BENEFITS GUIDE 2022 PLAN YEAR
TABLE OF CONTENTS
I ntroduction . . . . . . . . . . . . . . . . . . . . . . . Employee Navigator . . . . . . . . . . . . . . . . Medical . . . . . . . . . . . . . . . . . . . . . . . . . . . Aetna Products . . . . . . . . . . . . . . . . . . . . Dental . . . . . . . . . . . . . . . . . . . . . . . . . . Vision . . . . . . . . . . . . . . . . . . . . . . . . . . Basic Life AD&D. . . . . . . . . . . . . . . . . . Disability . . . . . . . . . . . . . . . . . . . . . . . . EAP . . . . . . . . . . . . . . . . . . . . . . . . . . . . Aflac . . . . . . . . . . . . . . . . . . . . . . . . . . . Member Claims Advocate . . . . . . . . . FAQ . . . . . . . . . . . . . . . . . . . . . . . . . . . . Legal Notices . . . . . . . . . . . . . . . . . . . . Medicare Part D. . . . . . . . . . . . . . . . . COBRA. . . . . . . . . . . . . . . . . . . . . . . . . Exchange Notices. . . . . . . . . . . . . . . . Contact Information. . . . . . . . . . . . . .
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Community Action for Improvement, Inc. is proud to offer you a comprehensive benefits package for the 2022 - 2023 plan year. Keep in mind that new enrollment and changes will become effective December 1st, 2022.
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About Deductions
In preparation of your enrollment, please have the following information readily available for you and your dependent(s): • Date(s) of birth • Social Security Number(s): Mandatory • Full name, relationship, and Social Security Number(s) for Life Beneficiary(ies). (Beneficiaries must be at least 18 years old or you will be required to name a guardian for him/her.) Information Needed for Enrollment Premiums for medical, dental and vision plans are all deducted on a pre-tax basis because they are covered under Section 125 of the Internal Revenue Code. Once you elect benefits you will not be approved to make changes to your election or drop coverage until the next Open Enrollment period, unless you have a qualifying event. Voluntary life, long-term disability and short-term disability insurance premiums are deducted on a post-tax basis and may be changed outside of the Open Enrollment period.
Eligibility Information
Qualifying Life Events
As an Community Action for Improvement, Inc. employee you may be eligible for enrollment in a variety of insurance products. Full-time employees may participate in the benefits package after 30 days. You may enroll your eligible dependents for coverage once you are eligible. Your eligible dependents include:
Qualifying events are events that cause an individual to lose his or her group health coverage. The type of qualifying event determines who the qualified beneficiaries are for that event and the period of time that a plan must offer continuation of coverage.
Qualifying events include:
• Marriage • Divorce or legal separation • Birth or adoption of a child • Death of spouse or dependent child • Change in employment status • Loss of other coverage • Entitlement to Medicare or Medicaid • Child turning 26 years old
• Your legal spouse • Your children up to age 26 (as identified in the plan document)
*Once your elections are effective, they will remain in effect through the plan year.
You must notify Human Resources within 30 days of the qualifying life event. Depending on the type of event, you may be asked to provide proof of the event. If you do not contact Human Resources within 30 days of the qualifying event, you will have to wait until the next annual enrollment period to make changes.
COMMUNITY ACTION FOR IMPROVEMENT, INC. 2022 BENEFITS GUIDE 3
How to Enroll
Step 1: Creating your Employee Navigator Account
Welcome Email:
• You will receive a Welcome email from Employee Navigator • Click on the “Registration Link” in the email • Create an account with username and password of your choice
• Go to https://www.employeenavigator.com/benefits/Account/Register • Enter [First Name], then [Last Name] • Enter your Company Identifier [COMMACT] • PIN: Last four of your SSN • Enter your birthdate: MM/DD/YYY • Click “Next” to continue • When prompted, your username will be as follows: [First Name].[Last Name] Option 2:
Step 2: Complete HR Tasks
• Once your account is set up, you will be taken to your employee homepage.
• On the homepage, click the “Complete HR Tasks” to begin your new hire tasks first.
• The first few tasks require you to put in demographic information and e-sign for online acknowledgment.
T I P If you hit “Dismiss, complete later” you’ll be taken to your Home Page. You’ll still be able to start enrollments again by clicking “Start Enrollments”
Step 3: Benefit Elections
• To enroll dependents in a benefit, click the checkbox next to the dependent’s name under “Who am I enrolling?” If you do not click on their name(s), they will not get the insurance. • Below your dependents you can view your available plans and the cost per pay period. To elect a benefit, click Select Plan underneath the plan cost.
4 COMMUNITY ACTION FOR IMPROVEMENT, INC. 2022 BENEFITS GUIDE
Step 4: Forms
• If you have elected benefits that require a beneficiary designation, Primary Care Physician or completion of an Evidence of Insurability form, you will be prompted or required to complete.
Step 5: Review & Confirm Elections
• Review the benefits you selected on the enrollment summary page to make sure they are correct then click “Sign & Agree” to complete your enrollment. Print a summary of your elections for your records.
T I P If you miss a step you’ll see Enrollment Not Complete in the progress bar with the incomplete steps highlighted. Click on any incomplete steps in the drop down bar to complete them. ALL STEPS MUST BE COMPLETED! Step 6: HR Tasks (if applicable)
• To complete any required HR tasks, click “Start Tasks”. If your HR department has not assigned any tasks, you’re finished!
