Enrollment booklet 2004-2005 State of Georgia Flexible Benefits Program

Life Changes...
Making healthy decisions for a changing lifestyle
Enrollment Booklet 2004-2005 State of Georgia Flexible Benefits Program

TERMS & CONDITIONS

The Flexible Benefits Program is offered by the Employee Benefit Plan Council, the Board of Community Health and participating departments and authorities. The Flexible Benefits Program is governed by the Internal Revenue Code, section 125, and rules issued by the Employee Benefit Plan Council and the Board of Community Health. The Flexible Benefits Program provides you with a method to have your employer purchase benefits with money that would have been paid to you. You do not receive the premium amounts and contributions for the pre-tax options you select as taxable income (and therefore do not pay taxes on that amount); you do receive the benefits as an employer paid benefit. The Option Statement is a binding salary agreement. Failure to comply with all contractual and administrative requirements will result in any excess salary reductions being retained by the Plan. The following statements apply to the benefit options listed on the Option Statement and on the Open Enrollment web site.
1) Your participation in the Flexible Benefits Program is voluntary. You are not required to choose any of the options. If you do not wish to participate in these benefits, mark `no coverage' in each benefit category, sign and date the Option Statement, and return it to your personnel or payroll office. If you choose your benefits through web enrollment, click `no coverage' in each benefit category and complete the confirmation process.
2) The coverage levels available to you and the premium amount for each coverage level may be calculated using your retirement salary, your age, your eligibility for disability retirement benefits, and FICA status. Any errors in your age, salary, eligibility for disability retirement benefits or FICA status should be reported to your personnel or payroll office immediately.
3) The calculation of tax savings does not take into consideration any other income reduction program such as Deferred Compensation or Tax Sheltered Annuities, or any changes you may make in coverages for the upcoming year.
4) By selecting coverages and indicating contributions to Spending Accounts, you are agreeing that your agency may reduce your taxable income by the amount necessary to purchase those coverages and make those contributions. Except in certain circumstances, the amount of income reduction may not be changed until the next enrollment period.
5) After this enrollment period you may become a participant or make changes in some coverages only under limited conditions in accordance with the rules of the IRS code, the Employee Benefit Plan Council, and the Board of Community Health. The Employee Benefit Plan Council and the Board of Community Health have the responsibility to interpret these rules and make the final decision as to whether you may enroll or change any coverage outside of the enrollment period. Your request for enrollment or a change outside of the enrollment period will only be considered if you submit the proper documentation within the timeframe allotted. To submit a request for enrollment or change to coverage under the State Health Benefit Plan, you must complete and submit a Membership or Discontinuation Form to your employer's Benefits Coordinator within 31 days to enroll or increase coverage and 90 days to cease or decrease coverage. Your request for enrollment or a change in any other coverage under the Flexible Benefits Program must be submitted in writing to your employer's Benefits Coordinator within 31 days to enroll or increase coverage and 90 days to cease or decrease coverage. Submission of a request for enrollment or a change, or the occurrence of one of the following events, does not guarantee that you will be able to enroll or change coverage outside the enrollment period. Please see your Benefits Coordinator if you have questions about when you may enroll or make changes outside the enrollment period. A list of events that might permit you to enroll or change one or more coverages under the Flexible Benefits Program: a) You gain or lose a spouse; or b) You gain (no time limit if due to judgment, decree or order) or lose an eligible dependent; or c) Your spouse or dependent becomes eligible for or loses coverage under another employer's plan, COBRA or a governmental plan; or d) An event causes your dependent to gain or lose eligibility for coverage under your employer's plan; or e) Your change of residence causes you or your spouse or dependents to gain or lose eligibility for coverage under your plan or another employer's plan; or f) The cost of your dependent care increases or decreases significantly and your dependent provider is not related to you, your spouse, or your dependent; or g) Your spouse's employer increases, decreases or ceases coverage, or conducts open enrollment; or h) You, your spouse or your dependent gain or lose eligibility for Medicare or Medicaid.

6) This salary agreement will be terminated if you change the agreement during the next enrollment period. If you do not change the agreement, your benefit choices will rollover in the next Plan year or default to a specified coverage.
7) If you are eligible to participate in the Plan, you terminate and are rehired during the same Plan Year, you must maintain the same options.
8) Options and coverage levels under the State Health Benefit Plan are set forth in the State Health Benefit Plan Document. Options and coverage under the Flexible Spending Accounts are set forth in the Flexible Benefit Plan Document. For all other benefits under the Flexible Benefits Program, the options and coverage levels offered conform to policies provided by the insurance company making the offer. By selecting an option and coverage level you agree to abide by the terms and conditions of that policy.
9) Contributions to Spending Accounts are voluntary. You should not participate in Spending Accounts until you thoroughly read the sections of the Enrollment Booklet related to Spending Accounts. By choosing to contribute money to one or more Spending Accounts you are agreeing to abide by the Rules of the Employee Benefit Plan Council related to Spending Accounts. In particular, you are agreeing to the following provisions: a) Money contributed for one type of Spending Account cannot be used to pay claims payable from another type of Spending Account. b) In general, the amount contributed for a Dependent Care Account cannot be greater than the earned salary of you or your spouse, whichever is less. c) If you are married filing separately, the amount contributed for a Dependent Care Account cannot be greater than $2,500. d) The validity of a claim against a Spending Account is determined in accordance with the Plan, Internal Revenue Code, and IRS regulations as interpreted by the Administrator subject to the appeal provisions of the Plan. e) Any money not reimbursable to you will be forfeited to the Flexible Benefits Program. Forfeited money will not be returned or paid to the employee but will be used to reduce the costs associated with providing this benefit. f) For the Spending Accounts, eligible expenses will be reimbursed in accordance with the Rules of the Employee Benefit Plan Council and the IRS code. g) For the Dependent Care Spending Account, you will not be reimbursed for more than the Plan has received from your department on your behalf.
10) Other terms and conditions: a) If you choose not to participate or choose not to continue coverages, your ability to enroll at a later date will be subject to contractual provisions, which may include medical proof of insurability or limited coverages. b) If you failed to enroll in options requiring medical underwriting when first eligible and you choose new or increased levels of coverage, you must complete the medical underwriting process and be approved. c) If you choose coverage under the Life Insurance options and the Accidental Death and Dismemberment options, the same Beneficiary Election Form will be used. If a beneficiary is not named, your Estate will be the beneficiary. d) If you select more than $50,000 under the Life Insurance option, you may choose to pay the premium with after-tax dollars to avoid imputed income; this will eliminate any tax savings on the life insurance premium.
11) If you do not use the web site to complete your Health Benefit selection, you may be required to complete additional forms to finalize your Health Benefit selection. You should contact your Personnel Office to obtain the necessary forms. Failure to complete the required forms may jeopardize your selected coverage or your opportunity to enroll or change coverage until the next enrollment period.
12) In the event of an administrative error with respect to the Flexible Benefits Program, decisions will be made in accordance with the Internal Revenue Code, the Rules of the State Health Benefit Plan, and the Rules of the Employee Benefit Plan Council for the Flexible Benefits Program.
Please choose your Plan coverage carefully. Only eligible dependents, as defined by the Plan Administrator and in Program communications, can participate in the Flexible Benefits Program. Any attempt to file claims for a dependent who is not eligible for coverage is fraud. The Plan Administrator will require repayment of any ineligible claims. If the employee purchased family coverage but is only eligible for single coverage, the difference in the premiums paid into the Plan will not be refunded. Also, the difference between single coverage and family coverage premiums will be included as income on a W-2 and/or amended W-2 for inclusion on the employee's tax return. Additionally, the inclusion of ineligible dependents for coverage under the Flexible Benefits Program may result in termination from the Program and/or prosecution for fraud.

TABLE OF CONTENTS

UNIT 1
State Health Benefit Plan ..........................................................................1 What's New For 20042005.....................................................................2 Who's Eligible To Participate ...................................................................2 Pre-Tax Premiums Help You Stretch Your Dollars .................................2 Points To Consider ....................................................................................3 Flexible Benefits Program Calendar ........................................................5 Where To Find More Information About Your Benefits .........................6
UNIT 2
Signing Up For Coverage .........................................................................7 Forms To Complete...................................................................................7 After You Enroll For Coverage ..............................................................10 When Coverage Begins ..........................................................................10 Confirming Your Choices .......................................................................10 Change Your Decisions At Annual Open Enrollment ...........................10 Change Your Decisions Outside Open Enrollment ...............................10 What Happens If You Leave The State ..................................................11 Taking Coverage With You When You Leave.......................................12
UNIT 3
Dental Insurance......................................................................................13 Regular Dental Option ............................................................................13 Preferred Provider Option (PPO) ...........................................................13 Prepaid Option.........................................................................................14 Late Entrant Provisions...........................................................................14 Some Important Information About
The Prepaid Option.........................................................................16 Some Important Information About
The Regular And PPO Options......................................................16 Pre-Determination Of Benefits...............................................................16 Exclusions List ........................................................................................16 Example Of Regular And PPO Benefit Payments ................................16 Dental Options Comparison Chart .........................................................17
UNIT 4
Vision Coverage ......................................................................................18 Medically Necessary ...............................................................................19 Exclusions................................................................................................19 Vision Coverage Chart............................................................................20

UNIT 7
Accidental Death And Dismemberment Insurance ...............................28
UNIT 8
Disability Insurance.................................................................................29 Short-Term Disability Protection............................................................29 How STD Works .....................................................................................29 What Is A Late Enrollment Penalty For Late Entrants..........................29 Long-Term Disability Protection............................................................30 Eligibility For An Early Disability Retirement......................................30
UNIT 9
Long-Term Care Insurance .....................................................................31 Your Long-Term Care Options...............................................................31 When Benefits Are Paid..........................................................................31 About Your Premiums And Enrolling....................................................32
UNIT 10
Legal Insurance .......................................................................................33 Telephone Legal Services .......................................................................33 In-Office Legal Services .........................................................................33 Online Legal Services .............................................................................34 Identity Theft Services ............................................................................34 Reduced Fee Legal Service ....................................................................35 Reduced Fee Exclusion...........................................................................35
UNIT 11
"Peach State Reserves" The Georgia Retirement Investment Plan...............................................................................36
Eligibility .................................................................................................36 What Is Peach State Reserves?...............................................................37 Emergency Withdrawals .........................................................................37 Enrolling In Peach State Reserves..........................................................37 Choosing A 401(k), 457 Or Both ...........................................................37 Plan Comparisons Chart .........................................................................38 Peach State Reserves vs. Conventional Savings....................................38 Investing Your Money For Retirement ..................................................39 Making Other Changes To Your Plan ....................................................41

UNIT 5
Spending Accounts..................................................................................21 Health Care Spending Account (HCSA) ..........................................21-22 Dependent (Child) Care Spending Account (DCSA)............................23 Important Information About HCSA and DCSA ..................................24 A Word About Forfeitures.......................................................................25 If You Leave Or Retire............................................................................25
UNIT 6
Employee Life, Spouse Life, And Child Life Insurance.......................26 How Employee Life Insurance Works ...................................................26 Spouse Life Insurance.............................................................................27 Child Life Insurance................................................................................27

UNIT 12
Electronic Open Enrollment..............................................................42-44
UNIT 13
Benefit Phone Directory .........................................................................45 Employee Check List..............................................................................46 HIPAA Privacy Notice .................................................Inside Back Cover
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Welcome to the State of Georgia Flexible Benefits Program
Are you planning or expecting the birth or adoption of a child? Getting married soon? Are you caring for an aging parent? Is it time to start thinking about supplementing your retirement? These are just some of life's changes that could affect the health care and financial needs of you and your family.
This 2004-2005 enrollment booklet gives you an opportunity to review and understand your benefits package. It summarizes benefits available to State employees and their eligible dependents, along with certain procedures to be followed to obtain these benefits.
There are important changes for the 2004-2005 Plan Year, so review all information carefully. It is up to you to understand all the options available and make the choices that best suit your needs. Making the right decisions about your options can make a real difference toward building a rewarding future for you and your family.
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STATE HEALTH BENEFIT PLAN

Making healthy decisions for a changing lifestyle

Please refer to the Decision Guide and new Pharmacy Benefit Comparison Brochure for information about your health insurance options. The Decision Guide provides valuable information, including a detailed summary of benefits for each option, a list of counties where the HMO Options are available, and information regarding enrollment deadlines. The Pharmacy Benefit Comparison Brochure outlines your pharmacy benefits under each option offered to eligible employees.
The current PPO, PPO Choice and Indemnity Options are being replaced by the PPO Basic, PPO Premier, PPO Choice Basic, PPO Choice Premier, Indemnity Basic and Indemnity Premier Plan Options. The medical benefits under these new Plan Options

have not changed from last year but there are significant changes to the pharmacy benefits. If you do not submit an election by May 14, 2004, and are currently participating in the PPO, PPO Choice, or Indemnity Options, your coverage will default to the New PPO Basic, New PPO Choice Basic or New Indemnity Basic Plan Option. Failure to respond will not allow you to retain your current level of pharmacy coverage.
If you have not received the Decision Guide and Pharmacy Benefit Comparison Brochure, contact your human resource department.

Unit One / 1

What's New For 2004-2005
Health Care Spending Account
The IRS issued a Revenue Ruling stating that certain over-the-counter ("OTC") items are eligible for reimbursement through Health Care Flexible Spending Accounts.
Disability Insurance
We are pleased to announce that The Standard Insurance Company will be our new vendor providing disability insurance, effective July 1, 2004. The Standard has made the following enhancements to the LTD and STD plans:
STD New Employee -
No Pre-existing Condition Current Employees (not currently participating in
the STD plan) No Pre-existing Condition No Medical Underwriting Late Entrant Penalty - During the 12-month period beginning on the date the insurance becomes effective, a 60 day waiting period will apply for all disabilities except for accidental injury.
LTD For termination other than retirement of State
service - LTD conversion opportunity.
For further information, please see the Short and Long Term Disability section in this Enrollment Booklet and the Employee Summary Plan Description or call The Standard at 1-888-641-7186.
Who's Eligible To Participate
In general, you are eligible to participate in the Flexible Benefits Program if: You are a full-time regular employee who works at
least 30 hours a week and are expected to work for at least nine months. Employees who work in a sheltered workshop or work transition program, contingent employees, temporary employees, and student employees are not eligible.

