A-Trend AD-L528 ATrend Helios / LE-511 Aboss AB-6863 Accura ADVD3836 Acoustic Solutions AS8099 / TE 118A Acoustic Solutions DVD150AS / DVD150 / DVD321 / DVD421 / DVD451 / DVD651 Acoustic Solutions DVD521 Acoustic Solutions DVD551 Acoustic Solutions DVD237 / DVD600K

no known hacks

AEG DVD 6500 HT AEG M-2002 AEG 2002P / 4502 / 4503 / 4504 / 4506 / 4511 / 4513 / 4602 HC / 4603 HC / 4609 HC
AFK DVD-100 / DVD-101 AFK DVD-AFK DVD-106 / HCS-101
Afreey ADV-2360 / ADV-2630 Afreey LD-2020/ LD-2060 Affrey PDV-2000 Airis L103C Airis L120 Airis L103B / L103E / L105A / L105B / L105C / L105D / L106 / L253 /

LW256 / LW257

Aiwa AVJ-R5 / AVJ-X55 / HV-DH1 / HV-DH10 / XD-AX36 Aiwa HT-DV50 / XD-DV50 Aiwa HT-DV90 Aiwa XD-520KS / XD-DV520 / XD-DV520 KS Aiwa XD-AX10
You need an OneForAll remote (URC 7030)
Aiwa XD-DV170 Aiwa XD-DV290 / XD-DV370 / XR-DV370 KN Aiwa XD-DV480 Aiwa XD-DW1 / XD-DW5 / XD-DW7 Aiwa XR-DV525 Aiwa XD-DV520 Aiwa AVJ-X33, AVJ-X55, HT-DV50, XD-AX1, XD-DK601, XD-DV10, XD-DV170, XD-DV290, XD-DV380, XD-DV485, XD-DV487, XD-DV500, XD-DV530, XD-DV600, XD-PK701, XP-K7, XP-KR9, XR-DV120, XRDV526, XR-DV700, XR-DV701, XS-DV335RW
Akai ADV-1120 / ADV-1250 / DV-P2340 / DV-P2440 / DV-P2540 / DVD-2100SS / DVR-2100SS Akai ADV-8000 / ADV-8175 / DV-P2500 / DVP-8000 Akai ADV-9000 / DV-P3410 / DVD-3140 Akai DHT-300 Akai DV-P1000 Akai DV-P2000
Akai DV-P3470 / DV-P3570 / DV-P3570S Akai DV-P3550 Akai DV-P4000 / DV-P4500 Akai DV-P4330S / DV-P5380S / DV-P5570SL / DV-P5580SK Akai DV-P4410 / DV-P4420S Akai DV-PX7000 Akai DVR-3100SS / DVR-3300SS / DV-R3400SS Akai DV-R4000SS / DV-R4150SS Akai DVD-200BL Akai DVD-2100 / DVD-2100SS Akai DVD-3850S Akai DVPS-760 Akai HV-DH10 / HV-DH10N Akai PDVD150 Akai ADV-1000, ADV-1150, ADV-2750, ADV-8175, APV-4300MB, CFTP2085V, DV-P3580SK, DV-P4500, DV-4530S, DV-P4580SL, DVPX6500, PX7000E, DV-PX7000E, DV-R4200SS, DV-4410SS, DVV605N, DVD-P5851, DVD-S3500P, DVPS-7000, VRD-975
Akura ACHTS02 Akura ADV14S / ADV145S / ADV146S / ADV147S / ADV147AS Akura ADV143S Akura APDV149TS / APDV150TS Akura ADV144S / ADVR-171S
Alba DVD103 / DVD106 / DVD108 Alba DVD104 / DVD114 Alba 108 xi Alba DVD109 Alba DVD113 / DVD70

is codefree

Alba DVD119 / DVD73 Alba DVD129 Alba DVD165 / DVD65 Alba DVD45 Alba DVD59 Alba DVDP500 Alba RDVD1002 Alba TDV3406 / TDV3450 Alba DVCR2, DVD54, DVD55, RDVD1000, RDVD1001, Roadstar DVD2551K, SYS2200CD DVD, TVD3455, TVD3456
All-Tel DVD-101 All-Tel DVD 8166F / XR900 / XR1000
Amoisonic DVD2002 Amoisonic DVD2002BM Amoisonic DVD8166 Amoisonic DVD8506F/ DVD8506 Amoisonic DVD7000 / DVD7300 / DVD8000 / DVD8156 / DVD8300 / VDR2000
Amphion ABT V101 Amstad DVD 2320 Amstrad DX 3016 Amstrad D240 / D320 / D400 / DR251 / DR300 / DV-150 / DV-200 / DV-250 / DV-303 / DX 3010 / DX 3014 / DX 3015
AMW M270 / M280 / P510 / T342 / T365 / V101 AMW P510 / P8A5 / P80L / P819 / V101 AMW P90L / R99 / U-100 AMW S99 / V99 AMW V120 AMW V250 AMW M520, P9C2T, T352, V120, V151
Apex AD-600A Apex AD-1000 / AD-1010W / AD-1130W / AD-1165 / PD-510 Apex AD-1110W Apex AD-1200 / AD-3201 / PD-100 Apex DRX-9000 Apex AD-1115, AD-1145, AD-1150, AD-1225, AD-1250X, AD-1700M, AD-2100, AD-2101, AD-2600, AD-2701, AD-703A, AD-7701, ADV3800, DRX-9100, DRX-9200, DVX-4351, GT2015DV, GT2715DV, HT100W, HT-150, HT-170, HT-180, MD-100, PD-10, PD-450, PD-480, PD500, PD-510, PD-650, PD-660S

Cybercom CC 4931 Cyberhome AD-L 528 / CD-LDV 712 / CH-DVD 302 / CH-DVD 500 / CH-LDV 702 Cyberhome AD-M 212 / AD-M 512 Cyberhome AD-N 212 Cyberhome CD-LDV 7000 / CH-LDV 7000 / CH-LDV 707B / CH-LDV 710 Cyberhome CD-DVD 655 / CH-DVD 300 / CH-DVD 320 / CH-DVD 401 / CH-DVD 635 / CH-DVD 4010 / CH-DVR 2500 / CH-LDV 1010A / CHLDV 1010B portable / CH-LDV 700B Cyberhome CH-DVD 400 / CH-DVD 402 / CH-DVD 405 / Prism DV302 / Prism DV-402 Cyberhome CH-DVD 412 Cyberhome CH-DVD 452 ZE / CH-DVD 462 / CH-DVD 465 Cyberhome CH-DVD 505 Cyberhome CH-DVR 1500 / CH-DVR 2500 Cyberhome MP016-A Cyberhome CH-DVD 4620, CH-DVR 465, CH-DVR 1530, CH-DVR 750, CH-DVR 710, CH-LDV 3550, CD-LDV 9000