5 COMMUNITY ACTION FOR IMPROVEMENT, INC. 2022 BENEFITS GUIDE
Medical and Pharmacy Coverage
Community Action for Improvement, Inc. offers the following Medical plans through Aetna and offers “in and out-of-network” benefits. Insurance Carrier: Aetna Medical Insurance Medical Plan: $2,500 / 100% Copay Plan $5,000 / 100% Copay Plan In-Network: Office Visit Copay - Primary Care $25 $35 Office Visit Copay - Specialist Care $75 $75 Urgent Care Copay $75 $75 Emergency Room Care Deductible; then 100% Coinsurance Deductible; then 100% Coinsurance Preventative Visit Copay $0 $0 Diagnostic Testing & Blood Work Deductible; then 100% Coinsurance Deductible; then 100% Coinsurance Imaging Deductible; then 100% Coinsurance Deductible; then 100% Coinsurance Coinsurance 100% 100% Employee Deductible $2,500 $5,000 Family Deductible $5,000 $10,000 Employee Out-of-Pocket Max $5,500 (includes deductible) $7,150 (includes deductible) Family Out-of-Pocket Max $11,000 (includes deductible) $14,300 (includes deductible) Inpatient Hospital Deductible; then 100% Coinsurance Deductible; then 100% Coinsurance Outpatient Hospital or Facility Deductible; then 100% Coinsurance Deductible; then 100% Coinsurance Out-of-Network: Coinsurance 50% 50% Employee Deductible $5,000 $10,000 Family Deductible $15,000 $30,000 Employee Out-of-Pocket Max $15,000 $25,000 Family Out-of-Pocket Max $45,000 $75,000 Prescription Drugs: ( 30 Day Supply) Tier 1 - Generic $3 or $10 $3 or $10 Tier 2 - Preferred $45 $50 Tier 3 - Non-Preferred $75 $80 Tier 4 - Specialty 20% up to $250 or 40% up to $500 20% up to $250 or 40% up to $500 Employee Semi-Monthly Deduction Employee Only $53.34 $28.34 Employee + Spouse $185.02 $135.02 Employee + Child(ren) $167.40 $117.40 Family $284.91 $234.91
6 COMMUNITY ACTION FOR IMPROVEMENT, INC. 2022 BENEFITS GUIDE
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Dental All family members
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Spending to date Spending summary
Medical - in network
Vision Robert
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Deductible - $5,000
Other coverage All family members
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$3,000.00
$2,000.00
Spent
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Out-of-pocket max - $10,000
Flex Spending Account
$2,091.84
Spent $3,000.00
Remaining $7,000.00
Health Savings Account
$11,302.98
What are deductibles, maximums and coinsurance? Right now your family pays 100% for all in-network medical services.
Spent $3,000.00
Remaining $7,000.00
Most recent Claims What are deductibles, maximums and coinsurance? Right now your family pays 100% for all in-network medical services.
Brookhaven Memorial Hospital Medical Center Inc, Patchogue
Unpaid $853.23
Dec 5
Robert
Unpaid $853.23
South Bedford Dental
Dec 4
Christopher
Dec 1 AT HOME Visit our member website at aetna.com . Robert South Bedford Dental Unpaid $853.23 Dec 2 Jack Comfort Dental Unpaid $853.23 Dec 3 Robert Wynkoop Imaging Center
ON THE GO Get the Aetna Health SM app by texting “ AETNA ” to 90156 for a link to download the app (message and data rates apply).*
Unpaid $853.23
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7 COMMUNITY ACTION FOR IMPROVEMENT, INC. 2022 BENEFITS GUIDE
Aetna MinuteClinic
Now offering access to MinuteClinic ® at no cost * to the member
Give your employees the care they need, when and where they need it.
8 COMMUNITY ACTION FOR IMPROVEMENT, INC. 2022 BENEFITS GUIDE
Aetna MinuteClinic
Bringing quality care close to home The time for a solution that gives people more options to take control of their health and get the care they need — on their terms — is now.
Lower costs
Improve health
Boost satisfaction
High-quality care that’s convenient and reliable MinuteClinic ® makes it easy for your employees to get the care they need, when and where they need it. And now your employees can get access to all covered MinuteClinic services at no cost to them — not just preventive care. *
MinuteClinic is a walk-in clinic inside select CVS Pharmacy ® and Target stores and is the largest provider of retail health care in the United States — with over 1,100 locations in 33 states and the District of Columbia.
Open every day, including evenings. MinuteClinic offers both walk-in and scheduled appointment options.
MinuteClinic health care providers treat a variety of illnesses, injuries and conditions. They can also write prescriptions, when medically appropriate.
Contact your Aetna representative today to learn more.
9 COMMUNITY ACTION FOR IMPROVEMENT, INC. 2022 BENEFITS GUIDE Eligible members enrolled in high-deductible plans must meet their deductible. However, such services would be subject to negotiated contract rates. Once the deductible has been met, members will be able to access MinuteClinic services at no cost-share. Members in Aetna Whole Health ACO, APCN Plus, HMO and indemnity plans are not eligible for this benefit. Such members should refer to their benefit plan documents in order to determine coverage and applicable cost- share for walk-in clinic benefits and services, as applicable. Aetna and MinuteClinic, LLC (which either operates or provides certain management support services to MinuteClinic-branded walk-in clinics) are both within the CVS Health family. Aetna is not responsible or liable in any manner for services received at CVS MinuteClinic locations. For more information about Aetna plans, refer to aetna.com. *Visit minuteclinic.com for age and service restrictions. This is for informational purposes only and is intended to be used only in connection with self-funded plans. It is not medical advice and is not intended to be a substitute for proper medical care provided by a physician. Information is believed to be accurate as of the production date; however, it is subject to change. Includes access to all covered services at MinuteClinic.
Aetna Access To Care
Aim high: Raise the bar on your health care
Aetna® health plans can help you raise the bar on your health and wellness goals. Get big opportunities for savings and support that fit your schedule, with programs that are part of your health plan. You can access easy-to-use in-person and online tools and resources. It’s what you need to stay happy, healthy and productive — in all parts of your life. You can access these programs and certain in-network services at low or no cost* under your medical and pharmacy plans.