You are a public schoolteacher, working at least 18 hours, and employed in a professionally-certified capacity, working half-time or more and not considered a "temporary" or "emergency" employee.
You are an employee of a local school system holding a non-certificated position. You must be eligible to participate in the Teacher's Retirement System (TRS) or its local equivalent, and you must work a minimum of 20 hours a week (or 60% of the time necessary to carry out the duties of the position, if that's more than 20 hours).
You are an employee of a local school system working at least 15 hours (or 60% of the time necessary to carry out the duties of your position, if that's more than 15 hours) and you are eligible to participate in the Public School Employees' Retirement System (PSERS), as defined by Paragraph 20 of Section 47-4-2 of the Georgia Code.
You are an employee of a county or regional library and work at least 18 hours per week.
If you aren't sure whether you're eligible, contact your personnel/payroll office.
Pre-Tax Premiums Help You Stretch Your Dollars
The Flexible Benefits Program allows you to save on taxes while you pay for your benefits. Pre-tax premiums reduce your taxable pay...and your taxes. That's because premiums for most of your insurance options, health benefit options, and spending account contributions are taken out of your paycheck before federal and state income taxes and Social Security (FICA) taxes are withheld.
This means your taxable pay is lower...and so are your taxes. It also means you have more in your paycheck - or more to spend on benefits than you would if you paid the same premiums with after-tax dollars.
The example on the next page shows the impact of the pre-tax advantage for an employee earning $25,000 a year with annual pre-tax premiums of $1,800.

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with after-tax premiums

with pre-tax premiums

Annual pay Annual pre-tax premiums Taxable pay Income and FICA taxes Annual after-tax premiums Take-home pay

$25,000 0
$25,000 3,513 1,800 $19,687

$25,000 1,800
$23,200 2,997
0 $20,203

With pre-tax premiums, this employee saves $516 in taxes, and has $516 more to spend on other benefits... or to take home.
Pre-tax premiums are available only for the state-wide benefits offered through the Flexible Benefits Program; they are not available for other agencysponsored benefits. This example is based on a married employee filing a joint return and claiming four exemptions.

Age Today

Reduction in Social Security Benefits at Age 65

25

2.6%

35

2.3%

45

1.7%

55

0.8%

Based on pay of $25,000 and $2,500 in pre-tax premiums until age 65.

Your Benefit Salary - which includes your base salary and salary supplements that are regular, nontemporary, and not more than the amount on which retirement contributions are calculated - is reflected on your Option Statement and remains constant for the entire Plan year. Benefit Salary is the pay used to calculate your pay-based coverage - employee life, AD&D, and disability.
A Few Words About Pre-Tax Premiums Using pre-tax premiums will not affect other employee benefits that are based on pay, such as any State of Georgia retirement system, life insurance, disability, and pension benefits. Those benefits will be based on your full pay before pre-tax premiums are taken out. It is worth noting that: except for any Peach State Reserves contri-
butions, you won't pay Social Security taxes (FICA) on your pre-tax premiums...potentially reducing your future Social Security benefits, although any reduction will be minimal in comparison with your total Social Security benefits; pre-tax premiums are not available for short-term disability, spouse life and child life, legal, or longterm care insurance.

As You Decide: Points To Consider
Whether you're single with no children, single with children, married with no children, or married with children, consider these points if...
Your Spouse Has Benefit Coverage
Spending Accounts If your spouse's plan offers spending accounts, you can each have a Health Care Spending Account at the maximum allowed. For Dependent (Child) Care Spending Accounts, however, IRS laws restrict your total family contributions to $5,000 per year.
Long-term Care This coverage is available to all eligible employees and some family members. Like legal insurance, few employers offer long-term care insurance.
Legal Since few employers offer legal insurance, this coverage may be worth considering if your family has legal needs.
Peach State Reserves (Deferred Compensation) Your spouse may save the maximum allowed in his or her company's savings plan and you may save the maximum allowed in the Peach State Reserves' Deferred Compensation Plans if you are eligible to participate. See page 36 for information on eligibility.
You Are A New Employee
Dental There is a much shorter waiting period in the Regular and PPO options if you sign up immediately. Late enrollment penalties will apply to the Regular and PPO options if you do not enroll now, but elect to do so in the future. The Prepaid Option does not have waiting periods or late enrollment penalties.
Spending Accounts If you are hired by the State after July 1, your paycheck reductions for the spending accounts will start the 15th of your first full calendar month of employment. Your total contributions to each account are prorated by the number of months you participate
Unit One / 3

in these options up to the maximum monthly amount allowed for each account.
Once you enroll, you may submit claims for services incurred on or after the first of the month after you have completed one full calendar month of employment. If, for example, you are hired July 8 and sign up for a spending account, reductions will start on August 15. You can begin submitting claims for services that you incur on or after September 1.
Long-Term Care You have a one-time opportunity to sign up for longterm care insurance without providing medical underwriting.

When Your Spouse Works For The State
Dental Each of you may take single coverage and enroll in different options if you choose, but your children will not be covered. As an alternative, one of you may take family coverage and cover your spouse and children. If you both take family coverage, the most the plan will pay is 100% of the allowable expenses.
Spending Accounts Each of you may have a Health Care Spending Account for the maximum allowed. For the Dependent (Child) Care Spending Account, however, you cannot exceed the $4,992 family maximum.

Employee Life, Spouse Life and Child Life You have a one-time opportunity to choose some employee, spouse and child life insurance coverage without providing medical underwriting. The chart on page 8 lists medical underwriting requirements.
Disability You have a one-time opportunity to sign up for
long-term disability coverage without providing medical underwriting. You have a one-time opportunity to sign up for short-term disability without being subject to a late entrant waiting period.
Other Coverage There are no medical underwriting requirements at any time for legal, AD&D, spending accounts, or vision.
You can sign up for the Peach State Reserves anytime if you are eligible to participate. See page 36 for information on eligibility.

Long-Term Care Each of you may enroll for the coverage you need.
Legal Each of you may take single coverage; in this case, your children will not be covered. Or, one of you may take family coverage and cover your spouse and children.
Employee Life and AD&D Each of you can enroll for the coverage you need.
Spouse Life Each of you may provide Spouse Life insurance for each other. Or, if you wish, one spouse may take coverage and the other spouse could choose "no coverage."
Child Life Each of you may provide Child Life insurance for your eligible children. Or, if you wish, one spouse may take coverage and the other spouse could choose "no coverage."

Be sure to consider your options carefully when you first enroll. If you decline or drop some of your State coverages and want to pick them up again another year, you may have to prove insurability through medical underwriting to be covered again, or have longer waiting periods to receive full benefits.

Disability Each of you may enroll for the coverage you need.
Peach State Reserves for Eligible Employees Each of you may contribute up to the maximum for your plans. If both spouses have accounts, you could have a substantial nest egg at retirement. See page 36 for information on eligibility.

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Flexible Benefits Program Calendar

What to Expect... When

April 1, 2004

All pay-related benefits (employee life insurance, AD&D, and disability) are based on your Benefit Salary and/or Benefit Age on this date.

April 15 May 14, 2004 April 16, June 9, 2004
May 14, 2004 June 15, 2004 June 30, 2004 July 1, 2004
July 14, 2004 May 2005 June 30, 2005 September 30, 2005

Open Enrollment period; look for your enrollment and benefit materials, and attend training meetings and benefit fairs.
Confirmation statements prepared, completed, and distributed showing the amount that will be taken from your paycheck beginning in June. Check your Statement carefully to be sure your choices have been recorded correctly. Contact your personnel/payroll office immediately if you discover an error.
Your deadline for submitting your Option Statement or completing web enrollment and all required forms. Note: Some agencies have an earlier deadline, so be sure to check with your personnel/payroll office.
Your first payroll reductions of the new plan year for your health benefit plan premiums and one-half of your monthly spending account contributions. (Note: This date may be different for educational entities.)
Your first payroll reductions of the new plan year for premiums for all other Flexible Benefit options and the remaining one-half of your monthly spending account contributions. (Note: This date may be different for educational entities.)
Coverage effective date for FLEX... provided you are not absent from work on the first scheduled work day in July due to illness or disability; for Health benefits... provided you are at work or on a paid leave of absence on the first scheduled workday in July.
Notify your personnel/payroll office if you have not received your SHBP ID card or Notice of HMO Membership Action form by this date.
Last salary reductions for Flexible Benefit premiums for 20042005.
Last day of coverage for the 20042005 plan year, and the last day to incur eligible expenses for reimbursement from the spending accounts for the plan year.
Deadline for filing spending account claims for expenses incurred during the 20042005 Plan Year -- July 1, 2004-June 30, 2005. Claims must be postmarked by this date.

If you are married to a State employee covered by the Flexible Benefits Program, make sure you understand how your coverage works together. You may have some advantages.

Unit One / 5

Where To Find More Information About Your Benefits

Dental Coverage Summary Plan Description List of PPO dentists - Request from United
Concordia 1-866-215-2356 or www.ucci.com/was/ucciweb/clients/georgia.jsp List of participating dentists for the Prepaid Plan Request from CIGNA 1-800-642-5810 or www.cigna.com
Vision Coverage List of in-network providers (www.spectera.com)
Health Care Spending Account Summary Plan Description IRS Publication 502 www.shps.net www.gms.state.ga.us/employee/faqs.asp
Dependent (Child) Care Spending Account Summary Plan Description IRS Publications 503 and 504 www.shps.net www.gms.state.ga.us/employee/faqs.asp
Long-Term Disability Insurance Summary Plan Description Summary Plan Description for your retirement
system
Legal Insurance Summary Plan Description Legal Care Brochure http://members.araggroup.com/georgia service@araggroup.com

Employee Life Insurance Summary Plan Description
Spouse Life Insurance Summary Plan Description
Child Life Insurance Summary Plan Description
AD&D Insurance Summary Plan Description
Short-Term Disability Insurance Summary Plan Description Summary of State sick leave policy
Long-Term Care Insurance Enrollment kit - Request from Unum
1-888-764-3539
"Peach State Reserves" The Georgia Retirement Investment Plan Peach State Reserves brochure Fund Prospectus - Request from Great-West
1-800-701-8255 www.gms.state.ga.us/employee/psr.asp
Ask your personnel/payroll office about the availability of the publications listed.

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SIGNING UP FOR COVERAGE
Making healthy decisions for a changing lifestyle

Forms to Complete
Depending on the benefit choices made, you may be required to complete forms in addition to your Option Statement, such as: Unum Evidence of Insurability Form for approval
of employee life, spouse life, and child life. If you make any of these benefit selections on the web, you must complete the medical underwriting form on the web. Unum Group Long-Term Care Insurance Application Evidence of Insurability Form to be approved for long-term care coverage. This medical underwriting form is not available on the web. When you have completed the form, return it to your personnel office. The Standard Evidence of Insurability Form to be approved for long-term disability. This medical underwriting form is not available on the web. When you have completed the form, return it to your personnel office. Enrollment forms for health coverage, and the Prepaid Dental option.
For Dental Insurance
If you enroll in the Prepaid Dental Option, you must complete a dentist Selection Form to pre-select a participating dentist. Call CIGNA's Dental Member Services at 1-800-642-5810 or go online at www.cigna.com to obtain the Dental Selection Form.

For Employee, Spouse, and Child Life Insurance
In addition to your Option Statement or web enrollment, you may be required to complete the life medical underwriting process. If you are a current employee or new employee, the charts on the following page will assist you in determining medical underwriting requirements.
Unum Evidence of Insurability Form If you or your dependents are required to undergo the employee life, spouse life and child life medical underwriting process, you may complete the underwriting process on the web or obtain the paper Unum Evidence of Insurability Form from your personnel/payroll office. Based on the information you provide on the form, Unum, the insurance company, may require additional medical information for clarification.
Amplified Blood Test In addition to the Unum Evidence of Insurability Form, your employee life insurance selection may require the completion of an amplified blood test. After Unum receives your Evidence of Insurability Form, the paramedic company responsible for collecting a blood sample will contact you. The amplified blood test includes measurement of blood pressure, pulse, height, and weight. You will not be charged for this test. The amplified blood test is never required for spouse life and child life insurance selections. If you have any questions about the amplified blood test process, please call Unum toll free at 1-888-764-3539.
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Current Employees
Enrolling for the first time, re-enrolling or increasing coverage

Employee Life

Life Medical Underwriting Requirements

Enrolling for the first time in any level. Discontinued coverage and re-enrolling.

Unum Evidence of Insurability form required. Amplified Blood Test required for coverage over $150,000.

Currently Enrolled in Employee Life and increasing coverage.

Unum Evidence of Insurability form required. Amplified Blood Test required for coverage over $150,000.

Spouse Life
Enrolling for the first time in any level. Discontinued coverage and re-enrolling
Child Life
Enrolling for the first time in any level of coverage Discontinued coverage and re-enrolling

Life Medical Underwriting Requirements Unum Evidence of Insurability form required.
Life Medical Underwriting Requirements Unum Evidence of Insurability form required.

New Employees
Enrolling for the first time
Employee Life Enrolling in One times pay (capped at $250,000) Enrolling in Two, Three, Four or Five time pay
Spouse Life Enrolling in coverage up to $30,000 Enrolling in coverage over $30,000 Child Life Enrolling for the first time in any level

Life Medical Underwriting Requirements NONE Coverage over $100,000 Unum Evidence of Insurability form required. Amplified Blood Test required for coverage over $150,000 Life Medical Underwriting Requirements NONE Unum Evidence of Insurability form required Life Medical Underwriting Requirements NONE

When you request new or additional coverage, and your medical history warrants, the insurance company may ask for additional information, including an amplified blood test, even if your new coverage is for less than $150,000.
Flexible Benefits Beneficiary Election Form
The first time you enroll in employee life insurance coverage, remember to complete the Flexible Benefits Beneficiary Election Form to name your beneficiaries. If your address changes or you desire a beneficiary change, update your beneficiary information by completing another Flexible Benefits Beneficiary Election Form. Be sure to return the completed form to your Personnel Office. You are
8 / Unit Two

always the beneficiary of your spouse life and/or child life insurance option.
For Long-Term Care Insurance
If you are a current employee choosing long-term care for the first time or have discontinued coverage and are re-enrolling or are currently in the plan and wish to increase your benefit level or add options, you must complete the Long-Term Care Application. Call Unum at 1-888-SOG-FLEX (1-888-764-3539) or contact your local personnel/payroll office for an application. The long-term care medical underwriting process cannot be completed on the web.
If you are a new employee and select this coverage, you do not have to complete this form. Simply, select this coverage on your Option Statement.