Cyrus DVD-7 Cytron

Cytron TCM Edition Daewoo DDT-14H9s / DDT-21H9S / DQD-2100 / DQD-2100D / DQD2101D / DQD-2113 / DQD-6100D / DQD-6113D / DV6T811N / DV6T844B / DV6T85N / DV6T955B / DV6T999B / DVD-323 / DVD-363 / DVD-8100P / SD-3500P / SD-6200 / SD-7500 / SD-7800 / SD-8100 / SD-8800P / SD-9500P / SD-9800P / SH-7840 Daewoo DF-4100 / DF-4150 / DF-7100 / DF-7150 / DF-8100 / DF-8150 / DH-6105 / DH-6100P / DR2100P / DRX-1105 / DVR-06 / DVR-S05 Daewoo DG-K21 / DG-K22 / DV-150 / DV-500 / DV-800 / DVG-5200S / DVG-8300SE / DVG-8400N / DVG-8500N / DVG-9200N / DVN-3100N / DVN-8100N
1. Open the disc tray 2. Press 1, 3, 7, 9 3. Press the button for the desired RC (0=codefree) 4. Close the disc tray
Daewoo DG-K514 / DM-K40 / DM-K41 / DV-700S Daewoo DHC-2200 / DHC-5800K / DQD-200 / DQD-2000 Daewoo DHC-2200K / DHC-2300 Daewoo DHC-8000K / DVD-800K Daewoo DHC-X100 / DHC-X100NT Daewoo DHC-XD150E / DHC-XD300 / DHC-XD350 / DHC-XD500 Daewoo DPC-7100P Daewoo DQD-2112D / DQD-6112D / DV6T821N / DV6T834N / DVD260D Daewoo DS-2000N / DVD-3700 / DVD-5700 / DVD-5800 Daewoo DS-2500N Daewoo DV-115 / DV-135 / DHC-250 Daewoo DVD-6000G / DVD-S250 / DVG-6000D / DVG-9000N Daewoo DVD-702 / DVD-S150 / DVD-9000S / DVG-9000S Daewoo DVD-8000F
Daewoo DVD-P480 Daewoo DVD-P4851 / DVD-S151

is region free already

Daewoo DVD-P80S Daewoo DVG-3000N / DVG-5000D Daewoo DVG-4000S / DVG-5000N Daewoo DVG-5300N Daewoo DVR-06 Daewoo S2122 Deawoo TPSL-102 Daewoo BH-7840 / DCSA-8CN / DCSB-87N / DF-K528 / DQR-1000D / DQR-1100D / DQR-2000D / DV-1031 / DV-1091 / DV-600 / DVD-S200 / DVD-S500 / DVD-S900 / DVG-6500D / DVG-8000N / DVG-9100N / DVR-S04 / DVX-4021 / DX-7840 / DX-9810 / DX-9840S / HC-4130 / SD-7100

Telefunken TDV-0811 / TDV-0820 / TDV-8301 Telefunken TDV-1763 Telefunken TDV-7500 Telefunken TDV-8300 Telefunken TDV-080 / TDV-223 / TDV-228 / TDV-280 / TDV-668 / TDV-4350 / TDV-6000 / TDV-7221 / THT-152 / TLD-1701 / TMH-2000 / TMH-2800 / TNE-1301 / TNE-1302 / TNE-1501 / TRW-1018 / TTV-2181
Terratec DVD 5.1 Tevion DR-108 Tevion DR-1750 Tevion DRW-1000 Tevion DRW-8005 HDD Tevion DVD 160 HDD II Tevion DVD-200 (ALDI) / DVD-2001 Tevion DVD-2002 Tevion DVD-2003 / DVD-3000 / DVD-4000 Tevion DVD-5000 / DVD-6000 / DVD-7000 Tevion MD 80032 / MD 80120 Thomson 24 WT 25 UG / 24 WT 25 UG Thomson DPL 900 DV / DPL 910 VD Thomson DPL 909 VD Thomson DTH 195 E / DTH 212 / DTH 213 /DTH 231 / DTH 231 E Thomson DTH 210 / DTH 210 E / DTH 210 U / DTH 2100 / DTH 2200 / DTH 4600 / DTH 4601
Thomson DTH 211 / DTH 211 E / DTH 311 / DTH 311 U Thomson DTH 220 E Thomson DTH 3300 Thomson DTH 3600 / DTH 400 / DTH 4500 / DTH 5000 Thomson DTH 3700 / DTH 5200 Thomson DTH 4000 / DTH 4200 Thomson DTH 5400 Thompson DTH 7000 / DTH 7000 E / DTH 7500 E / DTH 7500 U Thomson DVD 430 / DVD 431 Tiny TPSL 102 Tokai 205N / 3500AT Tokai DVD 715 Tokai 823 Tokai 215, 223, 305, 503, 505, 515, 525, 613, 715, 723, 725, 815, DVX4350MUC
Toshiba SD1200 / SD1600 / SD1700 / SD210E / SD2109 / SD2150 / SD220E / SD2800 / SD3750 Toshiba SD120E / SD125E / SD220E Toshiba SD240 / SD350E / SD3960 / SD3980 Toshiba SD3109 Toshiba SD43HK Toshiba 23HLV84 / SD-24 VLSL / D-KR2 / D-R1 / D-R2 / D-R255 / DR4 / D-VR30 / D-VR4 / MD13N1 / MD13N3 / MD13P3 / MD14FN1 / MD20FM1 / MD20FN1 / MD20FP1 / MD20P1 / MD9DM1 / MD9DP1 /
MW20FM1 / MW20FN1 / MW20FP1 / MW20FP3 / MW24FM1 / MW24FN3 / MW24FP3 / RD-X2 / RD-XS34 / RDXS30 / RDXS32 / RDXS52 / RSTX20 / RSTX60 / SD1008 / SD100X / SD106E / SD114E / SD1209 / SD1209 / SD114E / SD1209 / SD1300 / SD130E / SD1402 / SD140E / SD145E / SD1850 / SD1900 / SD2006 / SD2008 / SD2108 / SD214E / SD22VE / SD22VL / SD245 / SD248E / SD24VB / SD2600 / SD2650 / SD2710 / SD2715 / SD2805 / SD2810 / SD2815 / SD2850 / SD320V / SD324ES / SD34VL / SD35VF / SD36VESE / SD3860 / SD400V / SD412V / SD4205 / SD44HK / SD4960 / SD500E / SD5205T / SD5907 / SD5915 / SD5980 / SD6915 / SD9100 / SDH400 / SDK200 / SDK220 / SDK330 / SDK350 / SDK530 / SDK730 / SDK740 / SDK750 / SDP1000 / SDP1400 / SDP1500 / SDP1600 / SDP2500 / SDP2600 / SDV290 / SDV291 / SDV390 / SDV391 / SDV395 / SDV396 / SDV593 / SDV65HT / VTD1420 / VTD1431 / VTW2185

