TABLE OF CONTENTS

TABLE OF CONTENTS

Welcome BusinessPlus/Employee Online Online Enrollment Directions Self-Funded Rates Medical Plans Pharmacy Plans Dental Plans Hospital Indemnity Plan (HIP) Vision Plan Dependent Eligibility Documents Employee Assistance Program (EAP) Employer Paid Long-Term Disability Basic Life and AD&D Voluntary Flexible Spending Accounts (FSA) Voluntary Term Life Insurance Voluntary Short-Term Disability Voluntary Long-Term Disability Wellness Centers Employee Benefits Portal HRA Surcharge Wellness Programs Mobile Apps (Teladoc, Florida Blue, ESI) Voluntary Group Whole Life Insurance Federal Notices Contacts

2 2 3 4 5 5 6 7 7 7 8 8 8 9 9 10 10 11 11 12 13 14-15 16 17-19 20

2021 b e n e f i t s

Hello, SJCSD Plan Members!

Welcome to the 2021 Plan Year for St. Johns County School District Employee Benefits. Enclosed in this booklet are details to help you make informed decisions during Open Enrollment, October 1--31, 2020. This booklet is an overview of the comprehensive benefits package offered to you by St. Johns County School District. We care about our employees and are commi ed to bringing you the best possible benefits at the most reasonable cost. Each year, we evaluate our benefits programs to ensure we keep this commitment to you.

Members of the HR Benefits office and The Bailey Group will be available via virtual mee ngs for all loca ons throughout October 1--31, 2020. The link to sign up is: h ps://go.SJCSD Locate the date and me assigned to your loca on. Once the calendar loads for October, choose the me that works for you. If the specific date and me for your loca on does not work for you, please choose OE CONSULT (OPEN TO ALL EMPLOYEES). On the Provide Informa on page, fill out the required fields to secure your appointment. You will receive an email with the confirma on of your scheduled consulta on. Should you need to cancel or reschedule, you can do so within the email confirma on NEW THIS YEAR:

Teladoc--Accessible to every benefit eligible member of St. Johns County School District, your Teladoc Benefit provides access to virtual care services from anywhere you are by phone, video, web or app. See page 14 for more informa on!

Employee Benefits Corp (EBC)--By enrolling in the BESTflex Plan Flexible Spending Account (FSA) Sec on 125, you set aside pre-tax dollars to pay for unreimbursed medical/dental/ vision /prescrip on expenses, or dependent day care.

MassMutual@Work--Whole life insurance is a type of permanent life insurance that provides a combina on of protec on and offers guaranteed death benefit, level premiums, and cash value accumula on. Learn more on page 16 or schedule me to learn more during a Whole Life Consult virtual mee ng at the website link above.

The Medical Benefit Spousal Surcharge Affidavit is for any employee who has a spouse on the SJCSD medical plan who is offered employer-sponsored insurance outside of the school district. The surcharge is $35 per pay period. If there have been any changes to your spouse's employment, you will need to update the Spousal Surcharge Affidavit form and submit by Saturday, October 31, 2020. You can find the form on h ps://sjcsd. or on Business+/Employee Online/Addi onal Forms/Spousal Surcharge Affidavit

Current rates are subject to nego a ons for 2020--2021 school year. By raising premium rates, we con nue to stabilize the Medical Fund, which pays for the claims that members of the self-funded medical plan incur.

SJCSD Wellness Centers powered by Marathon Health provide free and convenient healthcare for enrolled members (age 12+) of the SJCSD medical plan. Clinicians at the wellness centers provide preven ve, sick care, health coaching to develop wellness plans, mental health counseling, and help for managing chronic condi ons. The centers are there for you when you are not feeling well, but the greater focus is on helping you stay healthier longer. *NEW* Opt-In Text Messaging--Receive important updates and informa on from SJCSD about your benefits and well-being program. Text the keyword SJCSD to 47177 to join now! Msg & data rates may apply. 5 msgs/mth. Reply STOP to 47177 to cancel. Terms & privacy policy at

sms.sjcsd.

J. Wynn, Director of Benefits & Salaries

Login with your Employee ID number and password.

BusinessPlus Portal

You can access Employee Online through BusinessPlus. Use your Employee ID Number

and password to access your Benefits Summary.

Click on Employee Online and scroll down the left hand side menu to

Benefits Summary. Click on Current Insurance to view your enrollments.

