2018 Benefits at a Glance
PLAN YEAR:
January 15, 2014 – December 31, 2014
CONTENTS & CONTACT INFORMATION
Refer to this list when you need to contact one of your benefit vendors. For general information contact Human Resources.
HUMAN RESOURCES Name, Title
Sarah Cammer, Human Resources Generalist
hr@physicianleaders.org
Phone
813-636-2805
BROKER PARTNER – M.E. WILSON COMPANY Broker Contact
Katie Reeves Miller
kmiller@mewilson.com
Phone
813-229-8021 Ext. 132
MEDICAL
page 3
Provider Name
United Healthcare
Provider Phone Number
1-866-633-2446
Provider Web Address
www.myuhc.com
DENTAL
page 5
Provider Name
Guardian
Provider Phone Number
1-800-541-7846
Provider Web Address
www.GuardianAnytime.com
VISION
page 6
Provider Name
Advantica
Provider Phone Number
1-866-425-2323
Provider Web Address
www.advanticabenefits.com
BASIC AND VOLUNTARY LIFE AND AD&D INSURANCE page 7 Provider Name Standard Provider Phone Number 1-800-348-3226 Provider Web Address www.standard.com SHORT TERM AND LONG TERM DISABILITY page 8 Provider Name Standard Provider Phone Number 1-800-348-3226 Provider Web Address www.standard.com
EMPLOYEE ASSISTANCE PROGRAM
page 9
DISCLOSURE NOTICES
page 10
BENEFIT INFORMATION
Benefit
Who pays the cost?
AAPL pays 100% of the employee cost and 50% of the dependent cost for the Base HMO medical plan. You are responsible for the remaining dependent cost. You may also choose to enroll in the PPO medical plan for an additional cost. AAPL pays 100% of the employee only dental cost. You may enroll your eligible dependents for an additional cost, which you will be responsible for. AAPL pays 100% of the employee only vision cost. You may enroll your eligible dependents for an additional cost, which you will be responsible for.
Medical Insurance
YOUR BENEFITS
Dental Insurance
AAPL offers a variety of benefits allowing you the opportunity to customize a benefits package that meets your personal needs. In the following pages, you’ll learn more about the benefits offered. You’ll also see how choosing the right combination of benefits can help protect you and your family’s health and finances – and your family’s future.
Vision Insurance
Basic Life Insurance
AAPL pays 100% of the cost for Basic Life coverage.
AAPL offers you the option to purchase additional life insurance for yourself, your spouse, and/or your child(ren). You are responsible for the cost of coverage for yourself and your dependents.
Voluntary Life Insurance
Short and Long Term Disability Insurance
AAPL pays 100% of the cost for disability coverage.
ELIGIBILITY
All Regular full-time employees are eligible to join the AAPL Benefits Plan on the 1st of the month following 60 days from your date of hire. “Regular Full-Time Employees” must be regularly scheduled and working at least 25 hours per week.
You may also enroll your dependents in the Benefits Plan when you enroll.
Eligible dependents include:
Your legal spouse
•
• Your married or unmarried natural children, step-
children living with you, legally adopted children and any other children for whom you have legal guardianship, who are:
WHEN CAN YOU ENROLL?
You can sign up for Benefits at any of the following times:
► Under 26 years of age;
► A dependent who is older than 26 years of age, but less than 30 years of age may be eligible for medical benefits. To be eligible, a Dependent must: • Be unmarried and not have dependents of his or her own; AND
• After completing your initial eligibility period; • During the annual open enrollment period; • Within 30 days of a qualified family-status change. If you do not enroll at one of the above times, you may enroll during the next annual open enrollment period.
Be a resident of Florida or a student; AND
•
Not have coverage of their own, or covered under any other plan, including Medicare
•
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BENEFIT INFORMATION
?
CHOOSING YOUR BENEFITS
You are required to actively choose any benefits paid for by AAPL or that you pay for or share in the cost of. Your part of the cost is automatically taken out of your paycheck. There are two ways that the money can be taken out:
WHY DO I PAY FOR BENEFITS WITH BEFORE-TAX MONEY?
There is a definite advantage to paying for some benefits with before-tax money:
• BEFORE YOUR TAXES ARE CALCULATED – Medical, Dental, and Vision
Taking the money out before your taxes are calculated lowers the amount of your pay that is taxable. Therefore, you pay less in taxes.
• AFTER YOUR TAXES ARE CALCULATED – Life and Disability
MAKING CHANGES MAKING CHANGES
Generally, you can only change your benefit choices during the annual benefits enrollment period. However, you may be able to change your benefit choices during the plan year if you have a change in status including:
Your marriage
• Change in your work status that affects your benefits
•
Your divorce or legal separation
• Change in residence or work site that affects your eligibility for coverage
•
• Birth or adoption of an eligible child
• Change in your child’s eligibility for benefits
• Death of your spouse or covered child
• Receiving Qualified Medical Child Support Order (QMCSO)
• Change in your spouse’s work status that affects his or her benefits
If you fail to notify Human Resources within 30 days of a
family status change, you will be required to wait until the
next annual enrollment period to make benefit changes
unless you have another family status change.