Umax DVD-2100 Umax DVD-6000 Umax DVD-6400 Umax DVD-6500 United DVD 1151 United DVD 1155 United DVD 2023 M United DVD 2151 United DVD 2255 / 3052 M United DVD 3052 / DVD 3151 / DVD 3153 / DVD 3155 United DVD 3054 United DVD 3160 / DVD 3161 United DVD 4051 United DVD 4054 M United DVD 4062 M
United DVD 4053 United DVD 5000 United DVD 5054 M United DVH 3161 United DVH 4083 United DVH 4087 United DVX 4066 M United DVX 4069 United HDV 4080 / HDV 4090 Universum DVD 3015 Universum DVD 8112 Universum DVD DR-1020 Universum DVD DR-3021 / DVD DR-3022 Universum DVD DR-4020 Universum DVD DR-4342 Universum DVD DR-8120 Universum DVD 2211 / DVD 8100 / DVD DR-1030 / DVD DR-1044 / DVD DR-3015 / DVD-R-DR 4040 / DVD DR-4050
Veba AV2403 / AV2405 / AVPMK560 Veba AV2402

Veba AV2408 / AV2411

Venturer DVD 100K / PS166W / PVS1090 / PVS122B / PVS123 / PVS176W / PVS1760 / PVS177W / PVS17700 / PVS1950 / PVS1960 / PVS1971 / PVS1977 / PVS1988 / PVS2628 / PVS2628V / RTS2628 / STS20 / STS20S / STS 20 AAS 10 / STS 21 AAST / STS 21 AAS 10 /
STS75E / STS82 Venturer STS13S / STS 32 AAS 10 / STS32S Venturer SVP580 Venturer PVS126A / PVS17200 / PVS1951 / STS31S / STS91
Vieta DVD 2 Vieta DVD 3 Vieta DVD 4 Vieta DVD UNO Vieta DVD 40 / DVD 50
Voxson DVD-221 / DVD-250 / DVD-MXK2 Voxon DVD-320 / DVD-330 Voxson DVD-ZK7 / SL-50 Voxson T172 Voxson DVD-260, DVD-270, DVD-277, DVD-3777, DVD-MXK3, DVDMXK9, DVD-MXK10, DVD-MXK18, DVD-ZK5, DVD-ZK100, M9, MP9, SL-10, SL-10DTVB, SL-50TVS, SL-60, SL-77, SL-80, SLK-7

no hacks

Vtrek DVD-9901B / DVD-K11 Vtrek DVD-9908 / DVD-K9A Welltech DVD-20654 / 40112 / 40954 / HT DVD 02 Welltech 40280 Wharfedale DVD 50 ST / WDP-127 / WMTS-6801 Wharfedale DVD 750 Wharfedale DVD 750 S
Wharfedale WMTS-6801 Wharfedale M3 Wharefedale M5 Wharfedale DVD-800DivX / DVD2900F / DVDTV-1 Wintel WIN9663 Wintel WIN2010 / Wintel WIN3000 Xenius DVD1030 / DVD 2030 Xenius DVDX2040 Xenius HTX 2200 XLogic DVD-838J / XL0901 XMS 150 / 250 / 350 / 750 / 950 XMS 777 XMS 888 XMS 989 XORO HSD 201 XORO HSD 310 / HSD 400 pro / HSD 415 XORO HSD 420 XORO AEP 810 / HSD 303 / HSD 310 / HSD 311 / HSD 311 Pro / HSD 400 Pro / HSD 410 / HSD 415 / HSD 705 / HSD 706 / HSD 710 / HSD 711 / HSD 4000 / HSD 6000 / HSD R505 / HSD R545 / HVR 5500 XWave 9100 XWave LB 900 / LB 1000 XWave LB 1010 / LB 1100
Yamada DVD-2500 / DVD-2600 / DVD-5220 / DVD-5520 / DVX-6700 Yamada DVR-8000 / DVR-8400X Yamada DVR-8100 / DVR-9000H / DVR-9100H Yamaha DVX-5500 Yamaha DVX-6600 Yamada DVD-2001 / DVD-5700 / Chili DVD-6200XS / DVD-MX105 / DVDSlim-5120 / DVDSlim-5320 / DVDSlim-5520 / DVR-8200 / DVR930HX / PDiX-770 / PDV-520 Yamaha DV C6760 / DV C6770 / DV S5550 / DV S5650 / DV S5750 / DV SL100 / DVD 796 / DVD C750 / DVD C950 / DVD E600 / DVD S530 / DVD S540 / DVD S550 / DVD S557 / DVD S560 / DVD S600 / DVD S657 / DVX C300 / DVX C700 / DVX S30 Yamaha DV S5450 / DVD S510 / DVD S5350 Yamaha DVD S520 Yamaha S657 Yamaha DVD S700 / DVD S796 Yamaha DVD S2500 / DVR-S120 / DVR-S150 / DVX S120 / DVX S150 DV C6280, DV C6480, DV C6660, DV S5270, DV S5751, DV S5770, DVD 795, DVD C740, DVD-S80, DVD C900, DVD C920, DVD C940, DVD C996, DVD CX1, DVD S830, DVD S1200, DVD S1500, DVD S2300, DVR-S100, DVX S100, DVX S650, YHT 700 Yamakawa 215 / 255 Yamakawa 218 Yamakawa 238 / 265 / 285 / 285VGA / 288K/VGA Yamakawa 275 Yamakawa 365 DivX Yamakawa 711

100% after deductible 100% after deductible 100% after deductible Tier 1 - $15 Tier 2 - $30 Tier 3 - $55 100% after deductible 100% after deductible Not Covered Not Covered
Services Provided by Rider or Endorsement
Prescription drugs: 30-day supply at a pharmacy (includes contraceptives)* Mail Order: 90-day supply at a participating pharmacy Tier 1 - $15 Tier 2 - $30 Tier 3 - $55 Tier 1 - $15 Tier 2 - $30 Tier 3 - $55
*If a brand name medication is requested when a generic is available, you must pay 100% of the difference in price between the generic and brand name medication, plus the applicable brand copayment. Certain Covered Services require Prior Authorization, including Hospital and Skilled Nursing Facility confinements, Non-emergent transportation, Non-emergent Outpatient Hospital services, MRIs, CAT Scans, PET Scans, Hospice, Pain Management and N0n-emergent Wound care procedures. If you do not obtain authorization for services which require a Prior Authorization, the benefit otherwise payable by Coventry is reduced by $400. This additional out-of-pocket amount will not be used to satisfy Deductible, Coinsurance or Out-of-Pocket Maximum requirements. Please refer to the Certificate of Insurance for further details on Prior Authorization requirements. All Out-of-Network services are subject to the Out-of-Network Deductible and applicable Coinsurance. In addition to the applicable Deductible and Coinsurance, Covered Persons who receive services from Non-Participating Providers shall be responsible for the difference between the NonParticipating Providers bill and the Out-of-Network Rate. This schedule is provided for information only; it does not contain complete details of the Plan which are available only in the Certificate of Insurance and it does not constitute and Agreement. This plan has exclusions and limitations and terms under which the plan may be continued in force or discontinued.
Schedule of Benefits School Board of Broward County High Option PPO Plan 2011
Annual Deductible (Individual / Family) (per calendar year) (Eligible deductible expenses apply toward both the participating and nonparticipating providers) Annual Out-of-Pocket Maximum (Individual / Family) (per calendar year) (Excludes annual deductible and copays) Lifetime Maximum Individual Benefit $250 / $500 $1,000 / $2,000 Unlimited

