EMPLOYEE BENEFIT HIGHLIGHTS
2023-2024
Hillsborough County Aviation Authority
|
Employee Benefit Highlights
|
2023-2024
© 2016, Gehring Group, Inc., All Rights Reserved
Table of Contents
Contact Information 1
Introduction 2
Group Insurance Eligibility 2-3
Qualifying Events and Section 125 3
Medical Plan Resources 4
Telehealth 4
Summary of Benefits and Coverage 4
Medical Insurance 5-6
Aetna Open Access Plan At-A-Glance 7
Aetna Choice POS II Plan At-A-Glance 8
Dental Insurance 9
Humana PPO W/O & W/ Orthodontia Plans At-A-Glance 10
Vision Insurance 11
Humana Vision Plan At-A-Glance 12
Flexible Spending Accounts 13-14
Employee Assistance Program 15
Basic Life and AD&D Insurance 15
Voluntary Life and AD&D Insurance 16
Long Term Disability 17
Employee Health, Wellness, and Engagement 18
Notes 19-20
This booklet is merely a summary of employee benefits. For a full description, refer to the plan document. Where conflict exists between this summary and the plan document, the plan document controls.
Hillsborough County Aviation Authority reserves the right to amend, modify or terminate the plan at any time. This booklet should not be construed as a guarantee of employment.
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Hillsborough County Aviation Authority
|
Employee Benefit Highlights
|
2023-2024
© 2016, Gehring Group, Inc., All Rights Reserved
Contact Information
Human Resources
Lynn Davis
Human Resources Benefits Manager
Phone: (813) 554-1493
Email: ldavis@TampaAirport.com
Medical Insurance Aetna
Customer Service: (866) 983-0108
www.aetna.com
Prescription Drug Coverage
& Mail-Order Program
CVS Caremark
Customer Service: (888) 792-3862
www.aetna.com
Specialty Pharmacy Prudent Rx
Customer Service: (800) 578-4403
www.prudentrx.com
Telehealth Teladoc
Aetna | Customer Service: (855) 835-2362
www.teladoc.com
Dental Insurance Humana
Customer Service: (800) 233-4013
www.humana.com/dental
Vision Insurance Humana
Customer Service: (800) 448-6262
www.humana.com
Flexible Spending Accounts PayFlex
Customer Service: (844) 729-3539
www.PayFlex.com
Employee Assistance Program Aetna Resources for Living
Customer Service: (888) 238-6232
www.resourcesforliving.com
Basic Life and AD&D Insurance
Securian Financial, Administered
by Ochs
Customer Service: (800) 392-7295
www.ochsinc.com
Voluntary Life and AD&D Insurance
Securian Financial, Administered
by Ochs
Customer Service: (800) 392-7295
www.ochsinc.com
Long Term Disability Insurance The Standard
Customer Service: (800) 628-8600
www.standard.com
Retirement Plans
Florida Retirement System (FRS)
Customer Service: (844) 377-1888
www.myfrs.com
MissionSquare Retirement
Customer Service: (800) 669-7400
www.missionsq.org
Representative: Sharyn Hyla | Phone: (202) 759-7219
Email: [email protected]g
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Hillsborough County Aviation Authority
|
Employee Benefit Highlights
|
2023-2024
© 2016, Gehring Group, Inc., All Rights Reserved
Introduction
The Hillsborough County Aviation Authority provides group insurance benefits
to eligible employees. The Employee Benefit Highlights Booklet provides a
general summary of the benefit options as a convenient reference. Please refer
to the Authority's Personnel Policies and/or Certificates of Coverage for detailed
descriptions of all available employee benefit programs and stipulations
therein. If employee requires further explanation or needs assistance regarding
claims processing, please refer to the customer service phone numbers under
each benefit description heading or contact Human Resources.
Group Insurance Eligibility
The Authority's group insurance plan year
is August 1 through July 31.
Employee Eligibility
Employees are eligible to participate in the Authority's medical, dental and vision
insurance plans if they are full-time employees working a minimum of 30 hours
per week. Employees are eligible for the Authority's Basic and Voluntary Life
insurance plan if working a minimum of 40 hours per week. Coverage will be
effective the first of the month following 30 days of employment. For example,
if employee is hired on April 11, then the effective date of coverage will be June
1. Long Term Disability is available to employees following 6 months of full-time
employment.
Separation of Employment
If employee separates employment from The Authority, insurance for medical,
dental and vision will continue through the end of month in which separation
occurred. Other coverage may terminate on the last date of employment.
COBRA continuation of coverage may be available as applicable by law.
Group Insurance Eligibility (Continued)
Dependent Eligibility
A dependent is defined as the legal spouse/domestic partner and/or dependent
child(ren) of the participant or spouse/domestic partner. The term “child”
includes any of the following:
• A natural child • A stepchild • A legally adopted child
• A newborn child (up to the age of 18 months) of a covered
dependent (Florida)
• A child for whom legal guardianship has been awarded to the
participant or the participant’s spouse/domestic partner
Dependent Age Requirements
Medical Coverage: A dependent child may be covered through the
end of the calendar year in which the child turns age 26. An over-
age dependent may continue to be covered on the medical plan to
the end of the calendar year in which the child reaches age 30, if the
dependent meets the following requirements:
• Unmarried with no dependents; and
• A Florida resident, or full-time or part-time student; and
• Otherwise uninsured; and
• Not entitled to Medicare benefits under Title XVIII of the
Social Security Act, unless the child is disabled.
Dental Coverage: A dependent child may be covered through the
end of the calendar year in which the child turns age 26.
Vision Coverage: A dependent child may be covered through the end
of the calendar year in which the child turns age 26.
Please see Taxable Dependents if covering eligible over-age dependents.
Disabled Dependents
Coverage for a dependent child may be continued beyond age 26 if:
• The dependent is physically or mentally disabled and incapable of
self-sustaining employment (prior to age 26); and
• Primarily dependent upon the employee for support; and
• The dependent is otherwise eligible for coverage under the group's
insurance plans; and
• The dependent has been continuously insured.
