Admin

FAQ

  Who is eligible for OCPS insurance coverage?  

All full-time employees working 25 hours or more per week and regular part-time active employees working a minimum of 17.5 hours per week are eligible for coverage. (Employees must be hired in an eligible payroll area and complete the enrollment process on the MyOCPS portal within two weeks of the date of hire.)


  Do I have a waiting period before insurance coverage begins?  

Coverage begins the first day of the month following a 59 day waiting period based on the first day you begin working in a benefited position. An Effective Date Sheet is included at http://Insurance.ocps.net.


  My current coverage ends before my OCPS insurance becomes effective. What should I do in the interim?  

One option is to continue your current coverage through your previous employer through COBRA.


  Can I add my spouse/domestic partner and children to my plan when I initially enroll?  

Yes. Benefits are generally limited to:

1. Spouse (as defined under Federal Law and supported by a marriage certificate)
2. The Employee’s same-sex domestic partner (as supported by the OCPS Domestic Partner Affidavit, proof of residency and financial co-dependence). A domestic partner must meet the following requirements to enroll in a medical plan:
 a. Same gender as employee.
 b. Must be 18 years of age and mentally competent.
 c. Not related by blood in a manner that would bar marriage under Florida law.
 d. The domestic partner must be the Employee’s "sole spousal equivalent" and not married to or partnered with any other spouse, spousal equivalent or domestic partner.
 e. The employee and domestic partner must share the same residence and live together in an exclusive, committed relationship and intend to do so indefinitely.
 f. Must assume joint responsibility for basic living expenses—food, shelter, common necessities of life and welfare.
 g. Neither partner can have had another domestic partner at any time during the twelve (12) months preceding enrollment. (The length of cohabitation is waived for first time domestic partner applicants.)
3. A child of the covered Employee or the covered Employee’s spouse who is under the age of 26 (as supported by a birth certificate).
 The term child includes:
 a. A natural child.
 b. A stepchild.
 c. A legally adopted child.
 d. A child for whom the covered Employee or the covered Employee’s spouse has legal guardianship.
 e. A child for whom health care coverage is required through a “Qualified Medical Child Support Order” or other court or administrative order.
 f. Grandchild of a dependent other than spouse. A newborn child of a covered dependent child is eligible from birth until the end of the month in which the child reaches 18 months of age. Otherwise, grandchildren’s eligibility is contingent upon legal guardianship.
4. A child of the Employee’s domestic partner who is under the age of 26 (as supported by required domestic partner documentation and child’s birth certificate).

A child of an Employee’s domestic partner includes:
 a. A natural child.
 b. A legally adopted child.
 c. A child for whom the covered Employee’s domestic partner has legal guardianship.
 d. A child for whom health care coverage is required through a “Qualified Medical Child Support Order” or other court or administrative order.
 e. Grandchild of a dependent other than domestic partner. A newborn child of a covered dependent child is eligible from birth until the end of the month in which the child reaches 18 months of age. Otherwise, grandchildren’s eligibility is contingent upon legal guardianship.
5. An adult child covered in 3. and 4. above may continue coverage through the end of the calendar year in which the child attains the age of 30 if the adult child meets all of the following conditions:
 a. Unmarried; and
 b. No dependent children of their own; and
 c. Full-time or part-time student or reside in the State of Florida, if not a student; and
 d. Does not have private insurance coverage and is not eligible for public insurance coverage including coverage under Title XVII of the Social Security Act.
The premium is equal to the single adult rate for COBRA continuation coverage.
Coverage for an unmarried dependent child who is already enrolled in an OCPS medical plan and is not able to be self-supporting because of mental retardation or physical handicap will not end just because the child has reached a certain age. Coverage will be extended beyond the limiting age for as long as the child is incapacitated and primarily dependent upon the Covered Employee for support and maintenance. Annual documentation is required.

NOTE: When a dependent is no longer eligible for coverage, it is the Employee’s responsibility to contact the Insurance Benefits Office to verify that the correct amount of premium deduction is taken. Coverage will be effective upon approval and notification from OCPS.


  Can I add my spouse/domestic partner and/or children to my plan at any other time?  

You can add dependents to your plan each year during annual enrollment (currently May/June with an October 1 effective date) or in the event of a change in family status (examples: marriage, birth, adoption). In the event of a change in family status during the plan year, it’s important to remember that you have 30 days in which to complete paperwork to make your change.


  Does medical insurance cost the same for one child as it does for multiple children?  

