2019 Edition - Jackson County, MI
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2019 Edition
Table of Contents
Eligibility .................................................................................................................................................. 1
Annual Open Enrollment ........................................................................................................................ 2
Medical Plans .......................................................................................................................................... 3
Prescription Drugs .................................................................................................................................. 9
Dental Plan ............................................................................................................................................ 11
Vision Plan............................................................................................................................................. 12
Life and AD&D Coverage....................................................................................................................... 13
Disability Plans ...................................................................................................................................... 15
Flexible Spending Accounts .................................................................................................................. 17
Employee Assistance Program.............................................................................................................. 19
Consumerism Card................................................................................................................................ 20
LegalShield ............................................................................................................................................ 21
Contacts ................................................................................................................................................ 22
Required Notices................................................................................................................................... 23
Information about Medicare
If you and/or your dependents have Medicare or will become eligible for
Medicare in the next 12 months, a Federal law gives you more choices about
your prescription drug coverage. Please see the attached Creditable Coverage
Notice for details.
3
Welcome to Jackson County’s benefit program. This benefit guide will provide an overview of the benefit plans that
Jackson County sponsors. This is your opportunity to enroll in Jackson County’s benefit plans. After reviewing this
benefit guide, you will need to make decisions about the benefits you want to elect for you and your family. All
elections are made in BenXpress.
Eligibility
All active, regular full-time employees working a minimum of 20 hours per week are eligible to enroll in benefits.
Coverage will begin once the new hire waiting period has been satisfied. The new hire waiting period is dependent
on the employee group you are a part of.
Employee Group New Hire Waiting Period
Non-Union Date of Hire
Elected Officials Date of Hire
AFSCME 90 Days
MI Nurses Assoc. (MNA) 90 Days
Probation Agents Assoc. Date of Hire
Police Officers Assoc. of MI (POAM) 90 Days
Command Officers Assoc. of MI (COAM ) Date of Promotion
POAM—911 Operators 90 Days
Assistant Prosecutor's Assoc. (APA) Date of Hire
Capitol City Labor Program, Inc., Jackson County 90 Days
Corrections Deputies Unit
Attorney Referee / Magistrate's Assoc. (ARMA) Date of Hire
COAM-Jackson County Corrections Supervisors Date of Promotion
Jackson County Road Workers Association 90 Days
Dependents—As you become eligible for medical, dental, vision and prescription drug benefits, so do your eligible
dependents. In general, eligible dependents include your spouse and children under age 26, including adopted,
stepchildren or children covered under a Qualified Medical Child Support Order. If your child is mentally or physi-
cally disabled, coverage may continue beyond age 26 once proof of the ongoing disability is provided.
When does Coverage End—Should you terminate employment with Jackson County, your insurance benefits will
end on the date of your termination.
Dependent coverage will end on the date your coverage ends, the date no longer eligible, or the end of the month
they turn 26 for medical coverage.
1
Change in Status—When you first enroll or if you change coverage mid-year due to a qualified change in family
status event (marriage, divorce, birth, adoption, etc.), you are required to provide documentation substantiating
the eligibility of any dependents within 30 calendar days from the change or enrollment.
This definition will apply to all plans unless the specific insurance carrier or plan definition is more restrictive. In
that case, the insurance carrier or plan definition will apply to that specific individual benefit.
Annual Open Enrollment—October 29-November 9, 2018
Active Enrollment. Employees are required to enroll via BenXpress, even if they do not plan to make
changes to their current benefit elections. If you do not re-enroll, your current benefit elections will
carryover to the new benefit year and changes will not be allowed. Note: Flexible Spending Account
elections do not carryover.
Go online to BenXpress. Please select your 2019 benefits
online via the BenXpress enrollment system.
To get started, go to www.benxpress.com/jackson
Login using your User ID. This is your first initial, last
name (For example, if your name is John Doe, your User
ID is jdoe.)
If this is your first time logging in, your password is the
last four digits of your Social Security Number.
Confirm your dependents. Be sure to check your dependent Go to:
coverage and remove any ineligible dependents. www.benxpress.com
Remember to enroll. Make sure you get the medical, dental /jackson
and vision coverage that best suits your needs. If you would
like to begin or continue participating in a Flexible Spending
Account plan in 2019, you will need to enroll during this open
enrollment period.
Contact the plan providers. You will find carrier contact information on the back cover of this Guide, if
you have questions about benefits or participating providers.
Designate your life insurance beneficiaries. Please review your life insurance beneficiaries and make
changes as desired.
2
Medical Plans
There are two medical plans to choose from:
HAP Jackson Health Network Select
HAP PPO
HAP Jackson Health Network Select
This is an HMO option that provides two levels of in-network coverage. Tier 1 includes providers from
Jackson Health Network or from the Henry Ford Medical Group. Tier 2 includes all HMO participating HAP
providers. You must select a primary care physician, or one will be selected for you. This physician can
participate with either tier, however, selecting a Tier 1 provider means richer benefits for you. You do not
need a referral to seek services from a specialist. The only care provided out of state/network will be
emergencies, urgent care situations, and care for students away at college. Students away at college will
still need to complete routine work in Michigan. Emergency services are always covered when needed.
The deductible amounts differ between Tier 1 and Tier 2. You will need to meet each deductible amount if
you switch provider tiers. However, the deductible and coinsurance met under each Tier will accumulate
towards the same out-of-pocket limit.
HAP PPO with HSA
This is a qualified medical PPO plan. You are encouraged to seek services from an in-network participating
provider in order to receive the highest level of benefit. There is no requirement to select a primary care
physician, nor will you need a referral to receive care from a specialist. If you or a covered dependent needs care
outside the state of Michigan, you can still receive in-network care by finding a participating Cigna provider.
This plan requires that you meet the deductible first (including the full cost of prescription drugs) before the
coinsurance or copay’s apply. All costs (deductible, coinsurance, copayments) will accumulate to the out-of-pocket
maximum and once that has been reached, the plan pays 100%.
This plan also provides access to a Health Savings Account where you can elect to accumulate and spend pre-tax
dollars on eligible medical expenses. Specifically, it helps to pay for deductible expenses now and in the future.
More details are included in the following pages.
This is only a brief summary of your benefits. We have tried to ensure its accuracy but if there is any discrepancy
between the benefits shown in this benefit guide and the official plan documents, the official plan documents will rule.