WHEN COVERAGE ENDS
Coverage will stop on the last day of the month in which employment with the company ends.
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MEDICAL INSURANCE
AAPL offers two medical plans through United Healthcare. To find participating providers go to www.myuhc.com and click on “Find a Doctor”. On the following screen select “All United Healthcare Plans.” Select either “Choice HMO” or “Choice”, depending on which plan you are interested in. See chart below for network per plan. Complete the remaining information and click Search.
The chart below provides a brief overview of the medical plans. This chart is intended only to highlight the benefits available and should not be relied upon to fully determine your coverage. If the below illustration of benefits conflicts in any way with the Summary Plan Description (SPD), the SPD shall prevail. It is suggested that you review your exact description of services and supplies that are covered, those which are excluded or limited, and other terms and conditions of coverage.
HMO Plan Choice AUXC
PPO Plan Choice AUW4
IN-NETWORK
Choice HMO
Choice PPO
Deductible (Individual / Family)
$3,500 / $7,000
$2,000 / $4,000
Maximum Out-of-Pocket (Individual / Family)
$7,350 / $14,700
$4,000 / $8,000
Deductible, Coinsurance, & Copays
Deductible, Coinsurance, & Copays
Out-of-Pocket Max Includes
Coinsurance
80% / 20%
90% / 10%
Routine Preventive Services
Wellness
Immunizations
Covered 100%
Covered 100%
Mammography/Colonoscopy
Office Visits & Facility Services
Referral required
No
No
PCP Office Visits
$40 Copay
$25 Copay
Specialist Visits
$80 Copay
$50 Copay
Inpatient Hospital
20% after deductible
10% after deductible
Outpatient Surgery
20% after deductible
10% after deductible
Emergency Room
20% after deductible
$250 copay
Urgent Care
20% after deductible
$50 copay
OUTPATIENT DIAGNOSTIC SERVICES
Lab Services (Freestanding Lab)
20% after deductible
10% after deductible
X-Ray Services (Freestanding Lab)
20% after deductible
10% after deductible
Complex Diagnostic
20% after deductible
10% after deductible
PRESCRIPTIONS
Retail (30 day supply)
$10 / $35 / $60
$10 / $35 / $60
Mail Order (90 day supply)
2.5x retail
2.5x retail
OUT-OF-NETWORK
Deductible
Maximum Out-of-Pocket
Not Available
Not Available
Coinsurance
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MEDICAL INSURANCE
Employee Payroll Deductions
HMO Plan Choice AUXC
Employer Cost Monthly
Employee Cost Monthly
Employee Cost Bi-Weekly
Employee Only
$ 466.90
$ 0.00
$ 0.00
Employee + Spouse
$ 70035
$ 233.45
$ 107.75
Employee + Child(ren)
$ 665.34
$ 198.44
$ 91.59
Employee + Family
$ 898.79
$ 431.89
$ 199.33
HMO Plan Choice AUW4
Employer Cost Monthly
Employee Cost Monthly
Employee Cost Bi-Weekly
Employee Only
$ 466.90
$ 197.35
$ 91.08
Employee + Spouse
$ 700.35
$ 628.15
$ 289.92
Employee + Child(ren)
$ 665.34
$ 563.53
$ 260.09
Employee + Family
$ 898.79
$ 994.33
$ 458.92
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DENTAL INSURANCE
AAPL offers dental coverage through Guardian. The Dental PPO Plan allows you to use in-network or out-of-network benefits. If out-of-network dentists are used, you will be responsible to pay the difference between Guardian’s allowed amount and what the dentist may charge, also known as “balance billing”. The charts below provides a brief overview of the plan.
DentalGuard Preferred
In-Network
Out-Of-Network
Deductible
$0
$50
Individual
$0
$150
Family
Annual Maximum (per covered member)
$1,500
$1,000
Preventive Services
Covered in full
Covered in full
Exams, Cleanings, & Fluoride
Basic Services
Fillings, Simple Extractions, Perio & Endo (other than those listed below) Major Services Crowns, Bridges, Surgical Extractions, Root Canal, Dentures, Osseus Surgery & Endo Molars
90% covered after deductible
80% covered after deductible
60% covered after deductible
50% covered after deductible
Orthodontia
Coinsurance Lifetime Maximum
50% covered after deductible $1,000 (combined maximum for in-network and out-of network)
Employer Cost Monthly
Employee Cost Monthly
Employee Cost Bi-Weekly
Dental PPO
Employee Only
$ 41.54
$ 0.00
$ 0.00
Employee + Spouse
$ 41.54
$ 47.88
$ 22.10
Employee + Child(ren)
$ 41.54
$ 73.61
$ 33.97
Employee + Family
$ 41.54
$ 108.76
$ 50.20
1 Subject to balance billing. Please refer to your plan document for specific details.
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VISION INSURANCE
AAPL offers vision coverage through Advantica. The Advantica vision plan allows you the flexibility to see any provider. To search in-network providers go to www.AdvanticaBenefits.com and search under “future member”. For out-of-network claims you pay expenses at the time of service and file a claim for reimbursement. Below is a list of the reimbursement schedule.