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ONLINE ENROLLMENT

MEDICAL/DENTAL/VISION INSURANCE INSTRUCTIONS

STEP 1: Enter Dependent Informa on Login to BusinessPlus using your Employee ID and password. Click on the Employee Online tab. In the Benefits Summary sec on on the le , select Family Info. Complete all of the following informa on for

every dependent you want covered on any insurance benefit (Medical, Dental, Vision, or Addi onal Life). Add your dependent's First, Middle, Last Name (if they have a suffix, enter Last Name Suffix (e.g. Smith Jr)),

Rela onship, Date of Birth, Social Security Number (do not enter all 0 or all 9; must enter a legi mate Social Security Number), Gender, and check the box next to Address if they have the same address as you. If they do not have the same address, enter their address and phone number. You do not need to fill out any other informa on on this screen. Click SAVE bu on at the bo om of the page to save the dependent data. Click the BACK bu on to return to the Family Info screen, and add the next dependent. Do this for every dependent you want covered on any insurance. *Family with 2 - Both you and your spouse are employed full- me with SJCSD with children enrolled on the insurance policy. The total premiums will be divided equally among BOTH employee's paychecks. **Family w/2 Single Rate - Both you and your spouse are employed full- me with SJCSD with NO children enrolled on the insurance policy. Both Employees are considered Family w/2, but premiums will be deducted at the SINGLE rate.

*Male spouse of the family w/2 or family w/2 Single Rate is required to add ALL of their dependents (including Spouse) under Family Info in Employee Online. He will select either Family with 2 Children or Family with 2 Single. Then he will select all of his dependents who are to be covered under Medical, Dental, and Vision insurance.

*Female spouse of the family w/2 or family w/2 Single Rate will NOT have any dependents. She will select Family w/2 ? Single Spouse or Family w/2 Child/Spouse for Medical, Dental, and Vision insurance.

*Family w/2 Same Sex Spouses follow the person with the earliest birth month. For example, if you were born in January, but your same sex spouse was born in March, the employee born in January will add all of the dependents under their Family Info. See "Male Spouse" informa on above. For the employee born in March, see "Female Spouse" informa on above.

STEP 2: Select Insurance In the Benefits Summary sec on on the le , select Current Insurance: Add, Change, or Terminate Hospital, Dental,

Vision, or Indemnity. For each benefit you would like to change, select the coverage type (such as HOSPITAL, DENTAL, VISION), then

select the Plan Name (such as HOSPITAL 1) and choose the pre-tax or post-tax plan op on. On the Add Insurance Benefit screen, select the coverage category that you want to enroll in and select the dependents to enroll by clicking in the box next to their name. In the Change Events dropdown box, click on "Open Enrollment." Enter 01/01/2021 in the Reason for Change text box. Save and move on to the next benefit you're upda ng. The status will change to PENDING for any benefits you are elec ng. Delete Pending Change (If you have made a mistake): Select Current Insurance: Add, Change, or Terminate Hospital, Dental, Vision, or Indemnity to delete pending changes. On the Current Eligible Insurance Benefit screen, select the appropriate benefit (HOSPITAL, DENTAL, VISION). On the Update Insurance Benefit screen, click on the box "Delete this request" bu on, click SAVE. STEP 3: Submit Dependent Eligibility Documents For each dependent you are enrolling/upda ng for Medical, Dental, Vision, or Addi onal Life insurance, you must provide a copy of valid Dependent Eligibility Documenta on. See page 7 for details.

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2021 b e n e f i t s SELF-FUNDED INSURANCE RATES

19 Pay Periods

9/15/2020--6/15/2021

Current Rates Are Subject to Negotiations for 2020-2021 School Year.

HOSPITAL INDEMNITY ONLY MEDICAL - PPO HOSPITAL 1 (STANDARD PLAN) Single Family with 2* Family w/2 Single** Family MEDICAL - PPO HOSPITAL 2 (BUY-UP PLAN) Single

Employee Rates: $0.00

$63.84 $137.61 ($68.81/$68.80) $127.68 ($63.84 per employee) $270.07

$78.06

SJCSD Employer Contributions: $322.43

$322.43 $776.34 ($388.17 per employee) $776.34 ($388.17 per employee) $643.32

$322.43

Family with 2* Family w/2 Single** Family DENTAL Plan 1 Single Family with 2* Family w/2 Single** Family DENTAL Plan 2 Single Family with 2* Family w/2 Single** Family VISION Single Family with 2* Family w/2 Single** Family

