2019 Benefits Guide
PLAN YEAR:
January 15, 2014 – December 31, 2014
Our Mission
AMIkids is a non-profit organization dedicated to helping youth develop into responsible and productive citizens. AMIkids’ mission is to protect public safety and positively impact as many youth as possible through the efforts of a diverse and innovative staff. AMIkids works in partnership with youth agencies, local communicates and families.
CONTENTS & CONTACT INFORMATION
Refer to this list when you need to contact one of your benefit vendors. For general information contact the AMIkids Affiliated Programs Benefits Department.
AMIKIDS BENEFITS DEPARTMENT Brandie Holjes & Marie Haskins
813-887-3300 bholjes@amikids.org or mhaskins@amikids.org
M.E. WILSON COMPANY - BENEFITS PARTNER Katie Miller, Cindy Buttrill, or Jeff Lenderman
813-229-8021 kmiller@mewilson.com
MEDICAL & PRESCRIPTION
page 3
Medical : Blue Cross Blue Shield (Group # 71-60757)
1-800-830-1501 www.MyHealthToolkitFL.com
Prescription : OptumRX
1-800-334-8134 www.Optumrx.com/myCatamaranrx
HEALTH SAVINGS ACCOUNT
page 10
Optum Bank (Group # 71-60757)
1-866-234-8913 www.OptumBank.com
DENTAL
page 12
Blue Cross Blue Shield (Group # 71-60757)
1-800-222-7156 www.MyHealthToolkitFL.com
VISION
__ page 13
Blue Cross Blue Shield (EyeMed network) (Group# 71-60757)
1-866-723-0513 www.MyHealthToolkitFL.com
LIFE, SHORT-TERM & LONG-TERM DISABILITY
page 14
United Healthcare (Group # 305057)
1-888-299-2070 www.myuhc.com
403(B)
page 16
Fidelity (Group #64688)
1-800-343-0860 www.Fidelity.com/atwork
VOLUNTARY BENEFITS
page 17
United Healthcare (Group # 305057)
1-888-299-2070 www.myuhc.com
EMPLOYEE ASSISTANCE PROGRAM
page 19
LifeWorks
1-888-456-1324 www.lifeworks.com User ID: amikids Password: lifeworks
HOW TO ENROLL
page 21
Web Benefits Design
1-888-639-8077 www.mybensite.com/amikids
DISCLOSURE NOTICES
page 24
BENEFIT HIGHLIGHTS
Wage Benefits • Paid time off (PTO) • Paid Holidays (9) • Direct Deposit • Leave of Absences
Wellness Benefits • Employee Assistance Program (EAP) • Real Appeal Weight Loss Program • Rally (BCBS) Wellness Program • Health Coaching • Monthly newsletters • Wellness challenges • Wellness participation incentives • Smoking cessation programs • Stress management programs • Grief and loss care • Caregiving assistance • Chronic Condition Coaching Additional Benefits • Pet Insurance • World Travel Assistance Program • Will and Trust Services • Enterprise Car Sales Program • Enterprise/National Car Rental Program • Verizon Wireless discounts • Gym Membership discounts • AAA membership discounts • Dell product discounts • TicketsatWork Discount Program (diabetes, ADHD, CHF, COPD, etc.) • Healthy Lifestyle Coaching
• Bereavement Leave • Military Leave • Jury Duty • Family Medical Leave Act (FMLA) (Eligibility requirements)
Health Benefits • Medical plan options • Dental plan options • Vision plan option
(maternity, weight management, fitness)
• Prescription Drug plan option • Health Savings Account (HSA)
• Health Reimbursement Account (HRA) • Company paid Life Insurance and AD&D • Supplemental Life Insurance (including spouse & child) • Short and Long Term Disability Insurance • Accident Insurance • Critical Illness and Cancer Insurance
• Hospital Indemnity Insurance • Legal & Identity Theft Insurance • Telemedicine
(theme parks, movies, rentals and more)
Financial Benefits • Employer funded Pension Plan • Voluntary 403(b) Retirement Plan • PNC Bank- Workplace Financial Program (budgeting, saving, reducing debt, etc.) • Eligibility for the Student Loan Forgiveness Program for non-profit employees if meeting the qualifications
*Note* some of these benefits are available to family members as well
For more information on any of these benefits, visit the Benefits page on AMIkids Intranet at intranet.amikids.org under Support Services or contact Brandie Holjes at 813-887-3300 or email at bholjes@amikids.org
BENEFIT INFORMATION
Benefit
Who pays the cost?
