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 Benefits FAQ
Living Well Program FAQ
Workers' Compensation FAQ
Benefits FAQ
Aetna HealthFund (AHF)
What is the Aetna HealthFund (AHF)?
What is the money in the fund account used for?
Do expenses paid out of the fund account apply towards the plan deductible?
What happens when my fund account is depleted?
Are there maximum annual out-of-pocket limits?
Is the Aetna HealthFund an additional option to the POSII and HMO medical plans?
Does the Aetna HealthFund cover the cost of prescriptions?
Does the HealthFund cover preventive services?
How can I find out how much money is in my fund account?
Aexcel® Network
What is an Aexcel Provider?
Why should I consider using an Aexcel Provider?
How do I find out if my physician is an Aexcel Provider?
Do I have to be enrolled in the AHF plan to obtain the lower co-insurance associated with using an Aexcel provider?
Flexible Spending Accounts (FSA)
What is a Flexible Spending Account (FSA)?
Is it true that SCG is contributing 25% to Dependent FSA accounts?
How much can be contributed per year?
What happens if I do not use all of the money in my FSA account?
Is there a way to estimate my / my dependents medical expenses without having to do a lot of research?
What can type of expenses can I get reimbursed for from my medical FSA?
Locating a Provider
How can I find out whether a doctor is a member of the Aetna network?
Aetna HealthFund (AHF)
What is the Aetna HealthFund (AHF)?
The Aetna HealthFund (AHF) is a consumer driven medical plan that integrates a reimbursement account (or fund) with an insurance plan to provide coverage for medical and prescription claims. The reimbursement account (annually funded at $750 Individual / $1500 Family) pays for covered expenses first. These expenses also count towards satisfying the insurance plan deductible. If the account is depleted the participant will be required to satisfy the remaining deductible and then begin paying co-insurance after the deductible has been met. As with the Aetna Point-of-Service plan, the insurance portion of the Aetna HealthFund will pay 100% of covered expenses after the annual maximum out-of-pocket limit has been reached. If a participant does not deplete their account in any given calendar year, the balance rolls forward to the next year and is combined with an additional $750 Individual / $1500 Family to create the beginning balance for the next plan year. Therefore, the minimum account balance at the beginning of any subsequent plan year is $750 Individual / $1500 Family, but could be much higher depending on any rollover amounts from prior year(s).. The AHF plan provides the employee with a Fund Account which is used to pay for medical/prescription claims. After the Fund Account is depleted the participant will be required to satisfy the remaining deductible prior to sharing the expense with Aetna through Co-insurance. If a participant does not use all of their Fund Account in any given calendar year the balance rolls forward to the next calendar year to reduce the participant’s deductible.
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What is the money in the fund account used for?
Any eligible covered medical or prescription expenses in the medical insurance plan.
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Do expenses paid out of the fund account apply toward the plan deductible?
Yes. Any expenses paid from the fund account apply towards the insurance plan deductible ($1,500 per person; $3,000 per family).
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What happens when my fund account is depleted?
Once your fund account is depleted, you are responsible for any remaining deductible and then co-insurance once the deductible has been met.
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Are there maximum annual out-of-pocket limits?
Yes. The annual maximum is $3,000 for individuals and $9,000 for families.
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Is the Aetna HealthFund in addition to the POSII and HMO medical plans?
Yes, we will continue to offer both the POSII and HMO plans for 2007 (Teamsters should consult their contract for plan availability).
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Does the Aetna HealthFund pay for prescriptions?
Yes, the Aetna HealthFund covers prescriptions two different ways. Preventive and Chronic medications are paid at the same co-pay/co-insurance level as in the POSII and HMO plans. If you have available money in your Fund Account the co-pay/co-insurance will be paid by the fund resulting in a zero responsibility from you at the pharmacy. To get a list of Aetna’s chronic and preventive medications please visit AHF page on the TPM website.
If the prescription is not on Aetna’s preventive and chronic illness medication list, the full Aetna-negotiated price of the prescriptions will be deducted from any available balance in the fund account. Once your account is depleted you will be required to satisfy any remaining deductible. Once your deductible is met, co-pays/co-insurance will apply to all covered prescriptions. Co-pays/co-insurance amounts count towards the maximum annual out-of-pocket limit. Once an individual reaches their annual maximum out-of-pocket limit, all prescriptions will be paid at 100%.
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Does the HealthFund cover preventive services?
Yes. Aetna uses the U.S. Preventive Services Task Force guidelines (available through the TPM website) for determining coverage of preventive services for all of three plans, including the HealthFund. In-network preventive services (correctly coded by the provider) are covered at 100% and will not reduce the fund account balance or apply to the annual deductible. Please remind your provider’s office to verify that preventive services are correctly coded to avoid potential claim processing problems. Out-of-network preventive services are covered at 60% and participant co-insurance amounts are applied to the fund account and deductible.
