Employee Benefit Summary - EFFECTIVE JANUARY 1, 2021 - Montgomery County ...
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2021
Employee
Benefit Summary
EFFECTIVE JANUARY 1, 2021
MEDICAL, D E N TA L ,
V I S I O N , D RU G , F S A ,
LIFE INSURANCE,
403(b) & 457(b),
AND RETIREMENT
BENEFITS
Benefits Plan Highlights for 2021
¡¡ There will be no changes to insurance vendors for 2021.
¡¡ The tobacco-user surcharge and attestation will be discontinued.
¡¡ CareFirst and Kaiser Permanente will offer MCPS employees and
dependents hearing aid coverage of up to $1,500 per ear every
36 months.
Employee and Retiree Service Center ¡ 45 W. Gude Drive, Suite 1200, Rockville, MD 20850
301-517-8100 ¡ w ww.montgomeryschoolsmd.org/departments/erscBoard of Education
Mrs. Shebra L. Evans
President
Ms. Brenda Wolff
Vice President
Ms. Jeanette E. Dixon
Dr. Judith R. Docca
VISION
Mrs. Patricia B. O’Neill
We inspire learning by
providing the greatest Ms. Karla Silvestre
public education to each
and every student. Mrs. Rebecca K. Smondrowski
Mr. Nicholas W. Asante
MISSION Student Member
Every student will have
the academic, creative Montgomery County
problem solving, and Public Schools (MCPS)
social emotional skills Administration
to be successful in Jack R. Smith, Ph.D.
college and career. Superintendent of Schools
Monifa B. McKnight, Ed.D.
CORE PURPOSE Deputy Superintendent
Prepare all students to
thrive in their future. Henry R. Johnson, Jr., Ed.D.
Chief of Staff
CORE VALUES Derek G. Turner
Chief of Engagement, Innovation, and Operations
Learning
Relationships Janet S. Wilson, Ph.D.
Respect Chief of Teaching, Learning, and Schools
Excellence
Equity
850 Hungerford Drive
Rockville, Maryland 20850
www.montgomeryschoolsmd.org2021 Montgomery County Public Schools 2021 Employee Benefit Summary for Active Employees Montgomery County Public Schools (MCPS) provides a comprehensive benefit plan for employees, retirees, and their eligible dependents. As an eligible MCPS employee, you have a variety of benefit options from which to choose, including benefits to protect your health, your income, and your future. The Employee Benefit Summary provides an overview of the benefits available to eligible active employees, effective January 1, 2021. This summary includes information about eligibility for MCPS benefits, a list of benefit costs, opportunities to reduce benefit costs through the Wellness Initiatives program, and important contact information. It also includes instructions for accessing the online Benefits Enrollment System (BES) during Open Enrollment, for new employees enrolling in benefits for the first time, and for employee experiencing a qualifying life event during the plan year. Keep in mind that this is a summary of the MCPS benefit plan and is intended to help you understand and properly enroll in the plan. Full benefit plan details are available on the Employee and Retiree Service Center (ERSC) website at www.montgomeryschoolsmd.org/departments/ersc. The website includes summary plan and evidence of coverage documents, along with links to provider websites. During Open Enrollment, ERSC staff is available to assist you via email or by telephone Monday–Friday, from 7:30 a.m.–4:45 p.m. Staff is available throughout the year to assist you via email or by telephone Monday through Friday from 8:00 a.m.–4:15 p.m. Due to the COVID-19 pandemic, ERSC is closed for in- person service until further notice. Our email address and telephone number are below: Montgomery County Public Schools Employee and Retiree Service Center 45 West Gude Drive, Suite 1200 Rockville, Maryland 20850 301-517-8100 ERSC@mcpsmd.org Important Notice You are not enrolled automatically in the MCPS employee benefit plan. New employees must enroll online within 60 days following employment or wait for a future Employee Benefits Open Enrollment, typically held for four weeks beginning in early October, with coverage effective January 1 of the following year. To enroll online, new employees must log in to the Benefits Enrollment System (BES) by visiting the Employee Self Service (ESS) web page at: www.montgomeryschoolsmd.org/departments/ersc/employees/employee-self-service/ From there, click the Benefits enrollment for new employees link, log in with your Outlook username and password, and follow the onscreen instructions. During Open Enrollment, employees visit the ESS web page and click the Open Enrollment link to log in to the BES and make changes to their benefits. Outside of Open Enrollment, employees who experience a qualifying life event or return from long-term leave must visit ESS and click the Benefits enrollment/changes due to a qualifying life event link to log in to BES and re-enroll in or make changes to their benefits. BES also can be used at any time to designate and change beneficiaries for basic employee term life insurance.