3
HAP PPO with HSA
This plan is designed to give you more choice and control over how you spend your health care dollars. It has two
components, one to help pay for medical expenses: a qualified medical plan insured by HAP/JHN and a Health
Savings Account (HSA).
How the qualified medical plan works:
The plan provides preventive care at no cost when you use PPO participating providers.
You pay the discounted cost for covered services up to the annual deductible of $1,500 for single and
$3,000 for family. You can use the money in your HSA to satisfy the deductible.
Once you meet the annual deductible, the plan covers 80% for most of your medical services. You begin
paying the fixed dollar copays for prescription drugs.
You pay the applicable prescription drug copays and coinsurance until you reach the annual out-of-pocket
maximum for the year. Then the plan pays 100% for covered medical and prescription drugs.
Health Savings Account (HSA) administered by Health Equity
When you enroll in the HAP PPO, you can establish a Health Savings Account (HSA). An HSA allows you to save
money through pre-tax payroll contributions to help you pay for qualified health care expenses for you and your
eligible dependents, as well as save to pay for future health care expenses, if enrolled in a qualified medical plan.
Jackson County’s HAP PPO meets the criteria of a qualified plan, as defined by the U.S. Internal Revenue Service
(IRS). The HSA provides a triple tax advantage: money goes in tax-free, grows in a tax-free investment account
and is tax-free when used to pay for qualified health care expenses. If you don’t use all the money in the HSA dur-
ing the benefit year, it will roll over year to year. The HSA is owned by you and it goes with you if you change jobs
or retire. The balance in your account is always available. Health Equity, one of the nation’s leading financial
institutions, is the HSA administrator.
Qualified health care expenses include (but are not limited to) deductibles, office visits, hospital charges,
prescription drugs, mental health treatment, diagnostic fees, chiropractic care, contact lenses, vision correction
surgery, hearing aids, and orthodontia. IRS Publication 502 provides a list of most allowable HSA expenditures.
If you enroll in the HAP PPO, you are eligible to set aside funds on a pre-tax basis into an HSA if:
You are not enrolled in Medicare.
You are not covered by other health insurance such as a spouse’s traditional medical plan or full ser-
vice health flexible spending account.
You have not received VA medical benefits in the preceding three months.
You have not received benefits or been covered under TRICARE.
You are not claimed as a dependent on someone else’s tax return.
Eligible employees can contribute – via pre-tax payroll deductions – up to the IRS’ indexed statutory maximums of
$3,500 for single coverage and $7,000 for family coverage during the course of the 2019 calendar year. If you are
age 55 or older, you are also entitled to make “catch-up” contributions in the amount of $1,000 for the 2019
calendar year.
Jackson County will also contribute up to $400 per single and $800 per family in 2019 providing the employee is
also contributing those amounts. This will be deposited each pay period into your HSA. This amount will be
pro-rated based on the effective date of enrollment. Jackson County will also pay the monthly administration fee
associated with maintaining your HSA account.
4Health Savings Account (HSA) administered by Health Equity, continued.
Health Equity will supply you with a Visa debit card to make it easier for you to cover your out-of-pocket expenses,
without having to first pay the medical expense and then submit the charge for reimbursement from your HSA
account. For instance, if your pharmacy accepts the debit card, you can use it to pay for your prescriptions at the
time of purchase. Nothing comes out of your pocket.
If you do not use your debit card, you can submit health care expenses for reimbursement directly to HSA Bank.
The Reimbursement Request Form can be found at HSA’s website or can be obtained from Human Resources. Alt-
hough you are not required to submit supporting documentation, it’s a good idea to start a file at home to main-
tain documentation of your qualified health care expenses. You will be supplied with two identical debit cards. If
additional debit cards are needed, they are available from Health Equity for $5.00 per card.
An important component of the HSA is your ability to invest and grow your money. You will have a choice of sev-
eral HSA funds, with various rates of risk and return. A Health Savings Account Employee Enrollment Booklet, pro-
vided by HSA Bank, provides additional detail on the available funds.
How to find a HAP Jackson Health Network Select Provider
Visit hap.org/jhnhmo
Enter a ZIP code or address
Enter a doctor’s name or specialty, facility name, condition, symptom or procedure
How to find a HAP PPO Provider
Visit hap.org
I’m a HAP Member
Scroll to Log in or select “Search now”
At the top of the next screen, be sure to “change plan” to PPO
Enter your zip code or address
Enter doctors name, facility, specialty, condition or procedure
Click “Search”
HAP coverage at non-participating (providers who do not participate with HAP) hospitals is limited to services
needed to treat an accidental injury or medical emergency. There is NO COVERAGE for non-emergency hospital
services or services received at mental health or substance abuse treatment facilities, ambulatory surgery
facilities, end stage renal dialysis facilities, home infusion therapy providers, hospices, outpatient physical therapy
facilities, skilled nursing facilities or home health care agencies.
This is only a brief summary of your benefits. We have tried to ensure its accuracy but if there is any discrepancy
between the benefits shown in this benefit guide and the official plan documents, the official plan documents will rule.
5Medical Plans, continued
HAP Jackson Health Network Select HAP PPO
Item/Service
Tier 1 Tier 2 In-Network
Calendar Year Deductibles, Coinsurance and Maximums (In-Network Only)
Deductible $250 individual / $1,000 individual / $1,500 single /
$500 family $2,000 family $3,000 family
Co-insurance 100% coverage after deductible 60% coverage after deductible 80% coverage after deductible
Annual Out-of-Pocket
Maximums (includes $4,000 individual / $3,000 single /
deductibles, co-insurance, $8,000 family $6,000 family
flat dollar copays)
Prescription Drugs
Retail Pharmacy Copay After deductible
$10 generic / $40 brand / $10 generic / $40 brand /
(30 day supply) $10 generic / $40 brand /
50% to $200 max 50% to $200 max
50% to $200 max
Mail Order Copay
After deductible
(90 day supply) $20 generic / $80 brand $20 generic / $80 brand
$20 generic / $80 brand
Preventive Services - Limitations Apply
Annual Physical Exams 100% coverage 100% coverage 100% coverage
Annual Gynecological Exams 100% coverage 100% coverage 100% coverage
Pap Smear Screening
100% coverage 100% coverage 100% coverage
(lab services only)
Well-Baby and Child Care 100% coverage 100% coverage 100% coverage
Child Immunizations 100% coverage 100% coverage 100% coverage
Prostate Specific Antigen
(PSA) Screening 100% coverage 100% coverage 100% coverage
(lab services only)
Mammography Screening 100% coverage 100% coverage 100% coverage
Physician Office Services
Primary Care Physician
$10 copay $50 copay 80% coverage after deductible
Office Visits
Specialist Office Visits $35 copay $75 copay 80% coverage after deductible
Emergency Services
Hospital Emergency Room $200 copay, $200 copay,
80% coverage after deductible
waived if admitted waived if admitted
Urgent Care Center $75 copay $75 copay 80% coverage after deductible
Ambulance Services 100% after deductible 100% after Tier 1 deductible 80% coverage after deductible
Diagnostic Services
Diagnostic Tests, Labs
100% after deductible 60% coverage after deductible 80% coverage after deductible
and X-Rays
This is only a brief summary of your benefits. We have tried to ensure its accuracy but if there is any discrepancy
between the benefits shown in this benefit guide and the official plan documents, the official plan documents will rule.
