2018 Benefits at a Glance
PLAN YEAR:
January 15, 2014 – December 31, 2014
Passionate about healthcare. Committed to your care.
Fast Track Urgent Care is dedicated to delivering quality healthcare options to employees as well as patients. We understand the healthcare for you and your loved ones are of top priority. That is precisely why we offer a variety of benefit and plan options.
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, Benefits Manager Email
HR@fasttrack.com
Phone
813-xxx-xxxx
BROKER PARTNER - M.E. WILSON COMPANY Broker Contact
Katie Miller
Phone
813-229-8021 Ext. 132
kmiller@mewilson.com
MEDICAL
page 3
Provider
Aetna (Policy #12345)
Phone
xxx-xxx-xxx
Web Address
www.Aetna.com
DENTAL Provider
page 4
Aetna (Policy #12345)
Phone
xxx-xxx-xxx
Web Address
www.Aetna.com
VISION Provider
page 5
Aetna (Policy #12345)
Phone
xxx-xxx-xxx
Web Address
www.Aetna.com
LIFE INSURANCE
page 6
Provider
Aetna
Phone
xxx-xxx-xxx
Web Address
www.Aetna.com
DISABILITY INSURANCE
page 7
Provider
Aetna
Phone
xxx-xxx-xxx
Web Address
www.Aetna.com
DISCLOSURE NOTICES
page 9
BENEFIT INFORMATION
Benefit
Who pays the cost?
Fast Track Urgent Care pays xx%/$xxx of the cost of medical coverage with three plan options to choose from.
Medical
YOUR BENEFITS PLAN
Fast Track Urgent Care 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.
Fast Track Urgent Care offers dental coverage on a voluntary basis.
Dental
Fast Track Urgent Care offers vision coverage on a voluntary basis.
Vision
Fast Track Urgent Care offers vision coverage on a voluntary basis.
Life
Short Term Disability
Fast Track Urgent Care pays 100% of the cost for employee disability coverage.
Long Term Disability
Fast Track Urgent Care pays 100% of the cost for employee disability coverage.
PRE-TAX BENEFITS
CHOOSING YOUR BENEFITS
The premium for elected coverages are taken from your paycheck automatically. There are two ways that the money can be taken out, pre-tax or post –tax.
WHY DO I PAY FOR BENEFITS WITH BEFORE-TAX MONEY?
There is a definite advantage to paying for some benefits with before-tax money. Taking the money out before your taxes are calculated lowers the amount of your pay that is taxable. Therefore, you pay less in taxes.
WHICH BENEFIT PREMIUMS ARE TAKEN BEFORE TAX?
BEFORE tax –
Medical, Dental, and Vision
AFTER tax –
$
$
$
Life and Disability
1
ELIGIBILITY All Regular full-time employees are eligible to join the Fast Track Urgent Care Benefits Plan on the 1st of the month following 30 days. “Regular Full-Time Employees” must be regularly scheduled and working at least 30 hours per week. You may also enroll your dependents in the Benefits Plan when you enroll.
WHO’S AN ELIGIBLE DEPENDENT?
Your legal spouse
•
• Your married or unmarried natural children, step-children living with you, legally adopted child(ren) and any other child(ren) for whom you have legal guardianship, up to age 26 • 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 they must: • Be unmarried and not have a dependent of his or her own, AND • Be a resident of Florida or full-time student, AND • Not have coverage of their own, or covered under another plan, including Medicare
WHEN CAN YOU ENROLL?
You can sign up for Benefits at any of the following times:
• As a new hire, at your initial eligibility date. You must enter your election via Paylocity no later than 7 days from your date of hire.
• During the annual open enrollment period in 2017 (March 1 st , 2017)
• 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.
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 you r benefits
•
Your divorce
• Change in residence 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 your benefits
You must initiate the life event in the Web Benefits Portal and submit documentation to Benfits@DirectionsforLiving.com within 30 days. The IRS allows changes to be made within 60 days for those eligible for Medicaid or CHIP under HIPAA Special Enrollment Rights. If you fail to do so 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
Fast Track Urgent Care offers medical coverage through Aetna, you have three plan options to choose from. To find participating providers go to www.Aetna.com and click on “Find a Doctor”, then follow the prompts to complete the search within the “Network Name” network. The chart below provides a briefly overview of the medical plan offered. 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 recommended 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.