For AD&D Insurance
If you have enrolled in life insurance coverage, the beneficiary you name for your life insurance benefits is also the beneficiary for your AD&D benefits. If you did not take life insurance coverage, you should complete a Flexible Benefits Program Beneficiary Election Form for your AD&D coverage. You can change beneficiaries any time by filing a new form with your department.

For Long-Term Disability Insurance
If you are a current employee choosing coverage for the first time, or discontinued coverage and/are reenrolling, you must complete the disability medical underwriting process, along with your Option Statement. The Long-Term disability medical underwriting process cannot be completed on the web.
The Standard Evidence of Insurability Form The medical underwriting process includes the completion of the Evidence of Insurability Form, which you may obtain from your personnel/payroll office. The paper form must be completed and returned to your department by the designated deadline. Based on the information you have provided, the insurance company may require additional medical information for clarification. If you are a new employee and select the long-term disability option, you do not have to complete the medical underwriting process.

underwriting process, you may be contacted by telephone for additional information by The Standard or one of The Standard's representing companies. If you have any questions, please contact The Standard's Medical Underwriting staff toll-free at 1-888-641-7186.
For Peach State Reserves (Deferred Compensation)
You can enroll in Peach State Reserves anytime. There is no specific Enrollment Period. To enroll in either the 401(k) or 457 Deferred Compensation Plan, you are required to complete one or more of the following forms for each Plan. Each Plan has forms specific to that Plan. Make sure you get the correct forms. Employees of the educational entities listed on page 36 are not eligible for Peach State Reserves.

After you've decided which benefits are best for you, it's time to sign up for them. Refer to the employee checklist on page 46 to assure you are covering all bases.
Additional Required Information Additional information you may be required to furnish, may include medical history questions, medical records from your physician, an amplified blood test, and/or a paramedical examination. There is no additional expense to you for the blood test or for medical records. To speed up the medical

Deferred Compensation Plan New Enrollment Participation Agreement Request this form from your personnel/payroll office to enroll in the chosen Deferred Compensation Plan for the first time.
Deferred Compensation Plan Beneficiary Election Form Request this form from your personnel/payroll office when you enroll in the selected Plan for the first time or when you want to update beneficiary information or change your beneficiary.
Unit Two / 9

Deferred Compensation Spousal Waiver Form (401(k) only) Request this form from your personnel/payroll office when you enroll in the 401(k) plan if you are married and are electing anything other than 100% spousal beneficiary.
After You Enroll For Coverage
When Coverage Begins Generally, coverage for new options selected during open enrollment will begin on July 1, as long as you have met all contractual and administrative requirements.
If you are a new employee, complete your personalized paper Option Statement and other needed forms by your department's deadline, but no later than 31 days after your hire date. Your coverage will begin on the first day of the month after you have completed a full calendar month of employment.
Confirming Your Choices You will receive a Confirmation Statement. Check it to be sure your choices were correctly entered. The Confirmation Statement does not guarantee your coverage in some benefit coverages that require additional information. If you have not completed and submitted the additional forms/information required by your selected plan and have not been approved by the respective insurance companies, the choices shown on your Confirmation Statement for employee life, spouse life, child life insurance, and long-term disability insurance, long-term care, and State Health Benefit Plan PPO, Indemnity and HMO Options may not be valid.
Your new premiums for your health benefit plan and spending account reductions begin June 15; other premiums begin June 30. See specific plan descriptions for information about when your coverage begins.
Compare your paycheck statements with your Confirmation Statement. It is your responsibility to notify your personnel/payroll office if there is an error.
10 / Unit Two

NOTE: If you do not submit your Option Statement or complete the enrollment process on the web by the deadline, your 2003-2004 Plan Year choices will roll over in the 2004-2005 Plan Year.
To Change Your Decisions at Annual Open Enrollment Every Open Enrollment you can change your benefit decisions, based on which benefits are available and right for you. Remember, this is an annual agreement to allow the State to purchase some benefits for you through pre-tax premiums. You will not be able to change these benefit decisions until the next Open Enrollment unless you have a qualifying change in status as described in the Terms and Conditions. The Open Enrollment restrictions do not apply to Peach State Reserves. If eligible, you may enroll, change deferral amounts or discontinue deferrals at any time during the year.
To Change Your Decisions Outside Annual Open Enrollment
Qualifying Change in Status Event In general, the Internal Revenue Service prohibits you from changing any coverage elections, or enrolling in or canceling any coverage under the Flexible Benefits Program outside of Open Enrollment. However, the rules of the Internal Revenue Service, the Board of Community Health and the Employee Benefit Plan Council do permit you to change coverage or enroll or cancel coverage in certain limited circumstances, if the change corresponds to a qualifying change in status event.
The Employee Benefit Plan Council and the Board of Community Health have the responsibility to interpret these rules and make the final decision as to whether you may enroll or change any coverage outside of the Open Enrollment period. Your request for enrollment or a change outside of the enrollment period will only be considered if you submit the proper documentation within the time frame allotted. To submit a request for enrollment or changes to coverage under the State Health Benefit Plan, you must submit a completed Membership or Discontinuation Form to your employer's Benefits Coordinator within 31 days of a qualifying event

If you have questions regarding a change in any of your coverages, first call your employer's Benefits Coordinator. If you need further information about eligibility for health coverage, call the State Health Benefit Plan at 404-656-6322 or 1-800-610-1863. For questions regarding other coverages, call the Flexible Benefits Program at 404-656-2730 or 1-888968-0490.

What Happens If You Leave State Employment

(unless another time period is specified). Your request for enrollment or a change in any other coverage under the Flexible Benefits Program must be submitted on the Change in Status Event Form and given to your employer's Benefits Coordinator within 31 days of a qualifying event (unless another time period is specified).
Submission of a request for enrollment or a change, or the occurrence of a qualifying event, does not guarantee that you will be able to enroll or change coverage outside the enrollment period. Please see your Benefits Coordinator if you have questions about when you may enroll or make changes outside the enrollment period. For a list of possible change in status events that might permit you to enroll or change one or more coverages under the Flexible Benefits Program, please refer to the Terms and Conditions in the front of this booklet.
Any changes will go into effect the first of the month following the date when the payroll deduction is changed to reflect your new choice. However, when you change coverage based on the acquisition of dependents, the coverage effective date for the new coverage may be retroactive to the date of the acquisition of the dependent in some circumstances, or may be the first of the month following the request to change coverage.

If you leave State employment, you can continue some of your Flexible Benefits Program choices: You may be eligible to continue your medical,
dental, vision coverage and/or Health Care Spending Account for you and eligible family members after your last day of employment. A conversion or portability feature may apply to your employee life, spouse life, and child life insurance, long-term disability and/or AD&D coverage. You can be billed directly for legal coverage for the rest of the plan year and then convert coverage to an individual policy. You can continue long-term care. Unum will bill you directly. You can convert your Prepaid Dental option coverage to an individual policy and be billed directly by CIGNA Dental.
If you leave active State employment and then return during the same plan year, your previous choices will remain in effect unless you report a qualifying change in status event.
When you go on leave without pay, contact your personnel/payroll office, the State Health Benefit Plan, and the Flexible Benefits Program. If you do not continue paying premiums for coverage, your benefits will be cancelled. Be sure to review each Plan Description for each option and see your personnel/payroll office for more information.

Unit Two / 11

Taking Coverage With You When You Leave

Benefits

Retiree Coverage Available

Through Retirement Plan Coverage Can Be Continued

Benefit Deductions

Through COBRA

Coverage Can Be Direct Billed By Carrier Or Converted To An Individual Policy

State Health

Yes

Yes

Yes

Benefit Plan

Dental Coverage

Regular & PPO

Yes

Yes

No

Prepaid Option

Yes

Yes

Yes

Vision Coverage

No

Yes

No

Health Care

No

Yes

No

Spending Account

Dependent (Child)

No

No

No

Care Spending

Account

Employee/Spouse/

No

No

Yes

Child Life Insurance

AD&D Insurance

No

No

Yes

Disability Coverage

Short-Term,

No

No

No

Long-Term

No

No

Yes

You Must Decide And Complete Forms Within
60 days
COBRA -- 60 days Convert 31 Days --
Prepaid Option 60 days 60 days
--
31 days
31 days --
31 days

Legal Insurance

No

No

Yes

31 days

Long-Term Care

No

No

Yes

31 days

Insurance

12 / Unit Two

DENTAL INSURANCE
Making healthy decisions for a changing lifestyle

Under any of the dental options, single or family coverage is offered. Your cost depends on the option you choose and whether you select single or family coverage. You may have a choice of up to three dental options depending on where you live or work: Regular - For all employees. Preferred Provider Option - For employees who
live or work in the metropolitan Atlanta, Augusta, Columbus, Macon, and Savannah areas. Prepaid - For employees who live or work in the metropolitan Atlanta area.
If a PPO dentist or a Prepaid dentist is available in the area where you live or work, you may choose the applicable option. Under the PPO, you have the freedom to go to any dentist, but, there are benefits of using a PPO participating dentist. However, if your dentist leaves the Prepaid plan during the plan year, you must select another participating dentist. It is important that you consider your particular needs and be aware of the potential lack of convenience by choosing a dental option that does not have a dental provider in close proximity to where you live.
Contact your personnel/payroll representative if you need assistance in choosing the PPO or Prepaid option.
Consider the following: If you select the Dental PPO and choose to use a
non-PPO dentist, you should expect to pay more out of pocket. If you select the Dental Prepaid option you must visit a dentist within the CIGNA Dental Care network to receive benefits. You will not receive benefits if you visit a dentist outside the network.

Your Plan Choices
Regular Dental Option Benefits are determined using the 90th percentile
rates for procedures. You may use any dentist you choose. You may choose a dentist in the available PPO
network with benefits based on the maximum allowable charge (MAC). This may result in lower out of pocket costs. A non-network dentist is entitled to collect from you the difference between the amount of benefits payable by United Concordia and the dentist charge for that service.
Preferred Provider Option (PPO) Benefits are based on the MAC determined by
United Concordia and accepted by the PPO dentist. Enrollment in the PPO is with the PPO Program,
not with a particular dentist. PPO dentists can discontinue their arrangement with the Program at any time. If you require the services of a specialist, ask your dentist to refer you to a PPO specialist. If you use the services of a non-PPO dentist: The dentist is entitled to charge you the difference between the amount of benefits payable by United Concordia and the dentist's charge. This means you could pay more out-of-pocket expense for using a non-PPO dentist, because the payment will reflect the lower PPO scheduled fee.
Unit Three / 13

Prepaid Option The Prepaid option through CIGNA Dental Care is
an easy to use plan offering choice, quality, and savings with a focus on preventive care. Choose a general dentist from the CIGNA Dental network. Covered family members can each choose their own dentists, near home, work, or school. You will receive a Patient Charge Schedule listing all covered services and the corresponding patient charge for each service. For many services, there is no charge at all. Other plan features include: No deductibles to meet. No annual dollar maximums. No claim forms to file and no waiting periods for coverage. If you choose this option, you must select and use a CIGNA Dental Care Participating General Dentist to receive the benefits the option offers. Each family member you enroll may select a personal Participating General Dentist. If your dentist recommends specialty treatment, he/she will refer you to a participating CIGNA Dental Care Specialist. Whether seeing a general dentist or specialist, you will still only be responsible for the fees listed on your Patient Charge Schedule. To find a participating CIGNA Dental Care network dentist call 1-800-642-5810 or log onto www.cigna.com. If a procedure is not listed on your Patient Charge Schedule, it is not covered. A full explanation of plan exclusions and limitations is included in your Patient Charge Schedule.
Did You Know ... Your dental benefits are not taxed, and most dental expenses that are not paid by dental coverage - such as deductibles and co-payments - can be submitted to your health care spending account, providing a tax savings of 26% - 45% on these expenses.

Late Entrant Provisions for Regular and PPO Late Entrant Limitations result in delayed benefits. This means you won't receive some benefits until you have participated in the dental plan for a specified period of time.
Late Entrant Limitations will apply to: current employees who are enrolling in either the
Regular or PPO Options for the first time; or employees who fail to pay premiums when they
are on an unpaid leave. current employees who choose not to continue
coverage and re-enroll at a later date.
Late Entrant Limitations will not apply: if you enroll in the Prepaid Option as a new or
current employee when you transfer between the dental options (if
not currently under Late Entrant); if you enroll in the PPO or Regular Option plan
when you are first eligible as a new employee; or to employees who fail to pay premiums when they
are on unpaid Family Medical Leave or Military Leave (if not currently under Late Entrant)
New employees are not subject to the Late Entrant Limitations - as long as they enroll when first eligible. If you are a new employee and are interested in the Regular or PPO Options, sign up now to avoid these limitations in the future. Under the Regular and PPO Options, new employees have a six-month waiting period for Major and Orthodontic (dependents under age 19) services.
Certain Restrictions, along with age and frequency limitations, apply to all dental options. For more information on the Regular and PPO Options, call United Concordia toll free at 1-866-215-2356. For more information on the Prepaid option, call CIGNA at 1-800-642-5810.

14 / Unit Three

Dental Options Comparison Chart

REGULAR

TYPE I PREVENTIVE

100% of the 90th percentile***

PPO 100% MAC**

TYPE II BASIC

80% of the 90th percentile***

90% MAC**

TYPE III MAJOR

50% of the 90th percentile***

50% MAC**

ORTHODONTIA

50% of the 90th percentile*** for dependents under 19

50% MAC** for dependents under 19

ANNUAL DEDUCTIBLE
MAXIMUM BENEFITS
WAITING PERIOD FOR BENEFITS LATE ENTRANT LIMITATIONS FOR BENEFITS

$50 per person; $150 for family (applies to Type II and Type III Major services only) each plan year
$1,000 per person each plan year; $1,500 lifetime benefit for Orthodontia
New employees or newly enrolled dependents after six months of continuous coverage for Type III Major services and Orthodontia
Current employees enrolling for coverage for the first time after 12 months continuous coverage for Type II Basic services; after 24 months continuous coverage for Type III Major services and Orthodontia

PREPAID
100% Reduced, fixed, preset charges for all covered services. See your patient Charge Schedule for Specific Charges
100% Reduced, fixed, preset charges for all covered services. See your patient Charge Schedule for Specific Charges
60%* Reduced, fixed, preset charges for all covered services. See your patient Charge Schedule for Specific Charges
50% for employee (and eligible dependents*) Reduced, fixed, preset charges for all covered services. See your patient Charge Schedule for Specific Charges
NONE
NO MAXIMUM
NO WAITING PERIOD
NO LIMITATION

* Your share of the cost for these services will actually be a flat dollar co-payment. See Schedule of Benefits for details.

