MyPCPSBenefitsGuide2025 : simplebooklet.com

Polk County Public SchoolsGetting Started2025 Employee BenefitsWelcome to Polk County Public Schools 2025 Employee Benefits! Offering acomprehensive benefits package is one way we recognize your contribution to thesuccess of PCPS. Our role is to help you and your family to be healthy, feel secureand maintain work/life balance. In this guide, you can find information about ourhealth care benefit offerings and tools to help you make confident and informeddecisions.To get started, we recommend thoroughly reviewing this guide and considerdiscussing decisions with your family members. Once you’re ready to enroll, you canlogin to your online enrollment portal, Benefitplace, to elect, review, and makechanges to your health care benefits.Questions? Contact Us!PCPS Risk Management & Benefits Department Phone: 863-519-3858Email: RiskManagement-AllStaff@polk-fl.netAddress: 1915 South Floral Ave., Bartow, FL 33830Mailing: P. O. Box 391, Bartow, FL 33831Website: secure3-enroll.com/go/polkschools2

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If you cancel benefits during Open Enrollment, yourbenefits will end on December 31st For 10- and 11-month employees: If you workthrough the last day of your contract, your benefits willend on Au-gust 31st.For 12-month employees: Your benefits will end thelast day of the month in which you pay from your lastpaycheck. Once your termination of benefits is processed, you willbe sent information about continuing coverage optionsfrom our COBRA administrator TASC.Termination DateCoverage End Date1st-15thEnd of current month16th-End of MonthEnd of following month Covering a spouse or dependent? Make sure you have up to date documentation. See page 6 for details. PCPS provides you Basic Life Insurance at no cost to you! Add or update your life insurance beneficiary(ies) anytime via Benefitplace. Do you want to receive text and email reminders? Log in to Benefitplace to update your communication preference. Go Paperless! Opt-in to receive your health insurance tax documents (Form 1095C) electronically via Benefitplace.Important Benefit InformationNew hires have 60 days from their date of hire (or jobchange) to enroll in benefits. Benefits are effective thefirst of the month following 60 days of employment. If you do not elect benefits within 60 days, you will beauto-enrolled in employee-only Health Insurance and BasicLife insurance, but will forfeit your rights to enroll inoptional benefits until the next open enrollment, unless youexperience a qualified life event.NEW HIRE ENROLLMENTWAIVING COVERAGE?Open Enrollment is the annual opportunity for you to makechanges to your benefits. Beginning October 18th throughNovember 1st, all employees can login to their BenefitplacePortal to make changes to their benefit elections andcovered dependents. New elections will be effective January 1, 2025. All dependent documentation and HealthStatement/Evidence of Insurability must be submitted byNovember 12, 2024 or your coverage may not be effectiveJanuary 1, 2025.If you are not making any changes then your benefits willautomatically carry over to the next year. Exception: if youcontribute to a Health or Dependent Care Flexible SpendingAccount (FSA), you must reelect contributions each year(FSA elections will not rollover). New Hire Enrollment AND Open Enrollment: If you are anew hire for the 2024-2025 school year, you will need toparticipate in both New Hire Enrollment and OpenEnrollment in order to add/remove coverage for theupcoming calendar year. Keep in mind that new hires canelect up to $150,000 in Additional Life Insurance and mayenroll in any of the Disability Plans without the need tocomplete a Health Statement/Evidence of Insurability (seepages 22-23 for details). If you wait to elect Life &Disability benefits during Open Enrollment, you will besubject to a Health Statement/Evidence of Insurability(EOI).OPEN ENROLLMENTIf you are covered by another health plan and/or do notwish to enroll in the PCPS Health Plan, please log intoBenefitplace and select “Decline Coverage”. Important Note: If you are covered under another healthplan, failure to waive the PCPS Health Plan means that ourplan is considered your primary insurance and your otherplan will be your secondary insurance.THINKING ABOUT RETIREMENT?Open enrollment is the perfect time to review yourcurrent benefit elections and dependent coveragesyou’d like to continue upon retirement. Log intoBenefitplace to view your current coverages. Once you retire you are only allowed to continuehealth, dental, vision and employee life benefits thatyou are currently enrolled in at the time of retirement.For more information about Retiree Benefits, see pages32-36. WHEN COVERAGE ENDS12344

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EligibilityAll employees who work at least 30 hours per week and havecompleted their necessary waiting period are eligible forbenefits. Employees working less than 30 hours per week whowere hired prior to October 1, 2013 may have“grandfathered” benefits eligibility. You are automaticallyenrolled in employee-only Health Insurance and Basic LifeInsurance unless the you actively waive coverage onBenefitplace. Health, dental and vision coverages are also extended to youreligible dependents. Eligible dependents include: Legally married spouse (an ex-spouse does not meeteligibility criteria even if insurance coverage is specifiedby a judge in a divorce decree) Dependent children are eligible until end of thecalendar month in which they turn 26 (coverage my becontinued beyond age 26 under certain criteria) Grandchildren can be covered up to 18 months of age(only eligible if the parent, i.e. employee’s dependent,remains a covered dependent) Definition of children includes the employee’s natural born,adopted, foster, or stepchild, and a child for whom theemployee has been court-appointed as legal guardian or legalcustodian. WHO’S ELIGIBLE?DependentDocumentation RequiredSpouseCopy of marriage certificate AND Copy of your most recent joint federal taxreturn or both of your tax returns if you fileseparatelyNatural Childor legallyadopted childCopy of state or county issued birthcertificate showing employee’s name orsigned court order If birth certificate lists employee’s maidenname, please provide a copy of marriagecertificate or other documentationproving current nameStepchildCopy of state or county issued birthcertificate showing parents’ names ANDCopy of your marriage certificate ANDCopy of your joint federal tax return DisabledDependentover age 26Copy of state or county issued birthcertificate showing employee’s name orsigned court order ANDCopy of your most recent federal taxreturn claiming the child as a dependentANDOver-ageDependent upto age 30Copy of state or county issued birthcertificate showing employee’s name orsigned court order AND GrandchildCopy of state or county issued birthcertificate showing parents’ names forchild and grandchild The employee’s child must be listed asparent on birth certificate & remain acovered dependentLegal CustodyorGuardianshipCopy of signed court order ANDCopy of your most recent federal taxreturn claiming the child as a dependentUpload your documents safely and securely to Benefitplace Staff will receive a notification of your submission and will verify the documents meet the requirements. You can checkthe status of your documentation under the “Document Center” tab in Benefitplace.Completed Disabled DependentVerification FormCompleted Over-age Dependent EligibilityAffidavit (must also submit annually duringOpen Enrollment) DEPENDENT DOCUMENTATIONNEW HIRES: You have 60 days from your hire date enroll inbenefits and to submit any required documentation. MID-YEAR CHANGES: You have 31 days from the date ofthe event to change your elections and submit any requireddocumentation. Exception: newborns have 60 days to beenrolled from date of birth. If the newborn is enrolled within31 days, you will not be charged the additional premium forthe first month of coverage. If documentation is not received within these timeframes,your dependents will not be enrolled in benefits.5

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Download & Print the Annual Affidavit Age 26-30 DependentsFlorida Statute 627.6562 requires extended healthcarecoverage to dependents up to age 30 under certainconditions. This law allows employees to cover their “over-age dependents” under the PCPS’s Group Health Planprovided ALL the following Eligibility Requirements are met: The dependent must be continuously enrolled in either thePCPS Group Health Plan or other creditable medicalcoverage without a gap of more than 63 days, 1.The dependent is unmarried and has no dependents of hisor her own,2.The dependent is a Florida resident OR is a full or part-time student, AND3.The dependent does not have health insurance availableto them through their employer or through another grouphealth plan (i.e. Medicare or Medicaid).4.ELIGIBILITYShould the status of a Dependent Child change such that theeligibility rules set forth above are no longer met, you MUSTnotify the PCPS Risk Management & Employee BenefitsDepartment within 31 days to remove the dependent From thePCPS Group Health Plan. If you have any questions regardingdependent eligibility, please contact Risk Management &Employee Benefits Department at 863-519-3858.CHANGE OF DEPENDENT ELIGIBILITY STATUSYou are required to complete an Over-age DependentEligibility Affidavit during initial enrollment of your Over-age Dependent and every year during the annual openenrollment period in order for your Over-age DependentChild(ren) to be covered under the PCPS Group HealthPlan. If requested by the Risk Management & EmployeeBenefits Department, the employee must also submitother supplemental documentation required for proof ofeligibility. Failure to complete the annual affidavit willresult in your Over-Age dependent being removed fromcoverage. ANNUAL AFFIDAVITEnrollment of Over-age Dependents is not automaticand must be manually enrolled through the RiskManagement Department. Please contact RiskManagement to enroll your Over-age Dependent: ENROLLMENTAs a result of the Affordable Care Act (ACA) that became lawin March 2010, employee health insurance premiums for tax-qualified dependent children up to age 26 are generallyprovided on a pre-tax basis. Because the State of Floridarequires the PCPS Group Health Plan to provide coverage fordependent children beyond the ACA federal age limit, healthinsurance premiums for over-age dependents who meet thecriteria outlined in F.S. 627.6562 will be paid on an after-taxbasis and billed monthly through TASC, and not throughpayroll deductions. Premiums for over-age dependents arecharged at the fair market value of the benefit. PREMIUMSPhone: 863-519-3858 Email: RiskManagement-AllStaff@polk-fl.net6

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Making Benefit ElectionsBoard-Funded Benefits:PCPS is pleased to offer the following employee benefitsat NO COST to you:Employee-only Health Care—Includes medical andprescription drug coverage through MyPCPSHealth. Ifyou and your spouse both work for PCPS, you may beeligible for Board Spouse Coverage, which is freeEmployee + Spouse premiums, plus combined healthspending accumulators (deductible and out of pocketmaximum). Contact the Risk Management & BenefitsDepartment to enroll or change Board SpouseCoverage. Basic Term Life Insurance—Includes $20,000 of BasicLife and $10,000 of AD&D coverage which isadministered by The Standard.Health & Wellness Centers—All employees from theirdate of hire are eligible to utilize our Health & WellnessCenters operated by Everside Health.Employee Assistance Program—Includes up 7 freecounseling sessions per issue per year through AetnaResources for Living. This is available to all employeesand dependents from date of hire. Texting is alsoavailable through Talkspace.Optional Benefits:The following benefits are available to you for an additionalcost:Dependent Health CareDental InsuranceVision InsuranceHealth Care Flexible Spending AccountDependent Care Flexible Spending AccountShort-Term DisabilityLong-Term DisabilityAdditional Employee Life and AD&DDependent Child Life InsuranceDependent Spouse Life InsuranceRetirement PlansFlorida Retirement System (FRS)403(B) Annuity Programs and 457(B) DeferredCompensation Programs (eligible from date of hire)WHAT PLANS ARE OFFERED?Enrolling is easy! Read your materials and make sure youunderstand all of the options available.Carefully review this Benefits Guide and considerdiscussing decisions with your spouse or familymembers1.Take time to update your home address, email, phonenumber, and emergency contact in the Staff Portal byvisiting staff.mypolkschools.net/2.Log into Benefitplace by visiting secure3-enroll.com/go/polkschools3.Click Get Started and select the coverages you’d liketo enroll in or make changes to.4.Check your TO DO LIST to review any pending tasks.5.Save or print your Benefits Confirmation Statement.6.If you have any questions, please contact the RiskManagement & Benefits Department: HOW TO ENROLLPhone: 863-519-3858 Email: RiskManagement-AllStaff@polk-fl.net7