Start today. Log in to your member website through Aet.Na/Health-Login. There, you can manage your benefits, connect with care, and view and pay claims.
*If the member is enrolled in a qualified high-deductible health plan, they can receive preventive services at no cost. To receive no-cost care on all covered non-preventive services, the member will first need to meet their deductible. Indemnity plans will apply the plan’s deductible and coinsurance for most services. Refer to plan documents for cost-sharing and additional plan details.
Aetna.com 1126755-01-01 (7/22)
10 COMMUNITY ACTION FOR IMPROVEMENT, INC. 2022 BENEFITS GUIDE
Aetna Access To Care
Access to care
MinuteClinic Your plan gives you access to covered MinuteClinic® services at no cost to you.* MinuteClinic is a clinic inside many select CVS Pharmacy,® CVS HealthHUB and Target® locations.** They’re open every day, even evenings and weekends. And now you can get care quickly from the comfort of your own home with virtual care visits any day of the week. If you’re in a qualified high-deductible health plan, you can get preventive care at no extra cost. And you’ll get lower-cost care for other covered minor illness and injury care at MinuteClinic. To receive no-cost care on all covered services, you will first need to meet your deductible. Find a MinuteClinic near you at CVS.com/MinuteClinic . Or log in to your Aetna Health SM app by going to Aet.Na/Health-App to set up an appointment. For a list of other providers in the network, log in to Aet.Na/Health-Login and use our search tool. Teladoc® You can connect directly with a board-certified doctor by phone or video through Teladoc. This service is best for general medical, dermatology or mental health visits at no cost to you. To start:
•Call 1-855-TELADOC (835-2362) •Visit Aet.Na/AFA-Tdoc •Download the Aetna Health app at Aet.Na/Health-App
*Includes select MinuteClinic services. Not all MinuteClinic services are covered. Please consult benefit documents to confirm which services are included. Members enrolled in qualified high-deductible health plans must meet their deductible before receiving covered non-preventive MinuteClinic services at no cost-share. However, such services are covered at negotiated contract rates. This benefit is not available in all states and on indemnity plans. Visit MinuteClinic.com for age and service restrictions. This is for informational purposes only and is intended to be used only in connection with self-funded plans. It is not medical advice and is not intended to be a substitute for proper medical care provided by a physician. **For a complete list of other participating providers, log in to your member site at Aetna.com and use our provider search tool.
11 COMMUNITY ACTION FOR IMPROVEMENT, INC. 2022 BENEFITS GUIDE
Aetna Access To Care
Mental well-being
Employee Assistance Program (Aetna Resources For Living SM ) You and your eligible household members can get help with all aspects of life, from emotional well-being, (stress management, work/life balance, depression, anxiety) to help with daily life (e.g., stress, care for children, older adults and pets). There’s even legal and financial help. You can seek personal help 24/7 with the Resources For Living mobile app. We’re here for you, 24/7. Give us a call at 1-866-326-7172, TTY: 711 . Or check out Aet.Na/AFA-RFL (Username: SGEAP Password: EAP).
Behavioral Telehealth/Virtual providers and services In addition to in-person counseling, these services offer another way to get help. You can
also choose between multiple providers. Check out Aet.Na/AFA-BH to get started.
Managing health
Aetna One® Essentials Your health — both physical and mental — is everything. Whether you’re managing an acute issue or dealing with other complex health challenges, our nurses can help. If you’re identified for care management, a nurse can work with you to set up a care plan, help you understand your benefits and answer your health questions. You can start using these resources today. Go to Aet.Na/Health-Login to log in to your member website or call the number on your member ID card. Enhanced Maternity Program Going through a maternity journey is unique for each person. So whether you need support for family planning or postpartum care, we’ll be right there as a trusted, reliable resource. To learn more and sign up, call us at 1-800-272-3531 (TTY: 711) weekdays from 8 AM to 7 PM ET. Or log in to your member website at Aetna.com and look under “Stay Healthy.” Diabetic Meter Program Looking for an easier way to monitor your levels? Here you go: We offer no-cost* meters to eligible plan members. Regular blood glucose testing is vital to successful diabetes management. That’s why your prescription plan includes this helpful program. Call the number on your member ID card to learn more. Order your new meter today by going to Aet.Na/AFA-DMP and filling out the form.
*Blood glucose meters are funded by the manufacturer. Choice of meters is subject to change. Meters will be shipped to members within 7 to 10 days of order. Additional requirements or limitations may apply.