Yes, medical insurance currently is available for employee only, employee plus child(ren), employee plus spouse/same-sex domestic partner or employee plus children and spouse/same-sex domestic partner.


  Can I cover my parents on my medical insurance if they are dependent on me?  

Unfortunately, only your spouse/same-sex domestic partner and dependent children are eligible dependents for the medical plan.


  Will my pre-existing condition be covered right away?  

Yes. As a result of the Affordable Care Act, pre-existing condition exclusions no longer apply.


  Do I have to pay for my medical coverage?  

If you’re an eligible, full-time, active employee working 25 hours or more per week, one plan is available where the Employee only rate is fully paid for you by OCPS. If you are an eligible, part-time, active employee working at least 17½ hours per week, but less than 25 hours per week, 50 percent of the premium is paid for you by OCPS in this plan. In addition, there are two plans available that require a small employee contribution for coverage. A rate sheet is available on this website. Medical insurance also is available through payroll deduction for your spouse/same-sex domestic partner and/or your eligible children.


  What is “half family” and how does it work?  

If you and your spouse/same-sex domestic partner both work for OCPS in benefited positions and have eligible dependent children, you qualify for the half family plan. It is necessary for both employees to complete paperwork and you must be on the same medical plan. When one employee terminates employment with OCPS, or in the event of divorce/termination of domestic partnership, employees would no longer be eligible for this benefit.


  What is the Section 125 Plan?  

The OCPS Section 125 Plan, officially known as The Cafeteria Plan of the School Board of Orange County, allows you to purchase certain optional insurance coverage with pre-tax dollars. Federal income tax and social security taxes are not deducted from the amount you pay in premiums on a pre-tax basis under the Section 125 Plan. Your take home pay will be higher by participating in the Section 125 Plan compared to purchasing insurance coverage with after tax dollars. You can find more information, as well as which plans are available under Section 125 in your Insurance Handbook. Once you are enrolled in the Section 125 plan, coverage can’t be dropped until the next annual enrollment (unless a change in family status occurs).

Under IRS regulations, domestic partners and the children of domestic partners do not qualify as tax dependents, as a result premiums for any plans with a domestic partner or child(ren) of a domestic partner will be deducted post-tax and the medical premiums made by OCPS on behalf of dependents will be treated as taxable income. Examples of the impact of imputed income can be found on the Enrollment Information page at http://insurance.ocps.net. Employees should consult a tax advisor prior to adding coverage.


  I’m a teacher who only receives paychecks ten months of the year. How will I pay for coverage during the summer months when I’m not receiving a paycheck?  

Deductions (including additional adjustments if necessary) for all insurance plans are taken bi-weekly over ten months (September – June) each plan year for twelve months of coverage for all employees.


  If I don’t elect to cover my dependents under my medical plan, can I add them to any optional insurances that are available to me?  

As long as they meet the dependent criteria, you can add your spouse/same-sex domestic partner and/or children to any of the optional insurances available to them during your initial and/or annual enrollment, even if they are not added to your medical plan.


  What’s the difference between the “plan year” and “calendar year?”  

The current plan year is October 1 through September 30. (The plan year for Flexible Spending Accounts is September 1 through August 31 with a grace period through November 15.); the calendar year is January 1 through December 31.


  Do I have to get referrals to see a specialist?  

While it is recommended that you choose a primary care physician, it is not necessary to get a referral before visiting a specialist.  In plan A and plan C, you must use providers in the Cigna Health Care network.


  What if I already have medical insurance elsewhere and don’t want the OCPS medical plan?  

If you have other group medical insurance (ex. through your spouse/domestic partner) and you do not want the medical insurance offered by OCPS, you may select one of the two OCPS paid alternatives:
  1.  Hospital Indemnity Plan, including prescription coverage and additional term life insurance; or
  2.  Disability and vision coverage.


  Which is the “best” dental plan?  

The plan that is best for you and your family’s needs must be determined by you. Look at the deductions that will come out of your paycheck and at the cost of procedures that you might need and decide which plan will best meet your needs. The comprehensive plan is the only plan with orthodontia coverage.
As an OCPS employee you and your dependents are eligible to receive a 25 percent courtesy discount on orthodontics with participating orthodontists. There is no monthly premium and it’s not necessary to complete any enrollment forms.


  Does OCPS offer life insurance to employees?  

The term life insurance offered by OCPS provides protection while you are an employee. This coverage will be terminated once you leave employment with OCPS.