A complete listing, by carrier, of the co-payments associated with each procedure (Schedule of Benefits), can be found in this publication or on the specific carriers website. Additionally, a listing of the in-network providers can also be found on the specific carriers website.
On the next page is a DHMO Comparison chart which compares the six DHMO plans that are available. Additionally, a Procedure Cost Comparison chart, by carrier, provides a side by side comparison of select dental procedures. The plans are very similar, however, the providers within each network may differ.

DHMO COMPARISON

Plan Provisions
Plan Annual Deductible Annual Benefit Maximum Specialty Care Referral to a Specialist Required Must use in-network providers to obtain benefits. Basic Enhanced FLM86 FLM87 None None None None U&C less 25%* Listed co-payment Yes Yes Most services are covered at no charge. Covered at the listed co-payment. Covered at the listed co-payment.

Delta Dental

Must use in-network providers to obtain benefits Basic Enhanced SBBC97 FGC+B None None None None U&C less 25%* Listed co-payment No No Most services are covered at no charge. Covered at the listed co-payment if performed by your general dentist. Covered at the listed co-payment if performed by your general dentist. 25% Discount Most services are covered at no charge. Covered at the listed co-payment. Covered at the listed co-payment.

Humana/CompBenefits

Must use in-network providers to obtain benefits Basic Enhanced None None U&C less 25%* No Most services are covered at no charge. Covered at the listed co-payment if performed by your general dentist. Covered at the listed co-payment if performed by your general dentist. 25% Discount None None Listed co-payment No Most services are covered at no charge. Covered at the listed co-payment. Covered at the listed co-payment.

MetLife/SafeGuard

Diagnostic & Preventative Most services Oral exams, cleanings, X-rays, topical are covered at no fluoride treatments, etc. charge. Basic Services Filings, root canals, periodontal scaling, oral surgery,extractions, etc. Covered at the listed co-payment if performed by your general dentist. Covered at the listed co-payment if performed by your general dentist. 25% Discount
Major Services Crowns, dentures, bridgework, etc.

Orthodontia (braces)

Covered
This is a comparison only and not a complete summary of benefits. Exclusions and limitations apply. *U&C refers to the usual and customary fees that are customarily charged for dental services by a participating dentist.

Removable partial denture: - Cast metal (D5213, D5214), one or more teeth are missing in an arch. - Resin based (D5211, D5212), one or more teeth are missing in an arch and abutment teeth have extensive periodontal disease.
Retained primary teeth shall be covered as primary teeth. Benefits provided by a pediatric Dentist are limited to children through age seven following an attempt by the assigned Contract Dentist to treat the child and upon referral by the assigned Contract Dentist to a Contract pediatric Dentist, less applicable Copayments. Exceptions for medical conditions, regardless of age limitation, will be considered on an individual basis. The cost to an Enrollee receiving orthodontic treatment whose coverage is cancelled or terminated for any reason will be based on the Contract Orthodontists usual fee for the treatment plan. The Contract Orthodontist will prorate the amount for the number of months remaining to complete treatment. The Enrollee makes payment directly to the Contract Orthodontist as arranged. Orthodontic treatment in progress is limited to new DeltaCare USA Enrollees who, at the time of their original effective date, are in active treatment started under their previous employer sponsored dental plan, as long as they continue to be eligible under the DeltaCare USA program. Active treatment means tooth movement has begun. Enrollees are responsible for all Copayments and fees subject to the provisions of their prior dental plan. Delta Dental is financially responsible only for amounts unpaid by the prior dental plan for qualifying orthodontic cases.
Exclusions of Benefits 1. 2. 3. Any procedure not specifically listed under Schedule A, Description of Benefits and Copayments may be available at the Contract Dentist or Contract Specialists filed fees less 25 percent. Any procedure that in the professional opinion of the Contract Dentist: a. has poor prognosis for a successful result and reasonable longevity based on the condition of the tooth or teeth and/or surrounding structures, or b. is inconsistent with generally accepted standards for dentistry. Services solely for cosmetic purposes, with the exception of procedure D9972, External bleaching, per arch, or for conditions that are a result of hereditary or developmental defects, such as cleft palate, upper and lower jaw malformations, congenitally missing teeth and teeth that are discolored or lacking enamel, except for the treatment of newborn children with congenital defects or birth abnormalities. Porcelain crowns, porcelain fused to metal or resin with metal type crowns and fixed partial dentures (bridges) for children under 16 years of age. Lost or stolen appliances including, but not limited to, full or partial dentures, space maintainers, crowns and fixed partial dentures (bridges). Procedures, appliances or restoration if the purpose is to change vertical dimension, or to diagnose or treat abnormal conditions of the temporomandibular joint (TMJ).