6Medical Plans, continued
HAP Jackson Health Network Select HAP PPO
Item/Service
Tier 1 Tier 2 In-Network
Maternity Services Provided by Physician
Pre-Natal Care 100% coverage 100% coverage 100% coverage
Delivery and Nursery Care 100% coverage after deductible 60% coverage after deductible 80% coverage after deductible
Post-Natal Care $35 copay $75 copay 80% coverage after deductible
Hospital Care
Semi-Private Room, Inpatient
Physician Care, General
100% after deductible 60% coverage after deductible 80% coverage after deductible
Nursing Care, Hospital
Services/Supplies
Surgery and Related Services 100% after deductible 60% coverage after deductible 80% coverage after deductible
Ancillary Services
Home Health Care
100% coverage after deductible 60% coverage after deductible 80% coverage after deductible
Hospice Care
100% coverage after deductible 60% coverage after deductible 80% coverage after deductible
Limitations apply
Skilled Nursing Care 100% coverage after deductible, 60% coverage after deductible, 80% coverage after deductible,
up to 100 days per year up to 100 days per year up to 100 days per year
Mental Health Care and Substance Abuse Treatment
Inpatient Mental Health &
100% after deductible 60% coverage after deductible 80% coverage after deductible
Substance Abuse Care
Outpatient Mental Health &
$10 copay $50 copay 80% coverage after deductible
Substance Abuse Care
Other Services
Chiropractic Spinal $35 copay $35 copay 80% coverage after deductible
Manipulation up to 20 visits per year up to 20 visits per year up to 20 visits per year
Outpatient Physical, Speech, 100% after deductible 60% after deductible, 80% coverage after deductible,
Occupational Therapy up to 60 combined up to 60 combined up to 60 combined
visits per year visits per year visits per year
Durable Medical Equipment 80% after deductible 50% after deductible 80% coverage after deductible
This is only a brief summary of your benefits. We have tried to ensure its accuracy but if there is any discrepancy
between the benefits shown in this benefit guide and the official plan documents, the official plan documents will rule.
7Prescription Drugs
To be eligible for prescription drug coverage, you must elect to participate in one of the medical plan options.
HAP administers the program. You can fill your prescriptions in two ways – at the retail pharmacy or through the
mail-order program.
Mail-Order Program
When you use the mail-order program, you receive a 90-day supply of a medication for only two copays. That is
one month free! To get started with the mail-order program, have your doctor write a script for a 90-day supply
plus three refills. Submit your doctor’s original prescription for the 90-day supply, along with a mail-order request
form and payment to Pharmacy Advantage. You can submit your mail-order request online at pharmacyadvan-
tagerx.com after creating an account or via mail. For questions, please call (800) 456-2112.
Specialty Medications
Specialty medications typically require special handling and monitoring. Therefore, these types of medications
must be ordered through Pharmacy Advantage at 800-456-2112. These are limited to a 30-day supply and may
require prior authorization.
Prior Authorization
Prior Authorization is a program that makes sure you are getting a cost-effective drug that works for you. It works
much like healthcare plans that approve certain medical procedures before they are done, to make sure you are
getting tests you need. In this program, your own medical professionals are consulted. When your pharmacist
tells you that your prescription needs a prior authorization, it simply means that more information is needed to see
if your plan can cover the drug. Only your doctor (or sometimes a pharmacist) can provide this information and
request a prior authorization. For a list of medications that are subject to prior authorization, view the formulary
listing at hap.org/prescriptions.
Generic Policy
If your doctor writes a prescription stating that a Generic may be dispensed, we will only pay for the Generic drug.
If you choose to buy the Brand name drug in this situation, you will be required to pay the Brand co-pay plus the
difference in cost between the Generic and Brand name drug.
8Prescription Drugs (continued)
Step Therapy
Step Therapy is a program designed especially for people who take prescription drugs regularly to treat ongoing
medical conditions, such as arthritis and high blood pressure. The program is designed to get you the prescription
drugs you need, with safety, cost and your health in mind. In Step Therapy, drugs are grouped into categories,
based on cost. Your physician will start you with a Step 1 drug, typically a generic. If that drug is not right for you,
your physician can apply for approval to prescribe you a brand name Step 2 drug.
Step 1: These are generic drugs proven safe, effective and affordable. These drugs should be tried first be-
cause they can provide the same health benefit as the more expensive drugs, at a lower cost.
Step 2: These are brand-name drugs such as those you see advertised on TV. These drugs always cost more
than their generic equivalent.
Prescription Drug Copayments
The chart below illustrates the applicable copayment based on the drug tier and whether it is dispensed for 30 or
90 day supply. For those enrolled in the HAP PPO, you will need to meet the deductible first before these copay-
ments apply. Any payment made for prescriptions will accumulate to the out-of-pocket maximum.
1-30 Day Retail Supply 90 Day Retail Supply 90 Day Mail Order
Generic $10 $20 $20
Non-Preferred Brand $40 $80 $80
Specialty 50% to a max of $200 NA NA
9Dental Plans
As the gateway to the rest of your body, we cannot underestimate the importance of good oral health. Maintaining su-
perior oral health is proven to have a direct correlation in helping to reduce the risks of major health issues. Visiting
your dentist regularly will help to keep issues at bay.