Proof of disability will be required upon request. Please contact Human
Resources if further clarification is needed.
AUGUST
01
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Hillsborough County Aviation Authority
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Employee Benefit Highlights
|
2023-2024
© 2016, Gehring Group, Inc., All Rights Reserved
Group Insurance Eligibility (Continued)
Taxable Dependents
Employee covering adult child(ren) under employee's medical, dental and vision insurance plans may continue to have the related coverage premiums payroll deducted
on a pre-tax basis through the end of the calendar year in which dependent child reaches age 26. Beginning January 1 of the calendar year in which dependent child
reaches age 27 through the end of the calendar year in which the dependent child reaches age 30, imputed income must be reported on the employee’s W-2 for that
entire tax year and will be subject to all applicable Federal, Social Security and Medicare taxes. Imputed income is the dollar value of insurance coverage attributable
to covering each adult dependent child. Contact Human Resources for further details if covering an adult dependent child who will turn age 27 any time during the
upcoming calendar year or for more information.
Please Note: There is no imputed income if adult dependent child is eligible to be claimed as a dependent for Federal income tax purposes on the employee’s tax return.
Domestic Partner Coverage
Domestic partners may be eligible to participate in The Authority group insurance plans if the partner is officially registered as a domestic partner with The Authority.
The IRS guidelines state that employee may not receive a tax advantage on any portion of premiums paid related to domestic partner coverage. Employees insuring
domestic partners and/or child dependent(s) of a domestic partner are required to pay imputed income tax on subsidy amounts and should consult a tax advisor. Please
contact Human Resources for more information.
Qualifying Events and Section 125
Section 125 of the Internal Revenue Code
Premiums for medical, dental, vision insurance, contributions to Flexible Spending Accounts (FSA), and/or certain supplemental policies are deducted through a Cafeteria Plan
established under Section 125 of the Internal Revenue Code and are pre-taxed to the extent permitted. Under Section 125, changes to employee's pre-tax benefits can be made
ONLY during the open enrollment period unless the employee or qualified dependent(s) experience(s) a Qualifying Event and the request to make a change is made within 30 days
of the Qualifying Event.
Under certain circumstances, employee may be allowed to make changes to benefit elections during the plan year if the event affects the employee, spouse or dependent’s
coverage eligibility. An “eligible” Qualifying Event is determined by Section 125 of the Internal Revenue Code. Any requested changes must be consistent with and due to the
Qualifying Event.
Examples of Qualifying Events:
• Employee gets married or divorced
• Birth of a child
• Employee gains legal custody or adopts a child
• Employee's spouse and/or other dependent(s) die(s)
• Loss or gain of coverage due to employee, employee’s spouse and/or
dependent(s) termination or start of employment
• An increase or decrease in employee's work hours causes eligibility
or ineligibility
• A covered dependent no longer meets eligibility criteria for coverage
• A child gains or loses coverage with other parent or legal guardian
• Change of coverage under an employer’s plan
• Gain or loss of Medicare coverage
• Losing or becoming eligible for coverage under a State Medicaid or
CHIP (including Florida Kid Care) program (60 day notification period)
IMPORTANT NOTES
If employee experiences a Qualifying Event, Human Resources must
be contacted within 30 days of the Qualifying Event to make
the appropriate changes to employee’s coverage. Employee may be
required to furnish valid documentation supporting a change in status
or “Qualifying Event”. If approved, changes may be effective the date of
the Qualifying Event or the first of the month following the Qualifying
Event. Newborns are effective on the date of birth. Qualifying Events
will be processed in accordance with employer and carrier eligibility
policy. Beyond 30 days, requests will be denied and employee may be
responsible, both legally and financially, for any claim and/or expense
incurred as a result of employee or dependent who continues to be
enrolled but no longer meets eligibility requirements.
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Hillsborough County Aviation Authority
|
Employee Benefit Highlights
|
2023-2024
© 2016, Gehring Group, Inc., All Rights Reserved
Medical Plan Resources
Aetna offers all enrolled employees and dependents additional services
and discounts through value added programs. For more details regarding
other available plan resources, please contact Aetna's customer service at
(866) 983-0108, or visit www.aetna.com.
Aetna Online & Mobile App
Manage benefits from your phone with the Aetna Health App. Find in-network
doctors and facilities, compare costs of doctor visits, medical procedures and
medications by brand or name, view claims, access ID card and check Explanation
of Benefits
PrudentRx
As part of your prescription plan, the PrudentRx Copay Program allows you
to obtain select specialty medications at no cost to you. That means $0 out-
of-pocket (OOP) for any medications on your plan’s exclusive Specialty Drug
List when you fill by CVS Specialty®pharmacy. PrudentRx will work with
manufacturers to get copay card assistance, and will manage enrollment and
refills on your behalf.
Even if there is no copay card program for your medication, your cost will be $0
for as long as you are enrolled in the program. Copay assistance is a process in
which drug manufacturers provide financial support to patients by covering all
or most of the patient cost share for select medications, in particular specialty
medications. The PrudentRx Copay Program will help plan members receive
copay assistance from drug manufacturers to reduce a member’s cost share for
eligible medications thereby OOP expenses.
Members currently taking one or more medications included in your plan’s
exclusive Specialty Drug List, will receive a welcome letter and phone call
from PrudentRx that provides information about the program as it pertains
to your medication. All eligible members will be automatically enrolled in The
PrudentRx Copay Program, but you can choose to opt out of the program or
obtain more information by calling 1-800-578-4403.
Prudent Rx
Customer Service: (800) 578-4403 | www.prudentrx.com
Telehealth
Aetna provides access to telehealth services as part of the medical plan.
Teladoc is a convenient phone and video consultation company that provides
immediate medical assistance for many conditions.