BASE PLAN
BUY-UP PLAN #1
BUY-UP PLAN #2
IN-NETWORK
(Non-) Embedded
(Non-) Embedded
(Non-) Embedded
DEDUCTIBLE
(your first dollar cost for covered in-network claims)
Deductible (Individual / Family)
$ / $
$ / $
$ / $
COINSURANCE
(your responsibility on claims costs once you’ve met the deductible) Member%
Member%
Member%
OUT OF POCKET MAXIMUM
(once met all in-network covered services are covered by the plan)
Maximum Out-of-Pocket (Individual / Family)
$ / $
$ / $
$ / $
Maximum Includes
Deductible, Coinsurance, Prescription Costs & Copays
PREVENTIVE CARE Wellness, Immunizations, Mammography, Colonoscopy, etc.
Covered 100%, no cost to you
OFFICE VISITS
Referral Required
No
Office Visits (Illness/Injury)
$
$
$
Specialist Visits
$
$
$
HOSPITAL SERVICES Inpatient Hospital
__% after deductible
__% after deductible
__% after deductible
Outpatient Surgery
__% after deductible
__% after deductible
__% after deductible
Emergency Room
__% after deductible
__% after deductible
__% after deductible
Urgent Care
__% after deductible
__% after deductible
__% after deductible
DIAGNOSTIC TESTING Lab, X-Ray, Advanced Imaging (MRI, CAT, PET, etc.)
__% after deductible
__% after deductible
__% after deductible
PRESCRIPTIONS Retail (30 day supply) Tier 1 / 2 / 3 / 4
$ / $ / $
$ / $ / $
$ / $ / $
Medicare (Part D) Creditable
Yes / No
Yes / No
Yes / No
OUT-OF-NETWORK 1
Refer to plan summary for details Bi-Weekly Cost for Coverage
Employee Only
$
$
$
Employee + Spouse
$
$
$
Employee + Child(ren)
$
$
$
Employee + Family
$
$
$
1 Charges are subject to balance billing
3
DENTAL INSURANCE
Fast Track Urgent Care offers dental coverage through Aetna. 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 for pay the difference between Aetna’s allowed amount and what the dentist may charge, also known as “balance billing”. The chart below provides a brief overview of the plan.
DPPO PLAN
In-Network
Calendar Year Deductible
Individual
$
Family
$
Annual Maximum (pre covered member)
Per covered member
$
Preventive Services
Exams, Cleanings, & Fluoride
Covered in full
Basic Services
Fillings, Simple Extractions, & Periodontal Maintenance
__% after deductible
Major Services
Crowns, Bridges, Perio, Endo, Surgical Extractions, Root Canal, & Dentures
__% after deductible
Orthodontia
Child only
Member% $x,xxx lifetime maximum per person
Out-of Network 1
Calendar Year Deductible
$ / $
Schedule of Services: Preventive Basic Major
__% after deductible __% after deductible __% after deductible
Member% $x,xxx lifetime maximum per person
Orthodontia
Annual Maximum (pre covered member)
$
90 th Usual & Customary Charges
Basis of Payment
Bi-Weekly Cost for Coverage
$
Employee Only
$
Employee + Spouse
$
Employee + Child(ren)
$
Employee + Family
4 1 Subject to balance billing. Please refer to your plan document for specific details.
VISION INSURANCE
Fast Track Urgent Care offers vision coverage through Aetna. The Aetna vision plan allows you the flexibility to see any provider. To search in-network providers vision www.Aetna.com and search in the “Your Network Name”. You pay expenses at the time of service and file a claim for reimbursement. Below is a list of the reimbursement schedule.
VSP Choice Network
In-Network Routine Eye Exams
Every 12 months $__ Copay
Lenses 2
Every 12 months
Single Vision Bifocal Trifocal Lenticular
$__ Copay
Frames
Every 12 months
$__ Copay provides a $xxx allowance PLUS xx% off cost over the allowance
Contact Lenses (in lieu of glasses)
Every 12 months
Elective Contact Lenses Preferred Non-Preferred
$__ Copay provides up to x boxes $__ Copay provides a $xxx allowance
Medically Necessary
$__ Copay
Out-of-Network 1
Routine Eye Exams
Every 12 months Reimbursed up to $XXX Every 12 months Reimbursed up to $XXX Reimbursed up to $XXX Reimbursed up to $XXX Reimbursed up to $XXX Every 12 months Reimbursed up to $XXX
Lenses 2 Single Bifocal
Trifocal Lenticular
Frames
Contact Lenses (in lieu of glasses)
Every 12 months Reimbursed up to $XXX Reimbursed up to $XXX Bi-Weekly Cost for Coverage
Employee Only
$
Employee + Spouse
$
Employee + Child(ren)
$
Employee + Family
$
1 Reimbursable amount, less applicable copay.
2 Lenses benefit listed are for a pair of lenses.
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VOLUNTARY LIFE INSURANCE
Fast Track Urgent Care offers employees the option to purchase voluntary life insurance, this coverage is though Aetna.
