Forms & Notices

If you (and/or your dependents) have Medicare or will become eligible for Medicare in the next 12 months, a Federal law gives you more choices about your prescription drug coverage. Please see the Creditable Coverage Notice and Non-Creditable Coverage Notice for more details.

You have the right to request and obtain a paper version of any notice free of charge.

Notice of Patient Protections

The Plan generally allows the designation of a primary care provider. You have the right to designate any primary care provider who participates in the network and who is available to accept you or your family members. For...

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COBRA Notice

FBMC Benefits Management Inc., benefits manager for Duval County Public Schools (DCPS) has contracted with PayFlex Systems USA, Inc. to administer COBRA services as required by law. The Consolidated Omnibus Budget Reconciliation Act (COBRA) gives workers and their families who lose their health benefits the right to choose to continue group health benefits provided by their group health plan for limited periods of time under certain circumstances, such as voluntary or involuntary job loss, reduction in the hours worked, transition between jobs, death, divorce, and other life events. This right extends to your plan’s Medical and Health FSA.

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Creditable Coverage Notice

– DCPS Contributory Plan
– DCPS Non-Contributory Plan

This notice has information about your current prescription drug coverage with DCPS and about your options under Medicare’s prescription drug coverage. This information can help you decide whether or not you want to join a Medicare drug plan.

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Non-Creditable Coverage Notice

– DCPS High Deductible Health Plan

This notice has information about your current Prime Therapeutic prescription drug coverage with DCPS and about your options under Medicare’s prescription drug coverage

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Medicaid and the Children’s Health Insurance Program (CHIP)

If you or your children are eligible for Medicaid or CHIP and you’re eligible for health coverage from your employer, your state may have a premium assistance program that can help pay for coverage, using funds from their Medicaid or CHIP programs. If you or your children aren’t eligible for Medicaid or CHIP, you won’t be eligible for these premium assistance programs but you may be able to buy individual insurance coverage through the Health Insurance Marketplace.

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Notice of special enrollment rights

This notice is provided to ensure you understand your right to apply for the DCPS District Group Healthcare Plan in the event of a change in your status, including marriage, birth or adoption. Please read the notice even if you plan to waive coverage at this time.

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Taxable Benefits and the IRS

Certain benefits may be taxed if you become disabled, depending on how the premiums were paid during the year of the disabling event. Payments, such as disability, from coverages purchased with pretax premiums and/or nontaxable employer credits, will be subject to...

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Social Security

Social Security consists of two tax components: the FICA or OASDI component (the tax for old-age, survivors’ and disability insurance) and the Medicare component. A separate maximum wage to which the tax is assessed applies to both tax components. There is no maximum...

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Life Insurance Premiums and the IRS

According to IRS regulations, you can pay premiums on a pretax basis for the first $50,000 of life insurance coverage under a group term life insurance, a group term life insurance plan, covering your life. However, you must pay tax on such coverage exceeding $50,000.

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Notice of FBMC’s Capacity

FBMC Benefits Management, Inc. (FBMC) has been authorized by your employer to provide certain administrative services for some the insurance plans offered within your employer’s benefit program. Importantly, FBMC is not the policyholder or an insurance company. The...

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Newborn and Mothers Health Protection Act

The Newborn and Mothers Health Protection Act has set rules for group health plans and insurance issuers regarding restrictions to coverage for hospital stays in connection with childbirth. The length of stay may not be limited to less than: 48 hours following a...

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HIPAA Privacy

The Plan complies with the privacy requirements of the Health Insurance Portability and Accountability Act of 1996 (HIPAA). These requirements are described in a Notice of Privacy that is included on this website. A copy of this notice is available upon request.

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Glossary of terms

Allowable Charge - This is the dollar amount typically considered payment-in-full by an insurance company. The Allowable Charge is typically a discounted rate rather than the actual charge. For example: You visit your doctor for the flu. The total charge for the visit...

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Plan documents

The information contained in this guide provides a detailed overview of the benefits available to you through DCPS. More information is contained within the formal plan documents. If there is any discrepancy between the information in this guide and the formal plan...

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District Guidelines and Employee Responsibilities

Participation in the District Benefit Program  Be aware that when you participate in the District Benefit Program, you are making the following affirmations: You authorize the District to deduct premiums for the benefits rolled over or elected for the plan...

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