The benefit is provided to all enrolled members. Registration is required and
should be completed ahead of time. This program allows members 24 hours
a day, seven (7) days a week on-demand access to affordable medical care via
phone and online video consultations when needing immediate care for non-
emergency medical issues. Telehealth should be considered when employee's
primary care doctor is unavailable, after-hours or on holidays for non-emergency
needs. Many urgent care ailments can be treated with telehealth, such as:
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Sore Throat
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Headache
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Stomachache
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Fever
9
Cold And Flu
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Allergies
9
Rash
9
Acne
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UTIs And More
Telehealth doctors do not replace employee's primary care physician but
may be a convenient alternative for urgent care and ER visits. For further
information please contact Teladoc.
Aetna
Teladoc | Customer Service: (855) 835-2362 | www.teladoc.com
Summary of Benefits and Coverage
A Summary of Benefits & Coverage (SBC) for the Medical Plan is provided as a
supplement to this booklet being distributed to new hires and existing employees
during the Open Enrollment period. The summary is an important item in
understanding employee's benefit options. A free paper copy of the SBC document
may be requested or is also available as follows:
From: Human Resources
Address: 5411 SkyCenter Drive
Suite 500, Tampa, FL 33607
Phone: (813) 554-1493
Email: LDavis@Tampaairport.com
Website URL: www.healthcare.gov/sbc-glossary
The SBC is only a summary of the plan’s coverage. A copy of the plan document, policy,
or certificate of coverage should be consulted to determine the governing contractual
provisions of the coverage. A copy of the group certificate of coverage can be reviewed
and obtained by contacting Human Resources.
If there are any questions about the plan offerings or coverage options, please contact
Human Resources at (813) 554-1493.
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Hillsborough County Aviation Authority
|
Employee Benefit Highlights
|
2023-2024
© 2016, Gehring Group, Inc., All Rights Reserved
Medical Insurance
The Authority offers medical insurance through Aetna to benefit-eligible employees. The monthly cost for coverage are listed in the premium table below and a brief
summary of benefits is provided on the following page. For more detailed information about the medical plans, please refer to the carrier's Summary of Benefits and
Coverage (SBC) document or contact Aetna's customer service.
Medical Insurance – Aetna Open Access Plan
(Salary Under $40,000)
Payroll Deductions - Monthly Cost
Tier of Coverage Employee Cost
Employee Only $125.28
Employee + 1 $209.61
Employee + Family $237.71
Medical Insurance – Aetna Open Access Plan
(Salary Under $40,000-$75,000)
Payroll Deductions - Monthly Cost
Tier of Coverage Employee Cost
Employee Only $149.94
Employee + 1 $257.17
Employee + Family $305.97
Medical Insurance – Aetna Open Access Plan
(Salary Under $75,000-$90,000)
Payroll Deductions - Monthly Cost
Tier of Coverage Employee Cost
Employee Only $176.91
Employee + 1 $309.29
Employee + Family $360.22
Medical Insurance – Aetna Open Access Plan
(Salary Under $90,000-$125,000)
Payroll Deductions - Monthly Cost
Tier of Coverage Employee Cost
Employee Only $184.28
Employee + 1 $322.18
Employee + Family $375.23
Medical Insurance – Aetna Open Access Plan
(Salary Above $125,000)
Payroll Deductions - Monthly Cost
Tier of Coverage Employee Cost
Employee Only $193.73
Employee + 1 $338.70
Employee + Family $394.46
Aetna | Customer Service: (866) 983-0108 | www.aetna.com
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Hillsborough County Aviation Authority
|
Employee Benefit Highlights
|
2023-2024
© 2016, Gehring Group, Inc., All Rights Reserved
Medical Insurance
The Authority offers medical insurance through Aetna to benefit-eligible employees. The monthly cost for coverage are listed in the premium table below and a brief
summary of benefits is provided on the following page. For more detailed information about the medical plans, please refer to the carrier's Summary of Benefits and
Coverage (SBC) document or contact Aetna's customer service.
Medical Insurance – Aetna Choice POS II Plan
(Salary Under $40,000)
Payroll Deductions - Monthly Cost
Tier of Coverage Employee Cost
Employee Only $247.04
Employee + 1 $415.67
Employee + Family $509.34
Medical Insurance – Aetna Choice POS II Plan
(Salary Under $40,000-$75,000)
Payroll Deductions - Monthly Cost
Tier of Coverage Employee Cost
Employee Only $296.19
Employee + 1 $510.72
Employee + Family $608.21
Medical Insurance – Aetna Choice POS II Plan
(Salary Under $75,000-$90,000)
Payroll Deductions - Monthly Cost
Tier of Coverage Employee Cost
Employee Only $349.98
Employee + 1 $614.75
Employee + Family $716.53
Medical Insurance – Aetna Choice POS II Plan
(Salary Under $90,000-$125,000)
Payroll Deductions - Monthly Cost
Tier of Coverage Employee Cost
Employee Only $364.58
Employee + 1 $640.39
Employee + Family $746.38
Medical Insurance – Aetna Choice POS II Plan
(Salary Above $125,000)
Payroll Deductions - Monthly Cost
Tier of Coverage Employee Cost
Employee Only $383.26
Employee + 1 $673.22
Employee + Family $784.64
Aetna | Customer Service: (866) 983-0108 | www.aetna.com
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Hillsborough County Aviation Authority
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Employee Benefit Highlights
|
2023-2024
© 2016, Gehring Group, Inc., All Rights Reserved
Aetna Open Access Plan At-A-Glance
Network Aetna Select (Open Access)
Calendar Year Deductible (CYD) In-Network
Single $0
Family $0
Coinsurance
Member Responsibility 0%
Calendar Year Out-of-Pocket Limit
Single $2,000
Family $4,000
What Applies to the Out-of-Pocket Limit? Copays
Physician Services
Primary Care Physician (PCP) Office Visit (No PCP Election Required) $30 Copay
Specialist Office Visit (No Referral Required) $40 Copay
Telehealth Services (PCP/ Specialist) $10 Copay / $40 Copay
Non-Hospital Services; Freestanding Facility
Clinical Lab (Bloodwork)* No Charge
X-rays $40 Copay
Advanced Imaging (MRI, PET, CT) $150 Copay
Outpatient Surgery in Surgical Center $200 Copay
Physician Services at Surgical Center No Charge
Urgent Care (Per Visit) $40 Copay
Hospital Services
Inpatient Hospital (Per Admission) $300 Copay
Outpatient Hospital (Per Visit) $200 Copay
Physician Services at Hospital No Charge
Emergency Room (Per Visit; Waived if Admitted) $200 Copay
Mental Health/Alcohol & Substance Abuse
Inpatient Hospital Services (Per Admission) $300 Copay
Outpatient Services (Per Visit) No Charge
Outpatient Office Visit No Charge
Prescription Drugs (Rx)
Generic $15 Copay
Preferred Brand Name $30 Copay
Non-Preferred Brand Name $60 Copay
Mail Order Drug (90-Day Supply) 2x Retail Copay
Locate a Provider
To search for a participating provider,
contact Aetna's customer service
or visit www.aetna.com. When
completing the necessary search
criteria, select Aetna Select (Open
Access) network.