You may apply for portable coverage or convert to an individual policy. There are two life insurance plans available: one is paid for by OCPS, and the other one is available through payroll deduction.


  How much life insurance does OCPS pay for?  

OCPS pays the life insurance premium for term insurance which is equal to your base annual salary, with a minimum of $7,500.


  What life insurance is available through payroll deduction?  

As a new employee or during annual enrollment, you may purchase life insurance for your spouse/same-sex domestic partner up to $10,000, and for each child up to $5,000, depending on your annual salary; no health questions are required to be eligible for this coverage. OCPS also offers Group Universal Life insurance to employees, spouses/same-sex domestic partners and dependent children. As a new employee certain amounts are available without answering health questions. You can read more about the Group Universal Life (GUL) plan in the GUL section of the OCPS Insurance Handbook.


  What is disability insurance?  

Disability insurance replaces a portion of your income if you become disabled and unable to work. You may select the benefit level you wish to receive, and your premiums will be based on the level of protection you select.


  How does disability insurance work?  

The waiting period is the length of time of continuous disability due to sickness or injury that must be satisfied before you are eligible to receive benefits. The duration of benefits is based on your age when the disability occurs. Benefits are available from $200 to $7,500, up to 66 2/3 percent of your salary. You also choose the waiting period, so that benefits will begin after day(s) 14, 30, 60 or 180. If you have the 14- or 30-day waiting period and you are hospitalized, the waiting period is waived. No proof of good health will be required to sign up for disability insurance if you are a new employee enrolling during your initial enrollment period.


  What other optional insurances are available to me as a new employee?  

Your Insurance Handbook is your best guide to the optional plans available. Other insurances available include life, disability, dental, vision, and flexible spending accounts. Your Handbook also contains a list of frequently called telephone numbers and the Web site addresses for provider directories. Take the time to review your Handbook carefully before you make your final decisions.


  What is a Flexible Spending Account (FSA) and how does it work?  

By taking advantage of tax laws, Flexible Spending Accounts (FSAs) work with your benefits to save you money. Almost everyone has a number of necessary, predictable expenses that are not covered by insurance programs, including, but not limited to health plan copays or deductibles and prescriptions. FSAs offer a unique way to help pay for health care expenses not covered by your health plan, as well as the expense of dependent care while you are working.

Due to IRS regulations, domestic partners and the children of domestic partners are not eligible to participate in an employee's FSA.


  When do I need to make my insurance selections?  

New Employee Enrollment must be completed within two weeks of your first day of work. Your insurance selections will be processed through the My OCPS portal. Exception: Group Universal Life requires paperwork available on the intranet at http://Insurance.ocps.net.


  Where is the Insurance Benefits office located and what are their hours?  

The Insurance Benefits office is open from 7:30 a.m. to 4:30 p.m. Monday through Friday and is located on the 3rd floor of the Educational Leadership Center. The mailing address is 445 W. Amelia St., Orlando, FL 32801. The telephone number is 407.317.3245; the fax number is 407.317.3359.


  Where can I find the latest news about my benefits?  

Be sure to read the OCPS insurance and wellness newsletter, the Benefits Bulletin. The Benefits Bulletin is published monthly during the school year and is available on the OCPS Intranet.


  Are there any specialists where I don't need a referral from my PCP?  

You can see your OB/GYN, chiropractor, and podiatrist without a referral. You also can see a dermatologist for 5 visits per calendar year without a referral.


  What should I know about covering my same-sex domestic partner and/or the child(ren) of my same-sex domestic partner?  

Plans available to domestic partners and their children

  • Medical/pharmacy Insurance
  • Dental Insurance
  • Vision Insurance
  • Group Universal Life Insurance
  • Dependent Life Insurance

Plans NOT available to domestic partners or their children
  • Medical Flexible Spending Accounts
  • Dependent Care Flexible Spending Accounts
  • Continuation of coverage (COBRA)

Eligibility criteria for domestic partners and children of domestic partners can be found at http://insurance.ocps.net, select enrollment Information. Eligibility requirements will be listed on the right side of the page.
Please note, under IRS regulations, domestic partners and the children of domestic partners do not qualify as tax dependents, as a result the premiums for any plans with a domestic partner or child(ren) of a domestic partner will be deducted post-tax and the medical premiums made by OCPS on behalf of dependents will be treated as taxable income. Examples of the impact of imputed income can be found on the Enrollment Information page at http://insurance.ocps.net. Employees should consult a tax advisor prior to adding coverage.