2021
Table of Contents
About Your Benefits ................................................................................................................... 1
Who is Eligible ............................................................................................................................................. 1
Eligible Dependents .............................................................................................................................. 1
Disabled Dependents ............................................................................................................................ 1
When Benefits Coverage Begins .................................................................................................................. 2
Special Rule for 10-Month Employees ................................................................................................. 2
Enrolling New Dependents ........................................................................................................................... 2
Changes in or Cancellation of Coverage....................................................................................................... 3
Loss of Non-MCPS Coverage .............................................................................................................. 4
Paying for Coverage ..................................................................................................................................... 4
When Benefits Coverage Ends ..................................................................................................................... 4
Special Rule for 10-month Employees ................................................................................................. 4
Continuation of Benefits (COBRA) .............................................................................................................. 5
Insurance Coverage While on Leave ............................................................................................................ 5
Out-of-Area Coverage .................................................................................................................................. 6
Coordination of Benefits ............................................................................................................................... 6
Birthday Rule ........................................................................................................................................ 6
Enrollment in Medicare ................................................................................................................................ 6
Enrollment Basics ....................................................................................................................... 8
Using the Online Benefits Enrollment System (BES) .................................................................................. 8
Submitting Supporting Documentation ........................................................................................................ 8
Your Benefits at a Glance .......................................................................................................... 9
Wellness Initiatives ................................................................................................................... 10
Biometric Health Screenings ...................................................................................................................... 10
Health Risk Assessments ............................................................................................................................ 10
Disease Management Program for CareFirst Members .............................................................................. 10
Medical Coverage ..................................................................................................................... 11
Point-of-Service Plan .................................................................................................................................. 11
CareFirst BlueChoice Advantage POS Plan ....................................................................................... 11
Health Maintenance Organizations ............................................................................................................. 12
CareFirst BlueChoice HMO ............................................................................................................... 12
Kaiser Permanente HMO .................................................................................................................... 12
Preventive Care Services ............................................................................................................................ 13
Other Benefit Plan Coverage ................................................................................................... 19
Dental Coverage........................................................................................................................ 19
CareFirst Preferred Dental Plan (PPO) ....................................................................................................... 19
Aetna Dental Maintenance Organization (DMO) ....................................................................................... 202021
Kaiser Permanente Dental Plan................................................................................................................... 20
Vision Coverage ........................................................................................................................ 22
Davis Vision Plan ....................................................................................................................................... 22
Kaiser Vision Plan ...................................................................................................................................... 23
Prescription Drug Coverage .................................................................................................... 23
CVS/Caremark Prescription Plan................................................................................................................ 23
Kaiser Permanente Prescription Plan .......................................................................................................... 27
Life Insurance............................................................................................................................ 28
Employee Life Insurance ............................................................................................................................ 28
Basic Employee Term Life Insurance................................................................................................. 28
Optional Employee Term Life Insurance............................................................................................ 28
Dependent Term Life Insurance ................................................................................................................. 29
Basic Dependent Term Life Insurance .................................................................................................. 29
Optional Dependent Term Life Insurance .......................................................................................... 29
Flexible Spending Accounts .................................................................................................... 29
403(b) Tax Shelter Savings and 457(b) Deferred Compensation Plans .............................. 31
Applying for Distribution of Funds from 403(b) and/or 457(b) Accounts After Retirement ............. 32
Well Aware: Employee Wellness Program ............................................................................... 32
Retirement Benefits .................................................................................................................. 32
Social Security ............................................................................................................................................ 32
Pension Plans .............................................................................................................................................. 33
Postretirement Health Benefits ................................................................................................................... 33
Employee Benefit Rate Charts ................................................................................................. 342021
Stepchildren:
About Your Benefits Social Security number and
valid birth certificate or valid birth
WHO IS ELIGIBLE registration and
You are eligible to enroll in the employee shared or joint custody agreement (court
benefit plan if you are a permanent MCPS validated) up to age 18
employee regularly scheduled to work 20 hours
or more per week. If your spouse has health Adopted Children, Foster Children, Children in
coverage through the MCPS employee benefit Guardianship or Custodial Relationships:
plan and you are a covered dependent, you may Social Security number and one of the
not enroll for coverage as an individual under following:
the MCPS employee benefit plan.
o adoption documents (court validated)
o guardianship or custody documents
Eligible Dependents (court validated)
You may choose to cover your eligible dependents o foster child documents (county, state, or
under the MCPS employee benefit plan. Eligible court validated)
covered dependents must be enrolled in the same
benefits plan in which you are enrolled. Disabled Dependents
Any disabled dependent child remains eligible
Eligible dependents include your—
for medical and prescription coverage until the
spouse, and end of the month in which he/she turns 26. A
disabled dependent remains eligible for dental,
eligible children who meet the following age and vision coverage until the end of the month in
requirements: which he/she turns 24. Disabled dependents
o until the end of the month in which they remain eligible for life insurance coverage until
turn 26 for medical and prescription September 30 following his/her 23rd birthday.
coverage However, your disabled dependent child(ren)’s
o until the end of the month in which they coverage may be continued beyond these age
turn 24 for dental and vision coverage limits if—
o until September 30 following their 23rd he or she is permanently incapable of self-
birthday for life insurance coverage support because of intellectual disability or
The documentation you submit to show physical disability, or he/she became
eligibility of a spouse or child(ren) must include disabled, and
but is not limited to the following: the disability occurred before he or she
Spouse: reached age 19.
It is your responsibility to notify MCPS of the
Social Security number and
child’s incapacity and dependency to be
valid marriage certificate or current joint tax considered for continuous benefits coverage. If
return (signed by both parties or a copy of MCPS is not notified prior to—
the confirmation of electronic submission)
the dependent’s 26 th birthday, medical and
Newborn or Biological Children: prescription benefits will be cancelled;
the dependent’s 24th birthday, dental and
Social Security number and
vision coverage will be cancelled; and
valid birth certificate or valid birth
registration
EMPLOYEE BENEFIT SUMMARY
12021
September 30 following the dependent’s 23rd the chart below to see when your coverage
birthday, life insurance will be cancelled. would begin:
Unless otherwise terminated in accordance with
the plan terms, coverage will continue as long as If you submit your Your coverage will
the disabled child is incapacitated and online enrollment: begin on:
dependent. You will be asked to provide the plan On or before January 20 February 1
administrator with proof that the child’s
Between January 21 and
incapacity and dependency existed prior to age March 1
February 20
19. Before the plan administrator agrees to the
extension of coverage, the plan administrator On February 21 April 1
may require that a physician chosen by your
health plan examines the child. The plan
administrator may ask for ongoing proof that the Special Rule for 10-Month
child continues to be disabled. If you do not Employees
provide proof that the child’s incapacity and If you are a 10-month employee reporting at the
dependency existed prior to age 19, as described beginning of a school year, your coverage will
above, coverage for that child will end at the end begin October 1 if you enroll by September 20.
of the month in which he/she turns age 26 for If you enroll from September 21 to October 20,
medical and prescription coverage, at the end of your coverage will begin November 1. You must
the month in which he/she turns age 24 for enroll within 60 days of initial employment.
dental and vision coverage, and on September
30 following his/her 23rd birthday for life ENROLLING NEW DEPENDENTS
insurance.