Plan References
*LabCorp or Quest Diagnostics are the
preferred labs for bloodwork through
Aetna. When using a lab other than
LabCorp or Quest, please confirm they
are contracted with Aetna Select (Open
Access) network prior to receiving
services.
Important Notes
Services received by providers or
facilities not in the Aetna Select
network, will not be covered.
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Hillsborough County Aviation Authority
|
Employee Benefit Highlights
|
2023-2024
© 2016, Gehring Group, Inc., All Rights Reserved
Aetna Choice POS II Plan At-A-Glance
Network Aetna Choice POS II
Calendar Year Deductible (CYD) In-Network Out-of-Network*
Single $500 $1,000
Family $1,500 $3,000
Coinsurance
Member Responsibility 20% 40%
Calendar Year Out-of-Pocket Limit
Single $1,500 $3,000
Family $3,000 $6,000
What Applies to the Out-of-Pocket Limit? Coinsurance, Deductible, Copays
Physician Services
Primary Care Physician (PCP) Office Visit $30 Copay 40% After CYD
Specialist Office Visit $40 Copay 40% After CYD
Telehealth Services (PCP/ Specialist) $10 Copay / $40 Copay Not Covered
Non-Hospital Services; Freestanding Facility
Clinical Lab (Bloodwork)** No Charge 40% After CYD
X-rays No Charge 40% After CYD
Advanced Imaging (MRI, PET, CT) $150 Copay 40% After CYD
Outpatient Surgery in Surgical Center 20% After CYD 40% After CYD
Physician Services at Surgical Center 20% After CYD 40% After CYD
Urgent Care (Per Visit) $40 Copay 40% After CYD
Hospital Services
Inpatient Hospital (Per Admission) 20% After CYD 40% After CYD
Outpatient Hospital (Per Visit) 20% After CYD 40% After CYD
Physician Services at Hospital 20% After CYD 40% After CYD
Emergency Room (Per Visit) $200 Copay + 20% Coinsurance $200 Copay + 20% Coinsurance
Mental Health/Alcohol & Substance Abuse
Inpatient Hospital Services (Per Admission) 20% After CYD 40% After CYD
Outpatient Services (Per Visit) No Charge 40% After CYD
Outpatient Office Visit No Charge 40% After CYD
Prescription Drugs (Rx)
Generic $15 Copay $15 Copay + 20% Coinsurance
Preferred Brand Name $30 Copay $30 Copay + 20% Coinsurance
Non-Preferred Brand Name $60 Copay $60 Copay + 20% Coinsurance
Mail Order Drug (90-Day Supply) 2x Retail Copay 2x Retail Copay + 20% Coinsurance
Locate a Provider
To search for a participating provider,
contact Aetna’s customer service or visit
www.aetna.com. When completing the
necessary search criteria, select Aetna
Choice POS II network.
Plan References
*Out-Of-Network Balance Billing:
For information regarding out-of-
network balance billing that may be
charged by out-of-network providers,
please refer to the Summary of Benefits
and Coverage (SBC) document.
**LabCorp or Quest Diagnostics are the
preferred labs for bloodwork through
Aetna. When using a lab other than
LabCorp or Quest, please confirm they
are contracted with Aetna Choice POS II
network prior to receiving services.
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Hillsborough County Aviation Authority
|
Employee Benefit Highlights
|
2023-2024
© 2016, Gehring Group, Inc., All Rights Reserved
Dental Insurance
Humana PPO Plan
The Authority offers dental insurance through Humana to benefit-eligible
employees. The monthly cost for coverage are listed in the premium table
below and a brief summary of benefits is provided on the following page. For
more detailed information about the dental plan, please refer to the carrier's
summary plan document or contact Humana's customer service.
Dental Insurance – Humana PPO Without Orthodontia Plan
Payroll Deductions - Monthly Cost
Tier of Coverage Employee Cost
Employee Only $2.00
Employee + Family $42.87
Dental Insurance – Humana PPO With Orthodontia Plan
Payroll Deductions - Monthly Cost
Tier of Coverage Employee Cost
Employee Only N/A
Employee + Family $53.33
In-Network Benefits
The DPPO plan provides benefits for services received from in-network and
out-of-network providers. It is also an open-access plan which allows for
services to be received from any dental provider without having to select a
Primary Dental Provider (PDP) or obtain a referral to a specialist. The network
of participating dental providers the plan utilizes is the Humana Dental
Traditional Preferred. These participating dental providers have contractually
agreed to accept Humana's contracted fee or “allowed amount.” This fee is
the maximum amount a Humana dental provider can charge a member for
a service. The member is responsible for a Calendar Year Deductible (CYD) and
then coinsurance based on the plan’s charge limitations.
