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OPEN ENROLLMENT & BENEFITS REFERENCE GUIDE
YOUR BENEFIT
Options At-a-Glance
This chart can help you make your enrollment decisions quickly – start with the brief descriptions here, then turn to the pages
indicated for more information.
TYPE OF BENEFIT
YOUR BENEFIT OPTIONS FOR 2017
PAGE
Medical Care
(includes Caremark
Prescription Drug
coverage)
CareFirst
BlueChoice
Triple Option
Open Access
Offers three levels of coverage depending on the provider you visit, along with the
freedom to see any provider you wish. Annual deductible and co-payment/co-
insurance vary by coverage level. Choose in-network providers for lower out-of-
pocket cost.
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CareFirst
BlueChoice
HMO Open
Access
Members select a BlueChoice HMO network Primary Care Physician (PCP)
selection based in Maryland, DC or Northern Virginia. Care received outside
the network is not covered. Referrals are not necessary for visits with network
specialists.
13
CareFirst EPO All care must be provided by in-network providers. The EPO network includes
providers nationwide. Referrals are not necessary for visits with network
specialists.
24
Dental Care
CIGNA
Dental HMO
(DHMO)
Plan payments are based on a schedule of co-pays for dental services. All care
must be coordinated by a CIGNA DHMO Network Dentist. No benefits are paid
for out-of-network care. CIGNA DHMO is a national network—contact Cigna for
a list of participating DHMO dentists.
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CIGNA
Dental PPO
(Indemnity)
Plan pays a percentage of most dental services and supplies. $1,000 annual benefit
maximum plus separate $1,000 orthodontia benefit. Participants may use CIGNA
PPO network or non-network dentists. Use network dentists for the lowest out-of-
pocket cost.
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Vision Care
VSP Vision Plan pays set amount towards annual eye exams, eyeglasses or contact lenses. Use
VSP providers for the lowest out-of-pocket cost.
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Flexible Spending
Accounts
(Employees Only)
Health Care
FSA
Set aside up to $2,550 to pay for eligible healthcare expenses with tax-free dollars.
(Employees Only)
57
Dependent
Care FSA
Set aside up to $5,000 ($2,500 if married, filing separately) to pay for eligible
dependent day care expenses with tax-free dollars. 13 is the age limit for
dependent children.
(Employees Only)
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Life Insurance
Basic Life
Insurance
In the event of your death, pays your beneficiary a benefit based on your
employment classification.
(Employees only)
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Supplemental
Life Insurance
Elect additional life insurance coverage in amounts from $25,000 to $400,000.
Completion of the Evidence of Insurability form is required for new or increased
coverage requested during Open Enrollment.
(Employees Only; Retirees may not
add or increase coverage)
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Spouse Life
Insurance
Elect to receive $5,000, $25,000 or $50,000 in the event of your spouse’s death.
Policy value may not exceed 50% of the Employee’s policy value. Completion
of the Evidence of Insurability form is required for new or increased coverage
requested during Open Enrollment.
(Employees Only)
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Dependent Life
Insurance
Elect to receive $2,500, $5,000 or $10,000 in the event of your dependent
child(ren)’s death. Dependents up to age 26 are eligible. Policy value may not
exceed 50% of the Employee’s policy value. (Employees Only)
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AD&D
Insurance
Pays your beneficiary an additional benefit if your death results from an accident.
Also pays a benefit for certain injuries resulting from an accident.
(Employees
Only)
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Other Benefits
Voluntary and
Other Benefits
Includes short-term disability coverage, universal life insurance with a long-term
care rider, long term care insurance, and group legal benefits.
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