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How can I find out how much money is in my fund account?
You can log on to Aetna’s website to track your fund account balance and view claim explanations of benefits. Additional tools are also available on Aetna’s website to assist in managing your fund account. These include Price-a-Drug and many other Cost of Care tools designed to help make you a more informed consumer of health care.
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Aexcel® Network
What is an Aexcel® Provider?
These specialists have demonstrated cost-efficiency in the delivery of care and have met certain defined measures of clinical performance. Additionally, by using Aexcel® providers, Aetna HealthFund and Choice POS II participants will receive reimbursement at 90% after satisfaction of the deductible instead of the standard 80% reimbursement. Aexcel® providers can be found by using Aetna DocFind® and are identified by a  .
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Why should I consider using an Aexcel Provider?
Aexcel® physicians have received this designation for being a Top Performing Specialist. Also, participants that choose to utilize an Aexcel® specialist will be responsible for only a 10% co-insurance amount rather than 20% co-insurance for the non-Aexcel® network specialist.
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How do I find out if my physician is an Aexcel® Provider?
All Aexcel® providers are listed on Aetna’s Doc Find with a by their name.
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Do I have to be enrolled in the AHF plan to obtain the lower co-insurance associated with using an Aexcel® provider?
No, the 10% co-insurance is applicable to POSII participants as well.
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Flexible Spending Accounts (FSA)
What is a Flexible Spending Account (FSA)?
Flexible Spending Accounts allow employees to set aside tax-free dollars for medical or dependent care expenses. FSA accounts allow employees to make payroll contributions tax free to either a Medical FSA (used for employee and dependent non-covered medical expense, ie., co-pays) or to Dependent Care accounts (dependent care expenses are child and adult day care expenses for a covered dependent).
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Is it true that SCG is contributing 25% to Dependent FSA accounts?
Yes, SCG understand how expensive dependent care is and is assisting employees by contributing 25% (up to $1,000) of the participants annual election to their FSA dependent care account.
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How much can be contributed per year?
A total of up to $5,000 per year can be contributed toward each type of account (medical and dependent care). Since SCG is matching 25% of the dependent care account contributions (up to $1,000), the maximum employee contribution is $4,000.
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What happens if I do not use all of the money in my FSA account?
Unclaimed funds will be forfeited per IRS guidelines, therefore you should plan accordingly when determining how much to contribute to an FSA account.
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Is there a way to estimate my / my dependents medical expenses without having to do a lot of research?
Yes, if you have medical insurance through SCG you can view all medical and prescriptions claims through the Aetna Navigator. This will enable you to determine what you and your dependents have spent since the beginning of the year. An expense worksheet is available on the FSA page of the TPM website.
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What can type of expenses can I get reimbursed for from my medical FSA?
Medical FSA’s will reimburse you for medical expenses that are not covered by your insurance. These expenses can be incurred by you and/or your dependents. Eligible expenses include co-pays/co-insurance payments for prescriptions and medical services, dental expenses, Lasik surgery, over the counter medications, prescription glasses and contacts. Medical FSA’s do exclude some services therefore you should view the FSA information available on the TPM website before determining how much to contribute.
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Locating a Provider
How can I find out whether a doctor is a member of the Aetna network?
To search for a provider, follow these steps:
1. Log on to Aetna’s Web site
2. In the top blue box at the right, click Find a Doctor, Dentist
3. Click Go to DocFind >>
4. In the Search By box, select zip code, city or county; in the State box, select Florida and click Start Search
5. Follow the instructions regarding search criteria and provider type, then click Continue
Select the appropriate plan:
1. To search for HMO providers select Aetna Standard Plans and then HMO
2. To search for POSII (non-bargaining only) providers select Aetna Open Access Plans and then Aetna Choice POS II (Open Access)
3. To search for PPO (bargaining only) providers select Aetna Standard Plans and then Open Choice PPO
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Living Well Program FAQ
Classes:
How do I sign up for a class I saw advertised in Stall Talk?
Employees can enroll in classes through TRAC, the county's online course catalog.
Where are classes advertised?
Complete course descriptions, including dates, locations and instructors can be found on TRAC, the county's online course catalog.
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Workers' Compensation FAQ
Why is the workers’ compensation program changing?
Historically, workers’ compensation has primarily been a reactive system based on state-determined, discounted fees for services. Opportunities for efficiencies between the injured workers, providers, insurance carriers and employers were often overlooked. To better assist injured workers in their recovery and return to work process, a criteria-based model is being implemented. The new, collaborative approach aligns desired outcomes of all parties - enhancing medical care, reducing lost days from work and minimizing residual disability by using a progressive sports medicine approach to injury management and recovery with a strong focus on functional restoration.