If you elect medical coverage with HAP, you will automatically be enrolled in the dental plan. You also have the option
to waive medical and only elect dental and vision. Since the plans are bundled, the election tier (employee only, two-
person or family) will be the same across the plans you select.
Blue Cross Blue Shield of Michigan is the administrator of the dental plan. To receive the highest level of savings, visit a
Dental Network of America (DNoA) Preferred Network of PPO dentist. To find a dentist, visit BCBSM.com/bluedental or
call 888-826-8152. Most other dentists will participate as a Blue Par Select dentist. These dentists participate on a “per
claim” basis only. You should ask their participation before each treatment is received.
Item/Service Blue Dental PPO Plus
Calendar Year Deductible for Basic & Major Services $0 single/$0 family
Annual Benefit Maximum for Preventive, Basic &
$1,000 per person
Major Services
Lifetime Orthodontic Treatment Maximum $1,000 per person
Preventive Services
Oral exams, x-rays
100% coverage
Cleanings
Basic Services
Fillings & extractions
Periodontal & root canal treatment 75% coverage
Repair/maintenance of crowns, bridges, dentures
Major Services
Crowns
50% coverage
Bridges and dentures
Orthodontic Services
Orthodontic Services for children 19 and under 50% coverage
This is only a brief summary of your benefits. We have tried to ensure its accuracy but if there is any discrepancy
between the benefits shown in this benefit guide and the official plan documents, the official plan documents will rule.
10Vision Plans
Taking care of your eyes is essential. Our BCBS VSP vision program provides you with coverage for routine eye
exams and eyeglasses or contact lenses. When you visit a VSP provider for your vision care needs, you’ll receive the
highest level of benefits the plan offers. You can find VSP providers at www.vsp.com or by calling 800-877-7195.
Login to www.vsp.com, using your Social Security number, to view your personal and benefit information. Your
membership ID number is the one found on your BCBS card, less any letters.
VSP does not issue ID cards – simply let your VSP Provider know you are a VSP member and provide your Social
Security number.
IMPORTANT — If you elect medical coverage or dental coverage, you will also automatically be enrolled in this vi-
sion plan.
BCBSM VSP
Item/Service
In-Network Out-of-Network
Eye Exam $5 copay $5 copay applies to charge
Lenses
Standard $10 copay
$10 copay
(combined with Frames copay)
Medically necessary contacts
$10 copay $210 after $10 copay
(one pair in any period of 12 consecutive months)
Elective contact lenses $130 allowance $105 allowance
Includes fitting and materials Includes fitting and materials
Frames
Standard $130 allowance after $10 copay
(One frame in any period of 12 consecutive months) $70 less $10 copay
(combined with Lens copay)
Notes:
You may choose between prescription glasses (frames and lenses) or contact lenses, but not both.
Additional charges may apply for tinted, oversized, blended, photochromic, coating, or antireflective lenses
This is only a brief summary of your benefits. We have tried to ensure its accuracy but if there is any discrepancy
between the benefits shown in this benefit guide and the official plan documents, the official plan documents will rule.
11Life and AD&D Coverage
Life insurance is extremely important if you have family members that depend on your income. Life insurance pro-
vides financial security for you or your dependents should you die while an employee of Jackson County. Acci-
dental Death and Dismemberment (AD&D) insurance pays an additional benefit if your death is a result of an acci-
dent. In addition, AD&D insurance will pay a portion of the benefit for a loss of limb, eyesight, or both, if the loss is
a direct result of an accident.
Jackson County provides a company paid Basic Life and AD&D benefit for you, and also provides you with the op-
portunity to purchase Optional Life for yourself and Optional Life coverage for your dependents. Coverage is in-
sured by The Hartford.
Benefit reductions may apply for employees and spouses when the employee reaches age 65 and older.
Your coverage effective dates and increases in coverage will be delayed if you are not in active employment be-
cause of an injury, sickness, temporary layoff, or leave of absence on the date that insurance would otherwise be-
come effective.
Your dependent’s coverage effective dates and increases in coverage will be delayed if that dependent is totally
disabled on the date that insurance would otherwise be effective. Totally disabled means that, as a result of an
injury, a sickness or a disorder, your dependent is confined in a hospital or similar institution; is unable to perform
two or more activities of daily living (ADLs) because of a physical or mental incapacity resulting from an injury or a
sickness; is cognitively impaired; or has a life threatening condition. The exception is that infants are insured from
live birth.
Review the certificate/benefit book for details on these and other important provisions.
Basic Life and AD&D Coverage
Your Basic Life and AD&D benefit is dependent on your union affiliation or non-union status. Please see Human
Resources for more information.
A Note About Imputed Income: Any employee whose company-paid life insurance amount exceeds $50,000 will
have the value of the insurance over $50,000 applied as imputed income when calculating income taxes. These
amounts are taxable to you and will be withheld as payroll tax and will be reported on your W-2. The monthly rate
of imputed income is determined by multiplying the age-banded rate by the amount of insurance over $50,000.
These rates are found on Table 1 of IRS Code Section 79. For more information, consult your tax advisor.
This is only a brief summary of your benefits. We have tried to ensure its accuracy but if there is any discrepancy
between the benefits shown in this benefit guide and the official plan documents, the official plan documents will rule.
12Life and AD&D Coverage, continued
Optional Term Life
You have the opportunity to purchase Optional Life insurance for yourself and Optional Life coverage for your
spouse and your children through post-tax payroll deductions. In order to purchase coverage for your spouse or
children, you must first purchase Optional Life coverage for yourself.
The amount of insurance on your dependent(s) will not exceed 50% of your election. A dependent child cannot be
covered twice under the Optional Life plan as a dependent of two married employees.
Benefits reduce based on age. Coverage effective dates and increases in coverage may be delayed if you and/or
your dependents are disabled on the date coverage is scheduled to take effect. Review the carrier certificate/
benefit booklet for details.
Optional Coverage Do You Need to Provide Medical
Individual
Amounts Information (Evidence of Insurability)
Yes, if you:
are electing in excess of $150,000; or
want to increase your coverage at future
Any multiple of $10,000;
open enrollment periods; or
maximum of $500,000 or 5x
Employee Optional Term Life do not elect coverage when first eligible and
annual earnings;
later decide to elect coverage
minimum of $10,000
Coverage does not become effective until your
request has been approved by The Hartford.
