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Martin County Sheriff's Office I Employee Benefit Highlights 12020-2021 <br /> Medical Insurance <br /> The Sheriffs Office offers medical insurance through Florida Blue to benefit- Non-Tobacco Use Discount <br /> eligible employees.The monthly costs for coverage are listed in the premium <br /> tables below and a brief summary of benefits is provided on the following The Sheriff's Office recognizes the impact tobacco use has on medical expenses <br /> pages. For more detailed information about the medical plans, please refer and insurance costs.Effective October 1,2013 the Sheriff's Office implemented <br /> to the carrier's Summary of Benefits and Coverage(SB0 document or contact a Non Tobacco users discount.Employee enrolled in a Sheriff's Office medical <br /> Florida Blue's customer service. plan will have a reduced rate per month if they do not use tobacco products,or <br /> if they complete a tobacco cessation program.The discount will be applied to <br /> any employee who submits a signed Non-Tobacco Users Affidavit,or submits a <br /> Medical Insurance—Florida Blue certificate of completion from the MCSO sponsored tobacco cessation program <br /> BlueOptions PPO 3748 Plan* (or other equivalent program).Employee who does not submit the Affidavit <br /> Payroll Deductions—Monthly Premiums or certificate of tobacco cessation program completion will be charged the <br /> Tier of Coverage Employee Cost Non Tobacco Users regular payroll deduction. Employee who falsifies this document(s) and/or <br /> fails to be truthful will be subject to disciplinary action up to and including <br /> [-Employee Only $165.50 $140.97 termination. Employee who chooses to become tobacco free,or chooses to <br /> • <br /> Employee+Family $446.89 $380.68 complete a tobacco cessation course during the benefit year will have their <br /> medical insurance premium reduced accordingly the following month.Please <br /> Group#46006 contact Human Resources to obtain information on the tobacco cessation <br /> courses provided through MCSO and other tobacco cessation courses available <br /> Medical Insurance—Florida Blue to employee and covered dependent(s). <br /> BlueOptions Alternative Health 5360 Plan* <br /> Payroll Deductions—Monthly Premiums Florida Blue I Customer Service:(800)352-2583 I www.floridablue.com <br /> Tier of Coverage Employee Cost Non-Tobacco Users <br /> Employee Only $117.29 $86.88 Summary of Benefits and Coverage <br /> F. - - - -- - <br /> Employee+Family $316.73 $234.62 A Summary of Benefits&Coverage(SBC)for the Medical Plan is provided as a <br /> supplement to this booklet being distributed to new hires and existing employees <br /> GroupR46006 during the Open Enrollment period. The summary is an important item in <br /> understanding the employee benefit options.A free paper copy of the SBC document <br /> may be requested or is available as follows: <br /> From: Aimie Pieper-Manager,Human Resources Unit <br /> Address: 800 SE Monterey Road <br /> Stuart,FL 34994 <br /> Phone: (772)220-7005 <br /> Email: ampieper@sheriffmartin.fl.us <br /> The SBC is only a summary of the plan's coverage.A copy of the plan document,policy, <br /> or certificate of coverage should be consulted to determine the governing contractual <br /> provisions of the coverage.A copy of the group certificate of coverage can be reviewed <br /> and obtained by contacting Human Resources. <br /> If there are questions about the plan offerings or coverage options,please contact <br /> Human Resources at(772)220-7005. <br /> 112 <br /> 3 <br /> ©2016,Gehring Group,Inc.,All Rights Reserved <br />