12 COMMUNITY ACTION FOR IMPROVEMENT, INC. 2022 BENEFITS GUIDE
Aetna Access To Care
Wellness and discount programs
Attain by Aetna® app Attain® * helps you follow your own path to better health. It combines your unique health history with your wearable activity device. The result: personalized goals, ** achievable actions and motivating rewards. Download on the App Store® or Google Play.™ Or text “ATTAINAPP” to 37046 for a link to download (message and data rates may apply). *** Explore more at Aet.Na/AFA-Attain. Peerfit Peerfit helps you stay active with monthly credits † you can redeem for group fitness classes. These include virtual classes at any gym or fitness center that participates in the Peerfit network. Fitness classes include yoga, barre, CrossFit, kickboxing and more. Get active on your own terms with Peerfit. Visit Aet.Na/AFA-Peerfit. Wellness tools You can access a health assessment and online health programs to help you meet your goals. You choose the goals to work on and your pace. You can also get helpful details about procedures, conditions and treatments. To start using these tools, log in to your member website on Aet.Na/Health-Login. Discount program The Aetna Discount Program helps you save on health products and services. You’ll get discounts on things like eyewear, hearing exams, healthy lifestyle services and natural health offerings. To start, log in to your member website on Aet.Na/Health-Login. **Goals and suggested health actions should not replace your doctor’s advice. If you have a medical condition that prevents you from meeting your goals, or if your doctor advises you not to take part in physical activity, there may be an opportunity for you to earn the same rewards by different means. Please contact 1-866-820-3731 (TTY: 711). ***Terms and Conditions: Aet.na/2IyZvfc Privacy Policy: Aet.na/2GqxsuN. iPhone is a trademark of Apple Inc., registered in the U.S. and other countries. App Store is a service mark of Apple Inc. Google Play and Android are trademarks of Google LLC. † Employees are provided with 40 monthly credits that can be exchanged for classes from studios in the Peerfit network. Credits reset each month. The number of credits required per class varies based on studio and class type. DISCOUNT OFFERS ARE NOT INSURANCE. They are not benefits under your insurance plan. You get access to discounts off the regular charge on products and services offered by third party vendors and providers. Aetna makes no payment to the third parties — you are responsible for the full cost. Check any insurance plan benefits you have before using these discount offers, as those benefits may give you lower costs than these discounts. Peerfit, Inc., is an independent provider of fitness and wellness technologies, empowering individuals to live healthy and active lifestyles by making wellness accessible and enjoyable through the power of choice and community-driven motivation. Aetna Resources For Living SM is the brand name used for products and services offered through the Aetna group of companies. The EAP is administered by Aetna Behavioral Health, LLC; and in California, for Knox-Keene plans, by Aetna Health of California, Inc. and Health and Human Resources Center, Inc. All EAP calls are confidential, except as required by law. This material is for informational purposes only. It contains only a partial, general description of programs and services and does not constitute a contract. EAP instructors, educators and network participating providers are independent contractors and are neither agents nor employees of Aetna. Aetna does not direct, manage, oversee or control the individual services provided by these persons and does not assume any responsibility or liability for the services they provide and, therefore, cannot guarantee any results or outcomes. The availability of any particular provider cannot be guaranteed and is subject to change. Information is believed to be accurate as of the production date; however, it is subject to change. For more information about Aetna plans, refer to Aetna.com. Aetna, CVS Pharmacy® and MinuteClinic, LLC (which either operates or provides certain management support services to MinuteClinic-branded walk-in clinics) are part of the CVS Health® family of companies. Aetna Funding Advantage℠ plans are self-funded, meaning the benefits coverage is provided by the employer. Aetna Life Insurance Company provides administrative services to the employer. Not all services are covered. See plan documents for a complete description of benefits, exclusions and limitations of coverage. Aetna.com ©2022 Aetna Inc. 1126755-01-01 (7/22) *The Attain by Aetna® app is available now on the App Store or Google Play store. You need to be at least 18. You need a compatible iPhone® or Android™ device, and a compatible wearable device.
13 COMMUNITY ACTION FOR IMPROVEMENT, INC. 2022 BENEFITS GUIDE
Dental Coverage
Good dental care is critical to your overall well-being. With Unum Dental Insurance, you can get the attention your teeth need - at a cost you can afford. To get the most from your benefits and reduce out-of-pocket costs, choose an in-network provider by utilizing our large national network. These providers have agreed to file your claims and uphold the highest quality standards. You can find in-network providers at unumdentalcare.com
Insurance Carrier:
Unum Dental Insurance
Plan Type:
Base Plan
Buy-Up Plan
Calendar Year Deductible Calendar Year Maximum
$50 Individual / $150 Family
$50 Individual / $150 Family
$1,000
$2,000
Preventive Services
100%
100%
Basic Services Major Services
80% 50% N/A
80% 50% N/A
Orthodontia (dependent children only) Out-of-Network Reimbursement Employee Semi-Monthly Deduction Employee Only
90% UCR
90% UCR
$4.78 $9.56
$10.40 $20.81 $26.53 $36.93
Employee + Spouse Employee + Child(ren)
$12.19 $16.97
Family
14 COMMUNITY ACTION FOR IMPROVEMENT, INC. 2022 BENEFITS GUIDE
Vision Coverage
The vision plan covers routine eye exams and also pays for all or a portion of the cost of glasses or contact lenses if you need them. Your vision plan is through Unum and offers “in and out-of-network” benefits. You can find vision providers at unumvisioncare.com
Insurance Carrier:
Unum Vision Insurance
Plan Type:
EyeMed
In-Network $10 Copay $60 Copay $10 Copay $10 Copay $10 Copay
Out-of-Network
Exam Copay
Up to $35 Up to $31 Up to $25 Up to $40 Up to $50 Up to $50
Contact Lens Exam Copay
Lenses - Single lined Lenses - Bifocal lined Lenses - Trifocal Lenses - Lenticular
$80 Allowance
$ 130 Allowance; then 20% off remaining balance
Frames
Up to $50
Elective Contact Lenses (in place of lenses & frame) Medically Necessary Contacts
$130 Allowance
Up to $100
$210 Allowance
Up to $210
Frequency for Exam / Lenses / Frames Employee Semi-Monthly Deduction Employee Only
12 months / 12 months / 24 months
$0.80 $1.60 $1.78 $2.79
Employee + Spouse Employee + Child(ren)
Family
15 COMMUNITY ACTION FOR IMPROVEMENT, INC. 2022 BENEFITS GUIDE
Basic Life and AD&D Insurance Coverage
Community Action for Improvement, Inc. provides all Full Time employees with Basic Life and Accidental Death & Dismemberment at no cost to employees.
Insurance Carrier: Basic Life w/ AD&D Eligibility Requirement Employee Benefit Amounts Employee
Unum Basic Life w/AD&D Insurance
All Full Time Employees
$50,000 $15,000 $10,000
Spouse
Child(ren)
Guarantee Issue Accidental Death & Dismemberment Benefit (AD&D) *Employee Only
$50,000
Voluntary Term Life Insurance Coverage
As a supplemental benefit, Community Action for Improvement, Inc. allows eligible employees to purchase additional life insurance coverage for yourself and your dependents. This coverage is paid for by you and is offered through Unum. Rates for the voluntary term life insurance are based on age, and volume, and benefits are subject to applicable age reductions.