Out-of-Network Benefits
Out-of-network benefits are used when member receives services by a
non-participating Humana Dental Traditional Preferred provider. Humana
reimburses out-of-network services based on what it determines as the
Usual, Customary, and Reasonable Allowances. The UCR is defined as the
most common charge for a particular dental procedure performed in a specific
geographic area. If services are received from an out-of-network dentist,
the member may be responsible for balance billing. Balance billing is the
difference between Humana's UCR and the amount charged by the out-of-
network dental provider. Balance billing is in addition to any applicable plan
deductible or coinsurance responsibility.
Calendar Year Deductible
The PPO plan requires a $50 individual or a $150 family deductible to be met
for in-network or out-of-network services before most benefits will begin. The
deductible is waived for preventive services.
Calendar Year Benefit Maximum
The maximum benefit (coinsurance) the PPO plan will pay for each covered
member is $2,500 for in-network and out-of-network services combined. All
services, including preventive, accumulate towards the benefit maximum.
Once the plan's benefit maximum is met, the member will be responsible for
future charges until next calendar year.
Humana | Customer Service: 800-233-4013 | www.humana.com/dental
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Hillsborough County Aviation Authority
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Employee Benefit Highlights
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2023-2024
© 2016, Gehring Group, Inc., All Rights Reserved
Humana PPO W/O & W/ Orthodontia Plans At-A-Glance
Plan Dental Plan PPO Without Orthodontia Dental Plan PPO With Orthodontia
Network Traditional Preferred Network Traditional Preferred Network
Calendar Year Deductible (CYD) In-Network Out-of-Network* In-Network Out-of-Network*
Per Member $50 $50 $50 $50
Per Family $150 $150 $150 $150
Waived for Class I Services? Yes Yes
Calendar Year Benefit Maximum
Per Member $2,500 $2,500
Class I Services: Diagnostic & Preventive Care
Routine Oral Exam (3 Per Calendar Year)
Plan Pays: 100%
Deductible Waived
Plan Pays: 100%
Deductible Waived
(Subject to Balance Billing)
Plan Pays: 100%
Deductible Waived
Plan Pays: 100%
Deductible Waived
(Subject to Balance Billing)
Routine Cleanings (3 Per Calendar Year)
Complete X-rays (1 Every 3 Calendar Years)
Bitewing X-rays (4 Per Calendar Year)
Class II Services: Basic Restorative Care
Fillings
Plan Pays: 80% After CYD
Plan Pays: 80% After CYD
(Subject to Balance Billing)
Plan Pays: 80% After CYD
Plan Pays: 80% After CYD
(Subject to Balance Billing)
Simple Extractions
Oral Surgery
Periodontal Services
Anesthetics
Endodontics (Root Canal Therapy)
Class III Services: Major Restorative Care
Crowns
Plan Pays: 50% After CYD
Plan Pays: 50% After CYD
(Subject to Balance Billing)
Plan Pays: 50% After CYD
Plan Pays: 50% After CYD
(Subject to Balance Billing)
Bridges
Dentures
Class IX Services: Dental Implants
Dental Implants (Requires Pre-Authorization) Plan Pays: 50% After CYD
Plan Pays: 50% After CYD
(Subject to Balance Billing)
Plan Pays: 50% After CYD
Plan Pays: 50% After CYD
(Subject to Balance Billing)
Class IV Services: Orthodontia
Lifetime Maximum
Not Covered
$1,500
Benefit (Dependent Children Up To Age 19)
Plan Pays: 50%
Deductible Waived
Plan Pays: 50%
Deductible Waived
(Subject to Balance Billing)
Locate a Provider
To search for a participating provider,
contact Humana's customer service or
visit www.humana.com/dental. When
completing the necessary search criteria,
select Traditional Preferred Network.
Plan References
*Out-Of-Network Balance Billing:
For information regarding out-of-network
balance billing that may be charged by an
out-of-network provider, please refer to
the Out-of-Network Benefits section on
the previous page.
Important Notes
Each covered family member may receive up to two (3) routine
cleanings per calendar year covered under the preventive
benefit.
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Hillsborough County Aviation Authority
|
Employee Benefit Highlights
|
2023-2024
© 2016, Gehring Group, Inc., All Rights Reserved
Vision Insurance
Humana Vision Plan
The Authority offers vision insurance through Humana to benefit-eligible
employees. The monthly cost for coverage are listed in the premium table
below and a brief summary of benefits is provided on the following page. For
more detailed information about the vision plan, please refer to the carrier's
summary plan document or contact Humana's customer service.
Vision Insurance - Humana Vision Plan
Payroll Deductions - Monthly Cost
Tier of Coverage Employee Cost
Employee Only $2.48
Employee + Family $9.62
In-Network Benefits
The vision plan offers employee and covered dependent(s) coverage for routine
eye care, including eye exams, eyeglasses (lenses and frames) or contact
lenses. To schedule an appointment, employee and covered dependent(s) may
select any network provider who participates in the Humana Insight network.
At the time of service, routine vision examinations and basic optical needs will
be covered as shown on the plan’s schedule of benefits. Cosmetic services and
upgrades will be additional if chosen at the time of the appointment.
Out-of-Network Benefits
Employee and covered dependent(s) may choose to receive services from
vision providers who do not participate in the Humana Insight network.
When going out of network, the provider will require payment at the time of
appointment. Humana will then reimburse based on the plan’s out-of-network
reimbursement schedule upon receipt of proof of services rendered.
Calendar Year Deductible
There is no calendar year deductible.
Calendar Year Out-of-Pocket Maximum
There is no out-of-pocket maximum. However, there are benefit reimbursement
maximums for certain services.
