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2022 the chart below to see when your coveragewould begin:September 30 following the dependent’s 23rdbirthday, life insurance will be cancelled.Unless otherwise terminated in accordance withthe plan terms, coverage will continue as long asthe disabled child is incapacitated anddependent. You will be asked to provide the planadministrator with proof that the child’sincapacity and dependency existed prior to age19. Before the plan administrator agrees to theextension of coverage, the plan administratormay require that a physician chosen by yourhealth plan examines the child. The planadministrator may ask for ongoing proof that thechild continues to be disabled. If you do notprovide proof that the child’s incapacity anddependency existed prior to age 19, as describedabove, coverage for that child will end at the endof the month in which he/she turns age 26 formedical and prescription coverage, at the end ofthe month in which he/she turns age 24 fordental and vision coverage, and on September30 following his/her 23rd birthday for lifeinsurance.If you submit youronline enrollment:Your coverage willbegin on:On or before January 20February 1Between January 21 andFebruary 20March 1On February 21April 1Special Rule for 10-MonthEmployeesIf you are a 10-month employee reporting at thebeginning of a school year, your coverage willbegin October 1 if you enroll by September 20.If you enroll from September 21 to October 20,your coverage will begin November 1. You mustenroll within 60 days of initial employment.ENROLLING NEW DEPENDENTSYour new dependents are not covered orenrolled automatically under the benefit plan—you must take action to enroll new dependents inyour plan. You may enroll a new eligibledependent in your benefit plan during OpenEnrollment or when you experience a qualifyinglife event.If you change your medical plan, you will berequired to submit new medical documentationto the new health plan provider for review.Coverage ends if you predecease your disableddependent, except as provided under federalConsolidated Omnibus Budget ReconciliationAct (COBRA) legislation.Please note that you must enroll your newdependent through ERSC, not through thebenefit plan provider.WHEN BENEFITS COVERAGEBEGINSWhen you enroll a dependent in your plan,whether as a new employee, during OpenEnrollment, or due to a qualifying life event, youare required to use the BES. (See EnrollmentBasics in this booklet for benefits enrollmentinstructions.) You will be required to providesupporting documentation.New employees must enroll in benefits via theonline Benefits Enrollment System (BES) within60 days of initial employment or wait until afuture Open Enrollment to enroll online. (SeeEnrollment Basics in this booklet for benefitsenrollment instructions.) Coverage begins on thefirst day of the month following the month thatyou enroll, provided you submit your onlineenrollment by the 20th day of the month.Refer to the chart below for information aboutenrolling an eligible dependent if you experiencea qualifying life event. It includes importantdeadlines and documentation you are required tosubmit. Note: All documentation must betranslated to English prior to submitting it toERSC.If you enroll online after the 20th day of themonth, your benefits coverage begins on the firstday of the second month. For example, let’sassume you are hired on December 23. Refer toEMPLOYEE BENEFIT SUMMARY2