Your new dependents are not covered or
If you change your medical plan, you will be enrolled automatically under the benefit plan—
required to submit new medical documentation you must take action to enroll new dependents in
to the new health plan provider for review. your plan. You may enroll a new eligible
dependent in your benefit plan during Open
Coverage ends if you predecease your disabled
Enrollment or when you experience a qualifying
dependent, except as provided under federal
life event.
Consolidated Omnibus Budget Reconciliation
Act (COBRA) legislation. Please note that you must enroll your new
dependent through ERSC, not through the
WHEN BENEFITS COVERAGE benefit plan provider.
BEGINS When you enroll a dependent in your plan,
New employees must enroll in benefits via the whether as a new employee, during Open
online Benefits Enrollment System (BES) within Enrollment, or due to a qualifying life event, you
60 days of initial employment or wait until a are required to use the BES. (See Enrollment
future Open Enrollment to enroll online. (See Basics in this booklet for benefits enrollment
Enrollment Basics in this booklet for benefits instructions.) You will be required to provide
enrollment instructions.) Coverage begins on the supporting documentation.
first day of the month following the month that
Refer to the chart below for information about
you enroll, provided you submit your online
enrolling an eligible dependent if you experience
enrollment by the 20th day of the month.
a qualifying life event. It includes important
If you enroll online after the 20th day of the deadlines and documentation you are required to
month, your benefits coverage begins on the first submit. Note: All documentation must be
day of the second month. For example, let’s translated to English prior to submitting it to
assume you are hired on December 23. Refer to ERSC.
EMPLOYEE BENEFIT SUMMARY
22021
Qualifying Life Event Forms Required Deadline to Add
Newborn/adopted child Social Security number* 60 days from the date of birth or adoption
Birth certificate/registration* or
Legal court documentation
Legal guardianship/custody Social Security number* 60 days from the court award of legal
Legal court documentation guardianship
Spouse Social Security number 60 days from the date of marriage
Marriage certificate
Loss/gain of coverage Insurance cancellation form or 60 days from the date of loss/gain of
COBRA notice coverage
* If you cannot provide a Social Security number and a birth certificate or birth registration within the 60-
day time frame, you may enroll your newborn with evidence that you have applied for a social security
number and a birth certificate or birth registration. You must provide the social security number and birth
certificate or birth registration to ERSC upon receipt. Failure to provide this information in a timely
manner will result in termination of coverage.
Coverage for your newborn/newly adopted work event. Qualifying life or work events
dependent child(ren) will be retroactive to the include:
date of birth, adoption, or legal guardianship
when forms are submitted within the 60-day Marriage/divorce
time frame. Birth of child; adoption or legal
If ERSC receives all required documentation by guardianship
the 20th of the month, coverage for your new Death
dependent will begin on the first day of the
following month. If ERSC receives the forms Aging off plan
and necessary documents after the 20th of the Change of work status (e.g., you are a .4
month, coverage for your new dependent will paraeducator, not benefits eligible, and your
start on the first day of the second month. hours increase to .6—you now are benefits
If you do not enroll your new dependent within eligible)
the 60-day time frame listed above, you must Loss of non-MCPS coverage
wait until a future Open Enrollment to enroll
him or her using the BES. Changes due to qualifying life or work events
may be made during the plan year, as described
in the section Enrolling New Dependents.
CHANGES IN OR CANCELLATION
OF COVERAGE You may cancel your coverage at any time, but
you may not cancel your dependent’s coverage
In general, you are not permitted to make without proof that the dependent has coverage
changes to your benefits plan during the plan elsewhere.* Also, while you may add or drop
year. You may make changes to your benefits yourself, a spouse, or dependent(s) from your
plan during the annual Open Enrollment held benefits plan outside of Open Enrollment due to
each fall. a qualifying event, you may not make changes to
Certain benefit changes may be made during the your benefits plan outside of Open Enrollment.
plan year if you experience a qualifying life or This means you may not change insurance plans
EMPLOYEE BENEFIT SUMMARY
32021
or cancel individual components of your benefit benefits coverage will be effective the first of
plan during the plan year. the month following your enrollment.
If you choose to cancel coverage outside of
Open Enrollment, you must cancel the entire PAYING FOR COVERAGE
employee benefit plan—with the exception of You pay for your health plan coverage with
life insurance coverage(s). premiums deducted from your paycheck on a
To cancel or change coverage due to a pretax basis. Your premiums are deducted
qualifying life event outside of Open before income and payroll taxes are calculated,
Enrollment, you must visit the Employee Self- and your deductions are taken in equal amounts.
Service web page at The detailed cost is shown on your ePaystub.
www.montgomeryschoolsmd.org/departments/er Ten-month employees have deductions
sc/employees/employee-self-service/ and click on taken from 20 paychecks during the school
the Benefits enrollment/changes due to a year.
qualifying life event link. You have 60 days
from the date of the qualifying event to enroll Twelve-month employees have deductions
and submit the required supporting taken from 26 paychecks.
documentation to ERSC. You must either Refer to the rate chart at the end of this
upload this information to the BES when you document for the base health coverage costs for
enroll or mail it to ERSC. 2021.