AMIkids shares the cost of your medical premiums no matter what medical plan you choose!
Medical Insurance
YOUR BENEFITS PLAN
AMIkids also shares the cost of your dental premiums regardless of your dental plan choice.
Dental Insurance
AMIkids offers a variety of benefits allowing benefit eligible team members 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
AMIkids offers vision coverage on a voluntary basis.
Basic Term Life Insurance
AMIkids pays 100% of the cost for Basic Term Life coverage.
AMIkids offers you the option to purchase additional term life insurance for yourself, as well as term life insurance for your spouse and/or child(ren).
Voluntary Term Life Insurance
Short Term Disability (STD)
See benefits page for more on the voluntary offer of STD and eligibility specifics for the employer sponsored benefit.
Long Term Disability (LTD)
AMIkids offers LTD coverage on a voluntary basis.
Voluntary Benefits
AMIkids offers a variety of voluntary benefits.
Eligible AMIkids team members are automatically enrolled into the AMIkids pension plan. You can also choose to open a 403(b) retirement savings account using pre-tax dollars.
Pension and Retirement Plan
ELIGIBILITY
Eligible team members are those averaging 30 hours worked per week. Newly eligible team member’s benefits will become effective on the 1 st of the month following 60 days of eligible employment status.
You may also enroll your dependents in the Benefits Plan when you enroll.
Eligible dependents include:
Your legal spouse
•
• You or your spouse’s child who is under age 26, including natural children, step-children, legally adopted children, a child placed for adoption or any other children for whom you or your spouse are legal guardian • A child who is or becomes disabled and is dependent upon you before reaching age 26 • A child for whom health care coverage is required through a Qualified Medical Child Support Order or other court or administrative order. Please verify all dependents meet the definition of qualified dependent. Initial and periodic audits requesting proof of qualified dependent status may be conducted . You are financially responsible for any claims incurred on the plan by a dependent who does not meet eligibility requirements.
WHEN CAN YOU ENROLL?
You MUST enroll within 60 days of your new hire date. Otherwise you must wait until the next annual open enrollment period, unless you experience a qualifying event.
If you have a qualifying event, you MUST notify AMIkids of the event within 30 days of a qualified family-status change.
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BENEFIT INFORMATION
?
CHOOSING YOUR BENEFITS
WHY DO I PAY FOR BENEFITS WITH BEFORE-TAX MONEY?
Your portion of the cost of benefits is automatically taken out of your paycheck. There are two ways that the money can be taken out:
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.
• BEFORE YOUR TAXES ARE CALCULATED – Medical, Dental, Vision, H.S.A and 403(b) contributions
• AFTER YOUR TAXES ARE CALCULATED – Life, Disability and Voluntary Benefits
MAKING CHANGES
Generally, you can only change your benefit choices during the annual benefits enrollment period. However, under certain circumstances you may be allowed to make changes to your benefit elections if you or your eligible dependents experience a qualifying life event. An eligible event is determined by the Internal Revenue Service (IRS) Code, Section 125. Examples of Qualifying Events:
Your marriage
• Change in your spouse’s work status that affects his or her benefits
•
Your divorce or legal separation
• Change in your work status that affects your benefits
•
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)
•
You must enter a life event via www.mybensite.com/amikids and notify AMIkids Benefits Department, in writing, within 30 days of the qualifying event. At this time you will also be required to provide appropriate documentation. Failure to make notification within this time period, removes the option to make a changes.
WHEN COVERAGE ENDS – Medical, Dental and/or Vision coverage will end
• On the last day of the month in which employment with the company ends.
• You or a covered dependent no longer meet the eligibility requirements.
• The plan ends, and/or failure to make required contributions outside payroll deductions (ex: on leave of absences).
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MEDICAL & PRESCRIPTION INSURANCE
AMIkids offers medical coverage through Blue Cross Blue Shield for the 2019 plan year. The plan year runs from May 1st, 2019 – April 30th, 2020. AMIkids contributes over 65% of the cost for team member coverage on the Base H.S.A. Plan making this plan one that complies with the affordability rules of the ACA. You are responsible for the additional cost associated with buying up to another plan and / or adding dependent(s) on the plan. The chart below provides an 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 the exact description of services and supplies that are covered, those which are excluded or limited, and other terms and conditions of coverage .