Insurance Carrier:
Unum Voluntary Life w/AD&D Insurance
Voluntary Life w/ AD&D Eligibility Requirement Employee Benefit Amounts Employee
All Full Time Employees
5x Annual Earnings to $500k in increments of $10k
Spouse
100% of Employee to $150k in increments of $5k
Child(ren)
Flat $10k
Guarantee Issue Employee
$70k $25k $10k
Spouse
Child(ren)
16 COMMUNITY ACTION FOR IMPROVEMENT, INC. 2022 BENEFITS GUIDE
Disability Coverage
The goal of Community Action for Improvement’s Disability Insurance Plan is to provide you with income replacement should you be unable to work due to a non-work-related illness or injury. The company provides employees with the option to purchase voluntary “Short and Long Term Disability” income benefits.
Both the short-term and long-term disability coverages are offered
through Unum.
Insurance Carrier:
Short-Term Disability Insurance
Plan Type:
Voluntary
Eligibility Requirement
All Full Time Employees 60% of Weekly Earnings
Benefit Percentage
Waiting Period - Accident Waiting Period - Sickness Maximum Weekly Benefit
7 Days 7 Days $1,250
Benefit Duration
12 Weeks
Insurance Carrier:
Long-Term Disability Insurance
Plan Type:
Voluntary
Eligibility Requirement
All Full Time Employees
Waiting Period
90 Days
Benefit Percentage
60%
Maximum Monthly Benefit
$5,000 SSNRA 3 / 12
Benefit Duration
Pre-Existing Condition
Own Occupation Coverage
2 Year Own Occupation
17 COMMUNITY ACTION FOR IMPROVEMENT, INC. 2022 BENEFITS GUIDE
Employee Assistance Program (EAP)
Help, when you need it most
With your Employee Assistance Program and Work/Life Balance services, confidential assistance is as close as your phone or computer.
EMPLOYEE ASSISTANCE PROGRAM (EAP) Your EAP is designed to help you lead a happier and more productive life at home and at work. Call for confidential access to a Licensed Professional Counselor* who can help you. A Licensed Professional Counselor can help you with:
Who is covered? Unum’s EAP services are available to all eligible partners and employees, their spouses or domestic partners, dependent children, parents and parents-in-law. Always by your side • Expert support 24/7 • Convenient website • Mobile App • Short-term help • Referrals for additional care • Monthly webinars • Medical Bill Saver TM — helps you save on medical bills
• Stress, depression, anxiety • Relationship issues, divorce • Anger, grief and loss
• Job stress, work conflicts • Family and parenting problems • And more
WORK/LIFE BALANCE You can also reach out to a specialist for help with balancing work and life issues. Just call and one of our Work/Life Specialists can answer your questions and help you find resources in your community. Ask our Work/Life Specialists about:
Help is easy to access: Phone support : 1-800-854-1446
Online support : unum.com/lifebalance In-person : You can get up to three visits, available at no additional cost to you with a Licensed Professional Counselor. Your counselor may refer you to resources in your community for ongoing support.
• Child care • Elder care • Financial services, debt management, credit report issues
• Identity theft • Legal questions • Even reducing your medical/dental bills! • And more
* The counselors must abide by federal regulations regarding duty to warn of harm to self or others. In these instances, the consultant may be mandated to report a situation to the appropriate authority. Unum’s Employee Assistance Program and Work/Life Balance services, provided by HealthAdvocate, are available with select Unum insurance offerings. Terms and availability of service are subject to change. Service provider does not provide legal advice; please consult your attorney for guidance. Services are not valid after coverage terminates. Please contact your Unum representative for details. Insurance products are underwritten by the subsidiaries of Unum Group. © 2020 Unum Group. All rights reserved. Unum is a registered trademark and marketing brand of Unum Group and its insuring subsidiaries. EN-2058-1 FOR EMPLOYEES (10-20)
18 COMMUNITY ACTION FOR IMPROVEMENT, INC. 2022 BENEFITS GUIDE
unum.com
Aflac
Aflac pays cash benefits directly to you in the event of a claim to help with out-of-pocket expenses.