If ERSC receives all required documentation by
the 20th of the month, changes to or cancellation WHEN BENEFITS COVERAGE ENDS
of your coverage will become effective on the
first day of the following month. If ERSC If you terminate employment with MCPS,
receives the forms after the 20th of the month, benefits coverage for you and any covered
changes to your coverage will become effective dependents ends on the last day of the month
on the first day of the second month. you terminate employment.
If you do not enroll and provide the necessary Dependent life insurance coverage for a
documentation within the 60-day period, you dependent child automatically ends on
must wait until a future Open Enrollment to September 30 following the child’s 23rd
make any changes using the BES. birthday. For dental and vision plans, benefits
coverage for a dependent child automatically
Remember: It is your responsibility to ends at the end of the month in which he/she
promptly notify ERSC of any changes to your turns age 24. For medical and prescription plans,
personal information (e.g., name or address) a dependent child’s coverage automatically ends
or coverage needs. at the end of the month in which he/she turns
age 26.
*It is recommended that you notify ERSC
promptly because removing a dependent could
change your coverage level and reduce your Special Rule for 10-month
cost. You must provide evidence of other Employees
coverage in order to drop a dependent from If you are a 10-month employee and you
coverage. terminate employment with MCPS at the end of
a school year, your coverage continues through
Loss of Non-MCPS Coverage September 30 because you have prepaid for
You may enroll in an MCPS-provided benefits benefits through the summer.
plan during the plan year if you or your benefits-
eligible dependents lose coverage provided by a
business or organization other than MCPS. Your
EMPLOYEE BENEFIT SUMMARY
42021
CONTINUATION OF BENEFITS required premium will result in cancellation of
(COBRA coverage.
If your coverage ends, you and your dependents Please be advised that if you terminate your
may be eligible to continue coverage as provided coverage while on leave and, after returning to
under COBRA. work at a later day, wish to re-enroll in benefits,
you must do so using the BES within 60 days of
You and/or your dependents may become returning to active work status. You must re-
eligible for coverage under COBRA if you enroll in the same coverage you had prior to
terminate employment or you and/or your going on leave. If you marry, have a child, or
dependents become ineligible for coverage adopt a child while on leave, they may be added
under the MCPS benefits plan. You may to your plan when you return from leave via the
continue coverage by paying the full cost of BES. You will need to provide the appropriate
coverage plus a 2 percent administrative fee for documentation.
a period legally-mandated by COBRA
regulations (generally 18–36 months). In most cases, you cannot continue your
participation in a flexible spending account
MCPS does not share the cost of COBRA (FSA) while on leave. Your FSAs are cancelled
coverage. A COBRA rate chart can be found on as of the last deduction taken once you are on
the ERSC website. You will receive a qualifying leave, and you must reenroll within 60 days of
event notice (QEN) from the MCPS third party returning from leave. You can incur expenses up
administrator. to the date your leave begins and have until
April 30 following the plan year to submit
INSURANCE COVERAGE WHILE claims for reimbursement.
ON LEAVE While on an approved leave of absence
If you are on an approved leave of absence, you protected by the Family and Medical Leave Act
may elect to continue or terminate your coverage (FMLA), you may choose to re-enroll in an
under the MCPS employee benefit plan. FSA. To do so, complete and submit MCPS
Depending on the type and duration of your Form 450-3, Flexible Spending Account Election
leave of absence, you may be required to pay to have your FSA contributions direct billed to
either the employee share or the full cost of you.
coverage. For most unpaid leave categories,
If you fail to reenroll in the employee benefit
there is not an MCPS subsidy, and you are
plan within 60 days of returning to active work
responsible for 100 percent of the cost of
status, you must wait until a future Open
insurance while on leave. More information
Enrollment. In order to reenroll for basic
regarding leave of absence policies is available
employee life insurance or optional employee
on the ERSC website at
and optional dependent life insurance, you and
www.montgomeryschoolsmd.org/departments/er
your spouse must provide evidence of
sc/employees/leave/.
insurability and be approved by MetLife.
You may elect to terminate coverage by
If you are absent from work without approved
indicating your choice on the appropriate BES
leave, you still are required to pay health
screen(s). If you wish to continue coverage
insurance premiums. If in any given pay period
while on leave, no action is required.
you do not have sufficient funds to cover the
You can continue life insurance coverage cost of your insurance premiums, the premiums
without continuing medical, dental, vision, or will be withheld from your next paycheck. In the
prescription coverage. If you elect to continue event of a longer unapproved absence from
life insurance coverage, you will be billed by the work, you will be billed the full cost premium
MCPS Division of Controller. Failure to pay the rate. Please keep in mind that you could
EMPLOYEE BENEFIT SUMMARY
52021
jeopardize your eligibility to continue health CareFirst BlueChoice does not have
insurance coverage if you are absent without participating doctors or facilities, the plan
approved leave. For additional information provides out-of-network benefits.
about leave of absence policies, visit the ERSC
website at COORDINATION OF BENEFITS
www.montgomeryschoolsmd.org/departments/er
sc/employees/leave/ If you or one of your dependents is covered by
more than one insurance plan, there is an order
OUT-OF-AREA COVERAGE of benefits determination established by the
National Association of Insurance
If you are enrolled in the Kaiser Permanente Commissioners. The primary plan will be the
Health Maintenance Organization (HMO) first to consider the medical services rendered
medical plan, any eligible dependents that reside for coverage. Any medical care not covered by
or attend school outside the service area of the the primary plan in full will be considered for
HMO will be covered only for urgent care or payment by the secondary plan.
emergency services.
Your employee plan is your primary coverage
You are covered anywhere in the world for over any other plan that covers you as a
emergency and urgent care with your Kaiser dependent spouse.