Humana | Customer Service: (800) 448-6262 | www.humana.com
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Humana Vision Plan At-A-Glance
Network Insight
Services In-Network Out-of-Network
Eye Exam $10 copay Up to $30 Reimbursement
Contact Lens Exam
Standard contact lens fit and
follow-up
$0 Copay Not Covered
Premium contact lens fit and
follow-up
10% off retail less $55 allowance Not Covered
Frequency of Services
Examination Once Every 12 Months
Lenses Once Every 12 Months
Frames Once Every 12 Months
Contact Lenses Once Every 12 Months
Lenses
Single $25 Copay $25 Copay
Bifocal $25 Copay $40 Copay
Trifocal $25 Copay $60 Copay
Frames
Allowance
$200 Retail Allowance: Then 20%
discount over allowance
Up to $65 Reimbursement
Contact Lenses*
Non-Elective (Medically Necessary) $0 Copay Up to $210 Reimbursement
Elective (Fitting, Follow-up & Lenses)
Conventional
$200 Allowance: Then 15% discount
over allowance
Up to $200 Reimbursement
Disposable $200 Allowance Up to $200 Reimbursement
Locate a Provider
To search for a participating provider,
contact Humana's customer service
or visit www.humana.com. When
completing the necessary search
criteria, select Insight network.
Plan References
*Contact lenses are in lieu of spectacle
lenses.
Important Notes
Member options, such as LASIK, UV
coating, progressive lenses, etc. are not
covered in full, but may be available at
a discount.
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Flexible Spending Accounts
The Authority offers Flexible Spending Accounts (FSA) administered through PayFlex. The FSA plan year is from January 1 to December 31.
If employee or family member(s) has predictable health care or work-related day care expenses, then employee may benefit from participating in an FSA. An FSA allows
employee to set aside money from employee's paycheck for reimbursement of health care and day care expenses they regularly pay. The amount set aside is not taxed
and is automatically deducted from employee’s paycheck and deposited into the FSA. During the year, employee has access to this account for reimbursement of some
expenses not covered by insurance. Participation in an FSA allows for substantial tax savings and an increase in spending power. Participating employee must re-elect
the dollar amount to be deducted each plan year. There are two (2) types of FSAs:
Health Care FSA Dependent Care FSA
This account allows participant to set aside up to an
annual maximum of $3,050. This money will not be
taxable income to the participant and can be used to
offset the cost of a wide variety of eligible medical
expenses that generate out-of-pocket costs. Participating
employee can also receive reimbursement for expenses
related to dental and vision care (that are not classified
as cosmetic).
Examples of common expenses that qualify for
reimbursement are listed below.
This account allows participant to set aside up to an annual maximum of $5,000 if
single or married and file a joint tax return ($2,500 if married and file a separate
tax return) for work-related day care expenses. Qualified expenses include day care
centers, preschool, and before/after school care for eligible children and dependent
adults.
Please note, if family income is over $20,000, this reimbursement option will likely
save participants more money than the dependent day care tax credit taken on a tax
return. To qualify, dependents must be:
• A child under the age of 13, or
• A child, spouse or other dependent who is physically or mentally
incapable of self-care and spends at least eight (8) hours a day in the
participant’s household.
Please Note: The entire Health Care FSA election is available for use on
the first day coverage is effective.
Please Note: Unlike the Health Care FSA, reimbursement is only up to the amount that has been deducted
from participant’s paycheck for the Dependent Care FSA.
A sample list of qualified expenses eligible for reimbursement include, but not limited to, the following:
9
Prescription/Over-the-Counter Medications
9
Physician Fees and Office Visits
9
LASIK Surgery
9
Menstrual Products
9
Drug Addiction/Alcoholism Treatment
9
Mental Health Care
9
Ambulance Service
9
Experimental Medical Treatment
9
Nursing Services
9
Chiropractic Care
9
Corrective Eyeglasses and Contact Lenses
9
Optometrist Fees
9
Dental and Orthodontic Fees
9
Hearing Aids and Exams
9
Sunscreen SPF 15 or Greater
9
Diagnostic Tests/Health Screenings
9
Injections and Vaccinations
9
Wheelchairs
Log on to http://www.irs.gov/publications/p502/index.html for additional details regarding qualified and non-qualified expenses.
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Flexible Spending Accounts (Continued)
FSA Guidelines
• Employee may carry over up to $610 of unused Health Care FSA
funds into the next plan year after a plan year ends and all claims
have been filed (only if the employee re-enrolls the next year).
• The Dependent Care FSA allows a grace period at the end of the
plan year (2 1/2 months). The grace period allows additional time
to incur claims and use any unused funds on eligible expenses after
the plan year ends. Once the grace period ends, any unused funds
still remaining in the account will be forfeited.
• The Health Care FSA and Dependent Care FSA both have a run out
period at the end of the plan year 90 days to submit reimbursement
on eligible expenses incurred during the period of coverage within
the plan year.
• When a plan year ends and all claims have been filed, all unused
funds with the exception of the $610 rollover for the Health Care
FSA will be forfeited and not returned.
• Employee can enroll in an FSA only during the Open Enrollment
Period, New Hire Orientation, or for Qualifying Life Events.
• Money cannot be transferred between FSAs.
• Reimbursed expenses cannot be deducted for income tax purposes.
• Employee and dependent(s) cannot be reimbursed for services not
received.
• Employee and dependent(s) cannot receive insurance benefits or
any other compensation for expenses reimbursed through an FSA.
• Domestic Partners are not eligible as Federal law does not recognize
them as a qualified dependent.
Filing a Claim
Claim Form
A completed claim form along with a copy of the receipt as proof of the expense
can be submitted by mail, fax, online or through the PayFlex Mobile App. The
IRS requires FSA participants to maintain complete documentation, including
copies of receipts for reimbursed expenses, for a minimum of one (1) year.
Debit Card
FSA participants will automatically receive a debit card for payment of eligible
expenses. With the card, most qualified services and products can be paid at the
point of sale versus paying out-of-pocket and requesting reimbursement. The
debit card is accepted at a number of medical providers and facilities, and most
pharmacy retail outlets. PayFlex may request supporting documentation for
expenses paid with a debit card. Failure to provide supporting documentation
when requested, may result in suspension of the card and account until funds
are substantiated or refunded back to the The Authority. Please keep the issued
card for use next year. Additional or replacement cards may be requested,
however, a small fee may apply.
HERE’S HOW IT WORKS!
An employee earning $30,000 elects to place $1,000 into a Health
Care FSA. The payroll deduction is $41.66 based on a 24 pay period
schedule. As a result, health care expenses are paid with tax-free
dollars, giving the employee a tax savings of $197.