The following policies are currently available through payroll deduction;
Accident: • 24-hour coverage on and off-the-job for Accidental Injury • Emergency Treatment benefits • Hospital Confinement • Accidental-Death and Dismemberment coverage • Wellness Benefit Cancer: • Pays benefits for the diagnosis/treatment of cancer • Initial Diagnosis Benefit • Radiation/Chemotherapy • Hospital Confinement • Travel/Transportation and Lodging
Hospital Indemnity: •
Hospital Confinement Emergency Room benefits
• •
Hospital Short-Stay
• Optional riders for additional benefits such as physician’s visits and surgery
Critical Care Protection: • Covers specified Health Events such as Heart Attack, Stroke, Coma, Cardiac Arrest • First-Occurrence benefits • Intensive Care • Hospital Confinement
For more information regarding these benefits, please contact your Aflac representative: Lisa McDaniel 706-332-8319 lisa_mcdaniel@us.aflac.com
19 COMMUNITY ACTION FOR IMPROVEMENT, INC. 2022 BENEFITS GUIDE
Employee Benefit Assistants You Can Count on M ember C laims A dvocate
Community Action for Improvement, Inc. provides you and your family members a complimentary member claims service to help with claims, billing, missing ID cards and more. give member claims advocate a call if : • You received a provider bill or EOB and feel the claim was processed incorrectly • You are at the doctor or pharmacy and having trouble with your coverage • You need to confirm if a provider is In-Network • You are missing your ID card Y ou can reach the M ember C laims A dvocate team by phone or email
Monday through Friday, 8:30 AM EST - 5:00 PM EST
Charlie McDaniel - cmcdaniel@yatesins.com Resa Carter - rcarter@yatesins.com Anna Meadows - ameadows@yatesins.com (706) 323-1600
20 COMMUNITY ACTION FOR IMPROVEMENT, INC. 2022 BENEFITS GUIDE
Frequently Asked Questions
What is included in the Medical Out-of-Pocket maximum? What is included in the Pharmacy Out- of-Pocket maximum? The Medical Out-of-Pocket maximum is the maximum amount a member must pay during the policy year for covered essential health benefits. The OOP includes a member’s deductible and any coinsurance member responsibility. The Pharmacy OOP includes only pharmacy co-pays. The Medical OOP does NOT include monthly premiums, or billing from out-of-network providers. What is an in-network vs out-of-network provider? Aetna contracts with a wide range of doctors, as well as specialists, hospitals, labs, radiology facilities and pharmacies. These are the providers that are considered “in your network”. Specifically, each of these providers has agreed to accept Aetna’s contracted rate for your medical care and services rendered. The contracted rate includes both Aetna’s share of the cost, and the member’s. Your share may be in the form of a co-payment, deductible, or co-insurance. For example, Aetna’s contracted rate for a primary care visit might be $125. The Plan has a $25 co-payment for the visit; the member will pay $25 of the cost and your insurance plan will pay the remaining $100. An “out-of-network” provider is a medical doctor or facility that is not in contract with Aetna. This means that the provider may charge members higher rates for medical services and care, outside of the standard “in-network” rates. For example, a out-of- network provider may charge $200 for a primary care visit. Aetna may pay an adjustment of an out-of-network benefit of $80 dollars to the provider, so the member may be balance-billed for the remaining $120 cost of the visit. When can I change my beneficiary information for my Basic Life Insurance? Any time! It is important that all beneficiary information be kept up-to-date. You may need to change it after a marriage, divorce, or birth of a child. You can go into Employee Navigator anytime to update your beneficiary.
Term
Definition
Network Office Visit (PCP) The “per visit” co-pay cost for a primary care or standard network doctor.
The “per visit” co-pay cost for a specialized doctor (cardiologist, OB/GYN,
Specialist Office Visit
orthopedic, gastrointestinal, etc.)
The amount of money a member owes for any In-network health care services before co-insurance coverage begins. These are generally services that are NOT covered under a standard co-pay (inpatient surgery, outpatient surgery, MRI, etc.) Deductibles run on a calendar year basis. After any applicable deductible is met, the remaining cost of any in-network health care service is divided between the insurance carrier and the member. A 70% / 30% network co-insurance would divide the cost of a service with 70% paid by the insurance carrier and 30% paid by the member. These are generally services that are NOT covered under a standard co-pay (inpatient surgery, outpatient surgery, MRI, etc.) The maximum amount a member must pay during the policy year for covered essential health benefits. The OOP includes a member’s deductible, any co-insurance member responsibility, primary care and specialist office visit co-pays, ER or Urgent Care co-pays, and prescription co-pays / costs. The OOP does NOT include monthly premiums, billing from out-of-network providers, or spending for non-essential health benefits. The cost of a one month supply of a prescription drug. All covered drugs are designated into tiered levels based on drug usage, cost, and clinical effectiveness. Tier 1 usually includes generics, while Tier 2 generally includes preferred brand name medications. Tier 3 typically includes non-preferred brand name medications, Tier 4 usually includes higher cost drugs and Specialty Drugs are covered under a separate tier.
Network Deductible
Co-Insurance
Network Out-of-Pocket Maximum (OOP)
Prescription Drug Tiers and Monthly Co-Pays
21 COMMUNITY ACTION FOR IMPROVEMENT, INC. 2022 BENEFITS GUIDE
Legal Notices