WHAT’S GUARENTEE ISSUE? Guarantee Issue (GI) is the amount you can purchase as a newly eligible employee without having to provide evidence of good heath (Evidence of Insurability (EOI)). The GI is $100,000 or 5x your annual salary (whichever is lesser). WHEN WOULD I NEED TO SHOW EVIDENCE OF GOOD HEALTH TO GET LIFE INSURANCE? If you elect a benefit over GI as a new hire, a benefit outside of your newly eligible period, or an increase to your current benefit you will be required to provide Evidence of Insurability (EOI). Completed EOIs should be submitted to Aetna directly, the fax number is listed on the form.
HOWMUCH LIFE INSURNACE CAN I PURCHASE?
You may purchase a benefit in increments of $10,000 for as little as $10,000 and as much as $500,000 , or 5x your annual salary (whichever is lesser).
Cost for coverage (per $1,000)
Age
WHAT’S THE COST? See the below chart to locate your age bracket. The rates shown are per $1,000 of life benefit, simply find the bi-weekly cost for coverage using the calculation below.
0-24
$0.055 $0.060 $0.080 $0.090 $0.118 $0.180 $0.314 $0.541 $0.753 $1.371 $2.713 $4.155
25-29 30-34 35-39 40-44 45-49 50-54 55-59 60-64 65-69 70-74
$
/ 1,000 =
X
Step 1
Desired benefit
75 +
X
x $
x 12 = $
/ 26
= $
Step 2
Your age rate
Annual cost for coverage
Cost per paycheck
WHAT HAPPENS WHEN I MOVE AGE BRACKETS? When you age into a new age bracket your rate will adjust accordingly as of the beginning of the new policy year. When you reach the ages listed below or are of the ages listed below your benefit amount will reduce by the percentages listed below.
Age Reduction Schedule
At age…
Your benefit will reduced by …
65 70 75
35% 60% 75%
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Fast Track Urgent Care offers you the option to purchase short term disability (STD) insurance. Short Term Disability is insurance for your paycheck should you become disabled due to injury or illness for a period of time. VOLUNTARY SHORT TERM DISABILITY
WHEN WOULD THE BENEFIT START?
Benefits would begin on the 30 th day from injury or illness.
HOWMUCH WOULD THE BENEFIT PAY?
The benefit would pay 60% of your weekly pre-disability earnings to a maximum of $1,000.00.
HOW LONG WILL THE BENENIT PAY?
The benefit would pay out to a maximum of 9 weeks.
WHAT WOULD BE A PRE-EXISITING CONDITION? If you become disabled due to injury or illness during the first 12 months of coverage , that disability will not be covered if you were treated or diagnosed with a condition contributing to the disability in the 3 months prior to your effective date of STD coverage. WHEN WOULD I NEED TO SHOW EVIDENCE OF GOOD HEALTH TO GET LIFE INSURANCE? If you elect coverage outside your newly eligible period you will be required to provide Evidence of Insurability (EOI). Completed EOIs should be submitted to Aetna directly, the fax number is listed on the form. LONG TERM DISABILITY
Fast Track Urgent Care provides you with long term disability (LTD) insurance. Long Term Disability is also insurance for your paycheck should you become disabled.
WHEN WOULD THE BENEFIT START?
Benefits would begin on the 90 th day from injury or illness.
HOWMUCH WOULD THE BENEFIT PAY?
The benefit would pay 60% of your monthly pre-disability earnings to a maximum of $4,000.00.
HOW LONG WILL THE BENENIT PAY?
The benefit would pay out until normal Social Security Normal Retirement Age.
Fast Track Urgent Care pays 100% of the cost for Long Term Disability coverage. This benefit is at NO COST TO YOU.
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EMPLOYEE ASSISTANCE
PROGRAM (EAP)
When you enroll in Voluntary Life insurance you automatically have access to Aetna’s Employee Assistance Program (EAP). The EAP program is a confidential resource available 24/7 to help you deal with a variety of life stages and/or concerns. These include but are not limited to the following:
Personal balance Emotional wellness
• • • • •
Stress management Alcohol and drug issues Work-related issues
• • • • •
Martial / relationship issues
Family issues
Grief
Communication skills
Financial and legal concerns
Call 1-855-283-1915
Visit www.mylifevalues.com Username: RESOURCES Password: RESOURCES
(
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LIFE ESSENTIALS PROGRAM
When you enroll in Voluntary Life insurance you automatically have access to Aetna’s Life Essentials Program. This program offers you access to the following services.
Will preparation Emotional support
• • • • •
Legal services
End of Life care and support
Greif counseling
You also can access referrals to local and national programs that ma y provide housing, food, prescription assistance, financial assistance, and behavioral health services.