With a Health
Care FSA
Without a Health
Care FSA
Salary $30,000 $30,000
FSA Contribution - $1,000 - $0
Taxable Pay $29,000 $30,000
Estimated Tax
19.65% = 12% + 7.65% FICA
- $5,698 - $5,895
After Tax Expenses - $0 - $1,000
Spendable Income $23,302 $23,105
Tax Savings
$197
Please Note: Be conservative when estimating health care and/or dependent care
expenses. IRS regulations state that any unused funds remaining in an FSA, after
a plan year ends and after all claims have been filed, cannot be returned or carried
forward to the next plan year with the exception of the $610 carry over that may be
allowed for the Health Care FSA. This rule is known as “use-it or lose-it.”
PayFlex | Phone: (844) 729-3539 | www.PayFlex.com
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Employee Assistance Program
The Authority cares about the well-being of all employees on and off the job
and provides, at no cost, a comprehensive Employee Assistance Program (EAP)
through Aetna. EAP offers employee and each dependent family member up
to age 26 access to licensed mental health professionals through a confidential
program protected by State and Federal laws. EAP is available to help
employee gain a better understanding of problems that affect them, locate
the best professional help for a particular problem, and decide upon a plan of
action. EAP counselors are professionally trained and certified in their fields
and available 24 hours a day, seven (7) days a week.
What is an Employee Assistance Program (EAP)?
An Employee Assistance Program offers covered employees and dependent
family members/domestic partners free and convenient access to a range of
confidential and professional services to help address a variety of problems
that may negatively affect employee or family member’s well-being.
Coverage includes eight (8) visits with a specialist, per person, per issue, per
year, telephonic consultation, online material/tools and webinars. EAP offers
counseling services on issues such as:
9
Child Care Resources
9
Legal Resources
9
Grief and Bereavement
9
Stress Management
9
Depression and Anxiety
9
Work Related Issues
9
Adult & Elder Care Assistance
9
Financial Resources
9
Family and/or Marriage Issues
9
Substance Abuse
Are Services Confidential?
Yes. Receipt of EAP services are completely confidential.
Aetna Resources for Living | Customer Service: (888) 238-6232
www.resourcesforliving.com | Username: HCAA | Password: EAP
Basic Life and AD&D Insurance
Basic Term Life Insurance
The Authority provides Basic Term Life insurance at no cost to all eligible
employees working 40 hours per week. Coverage is provided through Securian
Financial, Administered by Ochs. Eligible employees will receive a benefit
amount of $20,000.
Accidental Death & Dismemberment Insurance
Also, at no cost to employee, The Authority provides Accidental Death &
Dismemberment (AD&D) insurance, which pays in addition to the Basic Term
Life benefit when death occurs as a result of an accident. The AD&D benefit
amount equals the Basic Term Life benefit, partial benefits may also be payable.
Age Reduction Schedule
Benefit amounts are subject to the following age reduction schedule:
› Reduces to 65% of the benefit amount at age 70
› Reduces to 45% of the benefit amount at age 75
Always remember to keep beneficiary information
updated. Beneficiary information may be updated
at anytime through TPAConnect.
Securian Financial, Administered by Ochs
Customer Service: (800) 392-7295 | www.ochsinc.com
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Voluntary Life and AD&D Insurance
Voluntary Employee Life and AD&D Insurance
Eligible employee may elect to purchase additional Life and AD&D insurance
on a voluntary basis through Securian Financial, Administered by Ochs. This
coverage may be purchased in addition to the Basic Term Life and AD&D
coverage. Voluntary Life insurance offers coverage for employee, spouse and/
or child(ren) at different benefit levels.
New Hires may purchase Voluntary Employee Life insurance without
being subject to Medical Underwriting, also known as Evidence of
Insurability (EOI), up to the Guaranteed Issue amount of $300,000
• Units can be purchased in increments of $10,000 to the maximum of
$750,000
• Eligible employees have the opportunity during Open Enrollment to
purchase Voluntary Employee Life and AD&D insurance but must go
through medical underwriting known as Evidence of Insurability (EOI)
Voluntary Spouse Life and AD&D Insurance
New Hires may purchase Voluntary Spouse Life insurance without being
subject to Medical Underwriting, also known as Evidence of Insurability
(EOI), up to the Guaranteed Issue amount of $50,000.
• Employee does not need to participate in the Voluntary Employee Life
plan for spouse to participate.
• Eligible employees have the opportunity during Open Enrollment to
purchase Voluntary Spouse Life and AD&D insurance but must go
through medical underwriting known as Evidence of Insurability (EOI)
• Units can be purchased in increments of $10,000 to a maximum of
$250,000 not to exceed 100% of the employee’s Basic and Voluntary
Life coverage amount combined
For more detailed information on Voluntary
Life & AD&D rates scan the QR code
or access the link provided:
https://scnv.io/yqUR
Voluntary Life and AD&D Insurance Rate Table
Monthly Premium
Age Bracket
(Based on Employee Age)
Employee/Spouse
(Rate Per $1,000 of Benefit)
< 30 $0.055
30-34 $0.077
35-39 $0.100
40-44 $0.178
45-49 $0.310
50-54 $0.500
55-59 $0.770
60-64 $1.200
65-69 $1.900
> 69 $5.550
Voluntary Dependent Child(ren) Life Insurance
• Employee does not need to participate in Voluntary Employee Life
plan for dependent child(ren) to participate.
• For eligible dependent child(ren) from date of birth through
attainment of age 26.
• Employee may elect coverage of $10,000 or $15,000 not to exceed
100% of the employee's Basic and Voluntary Life coverage amount
combined.
• The monthly premium cost for $10,000 coverage is $1.30 and
$15,000 coverage is $1.95.
• If your spouse or child is eligible for employee coverage,they
cannot be covered as a dependent. Only one employee may cover
a dependent child. It is the employee’s responsibility to notify their
employer when dependents are no longer eligible for coverage.