Permanente plan. If you regularly travel to
another service area where you will receive Birthday Rule
Kaiser Permanente care, you can get a If dependent children are enrolled for insurance
health/medical record number and a kp.org coverage with both biological parents (one
account to seamlessly receive care. When MCPS plan, one non-MCPS plan), the primary
travelling in an area outside of any Kaiser insurance plan for the children is determined by
Permanente service area, you can get care at a the birthday of the parents.
MinuteClinic® and you will be charged your
The plan of the parent with the birthday that
standard copay or coinsurance. Learn more at
comes first in the calendar year (month and day
kp.org/travel. Refer to the HMO summary plan
only) is primary for the child(ren). This order of
document for details.
benefits determination for dependent children is
If you are enrolled in the CareFirst BlueChoice known as the birthday rule.
HMO, any dependent or employee who resides
All medical plans offered by MCPS use the
or attends school outside the service area will
birthday rule for primary insurance plan
only be covered for urgent care or emergency
determination. The birthday rule does not apply
services. You have access to the Away From
to stepchildren. Primary care for dependent
Home Care (AFHC) Program that provides
stepchildren is determined by the courts.
benefits for participants residing outside of the
HMO home service area for 90 days or more.
Some areas of the country do not participate in ENROLLMENT IN MEDICARE
the AFHC Program. Members must reapply to
As an active MCPS employee, if you and/or
the Program every year. To take advantage of
your covered dependent(s) are eligible for
the AFHC Program or to reapply, you should
Medicare due to age, illness, or disability, you
contact CareFirst BlueChoice at 1-888-452-6403
may defer Medicare Part B enrollment without
for more information and enrollment procedures.
penalty as long as you are covered by any active
If you are enrolled in the CareFirst BlueChoice MCPS medical plan. Deferring Medicare
Advantage Point of Service (POS), you have enrollment will save you the cost of additional
access to both a local and national network of monthly Medicare Part B premiums while
doctors and facilities. In the event that you maintaining your MCPS medical coverage.
and/or your dependents seek care where Enrollment in Medicare Part B will not provide
EMPLOYEE BENEFIT SUMMARY
62021
additional medical coverage beyond what
already is included in all MCPS medical plans. Enrollment Basics
Therefore, employees typically defer Medicare
Part B enrollment until retirement when deferral
USING THE BENEFITS ENROLLMENT
no longer is permitted.
SYSTEM (BES)
If you and/or your qualified dependent(s) defer
Employees who wish to enroll in or make
Medicare enrollment, you still will be required
changes to their benefits either when first hired,
to enroll in Medicare Parts A and B when you
during an annual Employee Benefits Open
retire and no longer are covered by the active
Enrollment, or when experiencing a qualifying
employee health plan. Enrollment in Medicare
life event or returning from long-term leave
must coincide with your retirement date and is
must make their elections using the BES. To
arranged by contacting the Social Security
access and use the system, visit the Employee
Administration at least three months prior to
Self-Service (ESS) web page at
your retirement. At the time of your retirement,
www.montgomeryschoolsmd.org/departments/er
you must submit a copy of the Medicare card(s)
sc/employees/employee-self-service/.
to ERSC with your retirement papers.
Conveying this information to ERSC will If you are a new employee, click on the Benefits
initiate the necessary process to update your enrollment for new employees link. Those
benefit enrollment and notify the insurance making changes during Open Enrollment click
carriers. on the Open Enrollment link. Those
experiencing a qualifying life event click on the
All retirees and dependents covered by any
Benefits enrollment/changes due to qualifying
MCPS retiree medical plan are required to enroll
life event link. Then, log in using your Outlook
in Medicare Parts A and B when first eligible to
username and password and follow the onscreen
remain covered by the MCPS plan. Once
instructions.
enrolled, Medicare will be your primary
insurance, and the MCPS medical plan provides The BES allows you to quickly and easily
secondary coverage as a supplement to review, update, and confirm your benefit
Medicare. elections; elect a medical or dependent care
flexible spending account (FSA); and designate
If you and/or your dependent(s) become
your life insurance beneficiaries. Since it is
Medicare eligible at any time due to end-stage
online, there are no paper forms to fill out or
renal disease (ESRD), you must notify ERSC at
send in. You simply make your elections and
301-517-8100.
submit them with a series of clicks.
Detailed information about post-retirement
health coverage and Medicare is provided during SUBMITTING SUPPORTING
the Retirement Informational Sessions offered DOCUMENTATION
by ERSC and also is included in the Retiree
Benefit Summary, which is available online at Employees adding a dependent to their benefit
www.montgomeryschoolsmd.org/uploadedFiles/ plan—whether during Open Enrollment or due
retiree_benefit_summary_current.pdf. to a qualifying life event—must submit the
necessary supporting documentation to ERSC.
Supporting documentation may be uploaded
during the online enrollment process via the
BES or mailed or delivered in one of the
following ways:
EMPLOYEE BENEFIT SUMMARY
72021
Email: ERSC@mcpsmd.org
Mail: 45 W. Gude Drive, Suite 1200,
Rockville, Maryland 20850
Pony mail: ERSC at 45 W. Gude Drive
Fax: 301-279-3651 or 301-279-3642
If you choose to submit supporting
documentation via the BES or email, you must
submit an electronically signed Adobe PDF file.
When submitting hard copies of supporting
documentation, please write your name and
employee identification number in the upper
right corner of each page.
EMPLOYEE BENEFIT SUMMARY
82021
Your Benefits at a Glance
The chart below is a brief overview of your benefit options for 2021. For more information, refer to the
appropriate section in this benefits summary.