Yes, if you:
are electing in excess of $30,000; or
$10,000 minimum up to
do not elect coverage when first eligible and
$50,000, not to exceed 50%
Spouse Optional Term Life later decide to elect coverage
of optional employee life
coverage amount
Coverage does not become effective until your
request has been approved by The Hartford.
Child(ren) Optional Term Life $5,000 or $10,000 No
This is only a brief summary of your benefits. We have tried to ensure its accuracy but if there is any discrepancy
between the benefits shown in this benefit guide and the official plan documents, the official plan documents will rule.
13Disability Plans
Short Term Disability
Our Short Term Disability (STD) plan pays you income if you are disabled from work due to a non-work related ill-
ness or injury. This coverage is provided to you and is administered by The Standard.
Your coverage effective dates and increases in coverage will be delayed if you are not in active employment be-
cause of an injury, sickness, temporary layoff, or leave of absence on the date that insurance would otherwise be-
come effective. Review the certificate/benefit book for details on these and other important provisions.
Item Benefit
Weekly Benefit 66.67% of your weekly earnings. Earnings are defined as base earnings not including com-
missions, overtime pay, bonuses, or any other special compensation not received as basic
salary.
Elimination Period 0 days for disability due to an accident;
7 days for disability due to an illness; or
Benefits begin the day after the elimination period is completed.
Benefit Period Benefits are payable for up to 13 weeks.
Definition of You are disabled when The Standard determines that:
Disability you are limited from performing the material and substantial duties of your regular
occupation due to your sickness or injury; and
you have a 20% or more loss in weekly earnings due to the same sickness or injury.
You must be under the regular care of a physician in order to be considered disabled.
This is only a brief summary of your benefits. We have tried to ensure its accuracy but if there is any discrepancy
between the benefits shown in this benefit guide and the official plan documents, the official plan documents will rule.
14Disability Plans, continued
Long Term Disability
We offer a Long Term Disability (LTD) plan to provide income to employees who are disabled for an extended peri-
od of time. The coverage is provided by Jackson County and insured by The Standard.
Your coverage effective dates and increases in coverage will be delayed if you are not in active employment be-
cause of an injury, sickness, temporary layoff, or leave of absence on the date that insurance would otherwise be-
come effective. Review the certificate/benefit book for details on these and other important provisions.
Item LTD Benefit
Monthly Benefit 60% of your monthly pre-disability earnings up to a maximum of $3,000. Earnings
are defined as gross monthly income in effect just prior to your date of disability,
including pre-tax deductions. It does not include overtime pay, bonuses,
commissions, other extra income or income received from sources other than your
Employer. Your benefit may be reduced by deductible sources of income and
disability earnings.
Elimination Period You must be continuously disabled through your elimination period. The days that
you are not disabled will not count toward your elimination period. Your
elimination period is 90 days. The Standard will treat your disability as continuous if
your disability stops for 30 consecutive days or less during the elimination period.
Benefit Period Benefits are payable up to age 65 or longer in some cases depending on a person’s
age at disability. Benefits are limited to 24 months in a person’s lifetime for mental/
nervous or substance abuse conditions.
Definition of Disability For the elimination period and the first 24 months, disability is the inability to
perform the material and substantial duties of your regular occupation due to
sickness or injury and you have a 20% or more loss of your indexed monthly
earnings due to that sickness or injury. After 24 months of payment, disability is the
inability to perform the duties of any gainful occupation for which you are
reasonably fitted by education, training, and experience.
Pre-existing Conditions Benefits are not payable for a disability due to a pre-existing condition that begins
within 12 months of your effective date of coverage. A pre-existing condition is an
injury or sickness for which you received medical treatment, consultation, care or
services including diagnostic measures, or took prescribed drugs or medications
during the 3 months prior to your effective date of coverage.
This is only a brief summary of your benefits. We have tried to ensure its accuracy but if there is any discrepancy
between the benefits shown in this benefit guide and the official plan documents, the official plan documents will rule.
15Flexible Spending Accounts
Flexible Spending Accounts let you pay for health care and day care expenses with tax-free dollars. They help you
stretch your money and reduce your federal, state, and Social-Security taxes. How much you save depends on how
much you pay in income tax.
There are two types of accounts under this plan: a Health Flexible Spending Account (HFSA) and a Dependent Care
Flexible Spending Account (DCFSA). Enroll in the DCFSA, and/or either the HFSA. BASIC administers the plan for
us.
With any account, you decide before the start of the year how much to contribute to each account. Your contribu-
tions are withheld in equal amounts from your paycheck on a pre-tax basis throughout the year. Claim the money
in your account(s) by using a debit card or you can file a claim form for reimbursement. Call BASIC, our administra-
tor with questions. See the contacts page for the phone number and website.
These accounts help you save money.
How the Accounts Save You Money Without an Account With an Account
Gross Salary $25,000 $25,000
Less Annual Amount Deposited into HFSA / DCFSA $0 ($2,000)
Taxable Income $25,000 $23,000
Less Annual Taxes (assumed at 25%) ($6,250) ($5,750)
Net Salary $18,750 $17,250
Less Out-of-Pocket Medical and/or Dependent Care
($2,000) N/A
Expenses for the Year
Disposable Income $16,750 $17,250
Tax Savings None $500
HFSAs (Health Flexible Spending Accounts)
The HFSA helps you pay for medical, dental, and vision bills that are not covered by insurance. You can put up to
$2,650 into the HFSA in 2019. The full amount will be available January 1, 2019.
For a complete list of the expenses eligible for reimbursement, visit the IRS website at www.irs.gov and search
“Publication 502”.
IMPORTANT: If you elect the HAP PPO, you will not be eligible to elect the HFSA.
This is only a brief summary of your benefits. We have tried to ensure its accuracy but if there is any discrepancy
between the benefits shown in this benefit guide and the official plan documents, the official plan documents will rule.
16Flexible Spending Accounts, continued
DCFSAs (Dependent Care Flexible Spending Account)
This account lets you pay eligible dependent care expenses with pre-tax dollars. Most child and elder care and
companion services are eligible expenses too. Your dependents must be:
Under age 13 or mentally or physically unable to care for themselves
Spending at least 8 hours a day in your home
Eligible to be claimed as a dependent on your federal income tax
Receiving care when you are at work and your spouse (if you are married) is at work or is searching for work, is
in school full-time, or is mentally or physically disabled and unable to provide the care
In 2019, you can put up to $5,000 in the DCFSA. But if both you and your spouse work, the IRS limits your maxi-
mum contribution to a DCFSA.