Your vision is important to your health. Whether your vision is 20/20 or less than perfect, everyone should receive regular vision care.
Vision
In-Network
Out-of-Network
Routine Eye Exams
$10 copay
$10 copay
Lenses
Every 12 months
Single Vision Bifocal Trifocal Lenticular
Standard Plastic :
Standard Plastic :
Covered in full after $10 copay
Reimbursed up to $100
Upgraded Materials or Lens types: Polycarbonate Lenses: Covered in full (ages 19 and under)
Upgraded Materials or Lens types: Not covered
Standard Progressives: additional $50 copay Photochromic Lenses: additional $60 copay
Frames
Every 12 months
$150 retail allowance
Reimbursed up to $60
Contact Lenses
Every 12 months
Elective Contact Lenses Medically Necessary
$150 retail allowance $250 retail allowance
Reimbursed up to $80 Reimbursed up to $250
Contact Lens Fitting
$40 allowance
Not covered
• Covered lenses include single vision, bifocal, trifocal and lenticular. • Lenses, Frames & Contacts are limited to either one pair of contacts or frames/lenses per calendar year.
Employer Cost Monthly
Employee Cost Monthly
Employee Cost Bi-Weekly
Vision
Employee Only
$ 7.39
$ 0.00
$ 0.00
Employee + Spouse
$ 7.39
$ 6.46
$ 2.98
Employee + Child(ren)
$ 7.39
$ 8.32
$ 3.84
Employee + Family
$ 7.39
$ 15.50
$ 7.15
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BASIC LIFE AND AD&D INSURANCE
AAPL provides all benefit eligible employees with Basic Life and AD&D insurance, at no cost to the employee!
Basic Life and AD&D
Benefit Amount
$50,000
At age 65: reduced by 35% At age 70: reduced by 50% At age 75: reduced by 65%
Age Reduction Schedule
AD&D
Included – equal to Basic Life amount
VOLUNTARY LIFE AND AD&D INSURANCE
AAPL offers all employees the opportunity to purchase Voluntary Life and AD&D Insurance.
Voluntary Life and AD&D
Employee Benefit Amount
Increments of $10,000 up to a maximum of $300,000
Guaranteed Issue Amount
$100,000
Spouse Benefit Amount
Increments of $5,000 up to $150,000
Guaranteed Issue Amount
$20,000
Child Benefit Amount
$10,000
Accidental Death & Dismemberment (AD&D)
Equal to Life benefit amount elected
At age 65: reduced by 35% At age 70: reduced by 50% At age 75: reduced by 65%
Age Reduction Schedule
Monthly Cost per $1,000 (includes cost of AD&D)
COST CALCULATION:
Age
Employee/Spouse*
Child(ren)
_____________________ Benefit Amount
<29
$0.09
$0.22
30 – 34
$0.10
/ 1,000
35 – 39
$0.11
X ____________________ Monthly Rate (from chart)
40 – 44
$0.15
45 – 49
$0.20
= ____________________ Approximate monthly cost
50 – 54
$0.33
X12
55 – 59
$0.54
60 – 64
$0.72
/ 26 =____________________ Approximate bi-weekly Cost
64 – 69
$1.27
70 – 74
$2.74
*Spouse’s cost of coverage is based on the employee’s age
75+
$10.31
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SHORT-TERM DISABILITY
AAPL provides all benefit eligible employees with Short-Term Disability insurance, at no cost to the employee!
Short-Term Disability Insurance
Benefit Percentage
60% of weekly income
Salary <$40,000: $1,500 Salary of $40,000+: $2,500
Maximum Weekly Benefit
7th day for Accident 7th day for Sickness
Elimination Period
Duration of Benefit
90 days
LONG-TERM DISABILITY INSURANCE
AAPL provides all benefit eligible employees with Short-Term Disability insurance, at no cost to the employee!
Long-Term Disability Insurance
Class 1: Employee salary <$40,000
Benefit Percentage
60% of monthly income
Salary <$40,000: $6,000 Salary of $40,000+ : $10,000
Maximum Weekly Benefit
Elimination Period
90 days
Duration of Benefit
Normal Social Security Retirement Age
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EMPLOYEE ASSISTANCE PROGRAM (EAP)
AAPL provides all benefit eligible employees with access to the Employee Assistance Program (EAP) through LifeWorks! This program is available to all employees and their dependents within the household at NO COST!
Who will you speak with?
When utilizing the EAP you’ll be connected with a master’s level staff clinician for information, consultation, resources and referrals on a range of work-life issues. LifeWorks on-staff clinicians have a minimum of five years’ clinical experience, their on-staff legal consultants are JDs, and on-staff financial consultants have both clinical and financial consulting expertise.
How can you access the EAP?
