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Important Legal Notices Glossary Patient Protection Provider Choice Florida Blue generally requires the designation of a primary care ACA(Patient Protection andAffordable Care Act) Also provider for members of the HMO plan. You have the right to called Health Care Reform,the intentoftheAffordableCare designate any primary care provider who participates in our Act is to make affordable health care available to all network and who is available to accept you or your family Americans.The ACA became law in March 2010.Sincethen, members. Until you make this designation, Florida Blue designates the ACA has required some changes to medical coverage— one for you. For information on how to select a primary care pro- like coveringdependentchildrentoage26,nolifetimelimits vider,and for a list of the participating primary care providers,con on medical benefits,reduced FSA contributions,free tact Florida Blue at 1-877-352-2583. preventive care,etc. For children,you may designate a pediatrician as the primary care provider. Brand Name Drug—The original manufacturer's version ofa You do not need prior authorization from Florida Blue or from any particular drug.Because the research and development costs other person (including a primary care provider) in order to obtain that went into developingthese drugs are reflected in the price, access to obstetrical or gynecological care from a health care brandnamedrugscostmorethangeneric drugs. professional in our network who specializes in obstetrics or Coinsurance—A percentage of costs you pay"out of pocket" gynecology. The health care professional, however, may be forcoveredexpensesafteryoumeetthedeductible. required to comply with certain procedures, including obtaining prior authorization for certain services, Copay(Copayment)-A fee you have to pay"out of pocket" following a pre-approved treatment plan,or procedures for making for certain services,such as a doctor's office visit referrals. For a list of participating health care professionals who or prescription drug. specialize in obstetrics or gynecology, contact the Florida Blue at 1-877-352-2583. Deductible—The amount you pay"out of pocket"before the health plan will startto pay its share of covered expenses. Patient Protection and Affordable Care Act (PPACA, or Health Care Reform) Employer Contribution—School District of Indian River The Affordable Care Act (ACA) has brought sweeping changes to County provides you with an amount of money that you can the U.S. health insurance system. Its goal is to make health applytowardthecost of your healthcarepremiums.The insurance available to everyone, regardless of medical history or amount of the employer contribution depends on who you ability to pay. Many of the ACA changes have already affected our cover.You canseetheamountyou'Ilreceivewhenyouenroll.lf plans, such as covering adult children through age 26, free you'reenrollingasanewhire,theemployer contribution preventive care, reducing or removing annual or lifetime limits on amount will be prorated based on your date of hire. essential health benefits, and the $2,750 cap on Medical Expense FSA contributions.Some of the biggest changes resulting from the Generic drug—Lower-cost alternative to a brand name drug that law took effect January 1, 2014. These changes are explained be- has the same activeingredients and worksthesame way. low. Medical Plan Enhancements Out-of-pocket maximum—The most you pay each year All of the medical plans offered by School District of Indian River "out of pocket"for covered expenses. Once you've reached comply with the required changes and result in the following the out-of-pocket maximum,the health plan pays 100%for changes: (1)The annual maximum includes the annual deductible. covered expenses. (2) The annual out-of-pocket maximum is capped, lowering the maximum that you could pay for eligible health care expenses in a Plan year—The yearfor which the benefitsyouchooseduring Annual Enrollment remain in effect.Ifyou'reanew employee, year. your benefits remain in effect for the remainder of the plan Social Security Numbers year in which you enroll, and you enroll for the next plan Effective January 2016, the Affordable Care Act (ACA) will require year during the next Annual Enrollment. employers and health insurance carriers to file reports under the Preventive care—Health care services you receive when you Internal Revenue Code to establish compliance with the employer are not sick or injured—so that you will stay healthy. These mandate. As part of this requirement, School District of Indian include annual checkups,gender-and age-appropriate health River County must provide. Social Security numbers for all screenings,well-babycare,and immunizationsrecommended individuals covered by a School District of Indian River County by the American Medical Association. sponsored medical plan.In compliance with the ACA requirements, you will be asked to provide Social Security numbers for yourself and all dependents enrolled in a School District of Indian River County sponsored medical plan. If you are unable to respond to this request our health insurance carrier may also request Social Security numbers for your enrolled dependents. 75 40