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How do I report a work-related injury?
If your injury is serious call 911 or go to the nearest emergency room. Once your condition is stable, the following steps should be taken: 1) all injuries should be immediately reported to your supervisor, 2) you should then contact the OptaComp intake nurse at 888-763-1450 (24/ 7 /365) for further medical guidance. If you are unable to contact OptaComp immediately due to the nature of the injury, your supervisor will call to start the process. This process is effective for all injuries, no matter when it occurs or how serious it is perceived to be.
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If I don’t want medical treatment at the time of my injury do I need to report it?
Yes. OptaComp at 888-763-1450 (24/ 7 /365) to report every injury. Reporting the injury promptly does two things: 1) it allows a nurse to assess your situation and recommend an appropriate course of action, if needed, and 2) help you understand the process should you need treatment in the future.
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Do I have to go to the Employee Health Center first before I go for treatment?
No. Call the OptaComp triage / intake nurse at 888-763-1450 (24/ 7 /365) for medical direction. The nurse will refer you to the best clinician to handle your specific needs. In many cases you may be referred directly to a specialist to treat your injury.
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Can I go to my regular doctor to treat my work injury?
No. All medical care must be authorized by the Comp Options nurse case manager, with the exception of emergency care. This preserves your workers' comp benefits, while also providing the best possible care at the earliest opportunity to mazimize your recovery potential.
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During the first seven days immediately following the date of injury you will be paid “I-Time” for any authorized time away from work, including doctor appointments. Beyond the first seven days you will not be paid workers’ compensation benefits for time missed due to doctor appointments unless your earnings drop below 80 percent of your average weekly wages. Your adjuster can explain in detail the benefits you are entitled to under workers’ compensation.
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Can I use sick/vacation time to supplement workers’ compensation benefits when I am unable to work?
Yes, you have the option of using any available sick/vacation time to supplement workers’ compensation benefits, not to exceed your normal wages.
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What should I do if I receive a medical bill related to my injury?
Mail or fax the bill to your adjuster. If you continue to receive bills on a regular basis you may need to contact the clinician to give them the address for OptaComp (below).
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What should I do if my doctor says I have restrictions?
Contact your supervisor immediately. Your supervisor will determine whether or not there is work available consistent with your functional limitations/restrictions within your business unit. If there is not work available within your business unit the County will attempt to find appropriate temporary transitional work for you in another area. In the unlikely event there is no transitional work available, your Adjuster will explain any additional benefits due to you.
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What should I do if I am not satisfied with my medical treatment?
Contact your nurse case manager to discuss the situation. You are entitled to a one-time change of clinician if you are dissatisfied with your recovery progress or treatment plan. The nurse case manager will coordinate any change of clinician.
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Is there a period of time after which my claim is no longer open?
If you were injured on or after Jan. 1, 1994, the claim is closed one year from the date of your last medical treatment or payment of compensation or 2 years from the date of your injury, whichever is later. This period of time is referred to as the Statute of Limitations. If you were injured before Jan. 1, 1994, the period is two years.
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Who do I contact regarding general questions/concerns regarding the workers’’ compensation program?
Your adjuster and nurse case manager should be your first point of contact regarding questions about your claim. The State of Florida also provides a free Employee Assistance Office to assist injured employees by answering questions and assisting with dispute resolution. They can be reached at 800-342-1741. General questions about Sarasota County’s workers’ compensation program may be directed to Steve Olmstead at 941-232-0744 or solmstead@scgov.net.
How do I contact OptaComp?
24/7 Intake/Triage Reporting Line – 888-763-1450
Contact this adjuster/nurse team for all Firefighter and Sheriff Law Enforcement claims.
Geni Livengood: (Adjuster)
Phone: (941) 378-7311
Email: geni.livengood@bcbsfl.com
Karen Bell (Nurse Case Manager)
Phone: (941) 378-7310
Email: Karen.Bell2@bcbsfl.com
Contact this adjuster/nurse team for non-Firefighter BCC employees (i.e. Public Works, Community Services),
Constitutional Offices, Sheriff Corrections and non-Law Enforcement claims.
Alexis VanCort (Adjuster)
Phone: (941) 378-7317
Email: Alexis.VanCort@bcbsfl.com
Susan Kohli (Nurse Case Manager)
Phone: (941) 378-7313
Email: Susan.Kohli@bcbsfl.com
OptaComp Mailing Address: P.O. Box 44220, Jacksonville, FL 32231
Prescription Billing: Matrix
Phone: 877-804-4900
Group# 20012114
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