Base HDHP H.S.A. Plan
Copay H.R.A. Plan
Copay Premium Plan
IN-NETWORK
PREVENTIVE CARE Wellness, Immunizations, Mammography, Colonoscopy, Annual bloodwork, etc. OFFICE VISITS Referral Required? Teledoc Virtual Visits Office Visits (Illness/Injury) Specialist Visits
Covered 100%, no cost to you.
No Meet deductible, then $25 Copay
No $25 Copay $50 Copay $75 Copay
No $25 Copay $35 Copay $60 Copay
Meet deductible, then 20% Meet deductible, then 20%
HOSPITAL SERVICES Inpatient Hospital Outpatient Surgery Emergency Room Urgent Care Clinic
Meet deductible, then 20% Meet deductible, then 20% Meet deductible, then 20% Meet deductible, then 20%
Meet deductible, then 30% Meet deductible, then 30%
Meet deductible, then 20% Meet deductible, then 20%
$500 Copay $100 Copay
$350 Copay $100 Copay
DIAGNOSTIC TESTING Lab, X-Ray, Advanced Imaging (MRI, CAT, PET, etc.)
Meet deductible, then 20%
Meet deductible, then 30%
Meet deductible, then 20%
PRESCRIPTIONS Retail (30 day supply) Tier 1 / 2 / 3
Meet deductible, then $10 / $35 / $60 Copay
$20 / $50 / $80 Copay
$10 / $35 / $60 Copay
Medicare (Part D) Creditable
NO
YES
YES
DEDUCTIBLE (your cost for covered in-network claims) Deductible (Individual / Family) $3,000 / $6,000
$4,500 / $9,000
$1,500 / $3,000
COINSURANCE (your responsibility on claims costs once you’ve met the deductible) 20% 30% OUT OF POCKET MAXIMUM (once met, all in-network covered services are covered by the plan) Maximum Out-of-Pocket (Individual / Family) $6,000 / $12,000 $6,000 / $12,000
20%
$5,000 / $10,000
Max Out-of-Pocket includes
Deductible , Coinsurance, Prescription Costs, and Copays paid by you during the course of the plan year OUT-OF-NETWORK (charges are subject to balance billing)
Deductible Coinsurance Out of Pocket Maximum
$7,500 / $15,000 50% $15,000 / $30,000
$10,000 / $20,000 50% $15,000 / $30,000
$7,500 / $15,000 50% $15,000 / $30,000
1 Charges are subject to balance billing
WHAT ARE TELADOC VIRTUAL VISITS? They allow you to see and talk to a doctor from your cell phone, tablet or computer regarding non-emergency medical conditions like the flu, pink eye, rashes and fever. These visits are subject to your deductible (or a copay depending upon your plan selection) but are typically at a lesser cost than an office visit. A great way to SAVE TIME AND MONEY! To access Teladoc, visit www.teladoc.com or call 1-800-Teladoc (835-2362)
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HOW TO FIND IN-NETWORK PROVIDERS
To utilize your benefits you want to seek services from in-network doctors and facilities. You can search and locate in-network providers by visiting www.MyHealthToolkitFL.com and following the below instructions.
Go to www.MyHealthToolkitFL.com and click on the highlighted field
Enter the name of the provider you wish to search and/or the desired location and/or the specialty.
Choose “Show me only doctors and hospitals in my Plan” and enter the alpha prefix EQO in the field that pops up.