Benefit Your Options
Protecting Your Health
Medical
Point-of-Service (POS) Health Plans CareFirst BlueChoice Advantage (POS)
Health Maintenance Organizations CareFirst BlueChoice HMO
(HMO) Health Plans Kaiser Permanente HMO
Prescription Drug CVS Caremark Prescription Drug
(only available to CareFirst BlueChoice plan participants)
Kaiser Permanente Prescription Drug
(only available to Kaiser Permanente plan participants)
Dental CareFirst Preferred Dental Plan (PPO)
Aetna Dental Maintenance Organization (DMO)
Kaiser Permanente Preventive Dental Coverage
(included in medical plan; available only to Kaiser Permanente medical plan
participants)
Vision Davis Vision (provided through CareFirst)
Kaiser Permanente Vision Plan
(included in medical plan; available only to Kaiser Permanente medical plan
participants)
Wellness Initiatives Health Risk Assessments
Biometric Health Screenings
CareFirst disease-management programs for diabetes, high cholesterol,
and hypertension
Protecting Your Income
Flexible Spending Accounts Medical spending account (up to $2,750/year)
Dependent care account (up to $5,000/year or $2,500/year if filing separately)
Basic Term Life Insurance MetLife—
Employee (83 percent paid by MCPS)—2 times annual salary
Dependent (paid by MCPS)—$2,000/spouse, $1,000/each eligible dependent
child up to age 23
Optional Life Insurance MetLife—
Employee—1 times annual salary (paid by employee)
Dependent—$10,000/spouse or each eligible dependent child (paid by
employee)
Protecting Your Future
Defined Contribution Plans Fidelity—Elect a percentage or flat amount of your salary to contribute to each
403(b) Tax Shelter Savings Plan 457(b) account, up to annual IRS limits (available at www.netbenefits.com/mcps)
Deferred Compensation Plan
Defined Benefit Pension Plans By completing the appropriate forms, you are enrolled in state and/or county-
sponsored pension plans.
EMPLOYEE BENEFIT SUMMARY
92021
Note to CareFirst BlueChoice plan members:
Wellness Initiatives If your primary care physician completes your
health screening, he/she must complete and sign a
CareFirst Health and Wellness Evaluation form.
To develop a culture of wellness within MCPS, Instructions for accessing the online form are
the Wellness Initiatives program was established available on the Wellness Initiatives for
as part of the school system’s benefit program. Employees web page at
Expanding the efforts of the MCPS employee www.montgomeryschoolsmd.org/departments/er
wellness program, Well Aware, the program is sc/employees/benefits/wellness-initiatives.aspx.
intended to educate employees about their health
while offering incentives to those who Note to Kaiser Permanente plan members:
participate. Wellness Initiatives is in accordance You must log in to the Kaiser Permanente website
with Montgomery County Education at www.webmdhealth.com/kp/750/landing to
Association (MCEA), Service Employees confirm your participation in the Wellness
International Union (SEIU) Local 500, and Initiatives program and determine if you must
Montgomery County Association of meet any additional requirements.
Administrators and Principals (MCAAP)/
Montgomery County Business and Operations HEALTH RISK ASSESSMENTS
Administrators (MCBOA) contracts.
Health risk assessments are online surveys that
Each year, if you are covered by an MCPS- ask basic health and lifestyle questions to
provided medical insurance plan through provide you with a baseline of your current
CareFirst or Kaiser Permanente, you can reduce health status. If you complete a health risk
your contributions to your health insurance by assessment by the deadline, your contribution to
completing a biometric health screening and/or your health insurance will be reduced by 1
an online health risk assessment. You must percent.
complete them between the first day of fall
Open Enrollment and the Friday before the Your online health risk assessment must be
next Open Enrollment begins a year later. completed through the medical plan in which
Once you have completed your biometric health you are enrolled. If you have not already done
screening and/or health risk assessment, the so, you will need to create an online account
incentive(s) will go into effect January 1 of the with your medical plan. To set up your account,
calendar year that follows the deadline. visit your medical plan’s website (listed below)
and complete a simple registration process:
BIOMETRIC HEALTH SCREENINGS • CareFirst—www.carefirst.com/mcps
Biometric health screenings monitor for disease • Kaiser Permanente—www.kp.org
and assess risk for future medical problems. By
MCPS will not receive the results of your
completing a biometric health screening of your
biometric health screening or health risk
blood pressure, blood sugar, body mass index
assessment. Your health insurance carrier will
(BMI), and cholesterol, you will be eligible for a
only indicate whether you have completed your
1 percent increase in MCPS contributions
screening and/or assessment. Your personal
toward your health insurance. This means that
information is protected by the federal Health
your contribution to your health insurance will
Information Portability and Accountability Act.
be reduced by 1 percent if you complete the
biometric screenings within the above time
frame. Your health screening may be completed DISEASE-MANAGEMENT PROGRAM
by your primary care physician or at one of your FOR CAREFIRST MEMBERS
medical plan’s health screenings sponsored by
Montgomery County Public Schools employees
Well Aware.
who are covered by CareFirst have the option of
EMPLOYEE BENEFIT SUMMARY
102021
participating in a disease-management program o Now with 24/7 member services
to better control and manage their diabetes, high support, excluding Thanksgiving,
cholesterol, and/or hypertension (high blood Christmas, and some Federal holidays)
pressure). The program includes health coaching
and participation incentives. Health Maintenance Organization (HMO)
options:
If you have one or more of these conditions, you
CareFirst BlueChoice HMO
are eligible to enroll in the program. Your
copayments for diabetic supplies and o Now with 24/7 member services
medications prescribed for these conditions will support, excluding Thanksgiving,
be waived after 12 months if you have— Christmas, and some Federal holidays)
maintained your participation in the Kaiser Permanente HMO
program, and
complied with program requirements by POINT-OF-SERVICE PLAN
using medications prescribed to treat your
A POS plan combines features of an HMO and
conditions exactly as your doctor has
an indemnity plan. You receive care in one of
instructed without missing any days.
two ways. There is an in-network HMO-like
To enroll in the program, CareFirst members component offering a full range of services
with one or more of the above conditions should provided or authorized by your primary care
do the following: physician or by an in-network specialist. In
addition, there is an out-of-network component
Telephone CareFirst Member Services at similar to traditional indemnity insurance. The
1-800-545-6199 and ask to enroll in a health out-of-network benefit provides payment for
coaching program. You will be connected treatments received from non-network
with Healthways, an independent company physicians or specialists after the coinsurance
that administers health improvement and a yearly deductible are met. You also will be
services. responsible for any amount above the usual,
Provide your name, date of birth, and customary, and reasonable (UCR) charges
address to verify your identity. determined by the plan.
