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Terms & Conditions

The Flexible Benefits Program is offered by the Employee Benefit Plan Council, the Board of Community Health and participating departments and authorities. The Flexible Benefits Program is governed by the Internal Revenue Code, section 125, and rules issued by the Employee Benefit Plan Council and the Board of Community Health. The Flexible Benefits Program provides you with a method to have your employer purchase benefits with money that would have been paid to you. You do not receive the premium amounts and contributions for the pre-tax options you select as taxable income (and therefore do not pay taxes on that amount); you do receive the benefits as an employer paid benefit. The Option Statement is a binding salary agreement. Failure to comply with all contractual and administrative requirements will result in any excess salary reductions being retained by the Plan. The following statements apply to the benefit options listed on the Option Statement and on the Open Enrollment web site.

Your participation in the Flexible Benefits Program is voluntary. You are not required to choose any of the options. If you do not wish to participate in these benefits, mark ‘no coverage’ in each benefit category, sign and date the Option Statement, and return it to your personnel or payroll office. If you choose your benefits through web enrollment, click ‘no coverage’ in each benefit category and complete the confirmation process.
The coverage levels available to you and the premium amount for each coverage level may be calculated using your retirement salary, your age, your eligibility for disability retirement benefits, and FICA status. Any errors in your age, salary, eligibility for disability retirement benefits or FICA status should be reported to your personnel or payroll office immediately.
The calculation of tax savings does not take into consideration any other income reduction program such as Deferred Compensation or Tax Sheltered Annuities, or any changes you may make in coverages for the upcoming year.
By selecting coverages and indicating contributions to Spending Accounts, you are agreeing that your agency may reduce your taxable income by the amount necessary to purchase those coverages and make those contributions. Except in certain circumstances, the amount of income reduction may not be changed until the next enrollment period.
After this enrollment period you may become a participant or make changes in some coverages only under limited conditions in accordance with the rules of the IRS code, the Employee Benefit Plan Council, and the Board of Community Health. The Employee Benefit Plan Council and the Board of Community Health have the responsibility to interpret these rules and make the final decision as to whether you may enroll or change any coverage outside of the enrollment period. Your request for enrollment or a change outside of the enrollment period will only be considered if you submit the proper documentation within the timeframe allotted. To submit a request for enrollment or change to coverage under the State Health Benefit Plan, you must complete and submit a Membership or Discontinuation Form to your employer’s Benefits Coordinator within 31 days to enroll, increase, cease, or decrease coverage. Your request for enrollment or a change in any other coverage under the Flexible Benefits Program must be submitted in writing to your employer’s Benefits Coordinator within 30 days (effective January 1, 2008) to enroll, increase, cease, or decrease coverage. Submission of a request for enrollment or a change, or the occurrence of one of the following events, does not guarantee that you will be able to enroll or change coverage outside the enrollment period. Please see your Benefits Coordinator if you have questions about when you may enroll or make changes outside the enrollment period. A list of events that might permit you to enroll or change one or more coverages under the Flexible Benefits Program:
1. You gain or lose a spouse; or
2. You gain (no time limit if due to judgment, decree or order) or lose an eligible dependent; or
3. Your spouse or dependent becomes eligible for or loses coverage under another employer’s plan, COBRA or a governmental plan; or
4. An event causes your dependent to gain or lose eligibility for coverage under your employer’s plan; or
5. Your change of residence causes you or your spouse or dependents to gain or lose eligibility for coverage under your plan or another employer’s plan; or
6. The cost of your dependent care increases or decreases significantly and your dependent provider is not related to you, your spouse, or your dependent; or
7. Your spouse’s employer increases, decreases or ceases coverage, or conducts open enrollment; or
8. You, your spouse or your dependent gain or lose eligibility for Medicare or Medicaid.
This salary agreement will be terminated if you change the agreement during the next enrollment period. If you do not change the agreement, your benefit choices will rollover in the next Plan year or default to a specified coverage.
If you are eligible to participate in the Plan, you terminate and are rehired during the same Plan Year, you must maintain the same options.
Options and coverage levels under the State Health Benefit Plan are set forth in the State Health Benefit Plan Document. Options and coverage under the Flexible Spending Accounts are set forth in the Flexible Benefit Plan Document. For all other benefits under the Flexible Benefits Program, the options and coverage levels offered conform to policies provided by the insurance company making the offer. By selecting an option and coverage level you agree to abide by the terms and conditions of that policy.
