HIPAA Privacy Notice (210K)

Benefits Summary
2008 Active Employees
effective January 1, 2008

Benefits at a Glance (53K)
A brief overview of benefit options for 2008.

Frequently Requested Web sites and Phone Numbers(22K)

 
2008 Rates
2008 Active Employee Health Care Rates (55K)
A comparison chart detailing the rates for all employee health benefits effective January 1, 2008.
2008 Leave Rates
2008 COBRA Rates

Summary Plan Documents (SPD)
COBRA Continuation Coverage (119K) July 2005
Dental Plans (453K) August 2004
Flexible Spending Accounts (160K) October 2006
Health Maintenance Organizations (324K) July 2003
Vision Plan (288K) July 2005

Point of Service Medical Plans
UnitedHealthcare
Standard (178K) July 2005
High Option (178K) July 2005

Evidence of Coverage
UnitedHealthcare Closed POS Plan (43K)
UnitedHealthcare Open POS Plan (43K)
UnitedHealthcare Select (40K)
Carefirst BlueChoice (563K)
Optimum Choice (85K)
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

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

Caremark Primary/Preferred Drug List
January/March 2008

Vision Care
National Vision Administrators (NVA) MCPS Claim for Vision Care Expense (19K)

Flexible Spending
Flexible Spending Account Information (102K)
Eligible Flexible Spending Expenses
Account Election Form-2008 (88K)

FSA Debit Card FAQ (38K) NEW
Participating Merchants for FSA Debit Card (17K) NEW

Flexible Spending Claim Forms
Healthcare Claim Form
Dependent Claim Form  

Optional Life Insurance
Optional Employee Enrollment ERSC Form 401(including rates) (105K)
Optional Dependent Enrollment ERSC Form 514(31K)

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


 

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

Optimum Choice HMO (MCPS
no longer participates in the Optimum Choice plan effective 12/31/07. Claims issues for 2007 may be directed to the number below)
 301-360-8040
 1-800-331-2102

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
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