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Can I Change My Benefits?WHEN CAN I CHANGE MY BENEFITS?Annually during Open EnrollmentOnce your new hire enrollment window closes, theonly other time outside of Open Enrollment you areallowed to make changes to your benefits electionsis if you experience a qualified life event. You mustlog on to Benefitplace and request the changewithin 31 days of the event to be eligible tochange your elections.Examples of qualified life events include:Marriage, divorce or legal separationChildbirth or adoptionInvoluntary loss of coverage under another planChange in employment status for you or yourspouseGain or loss of entitlement to Medicare orMedicaid insurance coverageYou will only be allowed to change your electionsthat are consistent with the life event. For example,if you were covered under your spouse’s healthinsurance, and he or she loses their job, you canelect to enroll both you and your spouse underPCPS’ health benefits.If you are making mid-year changes to yourbenefits, you may need to submit additionaldocumentation. Upload your documents safelyand securely to Benefitplace. Staff will receive anotification of your submission and will verify thedocuments meet the requirements. You can checkthe status of your documentation under the“Document Center” tab in Benefitplace.Check out this 1-minute video to learnabout Qualified LifeEvents. Click this linkor scan the QR codeto tune in:Qualified LifeEventDocumentationRequiredEffective date ofbenefit changesMarriageCopy of marriagecertificate 1st of the monthfollowing the eventBirth oradoptionCopy of state or countyissued birth certificate. Date of birth oradoption DivorceCopy of divorcedecreeDate of divorce Gain or Loss ofOther Coverage Proof of gain or loss ofeligibility for othergroup coverage 1st of the monthfollowing the eventDeath ofDependent Copy of deathcertificateDate of death Legal Custodyor GuardianshipSigned court order1st of the monthfollowing the event Medicare orMedicaid Proof of gain or loss ofMedicare or Medicaidcoverage 1st of the monthfollowing the event Leave ofAbsence,including FMLALeave of Absence approval required beforechanges are madeRetirementEmployees who are retiring must meet withthe Benefits Department to review coverageoptions and sign a waiver if they decline theirretiree benefits. 8

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BeneficiaryThe person, organization, or trustyou name in a life insurance policyto receive the death benefit. Youare required to designate at leastone (1) beneficiary. It is imperativethat you designate your lifeinsurance beneficiaries as thatinformation will be blank inBenefitplace.CoinsuranceAfter you’ve met your deductible,you’re sometimes responsible for apercentage of the cost of themedical care, dental care, orprescription medication youreceived. This percentage iscoinsurance.CopayA flat fee you pay each time youreceive a copay-eligible medical,dental, or vision service orprescription medication. DeductibleThe amount you’re responsible forpaying in care expenses before themedical or dental plan starts payingdeductible-eligible expenses.In-networkIn-network care is always yourlowest-cost option. Networks aregroups of medical, dental, andvision providers, pharmacies, andfacilities that agree to discount thecost of their care or service. Toverify if your provider is in-network,visit: MyPCPSHealth.comMedically Necessary Health care services or suppliesthat generally meet the followingcriteria: (1) are appropriate for thesymptoms and diagnosis and/ortreatment of the condition; (2) are inaccordance with standards of goodmedical practice; (3) are notprimarily serving as convenience;and (4) are considered the mostappropriate care available.Out-of-networkHealth care services received by anon-network service provider. Out-of-network health care and planpayments are subject to higherdeductibles and co-insurance(except in the event of anemergency).Out-of-pocket maximumThe most you’ll pay for covered in-network medical care in a year. Thisincludes your deductible, anycoinsurance or copays, andprescription drugs. The out-of-pocket maximum doesnot include your premium (theamount you pay for coverage), non-covered expenses, or out-of-network care that’s been balancebilled.Preferred ProviderOrganization (PPO)A plan that offers both in-networkand out-of-network benefits.How to handlemedical bills (4:46)Helpful Terms & ResourcesWe've removed as much jargon as possible.But you’ll probably still encounter some terms as you enroll in and use your benefits, and we want you to be prepared!9

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Employee ContributionsCoverage LevelSemi Monthly PremiumMonthly PremiumPCPS Health Care PlanEmployee Only (Board Funded)$0.00$0.00Employee & Spouse$297.00$594.00Employee & One Child$52.50$105.00Employee & Two Children$105.00$210.00Employee & 3+ Children$122.50$245.00Employee, Spouse, & One Child$349.50$699.00Employee, Spouse & Two Children$402.00$804.00Employee, Spouse & 3+ Children$419.50$839.00Over-age Dependent Age 26-30$605.88 per Over-age Dependent per month via TASC Direct BillDelta Dental - Low PlanEmployee Only$5.92$11.83Employee & Spouse$11.69$23.37Employee & Child(ren)$14.52$29.03Employee & Family$17.58$35.15Over-age Dependent Age 26-30$12.07 per Over-age Dependent per month via TASC Direct BillDelta Dental - Middle PlanEmployee Only$10.17$20.33Employee & Spouse$20.32$40.64Employee & Child(ren)$25.62$51.24Employee & Family$35.18$70.36Over-age Dependent Age 26-30$20.74 per Over-age Dependent per month via TASC Direct BillDelta Dental - High PlanEmployee Only$19.47$38.93Employee & Spouse$37.68$75.36Employee & Child(ren)$45.67$91.34Employee & Family$60.72$121.44Over-age Dependent Age 26-30$39.71 per Over-age Dependent per month via TASC Direct BillAvesis Vision - Low PlanEmployee Only$2.78$5.56Employee & Spouse$5.03$10.06Employee & Child(ren)$5.22$10.44Employee & Family$8.05$16.09Over-age Dependent Age 26-30$5.67 per Over-age Dependent per month via TASC Direct BillAvesis Vision - High PlanEmployee Only$4.26$8.52Employee & Spouse$7.71$15.42Employee & Child(ren)$8.01$16.01Employee & Family$12.34$24.67Over-age Dependent Age 26-30$8.69 per Over-age Dependent per month via TASC Direct Bill10

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Quantum Health, on a mission to make your healthcare simpler. Think of your Quantum Health Care Coordinators asyour personal team of nurses, benefits experts andclaims specialists who will do whatever it takes tohelp you with your unique healthcare needs. Eachtime you contact a Care Coordinator, you’ll talk to areal person who understands your benefits and knowshow to navigate the healthcare system. WHO IS QUANTUM HEALTH? Introducing the Quantum Health AppNavigating Your Quantum Health AppVIDEO RESOURCESWelcome to Quantum Health. We'rehere to help.UNDERSTANDING YOUR BENEFITSLook out for more information about how tocontact your Care Coordinators starting Dec. 1,2024. YOUR QUANTUM HEALTH CARE COORDINATORS ARE HERE TO HELPFrom replacing ID cards to more complicated matters, like claim resolutions, no request is too big or small for your Care Coordinators. Contact us whenever you need help with your healthcare, prescriptions or benefits.-Network of local and national providers -Negotiates with providers to offer discounted rates-Third-party administrator for claims processing and payment-Claims review and coverage verification-Explanation of benefits statements detailing claims submitted from providers, how much the plan covers and how much you owe-Pharmacy benefit manager -Prescription claims processing-Negotiates with pharmacies and drug manufacturers to offer discounted rates-Development and management of formulary (preferred drug list) and pharmacy network-Home delivery of prescriptionsGet answers to claims, billing and benefitsquestions Find in-network providers Verify coverage and get prior approval if needed Contact providers to coordinate your treatment Review your care options Replace ID cardsFrom replacing ID cards to more complicatedmatters, like claim resolutions, no request is too bigor small for your Care Coordinators. Empowered andresourceful, Care Coordinators do things like:When you need help, contact your Quantum HealthCare Coordinators. My PCPS Health Plan11

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Aetna Choice POS II NetworkIn-NetworkOut-of-NetworkDeductible (Ded) - Individual/Family$900/$1,800$1,500/$3,000Out of Pocket Maximum$5,000/$9,000No MaximumCoinsurance20%40%Professional ServicesTeladoc$0 copayN/AEmbold Doc Logic $35 copayN/AOffice Services-Primary or Specialist$50 copayDed + 40%Maternity Care$50-first visit; Ded + 20%Ded + 40%ER Physician, Inpatient Visit &ConsultationsDed + 20%Ded + 40%Radiology, Pathology, & AnesthesiologyAmbulatory Surgical CenterDed + 20%In Network Ded + 40%HospitalDed + 20%In Network Ded + 40%Medical PharmacyIncluded in Office CopayDed + 40%Emergency CareConvenient Care Centers$50 copayDed + 40%Urgent Care Centers$50 copayDed + 40%Ambulance (ground, air, & water)20% of billed charges20% of billed chargesFacility ServicesAmbulatory Surgical CenterDed + 20%Ded + 40%Independent Clinical Lab20% (Ded waived)Ded + 40%Outpatient Chemotherapy, DiagnosticLabs, Radiation Therapy & X-rayDed + 20%Ded + 40%Inpatient Hospital & Residential TreatmentDed + 20%Ded + 40%Mental Health & Substance AbuseInpatient Mental Health HospitalizationDed + 20%Ded + 40%Outpatient Mental Health Facility ServicesDed + 20%Ded + 40%My PCPS Health PlanThe information shown in this presentation is an illustrative summary only. The underlying plan contract or document governs all aspects of the plan. Finalrates are dependent on actual enrollment, insurance carrier or plan rules, plan selection, and eligibility criteria. Please refer to the plan document, contract,and other notices contained in this document, applications, and other corresponding communications for additional information.PCPS is pleased to offered a comprehensive PPO plan to eligible employees, retirees, and dependents. EffectiveJanuary 1, 2025, the PCPS Health Care Plan will be administered by Meritain (an Aetna Company) and WellDyne. PCPShealth plan members will receive access to dedicated Care Coordinators through Quantum Health as your one-stop-shop for all your health care needs. Look out for more information about how to contact your Care Coordinators starting Dec. 1, 2024 at (866) 871-0975 or by visiting www.MYPCPSHEALTH.com.Medical coverage is provided by Meritain, an Aetna Company. 12