TYPE I PREVENTIVE
Oral exams Prophylaxis Space maintainers for
dependents under 14 X-rays

TYPE II BASIC
Filings Root canals Extractions Scaling and root planing Repairs to dentures,
bridges, and crowns Sealants, children
under 16

TYPE III MAJOR
Crowns Dentures Bridgework Surgical periodontal

ORTHODONTIA
Cephalometric x-rays Treatment study Bands, appliances

**United Concordia reimburses all fee-for-service and PPO dentist according to the maximum allowable charge (MAC) schedules. The MAC is determined using charge data submitted to United Concordia from more than 100,000 participating providers. United Concordia policies & procedures and exclusions limitations apply. This chart is a representative listing of services covered under the program.
***You may use a PPO provider even if you enrolled in the Regular Dental Option. This may result in lower out-of-pocket costs.

Unit Three / 15

Some Important Information About the Prepaid Option
Once enrolled, you will receive a complete Patient Charge Schedule listing all covered services and associated fees along with your CIGNA Dental Care ID Card. Procedures not listed on the Patient Charge Schedule are not covered.
You do not need your ID card to receive care. CIGNA Dental will send each dentist a monthly listing of all members who have enrolled with their office. You may request a Patient Charge Schedule by calling CIGNA Dental Member Services at 1-800-642-5810 or online at www.cigna.com, then go to mycigna.com. This Patient Charge Schedule will provide a complete list of covered benefits and co-payments.
If you choose the Prepaid Option, you must select and use a CIGNA Dental Care Participating Dentist. Otherwise, you will not be eligible for benefits.
Each enrolled family member may select a different Participating General Dentist.
To select a CIGNA Dental Care dentist for the first time, fill out and send in the Dentist Selection Form included in your enrollment materials. If you enroll in the CIGNA Dental Care plan but do not choose a dentist, one will be chosen for you based on your zip code. You have the option to change network dentists as often as you like by calling 1-800-642-5810, or by logging onto www.cigna.com. Your change will be effective the first day of the following month.
Some Important Features Of The Regular and PPO Dental Options There are some features to keep in mind when you use the dental options, Regular or PPO. The options of the State Health Benefit Plan (PPO,
Indemnity, and HMO) provide limited, if any, coverage for dental treatment. See your SPD, UPDATERs and Health Plan Decision Guide for more information. For more detailed HMO information, contact the HMO directly. The PPO dentists have agreed to provide quality services at reduced rates. This means you save money if you use a PPO dentist. If you enroll in the dental PPO, receiving dental care from a nonPPO dentist can result in an increased out-of-
16 / Unit Three

pocket expense for you, as shown in the example on the following page. United Concordia uses the American Dental Association (ADA) procedure codes in effect at the time a claim is handled to determine benefits.
Pre-Determination of Benefits Under the Regular and PPO Dental Options, for any service of more than $300, it is recommended it be reviewed by United Concordia before receiving treatment. This is called a "pre-determination of benefits." You can call United Concordia toll free at 1-866-215-2356 with any claim questions you may have.
Some Exclusions For Regular and PPO Dental Options Items and services that are not covered by the Regular and PPO Options are set forth in the Summary Plan Description for those options. Some examples include: charges for oral hygiene, plaque control programs,
and dietary instruction; the initial placement of full or partial dentures or
bridges, if the prosthesis includes teeth that were missing before you were covered by the dental option.
Example of Regular and PPO Benefit Payments The chart on the next page shows the differences in benefits paid by the Regular and PPO Options for the same expense. In addition, it illustrates the advantages of using PPO dentists, if you choose the PPO option. For the same $500 charge, this employee would pay: $100 if covered under the Regular Option; $35 if covered under the PPO Option and using a
PPO dentist; $185 if covered under the PPO Option but using a
non-PPO dentist.

Dental Options Comparison Chart
Regular Dental
Non Network Dentist

Dentist's Normal Charge Discount PPO Fee For PPO Dentist Covered Expense Plan Pays Basic Expense/Type II Maximum Amount the Dentist Can Bill You Your Out-of-Pocket Expense

$500 Does Not Apply
$500 x 80% $400 $500
$100

PPO Dentist $500 $350

PPO Option Non-PPO Dentist $500 Does Not Apply

$350 x 90% $315 $350

$350 x 90% $315 $500

$35

$185

Unit Three / 17

VISION
Making healthy decisions for a changing lifestyle

The Vision Plan, provided through Spectera, features: covered exams and materials; statewide access to a network of panel
providers; no claims to file for "in-network" benefits; and benefits for "out-of-network" providers.

If you have any questions about your vision care plan option, please contact Spectera's customer service at 1-800-638-3120.
Important to Remember

Spectera's participating provider network includes private practice optometrists, ophthalmologists and retail chains (currently most of the Wal-Mart stores in Georgia). When you make an appointment with a network provider, ensure that they still are participating in Spectera's network. Then identify yourself as eligible through the State of Georgia Flexible Benefits Program Spectera Vision Plan and provide your (employee's) social security number along with the patient's date of birth.
If you receive covered services from a network eye care provider, you will receive the benefits shown in the chart on page 20. You will not be required to file a claim, but will be responsible at the time of service for any co-payments and the cost of any non-covered service or equipment.

Certain standard contact lenses, including daily wear, and up to 4 boxes of standard single vision disposable contacts are covered in full for your co-payments. If you purchase contacts that are not among Spectera's "covered in full" selection, you will receive an annual $100 allowance toward the purchase of contact lenses, and professional fees (i.e., fit and follow-up). Please note: To receive the full $100 allowance, you must receive your exam, fitting and evaluation at a single visit to the same network provider (at Wal-Mart, $65 of the $100 allowance is allocated to materials and $35 to professional fees). The allowance will only apply to one purchase per plan year. You must submit all receipts at the same time. Any balance remaining and not used during the plan year when the purchase occurred will be forfeited.

If you receive care from an out-of-network provider, you pay the cost at the time of service and submit a receipt to Spectera to be reimbursed for covered outof-network benefits. Receipts must be submitted together for services and materials purchased on different dates to receive reimbursement. Mail your itemized receipts, with your Social Security number and patient's date of birth to:
Spectera Attention: Claims 2811 Lord Baltimore Drive Baltimore, MD 21244-2644
18 / Unit Four

Spectera covers standard single vision and standard lined multi focal lenses for glasses. Cosmetic lens options such as scratch coating, UV coating, progressive lenses, etc., are not covered, but are provided to Spectera's members at a savings below normal retail charges.
Always verify coverage by identifying yourself as a Spectera member under the State of Georgia plan when making your appointment. Give the provider the employee's social security number and the patient's date of birth. In- or out-of-network benefits

are available every 12 or 24 months (depending on the benefit) measured from the last date of service.
Medically Necessary
A member qualifies for medically necessary contact lenses if Spectera establishes that an eligible member has any of the following: Keratoconus or irregular astigmatism; Anisometropia of 3.50 diopters or more; Post cataract surgery without intraocular lens; or Visual acuity in the better eye of less than 20/70
with spectacles, but better than 20/70 with contacts.

Exclusions
The Vision Plan does not cover: replacement of lost lenses or frames medical or surgical treatment of eye conditions amounts above the schedule of benefits or
allowances services or materials not included as eligible
expenses by the Vision Plan cosmetic extras such as no line multifocal lenses,
tints, UV coatings etc.

Unit Four / 19

Vision Coverage Chart

Service

In-Network Benefits

Out-of-Network Benefits

Routine Eye Exam Every 12 months

Covered after $10 co-pay

Reimburses up to $40

Lenses Standard Every 12 months, if prescribed

Covered after $20 materials co-pay*

Single vision, or

Reimburses up to $30

Lined Bifocal, or

Reimburses up to $45

Lined Trifocal, or

Reimburses up to $60

Lenticular

Reimburses up to $80

Frames Every 24 months after a $20 materials co-pay*

Retail locations (Wal-Mart) Up to $120 retail allowance toward any
frame package Frames below $120 provided at
no additional cost Private Doctor Office $50 wholesale allowance towards any
frame. You pay the difference. Group of select frames at
no additional cost

Reimburses up to $45 of retail

Contact Lenses Every 12 months in place of eyeglasses

Medically Necessary**

Covered after $20 materials co-pay*

Reimburses up to $200

Not Medically Necessary**

Covered after $20 material co-pay* for covered lenses selected from Spectera list. Effective 07-01-02 certain standard disposable contact lenses were added to Spectera's covered list (Previously disposables were available only through the allowance). Now, up to four boxes of covered disposable contact lenses are included when using a network provider. All other contacts available through a $100 allowance that includes fitting, follow-up and materials. Please note to receive the full $100 credit, you must receive your exam, fitting evaluation and all contact materials at the same provider at the same time. (At Wal-Mart $65 of the$100 allowance is allocated to materials and $35 to professional fees).

Up to $100 max that includes fit, follow-up & materials

Refractive Eye Surgery The Laser Center (TLC) 5505 Peachtree-Dunwoody Road, Suite 260 Atlanta, GA 30342

Discount only: The in-network benefit is a discount off the full retail price. Your out-of-pocket cost is not to exceed $1,800 per eye for Lasik and $1,500 per eye for PRK.

No benefits

Remember: If you use in-network providers, you are responsible only for your portion of cost. If you decide to use a non-network provider, you pay everything and seek the out-of-network benefits payments schedule.
* Only a one time $20 material co-pay applies per benefit period. **As defined herein (on page 19)

20 / Unit Four

SPENDING ACCOUNTS
Making healthy decisions for a changing lifestyle

NEW! The IRS issued a Revenue Ruling stating that certain over-the-counter ("OTC") items are eligible for reimbursement through Health Care Flexible Spending Accounts.
In order to be eligible, OTC purchases must be for medical reasons. Some example items include antacids, allergy medications, pain relievers and cold medicines, none of which require physician's prescription. Items such as vitamins and nutritional supplements for general well-being are not eligible.
When submitting your claims for OTC expenses, you must provide an itemized receipt including the date of service, the name of the over the counter item(s), and the name and address of the provider to be considered for reimbursement.
ABOUT SPENDING ACCOUNTS
Spending Accounts are available for two types of expenses under which you may choose:
up to $5,040 a year in a Health Care Spending Account
up to $4,992 a year per family in a Dependent (Child) Care Spending Account.
Spending accounts are like getting a tax rebate every time you pay for health care and child or other dependent care expenses, since your pay goes into the accounts before taxes are withheld. This can mean savings of approximately 26%-45%, depending on your tax situation! You can determine your potential annual tax savings at http:www.myshps.net/fsa_calculator.asp.

Go on-line with MySHPS at www.shps.net to print claim forms, direct deposit forms, and check your account status. By providing your email address, you may also receive routine correspondence via e-mail from SHPS about your account, confirmation of your faxed claim, and notification once your claim is processed. The claim fax number is (502) 267-3112.
Call SHPS AccountLink toll-free at 1-800-8930763. Use this automated phone system to find out your current account balance(s) and the status of your last claim. You may talk with a SHPS customer service counselor by staying on the line or pressing the (*) key.
AccountLink is available 8 a.m. - 2 a.m. Eastern time, Monday - Saturday. Benefit Counselors are available 8 a.m. - 8 p.m. Eastern time, Monday - Friday.
Health Care Spending Account
The Health Care Spending Account helps you save tax dollars on the health-related treatment you and your family receive.
The IRS rules and the rules of the Employee Benefit Plan Council designate eligible expenses for the Health Care Spending Account. The Employee Benefit Plan Council has the responsibility to interpret these rules and make all decisions as to an expense's eligibility. Some of these eligible expenses include: Deductibles and co-payments not paid by any
health or dental insurance in which you or your family members participate;
Unit Five / 21

Costs for procedures not covered or not covered fully by a health, dental or vision plan; and
Certain other IRS approved expenses.
Exclusions List
These are a few examples of health care expenses that are not eligible for reimbursement under the Health Care Spending Account: Cosmetic procedures/drugs Electrolysis Hair transplants Herbal supplements Insurance premiums Nicotine patches and gum Nutritional supplements Postage/handling fees Teeth whitening/bonding Vitamins

THE HEALTH CARE SPENDING ACCOUNT WORKS VERY MUCH LIKE INSURANCE. Your "elected coverage" is your monthly contribution times the number of months you are expected to contribute. You can submit claims and receive reimbursement from your account up to the total amount of your "elected coverage" for the plan year.
For further information on potentially eligible expenses, see IRS Publication 502, available at your personnel/payroll office, your local public library or IRS office, or online at www.irs.gov/prod/forms_pubs/pubs/pubs.html. Most, but not all, of these expenses are reimbursable under the Health Care Spending Account.

Health Care Spending Account Worksheet
You can use this worksheet or the one online at www.shps.net for help in determining how much pre-tax salary to deposit into a Health Care Spending Account. After using this worksheet and determining how much to deposit, complete your 20042005 Option Statement (or web enrollment) indicating your decision.

Annual Contribution Limits: Maximum: $5,040 Minimum: $120

WRITE in your:

medical plan deductible:

$

average annual out-of-pocket medical expenses (coinsurance or co-payments):

$

dental plan deductible:

$

average annual out-of-pocket dental expenses (coinsurance or co-payments):

$

annual expenses for routine medical, dental* or vision exams not covered by the plans:

$

out-of-pocket expenses for eyeglasses and contact lenses not covered by insurance:

$

annual orthodontia expenses:

$

other eligible annual expenses:

$

ADD the amounts from the lines above and enter the total; if the total amount is greater

than the annual maximum, enter the annual maximum:

$

DIVIDE by twelve months:

12

This is the amount you should have deposited each month into your Health Care

Spending Account.

$

*Coverage for specific Periodontal Disease Osseous surgeries are no longer covered by the State Health Benefit Plan. If you are considering periodontal surgery during the 20042005 plan year, be sure to speak with your health and dental representatives before deciding on the amount you set aside in your Health Care Spending Account.