AETNA’S DISCOUNT SAVINGS PROGRAM
is also apart of their Life Essential Program. The Discount Program provides discounts on services such as:
Weight management
• • • • • • •
Hearing Fitness
Vision
Oral health
Books
Etc.
Check out www.aetna.com/aetnalifeessentials/index.html to learn more about the service available through the Life Essentials Program.
8
ID CARDS
NEW ENROLLEES
To utilize your coverage prior to receiving you r ID card you may simply give your provider your Social Security Number instead as an alternate ID, as opposed to your member ID.
AETNA WENT DIGITAL
Aetna will no longer supply physical ID cards if requesting a replacement to extra card. You may access your digital card via Aetna Navigator or Aetna’s mobile app.
5 …
:
Terms To Know
When you enroll in coverage you become a UHC member. A member of UHC gets access to their network of providers (doctors and facilities) – these are in-network providers. UHC members receive Discounted Rates with these in-network providers. Discounted Rate
Copays
Copays are set dollar amounts you pay for specific services. These cost are typically collected at the time of service. EX: you have a $50 copay for a visit to your primary care physician.
Services not subject to a copay are subject to your deductible. You pay first dollar costs for claims subject to your deductible and you receive the Discounted Rate for all covered claims with an in-network provider. Deductible
Coinsurance
Coinsurance is a cost share. Once you meet the deductible UHC will share in the cost of your claims. The percent of the cost for the claim you are responsible for. The amounts you pay in coinsurance apply to your out of pocket maximum.
Out-of-Pocket
This amount is the maximum amount you will pay towards covered services on the plan for the calendar year. This amount includes the amounts you pay in deductible, coinsurance, copays, and prescription copays.
7
HOW TO ENROLL
STEP 1
Access the Web Pay Employee Self Service Portal , click on the “Applications” tab and select “Web Benefits” from the dropdown menu.
Insert Paylocity screenshots here
You will not need a separate User ID or password when accessing Employee Self Service Portal.
Insert Paylocity screenshots here
STEP 2
Click “Enroll Now”, located on the home page. The site will take you through 4 tabs to finalize your enrollment. 1. Employee (Personal Information) 2. Family (Family Information) 3. Enroll 4. Confirm
Insert Paylocity screenshots here
VERIFY PERSONAL INFORMATION
Please review the personal information listed for yourself and any enrolled family members to ensure accuracy. If any changes are needed, please make updated in Web Pay. Any changes made will be reflected in Web Benefits within 24 hours. (PLEASE NOTE: you will not need to wait for the updates to reflect within the system. You may proceed with enrollment.) Once confirmed and/or changes have been made please click “I Agree” , located at the bottom of the page and “Continue”.
Insert Paylocity screenshots here
** Any fields marked with an asterisk are required.**
FINALIZE ENROLLMENT
Insert Paylocity screenshots here
Once you’ve completed your review and changes click the “I agree, and I'm finished with my enrollment. “ then hit “Save my Enrollment!” Once completed you may email yourself confirmation of your enrollment, if email was entered in the Family Profile Information. Otherwise you may pint the confirmation by clicking on the “Print” icon located on the right hand side of the page.
Insert Paylocity screenshots here
LOG OFF
Although the online portal is secure and your information is encrypted during transit it’s important you log off once completed with your session. To do so, click the “LOG OUT” icon in the upper right-hand corner of the enrollment site.
For security purposes the system will automatically logout if left idle for 30+ minutes.
8
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;
WOMEN’S HEALTH AND CANCER RIGHTS ACT OF 1998 The Women’s Health and Cancer Rights Act of 1998 requires Fast Track Urgent Care to notify you, as a participant or beneficiary of the Fast Track Urgent Care 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
4. Require a mother to give birth in a hospital; or
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.
SECTION 111
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.
9
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.
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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 Aetna 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 Aetna 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 Aetna 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 Fast Track Urgent Care 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 Aetna 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 Aetna 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 Aetna 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: 1/1/16 Name of Entity/Sender: Fast Track Urgent Care Contact--Position/Office: Ashley McDowel
5315 Avion Park Drive, Suite 120 Tampa, FL 33607
Phone Number:
813-472-7390
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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.
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The information in this Benefits Summary is presented for illustrative purposes and is based on information provided by your employer. The text contained in this Summary was taken from various summary plan descriptions and benefit information. While every effort was taken to accurately report your benefits, discrepancies or errors are always possible. In case of discrepancy between the Benefits Summary and the actual plan documents, the actual plan documents will prevail. All information is confidential, pursuant to the Health Insurance Portability and Accountability Act of 1996. If you have any questions about this summary, contact Human Resources.
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