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30-Day Supply90-Day SupplyPharmacy Deductible$50 per person$50 per personTier 1 (Preferred Generic)$8$20Tier 2 (Non-Preferred Generic)$8$20Tier 3 (Preferred Brand)$40 + 10%* (max $80)$120 + 10%* (max $240)Tier 4 (Non-Preferred Brand) $80 + 10%* (max $160)$210 + 10%* (max $420)Tier 5 (Preferred Specialty)$80*Not CoveredTier 6 (Non-Preferred Specialty)$160*Not CoveredPharmacy Out of Pocket Maximum$1,600 individual$4,200 familyThe information shown in this presentation is an illustrative summary only. The underlying plan contract or document governs all aspects of the plan. Finalrates are dependent on actual enrollment, insurance carrier or plan rules, plan selection, and eligibility criteria. Please refer to the plan document, contract,and other notices contained in this document, applications, and other corresponding communications for additional information.WellDyne was selected by your plan to administer the pharmacy portion of your health benefits. WellDyne’s team ofservice specialists and pharmacists appreciate the opportunity to serve you and help you get the medications you needat an affordable cost. You automatically receive prescription drug coverage when you enroll in medical. Prescription drug coverage is provided through WellDyne.*subject to the pharmacy deductibleWhen you ﬁll your prescription at a retail pharmacy in your plan’s network, you may purchase up to a 90-day supply ofthe prescribed medication; you may only purchase up to a 30-day supply of specialty medications. If you purchase a brand-name medication when a generic medication is available, you will pay the appropriate costshare for the drug based on the current formulary, plus the difference in cost between the brand and the generic.Please note there may be prior authorization requirements for certain brand-name medications. View your prescription’s formulary tier and check if your medication requires a clinical review by visiting:CLINICAL FOCUS 2025 (adaptiverx.com) Note: My PCPS Health Plan covered benefits may vary from WellDyne’sstandard formulary.PHARMACY PROGRAMS - COMING SOONStarting January 1, 2025, we are introducing newpharmacy cost savings programs designed to helpyou save on your prescription medications. Theseprograms will offer significant discounts andbenefits, making it easier and more affordable foryou to access the medications you need.Stay tuned for more details on how you can takeadvantage of these savings and improve youroverall health and well-being.SUMMARY OF BENEFITS AND COVERAGEPlease note this is just a summary of beneﬁts. Thefull beneﬁt plan design can be found in theSummary Plan Description (SPD) and Summary ofBeneﬁts and Coverage (SBC) which are availableonline via Beneﬁtplace. Retail Pharmacy Network: CVS is not a network pharmacy.With many national and local pharmacies in our network, itshould be easy to find one nearby. Choosing a networkpharmacy helps keep your out-of-pocket costs low and youwill never have to file a paper pharmacy claim. Mail Order Pharmacy: We have a mail order pharmacylocated in Lakeland, FL for maintenance medication and aspecialty pharmacy for medications that are used to treatcancer, inflammatory diseases and other complex conditions. WellConnect: Our secure texting tool delivers timely healthand prescription information right to your mobile phone. Fromrefill reminders to cost saving opportunities, we give you theinformation you need to make healthy decisions.WELCOME TO WELLDYNE!Click here to view Frequently AskedQuestions or visit www.MYPCPSHEALTH.comto learn more. My PCPS Health Plan13

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Health & Wellness CentersPCPS Employee Health & Wellness Centers areoperated by Marathon (formerly Everside/Healthstat),which offers primary care and prevention services,health risk intervention, health coaching, chronicdisease management, and occupational medicine. Marathon’s passion for promoting overall well-beinghelps patients to form bonds with their clinicians. Theserelationships inspire healthier habits, help employees tostay focused on their health goals, and improves thepatient experience.WHO IS ELIGIBLE?All PCPS employees from date of hire regardless ofhealth coverage and dependents over age two (2) on thePCPS health plan.WHAT SERVICES ARE AVAILABLE?Primary care servicesPreventative careSports physicalsDOT physicalsWell women and male examsAcute careLab workFlu vaccinationsDigital x-ray services (Lakeland Only)EKGPhysical therapyOccupational therapyMedical massage therapyMedical nutrition therapyMental health counselingMedication managementPulmonary function testingLOCATIONSLakeland3215 Winter Lake Rd.Lakeland, FL 33803Haines City641 US HWY 17-92 W.Haines City, FL 33844CENTER HOURSMonday - Friday: 7am - 6pmSaturday: 8am - 12pmSunday: ClosedSCHEDULE AN APPOINTMENT TODAY!863-419-3322 ACCESS & SERVICE REMINDERS Available for employee-use on Day 1 ofemployment ALL services are available at NO COST to you! Certain generic medications are dispensedon-site. Same day appointments available! Download the Patient Portal App14

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Employee WellnessWe recognize that PCPS’ most valuable resource is our employees, and that the health and wellbeing of our employeeshas a direct impact upon the continued success of our organization. By taking charge of your health, you can increaseyour energy, decrease your chance of developing several preventable illnesses, and – best of all – you simplyfeel better. Below are a few of our wellbeing offerings that are available to you:EARLY STEPS™ MATERNITY PROGRAMPregnancy & Postpartum Support Combining coaching with integrated navigation, QuantumHealth’s Early Steps Maternity program offers unmatchedsupport for expecting mothers. Early Steps Maternityprogram offers personalized support throughout yourpregnancy journey. Here’s what you can expect:1:1 Support: Work directly with pregnancy healthcoaches who listen and provide tailored tips andtools. Discuss topics like pregnancy expectations,postpartum care, symptoms, feeding methods,lifestyle habits, and labor preparation.Maternity Assessment: Enroll in the program bycompleting an assessment by week 24, availableonline or via phone.Early Identification: Helps identify high-riskpregnancies sooner, ensuring timely intervention.Wellbeing Portal: Access resources for overallwellbeing, including a free pregnancy book, wellnesschallenges, and tracking tools for health goals.Care Coordination: Our trained Care Coordinatorsassist with provider selection, authorizations, benefitquestions, and more, reducing confusion during thisexciting time.WELLNESS RESOURCESThrough our Health & Wellness Centers you haveaccess to: Face-to-face and Telephonic Health CoachingMeal Planning with a Registered Dietician Cooking Classes and DemonstrationsWork Strides Cancer Support ProgramHypertension & Hyperlipidemia Education Tobacco Cessation Support Talk to a coach: 863-648-3057Join us every week for Well-Being Wednesdays! Click here to sign up for our weekly newsletter,view our wellness events calendar, and to contactour wellness team.HEALTHFUL LINKS Health & Wellness | Polk County PublicSchools (polkschoolsfl.com)Follow us on Facebook:@PCPSWellnessBenefits15

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The ABCs of Diabetes program is available to allemployees, spouses and dependents enrolled in thePCPS health plan who have been diagnosed withdiabetes. Self-management education and support isoffered at no cost to prevent complications andenhance well-being. The program provides on-goinghealth coaching, screenings, and FREE diabetessupplies and medications! To improve operational efficiency and control theincreasing costs of health care, PCPS has implementeda Value-Based Design (VBD) incentive structure. Allmedications and supplies covered in the ABCs ofDiabetes program will continue to be FREE, but onlywhen you use a participating pharmacy. Standardclinical and prior authorization protocols also apply.WellDyne determines all covered medication, supplies,and devices to be included in the VBD and are subjectto change as new products and market conditions arise. If you’re interested in joining or have any questionsabout the program, please reach out to the EversideWellness Team 863-648-3057.ABC’S OF DIABETESABC’s of DiabetesPARTICIPANT REQUIREMENTSLabs and VitalsVitals and HbA1c must be completed every six (6)months. The additional labs listed below are requiredannually.HeightWeightBlood pressureFasting blood glucoseHemoglobin A1c(HbA1c)Serum creatinineEstimated GFRLipid panelMicroalbumin urinalysisLabs may be completed in the PCPS Employee HealthClinic at no cost! Appointments fill up fast, so scheduleyour visit in a timely manner by calling the EmployeeHealth Clinic at (863) 419-3322.If you have labs and/or vitals completed at a healthcareprovider/physician outside of the PCPS EmployeeHealth Clinics, please have their office fax the results to(855) 777-2344 or bring a copy of your lab work to theEmployee Health Clinic. To enroll in the program, labs must have beencompleted within the last 6 months and sent to yourhealth coach prior to your on-boarding appointment.Education and Coaching with the Health CoachesTo maintain the wellness incentive, you must completeyour education and coaching appointments with yourhealth coach once per calendar quarter. The healthcoaches for the program are Ashley Cicchirillo, RDN,CDCES; Jordan Schultz, MS, CHES, CWHC; andJazmine Vermilyea, MS, CHES, CWHC. To schedule,please call their office at (863) 648-3057.REGISTER TODAY!For details and to schedule your on-boardingappointment to be enrolled, contact our WellnessCoaches at 863-648-3057.16

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Know Before You GoInpatient hospital admissionsSurgery (inpatient or outpatient)Home healthcare and hospice careTransplantsMRI, MRA and PET scansDurable medical equipment (DME)Oncology care and servicesDialysisSpecialty medicationsCan’t find your ID card? Quickly access your ID card through your onlineaccount or call us to request a new one. Visit www.MYPCPSHEALTH.com Call (866) 871-0975 (Monday-Friday, 8:30 a.m.-10 p.m. ET)When you need help with your healthcare and benefits,start with your Quantum Health Care Coordinators. YourCare Coordinators are your personal team of nurses,benefits experts and claims specialists who are your oneresource to contact whenever you need help. You canfind our contact information on your medical ID card, soyou always have expert help on hand. Call Quantum Health Get answers to claims, billing and benefitsquestions Find in-network providers Verify coverage and get prior approval if needed Contact providers to coordinate your treatment Review your care options Replace ID cardsPrior approval may be required, services that requirepreauthorization include:If you have an upcoming medical service or procedurethat may require preauthorization, call your CareCoordinators to confirm your coverage in advance.They’ll gather the necessary information from yourdoctor and confirm your medical plan coverage withyou and your doctor.How does anyone really know what they are gettingwhen it comes to health care? Embold Health’sProvider Guide, customized for PCPS, is an onlinesearch tool, both mobile and desktop, where you canfind top-performing providers, based on real data andgrounded in the latest clinical research and medicalguidelines. Get doctor-level insights and feelempowered to find physicians who deliver the highestquality care.Teladoc gives you 24/7/365 access to U.S. board-certified doctors through the convenience of web,phone or app. Get the care you need in minutes fromthe comfort of home, at work or while traveling. MyPCPS Health Plan members with free access toTeladoc. That’s right—$0 co-pay! It's an affordablealternative to costly urgent care and ER visits whenyou need care now.Visit Teladoc.comCall 1-800-TELADOC (835-2362)Specialist Providers - $35 CopayGeneral Medicine Virtual Care - $0 CopayVisit polk.emboldhealth.comCall 1-855-630-6824If you need to have a non-emergency surgicalprocedure, Lantern Surgery Care is available toemployees and their dependents enrolled in the MyPCPS Health Plan. My PCPS Health Plan members have access to ahigh-performance network of the nation’s topsurgeons.NO COST to youPLUS Travel BenefitsElective Surgery Network - Coming Soon 17