2022Qualifying Life EventForms RequiredDeadline to AddNewborn/adopted childSocial Security number*60 days from the date of birth or adoptionBirth certificate/registration* orLegal court documentationLegal guardianship/custodySpouseSocial Security number*Legal court documentation60 days from the court award of legalguardianshipSocial Security number60 days from the date of marriageMarriage certificateLoss/gain of coverageInsurance cancellation form orCOBRA notice60 days from the date of loss/gain ofcoverage* If you cannot provide a Social Security number and a birth certificate or birth registration within the 60day time frame, you may enroll your newborn with evidence that you have applied for a social securitynumber and a birth certificate or birth registration. You must provide the social security number and birthcertificate or birth registration to ERSC upon receipt. Failure to provide this information in a timelymanner will result in termination of coverage.Coverage for your newborn/newly adopteddependent child(ren) will be retroactive to thedate of birth, adoption, or legal guardianshipwhen forms are submitted within the 60-daytime frame.work event. Qualifying life or work eventsinclude:If ERSC receives all required documentation bythe 20th of the month, coverage for your newdependent will begin on the first day of thefollowing month. If ERSC receives the formsand necessary documents after the 20th of themonth, coverage for your new dependent willstart on the first day of the second month.If you do not enroll your new dependent withinthe 60-day time frame listed above, you mustwait until a future Open Enrollment to enrollhim or her using the BES. Marriage/divorce Birth of child; adoption or legalguardianship Death Aging off plan Change of work status (e.g., you are a .4paraeducator, not benefits eligible, and yourhours increase to .6—you now are benefitseligible) Loss of non-MCPS coverageChanges due to qualifying life or work eventsmay be made during the plan year, as describedin the section Enrolling New Dependents.CHANGES IN OR CANCELLATIONOF COVERAGEYou may cancel your coverage at any time, butyou may not cancel your dependent’s coveragewithout proof that the dependent has coverageelsewhere. It is recommended that you notifyERSC promptly because removing adependent could change your coverage leveland reduce your cost. You must provideevidence of other coverage in order to drop adependent from coverage.In general, you are not permitted to makechanges to your benefits plan during the planyear. You may make changes to your benefitsplan during the annual Open Enrollment heldeach fall.Certain benefit changes may be made during theplan year if you experience a qualifying life orEMPLOYEE BENEFIT SUMMARY3

2022Also, while you may add or drop yourself, aspouse, or dependent(s) from your benefits planoutside of Open Enrollment due to a qualifyingevent, you may not make changes to yourbenefits plan outside of Open Enrollment. Thismeans you may not change insurance plans orcancel individual components of your benefitplan during the plan year.benefits coverage will be effective the first ofthe month following your enrollment.PAYING FOR COVERAGEYou pay for your health plan coverage withpremiums deducted from your paycheck on apretax basis. Your premiums are deductedbefore income and payroll taxes are calculated,and your deductions are taken in equal amounts.The detailed cost is shown on your ePaystub.If you choose to cancel coverage outside ofOpen Enrollment, you must cancel the entireemployee benefit plan—with the exception oflife insurance coverage(s).To cancel or change coverage due to aqualifying life event outside of OpenEnrollment, you must visit the Employee SelfService web page loyees/employee-self-service/ and click onthe Benefits enrollment/changes due to aqualifying life event link. You have 60 daysfrom the date of the qualifying event to enrolland submit the required supportingdocumentation to ERSC. You must eitherupload this information to the BES when youenroll or mail it to ERSC. Ten-month employees have deductionstaken from 20 paychecks during the schoolyear. Twelve-month employees have deductionstaken from 26 paychecks.Refer to the rate chart at the end of thisdocument for the base health coverage costs for2022.WHEN BENEFITS COVERAGE ENDSIf you terminate employment with MCPS,benefits coverage for you and any covereddependents ends on the last day of the monthyou terminate employment.If ERSC receives all required documentation bythe 20th of the month, changes to or cancellationof your coverage will become effective on thefirst day of the following month. If ERSCreceives the forms after the 20th of the month,changes to your coverage will become effectiveon the first day of the second month.Dependent life insurance coverage for adependent child automatically ends onSeptember 30 following the child’s 23rdbirthday. For dental and vision plans, benefitscoverage for a dependent child automaticallyends at the end of the month in which he/sheturns age 24. For medical and prescription plans,a dependent child’s coverage automatically endsat the end of the month in which he/she turnsage 26.If you do not enroll and provide the necessarydocumentation within the 60-day period, youmust wait until a future Open Enrollment tomake any changes using the BES.Remember: It is your responsibility topromptly notify ERSC of any changes to yourpersonal information (e.g., name or address)or coverage needs.Special Rule for 10-monthEmployeesIf you are a 10-month employee and youterminate employment with MCPS at the end ofa school year (on your last duty day), yourcoverage continues through September 30because you have prepaid for benefits throughthe summer.Loss of Non-MCPS CoverageYou may enroll in an MCPS-provided benefitsplan during the plan year if you or your benefitseligible dependents lose coverage provided by abusiness or organization other than MCPS. YourEMPLOYEE BENEFIT SUMMARY4

