependents enroll in the group health benefits available throughyour Employer you may have access to COBRA continuation coverage under certain circumstances.Therefore, your plan makes available to you and your dependents the General Notice Of COBRAContinuation Coverage Rights. This notice contains important information about your right to COBRAcontinuation coverage, which is a temporary extension of coverage under the Plan. This noticegenerally explains COBRA continuation coverage, when it may become available to you and yourfamily, and what you need to do to protect the right to receive it. The full Notice is available on theweb at: www.jonescountyschoolsys.bswift.com. A paper copy is also available, free of charge, bycalling your Employer or NFP at 800-994-7429. Please note the participant is responsible for providinga copy to their spouse/dependents covered under the group health plan.

29

Disclosure Notice

Why Should I Contact the Service Center?

Order ID Cards: We can contact the insurance carrier directly and have yourreplacement card in ten to fifteen business days.

Claim Resolution and Research: We can help you understand your Explanation ofBenefits (EOB) as well as contact the insurance carriers on your behalf. We can assistin appealing a denied claim or help you request a Prior Authorization (PA) from yourphysician as it may be required by your medical carrier. We can also help you file out-of-network claims and assist with reimbursement if you require medical assistancewhile traveling outside of the United States.

Locate In-Network Providers: Staying in network saves everyone money. Our ServiceCenter can help you locate In-Network Providers for medical, dental and visioncoverage whether you are at home or away.

Request Copies of Any Necessary Forms: Medical claim forms, out-of-network claimforms, evidence of insurability forms, short and long term disability claim forms andany other applicable forms are always available if the need should arise.

Understanding Your Benefits: We can assist you with questions regarding deductibles,copayments and coinsurance. We can explain waiting periods, elimination periods andeligibility rules.

Explain Qualifying Events: Most benefit plans require that you have a QualifyingEvent (like marriage, birth of a child or other life event) to make a change in yourelection anytime other than during open enrollment. We work with your employer toensure that your change follows the rules of the plan, that your request is allowedwithin the appropriate timeframes, and that your give proper documentation of theevent.

Annual Enrollment Information: We can provide details about when open enrollmentbegins and ends and if your plan designs or payroll deductions are changing.

Enrollment Assistance: The Service Center Representative can walk you through everystep of the enrollment process. Whether it’s an online enrollment or paper enrollmentform, your Service Center Representative is available to help.

Confirmation Statements: We can provide copies of your online enrollmentconfirmation statement or a copy of your paper enrollment form at any time.

The Service Center is available from 8:30 a.m. to 5:00 p.m. Monday through Friday toassist you. We have an after-hours voice mailbox and your call will be returned thenext business day.

[email protected]

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Contact Information

Plan Administrator Website Phone Number

Benefit / Enrollment Questions

NFP www.shawhankins.com 800-994-7429

Medical Coverage State Health www.myshbp.ga.gov 800-610-1863

Dental Coverage Anthem www.anthem.com 855-397-9267

Vision Coverage EyeMed www.eyemedvisioncare.com 866-939-3633

Voluntary Life Standard Life www.standard.com 800-368-1135

Disability Standard Life www.standard.com 800-368-1135

Flexible Spending (FSA)

TASC www.tasconline.com 800-422-4661

Critical Illness AFLAC aflacgroupinsurance.com 800-433-3036

Accident AFLAC aflacgroupinsurance.com 800-433-3036

Whole Life AFLAC aflacgroupinsurance.com 800-433-3036

EAP Espyr www.espyr.com 800 869-0276

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NFP.com1-800-994-7429