22 / Unit Five









Dependent (Child) Care Spending Account
The Dependent (Child) Care Spending Account provides you with the opportunity to use tax-free dollars to pay for the care of your children under age 13 or other IRS/eligible dependents while you and your spouse work or go to school full time.
The IRS rules and rules of the Employee Benefit Plan Council designate eligible expenses for the Dependent Care Spending Account. The Employee Benefit Plan Council has the responsibility to interpret these rules and make all decisions as to an expense's eligibility.
Childcare services may include your cost to send a child to preschool, after school, or nursery school. Also, expenses for dependents of any age who are unable to care for themselves because of a physical or mental handicap are eligible. A person qualifying for this type of care must spend at least eight hours a day in your home. Elderly dependent care may include your cost to send a dependent parent to an elderly daycare facility or to have someone to care for them in your home.
How It Works
How the Dependent (Child) Care Spending Account works.
You put money into your account. Maximum: $416/month or $208 if married ling separately.
Minimum: $10/month
You receive dependent care services.
You either have your care provider sign a claim form or get a signed itemized receipt. With either the claim form or receipt, be
sure to include the provider's name and complete address.
Submit the spending account claim form along with your itemized receipt.
You get reimbursement from your account up to your current account balance, either by direct deposit to your bank account or by check. Approved expenses that are more than your current account balance are reimbursed as contributions are added to
your account.
You may fax your claims to (502) 2673112 or e-mail your scanned claim and documentation to feedback@shps.net.

If you are married, both you and your spouse must be working or a full-time student during the time the care is received. Your income tax return (long and short forms) will require you to include your dependent care provider's name and tax number or Social Security number.
Exclusions List These are a few examples of dependent care expenses that are not eligible for reimbursement: Activity and book fees Child support payments Cleaning and cooking services not provided by the
care provider Custodial nursing care Field trips Food, clothing, and entertainment Late payment fees Kindergarten Long Term Care premiums Overnight camps Placement fees for finding a dependent care
provider Sports lessons Transportation to and from the child care provider Tuition to private school
NOTE: The Economic Growth and Tax Relief Reconciliation Act (EGTRRA) of 2001 increased the amount of the employment-related expenses that may be taken into account for a taxable year to $3,000 for one qualifying individual and $6,000 for two or more qualifying individuals.
This increase applies to the Dependent Care Tax Credit only and not the Dependent (Child) Care Spending Account. For example, an employee who is a single parent filing as head of household with one child and $3,000 of dependent care expenses may have better tax savings using the dependent care tax credit instead of participating in the Dependent Care Spending Account. If there are two or more children with $6,000 in dependent care expenses, the employee could utilize both the dependent care tax credit and spending account by electing $4,992 through the spending account and claiming $1,008 through the tax credit. However, the rules for coordinating the dependent care tax credit and
Unit Five / 23

Dependent (Child) Care Spending Account Worksheet
You can use this worksheet or the one online at www.shps.net for help in determining how much pre-tax salary to deposit into a Dependent (Child) Care Account. After using this worksheet and determining how much to deposit, complete your 20042005 Option Statement (or web enrollment) indicating your decision.

Annual Contribution Limits: Maximum: $4,992 Minimum: $120

WRITE in your:

amount of day care expenses you normally pay each week:

$

other weekly eligible expenses you normally incur:

$

ADD the amounts from the lines above and enter the total:

$

MULTIPLY the number of weeks you will incur expenses for the plan year. If the total amount

is greater than the annual maximum, use the plan maximum:

$

DIVIDE by twelve months:

12

This is the amount you should have deposited each month into your Dependent (Child)

Care Spending Account.

$

spending account do not permit the reverse. Assume an employee is a single parent and has $5,000 in dependent care expenses. The employee could not use the $3,000 dependent care tax credit and put $2,000 in the spending account. This would cause the spending account benefit to reduce the expenses eligible for the dependent care tax credit from $3,000 to $1,000 because taking the exclusion under the spending account phases out the dependent care tax credit.
You should carefully review your option of using the dependent care tax credit or using the Dependent Care Spending Account. Everyone's situation is unique - it is very important that you consult a qualified tax advisor for assistance in determining if the dependent care tax credit, spending account, or a combination of the two is best for your situation.
Dependent (Child) Care Spending Account Limits
You may not be able to deposit the full $4,992 if any of the following situations apply to you. If your spouse works for the State or another
employer who offers a similar plan, the total of your family's contributions to a dependent (child) care spending account cannot exceed $4,992. If either you or your spouse earns less than $5,000

a year, you can deposit as much as the smaller of your two incomes. If your spouse is either a full-time student or incapable of self-care, you may deposit up to $3,000 a year for one dependent, or $4,992 a year for two or more dependents. If you are married but file a separate federal income tax return, you may deposit a maximum of $2,500 to your dependent (child) care spending account. If you are hired after July 1 or have a qualified change in status during the plan year (see Terms and Conditions in front of this booklet), you may contribute up to $416 per month for the remainder of the plan year.
Important Information About Health Care and Dependent (Child) Care Spending Accounts
There are some important things to keep in mind when deciding how much money to put into your spending accounts. Spending account reductions from your paycheck
begin June 15 for coverage effective July 1. If you are hired mid-year or have a qualified
change of status during the year (see Terms and Conditions in front of the enrollment booklet), you may not contribute the maximum allowed

24 / Unit Five

under each account for the remainder of the plan year. You may only contribute the maximum per month allowed to each account. Reductions for spending accounts are made every pay period. Your spending account enrollment is binding for the plan year. You may be able to make limited changes if you have a qualified status change. You cannot carry over expenses that you have incurred in one plan year into the next plan year for reimbursement. You may submit claims at any time for any amount, but payment will not be made until your claims total $25 or more. Reimbursement may be by check or by direct deposit to your bank account. You receive a quarterly statement showing how much money you have in each account. You cannot transfer money from one account to another. SHPS routinely issues reimbursements on a daily basis from their Louisville, Kentucky location. Spending account claims for the 2004-2005 Plan Year must be mailed with correct documentation and postmarked on or before September 30, 2005. Claims postmarked after September 30 will not be paid. Under IRS rules, any money left in your accounts on June 30, 2005 at the end of the plan year and not claimed for the previous plan year's expenses by the claim filing deadline is forfeited. It is retained by the plan and used for administrative expenses.

Although there is a possibility of forfeiting money, consider your tax savings. For example, an employee with an annual salary of $22,000 and spending account contributions of $2,000 could potentially save $580. If this same employee forfeits $55, he still saved $525.
If You Leave or Retire
If you terminate or retire from State employment during the plan year, your Health Care Spending Account coverage stops with the end of the month following the last full month of employment or contribution. For example, if you terminate employment on December 31, your last contribution to your Health Care Spending Account would be taken from your December 31 paycheck. Your coverage would end January 31, because contributions deducted from your paycheck in one month provide coverage for the following month. If you submit a claim for expenses incurred on or after February 1, your claim would not be paid.
If you have contributed more to the Health Care Spending Account than you have been reimbursed for on the date you leave or retire, your coverage may be extended temporarily under COBRA. Call the Flexible Benefits Program at 404-656-2730 or 1-888-968-0490 for more information.

A Word About Forfeitures
By putting money into your spending accounts, you can save approximately 26%-45% in taxes for eligible expenses. Many employees say they don't use the spending accounts because they are afraid of forfeiting money, although few employees actually do. In 2002-2003, only 23% of those participating forfeited money in the spending accounts. The average amount of forfeitures per participant was $55.

Unit Five / 25

Employee, Spouse, Child Life Insurance

Making healthy decisions for a changing lifestyle

If you want life insurance protection or you want to supplement the protection you already have, you may choose group term life coverage under the Flexible Benefits Program. You may choose coverage equal to: one times your pay (maximum coverage is
$250,000) two times your pay three times your pay four times your pay five times your pay
The coverage maximum is $500,000.
The life insurance amount you choose will be based on your Benefit Salary as of April 1, 2004, or your date of hire, whichever is later. This amount is rounded up to the next higher $1,000. If you are already enrolled for life insurance, the amounts of your coverage and premium have been adjusted for your April 1, 2004 pay and age. If you are age 65 or older, the value of your life coverage is reduced. Your premium cost for life insurance is based on your age, salary, and on the amount of coverage you choose. You may pay your premiums with pre-tax or after-tax dollars if you choose coverage over $50,000. If you have over $50,000 of life insurance coverage, it's worth knowing that: the extra "value" of your coverage will be shown as
"imputed income" on your W2 statement, and you will also pay FICA taxes as well on "imputed income." the extra taxes you may owe will be minimal... and the tax savings using pre-tax premiums will be greater than any "imputed income" tax withheld, unless you earn over $100,000 and are over age 65.

In any case, if you elect over $50,000 of coverage you have the option to pay for life insurance with after-tax premiums and avoid imputed income. If you wish to elect after-tax premiums, indicate your choice on your Option Statement.
How Employee Life Insurance Works The life insurance amount you choose is paid to your beneficiaries if you die while this coverage is in effect. Your beneficiaries are the persons you name to receive your life insurance benefits.
If you are choosing life insurance for the first time, name your beneficiaries by completing the Flexible Benefits Program Beneficiary Election Form, and file it with your personnel office. You can change your beneficiaries anytime by completing a new form.
Whenever you enroll or change your life insurance coverage, be sure to check the Life Medical Underwriting process so you will know what will be expected. These processes are described on pages 7 and 8.

26 / Unit Six

Spouse Life Insurance If you choose employee life insurance for yourself, you may also choose spouse life insurance coverage for your spouse. Your spouse is eligible for coverage if you are not legally separated or divorced. Spouse life insurance premiums are based on the coverage level and employee age. These premiums are aftertax. Employees may choose $6,000, $12,000, $30,000, $60,000 or $100,000 spouse coverage levels. However, if you are age 65 or older, the value of your spouse life coverage is reduced.
Depending on his/her coverage amount of Employee Life, an employee may not be eligible for some levels of Spouse Life. Spouse Life coverage cannot exceed 100% of the Employee Life coverage.
Child Life Insurance If you choose life insurance for yourself, you may also choose child life insurance coverage for your child(ren). Child life insurance premiums are aftertax.
Your children are eligible for coverage if they are: Unmarried, dependent on you for support and under
age 19. Unmarried and a full-time student under age 26. For the $3,000, $6,000, $10,000, $15,000 or
$20,000 child coverage levels, the child coverage can begin at live birth. Coverage from live birth to 6 months is the lesser of the elected amount or $6,000.

You are the beneficiary of child life insurance coverage and will receive the insurance benefit in the event of the child's death.
Available Coverage Amounts Spouse Life - $6,000 - $12,000 - $30,000
- $60,000 - $100,000
Child Life - $3,000 - $6,000 - $10,000 - $15,000 - $20,000
For more information about how the Employee Life, Spouse Life, and Child Life plans work, call 404656-2730 if local, or toll-free at 1-888-968-0490.
For information regarding conversion and portability of your Employee Life, Spouse Life, and Child Life insurance, contact Unum Life Insurance toll-free at 1-888-764-3539.
Enrolling For Coverage If your coverage selection requires medical underwriting you will need to complete the Unum Evidence of Insurability Form along with any other required information. An approval by Unum, the insurance carrier, must be made before coverage can be in effect.
If you are a newly eligible employee, you may elect up to $30,000 spouse life coverage and/or any coverage of child life without completing the medical underwriting process.

Depending on his/her coverage amount of Employee Life, an employee may not be eligible for some levels of Child Life. Child Life coverage cannot exceed 100% of the Employee Life coverage. Physically and/or mentally handicapped children covered under Child Life may continue to be covered beyond the age of 19 upon approval by Unum. A request must be filed with Unum within 60 days following the child's 19th birthday. For details, call Unum toll-free at 1-888-SOG-FLEX or 1-888-7643539 and ask for a National Accounts Representative.

If you have any questions, call the Flexible Benefits Program at 404-656-2730 or toll free at 1-888-9680490.

Unit Six / 27

Accidental Death and Dismemberment Insurance

Making healthy decisions for a changing lifestyle

The Flexible Benefits Program lets you decide if you want accidental death and dismemberment (AD&D) insurance. You may choose coverage equal to: one times your pay two times your pay three times your pay four times your pay five times your pay.
The coverage maximum is $500,000.
The terms of the AD&D plan are set forth in the Summary Plan Description for that option. In general for the AD&D insurance to be paid to you or your beneficiary, your death or injury must be the result of a covered accident. In case of permanent and total disability, you are eligible for AD&D benefits if your injury prevents you from working at any job for which you are qualified by education, training, or experience.
Enrolling For Coverage Your cost depends on how much AD&D insurance you choose. As with life insurance, your coverage will be based on your Benefit Salary as of April 1, 2004 or your date of hire, whichever is later. This amount is rounded to the next higher $1,000. If you are age 75 or older, the value of your coverage is reduced.

An Example
If You

AD&D Would Pay*

Die

100% of your coverage

Become permanently and totally disabled

100% of your coverage

Lose two or more limbs

100% of your coverage

Lose your hearing and speech

100% of your coverage

Lose one limb, hearing, or speech 50% of your coverage

Lose thumb and index finger from the same hand

25% of your coverage

*Paid in monthly installments over the period of your disability. A "limb" is a hand, foot, or sight in one eye.

The beneficiaries you name for life insurance are also your beneficiaries for AD&D insurance. If you are not enrolled in life insurance, be sure that you complete the Flexible Benefits Beneficiary Election Form to name your beneficiaries. You can change your beneficiaries anytime by completing a new form. Be sure to return the completed form to your personnel office.