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ONSITE HEALTH CENTERGo to your onsite healthcenter for non-lifethreatening conditions.Conditions treated include:AllergiesAnnual physicalsBladder treatmentCold/flu symptomsEar/sinus infectionHeadacheLab workManagement of diabetes,cholesterol, blood pressureSome generic medicationsSore throatWell-women visitsTELADOCContact Teladoc 24/7 fornon-life threateningconditions.Teladoc is an independent companyproviding phone and online physiciansconsultation services to My PCPS HealthPlan membersConditions treated include:AllergiesBronchitisCoughEar infectionFluNasal congestionPink eyeSinus problemsPRIMARY CAREPHYSICIAN (PCP)Go to your PCP for non-lifethreatening conditions. Ourhealth center can serve asyour PCP.Conditions treated include:Annual Wellness VisitCold/flu symptomsDiabetes ManagementFeverHigh blood pressure Minor sprainsSkin rashStomach acheURGENT CAREGo to an Urgent Care Facilityafter hours or when yourPCP is otherwiseunavailable.Conditions treated include:Bladder infectionBody achesEar infectionExcessive vomitingHeadacheMinor burnsPink eyeSore throatEMERGENCY ROOMGo to the ER immediately forsevere and life-threateningconditions.Conditions treated include:Broken bonesChest PainHead/neck injuryLoss of consciousnessSerious burnsSymptoms of strokeUncontrolled bleedingVomiting bloodKnow Before You GoIt’s important to understand your options when seeking medical care. Non-emergency care for a condition that is not lifethreatening is generally provided by your physician. Even after hours care is generally coordinated by your physician whocan instruct you on how to receive medical care outside of normal business hours, on weekends and on holidays. If youare in severe pain or your condition is life threatening, you can receive emergency care by calling 911 or visiting anemergency room. Please refer to the chart below for more information about your out-of-pocket costs.Onsite Health Center:1-863-419-3322 polkschoolsfl.com/clinicsProviderOut-of-Pocket CostsOnsite Clinic$0Teladoc (24/7)$0PCP$50Urgent Care$50Emergency Room80% subject to DEDMyPCPSHealth:(866) 871-0975 MyPCPSHealth.com18

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Low PlanMiddle PlanHigh PlanCoverage TypeIn-networkOut-of-NetworkIn-networkOut-of-NetworkIn-networkOut-of-NetworkProvider NetworkDelta Dental PremierDelta Dental PPODelta Dental PPOAnnual Deductible (DED)$50 individual $150 family $50 individual $150 family $50 individual $150 family Type AScheduleSchedule100% of PPOFee100% of PPOFee80% of PPO Fee80% of PPO MPA*Type BScheduleSchedule80% of PPO Fee80% of PPO Fee80% of PPO Fee80% of PPOMPA*Type CScheduleSchedule50% of PPO Fee50% of PPO Fee80% of PPO Fee80% of PPO MPA*Annual Max$1,000$1,000$1,500OrthodontiaNot CoveredCovered for children up to age 19Covered for children up to age 19Lifetime MaxN/A$1,000 per person$1,000 per personDental InsuranceDelta Dental Member Portalwww.deltadental.comCustomer Service:1-800-521-2651The information shown in this presentation is an illustrative summary only. The underlying plan contract or document governs all aspects of the plan. Finalrates are dependent on actual enrollment, insurance carrier or plan rules, plan selection, and eligibility criteria. Please refer to the plan document, contract,and other notices contained in this document, applications, and other corresponding communications for additional information.PCPS offers three (3) dental plan options through Delta Dental. If you enrollin one of the dental plans, you will have access to Delta Dental’s network ofproviders. Keep in mind, you will usually have the highest out-of-pocketcosts when you visit an out-of-network provider. To find out if your dentistparticipates in Delta Dental’s network, visit www.deltadentalins.comSelect from three dental options through Delta Dental.1‡ ‡2‡ ‡‡‡31—Type A: cleanings, oral examinations, fluoride, x-rays2—Type B: fillings, simple extractions, endodontics, general anesthesia, oral surgery, periodontal maintenance, sealants3—Type C: bridges, dentures, crowns, periodontal surgery† Deductible applies to Type B&C services only—waived on Type A services‡ For the most updated Schedule of Benefits for the Low Dental Plan contact Delta Dental Customer Service.*MPA—Maximum Plan AllowanceWHERE’S MY ID CARDWith Delta Dental, you don't need one!When visiting a Delta Dental networkprovider simply provide your socialsecurity number. The dentist’s officecan use this to verify your eligibility forbenefits. If you still would like an IDcard, you can print a customized IDcard via the Member Portal.SMILEWAYDid you know your oral health plays apart in disease prevention and overallwellness? Get all the tips you need tokeep your teeth and body healthy withDelta Dental’s Wellness Program:SmileWay. Learn more by visiting:www.deltadentalins.com/wellness19

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Low Vision PlanHigh Vision PlanIn-networkOut-of-Network In-networkOut-of-Network Annual Eye Exam Once every calendar year$20 copayUp to $35$10 copayUp to $40Standard Lenses Once every calendar yearSingle: Bifocal:Trifocal: Progressive L1-L3: Progressive L4: $20 copay$20 copay$20 copay$50 allowance$50 allowanceUp to $25Up to $40Up to $50Up to $40Up to $40$20 copay$20 copay$20 copayCovered in full$250 copayUp to $40Up to $60Up to $80Up to $48Up to $48FramesOnce every calendar year$120 allowanceUp to $45$150 allowanceUp to $50Contact Lenses Once every calendar year (in lieu of frame and lenses)Fit & Follow-upElective LensesMedically Necessary LensesUp to $50 copay$120 allowanceCovered in fullNoneUp to $110Up to $250Covered in full$130 allowanceCovered in fullUp to $25Up to $110Up to $250Vision InsuranceAvēsis Member Portalwww.avesis.comCustomer Service:1-866-205-0654The information shown in this presentation is an illustrative summary only. The underlying plan contract or document governs all aspects of the plan. Finalrates are dependent on actual enrollment, insurance carrier or plan rules, plan selection, and eligibility criteria. Please refer to the plan document, contract,and other notices contained in this document, applications, and other corresponding communications for additional information.With vision coverage, you have access to an extensive network ofparticipating vision providers. You also have the option to receive care froman out-of-network provider, however you receive the highest level ofbenefits when using an Avēsis provider. You can access a complete list ofparticipating ophthalmologists, optometrists, and opticians by logging on towww.avesis.comYour vision coverage is through Avēsis.OUR PLAN COVERS LASIK!With your Avēsis vision insurance, you receive a one-time/lifetime allowance of $150 that can be used when seeingan in or out-of-network LASIK provider. To locate an in-network LASIK provider, visit www.qualsight.com/-avesis orcall 877-712-2010.AVĒSIS VISION COVEDOrder your eyeglasses online! Choose from thousands offrames, in every shape, size, color, and material, and use UVP’sVirtual Mirror to see how your favorites look on you. Visit yourAvēsis Member Portal and click the “Online EyeglassOrdering” link to be directed to the UVP website accordingly.20

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Health Care FSADependent Care FSAMaximum$3,200 (or IRS maximum,whichever isgreater)$5,000 ($2,500 if marriedfiling separately)Minimum$300$3003 WAYS TO MANAGE YOUR FSA 1. Call Customer Service: 1-800-422-4661 2. Login to your Member Portal:www.tasconline.com 3. Download the Mobile App:www.tasconline.com/mobileWhen you enroll in an FSA, you will elect a dollaramount you want to contribute based on yourestimated expenses for the upcoming year. Yourcontributions will be deducted in equal amounts fromeach paycheck on a pre-tax basis. The more youcontribute to these accounts, the more you save bypaying less in taxes!Below are the maximum and minimum amounts youmay elect for 2025:Flexible Spending AccountsThe information shown in this presentation is an illustrative summary only. The underlying plan contract or document governs all aspects of the plan. Finalrates are dependent on actual enrollment, insurance carrier or plan rules, plan selection, and eligibility criteria. Please refer to the plan document, contract,and other notices contained in this document, applications, and other corresponding communications for additional information.Pay for qualifying expenses with tax-free money using your Flexible Spending Accountthrough TASC. FSA elections MUST be re-elected each year!Save tax dollars and tap into future savings through anFSA. There are two (2) types of FSAs:Health Care FSADependent Care FSAFLEXIBLE SPENDING ACCOUNTS (FSAs)FREQUENTLY ASKED QUESTIONSWhat can I use my FSA funds for?Health Care - pay for eligible medical, dental, orvision expenses and prescription drugs for you andyour qualifying dependents.Dependent Care - pay for dependent daycareexpenses that enable you (and your spouse, ifmarried) to be gainfully employed. This care may befor a child 12 or under, or for the care of yourspouse or other dependents such as an invalidparent who is incapable of selfcare.When are the funds available to me?Health Care: the day your benefits beginDependent Care: up to the amount that has beenpayroll deductedHow long do I have to use my funds?FSA dollars are available to use on qualified expensesthrough December 31. You may request reimbursementon qualified expenses received during the 2025calendar year through March 31. Employees whoterminate their FSA mid-year, or are terminated fromemployment, have 90 days from the date FSA benefitsended to submit claims for reimbursement.Can I change my election mid-year?You may change your FSA elections mid-year only if youexperience a qualified life event such as:• A marriage or divorce• Birth or adoption of a child , or• A change in employment statusTASC DEBIT CARDWhen you initially enroll in either the Health Careand/or the Dependent Care FSA, you will receive aTASC Debit Card in the mail. (make sure your addressis up to date in the Staff Portal!) If you enroll in one ofthe FSA plans next year, your card will be pre-loadedagain. If you need an additional card, the fee is $10.Note: Direct deposit or check reimbursements are alsoavailable.USE-IT OR LOSE-ITThis is a use-it or lose-it benefit, meaning if youcontribute more than you spend in the year, then youwill forfeit any unused monies. Look at your health anddependent care expenses from the last few years anddetermine your aver-age out-of-pocket expenses.21