V. PERIODONTICS D4000-D4999 - Includes preoperative and postoperative evaluations and treatment under local anesthetic. D4210 Gingivectomy or gingivoplasty - four or more contiguous teeth or tooth bounded $150.00 spaces per quadrant D4211 Gingivectomy or gingivoplasty - one to three contiguous teeth or tooth bounded $90.00 spaces per quadrant D4260 Osseous surgery (including flap entry and closure) - four or more contiguous $300.00 teeth or bounded teeth spaces per quadrant
D4261 D4271 D4341 D4342 D4355 D4910 CODE
Osseous surgery (including flap entry and closure) - one to three contiguous teeth or tooth bounded spaces per quadrant Free soft tissue graft procedure (including donor site surgery) Periodontal scaling and root planing - four or more teeth per quadrant - limited to 4 quadrants during any 12 consecutive months Periodontal scaling and root planing - one to three teeth per quadrant - limited to 4 quadrants during any 12 consecutive months Full mouth debridement to enable comprehensive evaluation and diagnosis - limited to 1 treatment in any 12 consecutive months Periodontal maintenance - limited to 1 treatment each 6 month period DESCRIPTION
$300.00 $185.00 $50.00 $40.00 $60.00 $35.00 ENROLLEE PAYS
D5110 D5120 D5130 D5140 D5211 D5212 D5213 D5214 D5410 D5411 D5421 D5422 D5510 D5520 D5610 D5620 D5630 D5640 D5650 D5660 D5710
VI. PROSTHODONTICS (removable) - For all listed dentures and partial dentures, Copayment includes after delivery adjustments and tissue conditioning, if needed, for the first six months after placement. The Enrollee must continue to be eligible, and the service must be provided at the Contract Dentists facility where the denture was originally delivered. - Rebases, relines and tissue conditioning are limited to 1 per denture during any 12 consecutive months. - Replacement of a denture or a partial denture requires the existing denture to be 5+ years old. $200.00 Complete denture - maxillary $200.00 Complete denture - mandibular Immediate denture - maxillary $230.00 Immediate denture - mandibular $230.00 Maxillary partial denture - resin base (including any conventional clasps, $175.00 rests and teeth) Mandibular partial denture - resin base (including any conventional clasps, $175.00 rests and teeth) Maxillary partial denture - cast metal framework with resin denture bases $250.00 (including any conventional clasps, rests and teeth) Mandibular partial denture - cast metal framework with resin denture bases $250.00 (including any conventional clasps, rests and teeth) Adjust complete denture - maxillary $10.00 Adjust complete denture - mandibular $10.00 Adjust partial denture - maxillary $10.00 Adjust partial denture - mandibular $10.00 Repair broken complete denture base $35.00 Replace missing or broken teeth - complete denture (each tooth) $15.00 Repair resin denture base $35.00 Repair cast framework $35.00 Repair or replace broken clasp $35.00 Replace broken teeth - per tooth $15.00 Add tooth to existing partial denture $25.00 Add clasp to existing partial denture $30.00 Rebase complete maxillary denture $50.00

In addition, all non-listed services are available with your SafeGuard selected general dentist or specialty care dentist at 75% of their usual and customary fees.
Benefits provided by SafeGuard Health Plans, Inc. Co-payment $0 $0

$0 $0 $0 $0 $0 $0 $0

$0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0

3/07 Basic-SOB

Diagnostic Treatment D0120 Periodic oral evaluation established patient D0140 Limited oral evaluation problem focused D0145 Oral evaluation for a patient under three years of age and counseling with primary caregiver D0150 Comprehensive oral evaluation new or established patient D0180 Comprehensive periodontal evaluation new or established patient D9491 Office visit - per visit (including all fees for sterilization and/ or infection control) $0 $0 $0
Restorative Treatment D2140 Amalgam one surface, primary or permanent D2150 Amalgam two surfaces, primary or permanent D2160 Amalgam three surfaces, primary or permanent D2161 Amalgam four or more surfaces, primary or permanent D2330 Resin-based composite one surface, anterior D2331 Resin-based composite two surfaces, anterior D2332 Resin-based composite three surfaces, anterior D2335 Resin-based composite four or more surfaces or involving incisal angle (anterior) D2390 Resin-based composite crown, anterior D2391 Resin-based composite one surface, posterior D2392 Resin-based composite two surfaces, posterior D2393 Resin-based composite three surfaces, posterior D2394 Resin-based composite four or more surfaces, posterior

$0 $35 $65 $75 $80 $80

Radiographs/Diagnostic Imaging (X-rays) D0210 Intraoral complete series (including bitewings) D0220 Intraoral periapical first film D0230 Intraoral periapical each additional film D0240 Intraoral occlusal film D0250 Extraoral first film D0260 Extraoral each additional film D0270 Bitewing single film D0272 Bitewings two films D0273 Bitewings three films D0274 Bitewings four films D0330 Panoramic film D0350 Oral/facial photographic images
Tests and Examinations D0460 Pulp vitality tests D0470 Diagnostic casts
Preventive Services D1110 Prophylaxis adult D1111 Additional Adult Prophylaxis (maximum of two additional per year) D1120 Prophylaxis child
Crowns **Case involving seven (7) or more crowns and/or fixed bridge units in the same treatment plan require additional $125 copayment per unit in addition to copayment for each crown/ bridge unit. There is a $75 copayment per crown/bridge unit in addition to regular copayments for porcelain on molars. There will be an additional charge for high noble metal or titanium. D2510 Inlay metallic one surface $85 D2520 Inlay metallic two surfaces $95 D2530 Inlay metallic three or more surfaces $120 D2543 Onlay metallic three surfaces $150 D2544 Onlay metallic four or more surfaces $150 D2740 Crown porcelain/ceramic substrate $225 D2750 Crown porcelain fused to high noble metal $185 D2751 Crown porcelain fused to predominantly base metal $185 D2752 Crown porcelain fused to noble metal $185 D2780 Crown cast high noble metal $175 D2781 Crown cast predominantly base metal $175 D2782 Crown cast noble metal $175 D2790 Crown full cast high noble metal $185 D2791 Crown full cast predominantly base metal $185 D2792 Crown full cast noble metal $185 D2794 Crown titanium $185 D2799 Provisional crown $0 D2910 Recement inlay, onlay, or partial coverage restoration $0