28 / Unit Seven

Disability Insurance

Making healthy decisions for a changing lifestyle

To help provide income protection against the unexpected, the Flexible Benefits Program allows you to choose: short-term disability insurance and/or long-term disability insurance.
Short-Term Disability Protection
If you choose short-term disability (STD) coverage, this plan will work with other income benefits to replace 60% of your Benefit Salary as shown on your Option Statement, (in effect during the Plan Year the disability began) up to $800 per week. Other benefits include Social Security, workers' compensation, any other governmental disability programs, any other group disability plans including the State retirement systems, or special injury benefits you are eligible to receive. If these other benefits total more than 60% of your Benefit Salary, the short-term disability plan will not pay for this disability. See your Summary Plan Description for specific information on coordination of benefits.
How STD Works
The terms of the STD plan are set forth in the Summary Plan Description for the disability options. In general: If your claim is approved by the insurance
company, you are eligible to receive short-term disability benefits after you have been disabled for 30 continuous calendar days or 7 continuous calendar days depending on the coverage level you have chosen. A late enrollment penalty may apply for late entrants to the STD plan. You may choose whether to use sick leave or receive these benefits. You cannot receive these

benefits and sick leave at the same time. You may, however, decide to receive these benefits and save your sick leave for future use. Your short-term disability benefits are calculated on the Benefit Salary that is in effect during the Plan Year your disability began, less other income benefits. For example, if your first day of disability is June 3, 2004, your disability benefit will be calculated on the Benefit Salary reflected on your 2003-2004 Option Statement, not your 2004-2005 Benefit Salary. Your short-term disability benefits can continue until you recover, return to work, or receive benefits for a maximum of 150 calendar days or a maximum of 173 calendar days, depending on the coverage level you have chosen. The calendar-day maximums are reduced by any days of paid sick leave, donated leave or Special Injury Leave that you use which exceeds the applicable wait period.
What Is A Late Enrollment Penalty For Late Entrants?
A current employee choosing coverage for the first time or re-enrolling after discontinuing coverage is considered a late entrant. If your STD Disability is caused by an accidental injury, benefits will begin after you have been disabled for 30 continuous calendar days or 7 continuous calendar days depending on the coverage level you have chosen after the benefit waiting period is satisfied for STD. However, for STD late entrants, who become disabled due to Physical Disease, Pregnancy, or Mental Disorder, during the 12-month period after the date your STD insurance becomes effective, benefits will not begin until after you have been
Unit Eight / 29

disabled for 60 days. For STD late entrants whose disabilities begin after this 12 month period, benefits will start after the benefit waiting period (7 or 30 continuous calendar days) is satisfied for STD.
Refer to the Disability Summary Plan Description for details. If you have any questions about eligibility or how the short-term and long-term disability insurance plans work, call 1-888-641-7186.
Enrolling For Short-Term Disability Coverage... Your premiums will be based on your coverage level and Benefit Salary. You pay for this coverage with after-tax premiums. You won't pay taxes on the benefits you receive.
Long-Term Disability Protection
The terms of the LTD plan are set forth in the Summary Plan Description for the disability options. The Flexible Benefits Program's long-term disability (LTD) coverage works with other benefits you are eligible to receive, including Social Security, workers' compensation, other governmental disability programs, any other group disability plans including the State retirement systems, or any special injury benefits you are eligible to receive. The plan assures that your combined disability benefits from all these sources will equal 60% of your pay as shown on your Option Statement, up to $4,000 a month. The plan will pay at least $100 a month, even if your disability benefits from all other sources total more than 60% of your Benefit Salary, up to $4,000 a month, unless you are in an overpayment situation.
How Long LTD Benefits May Be Payable
These benefits will begin after you have been disabled for 180 calendar days and are reduced by any sick leave you use. Long-term disability benefits end when you are no longer disabled or reach age 65, except benefits for disabilities caused by mental disorders, or other limited conditions (excluding schizophrenia, bi-polar or organic brain disease), which are limited to two years. If you become disabled after reaching age 60, however, your benefits could continue for a limited period after age

65. For the first two years of your disability, you are disabled if you cannot perform your occupation, and earn less than 80% of your monthly Benefit Salary from your employer. After that, you are disabled if you are unable to perform, with reasonable continuity, the material duties of any occupation and cannot earn more than 60% of your monthly Benefit Salary from any employer.
Enrolling For Long-Term Disability Coverage
Your cost for long-term disability coverage is based on your age, your FICA Status, Benefit Salary, and whether or not you are eligible for disability coverage through any State of Georgia retirement plan, and/or through Social Security. Long-term disability premiums are paid with pre-
tax dollars. The Internal Revenue Service (IRS) considers these premiums to be taxable income. If you become disabled and receive long-term disability benefits, you will be responsible for paying taxes on your benefits from this plan. However, since your income from disability benefits would be lower than your salary, you would owe less in taxes. If you are selecting LTD insurance for the first time, see page 9 for the medical underwriting process.
Eligibility For An Early Disability Retirement At total and permanent disability, some employees are eligible for early retirement through a State retirement system, as long as the disability is considered permanent. For the Employees' Retirement System, you may call 404-352-6400 for more information. For the Teachers' Retirement System, you may call 404-352-6500 or toll free at 1-800-352-0650.

30 / Unit Eight

Long-Term Care Insurance (LTC)

Making healthy decisions for a changing lifestyle

Long-term care refers to a wide range of personal care, health and social services for people of all ages who suffer a chronic disease or long-lasting disability. These services can be provided in a nursing facility, an adult day care center or at home, and can involve some nursing care. The cost for this kind of care is very high. Home care can be as much as $20,000 per year, and nursing home care can range in cost from $20,000 to $60,000 annually. Generally, you pay these expenses out of your own pocket, because medical insurance and Medicare do not cover long-term care. Typically, Medicaid is only available to members after they have significantly depleted their assets and income. Long-term care insurance is designed to protect you financially by paying benefits if you need long-term care. It also helps you maintain greater independence and a higher quality of life.
DID YOU KNOW... Nearly half of all Americans over age 65 require
long-term care for some period of time? Medical insurance and Medicare generally do not
cover long-term care? Medicaid covers some types of long-term care, but
restricts your choices of where this care can be provided? Many Americans will spend their life savings on less than one year of care?
Your Long-Term Care Options You can choose from one of three daily benefit levels and the corresponding monthly premium that is right for your needs and budget. The amount of the benefit depends on two factors: where the long-term care is

provided - either in a nursing facility, or home/day/ assisted living facility - and the daily dollar level of the coverage you have selected. With any of these daily benefit options, benefits are paid on a monthly basis. As the chart shows, the monthly benefit is equal to 100% of your elected daily benefit amount for care provided in a state-licensed nursing home facility, and 60% of your elected daily benefit amount for care provided in an assisted living facility or at home. If you wish, you can add on a reduced paid-up option and/or an inflation protection option.
Who Can Be Covered This plan is offered to you, your spouse, your parents or your parents-in-law. "Parents" are biological (natural), adoptive, or step-parents of eligible employees or spouses. Your spouse, parents and parents-in-law will have to complete a medical underwriting process and be approved to be accepted for long-term care coverage. Your family members' premiums will be billed directly by the insurance company. Your payroll deduction will be for your individual coverage only.
When Benefits Are Paid Benefits begin after a 90-day waiting period in which you or a covered family member has an eligible physical or cognitive disability. You qualify for benefits if the disability creates a need for you to receive continual help from another person to carry out any three of the following six activities of daily living: eating dressing
Unit Nine / 31

bathing using the toilet transferring from a bed to a chair continence
Benefits from long-term care insurance are not taxed when you receive them.
About Your Premiums and Enrolling You pay for your long-term care coverage through the convenience of payroll deduction with after-tax dollars. Your monthly premiums for coverage appear on your Option Statement. Premium costs are based on your age as of the Benefit Calculation Date or date of hire, whichever is later. Your family members' premiums are based on their age as of the date they apply for coverage. Their premiums will be sent directly to Unum, not deducted from payroll. If you are a current employee and selecting long-term care insurance for the first time, or are currently enrolled and want to increase your benefit level or add

options, or are re-enrolling after discontinuing coverage, check page 8 for medical underwriting requirements. For more information about long-term care coverage, call Unum at 1-888-SOG-FLEX (1888-764-3539).
The long-term care plan can play an important part in your future. Coverage will stay in effect for as long as you continue to pay the monthly premium, even if you should leave the State's employment. You could then apply for coverage continuation and be billed by Unum directly at your home.

Daily Benefit Option

options

nursing facility

home care/ assisted living facility/adult
day care

$125/day

$125

$75

$100/day

$100

$60

$75/day

$75

$45

lifetime maximum
benefit
$228,125 $182,500 $136,875

32 / Unit Nine

Legal Insurance
Making healthy decisions for a changing lifestyle

Life is complicated. Just balancing the demands of work and home can be a challenge. Then, along comes a legal problem, or any situation where you need the services of an attorney. In fact, more than two out of three U.S. households had an issue last year that might have led them to hire a lawyer.*
Do you know what to do when:
You want to create a will? You have a charge that's not yours on your credit
card bill? You want to adopt a child? You want to sell your house and buy a new one? You have been denied credit and you want to
challenge it? You have a legal dispute with a neighbor?
These situations happen every day...to people just like you. Did you know that over the past two years, employees of The State of Georgia have submitted 8,500 claims to ARAG North America Inc. to help satisfy their legal needs. What's more, when a legal problem comes up in your life, it's often when you least expect it, or when you can least afford it. With average attorney's fees in the United States reaching $220 per hour**, it is easy to see how even small legal issues can result in hefty legal expenses.
The Ultimate Legal PlanTM Benefits
The Ultimate Legal Plan offers the following benefits:
Personal Telephone Legal Services With The Ultimate Legal Plan, you have unlimited,

toll-free access to Telephone Network Attorneys in any state who average 20 years of experience and can quickly help you identify your legal needs and determine alternatives. Telephone Attorneys can provide you with: Unlimited, toll-free advice about personal legal
matters Follow-up calls and correspondence to third parties Document preparation - for powers of attorney,
childcare authorizations, challenge to denial of credit, promissory notes, affidavits and bills of sale (excludes real estate) Document review (up to four pages, excluding those related to trust or real estate property transfers) Standard will preparation and review
In-Office Legal Services The Ultimate Legal Plan makes in-office attorney visits easy! The Network Attorney will provide you with advice on most covered legal matters with attorney fees paid-in-full. If there isn't a Network Attorney within 30 minutes of your home, ARAG will assist in locating an attorney and you will still receive the full plan benefits - guaranteed.
Visit the ARAG N.A. web site at http://members.ARAGgroup.com/Georgia to view a list of In-Office Network Attorneys. Some of the matters covered under the plan include:
Real Estate Transactions (except title search, title insurance or abstracting) Purchase and/or sale of primary/secondary
residence
Unit Ten / 33

Consumer Protection Legal action to enforce both written or implied
warranties or promises related to the lease or purchase of goods or services

claim form, including your attorney's billing statement, with ARAG N.A. You'll receive direct reimbursement for the visit, up to the maximum allowed by the plan.

Trial Defense Defense of lawsuits for collection of a consumer
debt based upon a contract Defense of traffic charges that could lead to
suspension or revocation of your driver's license (except DWI and parking tickets) Defense of criminal misdemeanor charges (except DWI) Defense of juvenile court charges for an insured child Defense of civil damage claims after court action is initiated, except debt collection matters or those arising out of vehicular or boat accidents or which are covered by other insurance.
Domestic Matters Contested or uncontested divorce, legal separation
or annulment Defense of motion to modify or defense to enforce
a valid decree or separation agreement with respect to child custody, visitation, alimony, child support or contempt Contested or uncontested adoption
Will Preparation Individual simple will Husband and wife simple will Wills with trust provisions (excluding living trusts) Living wills Codicils or changes in a will Durable powers of attorney
Personal Bankruptcy Document preparation and court appearances
Other In-Office Services Establishment of guardianship of a minor Name changes IRS audit protection Administrative hearings Estate administration and closing Landlord and tenant disputes
You can also choose to see a Non-Network Attorney. When covered services have been completed, file a
34 / Unit Ten

NOTE: You will still have eight hours available to you to use towards legal advice, negotiation, document preparation and review (except those legal matters which are specifically excluded or otherwise covered). The coverage is limited to one hour per meeting up to a maximum of 8 hours per family per certificate year. When using a Network Attorney, each hour is paid in full; if you use a Non-Network Attorney, you will be reimbursed up to $70 per hour.
Additional Valuable Services Included in The Ultimate Legal Plan
Online Legal Services The Ultimate Legal Plan also offers Online Legal Services. These services give you access to The Law Guide. The Law Guide includes a wealth of information designed to help you learn more about common legal matters and become a better-informed legal consumer. Also included are Do-It-Yourself Legal DocumentsTM, which allow you to create your own legal documents.
Identity Theft Services As a value added service, The Ultimate Legal Plan provides plan members with toll-free unlimited access to Identity Theft Case Managers who answer questions about identity theft prevention and outline steps you can take to recover if you are a victim of identity theft.
Telephone Immigration Assistance The plan provides unlimited toll-free access to an Immigration Case Manager who will explain the benefit, provide educational materials, provide practical and cautionary information and monitor and assist you as you deal with your immigration matter.
How Others Use the Plan Are you curious about how others are using the plan? The "Top 5" legal needs of State of Georgia members over the last two years were: Consumer protection Property issues Wills

General advice via telephone Defense of civil damage claims
The Ultimate Legal Plan is a legal plan from ARAG North America, Inc., an industry leader in providing legal protection. And it's your connection to quality legal information and representation whenever you need it. When you have The Ultimate Legal Plan, you have experienced legal help on your side.
For more information on The Ultimate Legal Plan: Visit http://members.ARAGgroup.com/Georgia to
view detailed information on plan benefits, how to use the plan and FAQs. Talk to an ARAG Customer Care Counselor tollfree from 8:00 a.m. to 8:00 p.m. Eastern time, Monday through Friday at 800-247-4184. E-mail an ARAG Customer Care Counselor at service@ARAGgroup.com.
During Open Enrollment you may call ARAG N.A. at 1-800-247-4184 if you have question concerning how the legal insurance plan works, or visit their web site http://members.ARAGgroup.com/Georgia.
Reduced Fee Legal Services
Plan members can receive reduced rates of at least 25% for legal needs such as representation and other legal issues for non-covered matters subject to the reduced fee exclusions listed below when using an ARAG Group Reduced Fee Network Attorney. Access to a Reduced Fee Network Attorney is subject to availability. Plan members are encouraged to contact ARAG Group to determine proximity to a Reduced Fee Network Attorney within legal practice areas.

Reduced Fee Exclusions
We do not provide coverage for: Legal services for matters against us, the plan
sponsor, and/or your employer. Legal services arising out of named plan member's
profession, business matters, occupation, employment, workers' or unemployment compensation, occupation or relocation required by an employer. Legal representation deemed by the providing attorney to be lacking merit or representation that is, in the judgment of the providing attorney, in violation of attorney ethics rules. Immigration matters. Patents or copyrights.
If you choose legal insurance, you pay the cost with after-tax premiums, and the benefits you receive are not taxed.
* 2002 Survey, American Bar Association
**Law Firm Economics Study, Altman Weil, 2003 Certain restrictions and exclusions apply to covered benefits. A complete list of limitations is set forth in the Summary Plan Description for the legal insurance plan.
This document is intended to provide an overview of plan coverages. Please remember that only the insurance policy can give actual terms, coverages, amounts, conditions and exclusions.
Underwritten by ARAG Insurance Company, Des Moines, Iowa

Payment of attorney fees is handled directly between the plan member and the Reduced Fee Network Attorney.