UNDERSTANDING KEY TERMS
STARTING WITH THE BASICS
Deductible is the amount you have to pay out of pocket for services not covered by a copay before co-insurance starts. Once you’re enrolled in medical, you're a Blue Cross Blue Shield member. Because you’re a member you get the discounted rate with all in-network providers and facilities! This discount is typically 50%-70% off the amount charged to someone without insurance. Coinsurance is cost-sharing. The cost-sharing “kicks in” AFTER you meet the deductible. Even though you’ve met your deductible, you still get the discounted rates! On the medical summary chart you can see coinsurance is 20% or 30% depending upon which plan you choose. When you have coinsurance, you pay 20% or 30% of that discounted rate and the plan pays the rest! Copayment (aka Copay) is a flat fee that you pay for medical services and/or prescriptions. On the Base H.S.A. Plan you do not have copays with the exception of prescriptions and virtual visits, though you must meet your medical deductible prior to having copays for prescriptions and virtual visits. Out of Pocket Maximum is the maximum total amount you will pay in deductible costs, coinsurance and copays during the policy year. Once you meet the Out of Pocket Maximum, the plan pays 100% of your eligible costs on covered medical and pharmacy services.
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UNDERSTANDING HOW THE PLANS WORK
Base HDHP H.S.A. Plan
You’re responsible to pay the first dollar costs for medical services and prescriptions (Rx) until you meet your deductible ($3,000 individual/$6,000 family)
Phase 1
Once you’ve met the deductible, coinsurance kicks in for all medical services and now copays apply to Rx. That’s right, you’ll pay 20% of the cost for medical services and the plan pays the rest! You’ll pay the copay for Rx and the plan pays the rest!
Phase 2
You’ve got a maximum out-of-pocket. This amount is an accumulation of the deductible, Rx, coinsurance, and copays. Once all these costs add up to the total max out-of-pocket ($6,000/$12,000) the plan will pay 100% of all in-network, covered medical services and Rx for the rest of the policy year.
Phase 3
Copay H.R.A Plan & Copay Premium Plan
You pay the copay amount for day to day services, as stated on page 3. Your deductible applies to the additional services not covered by a copay. Once you meet your deductible your coinsurance will “kick in”.
• on the Copay H.R.A. Plan, you pay 30% of the cost and AMIkids pays 70% of the cost of the claim. • on the Copay Premium Plan, you pay 20% of the cost and AMIkids pays 80% of the cost of the claim.
The amounts you pay towards your deductible, coinsurance, copay amounts, and prescription copays apply to your out-of-pocket maximum.
Want to earn some Wellness Incent ives?
Register for one of AMIkids Wellness Programs!
Rally Wellness Program
Team members enrolled in one of the three AMIkids medical plans, have access to the Rally Wellness Program through BlueCross BlueShield at no cost to you year round!
Rally can help you get healthier one step at a time. It will show you how to make simple changes to your daily routine, set smart goals for yourself and stay on target. You’ll get personalized recommendations to get you moving more, eating better, feeling happier and you’ll have FUN doing it!
To get started, login to www.MyHealthToolKitFL.com. Once you register, select Wellness, then Rally.
Once you earn 2,000 coins, contact the Benefits Department to receive a new FitBit (while supplies last).
Real Appeal Weight Loss Program
AMIkids offers a FREE online weight loss program to ALL team members with a BMI of 20 or higher. You do not have to be enrolled in any of the AMIkids benefits to participate. Spouses and dependents over the age of 18 can also participate in Real Appeal as long as they’re enrolled in one of the three AMIkids medical plans. Real Appeal is a free, 52 week online weight loss program that is customized to what works for you! You will learn simple steps to help you transform and earn incentives along the way. You’ll have access to a transformation coach, digital tools, weekly online support group classes and a success kit full of healthy weight management tools.
To get started, login to www.amikids.realappeal.com. Once you complete ten group session, you will receive a FitBit.