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You have the option to elect Additional Life Insurance in increments up to 5xyour annual salary. Coverage amounts are rounded to the next higher multiple of$1,000, if not already a multiple of $1,000. The maximum amount you mayelect is $300,000. When you elect Additional Life, you are automatically enrolled in AdditionalAD&D. You or your beneficiaries may receive an extra $ amount in the event ofdeath or dismemberment as a result of an accident. Your AD&D coverage isequal to the amount of your Additional Life election. Additional Life has age-banded rates. Rates are based on your age as of January 1, 2025 and do notchange mid-year. NOTE: This is a pre-tax benefit up to $50,000 in coverage. This total includesthe $20,000 of Basic Life paid for by PCPS. Amounts greater than $50,000 willbe payroll deducted on a post-tax basis.ADDITIONAL LIFE AND AD&D INSURANCEAge as ofJan. 1, 2025Rate per$1,000<29$0.07330-34$0.08435-39$0.10540-44$0.14345-49$0.19850-54$0.26655-59$0.28060-64$0.30265+$0.340DEPENDENT LIFEDependent LifeCoverage AmountMonthly RateSpouse$10,000$5.49Child$5,000$0.75What is Evidence of Insurability (EOI)?EOI is an online medical historyquestionnaire. The Standard will usethis to evaluate your application forcoverage. When enrolling online viaBenefitplace, you will be prompted tocomplete your online EOI form whenapplicable. If you do not complete EOIwithin 31 days of enrollment then yourbenefits may not become effective.When EOI is required:When increasing your Additional LifeInsuranceWhen electing Additional Life and/orSpouse Life after your new hire periodWhen your salary increases resultingin a coverage amount greater than theGuarantee Issue ($150,000)When EOI is not required:If you are a New Hire electing SpouseLife and/or Additional Life up to theGuarantee IssueIf you experience a qualified life event(i.e. marriage) you may elect SpouseLife and/or Additional Life up to theGuarantee Issue Life and AD&D InsuranceThe benefit plan information shown in this guide is illustrative only. To the extent the benefit plan information summarized herein differs from the underlyingplan details specified in the insurance documents that govern the terms and conditions of the plans of insurance described in this guide, the underlyinginsurance documents will govern in all cases.BASIC LIFE AND AD&D INSURANCEPCPS provides each benefits-eligible employee with $20,000 of Basic Life Insurance. This coverage includes $10,000of Accidental Death & Dismemberment (AD&D). This benefit is provided to you at no cost. Make sure to designate abeneficiary for your life insurance coverage to ensure your family is cared for according to your wishes.You may elect Dependent Life Insurance at a flat amount of $10,000 for yourspouse and $5,000 for your child. “Child” means your unmarried child(ren) from birth through age 20 (throughage 24 if a registered full-time student at an accredited educationalinstitution), or your unmarried child(ren) who meets the definition of disabilityin the group policy. Your spouse or children must not be full-time member(s) of the armed forces. Ifboth spouses work for PCPS, you may ONLY elect Child Dependent Life.Also, only one spouse can elect Child Dependent Life. In other words, the childcan’t be covered by both parents. Employees cannot cover each other asdependent spouses.GRANDFATHERED TRANSAMERICA LIFEEmployees with Grandfathered Transamerica/Voluntary Life coverage may onlyelect to decrease or cancel their coverage. Spouse Life is limited to 50% of yourGrandfathered Transamerica/Voluntary employee life coverage amount. Loginto Benefitplace to view your current coverages. You may contact the RiskManagement & Benefits Department at any time to change your coverageamount. Did your salary increase? Login to Benefitplace and review your elections for pending Evidence ofInsurability (EOI) completion. Failure to complete EOI will default you to thegreater of the amount you were previously approved for, or the GuaranteeIssue.22

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OptionBenefit WaitingPeriodMaximum BenefitPeriodOption A7 daysup to 25 weeksOption B14 daysup to 24 weeksOption C30 daysup to 22 weeksEnter average weekly earnings,not to exceed $2,917 on Line 11: _____________Multiply Line 1 by 0.60 andenter on Line 2. (Note: thisamount cannot exceed $1,7502: _____________Select your rate from the tableto the right and enter on Line 3. 3: _____________Multiply Line 2 by the amountentered on Line 3.4: _____________Divide the amount on Line 4 by10 and enter on Line 5.5: _____________The amount shown on Line 5 is your estimated monthly payrolldeduction.Short Term Disability RatesAge as of01/01/2025Option A 7 DayOption B 14 DayOption C30 Day<29$1.18$0.83$0.5830-34$1.31$0.90$0.6335-39$0.85$0.56$0.3940-44$0.63$0.40$0.2645-49$0.68$0.42$0.2850-54$0.72$0.45$0.3055-59$0.93$0.5840.3860+$1.18$0.73$0.48Short Term Disability InsuranceThe benefit plan information shown in this guide is illustrative only. To the extent the benefit plan information summarized herein differs from the underlyingplan details specified in the insurance documents that govern the terms and conditions of the plans of insurance described in this guide, the underlyinginsurance documents will govern in all cases.Protect your paycheck with disability insurance through The Standard.Disability coverage insures your paycheck, replacing a portion of your income if you’reunable to work due to a covered illness or injury.STD coverage is designed to help you meet your financialneeds if you are unable to work due to a non-occupationalinjury or illness. STD is a weekly benefit up to 60% of yourpre-disability earnings based upon yearly salary split over52 weeks. This amount is then reduced by any of your otherdeductible income. The maximum weekly benefit is $1,750and the minimum weekly benefit is $15.VOLUNTARY SHORT TERM DISABILTIYSTD has age-banded rates. If you have moved from one age-band to the next, you may see an increase in your premium.Rates are based on your age and salary as of January 1, 2025 and do not change mid-year. Also, rates are taken on apost-tax basis so benefit payments are tax-free. Use the charts below to estimate your monthly payroll deduction.PREMIUM RATESBenefit Waiting Period— the time that you must be continuously disabled before benefits become payable.Maximum Benefit Period— maximum amount of time you can receive benefits. You must exhaust all of youraccumulated sick leave before collecting STD payments.Deductible Income— income you receive or are eligible to receive while disability benefits are payable, such as:Benefits under any state disability income benefit law or similar law.Earnings from work activity while disabled.KEY TERMS23

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AgeMaximumBenefit PeriodAgeMaximum Benefit Period623 years 6 months661 year 9 months633 years671 year 6 months642 years 6 months681 year 3 months652 years69+1 yearEnter average monthly earnings,not to exceed $12,500 on Line 11: _____________Select your rate from the ratetable and divide this by 100.2: _____________Multiply Line 1 by the amountshown on Line 2. 3: _____________The amount shown on Line 3 is your estimatedmonthly payroll deduction.Long Term Disability RatesAge as of 01/01/2025Rate<29$0.1730-34$0.2035-39$0.2540-44$0.3545-49$0.5350-54$0.7955-59$1.0060-64$1.0365-69$1.1470-74$1.2375+$1.94Long Term Disability InsuranceThe benefit plan information shown in this guide is illustrative only. To the extent the benefit plan information summarized herein differs from the underlyingplan details specified in the insurance documents that govern the terms and conditions of the plans of insurance described in this guide, the underlyinginsurance documents will govern in all cases.Protect your paycheck with disability insurance through The Standard.Disability coverage insures your paycheck, replacing a portion of your income if you’reunable to work due to a covered illness or injury.LTD coverage is important for financial protection in theevent your disability continues beyond your STD maximumbenefit period. LTD is a monthly benefit up to 60% ofpre-disability earnings. Keep in mind this is thenreduced by any other deductible income. The maximummonthly benefit is $7,500 and the minimum monthlybenefit is $100. If your claim for LTD benefits is approved by The Standard,benefits become payable after you have beencontinuously disabled for 180 days and remaincontinuously disabled. If you become disabled at age 62or older, the benefit duration is determined by your agewhen disability begins.VOLUNTARY LONG TERM DISABILTIYLTD also has age-banded rates. If you have moved fromone age-band to the next, you may see an increase in yourpremium. Rates are based on your age and salary as ofJanuary 1, 2025 and do not change mid-year. Use thecharts below to estimate your monthly payroll deduction.PREMIUM RATES Not quite sure you need Disability Insurance?Use the PCPS Decision Support Tool to help youdecide what coverage is best for you.Are you in DROP and would consider endingearly if you became ill? You may not want topurchase LTD.Evidence of Insurability (EOI)—If you arechanging LTD/STD disability plan(s) or electingdisability coverage for the first time, EOI is requiredunless you are a new hire. When enrolling inBenefitplace, you will be prompted to completeEOI and will have a pending task in your TO DOLIST. If you do not complete EOI within 31 days ofenrollment then your benefits may not becomeeffective.24

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Did you know our Health & Wellness Centersoffer FREE counseling sessions available both in-person and virtually?Call today to schedule an appointment!863-419-33221-800-272-7252www.resourcesforliving.comLogin: PCS | Password: PCSEmployee Assistance Program Care for your mind – and your life – with support through Aetna Resources for Living.Aetna Resources For Living (Aetna RFL) is an employer sponsored program, available at no cost to you and all membersof your household. That includes dependent children up to age 26, whether or not they live at home. Services areconfidential and available 24 hours a day, 7 days a week.You can call Aetna RFL 24 hours a day for in-the-moment emotional well-being support. You can alsoaccess up to seven (7) counseling sessions per issueeach year. Visit with a counselor face to face, online with televideoor get in-the-moment support by phone. Services arefree and confidential. Aetna RFL counselors can helpwith a wide range of issues including: Relationship supportStress ManagementFamily IssuesWork/family balanceGrief and lossDepression and anxietySUPPORTING YOUR MENTAL WELL-BEING MyStrength offers tools to improve your emotionalhealth and help you overcome depression, anxiety,stress, sub-stance misuse and/or chronic pain,mindfulness, sleep and health parenting. Download theapp today on the Apple or Google Play Store!MyStrength Mobile AppYour member website offers a full range of tools andresources to help with emotional wellbeing, work/lifebalance and more. You’ll find: Articles and self-assessmentsAdult care and child care provider search toolOn-demand videos and live webinarsDiscount center, including low-cost fitnessmemberships!Online Tools & ResourcesTry Talkspace to confidentially text with your therapistwhen you need it! One (1) week of texting equals one (1)EAP visit. Visit redemption.talkspace.com/faq/rfl fordetails.OTHER SERVICES AVAILABLE Mental Health Counseling Simply call for a free 30-minute consultation for eachnew financial topic related to: BudgetingRetirement or other financial planningMortgages and refinancingCredit and debt issuesCollege fundingTax and IRS questions and preparation You can also get a 25% discount on tax prep services.You can receive a 1-hour fraud resolution phoneconsultation or coaching session about ID theftprevention and credit restoration. Services include a freeemergency kit for victims.Identity Theft ServicesFinancial Services Legal ServicesYou can get a free 30-minute consultation with aparticipating attorney for each new legal topic relatedto: GeneralFamilyCriminal LawElder law and estate planning If you opt for services beyond the initial consultation youcan get a 25% discount.DivorceWills and other documentSeparationReal estate transactionsMediation services25