By phone All calls are answered live by LifeWorks employees 24/7/365. Phone consultations are unlimited and available to employees, family members and anyone significant to the employee. In-Person Up to 3 face-to-face sessions per issue for assessment and short-term problem resolution. No limit to the number of issues per year. National network of licensed EAP counselors who perform face-to-face assessments and short term problem resolution sessions. All EAP providers possess a master’s degree or higher, state licensure, EAP experience and three years or more of clinical experience. Online and Video ( www.Lifeworks.com ) Chat functionality enables employees and their families to easily and conveniently connect with a LifeWorks consultant in a secure online conversation. For employees and their families who have location, disability or time challenges, LifeWorks offers video counseling through a HIPAA compliant, secure platform.
Mobile An app for mobile devices makes the LifeWorks.com site accessible from anywhere at any time for iPhone and Android users.
What can you contact LifeWorks about?
Emotional Well-Being , such as: Relationship issues, stress, coping with change, grief and loss, family and marital issues, adjustment disorder, depression, anxiety and domestic violence. Addiction and Recovery , on-staff Substance Abuse Specialists can help with: Drug and alcohol abuse, mandated referrals, eating disorders and gambling. They can also provide referrals to treatment centers, individual counseling, self-help groups and community resources. Financial Services , On-staff accredited Financial Consultants can provide consultations regarding: Credit management, home buying, mortgage/refinancing evaluation, retirement planning, 401(k) plan questions, basic estate planning and questions about tax planning and preparation. Legal Services , on-staff licensed attorneys who help participants: Understand their legal issues and identify alternative ways to resolve those issues. Free 30-minute consultation with an attorney in- person or by phone, per issue. 25% discount on services beyond initial consultation. Consultations regarding divorce, family matters, landlord/tenant and real estate, consumer credit concerns, criminal matters or debtor/creditor issues.
Parenting and Child Care Parenting skills, positive discipline, child development, safety, becoming a parent and special needs issues.
Resources for Older Adults Caring for elders, as well as transition to retirement, the aging process, caregiver support, federally funded programs such as Medicare and Medicaid, long distance caregiving and communicating with an older relative.
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REQUIRED ANNUAL EMPLOYEE DISCLOSURE NOTICES
Required Annual Employee Disclosure Notices
THE NEWBORNS’ AND MOTHERS’ HEALTH PROTECTION ACT OF 1996 The Newborns’ and Mothers’ Health Protection Act of 1996 prohibits group and individual health insurance policies from restricting benefits for any hospital length of stay for the mother or newborn child in connection with childbirth; (1) following a normal vaginal delivery, to less than 48 hours, and (2) following a cesarean section, to less then 96 hours. Health insurance policies may not require that a provider obtain authorization from the health insurance plan or the issuer for prescribing any such length of stay. Regardless of these standards an attending health care provider may, in consultation with the mother, discharge the mother or newborn child prior to the expiration of such minimum length of stay. Further, a health insurer or health maintenance organization may not: 1. Deny to the mother or newborn child eligibility, or continued eligibility, to enroll or to renew coverage under the terms of the plan, solely to avoid providing such length of stay coverage; 2. Provide monetary payments or rebates to mothers to encourage such mothers to accept less than the minimum coverage; 3. Provide monetary incentives to an attending medical provider to induce such provider to provide care inconsistent with such length of stay coverage; 5. Restrict benefits for any portion of a period within a hospital length of stay described in this notice. These benefits are subject to the plan’s regular deductible and co- pay. For further details, refer to your Summary Plan Description. Keep this notice for your records and call Human Resources for more information. Effective January 1, 2009 group health plans are required by Federal government to comply with Section 111 of the Medicare, Medicaid, and SCHIP Extensions of 2007’s new Medicare Secondary Payer regulations. The mandate is designed to assist in establishing financial liability of claims assignments. In other words, it will help establish who pays first. The mandate requires group health plans to collect additional information, more specifically Social Security numbers for all enrollees, including dependents 6 months of age or older. Please be prepared to provide this information on your benefits enrollment form when enrolling into benefits. 4. Require a mother to give birth in a hospital; or SECTION 111