Unit Ten / 35

Peach State Reserves -
The Georgia Retirement Investment Plan

Making healthy decisions for a changing lifestyle

Eligibility
Peach State Reserves is available to most employees. However, employees of educational entities are only eligible to contribute if their local school system has chosen to participate. The following educational entities have not chosen to participate, therefore, their employees are not eligible for Peach State Reserves.
Libraries Athens Regional Library Newton Library Bartow Public Library Northwest Georgia Regional Library Brooks County Library Ocmulgee Regional Library Brunswick-Glynn Regional Library Oconee Regional Library Chattooga Library Ohoopee Regional Library Cherokee Regional Library Okefenokee Regional Library Chestatee Regional Library Peach Public Library Coastal Plain Regional Library Piedmont Regional Library Conyers-Rockdale Library Pine Mountain Regional Library Elbert County Public Library Roddenbery Memorial Library Fitzgerald-Ben Hill Library Sara Hightower Regional Library Flint River Regional Library Satilla Regional Library Hall Library Sequoyah Regional Library Hart Library
36 / Unit Eleven

South Georgia Regional Library Henry Library Southwest Georgia Regional Library Houston Public Library Statesboro Regional Library Jefferson County Library Thomas Public Library Kinchafoonee Regional Library Troup-Harris-Coweta Regional Library Lake Blackshear Regional Library Uncle Remus Regional Library Lee Library West Georgia Regional Library Moultrie-Colquitt Library
School Systems Chattooga County DeKalb County Fannin County Georgia Military College Hall County Lumpkin County Trion City Wayne County
Regional Educational Service Agencies Metropolitan RESA North Georgia RESA Northwest RESA Pioneer RESA
The following section describes Peach State Reserves - The Georgia Retirement Investment Plan. Peach State Reserves is separate from the Flexible Benefits Program, and we want to take this opportunity to remind eligible employees that this Program is available to help build their financial security.

What Is Peach State Reserves?
Peach State Reserves - The Georgia Retirement Investment Plan - is a program offered by the State of Georgia to its employees that provides an opportunity to save for retirement while reducing current taxable income and accumulating taxdeferred savings. Peach State Reserves offers 2 Deferred Compensation/Defined Contribution Plans for employees to take advantage of: a Section 401(k) Plan and a Section 457 Plan. Regulated by Congress, deferred compensation/defined contribution plans allow you to put aside a portion of your pay before State or Federal income taxes are deducted. As a rule, income taxes are not paid on either your contributions to the Plan, or any earnings or dividends that the investments generate until money is taken out of the Plan. This means that a Plan account can grow sheltered from income taxes (not Social Security taxes).

Enrolling In Peach State Reserves
The chart on the following pages is an overview comparison of both Plans. For complete and detailed information, contact your local personnel/benefit/ payroll representatives, the Great-West office tollfree at 1-800-701-8255, or visit our web site at www.gms.state.ga.us/employee/psr.asp. Those eligible for either Plan as indicated in the charts on the following pages but not currently participating, can enroll in the Section 457 Plan and the 401(k) Plan at any time (Remember, Peach State Reserves is not a part of the Flexible Benefits Program, so enrollment and changes are allowed year-round). You may stop making contributions at any time by completing a Change Participation Agreement Form and submitting it to your personnel/payroll office.

The intent is to allow you to build financial security for retirement or for other long-term needs above and beyond what your basic pension or retirement plans may offer. Pensions and retirement plans are often based on a "one size fits all" approach which may not meet individual needs well. Peach State Reserves is an excellent and smart way for you to help make sure your future is secure and retirement years are comfortable.
Emergency Withdrawals
The Section 457 and 401(k) Plans were designed by the Internal Revenue Service as a mechanism for saving towards retirement on a pre-tax basis. The Plans are not designed for emergency expenses or financial hardship. Therefore, withdrawals are very difficult to qualify for prior to separation from state service. While many private sector 401(k) Plans offer loans, through which participants may access funds to make a down payment on a house, or to supplement educational expenses, the state of Georgia 401(k) and 457 Plans do not have loan provisions, and the money you contribute to the Plan(s) is NOT eligible for withdrawal in cases of financial need, except under extremely limited circumstances (and in the case of 401(k), with additional tax penalty). All employees should be setting aside savings on an after-tax basis that they can access without restriction or penalty. Only after such an emergency fund is established should someone consider enrolling in Peach State Reserves.

To enroll, you must: read the prospectus for each fund choice fill out and sign the New Enrollment Participation
Agreement fill out and sign the Beneficiary Form complete the Spousal Waiver Form for the 401(k)
only, if applicable. The forms should be available from your local personnel/payroll office. Your contributions can begin the calendar month after your forms are approved and processed.
Choosing 401(k), 457 or Both
Obviously there are definite differences between the two Plans offered, and each offers features that would benefit some people more than others. You may participate in both Plans assuming eligibility requirements are met. If a balance is maintained in both Plans, you will be charged a $3 Quarterly Administrative Fee for each Plan (i.e., $6 quarterly). Both plans are very similar, however there are some differences that could determine which plan you might want to contribute to, if you do not enroll in both. The comparison chart on pages 38 & 39 can help you decide.
Even though the final choice must be yours, remember that Peach State Reserves is here to help by offering educational seminars, written materials, participant services via the Third Party Administrator
Unit Eleven / 37

A 457 and 401(k) Plan Comparison

Feature

457 Plan

401(k) Plan

Participation

Eligibility

For 457 All employees whether full-time or part-time. For 401(k) Employees in permanent, full-time positions and part-time or temporary employees working 1,000 hours or more per year.

Enrollment

Initial enrollment for eligible employees is available any time.

Rollovers

Upon hire, employees may transfer assets into PSR from their previous employer's 401(k), 403(b) or 457 Plan, or in some cases, from IRAs, with some restrictions. Upon termination of employment, participants may transfer assets to their new employer's 401(k), plan or into IRAs.

Contribution Limits

Contributions

Minimum $30 per month for each plan

Tax Year

Deferral Limit

2003

$12,000

2004

$13,000

2005

$14,000

2006

$15,000

Catch-Up and Additional Contributions

Special 457 Plan Catch-Up Double the normal contribution limit for the 3 years prior to the year of retirement, if eligible.

None in the 401(k) plan.

Age 50 and over Additional Contributions

Employees who are age 50 or older (or who will reach age 50 in the applicable tax year), may make "additional

contributions." These are additional amounts beyond the normal contribution limit, as indicated below:

Tax Year

Additional Amount

2003

$2,000

2004

$3,000

2005

$4,000

2006

$5,000

You cannot contribute to the Special 457 Catch-Up and Age 50 Additional Contributions (in either Plan) during the same tax year.

(TPA), and some very helpful information and tools through the web site www.gms.state.ga.us/employee/psr.asp.
How Does Peach State Reserves Beat Conventional Savings? First, you receive a significant tax break. In conventional savings, you pay taxes on income before you can set some aside for investing. Peach State Reserves allows you to invest the full amount.

Second, your earnings benefit from the tax deferral. The pre-tax dollars that you invest also compound on a tax-deferred basis. Since you do not pay taxes on the earnings each year, in most cases the earnings will accumulate more quickly than earnings in aftertax accounts for which you have to pay taxes each year. And the advantage grows the longer you can invest in the plan and the more you contribute, as illustrated on page 39.

38 / Unit Eleven

Feature
Changes to Current Contributions Employer Contributions
Rollovers
Payout Rules 10% Spousal Consent For Beneficiaries Hardship Withdrawals Loans

457 Plan

401(k) Plan

Contributions
Contributions can be started or stopped and amounts changed any time. Changes become effective the following calendar month.

None in the 457 plan.

None in the 401(k), except for participating Community Service Boards.

Distributions/Withdrawals

Upon separation from state service, funds may be rolled into another 401(k), 457, 403(b) or IRA in order to maintain the tax-deferred status of the assets. 457 assets that are rolled into anything other than another 457 Plan will be assessed the 10% early withdrawal penalty if a distribution is later taken prior to age 59 1/2.

Generally, payouts are not allowed until separation from state service, except in the case of 401(k), in which payouts can be made on or after age 59 1/2, even if still working. Payouts from both Plans are required to begin at age 70 1/2, if no longer working. For 401(k) Plans, if payout is taken prior to age 59 1/2, in most cases, a penalty is assessed in addition to taxes. This penalty does not apply to the 457 Plan, unless 457 assets are rolled into a 401(k) Plan, 403(b) Plan or IRA and payout is then taken prior to age 59 1/2.

For 457 -- Married participants don't have to specify their spouse as beneficiary.

For 401(k) -- Spouse must be named as beneficiary for entire account balance unless spouse submits a waiver.

Must meet strict IRS requirements. Extremely difficult to qualify.

Not Available

Investing Your Money For Retirement There are different ways to invest your money. For people who don't want to invest in the stock market, the Plan offers a stable value option that provides a guaranteed rate of return (updated quarterly) and does not invest in the stock market. For those who do wish to invest in the stock and bond markets, there are several mutual funds that provide a broad range of investment styles (also called "asset classes"), including growth and value stocks; small, medium and large company stocks; combinations of stocks and bonds; and popular "Index" funds. These "core" investment options are all no-load with no trading fees, and many are available at lower cost through Peach State Reserves than you would be able to obtain for the same funds if investing in them through a private broker (not to mention the tax advantage you get through Peach State Reserves!). In addition, a Self-Directed Brokerage Option with thousands of mutual funds and individual stocks and bonds is available for investment for those participants with an account balance of at least $10,000.

Before Tax Savings (PSR)

After Tax Savings (Credit Union, Broker, etc.)

$1,000 -$50 PSR deduction $950 Taxable Income -$266 Federal Taxes -$57 State Taxes $627

$1,000 -$280 Federal Taxes -$60 State Taxes $660 -$50 Taxable Savings Deduction $610

$17 more take-home pay when you save before taxes! And lower taxes paid!

Contributing $25 More Semi-Monthly Greatly Increases Savings By Age 60
Account Value in Thousands
$250

$200

$150

$100

$50

$0

35

40

45

50

55

60

Age

$50 Semi-monthly

$75 Semi-monthly

Unit Eleven / 39

Asset Class Allocations of Model Portfolios

Fixed Income

Domestic Stock Mutual Fund

International Real Estate

Stock

Mutual

Mutual

Fund

Fund

Aggressive

Portfolio

10% 70%

15%

5%

Moderate

Portfolio

30% 52.5%

10%

7.5%

Conservative

Portfolio

50% 35%

5%

10%

Model portfolios a simplified approach to investing For people who don't want to select which funds to invest in, Peach State Reserves has three preallocated portfolios. You just pick the portfolio that has the level of market risk/investment growth potential you are most comfortable with. The Plan has Conservative, Moderate and Aggressive portfolios already set up. Each portfolio allocates your contributions into the specific funds within the portfolio, providing automatic diversification across asset classes. Furthermore, the portfolios are rebalanced quarterly to maintain their asset class allocation targets. Diversification and rebalancing are strongly recommended by most financial advisors to help achieve long-term investment goals, and by choosing one of the pre-allocated portfolios, all of that is taken care of for you. The chart above illustrates the breakdown of each portfolio by asset class. For more detailed information regarding the individual funds in each portfolio, visit our website at www.gms.state.ga.us/employee/psr.asp.
Traditional pick-and-choose approach to investing
If you enjoy choosing your own investment options, you can make specific fund selections among the Peach State Reserves "core" investment options. These investment options cover various asset classes or fund types, including a stable value option that does not invest in the stock market. This approach gives you "hands on" control and flexibility to adjust investment holdings, without trading fees or load charges. It requires some monitoring of investment performance and risk exposure. The funds available through the "core" lineup are listed on the web site at www.gms.state.gs.us/employee/psr.asp.

Self-Directed Brokerage Option Investing For those Peach State Reserve participants who have accumulated enough assets in the "core" options, a Self-Directed Brokerage Option (SDB) is available for investing in a much greater range of mutual funds, as well as individual stocks and bonds. Individual funds within the SDB are not screened and would need to be thoroughly analyzed by you before investing. The SDB imposes greater risk, responsibility and cost to participants. Therefore, only knowledgeable investors should enroll in this option.
The Peach State Reserves SDB is available through Great-West and Harrisdirect Investing. As a plan requirement to participate in the SDB, you must maintain at least $5,000 in the "core" investment options. Payroll deductions continue to be invested in the "core" options as directed by you. Funds may subsequently be transferred from the "core" options into a money market fund within the SDB from which you may then transfer into the options offered by Harrisdirect Investing. A minimum of $5,000 is required to open the SDB account. Therefore, in order to be eligible, you must have at least $10,000 in your Plan account, $5,000 to transfer to the SDB and $5,000 to maintain the "core" minimum balance (457 and 401(k) balances cannot be combined to achieve the threshold). The SDB provides an extraordinary amount of investment flexibility for a $60 annual fee. Additional trading fees will apply for certain investment options in the SDB. For more information on the SDB, please visit the Peach State Reserves web site at www.gms.state.ga.us/employee/psr.asp.
Choosing Investment Options (Deferral Allocations) The first step in making any decision should be to determine where you are now and where you need to be by retirement age. The web site www.gms.state.ga.us/employee/psr.asp offers information to help you estimate how much you will need to save for retirement in the "Informational Resources" section. As you take advantage of all the information and help available, you should be able to craft an investment strategy and make other informed decisions that will serve you well in the future.

40 / Unit Eleven

Making Other Changes To Your Plan
Investment transfers and changes in your investment allocation (i.e. which options you are currently investing in) must be made by calling Great-West or by accessing your account through the internet. For changes in your contribution amount or to change your address or beneficiary, you must complete the applicable Peach State Reserves form available from your personnel or payroll office. You can make

investment changes any time, 24 hours a day through the Great-West toll-free line Interactive Voice Response system 1-800-701-8255, the web site www.gms.state.ga.us/employee/psr.asp, or 5 days a week during business hours through Great-West service personnel. Changes made before 4 p.m. Eastern time will be processed the following day at the previous day's closing market prices.