Determine a date and time to have your first The POS plans do not require you to obtain a
health coaching call. referral to visit a participating in-network
physician or specialist for medically necessary
Accept your health coach’s first call and care.
discuss your personal goals.
Participate in follow-up calls, as established CareFirst BlueChoice Advantage
by you and your coach. POS Plan
The BlueChoice Advantage POS plan offers in-
and out-of-network benefits and has the added
Medical Coverage advantage of access to either the local
BlueChoice network or the national
BluePreferred (PPO) network.
You may choose one of the following medical
plan options: Benefits of BlueChoice Advantage—
Access to more than 1 million providers
Point-of-Service (POS) option:
nationally
CareFirst BlueChoice Advantage POS
EMPLOYEE BENEFIT SUMMARY
112021
No Primary Care Physician (PCP) selection BlueChoice online search function at
required www.carefirst.com/mcps or by telephoning
1-800-545-6199. Your PCP will provide medical
No PCP referral required to see a specialist care and may refer you to a network specialist,
Pay copays when you receive care from an as necessary. However, the plan is an open
in-network provider access plan, and referrals are not necessary to
see an in-network specialist. Prior authorization
Preventive services, including well child is necessary for certain coverage such as
visits, annual adult physicals, and routine laboratory and X-ray services. Each covered
cancer screenings family member may select a different PCP. You
When care is rendered in Maryland, D.C., or must select a PCP prior to your first appointment
Northern Virginia, use the CareFirst BlueChoice by contacting CareFirst BlueChoice directly
network. If outside the service area, use the online or by phone at 1-800-545-6199.
BluePreferred network to receive the highest
Diabetic supplies are covered under the
level of coverage and pay lower out-of-pocket
prescription drug benefit administered by
costs.
CVS/Caremark. Specialty care benefits are
Members seeking care outside the CareFirst covered as follows:
service area will lower costs by using national Chiropractic Manipulation: 20 visits/year,
BluePreferred providers. You will still have the $20 copay/visit
option to seek care outside of the network, but
will pay a higher out-of-pocket expense if you Diabetic Education/Training: $20
do. copay (benefits are paid at 100 percent of
the allowed amount)
If you receive services from a provider outside
of the BluePreferred network, you will have Physical, Speech, and Occupational
to— Therapy: 30 visits/year, $20 copay/visit
pay the provider’s actual charge at the time Away From Home Care (AFHC)*
you receive care, and
*AFHC is an out-of-area program that provides
file a claim for reimbursement. benefits for CareFirst BlueChoice plan
participants residing outside of their home
HEALTH MAINTENANCE network service area for 90 days or more. Some
ORGANIZATIONS areas of the country do not participate in AFHC.
Members must reapply to the program every
A health maintenance organization (HMO) plan year. To take advantage of the AFHC program
offers a full range of services provided by your or to reapply, members should contact
PCP or by an in-network specialist. You may CareFirst BlueChoice at 1-888-452-6403 for
receive benefits only for medical services and more information and enrollment procedures.
supplies received from a network provider,
except in a true emergency. However, you do Kaiser Permanente HMO
not have to meet a deductible before the plan Kaiser Permanente brings your doctors,
pays benefits. specialists, pharmacy, labs, X-rays, and medical
facilities under one plan. There are more than 33
Refer to the HMO comparison chart outlined medical centers within the MCPS service area.
later in this document for further details. Included are 14 Urgent Care locations, six of
which are Advanced Urgent Care centers open
CareFirst BlueChoice HMO 24/7. You have the choice of more than 1,600
CareFirst BlueChoice is an individual practice physicians in 50+ specialties from which to
HMO where you select a PCP from a list of choose. You may receive information about
participating doctors through the CareFirst
EMPLOYEE BENEFIT SUMMARY
122021
locations at www.kp.org/locations or by
telephoning 1-800-777-7902. Medical centers
are staffed by doctors, nurses, and specialists
and offer a wide range of services such as
pharmacy, laboratory, X-ray, ambulatory
surgery, and health education. We encourage
you to select a center and PCP that best meets
your needs when you enroll in the plan. If you
do not choose a center, Kaiser Permanente
automatically will assign a center nearest to your
residence of record. You may change your
doctor anytime.
When scheduling an appointment, be sure to ask
for your PCP. You may call and change your
PCP or medical center location at any time.
Each of your covered family members may
select a center and PCP of their choice. Your
PCP is responsible for coordinating all health
needs including hospital and specialty care if
needed. If you enroll in the Kaiser Permanente
HMO, your prescription drug benefits and
diabetic supplies are provided under this plan.
Kaiser Permanente covers diabetic supplies and
provides certain discount specialty services.
Refer to the HMO comparison chart for more
information about the HMO plans.