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Website: https://polkschoolsfl.com/retirement/Phone: 863-519-3858Email: PCSB.Retiree@polk-fl.netVoluntary Retirement Savings PlansAuthorized Investment ProvidersAuthorized Investment TypesCompaniesPhone457(b)403(b)ROTH 403(b)American Century Investments1-800-345-3533xxAmeriprise Financial1-863-688-6863xAspire Financial ServicesAllen & Company CPS Investment Advisors1-863-688-90001-877-564-6277xAXA Equitable Life Insurance Co.1-800-628-6673xxxGreat American Financial Resources1-800-854-3649xxxHorace Mann Insurance Company1-800-999-1030xxxLife Insurance Company of the Southwest1-800-579-2878xxxPlan Member Services1-800-874-6910xxxReliastar Life Insurance Co. (ING Retirement) 1-877-884-5050xxxVALIC1-800-369-0314xxxPCPS offers 457(b) deferred compensation plans to itsemployees. These plans are available to certain tax-exempt and governmental employers. With the passageof the Economic Growth and Tax Relief ReconciliationAct of 2001 (EGTRRA), contribution limits weredramatically changed. In addition, 457(b) plans nowhave separate limits which are not reduced by employeecontributions into either a 403(b) or 401(k) plan. All Authorized Investment Providers listed have enteredinto information sharing agreements with the plansponsor. Board Policy and District administrativerequirements allow companies which meet certainstandards and maintain a minimum number of employeeaccounts to provide 403(b) TSA accounts to employees.The companies listed below are currently authorizedunder administrative guidelines to establish 403 and457(b) ac-counts for the employees of PCPS. This listdoes not reflect any opinion as to the financial strengthor quality of product or service for any company.Employees should contact a local representative toobtain specific information on plans available.457(B) DEFERRED COMPENSATION PLANSIn addition to 457(b) deferred compensation plans,PCPS currently supports a 403(b) retirement savingsplan. These plans are available only to employees ofpublic school systems and certain other non-profitorganizations. These employee accounts are commonlyreferred to as Tax Sheltered Annuities or TSAs becauseat one point only standard interest annuities and variableannuities were allowable account types. In 1974 thepassage of the Employee Retirement Income SecurityAct (ERISA) added mutual funds under custodialarrangements as an additional investment option. All regularly scheduled employees may elect tocontribute a limited portion of their salary before taxesto one of the authorized plans available through theiremployer. For more information on contribution limits,see the "Calculations" section of our website.403(B) RETIREMENT SAVINGS PLANThe BENCOR Special Pay Plan is an IRS Section 401(a)qualified retirement plan that permits district employeesto take maximum advantage of Federal tax laws bydeferring Federal withholding taxes and permanentlyavoiding Social Security and Medicare taxes on eligibleaccumulated sick and annual leave payments atretirement. Remember that Administrators (Principals,Directors and Assistant Principals) who also separateservice will also have their sick and vacation leave paidthrough Bencor. More information concerning this planis available in your "Annual Retirement Benefits Guide."BENCOR SPECIAL PAY PLAN26

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Voluntary Retirement Savings PlansThe 403(b) and 457(b) Plans are valuable retirementsavings options. This notice provides a brief explanationof the provisions, policies and rules that govern the403(b) and 457(b) Plans offered. Plan administration services for the 403(b) and 457(b)plans are provided by TSA Consulting Group, Inc.(TSACG). Visit the TSACG website (www.tsacg.com) forinformation about enrollment in the plan, investmentproduct providers available, distributions, exchanges ortransfers, 403(b) and/or 457(b) loans, and rollovers.403(B) & 457(B) DEFERRED COMPENSATION PLANSTHE BASIC CONTRIBUTION LIMIT FOR 2021 IS $19,500.Most employees are eligible to participate in the 403(b)and 457(b) plans immediately upon employment,however, private contractors, appointed/electedtrustees and/or school board members and studentworkers are not eligible to participate in the 403(b) Plan.Employees may make voluntary elective deferrals to boththe 403(b) and 457(b) plans. Participants are fully vestedin their contributions and earnings at all times.ELIGIBILITYUpon enrollment, participants designate a portion oftheir salary that they wish to contribute to theirtraditional 403(b) and/or 457(b) account(s) up to theirmaximum annual contribution amount on a pre-taxbasis, thus reducing the participant’s taxable income.Contributions to the participant's 403(b) or 457(b)accounts are made from income paid through theemployer's payroll system. Taxes on contributions andany earnings are deferred until the participant withdrawstheir funds.EMPLOYEE CONTRIBUTIONSTraditional 403(b) and 457(b)Contributions made to a Roth 403(b) account are after-tax deductions from your paycheck. Income taxes arenot reduced by contributions you make to your account.All qualified distributions from Roth 403(b) accounts aretax-free. Any earnings on your deposits are not taxed aslong as they remain in your account for five years fromthe date that your first Roth contribution was made.Distributions may be taken if you are 59½ (subject toplan document provisions) or at separation from service. The IRS regulations limit the amount participants maycon-tribute annually to tax-advantaged retirement plansand imposes substantial penalties for violatingcontribution limits. TSACG monitors 403(b) plancontributions and notifies the employer in the event ofan excess contribution. Roth 403(b)Participants who are age 50 or older any time during theyear qualify to make an additional contribution of up to$6,500 to the 403(b) and/or 457(b) accounts.Additional provisions allowed:AGE-BASED AMOUNTThe 403(b) special catch-up provision allowsparticipants to make additional contributions of up to$3,000 to the 403(b) account if, as of the precedingcalendar year, the participant has completed 15 or morefull years of employment with the current employer, notaveraged over $5,000 per year in annual contributions,and has not utilized catch-up contributions in excess ofthe aggregate of $15,000. For a detailed explanation ofthis provision, please visit https://www.tsacg.com.THE SERVICE-BASED CATCH UP AMOUNTEmployees who wish to enroll in the 403(b) and/or457(b) plan can simply go to myquickenroll.com, choosean investment provider, complete the short enrollmentprocess, and you will be on your way to to saving forretirement as soon as your next available payday. Yourcan also use the same system to stop or modifycontributions to 403(b) and/or 457(b) accounts. Unlessotherwise notified by your employer, you may enrolland/or make changes to your current contributionsanytime throughout the year. Please note: The total annual amount of a participant'scontributions must not exceed the Maximum AllowableContribution (MAC) calculation. For convenience, aMAC calculator is available at www.tsacg.com.ENROLLMENTA current list of authorized 403(b) and 457(b) InvestmentProviders are available on the employer's specific webpage at www.tsacg.com.INVESTMENT PROVIDER INFORMATIONDistribution transactions may include any of thefollowing depending on the employer's Plan Document:loans, transfers, rollovers, exchanges, hardships,unforeseen financial emergency withdrawals ordistributions. Participants may request thesedistributions by completing the necessary formsobtained from the provider and plan administrator asrequired. All completed forms should be submitted tothe plan administrator for processing.PLAN DISTRIBUTION TRANSACTIONS27

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Voluntary Retirement Savings PlansA plan-to-plan transfer is defined as the movement of a403(b) and/or 457(b) account from a previous plansponsor's plan and retaining the same account with theauthorized investment provider under the new plansponsor's plan.PLAN-TO-PLAN TRANSFERSParticipants may move funds from one qualified planaccount, i.e. 403(b) account, 401(k) account or an IRA,to another qualified plan account at age 59½ or whenseparated from service. Rollovers do not create ataxable event.ROLLOVERSRetirement plan distributions are restricted by IRSregulations. A participant may not take a distribution of403(b) plan accumulations without penalty unless theyhave attained age 59½ or separated from service in theyear in which they turn 55 or older. Generally, adistribution can-not be made from a 457(b) accountuntil you have a severance from employment or reachage 70½. In most cases, any withdrawals made from a403(b) or 457(b) ac-count are taxable in full as ordinaryincome.DISTRIBUTIONSWithin each plan, participants may exchange accountac-cumulations from one investment provider to anotherinvestment provider that is authorized under the sameplan; however, there may be limitations affecting ex-changes, and participants should be aware of anycharges or penalties that may exist in individualinvestment contracts prior to exchange. Exchanges canonly be made from one 457(b) plan to another 457(b)plan, or from one 403(b) plan to another 403(b) plan.Participants may be able to take a hardship withdrawalin the event of an immediate and heavy financial need.To be eligible for a hardship withdrawal according to IRSSafe Harbor regulations, you must verify and provideevidence that the distribution is being taken for specificrea-sons. These eligibility requirements to receive aHardship withdrawal are provided on the HardshipWithdrawal Dis-closure form at www.tsacg.com.HARDSHIP WITHDRAWALSYou may be able to take a withdrawal from your 457(b)account in the event of an unforeseen financialemergency. An unforeseeable emergency is defined as asevere financial hardship of the participant orbeneficiary. The eligibility requirements to receive aUnforeseen Financial Emergency Withdrawal areprovided on the Unforeseen Financial EmergencyWithdrawal Disclosure form at www.tsacg.com.UNFORESEEN FINANCIAL EMERGENCYWITHDRAWALParticipants in defined contribution plans areresponsible for determining which, if any, investmentvehicles best serve their retirement objectives. The403(b) and 457(b) plan assets are invested solely inaccordance with the participant’s instructions. Theparticipant should periodically review whether his/herobjectives are being met, and if the objectives havechanged, the participant should make the appropriatechanges. Careful planning with a tax ad-visor orfinancial planner may help to ensure that thesupplemental retirement savings plan meets theparticipant's objectives.EMPLOYEE INFORMATION STATEMENTEXCHANGESParticipants may be eligible to borrow their 403(b)and/or 457(b) plan accumulations depending on theprovisions of their 403(b) and/or 457(b) accountcontract and provisions of the employer plan. If loans areavailable, they are generally granted for a term of fiveyears or less (general-purpose loans). Loans taken topurchase a principal residence can extend the termbeyond five years depending on the provisions of their403(b) and/or 457(b) account contract and provisions ofthe employer. Details and terms of the loan areestablished by the provider. Participants must repaytheir loans through monthly payments as directed by theprovider. Prior to taking a loan, participants shouldconsult a tax advisor.403(B) AND 457(B) PLAN LOANSTransactionsP.O. Box 4037Fort Walton Beach, FL 32549Toll-free: 1-888-796-3786Toll-free fax: 1-866-741-0645For overnight deliveries73 Eglin Parkway NE, Suite 202 Fort Walton Beach, FL 32548Toll-free: 1-888-796-3786Toll-free fax: 1-866-741-064528

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COBRA CoverageThe Consolidated Omnibus Budget Reconciliation Act (COBRA) requires continuation coverage to be offered to coveredemployees, their spouses, their former spouses, and their dependent children when group health coverage wouldotherwise be lost due to certain specific events. PCPS provides COBRA coverage through our vendor partner TASC.COBRA provides a temporary continuation of grouphealth coverage that would otherwise be lost due tocertain life events. COBRA coverage typically lasts for18-36 months depending on the qualifying event.What is COBRA continuation coverage?COBRA coverage is identical to the coverage currentlyavailable to similarly situated employees. Generally, thisis the same health coverage that the individual hadimmediately before the qualifying event (i.e. Health,Dental, and/or Vision).What benefits are offered under COBRA?COBRA is offered to qualified beneficiaries after aCOBRA qualifying event has occurred. Qualified beneficiaries include:an employee who was covered by PCPS’ Health Planon the day before a qualifying event occurredthat employee's spouse, former spouse, ordependent child who were covered at the time ofthe event.In addition, any child born to or placed for adoptionwith a covered employee during a period ofcontinuation coverage is automatically considered aqualified beneficiary.Who is eligible for COBRA continuation coverage?Qualifying events are events that cause an individual tolose group health coverage. The type of qualifying eventdetermines who the qualified beneficiaries are and theperiod of time that a plan must offer continuationcoverage. The following are COBRA qualifying events that causean covered employee to lose coverage under PCPS’Health Plan:Termination of the employment for any reason otherthan “gross misconduct,” orReduction in the employee’s hours of employmentWhat is a COBRA qualifying event?The following are COBRA qualifying events for a spouseand dependent child of a covered employee if theycause the spouse or dependent child to lose coverage:Termination of the covered employee's employmentfor any reason other than “gross misconduct,”Reduction in hours worked by the coveredemployee,Covered employee becomes entitled to Medicare,Divorce or legal separation from the coveredemployee, orDeath of the covered employee. In addition to the above, the following is a qualifyingevent for a dependent child of a covered employee ifit causes the child to lose coverage: Loss of “dependent child” status under the planrules. Under the Affordable Care Act, plans that offercoverage to children on their parents’ plan mustmake coverage available until the child reaches theage of 26.More details about COBRA coverage, including COBRAnotice and election requirements, and how long COBRAcoverage must last, are included in the booklet AnEmployee's Guide to Health Benefits Under COBRA If you are a current COBRA participant, you may contactTASC at 800-422-4661 for assistance.Who can answer other COBRA questions?29