(All incentives will be available year round while supplies last and are taxable and subject to federal and state withholdings)
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MEDICAL (SEMI-MONTHLY) RATES
SALARY RANGE: BELOW $35,000
Cost for Coverage Amounts shown are per pay check ( 24 payments/year )
Base HDHP H.S.A Plan
Copay H.R.A. Plan
Copay Premium Plan
Employee Only
EE
$ 56.23
$ 91.73
$ 179.53
Employee + Spouse
ES
$ 153.51
$ 225.84
$ 423.00
Employee + Child(ren)
EC
$ 128.21
$ 192.31
$ 366.07
Employee + Family
FAM
$ 194.00
$ 294.16
$ 564.87
SALARY RANGE: $35,000 TO BELOW $50,000
Cost for Coverage Amounts shown are per pay check ( 24 payments/year )
Base HDHP H.S.A Plan
Copay H.R.A. Plan
Copay Premium Plan
Employee Only
EE
$ 64.67
$ 101.22
$ 192.67
Employee + Spouse
ES
$ 171.22
$ 245.77
$ 450.58
Employee + Child(ren)
EC
$ 144.23
$ 210.34
$ 391.03
Employee + Family
FAM
$ 219.30
$ 322.62
$ 604.28
SALARY RANGE: $50,000 AND OVER
Cost for Coverage Amounts shown are per pay check ( 24 payments/year )
Base HDHP H.S.A Plan
Copay H.R.A. Plan
Copay Premium Plan
Employee Only
EE
$ 73.10
$ 110.70
$ 205.81
Employee + Spouse
ES
$ 188.94
$ 265.69
$ 478.17
Employee + Child(ren)
EC
$ 160.26
$ 228.37
$ 415.99
Employee + Family
FAM
$ 244.60
$ 351.09
$ 643.69
REMINDER : If you sign up for the Base HDHP H.S.A Plan AMIkids WILL GIVE YOU $500, pro-rated, into your open and active Health Savings Account. Of course you have to open the account and keep it open to get the money! If you sign up for the Copay H.R.A. Plan AMIkids WILL GIVE YOU up to the first $500 of any deductible related expenses immediately as the claims are incurred. Your doctor submits the claim to BCBS and they will receive up to $500 from AMIkids.
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2019 Annual Enrollment Elections
?
As a current team member , the 2019 Annual Open Enrollment period begins on March 25 th , 2019 and runs through 11:59:59pm on April 8 th , 2019. All benefits eligible team members are strongly encouraged to participate in Annual Open Enrollment by visiting the online benefits administration site at www.mybensite.com/amikids or by calling 1-888-639-8077 and making their benefits selections. Team Members that are currently enrolled in any of the AMIkids benefits will automatically rollover into the new plan year as is unless you make changes. All elections, including optional coverages, will continue if you do not login to make a change. As a recently hired team member , you have a New Team Member Enrollment Period to elect your benefits. The enrollment period starts as soon as you are loaded into the BenAdmin system (usually the week after your first paycheck) and ends on your 60 th day following your date of hire. If you do not make your elections during this window, you cannot enroll in the AMIkids benefit plan until the next annual enrollment unless you experience a qualified change in status (see page 2).
Is participation in the 2019 Annual Open Enrollment Mandatory this year? • No, but participation in your health care decisions is STRONGLY encouraged.
• This is a great opportunity to make
sure your information on file is correct, to include your address, phone number and email and make any updates to your beneficiaries.
HOW DO I DETERMINE WHICH PLAN IS BEST FOR ME AND MY FAMILY?
“Nobody knew health care could be so complicated!”
We know and understand deciding which benefits are right for your situation is a personal choice based on each family’s dynamics. Because of the IRS 125 rules, the decisions you make during annual open enrollment or upon your initial eligibility in the plan year are with you until the beginning of the next plan year.
The next 2 pages provide a couple of scenarios that will assist you in determining which plan makes the most sense for you – if you want assistance with creating your own scenario, you may contact BCBS and they’ll walk through the process.
CHOOSE WISELY! The benefit elections you make will remain in effect until April 30, 2020
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HOW DO I DETERMINE WHICH PLAN IS BEST FOR ME AND MY FAMILY?
SCENARIO 1: TEAM MEMBER AND CHILD(REN) EARNING LESS THAN $35,000
Karl with EE + Ch <$35k
Base HDHP H.S.A. Plan
Copay H.R.A. Plan
Copay Premium Plan
Notes
Annual Plan Deductible AMIkids deposits $500 (prorated) into Karl’s H.S.A. Karl goes to his in-network Dr for his annual physical, blood work, etc. Karl’s son gets the flu! Karl takes him to the Dr and the office visit charge is $145 but the BCBS negotiated rate is $73, so Karl pays:
$3,000
$4,500
$1,500
$500
n/a
n/a
Only the Base Plan is eligible for the H.S.A. Preventative covered at 100% on all 3 plans! The $73 goes towards meeting Karl’s deductible and out of pocket (OOP) max, but the $50 or $35 copay would only go towards his OOP max. On the Base Plan, Karl can use his H.S.A. funds to cover his son’s office visit
$0
$0
$0
$73
$50 Copay
$35 Copay
HSA Balance
$427 ($500 - $73)
n/a
n/a
At his son’s office visit, the Dr prescribes Flu medication (generic):
$47
$20 Copay
$10 Copay
H.S.A. Balance
$380 ($427-$47)
n/a
n/a
On the Base Plan, Karl can use his H.S.A. funds to cover his son’s prescription.