If you file separate income tax returns, the annual contribution amount is limited to $2,500 each for you and
your spouse
If you file a joint tax return and your spouse also contributes to a DCFSA, your family’s combined limit is
$5,000
If your spouse is disabled or a full-time student, special limits apply
If you or your spouse earn less than $5,000, the maximum is limited to earnings under $5,000
With a DCFSA, you can be reimbursed up to the amount that you have in your account. If you file a claim for more
than your balance, you’ll be reimbursed as new deposits are made.
Eligible dependent care expenses can either be reimbursed through the DCFSA or used to obtain the federal tax
credit. You can’t use both options to pay for the same expenses. Usually the DCFSA will save more money than
the tax credit. But to find out what is best for you and your family, talk to your tax advisor or take a look at IRS
publication 503 at http://www.irs.gov/publications/p503/index.html.
If you contribute to a DCFSA, you must file an IRS Form 2441 with your Federal Income Tax Return. Form 2441 is
simply an informational form on which you report the amount you pay and who you paid for day care.
This is only a brief summary of your benefits. We have tried to ensure its accuracy but if there is any discrepancy
between the benefits shown in this benefit guide and the official plan documents, the official plan documents will rule.
17Employee Assistance Program
The Employee Assistance Program (EAP) is available to all eligible employees and your immediate family members.
Our EAP provides confidential assistance to help you with personal, family and job-related issues. This important
benefit is provided by Ulliance. Counselors are available 24 hours a day, 7 days a week.
This is an employer paid benefit to all full and part time employees. No enrollment is required via BenXpress.
An EAP counselor will:
Help you assess the problem
Provide short-term counseling, when appropriate
Assist you in selecting a local resource, when necessary
Provide support follow-up
Online Resources–valuable work/life resources are available online:
Legal and financial resources
Wellness Information
Elder Care Providers
Child Care Providers
Informational resource articles
This is only a brief summary of your benefits. We have tried to ensure its accuracy but if there is any discrepancy
between the benefits shown in this benefit guide and the official plan documents, the official plan documents will rule.
18Consumerism Card
All employees and their immediate family members have access to a variety of health care-related benefits and
discounts through the Consumerism Card. Jackson County offers the Card at no cost to those enrolled in the
HAP PPO plan. All other employees have the ability to purchase the card for $10 a month.
The available services include:
Consultations with board-certified physicians (including pediatricians) via telephone or online video through
the Teladoc program. Providers are available 24 hours a day, seven days a week. This service can be used for
common or routine medical conditions, such as colds, flu, ear infections, pink eye, allergies and sinus prob-
lems. You will not be charged a consultation fee, and the doctor can prescribe short-term prescriptions when
appropriate, like antibiotics and cough suppressants. Because you have access wherever you are, Teladoc is
especially useful when you are traveling.
You will generally speak with a doctor within 30 minutes of your phone call. The doctor will advise you
if you need to see a specialist, or should seek immediate treatment in an emergency room.
Personalized assistance with a wide variety of health care-related issues through the Health Advocate pro-
gram. A Personal Health Advocate, who is typically a registered nurse, can guide you through the complex and
challenging health care system. Health Advocate can help you to resolve claims and billing issues and to nego-
tiate payment plans with providers. Their staff is trained to assist you in finding the right providers and facili-
ties for your health condition, coordinating care amongst your providers, and answering questions about test
results and treatments.
In addition to your spouse and children, your parents and parents-in-law can also use Health Advo-
cate. The Personal Health Advocate can answer questions about Medicare and Medicaid, and can re-
search transportation to appointments and assist in locating care providers, such as adult day care
and assisted living.
Discounts for health-related services from participating providers. These discounts are not insurance, and are
not intended to be a substitute for insurance or your health plan. They apply to prescription drugs, dental
care, vision care, hearing care, lab testing, medical imaging services, diabetic supplies and vitamins. More in-
formation about these discounts is found at www.mymemberportal.com or by calling (800) 800-7616.
Medical travel assistance. Services are available if you suffer an injury or illness while traveling at least 100
miles from home. Benefits include emergency medical evacuation, medical and dental referrals and facilitation
of hospital payment.
The Consumerism Card is not insurance. When presenting the Card to your providers, please make sure they un-
derstand it is not “secondary insurance,” but a discount card.
When you receive your Consumerism Card, you should register at www.mymemberportal.com. You will be able
to see the benefits available to you, as well as contact information like phone numbers and websites to help you
easily access those benefits.
Please note that not all benefit features are available in all states.
19LegalShield
What is LegalShield?
LegalShield was founded in 1972, with the mission to make equal justice under law a reality for all North
Americans. The 3.5 million individuals enrolled as LegalShield members throughout the United States and Canada
can talk to a lawyer on any personal legal matter, no matter how trivial or traumatic, all without worrying about
high hourly costs. LegalShield has provided identity theft protection since 2003 with Kroll Advisory Solutions, the
world’s leading company in ID Theft consulting and restoration. We have safeguarded over 1 million members,
provided more than 200,000 identity consultations, and helped restore nearly 10,000 individual identities.
The LegalShield® Membership Includes:
Legal Advice – personal legal issues Trial Defense including Pre-Trial & Trial
Letters/calls made on your behalf Uncontested Divorce, Separation, Adoption and/
Contracts & documents reviewed (up to 15 pages) or Name Change Representation (available 90
days after enrollment)
Residential Loan Document Assistance
IRS Audit Assistance
Attorneys prepare your Will, your Living Will and
your Health Care Power of Attorney 25% Preferred Member Discount (Bankruptcy,
Criminal Charges, Other Matters, etc.)
Moving Traffic Violations (available 15 days after
enrollment) 24/7 Emergency Access for covered situations
IDShield
Membership Includes:
Full Service Restoration
Complete identity recovery services by Kroll Licensed Private Investigators and our $5 million service guarantee
ensure that if your identity is stolen, it will be restored to its pre-theft status.
Privacy Monitoring
Monitoring your name, SSN, date of birth, email address (up to 10), phone numbers (up to 10), driver’s license
& passport numbers, and medical ID numbers (up to 10) provides you with comprehensive identity protection
service that leaves nothing to chance.