Voluntary Dependent Life Insurance Package
• Employee may also purchase the Voluntary Dependent Life Insurance
Package offering coverage of $7,500 for spouse and child(ren). The
monthly premium rate for this coverage is $1.84
Always remember to keep beneficiary information
updated. Beneficiary information may be updated
at anytime through TPAConnect.
Securian Financial, Administered by Ochs
Customer Service: (800) 392-7295 | www.ochsinc.com
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Long Term Disability
The Authority provides Long Term Disability (LTD) insurance at no cost to all
eligible employees after six (6) months of employment, through The Standard.
The LTD benefit pays a percentage of monthly earnings if employee becomes
disabled due to an illness or injury.
Long Term Disability (LTD) Benefits
• LTD provides a benefit of 66 2/3% of employee's monthly earnings
up to a benefit maximum of $1,667 per month.
• Employee must be disabled for 60 consecutive days prior to
becoming eligible for benefits (known as the elimination period).
• Benefits will begin on the 61 day of disability.
• Employee may continue to be eligible for partial benefits if
employee returns to work on a part-time basis.
• The maximum benefit period is determined based on age at the
time of disability.
• Benefits may be reduced by other income.
• Disability benefits may be taxable.
Additional Long Term Disability (LTD) Benefit
The Authority offers additional, employee paid, LTD coverage as a second option.
This option will also pay 66 2/3% of employee's base salary up to $6,667 per
month. The additional benefit is employee paid on a post-tax basis.
Additional Long Term Disability Benefit Cost Estimator
Post Tax - Monthly Cost
Annual Salary___ ÷ 12 = ___ × .37 = ___ ÷ 100 = ___
The Standard | Customer Service: (800) 628-8600 | www.standard.com
Retirement Plans
Florida Retirement System (FRS)
The Authority participates in the Florida Retirement System plan. As a member
of the plan all employees must pay 3% into the retirement plan. There are two
plan options to choose from.
Pension Plan
• Vesting is eight years
• Eligibility for full retirement if vested and either age 65 or 33 years
of service
• Law Enforcement Officers (special risk) is age 60 or 30 years of service
• Monthly lifetime benefit is based on a formula to include
employee’s eight highest years of average compensation
Investment Plan
• Defined Contribution Plan
• Vesting is one year
• Employee decides how to allocate money in their account
• Employee’s benefit depends on the amount of money contributed
to their account and growth over time
Florida Retirement System (FRS)
Customer Service: (844) 377-1888 | www.myfrs.com
MissionSquare
457 Deferred Compensation Plan
The Authority also provides a pre-tax voluntary 457 Deferred Compensation
Plan through MissionSquare and will match up to 3% of employee base
salary. Contributions can be a percentage or dollar amount for calendar year
2023. Maximum contribution is $22,500. For those over age 50 (Catch-Up),
you can contribute a maximum of $30,000. Emergency withdrawals are
through MissionSquare Employees may also contact MissionSquare to obtain
information regarding loan
457 Roth
• Post tax contributions
• Withdrawals are tax free
• Maximum contributions are same as pre-tax 457 Deferred
Compensation Plan
• There is no match for the 457 Roth
• Emergency withdrawals are through MissionSquare
Annual contribution limits for your combined IRAs are adjusted periodically by
the IRS. You can contribute up to $6,000 ($7,000, if age 50 or older) for 2022 and
$6,500 ($7,500, if age 50 or older) for 2023.
MissionSquare Retirement
Customer Service: (800) 669-7400 | www.missionsq.org
Representative: Sharyn Hyla (202) 759-7219 | [email protected]g
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Employee Health, Wellness, and Engagement
The BeWELL employee health, wellness, and engagement program is based upon the book, Wellbeing: The Five Essential Elements by
Tom Rath and Jim Harter and includes 5 pillars of wellbeing – Career, Social, Physical, Financial, and Community. Throughout the year, the
Authority sponsors multiple events and opportunities to support employees in these important areas of their lives and careers. Below, you
will find examples of these initiatives. You are encouraged to monitor all employee communications which may include BeWELL emails,
TPATV, and TPAConnect for the most current information.
Career Well-Being
• Toastmasters
• TPAUniversity
• SKY Leadership Training
• Annual Service Awards
• Supplemental Education & Tuition Assistance
Social Well-Being
• Compliment a Colleague Program
• Cell Phone Lot Drive-In Movies
• Employee Appreciation BBQ
• Aetna Employee Assistance Program
Physical Well-Being
• Peerfit
• Annual Employee Health & Wellness Fair
• Aetna’s Get Active Digital Platform and Employee Challenges
• $500 annual employee wellness reimbursement
• Virtual Weight Watchers
• Smoking Cessation
• Onsite Workout Facilities
• Flu Shots
• Biometric Screening
• Onsite Walking Trails
Financial Well-Being
• Aetna Employee Discount Program
• Tickets at Work Employee Discount Program
• MissionSquare Retirement Planning Education
• FRS Retirement Planning Education
• Free Airport Parking
Community Well-Being
• Employee Golf Tournament
• Take Our Sons and Daughters to Work Day
• Toys for Tots Fundraisers
• United Way Fundraising and Partnership
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Notes
Use this section to make notes regarding personal benefit plans or to keep track of important information such as doctors' names and addresses or prescription medications.
© 2016, Gehring Group, Inc., All Rights Reserved
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Notes
Use this section to make notes regarding personal benefit plans or to keep track of important information such as doctors' names and addresses or prescription medications.
© 2016, Gehring Group, Inc., All Rights Reserved
3500 Kyoto Gardens Drive
Palm Beach Gardens, Florida 33410
Toll Free: (800) 244-3696 | Fax: (561) 626-6970
www.gehringgroup.com
© 2016, Gehring Group, Inc., All Rights Reserved
FINAL Revised
Last Modified: June 8, 2023 2:35 PM
Hillsborough County Aviation Authority
Tampa International Airport | Peter O. Knight Airport
Plant City Airport | Tampa Executive Airport