$250 $50 $50 $50 $50 $15 $5 $30 $45 $15 $7 $25 $45 $75 $75 $75 $75 $25 $25 $25 $25 $35
Co-payment $0 $0 $25 $10 $25 $12 $25 $40 $0 $0 $0 $0 $25 Available from Participating Orthodontist for discounted fee for service
D5751 D5760 D5761 D5820 D5821 D5850 D5851 D5999 $35 $35 $35 $75 $75 $0 $0 $100
Reline complete mandibular denture (laboratory) Reline maxillary partial denture (laboratory) Reline mandibular partial denture (laboratory) Interim partial denture (maxillary) Interim partial denture (mandibular) Tissue conditioning, maxillary Tissue conditioning, mandibular Duplicate denture
D7285 Biopsy of oral tissue hard (bone, tooth) D7286 Biopsy of oral tissue soft D7310 Alveoloplasty in conjunction with extractions four or more teeth or tooth spaces, per quadrant D7311 Alveoloplasty in conjunction with extractions one to three teeth or tooth spaces, per quadrant D7320 Alveoloplasty not in conjunction with extractions four or more teeth or tooth spaces, per quadrant D7321 Alveoloplasty not in conjunction with extractions one to three teeth or tooth spaces, per quadrant D7450 Removal of benign odontogenic cyst or tumor lesion diameter up to 1.25 cm D7451 Removal of benign odontogenic cyst or tumor lesion diameter greater than 1.25 cm D7510 Incision and drainage of abscess intraoral soft tissue D7960 Frenulectomy (frenectomy or frenotomy) separate procedure D7963 Frenuloplasty D7970 Excision of hyperplastic tissue per arch D7971 Excision of pericoronal gingiva Orthodontics D8660 Pre-orthodontic treatment visit
For Orthodontic services received from a SafeGuard contracted orthodontist, the copayment will be 75% of that orthodontists usual fee for those services. Adjunctive General Services D9110 Palliative (emergency) treatment of dental pain minor procedure $0 D9120 Fixed partial denture sectioning $0 D9215 Local anesthesia $0 D9230 Analgesia, anxiolysis, inhalation of nitrous oxide $10, per 30 minutes D9310 Consultation diagnostic service provided by dentist or physician other than requesting dentist or physician $0 D9430 Office visit for observation (during regularly scheduled hours) no other services performed $0 D9440 Office visit after regularly scheduled hours $35 D9450 Case presentation, detailed and extensive treatment planning $0 D9630 Other drugs and/or medicaments, by report $15 D9951 Occlusal adjustment limited $15 D9952 Occlusal adjustment complete $50 D9999 Broken appointment (less than 24 hour notice) $10, no charge if due to an emergency Current Dental Terminology American Dental Association
Crowns/Fixed Bridges - Per Unit **Case involving seven (7) or more crowns and/or fixed bridge units in the same treatment plan require additional $125 copayment per unit in addition to copayment for each crown/ bridge unit. There is a $75 copayment per crown/bridge unit in addition to regular copayments for porcelain on molars. There will be an additional charge for high noble metal or titanium. D6210 Pontic cast high noble metal $185 D6211 Pontic cast predominantly base metal $185 D6212 Pontic cast noble metal $185 D6214 Pontic titanium $185 D6240 Pontic porcelain fused to high noble metal $185 D6241 Pontic porcelain fused to predominantly base metal $185 D6242 Pontic porcelain fused to noble metal $185 D6545 Retainer cast metal for resin bonded fixed prosthesis $200 D6720 Crown resin with high noble metal $200 D6750 Crown porcelain fused to high noble metal $185 D6751 Crown porcelain fused to predominantly base metal $185 D6752 Crown porcelain fused to noble metal $185 D6780 Crown cast high noble metal $185 D6781 Crown cast predominantly base metal $185 D6782 Crown cast noble metal $185 D6790 Crown full cast high noble metal $185 D6791 Crown full cast predominantly base metal $185 D6792 Crown full cast noble metal $185 D6794 Crown titanium $185 D6930 Recement fixed partial denture $0 D6970 Post and core in addition to fixed partial denture retainer, indirectly fabricated $50 D6972 Prefabricated post and core in addition to fixed partial denture retainer $30 D6973 Core build up for retainer, including any pins $10 D6976 Each additional indirectly fabricated post same tooth $60

Oral Surgery D7140 Extraction, erupted tooth or exposed root (elevation and/or forceps removal) $0 D7210 Surgical removal of erupted tooth requiring elevation of mucoperiosteal flap and removal of bone and/or section of tooth $10 D7220 Removal of impacted tooth soft tissue $20 D7230 Removal of impacted tooth partially bony $50 D7240 Removal of impacted tooth completely bony $75 D7241 Removal of impacted tooth completely bony, with unusual surgical complications $130 D7250 Surgical removal of residual tooth roots (cutting procedure) $15 D7270 Tooth reimplantation and/or stabilization of accidentally evulsed or displaced tooth $110 D7280 Surgical access of an unerupted tooth $200
Dental Terminology Definitions
Exclusions and Limitations
Exclusions - Enhanced Proposed Plan 1. Services performed by a general dentist or specialty care dentist, not contracted with SafeGuard, without prior approval by SafeGuard (except for out of area emergency services). 2. 3. Any procedures not specifically listed as a covered benefit in the Schedule of Benefits.
These definitions are designed to give you a laymans understanding of some dental terminology in order for you to better understand your plan; they are not full descriptions.

Amalgam:

A silver filling

Anterior:

Teeth that are in the front of the mouth

Bicuspid:

Most people have eight bicuspid teeth; they are located immediately preceding the molar teeth with two in each quadrant of the mouth.

Bridge: 4.

A replacement for one or more missing teeth that is permanently attached to the teeth adjacent to the empty space(s).
Dental procedures initiated prior to the members eligibility under this plan or started after the members termination from the Plan, except in the limited circumstances in which there exists an acute condition, a serious chronic condition, or the performance of a surgery or other procedure that is authorized by SafeGuard as part of a documented course of treatment and has been recommended and documented by the provider to occur within 180 days of the prior contracts termination date or within 180 days of the effective date of coverage for any newly covered employee. Any dental services, or appliances which are determined to be not reasonable and/or necessary for maintaining or improving the members dental health, as determined by the SafeGuard Selected General Dentist. Dental procedures or services performed solely for cosmetic purposes or solely for appearance are excluded; however, cosmetic and procedures not listed in the Schedule of Benefits will be provided at 75% of the participating dentists usual and customary fee for those services. Orthognathic surgery. General anesthesia or intravenous sedation. Any inpatient/outpatient hospital charges of any kind including dentist and/or physician charges, prescriptions or medications. Replacement of dentures, crowns, appliances or bridgework that have been lost, stolen or damaged due to abuse, misuse, or neglect.

The retention phase of treatment shall include the construction, placement, and adjustment of retainers.
MetLife/SafeGuard Enhanced DHMO Schedule of Benfits

Co-payment $0

Enhanced
D1204 Topical application of fluoride (prophylaxis not included) adult D1206 Topical fluoride varnish; therapeutic application for moderate to high caries risk patients D1330 Oral hygiene instructions D1351 Sealant per tooth D1510 Space maintainer fixed unilateral D1515 Space maintainer fixed bilateral D1520 Space maintainer removable unilateral D1525 Space maintainer removable bilateral D1550 Recementation of space maintainer D1555 Removal of fixed space maintainer
This sample Schedule of Benefits lists the services available to you under your SafeGuard plan, as well as the copayments associated with each procedure. There are other factors that impact how your plan works and those are included here in the Exclusions and Limitations.
Specialty Care Information: During the course of treatment, your SafeGuard selected general dentist may recommend the services of a dental specialist. Your selected general dentist may refer you directly to a contracted SafeGuard specialty care provider; no referral or authorization from SafeGuard is required.
$0 $0 $0 $25 $25 $35 $35 $5 $5
In addition, all non-listed services are available with your SafeGuard selected general dentist or specialty care dentist at 75% of their usual and customary fees. Co-payment $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0
Benefits provided by SafeGuard Health Plans, Inc.
Diagnostic Treatment D0120 Periodic oral evaluation established patient D0140 Limited oral evaluation problem focused D0145 Oral evaluation for a patient under three years of age and counseling with primary caregiver D0150 Comprehensive oral evaluation new or established patient D0180 Comprehensive periodontal evaluation new or established patient D9491 Office visit - per visit (including all fees for sterilization and/ or infection control)
$0 $0 $0 $0 $0 $0 $0 $0 $35 $65 $75 $80 $80