Late one night, Karl’s son is ill and is running a bad fever so he takes him to the E.R. H.S.A Balance & Out of Pocket Expense (deductible) Total Annual Medical Premiums Karl paid Karl’s total health care expenses for the year in the scenario above
$600
$500 Copay
$350 Copay
$0 H.S.A. Balance $220 Out of Pocket ($600 – $380 = $220)
n/a
n/a
On the Base Plan, Karl uses up his H.S.A. funds to pay for part of the ER visit, but still has to pay the remainder out of pocket.
$3,077.04
$4,615.44
$8,785.68
$3,297.04 ($3,077.04 + $220) This plan is Karl’s best option!
$5,185.44 ($4,615.44+$50+$20+$500)
$9,180.68 ($8,785.68+$35+$10+$350)
Even though Karl used all of his H.S.A. funds & paid $220 out of pocket, the Base Plan is still best for him!
Treatment Cost Estimator
Lower Your Costs When necessary, compare costs before you schedule treatments. Try to price out fees with doctors or health care facilities before you receive services in order to help lower your out- of-pocket costs.
Login to www.MyHealthToolKitFL.com, plug in your zip code and name of a medical procedure to find real-time cost estimates for nearby hospitals, surgery centers and physician offices.
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HOW DO I DETERMINE WHICH PLAN IS BEST FOR ME AND MY FAMILY?
SCENARIO 2: TEAM MEMBER AND SPOUSE EARNING $48,000
Diane with EE + Sp $48k
Base HDHP H.S.A. Plan
Copay H.R.A. Plan
Copay Premium Plan
Notes
Annual Plan Deductible AMIkids deposits $500 into Diane’s H.S.A.
$3,000
$4,500
$1,500
$500
n/a
n/a
Only the Base Plan is eligible for the H.S.A.
H.S.A. balance
$500
n/a
n/a
Diane gets all of her annual preventative care (mammography, blood work, physical, etc.) During her annual exams, Diane’s Dr identifies a “lump” and order diagnostic testing that then leads to investigative surgery. The BCBS negotiated claim cost totals $27k
$0
$0
$0
Preventative covered at 100% on all 3 plans!
$6,000 ($3,000 deductible plus
AMIkids covers the first $500 as part of the H.R.A. arrangement
$1,500 (deductible) plus $3,500 (20% coinsurance until Out of Pocket of $5,000 is reached then plan pays $100%)
$3,000 [20% coinsurance until Diane reaches her Out of Pocket Max of $6,000] and then the plan pays 100% of the remainder)
then Diane pays the next $4,000 (deductible) plus
$1,500 (30% coinsurance until Diane reaches her Out of Pocket of $6,000 then the plan pays 100%)
Total Diane pays out of pocket for this $27k claim
$5,500 ($6,000 - $500 H.S.A.)
$5,500 ($6,000 - $500 H.R.A.)
$5,000 ($1,500 + $3,500)
In the Base Plan, Diane uses her AMIkids H.S.A. funds. On the Copay H.R.A. Plan, AMIkids pays the first $500 of deductible expenses.
H.S.A. Balance
$0
n/a
n/a
Total Annual Medical Premiums Diane paid Diane’s total health care expenses for the year in the scenario above
$4,109.28
$5,898.48
$10,813.92
$9,609.28 ($4,109.28 + $5,500) This plan is Diane’s best option!
$11,398.48 ($5,898.48 + $5,500)
$15,813.92 ($10,813.92 + $5,000)
In this scenario, even though Diane spent $5,500 out of pocket on the Base H.S.A. Plan, her annual expenses are still lower than the other two plans.
My Health ToolKit When you’re a member of BCBS, you have one main place to find answers about your health care. My Health Toolkit is a one-stop shop for managing your health benefits—customized just for you!
Go to www.MyHealthToolKitFL.com to learn more about your coverage, check medical claims, replace your membership card, view your medical history, find a doctor or hospital and more!