Medicaid and the Children’s Health Insurance Program (CHIP) Offer Free or Low-Cost Health Coverage to Children and Families If you or your children are eligible for Medicaid or CHIP and you’re eligible for health coverage from your employer, your state may have a premium assistance program that can help pay for coverage, using funds from their Medicaid or CHIP programs. If you or your children aren’t eligible for Medicaid or CHIP, you won’t be eligible for these premium assistance programs but you may be able to buy individual insurance coverage through the Health Insurance Marketplace. For more information, visit www. healthcare.gov. If you or your dependents are already enrolled in Medicaid or CHIP and you live in a State listed below, contact your State Medicaid or CHIP office to find out if premium assistance is available. If you or your dependents are NOT currently enrolled in Medicaid or CHIP, and you think you or any of your dependents might be eligible for either of these programs, contact your State Medicaid or CHIP office or dial 1-877-KIDS NOW or www. insurekidsnow.gov to find out how to apply. If you qualify, ask your state if it has a program that might help you pay the premiums for an employer-sponsored plan. If you or your dependents are eligible for premium assistance under Medicaid or CHIP, as well as eligible under your employer plan, your employer must allow you to enroll in your employer plan if you aren’t already enrolled. This is called a “special enrollment” opportunity, and you must request coverage within 60 days of being determined eligible for premium assistance. If you have questions about enrolling in your employer plan, contact the Department of Labor at www.askebsa.dol.gov or call 1-866-444-EBSA (3272). If you live in one of the following states, you may be eligible for assistance paying your employer health plan premiums. The following list of states is current as of January 31, 2021. Contact your State for more information on eligibility –
ALABAMA - Medicaid Website: http://myalhipp.com/ Phone: 1-855-692-5447 ALASKA - Medicaid The AK Health Insurance Premium Payment Program Website: http://myakhipp.com/ Phone: 1-866-251-4861 Email: Customer Service@MyAKHIPP.com Medicaid Eligibility: http://dhss.alaska.gov/dpa/Pages/medicaid/default. aspx ARKANSAS - Medicaid Website: http://myarhipp.com/ Phone: 1-855-MyARHIPP (855-692-7447) COLORADO - Medicaid Website: http://www.colorado.gov/hcpf Customer Contact Center: 1-800-221-3943 KANSAS - Medicaid Website: http://www.kdheks.gov/hcf/ Phone: 1-785-296-3512 KENTUCKY - Medicaid Website: http://chfs.ky.gov/dms/default.htm Phone: 1-800-635-2570 LOUSIANA - Medicaid Website: http://dhh.louisiana.gov/index.cfm/ subhome/l/n/331 Phone: 1-888-695-2447
FLORIDA - Medicaid Website: http://flmedicaidtplrecovery.com/hipp/ Phone: 1-877-357-3268 GEORGIA - Medicaid Website: http://dch.georgia.gov/medicaid - click on Health Insurance Premium Payment (HIPP) Phone: 404-656-4507 INDIANA - Medicaid Healthy Indiana Plan for Low-Income Adults 19-64 Website: http://www.hip.in.gov Phone: 1-877-438-4479 All other Medicaid Website: http://www.indianamedicaid.com Phone: 1-800-403-0864 IOWA - Medicaid Website: http://www.dhs.state.ia.us/hipp/ Phone: 1-888-346-9562 MAINE - Medicaid Website: http://maine.gov/dhhs/ofi/public-assistance/ index.html Phone: 1-800-442-6003 TTY: Maine relay 711
MASSACHUSETTS - Medicaid and CHIP Website: http://www.mass.gov/MassHealth
Phone: 1-800-462-1120 MINNESOTA - Medicaid Website: http://mn.gov/dhs/ma/ Phone: 1-800-657-3739
22 COMMUNITY ACTION FOR IMPROVEMENT, INC. 2022 BENEFITS GUIDE
Legal Notices
MISSOURI - Medicaid Website: http://www.dss.mo.gov/mhd/participants/pages/hipp.htm
RHODE ISLAND - Medicaid Website: http://www.eohhs.ri.gov/ Phone: 401-462-5300 SOUTH CAROLINA - Medicaid Website: http://www.scdhhs.gov Phone: 1-888-549-0820 SOUTH DAKOTA - Medicaid
Phone: 573-751-2005 MONTANA - Medicaid Website: http://dphhs.mt.gov/ MontanaHealthcarePrograms/HIPP
Phone: 1-800-694-3084 NEBRASKA - Medicaid
Website: http://www.dhhs.ne.gov/Children_Family_ Services/AccessNebraska/Pages/accessnebraska_ index.aspx Phone: 1-855-632-7633 NEVADA - Medicaid Website: http://dwss.nv.gov/ Phone: 1-800-992-0900 NEW HAMPSHIRE - Medicaid Website: http://www.dhhs.nh.gov/oii/documents/hippapp.pdf Phone: 603-271-5218 NEW JERSEY - Medicaid and CHIP Medicaid Website: http://www.state.nj.us/humanservices/dmahs/clients/ medicaid/ Medicaid Phone: 609-631-2392 CHIP Website: http://www.njfamilycare.org/index.html CHIP Phone: 1-800-701-0710 NEW YORK - Medicaid Website: http://www.nyhealth.gov/health_care/medicaid/ Phone: 1-800-541-2831 NORTH CAROLINA - Medicaid Website: http://www.ncdhhs.gov/dma Phone: 919-855-4100 NORTH DAKOTA - Medicaid Website: http://www.nd.gov/dhs/services/medicalserv/medicaid/ Phone: 1-844-854-4825 OKLAHOMA - Medicaid and CHIP Website: http://www.insureoklahoma.org Phone: 1-888-365-3742 OREGON - Medicaid Website: http://healthcare.oregon.gov/Pages/index.aspx http://oregonhealthcare.gov/index-es.html Phone: 1-800-699-9075 PENNSYLVANIA - Medicaid Website: http://www.dhs.pa.gov/hipp Phone: 1-800-692-7462
Website: http://dss.sd.gov Phone: 1-888-828-0059 TEXAS - Medicaid Website: http://www.dhs.state.ia.us/hipp/ Phone: 1-888-346-9562 UTAH - Medicaid and CHIP Medicaid Website: http://health.utah.gov/medicaid CHIP Website: http://health.utah.gov/chip
Phone: 1-877-543-7669 VERMONT - Medicaid Website: http://www.greenmountaincare.org Phone: 1-800-250-8427 VIRGINIA - Medicaid and CHIP Medicaid & CHIP Website: http://www.coverva.org/programs_premi- um_assistance.cfm Medicaid Phone: 1-800-432-5924 CHIP Phone: 1-855-242-8282 WASHINGTON - Medicaid Website: http://www.hca.wa.gov/free-or-low-costhealth-care/pro- gram-administration/premiumpayment- program Phone: 1-800-562-3022 ext. 15473 WEST VIRGINIA - Medicaid Website: http://www.dhhr.wv.gov/bms/Medicaid%20Expansion/Pages/ default.aspx Phone: 1-877-598-5820, HMS Third Party Liability WISCONSIN - Medicaid and CHIP Website: http://www.dhs.wisconsin.gov/publications/p1/p10095.pdf
Phone: 1-800-362-3002 WYOMING - Medicaid Website: http://wyequalitycare.acs-inc.com/ Phone: 307-777-7531
To see if any more States have added a premium assistance program since January 31, 2021, or for more information on special enrollment rights, you can contact either:
U.S. Department of Labor Employee Benefits Security Administration www.dol.gov/ebsa 1-866-444-EBSA (3272)
U.S. Department of Health and Human Services Centers for Medicare & Medicaid Services www.cms.hhs.gov 1-877-267-2323, Menu Option 4, Ext. 61565
23 COMMUNITY ACTION FOR IMPROVEMENT, INC. 2022 BENEFITS GUIDE
Legal Notices
Important Notices about Medical Coverage
HIPAA Special Enrollment Rights
These benefits will be provided subject to the same deductibles and co-insurance applicable to other medical and surgical benefits provided under this plan. Our plan complies with these requirements. Benefits for these items generally are compatible to those provided under our plan for similar types of medical services and supplies. Of course, the extent to which any of these items is appropriate following mastectomy is a matter to be determined by consultation between the attending physician and the patient. Our plan neither imposes penalties (for example, reducing or limiting reimbursements) nor provides incentives to induce attending providers to provide care inconsistent with these requirements. If you would like more information on WHCRA benefits, call Yates LLC at (706) 323-1600.