WOMEN’S HEALTH AND CANCER RIGHTS ACT OF 1998 The Women’s Health and Cancer Rights Act of 1998 requires AAPL to notify you, as a participant or beneficiary of the AAPL Health and Welfare Plan, of your rights related to benefits provided through the plan in connection with a mastectomy. You, as a participant or beneficiary, have rights to coverage to be provided in a manner determined in consultation with your attending physician for: 2. Surgery and reconstruction of the other breast to produce a symmetrical appearance; and 3. Prostheses and treatment of physical compilations of the mastectomy, including lymphedema. These benefits are subject to the plan’s regular deductible and co-pay. For further details, refer to your Summary Plan Description. Keep this notice for your records and call Human Resources for more information. The law allows for continued coverage for dependent children who are covered under your group health plan as a student if they lose their student status because of a medically necessary leave of absence from school. This law applies to medically necessary leaves of absence that begin on or after January 1, 2010 If your child is no longer a student, as defined in your Certificate of Coverage, because he or she is on a medically necessary leave of absence, your child may continue to be covered under the plan for up to one year from the beginning of the leave of absence. This continued coverage applies if your child was (1) covered under the plan and (2) enrolled as at student at a post- secondary educational institution (includes colleges, universities, some trade schools and certain other post- secondary institutions). Your employer will require a written certification from the child’s physician that states that the child is suffering from a serious illness or injury and that the leave of absence is medically necessary. 1. All stages of reconstruction of the breast on which the mastectomy was performed; MICHELLE’S LAW
10
REQUIRED ANNUAL EMPLOYEE DISCLOSURE NOTICES continued
Required Annual Employee Disclosure Notices continued
HIPAA PRIVACY POLICY FOR FULLY- INSURED PLANS WITH NO ACCESS TO PHI
PATIENT PROTECTION:
If the Group Health Plan generally requires the designation of a primary care provider who participates in the network and who is available to accept you or your family members. For children, you may designate a pediatrician as the primary care provider. You do not need prior authorization from the carrier or from any other person (including a primary care provider) in order to obtain access to obstetrical or gynecological care from a health care professional in the network who specializes in obstetrics or gynecology. The health care professionals, however, may be required to comply with certain procedures, including obtaining prior authorization for certain services, following a pre-approved treatment plan or procedures for making referrals. For a list of participating health care professionals who specialize in obstetrics or gynecology, or for information on how to select a primary care provider, and for a list of the participating primary care providers, contact the Plan Administrator or refer to the carrier website. It is your responsibility to ensure that the information provided on your application is accurate and complete. Any omissions or incorrect statements made by you on your application may invalidate your coverage. The carrier has the right to rescind coverage on the basis of fraud or misrepresentation. CHILDREN’S HEALTH INSURANCE PROGRAM REAUTHORIZATION ACT (CHIPRA) OF 2009 Effective April 1, 2009, a special enrollment period provision is added to comply with the requirements of the Children’s Health Insurance Program Reauthorization Act (CHIPRA) of 2009. If you or a dependent is covered under a Medicaid or CHIP plan and coverage is terminated as a result of the loss of eligibility for Medicaid or CHIP coverage, you may be able to enroll yourself and/or your dependent(s). However, you must enroll within 60 days after the date eligibility is lost. If you or a dependent becomes eligible for premium assistance under an applicable State Medicaid or CHIP plan to purchase coverage under the group health plan, you may be able to enroll yourself and/or your dependent(s). However, you must enroll within 60 days after you or your dependent is determined to be eligible for State premium assistance. Please note that premium assistance is not available in all states.
I. No access to protected health information (PHI) except for summary health information for limited purpose and enrollment / dis-enrollment information. Neither the group health plan nor the plan sponsor (or any member of the plan sponsor’s workforce) shall create or receive protected health information (PHI) as defined in 45 C.F.R. §160.103 except for (1) summary health information for purpose of (a) obtaining premium bids or (b) modifying, amending, or terminating the group health plan, and (2) enrollment and dis-enrollment information. The group health plan is a fully-insured group health plan sponsored by the “Plan Sponsor”. The group health plan and the plan sponsor intend to comply with the requirements of 45 C.F.R. §164.530 (k) so that the group health plan is not subject to most of HIPAA’s privacy requirements.
II. Insurer for group health plan will provide privacy notice
The insurer for the group health plan will provide the group health plan’s notice of privacy practices and will satisfy the other requirements under HIPAA related to the group health plan’s PHI. The notice of privacy practices will notify participants of the potential disclosure of summary health information and enrollment / dis-enrollment information to the group health plan and the plan sponsor.
III. No intimidating or retaliatory acts
The group health plan shall not intimidate, threaten, coerce, discriminate against, or take other retaliatory action against individuals for exercising their rights , filing a complaint, participating in an investigation, or opposing any improper practice under HIPAAA.
IV. No Waiver
The group health plan shall not require an individual to waive his or her privacy rights under HIPAA as a condition of treatment, payment, enrollment or eligibility. If such an action should occur by one of the plan sponsor’s employees, the action shall not be attributed to the group health plan.