Get Started Today Why wait? It’s easy to sign up for My Health Toolkit. In just a few clicks, you’ll have everything you need at your fingertips! 1. Go to www.MyHealthToolkitFL.com and select Register Now. 2. Enter the number on your membership card and your date of birth. If you don’t have your membership card, enter the policyholder’s social security number. 3. Choose a username and password. 4. Enter your email address and you are READY TO GO!
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HEALTH SAVINGS ACCOUNT (H.S.A)
When you’re enrolled in a qualified High Deductible Health Plan (HDHP) you and your employer can contribute to your H.S.A account. What are the perks?
ELECTING Base HDHP H.S.A. Plan?
CONGRATS, you’re eligible for an H.S.A! Congrats again because AMIkids is giving you $500 in your H.S.A . This gift will be pro-rated , thus deposited into your account throughout the year. All you have to do is open an H.S.A with Optum Bank and keep it active.
Your contributions are pre-tax .
•
• Money rolls over year to year, you never lose it. • It’s owned by you . The account and money in it are yours to keep whether you retire, come off the group plan, or cease employment. • It’s easy to use ! Optum Bank sends you an H.S.A card when you open an account. The card is just like a debit card, simply swipe the card when you want to use the funds.
Visit their website to open an account. Go to www.optumbank.com
2019 Maximum Contribution Limits*
If you do not open the account and keep it active AMIkids cannot deposit the money for you. Easiest $500 you’ve ever made!
Single Coverage
$3,500
Family Coverage
$7,000
* Individuals who are age 55 or older may contribute an additional $1,000 per year.
ELIGIBLE EXPENSES INCLUDE (but are not limited to):
Alcohol & drug dependency treatment
Hearing aids & batteries for use Hospital, Surgical, lab & X-Ray fees
• • •
• •
Artificial Teeth
Acupuncture & Chiropractic services
• Long-term care (medical expenses & premiums) & Nursing home • Physical & speech therapies • Smoking-cessation programs & products • Vasectomy • Wheelchairs
• Dental expenses (exams, X-rays, root canals, bridges, etc.) • Diagnostic devices (blood sugar test kits for diabetics) • Prescription drugs • Eyeglasses, exams, laser eye surgery, Contact lenses & solution
HOW TO GET $500?
OPEN AN H.S.A, IT’S SO EASY!
You can choose to enroll in the H.S.A. online or by completing and submitting a paper enrollment form to Optum Bank directly. The form is available on the Benefits Department page on the AMIkids Intranet or from your Business Manager. To enroll online:
Go to www.optumbank.com
• •
Select “ENROLL NOW”
• Scroll down and review the qualifications • If you qualify, select “If you qualify to open an H.S.A you can do so today by clicking here.” • ….And begin!
You will be asked for:
Your Social Security Number An email address, to receive information from Optum Your Group Number: 71-60757 IMPORTANT : Under requested contribution please indicate “0”.
If you wish to contribute to the HSA as well, you may enroll online at www.mybensite.com/amikids, or you may download the HSA contribution form from the Benefits department page of the AMIkids Intranet or contact your Business Manager.
Once your enrollment is processed, watch your mail! You’ll receive a Welcome Letter from Optum Bank with your account number H.S.A Debit card (MasterCard). Separately you will receive a Personal Identification Number (PIN) for your debit card. Optum Bank MUST validate your enrollment info prior to activating your account. This process may take up to two weeks. We strongly encourage you to enroll as soon as you’re eligible for benefits to ensure you receive your entire prorated gift ($500).
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HEALTH REIMBURSEMENT ACCOUNT (H.R.A.)
When you’re enrolled in a qualified Copay Plan your employer can contribute to an H.R.A. It can help with out-of-pocket deductible expenses. What are the perks? • It immediately covers the first $500 of your deductible eligible expenses. • The funds you receive do not count toward your gross income for tax purposes. • It’s easy to use ! Your doctor will be informed of this benefit when they verify your coverage with our medical provider (BCBS). Your doctor will submit the claim to BCBS and will receive payment up to $500 from AMIkids.
ELECTING the Copay H.R.A. Plan?
CONGRATS, you’re eligible for an H.R.A! Congrats again because AMIkids is giving you up to $500 in your H.R.A . This gift will be immediately available for you to use on medical deductible eligible expenses.