Enhanced-SOB

Preventive Services D1110 Prophylaxis adult D1111 Additional Adult Prophylaxis (maximum of two additional per year) D1120 Prophylaxis child D1121 Additional Child Prophylaxis (maximum of two additional per year) D1203 Topical application of fluoride (prophylaxis not included) child
Crowns **Case involving seven (7) or more crowns and/or fixed bridge units in the same treatment plan require additional $125 copayment per unit in addition to copayment for each crown/ bridge unit. There is a $75 copayment per crown/bridge unit in addition to regular copayments for porcelain on molars. There will be an additional charge for high noble metal or titanium. D2510 Inlay metallic one surface $85 D2520 Inlay metallic two surfaces $95 D2530 Inlay metallic three or more surfaces $120 D2543 Onlay metallic three surfaces $150 D2544 Onlay metallic four or more surfaces $150 D2740 Crown porcelain/ceramic substrate $225 D2750 Crown porcelain fused to high noble metal $185 D2751 Crown porcelain fused to predominantly base metal $185 D2752 Crown porcelain fused to noble metal $185 D2780 Crown cast high noble metal $175 D2781 Crown cast predominantly base metal $175 D2782 Crown cast noble metal $175 D2790 Crown full cast high noble metal $185 D2791 Crown full cast predominantly base metal $185 D2792 Crown full cast noble metal $185 D2794 Crown titanium $185 D2799 Provisional crown $0 D2910 Recement inlay, onlay, or partial coverage restoration $0 D2915 Recement cast or prefabricated post and core $0 D2920 Recement crown $0

FLORIDA RETIREMENT SYSTEM
Prior to 2002, the Florida Retirement System (FRS) offered one retirement option: the FRS Pension Plan. It provided a retirement benefit based on years of service at retirement, employees highest five years of pay and FRS membership class during the time an employee is with an FRS employer. Today, employees have a choice to either participate in the FRS Pension Plan or participate in the FRS Investment Plan. The FRS Investment Plan lets employees decide how to allocate employers monthly contributions among one or more investment funds. Both FRS options are funded entirely by the School Board of Broward County, Florida. Located on the following page is a summary of the key differences between the FRS Pension Plan and the FRS Investment Plan. In addition to the above information, the Florida Retirement System also offers individuals an opportunity to increase their retirement benefit by purchasing: prior service (as approved by the State of Florida, Division of Retirement) certain military service board approved leave of absence in-state and / or out-of state service (as approved by the State of Florida, Division of Retirement) To obtain more information on the Florida Retirement System (FRS), you may contact the Benefits Department at 754321-3100 or log onto www.browardschools.com/Benefits. Call FRS regarding the Pension Plan at 1-888-738-2252. Call My FRS Financial Guidance at 1-866-44-MYFRS regarding the Investment Plan or log onto www.myfrs.com.
Plan type Who contributes How it works Who invests Who assumes the investment risk and rewards Other Factors influencing employees benefit level Vesting (benefit ownership) Amount of benefit paid at retirement Will benefits continue to grow if employee changes employers? Retirement income options Deferred Retirement Option Program (DROP) participation

FRS Pension Plan

Defined benefit retirement plan Monthly contributions are employer-paid. Monthly contributions based on a percent of salary and FRS membership class - paid to a trust fund for all FRS members. Benefits are based on a formula (years of service, highest 5 years of salary, FRS membership class). The state Board of Administration (SBA) invests the Pension Plan trust Fund by choosing investment strategies and investment firms. FRS and employers.

FRS Investment Plan

Defined contribution retirement plan. Monthly contributions are employer-paid. Monthly contributions based on a percent of salary and FRS membership class - paid to to employees accounts. Benefits are based on employees account value (contributions plus investment earnings less expenses and losses). Employees choose how contributions are allocated among various investment funds. The SBA chooses private investment firms to manage the investment funds. You.

PART III - CAFETERIA PLAN GUIDELINES
Plan elections are effective for the entire plan year and cannot be changed except as permitted below. Changing your Elections Cafeteria Plan elections made during the annual Open Enrollment period become effective January 1 of the upcoming year, and remain in effect for the entire calendar year. The School Board intends to provide you with the broadest ability to make mid-year election changes permitted in accordance with Internal Revenue Service (IRS) rules. To summarize those IRS rules, you cannot change your level of participation unless you experience one of the following events and notify the Benefits Department within 31 days of such event. Change in Status. You may modify your Cafeteria Plan election for the remainder of the plan year if one of the following events affects the eligibility for coverage under the Plan for you, your spouse and/or dependent as long as your requested Cafeteria Plan change is consistent with the Change in Status: Marital Status: A change in your marital status, including marriage, death of a spouse, divorce or annulment. Change in Number of Tax Dependents: A change in the number of your dependents, including birth, death, adoption or placement for adoption. Change in Status of Employment Affecting Coverage Eligibility. A change in your employment status (or the employment status of your spouse or dependent) that affects the individuals eligibility under an employers plan, such as commencement or termination of employment.
Gain or Loss of Dependents Eligibility Status. A gain or loss of eligibility status is an event that causes your dependent to satisfy or cease to satisfy coverage requirements under the plan, such as change in age, student, marital, employment or tax dependent status. Change in Residence. A change in your residence, and/or the residence of your spouse or dependent, such as moving outside the HMO service area.
As an example of the consistency requirement, lets assume you are married and elect Employee Plus One coverage beginning January 1, 2011. However, you and your spouse divorce on May 15, 2011. You may change your election under the Cafeteria Plan from Employee Plus One coverage to Employee Only coverage if you notify the Benefits Department by June 15, 2011. Your election to drop your former spouse from the plan and choose Employee Only coverage is consistent with your divorce. Medicare, Medicaid or other governmental sponsored health coverage Entitlement: Gain or loss of Medicare or Medicaid by you, your spouse and/or dependent may allow you to drop or enroll the appropriate individuals in the Plan. Judgment, Decree or Court Order: If a judgment, decree or order from a divorce, annulment or change in legal custody requires that you provide accident or health coverage for your dependent child, you may change your election to provide coverage for the dependent child. If the order requires that another individual (such as your spouse or former spouse) cover the dependent child and provide coverage under that individuals plan, you may change your election to revoke coverage only for that dependent child and only if the other individual actually provides the coverage. Open Enrollment Under Other Employers Plan: You may make an election change when your spouse or dependent makes an Open Enrollment Change in coverage under their employers plan if they participate in their employers plan and (1) the other employers plan has a different period of coverage than the School Boards Plan and (2) the other employers plan permits mid-year election changes for this same event. Enrollment Rights with a 60 day Notice Requirement: : You may make an election change if you, your spouse and/or dependents lose eligibility under Medicaid or a state childrens health insurance program (SCHIP), or become eligible for premium assistance under Medicaid or a SCHIP program. You must notify the Benefits Department within 60 days of such event. Remember: You must give prompt notification in writing to the Benefits Department to make any of the above-described changes.

