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co.clayton.ga.us

OPEN ENROLLMENT 2010

Administration

Employment

Professional Development

Compensation/Records

Current Employment Opportunities

Instructions to Download Employment Application

Departmental Forms

INSURANCE/RISK MANAGEMENT

SAFETY
Vehicle Use Policy (pdf)

LIABILITY
- Vehicle Loss Notice (pdf)
- Sample Automobile Loss Notice (pdf)
- Vehicle Accident Supervisor's Report (pdf)

HIPAA
Overview of HIPAA
HIPAA Privacy Notice (pdf)
HIPAA Authorization Form (pdf)

EMPLOYEE INSURANCES
COBRA/ARRA
CHIP (pdf)
Federally Mandated Insurance Requirements (pdf)

- Medical/Dental Plan Booklet (pdf)

Self-Funded Medical
- Enrollment Form (pdf)

Self-Funded Dental
- Enrollment Form (pdf)

Self-Funded Prescription Drug Plan

Kaiser (HMO)
- Enrollment Form (pdf)

Kaiser Senior Advantage (HMO)
- Enrollment Form (pdf)

Humana Medicare Advantage

Life Insurance
- Active Employee Enrollment Form (pdf)
- Retired Employee Enrollment Form (pdf)

SUPPLEMENTAL INSURANCES
Davis Vision
Colonial Supplemental
AFLAC

LONG TERM DISABILITY

PREPAID LEGAL

WORKERS' COMPENSATION
- Form B (pdf)
- Form C (pdf)

 

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INSURANCE and RISK MANAGEMENT

The Clayton County Insurance and Risk Management office is responsible for the employee insurance for full-time employees, retirees, and vested COBRA participants of Clayton County Government. Nella Cooper leads the office. Working with Nella is: Cheryl White, Diane Stewart, Katrise Blades, Sherrie Martin, Kathy McAleer, Betty Walker, Karen Bohannon, Lisa Bomar, Captain Angelo Daniel, Bill Russaw and Rick Ditroia. Office hours are Monday through Friday from 8:00 a.m. - 5:00 p.m.

In addition to employee insurance, the office handles property insurance on Clayton County buildings and their contents, various forms of liability insurance, workers' compensation insurance, insurance premium payments, bonds for public officials and safety issues. Questions concerning any of these matters should be directed to this office.

LIABILITY INSURANCE and CLAIMS - All accidents/incidents involving county employees, county owned vehicles or accidents/incidents that occurred on county owned property must be submitted to Risk Management immediately following the incident. Complete the Vehicle Loss Notice Report (pdf) and send it to Lisa Bomar via email, fax, or inter-office mail. The contact information for reporting is:

Lisa Bomar, Claims Assistant
Direct Telephone: (678) 479-5031
Fax: (770) 473-5907
Email: Lisa Bomar@co.clayton.ga.us

Vehicle Accident Supervisor's Report (pdf) -This form is to be completed by the Supervisor in conjunction with the Accident/Incident Report when an incident occurs involving County equipment or a County employee during the work day.

SAFETY – Clayton County is committed to providing a safe work environment for all employees.  Our Safety Officer handles the investigation of all accidents/incidents involving county vehicles, damage of county buildings and/or property, the investigation of workers’ compensation accidents/injuries and provides defensive driving training classes for county personnel.  The contact information for the Safety is:

Captain Angelo Daniel Direct Telephone: (678) 479-5029 Fax: (770) 473-3995 Email:  Captain Angelo.Daniel@co.clayton.ga.us

EMPLOYEE INSURANCES Medical/Dental Plan booklet (pdf)

SPOUSAL SURCHARGE - If you are covering a spouse on either of the County Medical plans, the spousal surcharge form (pdf) must be completed. Failure to complete and submit this form will result in the monthly surcharge amount of $40.