11
Required Annual Employee Disclosure Notices - Continued REQUIRED ANNUAL EMPLOYEE DISCLOSURE NOTICES continued
MEDICARE PART D
When will you pay a higher premium (penalty) to join a Medicare drug Plan? You should also know that if you drop or lose your current coverage with Florida Blue and don’t join a Medicare drug plan within 63 continuous days after your current coverage ends, you may pay a higher premium (a penalty) to join a Medicare drug plan later. If you go 63 continuous days or longer without creditable prescription drug coverage, your monthly premium may go up at least 1% of the Medicare base beneficiary premium per month for every month that you did not have that coverage. For example, if you go nineteen months without creditable coverage, your premium may consistently be at least 19% higher than the Medicare 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 October to join. For more information about this notice or your current prescription drug coverage… Contact our office for further information (see contact information below). NOTE: You’ll get this notice each year. You will also get it before the next period you can join a Medicare drug plan, and if this coverage through Florida Blue changes. You also may request a copy of this notice at any time. 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’ll get a copy of the handbook in the mail every year from Medicare. You may also be contacted directly by Medicare drug plans. For more information about Medicare prescription drug coverage: • Call your State Health Insurance Assistance Program (see your copy of the Medicare & You handbook for their telephone number) for personalized help, • 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 information about this extra help, visit Social Security on the web at www.socialsecurity.gov, or call them at 1-800-772-1213 (TTY 1- 800-325-0778). Remember: Keep this notice. If you enroll in one of the new plans approved by Medicare which offer prescription drug coverage, you may be required to provide a copy of this notice when you join to show that you are not required to pay a higher premium amount. • Visit www.medicare.gov
This notice applies to employees and covered dependents who are eligible for Medicare Part D. Please read this notice carefully and keep it where you can find it. This notice has information about your current prescription drug coverage with Florida Blue and about your options under Medicare’s prescription drug Plan. If you are considering joining, you should compare your current coverage including which drugs are covered at what cost, with the coverage and costs of the plans offering Medicare prescription drug coverage in your area. Information about where you can get help to make decisions about your prescription drug coverage is at the end of this notice. 1. Medicare prescription drug coverage became available in 2006 to everyone with Medicare through Medicare prescription drug plans and Medicare Advantage Plan (like an HMO or PPO) that offer prescription drug coverage. All Medicare prescription drug plans provide at least a standard level of coverage set by Medicare. Some plans may also offer more coverage for a higher monthly premium. 2. UnitedHealthcare has determined that the prescription drug coverage offered by the Welfare Plan for Employees of AAPL under the UnitedHealthcare option are, on average for all plan participants, expected to pay out as much as the standard Medicare prescription drug coverage pays and is therefore considered Creditable Coverage. Because your existing coverage is Creditable Coverage, you can keep this coverage and not pay a higher premium (a penalty) if you later decide to join a Medicare drug plan. You should also know that if you drop or lose your coverage with Florida Blue and don’t enroll in Medicare prescription drug coverage after your current coverage ends, you may pay more (a penalty) to enroll in Medicare prescription drug coverage later. _________________________________________________ You can join a Medicare drug plan when you first become eligible for Medicare and each year from October 15 th to December 7 th . However, if you lose your current creditable prescription drug coverage, through no fault of your own, you will also be eligible for a two (2) month Special Enrollment Period (SEP) to join a Medicare drug plan. What happens to your current coverage if you decide to join a Medicare Drug Plan? If you decide to join a Medicare drug plan, your current Florida Blue coverage will not be affected. You can keep this coverage if you elect part D and this plan will coordinate with Part D coverage. If you decide to join a Medicare drug plan and drop your current Florida Blue coverage, be aware that you and your dependents will be able to get this coverage back. When can you join a Medicare Drug Plan?
Date: 01/01/18 Name of Entity/Sender: AAPL Contact--Position/Office: Sarah Cammer
400 N. Ashley Drive, Suite 400 Tampa, FL 33602
Phone Number:
813-636-2805
12
HEALTHCARE REFORM AND YOU
The Patient Protection and Affordable Care Act & The Health Care and Education Affordability Reconciliation Act of 2010, together, create the most comprehensive health insurance reform ever under taken in recent history by our Country. Many of the new law’s required changes have already been incorporated into company health plans across the country since the effective date in September of 2010. However, there will be many more changes taking place in the months to come, as more guidance is issued by the government to employers, insurance carriers and individuals. One of the key requirements of the new law beginning in 2014, is the mandate that all U.S. citizens & legal residents either carry health insurance or pay an income tax penalty. While the tax penalty is not too severe in the first year, it becomes progressively more costly each year thereafter. In 2014, the greater of $95 or 1% of taxable income; In 2015, the greater of $325 or 2% of taxable income; In 2016, the greater of $695 or 2.5% of taxable income; and After 2016, the penalty is indexed for inflation. However, there are two ways to avoid the tax penalty: You can buy coverage for you and your family through your place of employment, if your employer offers such coverage. That coverage must meet certain standards set by the law in order for you and the employer to escape respective tax penalties. The coverage must meet certain minimum coverage standards (Generally pays at least 60% of your covered medical expenses) and must be considered “affordable” (Employer cannot charge you a premium for single or employee only coverage greater than 9.5% of your W-2 earnings for the year). The 9.5% would apply to annual salaries of up to about $45,000. Or, you can provide coverage for you and your family through a Federally run Insurance Exchange that is supposed to be up and running by 1/1/2014. Essentially, an Exchange is an interactive site where an individual can go to research, evaluate and buy health plans. The State of Florida chose not to set up a state run exchange, so the Federal government will take over that responsibility. Penalties for failing to buy coverage Tax penalties for failing to buy coverage are phased in according to the following schedule:
If you obtain coverage through an Exchange:
The Exchange will eventually sell insurance policies at certain levels of coverage: • Bronze level – a medical plan designed to pay 60% of covered medical benefits; • Silver level – a medical plan designed to pay 70% of covered medical benefits; • Gold level – a medical plan designed to pay 80% of covered medical benefits; • Platinum level – a medical plan designed to pay 90% of covered medical benefits; • Catastrophic – available to young adults up to age 30 or those exempt from the individual mandate (additional requirements may apply) If you satisfy certain low income thresholds and do not have medical coverage through an employer, or have employer- provided coverage that is considered “unaffordable” or pays benefits that are below the “Bronze” plan discussed above, there are tax credits available to help you pay the premiums for coverage purchased through the Exchange. The credits also help pay for expenses like deductibles and co pays. More information on these credits will be provided to you later. If you and your family are below 133% of the Federal Poverty Level in 2014, you may qualify for Medicaid. Other changes to take effect in 2014 are: The health plan may no longer exclude coverage of a pre- existing condition; The health plan may not impose more than a 90-day waiting period for coverage; Your plan may no longer place an annual limit on key benefits in the plan; Your health plan must allow dependent children up to age 26 to enroll in coverage, regardless of the availability of employer- sponsored coverage where they work. You may only obtain coverage through an Exchange if you are not participating in your employer’s plan.