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COBRA PremiumsThe cost of COBRA coverage is 102% of the total premium. The total premium includes the employer portion plus theemployee portion. When you and/or your family members become eligible for COBRA under this plan, TASC will sendyou a personalized COBRA packet outlining your health coverage options, steps to enroll, and how to pay yourpremiums.Coverage LevelMonthly PremiumPCPS Health Care PlanEmployee Only (Board Funded)$978.18Employee & Spouse$1,584.06Employee & One Child$1,085.28Employee & Two Children$1,192.38Employee & Three Children$1,228.08Employee, Spouse & One Children$1,691.16Employee, Spouse & Two Children$1,798.26Employee, Spouse & 3+ Children$1,833.96Delta Dental - Low PlanEmployee Only$12.07Employee & Spouse$23.84Employee & Child(ren)$29.61Employee & Family$35.85Delta Dental - Middle PlanEmployee Only$20.74Employee & Spouse$41.45Employee & Child(ren)$52.26Employee & Family$71.77Delta Dental - High PlanEmployee Only$39.71Employee & Spouse$76.87Employee & Child(ren)$93.17Employee & Family$123.87Avesis Vision - Low PlanEmployee Only$5.67Employee & Spouse$10.26Employee & Child(ren)$10.65Employee & Family$6.41Avesis Vision - High PlanEmployee Only$8.69Employee & Spouse$15.73Employee & Child(ren)$16.33Employee & Family$25.1630

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Leave of AbsenceThe Leave of Absence (LOA) program run by Risk Management is designed to assist PCPS employees who aretemporarily unable to work due to a serious personal illness or the serious illness of a family member. The RiskManagement Department strives to ensure employees out due to medical necessity are placed on the appropriate leaveof absence as timely as possible in an attempt to eliminate the possibility of an over-payment to the employee.Leave of Absence (LOA) is a general term referring toemployer approved time off for a qualifying employee.There are several types of LOA; however, RiskManagement specifically handles those pertaining tomedical related reasons. Employees must be on approved leave of absence forabsesnces longer than three (3) consecutive days.What is a Leave of Absence?Risk Management handles the following types of LOA:Family Medical Leave (FMLA)Medical LeaveParental Leave To request a Leave of Absence Request Form pleasesubmit a ticket via Incident IQ. For questions pleasecontact Risk Management at 863-519-3858 option 4or email us at LeaveofAbsence.PCSB@polk-fl.net. Employee Relations handles the following type ofLOA:Charter LeavePersonal LeaveTeacher Intern w/BenefitsEducational LeaveMilitary LeaveWho processes Leave of Absences?No. FMLA, Medical, and Parental Leaves are unpaid.However, you may use your accumulated sick and/orvacation time in concurrence with you LOA. Alternative Resources that may be available for supplementingyour income include:If you are actively covered under Short-term and/or Long-term Disability, consider filing a claim with The Standard. Request to draw from the Sick Leave Bank if you are amember of this program and experience a catastrophicevent* Consider receiving donated sick time from a family or friendwho is also a PCPS employee. Donate up to 200 hours perleave to employees in need by contacting RiskManagement.* *Specific requirements must be met. Refer to the Boardpolicy on sick leave for more information.Are Leave of Absences paid?Additional Resources:Leave of Absence – Secretaries GuideLeave of Absence FAQ’sLeave of Absence – Quick Reference Guide31Maternity and paternity leave is available to all PCPSemployees. This leave can be requested throughIncident IQ or via email in the event you no longerhave access to District email/systems. The leave isunpaid, unless you have sick/personal time to coverabsences. Probationary employees also qualify formaternity or paternity leave. Parental leave can be taken after the child's birth orthe date of adoption. It is not available for use beforethese events. You can be out for up to 1 year from the baby’sdate of birth, or adoption. This leave does not cover health insurance andemployee will be billed for all deductions. Healthbenefits can be cancelled while out onmaternity/parental leave. Once an employee is ready to return to work, youmust contact Risk Management seven (7) days inadvance and provide a written notification of thereturn date to ensure a smooth transition back towork.All insurance billing for District-sponsored benefits is managedby the Risk Management Department. Employees areresponsible for payment of benefits that would normally be paidthrough payroll deductions. If you would like to make changesto your benefits, please contact the Risk ManagementDepartment. What happens to my insurance during leave? Is Maternity or Paternity Leave Available? FMLA is a federal law that provides eligible employeeswith up to 12 weeks (60 days) of job protected leave. The lawalso requires that during this time, the employee’s Boardhealth insurance premiums are paid for by PCPS just as theyare while the employee is actively working. The employee isstill responsible for all other deductions they may have.What is the Family and Medical Leave Act (FMLA)?You are eligible if you have met ALL of the following:Completed at least one (1) year of employment withPCPS in the last seven (7) yearsWorked at least 1250 hours in the immediate 12 monthspreceding the start date of your leaveHave not exhausted 12-weeks or 60 days of FMLA time inthe immediate 12 months preceding the start date of yourleave. Please note that ADA accommodations may be availableto you if you are not eligible for LOA or FMLA.How do I know if I am eligible for FMLA leave?

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Retiree Benefits Eligibility Employees and dependents who retire are eligible tocontinue insurance coverage(s) as long as they werecovered by the PCPS’ Health Plan (plan). Coveragewould be on the same plan, and level of coverage inplace at the time of retirement (e.g., employee andspouse). The employee must also begin receivingretirement benefits immediately upon retirement.UNDER 65 (NON-MEDICARE ELIGIBLE)For new retirees over 65 or for those approaching age 65(typically 6 months prior), they may begin reviewingbenefits offered through the Florida Retiree BenefitsConsortium (FSRBC) and register for an account athttps://myfsrbc.com. FSRBC is a large pool of retiredschool board agencies that group their purchasingpower to purchase unique benefits for the over 65 ofSchool Board retirees. FSRBC will assist the retiree with new enrollment,changes, and future open enrollments. Even if a retireedid not elect benefits with Polk when they retired, theycan still access benefits through FSRBC. For retirees/dependents turning 65 at various times,please see the information about “split plan coverage”below.OVER 65 (MEDICARE-ELIGIBLE)Has met the age and service requirements to qualifyfor a normal retirement as set forth in s. 121.021(29),Florida Statutes Attained the age specified by s. 72(t)(2)(A)(i) of theInternal Revenue Code (age 59-1/2) and has theyears of services required for vesting as set forth in s.121.021(45) Is placed on disability retirement and beginsreceiving retirement benefits immediately afterretirement from employment Takes a distribution from the Investment Planimmediately (minimum rollover of all funds from FRSto another fund or a cash distribution). You MUSTindicate you are retiring with Polk County Schoolswhen you turn in your letter to yourPrincipal/Supervisor. Dependents are eligible until they reach the limiting ageor until the death of the employee. For a spouse, legalmarriage must exist for continued eligibility. Followingthe death of the employee, or divorce, COBRA coverageis offered. See page 5 for the dependent eligibilityguidelines.Other situations when the employee:For retirees who turn 65, but have a spouse ordependent covered under 65, the following are therule(s)/option(s):Medical – The spouse/retiree is enrolled under theirown social security number/contract number at theUnder 65 price.Dental & Vision – The spouse or dependent followsthe retiree.Retiree is over 65 - the entire family enrollsunder the dental and vision plans offered by theFSRBC (over 65 group benefit administrator).Retiree Under 65 - the family stays under theSchool Board’s group plans until the retiree isover 65.SPLIT PLAN COVERAGE – RETIREES OVER 65 &UNDER 65 DEPENDENTS (OR VICE VERSA)32

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Retiree Dental, Vision, Life & WellnessRetirees and dependent(s) under 65 that are coveredunder the PCPS Health Care Plan are eligible to utilizethe Health & Wellness Centers. In addition, retirees andtheir dependent(s) under 65 can take advantage ofwellness programs, such as ABCs of Diabetes at no cost.See page 14-16 for available programs. Retirees and dependent(s) that are Medicare-eligible orare not covered under the Polk Health Plan are noteligible to use the Employee Health Center or WellnessPrograms. Retirees and dependent(s) who were enrolled in BCBSBlue Medicare Program prior to January 1, 2019, areeligible to use the Employee Health Center & WellnessPrograms. These retirees must continue enrollment inthat specific plan option (BCBS Blue Medicare) tocontinue eligibility.HEALTH & WELLNESS CENTERSYou may continue into retirement the district-paiddental or vision policies by paying the group rate. Forinformation on the vision & dental benefits, see pages19-20. You must continue the same dental and vision insuranceoption you had when you were employed. You maychange plans during annual enrollment. Please see page 32 for rules on Split Plan Coverage forthose employees or spouses attaining age 65 orMedicare early due to disability.DENTAL AND VISION INSURANCEYour life insurance premium also increases with agebased on each age band. Therefore, retirees areencouraged to only buy what is necessary for finalexpenses and to consult with their family membersor beneficiary. If you would like to decrease yourcoverage, you may do so at any time by contacting RiskManagement.LIFE INSURANCE PREMIUMSRetirees are given the option to continue group term lifeinsurance through The Standard. At the time ofretirement, you have the option to maintain your basicand/or additional life insurance as a “combined” lifeinsurance amount. As a retiree, you may only decreasecover-age in percent increments of 65%, 50%, and 35%.The minimum amount you may purchase is 35% of theamount in effect prior to your retirement date. Inaddition, coverage automatically reduces when youreach ages shown below:RETIREE LIFE INSURANCEAgePercent65-6965% (would reduce coverage by 35%)70-7450% (would reduce coverage by 50%)75+35% (would reduce coverage by 65%)Each reduction is based on the original coverage amountat retirement. Example: you had $100,000 of coverage at time ofretirement. Your coverage would reduce as follows: Age 65 – 69: $65,000Age 70 – 74: $50,000Age 75+: $35,000Age as of 01/01/2025Rate per $1,0000-50$0.40651-54$0.58255-59$0.87460-64$1.11365-69$1.75870-74$2.79875-79$4.61880-84$7.31185-89$11.65890+$38.355Beneficiaries can be kept up-to-date by logging intoBenefitplace and submit-ting a change online or bycontacting Risk Management.33