Security Monitoring
SSN, credit cards (up to 10), and bank account (up to 10) monitoring, sex offender search, financial activity alerts
and quarterly credit score tracking keep you secure from every angle.
Consultation
Your identity protection plan includes 24/7/365 live support for covered emergencies, unlimited counseling,
identity alerts, data breach notifications and lost wallet protection.
For more information log on to www.legalshield.com/info/jacksoncounty
or contact Sue Adams - Unique Benefits • 989-414-3196• sueadams@uniquebenefits.org •
www.UniqueBenefits.org
This is only a brief summary of your benefits. We have tried to ensure its accuracy but if there is any discrepancy
between the benefits shown in this benefit guide and the official plan documents, the official plan documents will rule.
20Contacts
Provider Benefit Contact Information
800-422-4641
HAP Medical/Prescription Drugs
www.hap.org
Jackson Health Network Care Management, It’s Your Life 517-205-7495
866-346-5800
HAP / Health Equity Health Savings Account
www.healthequity.com
BCBSM / Dental Network of 888-826-8152
Dental
America www.BCBSM.com/bluedental
800-877-7195
BCBSM / VSP Vision
www.vsp.com
800-523-2233
The Hartford Life & AD&D
www.thehartfordatwork.com/thaw/
Short Term Disability
800-368-2859
The Standard Long Term Disability
www.standard.com
FMLA
888-472-0777
BASIC Flexible Spending Accounts
hrbenefitsdirect.com/basic
800-448-8326
Ulliance Employee Assistance Program
www.lifeadvisoreap.com
Consumerism Card
800-800-7616
New Benefits Teladoc, Health Advocate,
www.MyMemberPortal.com
Discounts
Legal Plan 989-414-3196
LegalShield
Identity Theft www.uniquebenefits.org
BenXpress Online Enrollment www.benxpress.com/jackson
Insurance
517-788-4340
Human Resources Eligibility
www.co.jackson.mi.us
Enrollment
21Required Notices
Qualified Changes in Status / Changing Your Pre-Tax Contribution
Amount Mid-Year
We sponsor a program that allows you to pay for certain benefits using pre-tax dollars. With this program,
contributions are deducted from your paycheck before federal, state and Social Security taxes are withheld. As
a result, you reduce your taxable income and take home more money. How much you save in taxes will
vary depending on where you live and on your own personal tax situation.
These programs are regulated by the Internal Revenue Service (IRS). The IRS requires you to make your
pre-tax elections before the start of the plan year January 1 – December 31. The IRS permits you to
change your pre-tax contribution amount mid-year only if you experience a change in status, which in-
cludes the following:
Birth, placement for adoption, or adoption of a child, or being subject to a Qualified Medical Child
Support Order which orders you to provide medical coverage for a child.
Marriage, legal separation, annulment or divorce.
Death of a dependent.
A change in employment status that affects eligibility under the plan.
A change in election that is on account of, and corresponds with, a change made under another
employer plan.
A dependent satisfying, or ceasing to satisfy, eligibility requirements under the health care plan.
Electing coverage under your state’s Marketplace (also known as the Exchange) during annual
enrollment or as a result of a special enrollment.
The change you make must be consistent with the change in status. For example, if you get married, you
may add your new spouse to your coverage. If your spouse’s employment terminates and he/she loses
employer-sponsored coverage, you may elect coverage for yourself and your spouse under our program.
However, the change must be requested within 30 days of the change in status. If you do not notify Hu-
man Resources within 30 days, you must wait until the next annual enrollment period to make a change.
These rules relate to the program allowing you to pay for certain benefits using pre-tax dollars. Please re-
view the medical booklet and other vendor documents for information about when those programs allow
you to elect or cancel coverage, add or drop dependents, and make other changes to your benefit cover-
age, as the rules for those programs may differ from the pre-tax program.
22Required Notices, continued
HIPAA Notice of Special Enrollment Rights
If you are declining enrollment for yourself or your dependents (including your spouse) because of other health
insurance or group health plan coverage, you may be able to enroll yourself and your dependents in this plan if
you or your dependents lose eligibility for that other coverage (or if the employer stops contributing towards your
or your dependents’ other coverage). However, you must request enrollment within 30 days after you or your
dependents’ other coverage ends (or after the employer stops contributing toward the other coverage).
In addition, if you have a new dependent as a result of marriage, birth, adoption or placement for adoption, you
may be able to enroll yourself and your dependents. However, you must request enrollment within 30 days after
the marriage, birth, adoption or placement for adoption.
To request special enrollment or obtain more information, contact Human Resources.
The Children’s Health Insurance Program Reauthorization Act of 2009 added the following two special enrollment
opportunities:
The employee’s or dependent's Medicaid or CHIP (Children's Health Insurance Program) coverage is
terminated as a result of loss of eligibility; or
The employee or dependent becomes eligible for a premium assistance subsidy under Medicaid or CHIP.
It is your responsibility to notify Human Resources within 60 days of the loss of Medicaid or CHIP coverage, or
within 60 days of when eligibility for premium assistance under Medicaid or CHIP is determined. More information
on CHIP is provided later in this packet.
Women’s Health and Cancer Rights Act of 1998
The Women’s Health and Cancer Rights Act (WHCRA) of 1998 is also known as “Janet’s Law.” This law requires that
our health plan provide coverage for:
All stages of reconstruction of the breast on which the mastectomy has been performed;
Surgery and reconstruction of the other breast to produce a symmetrical appearance; and
Prostheses and physical complications of mastectomy, including lymphedemas, in a manner determined
in consultation with the attending physician and the patient.
Benefits will be payable on the same basis as any other illness or injury under the health plan, including the
application of appropriate deductibles, coinsurance and copayment amounts. Please refer to your benefit plan
booklet for specific information regarding deductible and coinsurance requirements. If you need further
information about these services under the health plan, please contact the Customer Service number on your
member identification card.
Michelle’s Law
Effective November 1, 2010, if a full-time student engaged in a postsecondary education loses full-time student
status due to a severe illness or injury, he/she will maintain dependent status until the earlier of (1) one year after
the first day of a medically necessary leave of absence; or (2) the date on which such coverage would otherwise
terminate under the terms of the plan. A medically necessary leave of absence or change in enrollment at that
institution must be certified by the dependent’s attending physician.