13
GENERAL NOTICE OF COBRA RIGHTS *Continuation coverage rights under COBRA*
Introduction You’re getting this notice because you recently gained coverage under a group health plan (the Plan). This notice has important information about your right to COBRA continuation coverage, which is a temporary extension of coverage under the Plan. This notice explains COBRA continuation coverage, when it may become available to you and your family, and what you need to do to protect your right to get it. When you become eligible for COBRA, you may also become eligible for other coverage options that may cost less than COBRA continuation coverage. The right to COBRA continuation coverage was created by a federal law, the Consolidated Omnibus Budget Reconciliation Act of 1985 (COBRA). COBRA continuation coverage can become available to you and other members of your family when group health coverage would otherwise end. For more information about your rights and obligations under the Plan and under federal law, you should review the Plan’s Summary Plan Description or contact the Plan Administrator. You may have other options available to you when you lose group health coverage. For example, you may be eligible to buy an individual plan through the Health Insurance Marketplace. By enrolling in coverage through the Marketplace, you may qualify for lower costs on your monthly premiums and lower out-of-pocket costs. Additionally, you may qualify for a 30-day special enrollment period for another group health plan for which you are eligible (such as a spouse’s plan), even if that plan generally doesn’t accept late enrollees. What is COBRA continuation coverage? COBRA continuation coverage is a continuation of Plan coverage when it would otherwise end because of a life event. This is also called a “qualifying event.” Specific qualifying events are listed later in this notice. After a qualifying event, COBRA continuation coverage must be offered to each person who is a “qualified beneficiary.” You, your spouse, and your dependent children could become qualified beneficiaries if coverage under the Plan is lost because of the qualifying event. Under the Plan, qualified beneficiaries may elect COBRA continuation coverage, but they may be required to pay for the coverage. If you’re an employee, you’ll become a qualified beneficiary if you lose your coverage under the Plan because of the following qualifying events: • Your hours of employment are reduced, or • Your employment ends for any reason other than your gross misconduct.
If you’re the spouse of an employee, you’ll become a qualified beneficiary if you lose your coverage under the Plan because of the following qualifying events: • Your spouse dies; • Your spouse’s hours of employment are reduced; • Your spouse’s employment ends for any reason other than his or her gross misconduct; • Your spouse becomes entitled to Medicare benefits (under Part A, Part B, or both); or • You become divorced or legally separated from your spouse . Your dependent children will become qualified beneficiaries if they lose coverage under the Plan because of the following qualifying events: • The parent-employee dies; • The parent-employee’s hours of employment are reduced; • The parent-employee’s employment ends for any reason other than his or her gross misconduct; • The parent-employee becomes entitled to Medicare benefits (Part A, Part B, or both); • The parents become divorced or legally separated; or • The child stops being eligible for coverage under the Plan as a “dependent child.” When is COBRA continuation coverage available? The Plan will offer COBRA continuation coverage to qualified beneficiaries only after the Plan Administrator has been notified that a qualifying event has occurred. The employer must notify the Plan Administrator of the following qualifying events: • The end of employment or reduction of hours of employment; • Death of the employee; • The employee’s becoming entitled to Medicare benefits (under Part A, Part B, or both). For all other qualifying events (divorce or legal separation of the employee and spouse or a dependent child’s losing eligibility for coverage as a dependent child), you must notify the Plan Administrator within 60 days after the qualifying event occurs. You must provide this notice to the employer sponsoring the Plan.