$204.92 ($102.46 per employee) $156.12 ($78.06 per employee) $337.94

$776.34 ($388.17 per employee) $776.34 ($388.17 per employee) $643.32

$0.00 $4.23 ($2.12/$2.11) $0.00 ($0.00 per employee) $20.02

$18.14 $36.28 ($18.14 per employee) $36.28 ($18.14 per employee) $18.14

$5.72 $21.08 ($10.54 per employee) $11.44 ($5.72 per employee) $38.72

$18.14 $36.28 ($18.14 per employee) $36.28 ($18.14 per employee) $18.14

$0.00 $3.59 ($1.80/$1.79) $0.00 ($0.00 per employee) $7.53

$5.97 $11.78 ($5.89 per employee) $11.94 ($5.97 per employee) $7.84

(1) If you make a change during Open Enrollment, your premiums will be at a Pro-Rated amount from December 15, 2020--June 15, 2021. If you have deductions through June 15, 2021, you will have coverage through September 30, 2021, regardless of whether you continue with SJCSD in 2021-2022. If you do continue, your premiums will revert to the normal premium amounts above. The rates are subject to change if there are rate increases during the plan year.

(2) Please note: Premium deductions are taken out pre-tax with your permission. (3) If you cover a spouse on SJCSD medical plans, and the spouse is offered medical coverage through their employer, you will be assessed a $35 Spousal

Surcharge in addition to your per-pay-period medical deduction. (4) *Family with 2 - Both you and your spouse are employed full-time with SJCSD with children enrolled on the insurance policy. The total premiums will be divided

equally among EACH employee's paychecks. **Family w/2 Single Rate - Both you and your spouse are employed full-time with SJCSD with NO children enrolled on the insurance policy. Both Employees are considered Family w/2, but premiums will be deducted at the SINGLE rate.

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1

Benefit Description and Cost Sharing Network

MEDICAL

(Administered by Florida Blue)

PPO Hospital 1

(Standard Plan)

In-Network

Out-of-Network

Blue Options

N/A

PPO Hospital 2

(Buy-up Plan)

In-Network

Out-of-Network

Blue Options

N/A

Calendar Year Deductible (CYD) Per Individual Family Maximum Coinsurance (Coins)

Annual Out of Pocket Maximum

Lifetime Maximum Per Insured

Office Visit Family Physician Specialist (no referral needed) Independent Lab Inpatient Hospital Facility Outpatient Hospital Surgery Facility

$1000 $3000 80%/20%

$5,000/$13,200 (includes CYD)

Unlimited

$30 $60 $30 CYD+ coins. CYD + coins.

$2000 $6000 60%/40%

$6,500/$20,000 (includes CYD)

Unlimited

CYD + coins. CYD + coins. CYD + coins. CYD+ coins. CYD + coins.

$300 $600 80%/20%

$5,000/$13,200 (includes CYD)

Unlimited

$30 $50 $30 CYD+ coins. CYD+ coins.

$600 $1200 75%/25%

$6,500/$20,000 (includes CYD)

Unlimited

CYD + coins. CYD + coins. CYD + coins. CYD+ coins. CYD+ coins.

Emergency Room Facility

$100 Copay + CYD/coins. $100 Copay + CYD/coins

$100 Copay + CYD/coins $100 Copay + CYD/coins

Urgent Care Center

$30 Copay

CYD+ coins.

$30 Copay

CYD+ coins.

PHARMACY

(Administered by Express Scripts Inc. (ESI)) PPO Hospital 1

PPO Hospital 2

(Standard Plan)

(Buy-up Plan)

Rx Retail/Mail-Order

Mandatory Generic*

Mandatory Generic*

Deductible

$200 Individual/$600 Family

N/A

Generic

$20/$40

$15/$30

Formulary Brand Name

$35/$70

$30/$60

Non-Formulary Brand Name

$55/$110

$50/$100

Specialty Drugs Current Rates Are Subject to Negotiations for 2020-2021 School Year

Single

Copay Employee Cost Per Pay Period for Medical Plans

$63.84

Copay $78.06

Family with 2*

$137.61 ($68.81/$68.80)

$204.92 ($102.46 per employee)

Family w/2 Single**

$127.68 ($63.84 per employee)

$156.12 ($78.06 per employee)

Family

$270.07

$337.94

*Mandatory generic prescriptions required for all members. When members choose to fill a brand-name prescription when a lower cost generic is available, the member pays the brand co-pay and the cost difference between the brand and generic drug. Physician must write "medically necessary" on the script to have the upcharge waived.

*By utilizing the mail-order or Retail90 program, you pay for 2 months of supply but receive 3! All major chain pharmacies participate in the Express Scripts Home Delivery maintenance network. The prescription drug coverage for all medical plans is considered to be Medicare Part D creditable coverage.

This is only a summary of benefits and not a contract. Please refer to your summary plan description for complete details.

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