PREVENTIVE CARE SERVICES
As a result of the Patient Protection and
Affordable Care Act, certain preventive care
procedures no longer will have copays when
they are provided by in-network providers,
regardless of your medical plan choice. The
specific procedures provided for adults and
children are listed separately in the following
charts. Preventive care procedures not listed
specifically will be covered by in-network
providers with copays outlined in the HMO and
POS comparison charts on the following pages.
Out-of-network coverage remains unchanged,
and copays are listed in the POS comparison
chart later in this document.
EMPLOYEE BENEFIT SUMMARY
132021
Preventive Services Covered with Zero Copay for Adults*
Preventive Service Covered Who is Eligible, Additional Details
Abdominal Aortic Aneurysm Screening one-time screening for men of specified ages who have ever smoked
Alcohol Misuse Screening and Counseling all adults
Aspirin Use men and women of certain ages
Blood Pressure Screening all adults
Cholesterol Screening adults of certain ages or at higher risk
Colorectal Cancer Screening adults over 50
Depression Screening all adults
Type 2 Diabetes Screening adults with high blood pressure
Diet Counseling adults at higher risk for chronic disease
HIV Screening all adults at higher risk
Immunizations for: doses, recommended ages, and recommended populations vary
Hepatitis A
Hepatitis B
Herpes Zoster
Human Papillomavirus
Influenza
Measles, Mumps, Rubella
Meningococcal
Pneumococcal
Tetanus, Diphtheria, Pertussis
Varicella
Obesity Screening and Counseling all adults
Sexually Transmitted Infection (STI) Prevention Counseling adults at higher risk
Tobacco Use Screening all adults and cessation interventions for tobacco users, expanded
counseling for pregnant tobacco users
* Using in-network providers only
EMPLOYEE BENEFIT SUMMARY
142021
Preventive Services Covered with Zero Copay for Women *
Preventive Service Covered Who is Eligible, Additional Details
Annual well-woman visit all women
Syphilis Screening all pregnant women, all adults at higher risk
Anemia Screening pregnant women, on a routine basis
Bacteriuria Urinary Tract or Other Infection Screening pregnant women
BRCA Counseling about Genetic Testing women at higher risk
Breast Cancer Mammography Screenings women over 40, every 1 to 2 years
Breast Cancer Chemoprevention Counseling women at higher risk
Breast Feeding Interventions women (to support and promote breast feeding)
Breast Feeding Support, Supplies, and Counseling women (to support and promote breast feeding)
Cervical Cancer Screening sexually active women
Chlamydia Infection Screening younger women and other women at higher risk
Contraceptive Methods and Counseling (FDA-approved**), all women
including:
Female Condom (OTC)
Diaphragm (P) with Spermicide (OTC)
Sponge (OTC) with Spermicide (OTC)
Cervical Cap (P) with Spermicide (OTC)]
Spermicide (OTC)
Oral Contraceptive (P)
Combined Pill
Progestin
Extended/Continuous
Patch (P)
Vaginal Contraceptive Ring (P)
Shot/Injection (P)
Morning After Pill (over 17 years of age OTC; under
17 years of age P)
IUD (P)
Implantable Rod (inserted by doctor)
Sterilization Surgery
Sterilization Implant
(OTC) Over the Counter
(P) Prescription Required
Folic Acid Supplements women who may become pregnant
Gonorrhea Screening all women at higher risk
Gestational Diabetes Screening pregnant women
Hepatitis B Screening pregnant women at their first prenatal visit
Human Immunodeficiency Virus (HIV) Counseling and all women, on an annual basis
Screening
Human Papillomavirus (HPV) Testing all women
Interpersonal and Domestic Violence Screening and all women
Counseling
Osteoporosis Screening women over age 60 depending on risk factors
Rh Incompatibility Screening all pregnant women and follow-up testing for women at higher risk
Sexually Transmitted Infections Counseling all women, on an annual basis
* Using in-network providers only
** Includes surgical, prescription, medical, and OTC services/products. Sterilization is considered a contraceptive method.
Abortion IS NOT considered a contraceptive method.
EMPLOYEE BENEFIT SUMMARY
152021
Preventive Services Covered with Zero Copay for Children*
Service Who is Eligible, Additional Details
Alcohol and Drug Use Assessments adolescents
Autism Screening children at 18 and 24 months
Behavioral Assessments children of all ages
Cervical Dysplasia Screening sexually active females
Congenital Hypothyroidism Screening newborns
Developmental Screening children under age 3, and surveillance throughout childhood
Dyslipidemia Screening children at higher risk of lipid disorders
Fluoride Chemoprevention Supplements children without fluoride in their water source
Gonorrhea Preventive Medication for the Eyes all newborns
Hearing Screening all newborns
Height, Weight, and Body Mass Index Measurements children of all ages
Hematocrit or Hemoglobin Screening children of all ages
Hemoglobinopathies or Sickle Cell Screening newborns
HIV Screening adolescents at higher risk
Immunization Vaccines for: children from birth to age 18; doses, recommended ages, and
Diphtheria, Tetanus, Pertussis recommended populations vary
Haemophilus Influenzae Type B
Hepatitis A
Hepatitis B
Human Papillomavirus
Inactivated Poliovirus
Influenza
Measles, Mumps, Rubella
Meningococcal
Pneumococcal
Rotavirus
Varicella
Iron Supplements children ages 6 to 12 months at risk for anemia
Lead Screening children at risk of exposure
Medical History all children, available throughout development
Obesity Screening and Counseling children of all ages
Oral Health Risk Assessment young children
Phenylketonuria (PKU) Screening for Genetic Disorder newborns
Sexually Transmitted Infection (STI) Prevention Counseling adolescents at higher risk
Tuberculin Testing children at higher risk of tuberculosis
Vision Screening children of all ages
* Using in-network providers only
EMPLOYEE BENEFIT SUMMARY
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