14
GENERAL NOTICE OF COBRA RIGHTS Continued
How is COBRA continuation coverage provided? Once the Plan Administrator receives notice that a qualifying event has occurred, COBRA continuation coverage will be offered to each of the qualified beneficiaries. Each qualified beneficiary will have an independent right to elect COBRA continuation coverage. Covered employees may elect COBRA continuation coverage on behalf of their spouses, and parents may elect COBRA continuation coverage on behalf of their children. COBRA continuation coverage is a temporary continuation of coverage that generally lasts for 18 months due to employment termination or reduction of hours of work. Certain qualifying events, or a second qualifying event during the initial period of coverage, may permit a beneficiary to receive a maximum of 36 months of coverage. Disability extension of 18-month period of COBRA continuation coverage: If you or anyone in your family covered under the Plan is determined by Social Security to be disabled and you notify the Plan Administrator in a timely fashion, you and your entire family may be entitled to get up to an additional 11 months of COBRA continuation coverage, for a 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 COBRA continuation coverage. Second qualifying event extension of 18-month period of continuation coverage If your family experiences another qualifying event during the 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 the Plan is properly notified about the second qualifying event. This extension may be available to the spouse and any dependent children getting COBRA continuation coverage if the employee or former employee dies; becomes entitled to Medicare benefits (under Part A, Part B, or both); gets divorced or legally separated; or if the dependent child stops being eligible under the Plan as a dependent child. This extension is only available if the second qualifying event would have caused the spouse or dependent child to lose coverage under the Plan had the first qualifying event not occurred. There are also ways in which this 18-month period of COBRA continuation coverage can be extended:
Are there other coverage options besides COBRA Continuation Coverage? Yes. Instead of enrolling in COBRA continuation coverage, there may be other coverage options for you and your family through the Health Insurance Marketplace, Medicaid, or other group health plan coverage options (such as a spouse’s plan) through what is called a “special enrollment period.” Some of these options may cost less than COBRA continuation coverage. You can learn more about many of these options at www.healthcare.gov . 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 the Employee Retirement Income Security Act (ERISA), including COBRA, the Patient Protection and Affordable Care Act, and other laws affecting group health plans, contact the nearest Regional or District Office of the U.S. Department of Labor’s Employee Benefits Security Administration (EBSA) in your area or visit www.dol.gov/ebsa . (Addresses and phone numbers of Regional and District EBSA Offices are available through EBSA’s website.) For more information about the Marketplace, visit www.HealthCare.gov . Keep your Plan informed of address changes To protect your family’s rights, let the Plan Administrator know about 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.
15
New Health Insurance Marketplace Coverage Options and Your Health Coverage
Form Approved OMB No. 1210-0149 (expires 1-31-2017)
PART A: General Information When key parts of the health care law take effect in 2014, there will be a new way to buy health insurance : the Health Insurance Marketplace. To assist you as you evaluate options for you and your family, this notice provides some basic information about the new Marketplace and employment-based health coverage offered by your employer. What is the Health Insurance Marketplace? The Marketplace is designed to help you find health insurance that meets your needs and fits your budget. The Marketplace offers "one-stop shopping" to find and compare private health insurance options. You may also be eligible for a new kind of tax credit that lowers your monthly premium right away. Open enrollment for health insurance coverage through the Marketplace begins in October 2013 for coverage starting as early as January 1, 2014.
Can I Save Money on my Health Insurance Premiums in the Marketplace? You may qualify to save money and lower your monthly premium, but only if your employer does not offer coverage, or offers coverage that doesn't meet certain standards. The savings on your premium that you're eligible for depends on your household income.
Does Employer Health Coverage Affect Eligibility for Premium Savings through the Marketplace? Yes. If you have an offer of health coverage from your employer that meets certain standards, you will not be eligible for a tax credit through the Marketplace and may wish to enroll in your employer's health plan. However, you may be eligible for a tax credit that lowers your monthly premium, or a reduction in certain cost-sharing if your employer does not offer coverage to you at all or does not offer coverage that meets certain standards. If the cost of a plan from your employer that would cover you (and not any other members of your family) is more than 9.5% of your household income for the year, or if the coverage your employer provides does not meet the "minimum value" standard set by the Affordable Care Act, you may be eligible for a tax credit. 1 Note: If you purchase a health plan through the Marketplace instead of accepting health coverage offered by your employer, then you may lose the employer contribution (if any) to the employer-offered coverage. Also, this employer contribution -as well as your employee contribution to employer-offered coverage- is often excluded from income for Federal and State income tax purposes. Your payments for coverage through the Marketplace are made on an after-tax basis.
How Can I Get More Information? For more information about your coverage offered by your employer, please check your summary plan description or contact:
Sarah Cammer – 813-636-2805
The Marketplace can help you evaluate your coverage options, including your eligibility for coverage through the Marketplace and its cost. Please visit HealthCare.gov for more information, including an online application for health insurance coverage and contact information for a Health Insurance Marketplace in your area.
PART B: Information About Health Coverage Offered by Your Employer This section contains information about any health coverage offered by your employer. If you decide to complete an application for coverage in the Marketplace, you will be asked to provide this information. This information is numbered to correspond to the Marketplace application.
3. Employer Name
4. Employer Identification Number (EIN)
American Association for Physician Leadership
5. Employer Address
6. Employer Phone Number
400 N. Ashley Drive, Suite 400
813-636-2805
7. City
8. State
9. Zip Code
Tampa
FL
33602
10. Who can we contact about employee health coverage at this job?
Sarah Cammer
11. Phone Number (if different from above)
12. E-mail address
813-636-2805
scammer@physicianleaders.org
1 An employer-sponsored health plan meets the "minimum value standard" if the plan's share of the total allowed benefit costs covered by the plan is no less than 60 percent of such costs
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