The following employee insurances are handled through this office:

SELF-FUNDED MEDICAL PLAN - Enrollment Form (pdf)
The Self-Funded Medical Plan utilizes a network of providers to deliver care at a more affordable cost.  For information about the networks available and to determine if your provider is currently in the network, please visit www.humana.com.  Full-time employees are required to complete their insurance enrollment forms within two weeks of their date of employment.  Mid-year changes are permitted within limited provisions as outlined in the plan document and summarized in the booklet. For information regarding medical benefits under this plan, download the Medical/Dental Plan booklet (pdf)

SELF-FUNDED MEDICAL PLAN CLAIMS ADMINISTRATION:

Humana Claims, PO Box 14610, Lexington, Kentucky 40512-4610
The Toll-Free telephone number for Humana is 1-888-357-6787

SELF-FUNDED DENTAL PLAN CLAIMS ADMINISTRATION:

Humana Dental Claims Office, PO Box 14611, Lexington, Kentucky 40512-4611
The Toll-Free telephone number is 1-800-233-4013

If you have questions about claims prior to January 1, 2010, you may contact Core Administrative Services at 1-888-741-2673. Should you need our help, do not hesitate to let us know at 1-770-477-3590

SELF-FUNDED PRESCRIPTION BENEFIT PROGRAM -The Caremark benefit program is available to participants in the Self-Funded Medical Plan. For more information contact Caremark Customer Service at   1 (866) 260-4646 or you may visit their Web site at www.caremark.com. Caremark Customer Service Representatives are available 24 hours a day Monday through Friday.  They are available 9:00 a.m. to 8:00 p.m. (EST) on Saturday and 9:00 a.m. to 6:00 p.m. (EST) on Sunday. 

KAISER PERMANENTE HMO PLAN - Enrollment Form (pdf)
For information regarding medical benefits under this plan you may visit their Web site at http://www.kaiserpermanente.org.

Full-time employees are required to complete their insurance enrollment forms within two weeks of their date of employment. Mid-year changes are permitted within limited provisions of the Flexible Benefits Plan. Questions concerning coverage should be directed to Kaiser Member Services at (404) 261-2590. Questions concerning enrollment and eligibility should be directed to the Clayton County Risk Management/Insurance Department at (770) 477-3590.

KAISER SR. ADVANTAGE HMO - Enrollment Form (pdf)

YOU MUST BE:

• Retired and live in the metropolitan Atlanta area (specific zip codes only)
• Enrolled in Medicare Part A & B
• No Longer a Working Employee

HUMANA MEDICARE ADVANTAGE - Enrollment Form (pdf)

YOU MUST BE:

• Enrolled in Medicare Part A & B
• No longer a Working Employee

SELF-FUNDED DENTAL PLAN - Enrollment Form (pdf)
For information regarding dental benefits under this plan you may download the Self-Funded Dental/Medical booklet (pdf).

LIFE INSURANCE (Active Employees) - Clayton County provides, at no cost to you, Basic Life Insurance in the amount of $25,000.  Employee Supplemental Life Insurance in the amount of $25,000, may be purchased at a current cost of $9.25 per month. Both coverages are insured through Standard Life  Insurance Company and double their face value in the event of death as a result of a covered accident while you are an active employee. In addition, both coverages include some coverage for accidental dismemberment. Upon retirement, Basic Life and Employee Supplemental Life Insurance coverages are reduced by 50% and the accidental provision no longer applies. Certain disabled employees may remain covered by former our life carrier (Greater Georgia Life Insurance Company) as a result of that carrier approving them for "Waiver of Premium".

Clayton County also provides Dependent Life Insurance coverage that enables you to cover your eligible dependents (legal spouse and dependent children - age 15 days - 19 years or 24 years, if a full-time student). Dependent Life Insurance in the amount of $3,000, $5,000, $6,000 or $11,000 coverage may be purchased on your dependents. One premium pays for all eligible dependents to be covered but the amount of coverage is "per individual". Clayton County pays $.50 towards your applicable monthly premium.  Current Dependent Life premium amounts are:

Amount of Coverage	Monthly Premium	Amount of Coverage	Monthly Premium
$ 3,000	$ .22	$ 6,000	$ 1.30
$ 5,000	$ .94	$11,000	$ 2.70

If you need to make any changes to your life insurance coverages, download the Life Insurance Application form (pdf). Complete it in full and return it to the Risk Management Office.