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The benefit plan information shown in this guide is illustrative only. To the extent the benefit plan information summarized herein differs from the underlyingplan details specified in the insurance documents that govern the terms and conditions of the plans of insurance described in this guide, the underlyinginsurance documents will govern in all cases. Retiree Benefits EnrollmentRetirees have 60 days from the date of retirement(finalized Retirement employment action) to elect retireebenefits using Benefitplace. Failure to enroll during thistime, means benefits are permanently forfeited.ENROLLMENTIf you returning to work as a sub, you will keep yourpost 65 benefits. Employees over 65 that elect Medicare Part B may wantto consider if they want to elect the PCPS Health Plan(coverage can be waived) or keep Part B when theyreturn to work. Remember: you will continue to pay apremium through Social Security for Part B, and it will besecondary to PCPS Health Plan when you are activelyworking. Note that separation from employment entitlesyou to a special enrollment with Medicare without apenalty for late enrollment.RE-EMPLOYED RETIREESThe only other time outside of Open Enrollment you areallowed to make changes to your benefits elections is ifyou experience a qualified life event. You must log on toBenefitplace and request the change within 31 days ofthe event to be eligible to change your elections.New Dependent – Retirees may add a new spouseand/or any newly eligible children because of themarriage only if the marriage occurs after retirement.Adoption, birth, or court-ordered coverage are alsopermitted changes. All changes must be requestedwithin 31 days with appropriate documentation. Gain of Other Coverage – If a retiree or dependentgains other coverage during the year, they canterminate coverage. Additional documentation isrequired, and the request must be made within 31days of the new coverage effective date. Death of Retiree – Any eligible dependentscovered by the retiree shall cease to be eligible forbenefits with Polk County Schools and will beoffered COBRA coverage.CHANGING YOUR BENEFIT ELECTIONSAfter one month - Retirees who return toemployment with PCPS are required to re-satisfy awaiting period for all group insurance benefits. Newbenefits must be elected, or default benefits will beassigned, including paid medical coverage and lifeinsurance coverage. To waive benefits, an activeenrollment election must be made. Less than one month – Retirees who return to workwithin 30 days are not required to satisfy a waitingperiod. The benefits will be assigned that were inplace prior to separation. Substitute(s) or Ineligible Position – A substituteor an employee in a non-benefits eligible position,means you would maintain your retiree benefits.When can I return to work?Make sure you understand FRS rules forreemployment or you may have to repay DROP &pension benefits. See the resource links below:Re-employment Rules for Pension PlanRe-employment Rules for Investment PlanPension Plan Re-employment TableInvestment Plan Re-employment Table34

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Retiree PremiumsThe following rates are for non-Medicare Retirees and Split Plan Retirees:Coverage LevelMonthly PremiumPCPS Health Care PlanRetiree Under 65 Only$594.00Retiree & Spouse Under 65$1,188.00Retiree Under 65 & 3+ Children$839.00Retiree Under 65 & One Child$699.00Retiree Under 65 & Two Children$804.00Retiree, Spouse & 3+ Child Under 65$1,433.00Retiree, Spouse & One Child Under 65$1,293.00Retiree, Spouse & 2 Children Under 65$1,398.001 Child Only$105.002 Children Only$210.003+ Children Only$245.00Spouse Only$594.00Spouse Under 65 & 3+ Children Only$839.00Spouse Under 65 & 1 Child Only$699.00Spouse Under 65 & 2 Children Only $804.00Delta Dental - Low PlanRetiree Only$11.83Retiree & Spouse$23.37Retiree & Child(ren)$29.03Retiree & Family$35.15Delta Dental - Middle PlanRetiree Only$20.33Retiree & Spouse$40.64Retiree & Child(ren)$51.24Retiree & Family$70.36Delta Dental - High PlanRetiree Only$38.93Retiree & Spouse$75.36Retiree & Child(ren)$91.34Retiree & Family$121.44Avesis Vision - Low PlanRetiree Only$6.54Retiree & Spouse$11.84Retiree & Child(ren)$12.29Retiree & Family$18.94Avesis Vision - High PlanRetiree Only$8.52Retiree & Spouse$15.42Retiree & Child(ren)$16.01Retiree & Family$24.6735

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Payment Due DatesPayments are due by the 1st of the monthfor the following month’s cover-age. TheDistrict will not send reminders. It will beyour responsibility to pay by the due date.The District will allow a 10-day grace period.Late PaymentsWith automated deduction of retireepremium, we do not anticipate latepayments, however, in the event of a non-payment by the bank or FRS, the District willexpect that these payments be made by the10th of the month they are due. Anysubsequent late payments can result in achange in benefit payment method orpermanent cancellation of retiree benefitsthat are not able to be reinstated.Grace periods may be extended for dis-abled retirees who are awaiting approval andretroactive disability benefits.Retiree Benefit Payment OptionsThis is the recommended payment method for retiree insurancepremiums for those retirees on the pension plan. Payments aretaken through payroll deductions. The first month may be handled by direct bill depending uponwhen you will be added to the retirement payroll. Deductions arepaid in advance for the following month’s coverage (e.g., end ofFebruary payroll is for March premium).FLORIDA RETIREMENT SYSTEM (FRS)Direct billing via coupons is the alternate method of payment forretiree insurance benefits. This payment type is reserved forthose retirees who qualify to continue health insurance benefitsunder the investment plan option or whose pension is insufficientto handle the retiree insurance premiums.DIRECT BILLINGThe alternate method of payment for retirees is a direct deductionfrom the retiree’s bank account. This method is used for retireeswhose insurance deduction(s) exceed the amount of their FRSpayroll check or for Investment Plan participants who do notreceive a monthly FRS check. Retirees must sign an authorizationform. Deductions are made from your bank account on the 3rd ofthe month for that month’s insurance premium.ACH BANK ACCOUNT DRAFTThe Health Insurance Subsidy (HIS) is additional moneyadded to your monthly retirement benefit to help offsetthe cost of your health insurance. The HIS is not a healthinsurance policy. Eligible retirees will receive $5 permonth for each year of creditable service used tocalculate the retirement benefit. Years of employment inthe Deferred Retirement Option Program (DROP) do notcount towards your total years of service for the HIScalculation. Effective July 1, 2001, the paymentincreased to at least $30 but no more than $150 permonth. This subsidy is contingent upon continuedapproval by the Florida Legislature.HEALTH INSURANCE SUBSIDY (HIS)If your health insurance will be through PCPS HealthPlan AND the District is providing you with your healthinsurance AND you have signed up for FRS deduction,then you may complete the form yourself by checkingthe first option on the application, sign and mail the formback to the FRS. You pay through direct billing (ACH or Invoice). TheDistrict must complete the form for you. The completed HIS application must be returned to theFlorida Division of Retirement within six months of thedate retirement benefits started to receive the subsidyretroactive to the effective date of retirement (or themonth following DROP termination if applicable). If theHIS form is not received within six months, retroactivesubsidy payments will be limited to a max of six months.DROP participants cannot apply for the HIS until theyhave terminated employment and participation in DROP.The subsidy must be applied for—it is not automatic.FRS will mail the retiree an application after beingadded on the State’s payroll. It is the retiree’sresponsibility to apply in a timely manner to receive thebenefit. Please refer to your FRS information for moredetails.36

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Benefit TypeCarrier/Vendor Phone/WebMy PCPS Health Plan Meritain (Medical)WellDyne (Pharmacy)Quantum Health (Care Coordinator)866-871-0975www.MyPCPSHealth.comVision InsuranceAvesis1-800-828-9341www.avesis.comDental InsuranceDelta Dental1-800-521-2651www.deltadentalins.comFlexible Spending Accounts (FSAs)TASC1-800-422-4661www.tasconline.comEmployee Assistance Program (EAP)Aetna Resources for Living1-800-272-7252www.resourcesforliving.comLogin: PCS | Password: PCSHealth & Wellness CenterMarathon1-863-419-3322polkschoolsfl.com/wellness/Health & Wellness Center -Wellness StaffMarathon1-863-419-3322polkschoolsfl.com/wellness/Life and AD&D InsuranceThe Standard1-800-628-8600www.standard.com/Short-Term Disability InsuranceThe Standard1-800-368-2859www.standard.com/Long-Term Disability InsuranceThe Standard1-800-368-1135www.standard.com/Risk Management &Benefits DepartmentRisk Management &Benefits Department1-863-519-3858polkschoolsfl.com/benefits/COBRATASC1-800-422-4661www.tasconline.comFlorida Retirement System (FRS)Florida Retirement System (FRS)1-866-446-9377www.myFRS.comBenefitplaceBenefitplace1-877-336-8082 (login support only)secure3-enroll.com/go/polkschoolsBenefits Contact Information37

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The benefit plan information shown in this guide is illustrative only. To the extent the benefit plan information summarized herein differs from the underlyingplan details specified in the insurance documents that govern the terms and conditions of the plans of insurance described in this guide, the underlyinginsurance documents will govern in all cases.Required Notices & DisclosuresNon-Discrimination StatementThe School Board of Polk County, Florida, prohibits anyand all forms of discrimination and harassment. It is thepolicy of Polk County Public Schools to not dis-criminate in admission or access to, or employment in itsprograms and activities on the basis of race, color,national origin, sex, gender, sexual orientation, genderexpression or identity, pregnancy, age, homelessness,disability, or the use of trained guide dog or serviceanimal, veteran or military status, marital status, geneticinformation, or other legally protected classification inits educational programs or services. The District also provides equal access to its facilities tothe Boy Scouts and other Title 34 patriotic youth groups,as required by the Boys Scout of America Equal AccessAct (34 C.F.R. 108.9). This holds true for all studentswho are interested in participating in educationalprograms and extracurricular school activities. The following persons have been designated to handleinquiries regarding the non-discrimination policies,reports of alleged violations, concerns aboutcompliance and the grievance procedure(s), etc.: The School Board of Polk County, Florida, Policies 1122,2260, 3122 and 4122, Florida Educational Equity Act,Section 1000.05, F.S., Rule 6A‐19.000 through 6A‐19.010, FAC, Title VII of the Civil Rights Act of 1964,Section 504, Americans with Disabilities Act of 1990 asamended, Vocational Guidelines, Age Discrimination inEmployment Act of 1967, Title IX of the EducationAmendments of 1972, and the Boy Scouts of AmericaEqual Access Act 34 C.F.R. 108.9.ADA/EEO Coordinator: ConSheryl Adams – Equity Compliance Officer Office of Equity and Diversity Management Polk County Public Schools 1915 S. Floral Avenue Bartow, FL 33831863-534-0781 ext. 570consheryl.adams@polk-fl.netSection 504: Tammy Williams – Assistant Superintendent Office ofLearning Support Polk County Public Schools 1915 S. Floral Avenue Bartow, FL 33831 863-535-6488 ext. 464tammy.williams@polk-fl.netTitle IX:Dr. Adrian Anthony, MBA, Ed.S., Ed.D - Senior DirectorOffice of Equity and Diversity ManagementPolk County Public Schools1915 S. Floral AvenueBartow, FL 33831863-534-0781 ext. 569adrian.anthony@polk-fl.netAll of our required benefit notices are available onlinevia Benefitplace. To request paper copies, pleasecontact the Risk Management & Benefits Department.38

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