Unit Eleven / 41

Electronic Open Enrollment
Making healthy decisions for a changing lifestyle

Web On-Line Instruction Open Enrollment 2004-2005
State of Georgia Flexible Benefits Program Web available April 15 - May 14, 2004 7:00 a.m. - midnight
Help Desk 404-656-3000 / 1-800-264-3941
7:00 a.m. - 5:00 p.m. (excluding Saturday, Sunday & State holidays)

During the 2004-2005 annual Open Enrollment period, you will have the choice of selecting your State of Georgia Flexible Benefits Program options via the Electronic Open Enrollment web site. Employees who have access to the Internet at work or at home can select their benefits electronically by accessing the Flexible Benefits Program's web site at www.gabenefits.org. The web site will be available Thursday, April 15 through Friday, May 14, 2004, Monday - Sunday, from 7:00 a.m. to midnight.
The menu design enables you to click on your selections and submit them on-line. You are provided a summary of selections available to you for the upcoming 2004-2005 Plan Year, as well as the options in which you are currently enrolled.
Before making your selections, carefully review your 2004-2005 Enrollment booklet, including "Terms and Conditions" of your enrollment. Entry of your selected options indicates that you agree to the Terms and Conditions and understand that this is a binding salary agreement for the duration of the 2004-2005 Plan Year.
Consider your personal situation and look at the array of choices the Flexible Benefits Program offers.
NOTE: If you were hired after February 2, 2004, you will not be able to make selections on the web site this year. Please complete your paper Option Statement and return the signed form to your personnel/payroll office by your agency's designated deadline.
42 / Unit Twelve

Going On-Line
Go on-line using your regular internet browser. Type in web-site address: www.gabenefits.org
Initial Sign-On
Please read the Welcome page. It provides valuable information about the selection process. Click the READY button to proceed.
Enter the following information: - User ID (your social security number without the dashes). Click the SUBMIT USER ID button. - Your birthdate (mm-dd-yyyy). - Password (the length of the password you create can be from 6-10 characters). - Re-enter password. - Select a security question. Click the drop-down arrow to see the choice of questions. - Answer the question (this will allow you to reset your password at a later date should you forget it).
Click the SUBMIT FIRST TIME DATA button. You are now ready to review and submit your choices on-line.
Selecting Your Options
Before making your selections, carefully review the Terms and Conditions of your enrollment located in your Enrollment booklet. Select options in any order you wish. However, it
is necessary to have the Employee Life option before you can select the spouse life and/or child life options. If you do not wish to change an option, you do not have to click on that option.

To select an option: - Click the option in the menu box or in the Flexible Benefit Option column in the 2004-2005 Summary box. - Click the radio button next to the coverage choice except for the Spending Account options. - Enter MONTHLY amount or 00 for the Health Care and Dependent Care Spending Account options. - Click the SUBMIT YOUR SELECTION button each time you make a benefit selection. - Each time you click the SUBMIT YOUR SELECTION you will be taken back to the 2004-2005 Summary page, except:
When selecting employee life, spouse life, and/or child life that requires medical underwriting;
When selecting family coverage for the Health option.
(*) See the Special Instructions section for additional entry instructions.
Confirming Your Selections
Your selections are not final until you complete the confirmation process. Click the CONFIRMATION button on the
2004-2005 Summary page. Click the CONFIRM MY BENEFIT CHOICES if
you are positive you have completed all your selections. After you click the PLEASE CONFIRM MY BENEFIT CHOICES you will not be able to make further changes on the web site. Print your confirmation page with your unique confirmation number.
Note:If you want to change your selection after confirming on the web site, you will need to complete a paper Option Statement, available from your personnel/payroll office.
Log Off
Click LOG OFF if you are not ready to complete the final confirmation process and would like to make a subsequent sign-on later.

Subsequent Sign-On
Enter your User ID (ssn without dashes). Click the SUBMIT USER ID button. Enter your password. Click the SUBMIT
PASSWORD button.
Forgot your password?
Click I FORGOT MY PASSWORD. Answer the security question. Enter a new password. Re-enter the new password. Click the HERE button.
Special Instructions
Evidence of Insurability (E/I) If you select option(s) (employee life, spouse life and/or child life) requiring medical underwriting, you will automatically be taken to a page to complete the form on-line. (Please contact your local personnel office for the appropriate medical underwriting forms for long term disability and long term care.)
NEW THIS YEAR You must complete the medical underwriting form for employee life, spouse life and/or child life on-line in order to complete the final confirmation process. You may click the "FINISH LATER" button to save your entry and return to the web application to finish no later than Friday, May 14, 2004. You will not be allowed to finish the Final Confirm process unless you complete the medical underwriting form on-line for the employee life, spouse life and/or child life options.
If you do not wish to complete the medical underwriting form on-line, you may either change your selection to one that does not require medical underwriting or log-off the web application and fully complete your paper Option Statement and paper medical underwriting form for employee life, spouse life and/or child life and return it to your local personnel office by your agency's designated deadline.
Options - Employee Life: 1. Review your address information and correct, if necessary. 2. Complete the Employee Information Section. 3. Complete the Primary Care Physician Section.
Unit Twelve / 43

4. Click the drop down arrow next to Answer: for Question 001. If the answer is N, no additional information needs to be completed. If the answer is Y, enter information in all the boxes.
5. Continue the same process for Questions 2-6. 6. Click the SUBMIT button if you have
completed the form, or click the FINISH LATER button if you wish to complete the form later.
Options - Spouse Life and Child Life See instructions on the web site to complete the medical underwriting form on-line.

3. Fill in all the boxes for each dependent when adding new dependents.
4. Dependents may be removed by clicking N in the YES/NO drop down arrow.
5. Click the UPDATE button if you have completed the form, or click the FINISH LATER button if you wish to complete the form later.
Other
Employee Life After-Tax - If you select over $50,000 of Life coverage, you may choose to pay with after tax dollars by clicking the box in the after tax section on the Employee Life page.

Special Instructions
Health Benefits If you select Family Health coverage, you will automatically be taken to a page to update/add dependents.
Updating/Adding Health Dependents: 1. Enter the total number of dependents if the number given is not accurate. 2. Click the CONTINUE button.

44 / Unit Twelve

BENEFIT PHONE DIRECTORY

Call if you have a question about how the plan works

Call if you have a question about a claim that has been submitted

PPO, PPO Choice Indemnity Option Atlanta metropolitan area
PPO Provider Information Prescription Drug Information

Contact your personnel/payroll Outside metro area representative. If representative is not available, call claim numbers at right. 1-800-483-6983 1-877-650-9342

404-233-4479 1-800-483-6983
Not applicable 1-877-650-9342

Medical Certification Program (MCP) Atlanta metropolitan area Outside metro area

770-438-9770 1-800-762-4535

404-233-4479 1-800-483-6983

Behavioral Health Services (BHS) Atlanta metropolitan area Outside metro area

1-800-631-9943 1-800-631-9943

404-233-4479 1-800-483-6983

NurseCall 24

1-800-524-7130

Not applicable

HMOs BlueChoice Healthcare Plan CIGNA Healthcare of Georgia Kaiser Permanente United Healthcare of Georgia

1-800-464-1367 1-800-564-7642 404-261-2590 1-866-527-9599

1-800-464-1367 1-800-244-6224 404-261-2825 1-866-527-9599

Employee Life, Spouse Life, Child Life Insurance and AD&D

Life conversion and

404-656-2730

portability information

or 1-888-968-0490

1-888-SOG-FLEX or 1-888-764-3539

Peach State Reserves Peach State Reserves Office
Great-West "Key Talk"`

404-651-6088 or 1-800-331-7180 1-800-701-8255

Not applicable

Dental Insurance CIGNA United Concordia-Regular & PPO

1-800-642-5810 1-866-215-2356

1-800-642-5810 1-866-215-2356

Vision Coverage

1-800-638-3120

1-800-638-3120

Disability Insurance

1-888-641-7186

1-888-641-7186

Long-Term Care Insurance

1-888-SOG-FLEX or 1-888-764-3539

or 1-888-764-3539

Legal Insurance Hearing Impaired

1-800-247-4184 1-800-383-4184

1-800-247-4184 1-800-383-4184

Spending Accounts Hearing Impaired

1-800-893-0763 1-800-952-0450

1-800-893-0763 1-800-952-0450

Unit Thirteen / 45

EMPLOYEE CHECKLIST
u Check with personnel/payroll office for deadlines.
u Review the enrollment booklet, providing you with valuable information for each option descriptions of required supplemental forms medical underwriting requirements (pages 7 - 9), and Terms & Conditions (inside front cover).
u During the 2004-2005 Open Enrollment, make your benefit selections on the web site (www.gabenefits.org) or by completing your paper Option Statement from April 15 May 14, 2004.
u Check Option Statement and enrollment booklet to confirm if forms are required, such as Medical Underwriting forms.
u Review your Confirmation Statement thoroughly and immediately report discrepancies to personnel/payroll office. Follow-up to assure corrections were made.
u Compare your June pay stub(s) against options selected. Contact your personnel/payroll office with discrepancies.
u Report any incorrect information to your personnel/payroll office.
Check the following forms that you need to complete and contact personnel/payroll office for forms:
u Health "Dependent & Miscellaneous Update Form" *
u Health "Discontinuation of Health Benefit Coverage Form"
u Health "Declination of Health Benefit Coverage Form"
u Health "Membership Form"
u "Flexible Benefits Program Beneficiary Election Form"
u Unum "Evidence of Insurability Form" ** For Employee Life For Spouse Life For Child Life
46 / Unit Thirteen

u The Standard "Evidence of Insurability Form" For Long-Term Disability
u Unum Long-Term Care Application
u Prepaid Dental Option "Dental Selection Form" (call CIGNA at 1-800-642-5810).
*If enrolling on-line, these forms may also be completed on the web through May 14, 2004.
**If enrolling on-line, these forms must also be completed on the web through May 14, 2004.
For questions about claims or benefits for the State Health Benefit Plan, see page 45 for phone numbers.
For general questions about the Flexible Benefits Program, call 404-656-2730 if it's a local Atlanta call, or toll-free at 1-888-968-0490 outside the local area.
If changes in the Program are necessary to comply with the law or IRS regulations, you will be notified.
If you do not complete and return your paper Option Statement or enroll online by the deadline, your 2003-2004 Plan Year choices will roll over in 2004-2005 unless you are currently participating in the PPO, PPO Choice or Indemnity options. These options are being replaced by the PPO Basic, PPO Premier, PPO Choice Basic, PPO Choice Premier, Indemnity Basic and Indemnity Premier Plan Options. If you do not submit an election by May 14, 2004, and are currently participating in one of these plans, your coverage will default to the new PPO Basic, new PPO Choice Basic or new Indemnity Basic Plan Option.
This booklet summarizes the benefits you can choose through the State of Georgia Flexible Benefits Program. A more detailed explanation of benefit provisions is provided in each benefit plan description. Every attempt has been made to ensure that the information in this booklet is accurate.
The State of Georgia Flexible Benefits Program is governed by legal documentation and insurance contracts. However, in the event there are any conflicts between this booklet and the official plan descriptions and contracts, the terms of the official plan descriptions and contracts will prevail.
The Flexible Benefits Program is governed by the current tax law and is subject to and operated in accordance with the regulations of the Internal Revenue Service (IRS).

PRIVACY NOTICE
The Health Insurance Portability and Accountability Act of 1996 (HIPAA) requires that covered entities including state agencies who deal with Protected Health Information (PHI) provide you with this privacy notice. This notice pertains to those programs specifically administered by the Georgia Merit System (GMS) and where GMS may maintain various types of your PHI. The GMS understands that information about you and your family is very personal, and is committed to protecting your information.
This notice tells you how GMS uses and discloses information about you and discusses your rights to keeping this information private. Please review this notice carefully.
Overview What is HIPAA? HIPAA, Health Insurance Portability and Accountability Act of 1996, is a federal law regarding the confidentiality and security of your Protected Health Information (PHI). It imposes new restrictions on how your health information can be used and shared and creates new rights for individuals concerning their own health information.
What is PHI? PHI, Protected Health Information, is individually identifiable health information that is maintained or transmitted by a covered entity. It is information related to a person's health, provision of care, or payment. Some examples may include: bill for health services; explanation of benefits statement; receipts for reimbursement from a health flexible spending account plan; any list showing amount of benefits paid with a breakdown by social security number. Another example may include your employer (state agency, school system, authority, etc.) transmitting information about you to the GMS. This information may include your name, address, birth date, phone number, social security number, and employee identification number and certain types of health information
How GMS Uses and Discloses Protected Health Information When services are contracted, GMS may disclose some or all of your information to the company so they can perform the job GMS has contracted with them to do. To protect your information, the GMS requires the company to safeguard your information in accordance with the law.
Privacy Law Requirements GMS is required by law to:
Maintain the privacy of your information. Give you this notice of GMS's legal duties and privacy
practices regarding the information that GMS has about you. Follow the terms of this notice. Not use or disclose any information about you without your
written permission, except for the reasons given in this notice. You may revoke your permission at any time, in writing, except for the information that GMS disclosed prior to your revocation. If you cannot give your permission due to an emergency, GMS may release the information if it is in your best interest. GMS must notify you as soon as possible after releasing the information.

Your Health Information Rights You have the following rights regarding the health information maintained by the GMS about you.
You have the right to see and obtain a copy of your health information. An exception is information that is needed for a legal action relating to GMS.
You have the right to ask GMS to change health information that is incorrect or incomplete. GMS may deny your request under certain circumstances.
You have the right to request a list of the disclosures that GMS has made of your health information beginning in April 2003.
You have the right to request a restriction on certain uses or disclosures of your health information. GMS is not required to agree with your request.
You have the right to request that GMS communicates with you about your health in a way or at a location that will help you keep your information confidential.
You may request GMS's Privacy Officer to give you another copy of this notice, or you may obtain a copy from GMS's Web site, www.GMS.state.ga.us (under "Privacy").
For More Information and To Report a Problem If you have questions and would like additional information about Protected Health Information (PHI) you may contact GMS's Privacy Officer at 404-656-2730 (Atlanta calling area) or 1-888968-0490 (outside of Atlanta calling area). You may also visit GMS's Web site, www.gms.state.ga.us (Under "Frequently Asked Questions" FAQ).
The GMS does not discriminate on the basis of disability in the admission or access to, or treatment of employment in its programs or activities. If you have a disability and need additional accommodations to participate in any Merit System programs, please contact GMS's Customer Service Division. For TDD relay service only: 18002550056 (text-telephone) or 18002550135 (voice).
If you believe your privacy rights have been violated: You may file a complaint by calling the GMS Privacy Unit at 4046562730 (Atlanta calling area) or 1-8889680490 (outside of Atlanta calling area), or by writing to: Georgia Merit System Attn: Privacy Officer 2 MLK Jr. Drive, SE Suite 1016, West Tower Atlanta, GA 30334 You can file a complaint with the Secretary of Health and Human Services by writing to: Secretary of Health and Human Services, 200 Independence Ave. SW, Washington, DC 20201. For additional information, call 1-8776966775. You may file a grievance with the United States Office for Civil Rights by calling 1-866OCRPRIV (1-8666277748) or 1-8867884989 TTY.
There will be no retaliation for filing a complaint or grievance.
If GMS changes its privacy practices significantly, GMS will post the new notice on its Web site at www.gms.state.ga.us (Under "Privacy"). This notice is effective April 14, 2003.