Contributions to Spending Accounts are voluntary. You should not participate in Spending Accounts until you thoroughly read the sections of the Enrollment Booklet related to Spending Accounts. By choosing to contribute money to one or more Spending Accounts you are agreeing to abide by the Rules of the Employee Benefit Plan Council related to Spending Accounts. In particular, you are agreeing to the following provisions:
1. Money contributed for one type of Spending Account cannot be used to pay claims payable from another type of Spending Account.
2. In general, the amount contributed for a Dependent Care Account cannot be greater than the earned salary of you or your spouse, whichever is less.
3. If you are married filing separately, the amount contributed for a Dependent Care Account cannot be greater than $2,500.
4. The validity of a claim against a Spending Account is determined in accordance with the Plan, Internal Revenue Code, and IRS regulations as interpreted by the Administrator subject to the appeal provisions of the Plan.
5. Any money not reimbursable to you will be forfeited to the Flexible Benefits Program. Forfeited money will not be returned or paid to the employee but will be used to reduce the costs associated with providing this benefit.
6. For the Spending Accounts, eligible expenses will be reimbursed in accordance with the Rules of the Employee Benefit Plan Council and the IRS code.
7. For the Dependent Care Spending Account, you will not be reimbursed for more than the Plan has received from your department on your behalf.
8. If you decide to activate and use the Spending Account debit card, you agree to abide by all requirements as indicated in the cardholder agreement received with the card.
By selecting the Specified Illness Benefit, you are agreeing to the following:
1. I am asserting that to the best of my knowledge and belief, the answers to the questions on this application are true and complete. They are offered to American General Assurance Company as the basis for any insurance issued. It is understood and agreed that coverage will not become effective unless I am actively at work on the date of enrollment and the effective date of coverage.
2. I understand and agree that no benefits are payable for loss starting or occurring within 12 months of the effective date of coverage which is caused by, contributed to by, due to or resulting from a Pre-existing condition, unless I have gone 12 months without medical care, treatment or supplies for the Pre-existing condition.
3. I realize that any false statement or misrepresentation may result in loss of coverage under the certificate. I understand that no insurance will be in effect until approved by American General Assurance Company and the necessary premium is paid. Any person who, with intent to defraud or knowing that he is facilitating fraud against an insurer, submits an application or files a claim containing a false or deceptive statement may be guilty of insurance fraud.
4. I authorize my employer to deduct appropriate amount from my earnings and to deduct and pay American General Assurance Company the premium required thereafter each month for my insurance.
Other terms and conditions:
1. If you choose not to participate or choose not to continue coverages, your ability to enroll at a later date will be subject to contractual provisions, which may include medical proof of insurability or limited coverages.
2. If you failed to enroll in options requiring medical underwriting when first eligible and you choose new or increased levels of coverage, you must complete the medical underwriting process and be approved.
3. If you choose coverage under the Life Insurance options and the Accidental Death and Dismemberment options, the same Beneficiary Election Form will be used. If a beneficiary is not named, your Estate will be the beneficiary.
4. If you select more than $50,000 under the Life Insurance option, you may choose to pay the premium with after-tax dollars to avoid imputed income; this will eliminate any tax savings on the life insurance premium.
If you do not use the web site to complete your Health Benefit selection, you may be required to complete additional forms to finalize your Health Benefit selection. You should contact your Personnel Office to obtain the necessary forms. Failure to complete the required forms may jeopardize your selected coverage or your opportunity to enroll or change coverage until the next enrollment period.
In the event of an administrative error with respect to the Flexible Benefits Program, decisions will be made in accordance with the Internal Revenue Code, the Rules of the State Health Benefit Plan, and the Rules of the Employee Benefit Plan Council for the Flexible Benefits Program.

Please choose your Plan coverage carefully. Only eligible dependents, as defined by the Plan Administrator and in Program communications, can participate in the Flexible Benefits Program. Any attempt to file claims for a dependent who is not eligible for coverage is fraud. The Plan Administrator will require repayment of any ineligible claims. If the employee purchased family coverage but is only eligible for single coverage, the difference in the premiums paid into the Plan will not be refunded. Also, the difference between single coverage and family coverage premiums will be included as income on a W-2 and/or amended W-2 for inclusion on the employee's tax return. Additionally, the inclusion of ineligible dependents for coverage under the Flexible Benefits Program may result in termination from the Program and/or prosecution for fraud.

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