(Available on Regular School Days or Teacher Work Days)
Blood Pressure Cholesterol Hearing Vision Blood Sugar Skin Colon Body Mass Index Posture Mammogram Van (Minimum of 10 women) Bone Density Prostate (Once a year)
Flu Shots (Seasonal) Weight Loss Programs: Weight Watchers(Minimum of 15 people) www.weightwatchers.com The Weight Manager (Minimum of 8 people) www.theweightmanager.com
This booklet covers some of the major highlights and provisions of the benefits available to The School Board of Broward County, Florida employees. It is not intended to replace the Certificates of Coverage provided by the carriers. The Board approved contracts and the Certificates of Coverage will serve as the final authority in determining benefits. Please read ALL material carefully. If you have any questions, please contact the Benefits Department at 754-321-3100 or you may contact the appropriate company directly.
If you have questions about the following benefit coverages, please refer to the listing delineated below for the appropriate company to contact:

MEDICAL DENTAL

DELTA DENTAL METLIFE
COVENTRY (In-House Representatives)
954-832-9061 (8:00am - 5:00pm)

HUMANA/COMPBENEFITS

866-890-4464 954-527-4088 800-422-4234 888-865-6878 954-321-6911 800-936-5315 954-590-9560 954-308-5562

METLIFE/SAFEGUARD

HUMANA/COMPBENEFITS VISION PLAN

800-865-3676

RELIANCE STANDARD LIFE INSURANCE
877-268-7606 954-846-7370 800-842-1718

DISABILITY

THE PRUDENTIAL INSURANCE COMPANY
FRINGE BENEFITS MANAGEMENT COMPANY

800-342-8017

VOLUNTARY SUPPLEMENTAL INSURANCE
AMERICAN HERITAGE LIFE INSURANCE COMPANY Cancer/Specified Disease, Hospital Indemnity, and Individual Universal Life 954-485-9909
CNA INSURANCE Long Term Care

866-357-8482

ING EMPLOYEE BENEFITS Group Universal Life

954 485-9909

MASS MUTUAL LIFE INSURANCE COMPANY Long Term Care

Page 2 of 3

Disability extension of 18-month period of continuation coverage If you or anyone in your family covered under the Plan is determined by the Social Security Administration to be disabled and you notify the Plan Administrator in a timely fashion, you and your entire family may be entitled to receive up to an additional 11 months of COBRA continuation coverage, for a total maximum of 29 months. The disability would have to have started at some time before the 60th day of COBRA continuation coverage and must last at least until the end of the 18-month period of continuation coverage. You must provide this notice to: Benefits Department, School Board of Broward County, 7770 W. Oakland Park Blvd., Sunrise, FL 33351. Supporting documentation is required to support the date and qualifying event. Second qualifying event extension of 18-month period of continuation coverage If your family experiences another qualifying event while receiving 18 months of COBRA continuation coverage, the spouse and dependent children in your family can get up to 18 additional months of COBRA continuation coverage, for a maximum of 36 months, if notice of the second qualifying event is properly given to the Plan. This extension may be available to the spouse and any dependent children receiving continuation coverage if the employee or former employee dies, becomes entitled to Medicare benefits (under Part A, Part B, or both), or gets divorced or legally separated, or if the dependent child stops being eligible under the Plan as a dependent child, but only if the event would have caused the spouse or dependent child to lose coverage under the Plan had the first qualifying event not occurred. If You Have Questions Questions concerning your Plan or your COBRA continuation coverage rights should be addressed to the contact or contacts identified below. For more information about your rights under COBRA, the Health Insurance Portability and Accountability Act (HIPAA), and other laws affecting group health plans, contact the nearest Regional or District Office of the U.S. Department of Labors Employee Benefits Security Administration (EBSA) in your area or visit the EBSA Web site at www.dol.gov/ebsa. (Addresses and phone numbers of Regional and District EBSA Offices are available through EBSAs Web site.) Keep Your Plan Informed of Address Changes In order to protect your familys rights, you should keep the Plan Administrator informed of any changes in the addresses of family members. You should also keep a copy, for your records, of any notices you send to the Plan Administrator. Plan Contact Information: Broward County Public Schools Attn: Benefits Department 7770 W. Oakland Park Blvd. Sunrise, FL 33351 PH: 754-321-3100 FAX: 754-321-3280

Important Notice from The School Board of Broward County, Florida About Your Prescription Drug Coverage and Medicare
You should also know that if you drop or lose your coverage with SBBC and do not join a Medicare prescription drug plan within 63 continuous days after your current coverage ends, you may pay a higher premium (a penalty) to join a Medicare prescription drug plan later. If you go 63 continuous days or longer without prescription drug coverage that is at least as good as Medicares prescription drug coverage, your monthly premium may go up by at least 1% of the base beneficiary premium per month for every month that you did not have that coverage. For example, if you go 19 months without coverage, your premium may consistently be at least 19% higher than the base beneficiary premium. You may have to pay this higher premium (a penalty) as long as you have Medicare prescription drug coverage. In addition, you may have to wait until the following November to join. For more information about your options under Medicare prescription drug coverage More detailed information about Medicare plans that offer prescription drug coverage is in the Medicare & You handbook. You will get a copy of the handbook in the mail every year from Medicare. You may also be contacted directly by Medicare prescription drug plans. For more information about Medicare prescription drug coverage: Visit www.medicare.gov Call your State Health Insurance Assistance Program (see the inside back cover of your copy of the Medicare & You Handbook for their telephone number) for personalized assistance, Call 1-800-MEDICARE (1-800-633-4227). TTY users should call 1-877-486-2048. If you have limited income and resources, extra help paying for Medicare prescription drug coverage is available. For more information about this extra help, visit Social Security on the web at www.socialsecurity.gov, or you may call them at 1-800-772-1213. (TTY 1-800-325-0778) For more information about this notice or your current prescription drug coverage: Contact SBBCs Benefits Office by calling Ms. Donna Mongston, Personnel Administrator III, at 754-321-3100, or via email at donna.mongston@browardschools.com NOTE: You may receive this notice at other times in the future such as before the next period you can enroll in Medicare prescription drug coverage, if this coverage through SBBC changes. You may also request a copy. Remember: Keep this Credible Coverage notice. If you decide to join one of the Medicare drug plans, you may be required to provide a copy of this notice when you join to show whether or not you have maintained creditable coverage and whether or not you are required to pay a higher premium (a penalty).