23Required Notices, continued
Newborns’ and Mothers’ Health Protection Act Notice
Group health plans and health insurance issuers may not, under Federal law, restrict benefits for any hospital
length of stay in connection with childbirth for the mother or newborn child to less than 48 hours following vaginal
delivery or less than 96 hours following a cesarean section.
However, Federal law generally does not prohibit the mother's or the newborn's attending provider, after
consulting with the mother, from discharging the mother or her newborn earlier than 48 hours, or 96 hours as
applicable. In any case, plans and insurers may not, under Federal law, require that a provider obtain authoriza-
tion from the plan or the insurance issuer for prescribing a length of stay not in excess of 48 hours/96 hours.
Protecting Your Privacy
The Health Insurance Portability and Accountability Act of 1996 (HIPAA) requires employer health plans to main-
tain the privacy of your health information and to provide you with a notice of the Plan’s legal duties and privacy
practices with respect to your health information. If you would like a copy of the Plan’s Notice of Privacy Practices,
please contact Human Resources.
Summary of Material Modification
The information in this packet and in the benefit guide applies to the Jackson County Welfare Plan, Plan Number
502. This information meets the requirements for a Summary of Material Modification as required by the Employ-
ee Retirement Income Security Act (ERISA).
Disclosure about the Benefit Enrollment Communications
The benefit enrollment communications (the Benefit Guide, etc.) contains a general outline of covered benefits
and does not include all the benefits, limitations, and exclusions of the benefit programs. If there are any discrep-
ancies between the illustrations contained herein and the benefit proposals or official benefit plan documents, the
benefit proposals or official benefit plan documents prevail. See the official benefit plan documents for a full list of
exclusions. Jackson County reserves the right to amend, modify or terminate any plan at any time and in any
manner.
In addition, please be aware that the information contained in these materials is based on our current understand-
ing of the federal health care reform legislation, signed into law in March 2010. Our interpretation of this complex
legislation continues to evolve, as additional regulatory guidance is provided by the U.S. government. Therefore,
we defer to the actual carrier contracts, processes and the law itself as the governing documents.
24Required Notices, continued
Premium Assistance Under Medicaid and the Children’s Health
Insurance Program (CHIP)
If you or your children are eligible for Medicaid or CHIP and you’re eligible for health coverage from your employer, your state may have a
premium assistance program that can help pay for coverage, using funds from their Medicaid or CHIP programs. If you or your children
aren’t eligible for Medicaid or CHIP, you won’t be eligible for these premium assistance programs but you may be able to buy individual
insurance coverage through the Health Insurance Marketplace. For more information, visit www.healthcare.gov.
If you or your dependents are already enrolled in Medicaid or CHIP and you live in a State listed below, contact your State Medicaid or CHIP
office to find out if premium assistance is available.
If you or your dependents are NOT currently enrolled in Medicaid or CHIP, and you think you or any of your dependents might be eligible
for either of these programs, contact your State Medicaid or CHIP office or dial 1-877-KIDS NOW or www.insurekidsnow.gov to find out
how to apply. If you qualify, ask your state if it has a program that might help you pay the premiums for an employer-sponsored plan.
If you or your dependents are eligible for premium assistance under Medicaid or CHIP, as well as eligible under your employer plan, your
employer must allow you to enroll in your employer plan if you aren’t already enrolled. This is called a “special enrollment” opportunity,
and you must request coverage within 60 days of being determined eligible for premium assistance. If you have questions about enrol-
ling in your employer plan, contact the Department of Labor at www.askebsa.dol.gov or call 1-866-444-EBSA (3272).
If you live in one of the following states, you may be eligible for assistance paying your employer health plan premiums. The following
list of states is current as of July 31 , 2018. Contact your State for more information on eligibility.
ALABAMA – Medicaid All other Medicaid
Website: http://myalhipp.com/ Website: http://www.indianamedicaid.com
Phone: 1-855-692-5447 Phone 1-800-403-0864
ALASKA – Medicaid IOWA – Medicaid
The AK Health Insurance Premium Payment Program Website:
Website: http://myakhipp.com/ http://dhs.iowa.gov/hawk-i
Phone: 1-866-251-4861 Phone: 1-800-257-8563
Email: CustomerService@MyAKHIPP.com
KANSAS – Medicaid
Medicaid Eligibility: http://dhss.alaska.gov/dpa/Pages/medicaid/
Website: http://www.kdheks.gov/hcf/
default.aspx
Phone: 1-785-296-3512
ARKANSAS – Medicaid
KENTUCKY – Medicaid
Website: http://myarhipp.com/
Website: https://chfs.ky.gov
Phone: 1-855-MyARHIPP (855-692-7447)
Phone: 1-800-635-2570
COLORADO – Health First Colorado (Colorado’s Medicaid Pro-
LOUISIANA – Medicaid
gram) & Child Health Plan Plus (CHP+)
Website: http://dhh.louisiana.gov/index.cfm/subhome/1/n/331
Health First Colorado Website: https://
Phone: 1-888-695-2447
www.healthfirstcolorado.com/
Health First Colorado Member Contact Center: 1-800-221-3943/ MAINE – Medicaid
State Relay 711 Website: http://www.maine.gov/dhhs/ofi/public-assistance/
CHP+: Colorado.gov/HCPF/Child-Health-Plan-Plus index.html
CHP+ Customer Service: 1-800-359-1991/State Relay 711 Phone: 1-800-442-6003
TTY: Maine relay 711
FLORIDA – Medicaid
Website: http://flmedicaidtplrecovery.com/hipp/ MASSACHUSETTS – Medicaid and CHIP
Phone: 1-877-357-3268 Website: http://www.mass.gov/eohhs/gov/departments/
masshealth/
GEORGIA – Medicaid
Phone: 1-800-862-4840
Website: http://dch.georgia.gov/medicaid
Click on Health Insurance Premium Payment (HIPP) MINNESOTA – Medicaid
Phone: 1-404-656-4507 Website: https://mn.gov/dhs/people-we-serve/seniors/health-
care/health-care-programs/programs-and-services/other-
INDIANA – Medicaid
insurance.jsp
Healthy Indiana Plan for low-income adults 19-64
Phone: 1-800-657-3739
Website: http://www.in.gov/fssa/hip/
Phone: 1-877-438-4479
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