If you are declining enrollment for yourself or your dependents (including your spouse) because of other health insurance or group health plan coverage, you may be able to enroll yourself or your dependents in this plan if you or your dependents lose eligibility for that other coverage (or if the employer stops contributing towards your or your dependents’ other coverage). However, you must request enrollment within 30 days after your or your dependents’ other coverage ends (or after the employer stops contributing toward the other coverage). In addition, if you have a new dependent as result of marriage, birth, adoption, or placement for adoption, you may be able to enroll yourself and your dependents. However, you must enroll within 30 days after the marriage, birth, adoption, or placement for adoption. Effective April 1, 2009 special enrollment rights also exist in the following circumstances: • If you or your dependents experience a loss of eligibility for Medicaid or your State Children’s Health Insurance Program (SCHIP) coverage; or • If you or your dependents become eligible for premium assistance under an optional state of Medicaid or SCHIP program that would pay the employee’s portion of the health insurance premium. NOTE: In the two above listed circumstances only, you or your dependents will have sixty (60) days to request special enrollment in the group health plan coverage. An individual must request this special enrollment within sixty (60) days of the loss of coverage described at bullet one, and within sixty (60) days of when eligibility is determined as described in bullet two. Women’s Health and Cancer Rights Act of 1998 Annual Notice If you have had or are going to have a mastectomy, you may be entitled to certain benefits under the Women’s Health and Cancer Rights Act of 1998 (WHCRA). For individuals receiving mastectomy-related benefits, coverage will be provided in a manner determined in consultation with the attending physician and the patient, for all stages of reconstruction of the breast on which the mastectomy was performed; surgery and reconstruction of the other breast to produce a symmetrical appearance; prostheses; and treatment of physical complications of the mastectomy, including lymphedema.
Paperwork Reduction Act Statement
According to the Paperwork Reduction Act of 1995 (Pub. L. 104-13) (PRA), no persons are required to respond to a collection of information unless such collection displays a valid Office of Management and budget (OMB) control number. The Department notes that a Federal agency cannot conduct or sponsor a collection of information unless it is approved by OMB under the PRA, and displays a currently valid OMB control number, and the public is not required to respond to a collection of information unless it displays a currently valid OMB control number. See 44 U.S.C. 3507. Also, not withstanding any other provisions of law, no person shall be subject to penalty for failing to comply with a collection of information if the collection of information does not display a currently valid OMB control number. See 44 U.S.C. 3512. The public reporting burden for this collection of information is estimated to average approximately seven minutes per respondent. Interested parties are encouraged to send comments regarding the burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden, to the U.S. Department of Labor, Employee Benefits Security Administration, Office of Policy and Research, Attention: PRA Clearance Officer, 200 Constitution Avenue, N.W., Room N-5718, Washington, DC 20210 or email ebsa. opr@dol.gov and reference the OMB Control Number 1210- 0137.
24 COMMUNITY ACTION FOR IMPROVEMENT, INC. 2022 BENEFITS GUIDE
Medicare Part D
Medicare Part D Notice of Creditable Coverage
Please read this notice carefully and keep it where you can find it. This notice has information about your current prescription drug coverage with Community Action for Improvement, Inc. and about your options under Medicare’s prescription drug coverage. This information can help you decide whether or not you want to join a Medicare 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. There are two important things you need to know about your currant coverage and Medicare’s prescription drug coverage: 1. Medicare prescription drug coverage became available in 2006 to everyone with Medicare. You can get this coverage if you join a Medicare Prescription Drug Plan or join a Medicare Advantage Plan (like an HMO or PPO) that offers prescription drug coverage. All Medicare 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. Community Action for Improvement, Inc. has determined that the prescription drug coverage offered by Aetna plans are on average for all plan participants, expected to pay out as much as 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. When Can You Join a Medicare Drug Plan? You can join a Medicare drug plan when you first become eligible for Medicare and each year from October 15th through December 7th. 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 Join a Medicare Drug Plan? If you decide to join a Medicare drug plan, your current Community Action for Improvement, Inc. coverage may or may not be affected. See pages 7-9 of the CMS Disclosure of Creditable Coverage to Medicare Part D Eligible Individuals Guidance (available at https://www.cms.hhs.gov/Creditable Coverage/ ), which outlines the prescription drug plan provisions / options that Medicare eligible individuals may have available to them when they become eligible for Medicare Part D. If you do decide to join a Medicare drug plan and drop your current Community Action for Improvement, Inc. coverage, be
aware that you and your dependents may or may not be able to get this coverage back. 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 Community Action for Improvement, Inc. 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 a creditable prescription drug coverage, your monthly premium may go up by 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 further information, call Yates LLC at (706) 323- 1600. 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 Community Action for Improvement, Inc. changes. You may also request a copy of this notice at any time. 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: Medicare Part D Notice of Creditable Coverage, cont. 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 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 Creditable 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, therefore, whether or not you are required to pay a higher premium.
25 COMMUNITY ACTION FOR IMPROVEMENT, INC. 2022 BENEFITS GUIDE
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