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EMPLOYEE AND RETIREE SERVICE CENTER > BENEFITS, ACTIVE

Benefits for Active Employees

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Employee Benefit Plan Documents


HIPAA Privacy Notice (210K)

Benefits Summary
*Open Enrollment 2010 (6MB)
New benefit information for open enrollment with a January 1, 2010 effective date.
*
New Employees, 2009 (726K)
Benefit information for newly hired employees with a January 1, 2009 effective date.

Benefits at a Glance (34K)
A brief overview of benefit options.

Frequently Requested Web sites and Phone Numbers(11K)
updated 10.08


Rates for 2010
*Active Employee Health Care Rates 2010
(17K)
A comparison chart detailing the rates for all employee health benefits effective January 1, 2010.
Leave Rates 2010 (17K)
Leave rate schedule for active employees on leave.
COBRA Rates 2010(17K)
COBRA rates for 2009.

Rates for 2009
*Active Employee Health Care Rates 2009
A comparison chart detailing the rates for all employee health benefits effective January 1, 2009.
Leave Rates 2009(18K)
Leave rate schedule for active employees on leave.
COBRA Rates 2009(17K)
COBRA rates for 2009.

Summary Plan Documents (SPD)
*COBRA Continuation Coverage (119K) July 2005
*Dental Plans (453K) August 2004
Vision Plan (288K) July 2005

Evidence of Coverage
UnitedHealthcare Closed POS Plan (43K)
UnitedHealthcare Open POS Plan (43K)
UnitedHealthcare Select (40K)
Carefirst BlueChoice (563K)
Kaiser Permanente (158K)

Domestic Partnership
*Same-sex Domestic Partner Information and Affidavit (232K)

Retirement Savings Information

The Montgomery County Public Schools has created an educational Web site dedicated to defined contribution plans offered to all employees. The Web site includes comprehensive question and answer sections for both the 403(b) tax-sheltered savings plan and the 457(b) deferred compensation plan. The new Web site link is:

http://mcps.yourplan.info


 
Forms


Enrollment
*Employee Benefit Plan Enrollment Form-MCPS Form 455-20 (212K)

Dental

*Aetna Dental PPO Claim Form (278K)

CareFirst
*CareFirst Claim Form
*BlueChoice POS and HMO–Primary Care Physician Selection Form (35K)

CareFirst POS and HMO plan members must select a primary care physician.
Please review the following directions to search doctors in the POS or HMO networks.   

*Carefirst Provider Directory (POS)
*Carefirst Provider Directory (HMO)

UnitedHealthcare
*UnitedHealthcare Claim Form (979K)
*UnitedHealthcare International Claim Form (139K)
*Closed Point-of-Service Comparison Chart (31K)

UnitedHealthcare Provider Information
*UnitedHealthcare Provider Directory
*UnitedHealthcare Provider Nomination Form (34K)

Prescriptions

*CVS Caremark Mail Order Form (192K)
*CVS Caremark Claim Form (65K)

CVS Caremark Primary/Preferred Drug List
* January 2009

Vision Care
*National Vision Administrators (NVA) MCPS Claim for Vision Care Expense (19K)
*Opti-Vision Discount Benefits
*Lasik Benefits

Flexible Spending
*Flexible Spending Account Video
*Flexible Spending Account Information (625K)
*Eligible Flexible Spending Expenses
*2010 Account Election Form (21K)
*Account Election Form-2009 (new employee only) (88K)


*FSA Debit Card Facts (436K)
*Participating Merchants for FSA Debit Card (1,029K)

Flexible Spending Claim Forms
*Healthcare Claim Form
*Dependent Claim Form  

Optional Life Insurance

* Optional Employee Enrollment ERSC Form 401(including rates) (22K)
*Optional Dependent Enrollment ERSC Form 514(18K)

Retirement Estimate

MCPS Core and Supplemental Benefit Estimate
*Request for Estimate of Retirement Benefits (90K)

State Core Benefit Estimate
*Request for Estimate of Retirement Benefits (88K) 

*MCPS Employees’ Retirement/Pension System Federal and Maryland State Withholding Request


 

Links


Health Plans

Point-of-Service
*CareFirst BlueChoice POS Plan
1-800-545-6199
8am–10pm (EST); M–F
8am–1pm (EST); Sat

*UnitedHealthcare Select Plus POS Plans
1-888-607-5214
8am–8pm (EST); M–F
*United Behaviorial Healthcare
1-888-291-2507
8am–6pm (EST); M–F

HMO

*CareFirst BlueChoice HMO
1-800-545-6199
8am–10pm (EST); M–F
8am–1pm (EST); Sat

*Kaiser Permanente HMO
301-468-6000 & 1-800-777-7902
7:30am–5:30pm (EST); M–F
703-359-7878
5:30am–8:30pm (EST); M–F
7:30am–11:30am (EST); S/S/Hol

*UnitedHealthcare Select HMO
1-800-638-1103
8am–8pm (EST); M–F

Dental Plan
*Aetna PPO Dental
1-800-282-0555
8am–8pm (EST); M–F

*Aetna DMO Dental
1-800-843-3661
8am–8pm (EST); M–F

Vision Plan
*National Vision Administrators
1-800-672-7723
8am–6pm (EST); M–F
8:30am–5pm (EST); Saturday

Prescription Drug Plans
*Kaiser Permanente
Refill-By-Phone
1-800-700-1479; Anytime

*CVS Caremark Customer Service
1-800-378-7558
8am–10pm (EST); M–F


Flexible Spending

*SHPS, Inc.
1-800-678-6684
8am–8pm (EST); M–F

Life Insurance
*Prudential
1-800-732-0416
8am–8pm (EST); M–F

Retirement System
*State Retirement System of Maryland
*Mentor Newsletter
*Retiree News and Notes

Other Useful Information
*Adventist Healthcare
*Shady Grove Health Tips
*Smoking Cessation: A Personal Journey

Updated October 9, 2009 | Contact webmaster

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