LIFE INSURANCE (Retirees) - Your life insurance is reduced by 50% of the amount in force just prior to your retirement and remains in place, unless you fail to pay any required premiums. It is important for you to keep your beneficiary designations up to date and you may do this at any time during the year. Life Insurance Application (pdf)

LONG TERM DISABILITY (available only to Active employees) - Clayton County offers a Voluntary Disability Policy, insured through The Hartford Insurance Company. Like the other County coverages, you must be employed as a full-time employee for 3 months before this coverage can go into effect. This policy permits you to purchase protection in the event that you are disabled from working. The policy requires that you must be disabled for 3 months and have exhausted all full-pay benefits available to you from the County before receiving benefits from this plan. You may purchase protection of $500 (minimum) per month or you may purchase up to approximately 60% of your monthly earnings. The policy contains a "pre-existing condition clause" that you should read carefully to assure complete understanding. The cost of this protection varies based upon the amount of monthly coverage purchased and your age. The cost will increase the year that you move into another age bracket. Please review all information about this coverage as this benefit could mean the difference in whether or not you could be financially secure in the event of your disability. The premiums for this coverage are paid with after-tax deductions. Also, please be aware that if you are already participating in this plan and have enjoyed salary increases, you may now be eligible for more coverage than you are currently purchasing. You may wish to increase the amount of this protection during the Annual Open Enrollment  period by completing a new LTD Application form, requesting the increased amount of coverage.

DAVIS VISION - Vision benefits available to enrolled participants. For more details avout the plan, log on to the Open Enrollment/Discount Pam section of davisision.com, call 1 (877) 923-2847 and etner Client Code 7663 or download the enrollment application and summary (pdf).

COLONIAL SUPPLEMENTAL LIFE – Accident insurance, short term disability, cancer insurance, critical illness and life insurance are a few of the supplemental plans available through Colonial Supplemental Life.  For more information contact the agent, Felicia Warner, at (404) 668-9440.

AFLAC – Cancer plans, accident/disability plans, hospital confinement plan, intensive care plan, life insurance are supplemental plans available through AFLAC.  For more information, contact the agent, Melissa Leedy, at (404) 247-2609.

PREPAID LEGAL - This plan provides affordable legal insurance to protect employees in many cases. It utilizes contracted attorneys primarily and is designed to provide unlimited telephone access to attorneys in many specialized areas of law. For more information contact Prepaid Legal at 1 (800) 654-7757. You may also call the agent, Wes Greene, at (770) 472-1800 for information.

WORKERS' COMPENSATION (Self-Funded) - This protection is provided to all county personnel in the event of injury/illness caused or contributed to during the course of their employment. If injured at work it is imperative that you report the injury immediately to your Supervisor whether or not you believe medical attention is required. If medical attention is needed, you must choose a physician from the Panel of Physicians (Official Notice) list (Form C (pdf)). Employees are not permitted to utilize their own physician.  In the event of a life-threatening emergency, care may be sought from the nearest medical facility.  Form C (pdf) - Use to certify coverage to the panel doctor for the injured workers' first visit. Form B (pdf) is used to show the number of hours missed and contains the payroll codes Departments should use when an injured employee has lost time due to a Workers' Comp injury.

Supervisor's Investigative Report (pdf) - This form is to be completed by the Supervisor on all employee's that have a job work related illness or injury. If it appears the employee will not require outside medical attention and no lost time from work, this form should be completed in lieu of the First Aid Report.

Clayton County Official Code Sec. 70-3. Workers' Compensation (pdf)

Workers' Compensation Bill of Rights for the Injured Worker (pdf)

Workers' Compensation Official Notice (Panel of Physicians (pdf) - Additional doctors may be added on a separate sheet.

If additional information is needed concerning your rights to Workers' Comp benefits, please contact the Clayton County Insurance/Risk Management Office at (770) 477-3590. The State Board of Workers' Compensation is also available to answer general workers' compensation questions.