2022CONTINUATION OF BENEFITS(COBRA)required premium will result in cancellation ofcoverage.If your coverage ends, you and your dependentsmay be eligible to continue coverage as providedunder COBRA.Please be advised that if you terminate yourcoverage while on leave and, after returning towork at a later day, wish to re-enroll in benefits,you must do so using the BES within 60 days ofreturning to active work status. You must reenroll in the same coverage you had prior togoing on leave. If you marry, have a child, oradopt a child while on leave, they may be addedto your plan when you return from leave via theBES. You will need to provide the appropriatedocumentation.You and/or your dependents may becomeeligible for coverage under COBRA if youterminate employment or you and/or yourdependents become ineligible for coverageunder the MCPS benefits plan. You maycontinue coverage by paying the full cost ofcoverage plus a 2 percent administrative fee fora period legally-mandated by COBRAregulations (generally 18–36 months).In most cases, you cannot continue yourparticipation in a flexible spending account(FSA) while on leave. Your FSAs are cancelledas of the last deduction taken once you are onleave, and you must reenroll within 60 days ofreturning from leave. You can incur expenses upto the date your leave begins and have untilApril 30 following the plan year to submitclaims for reimbursement.MCPS does not share the cost of COBRAcoverage. A COBRA rate chart can be found onthe ERSC website. You will receive a qualifyingevent notice (QEN) from the MCPS third partyadministrator.INSURANCE COVERAGE WHILEON LEAVEWhile on an approved leave of absenceprotected by the Family and Medical Leave Act(FMLA), you may choose to re-enroll in anFSA. To do so, complete and submit MCPSForm 450-3, Flexible Spending Account Electionto have your FSA contributions direct billed toyou.If you are on an approved leave of absence, youmay elect to continue or terminate your coverageunder the MCPS employee benefit plan.Depending on the type and duration of yourleave of absence, you may be required to payeither the employee share or the full cost ofcoverage. For most unpaid leave categories,there is not an MCPS subsidy, and you areresponsible for 100 percent of the cost ofinsurance while on leave. More informationregarding leave of absence policies is availableon the ERSC website loyees/leave/.If you fail to reenroll in the employee benefitplan within 60 days of returning to active workstatus, you must wait until a future OpenEnrollment. In order to reenroll for basicemployee life insurance or optional employeeand optional dependent life insurance, you andyour spouse must provide evidence ofinsurability and be approved by MetLife.You may elect to terminate coverage byindicating your choice on the appropriate BESscreen(s). If you wish to continue coveragewhile on leave, no action is required.If you are absent from work without approvedleave, you still are required to pay healthinsurance premiums. If in any given pay periodyou do not have sufficient funds to cover thecost of your insurance premiums, the premiumswill be withheld from your next paycheck. In theevent of a longer unapproved absence fromwork, you will be billed the full cost premiumrate. Please keep in mind that you couldYou can continue life insurance coveragewithout continuing medical, dental, vision, orprescription coverage. If you elect to continuelife insurance coverage, you will be billed by theMCPS Division of Controller. Failure to pay theEMPLOYEE BENEFIT SUMMARY5

2022CareFirst BlueChoice does not haveparticipating doctors or facilities, the planprovides out-of-network benefits.jeopardize your eligibility to continue healthinsurance coverage if you are absent withoutapproved leave. For additional informationabout leave of absence policies, visit the ERSCwebsite loyees/leave/COORDINATION OF BENEFITSIf you or one of your dependents is covered bymore than one insurance plan, there is an orderof benefits determination established by theNational Association of InsuranceCommissioners. The primary plan will be thefirst to consider the medical services renderedfor coverage. Any medical care not covered bythe primary plan in full will be considered forpayment by the secondary plan.OUT-OF-AREA COVERAGEIf you are enrolled in the Kaiser PermanenteHealth Maintenance Organization (HMO)medical plan, any eligible dependents that resideor attend school outs

time and for employee experiencing a qualifying life event during the plan year. Keep in mind that this is a summary of the MCPS benefit plan and is intended to help you understand and properly enroll in the plan. Full benefit plan details are available on the Employee and Retiree Service