The HRA $500 gift does not rollover and is only available when you have deductible eligible expenses.
MEDICAL DEDUCTIBLE ELIGIBLE EXPENSES INCLUDE (but are not limited to):
Hospital Stays
Hospital, Surgical, lab & X-Ray fees
• • •
•
Outpatient Surgeries Ambulance services
• Long-term care (medical expenses & premiums) & Nursing home • Physical & speech therapies
HOW TO GET $500?
H.R.A, IT’S SO EASY!
If you are enrolled in the copay H.R.A plan, then AMIkids will automatically cover up to $500 of your deductible eligible expenses.
The H.R.A does not rollover and is only available when you have deductible eligible expenses.
Want to check your paid claims status?
Go to www.checkmyhra.com Your user name is your SSN
• •
• Your password is your date of birth (format mmddyyyy) • Click on the Claims tab, select Claims History
You may also view your claims balance and history on your www.MyHealthToolkitFL.com account or call the Blue Cross Blue Shield customer service line at 1-800-300-5248.
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DENTAL INSURANCE
AMIkids offers dental coverage through Blue Cross Blue Shield (BCBS). Both plan options are Dental PPOs, which allow you to use in- network or out-of-network benefits. If out-of-network dentists are used, you will be responsible for the balance billed amount (the difference between BCBS’ allowed amount and what the dentist charges). The chart below provides a brief overview of the plans. To find in-network providers visit www.MyHealthToolkitFL.com and click on “Find a Dentist” within the right column. If the below illustration of benefits conflicts in any way with the plan description, then the plan description shall prevail.
Base PPO Plan
Premium PPO Plan
In-Network
Deductible (applies to Basic & Major services)
$50
$50
Individual
$150
$150
Family
Annual Maximum (per covered member)
$1,000
$1,500
Preventive Services
Covered in full
Covered in full
Exams, Cleanings, & Fluoride
Basic Services
Fillings, Simple Extractions, Perio & Endo (other than those listed below)
You pay 20% after deductible
You pay 20% after deductible
Major Services
Crowns, Bridges, Surgical Extractions, Root Canal, Dentures, Osseus Surgery & Endo Molars
You pay 50% after deductible
You pay 50% after deductible
Orthodontia (child 18 and under only)
40% $2,000 lifetime maximum per person
None
Out-of Network 1
Basis of Payment
90% Usual & Customary Charges
Deductible (applies to Basic & Major services) Individual / Family
$50 / $150
$50 / $150
Annual Maximum (per covered member)
$1,000
$1,500
Services Preventive Basic Major
Covered in full You pay 20% after deductible You pay 50% after deductible
Covered in full You pay 20% after deductible You pay 50% after deductible
Orthodontia (child 18 and under only)
40% $2,000 lifetime maximum per person
None
1 Subject to balance billing . Please refer to your plan document for specific details.
Cost for Coverage Amounts shown are per pay check ( 24 payments/year )
Base PPO
Premium PPO
Employee Only
EE
$ 4.68
$ 9.35
Employee + Spouse
ES
$12.13
$21.56
Employee + Child(ren)
EC
$14.78
$29.52
Employee + Family
FAM
$24.51
$45.26
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VISION INSURANCE
AMIkids offers vision coverage through Blue Cross Blue Shield (BCBS). The Blue Cross Blue Shield vision plan provides you access to the EyeMed Vision network and allows you the flexibility to see any provider but, to maximize savings seek services from a EyeMed network provider. If you utilize an out-of-network provider, you’ll pay expenses at the time of service and file a claim for reimbursement. The chart below provides a brief overview of the plan and reimbursement schedule for out-of-network services. See Summary Plan Description for more details. Your vision is important to your health. Whether your vision is 20/20 or less than perfect, everyone should receive regular vision care. To find in-network providers visit www.MyHealthToolkitFL.com and hover over on the “Education Center” in the top menu and click on “Enrollment Tools”. Under Healthy Vision you will find a link for “EyeMed Provider Locator”. Get results by entering your location and select the “Access” network.
Vision EyeMed Access Network
Out-of-Network 1
In-Network
Routine Eye Exams
Every 12 months
$20 Copay
Reimbursed up to $200
Lenses 2
Every 12 months
Single Vision Bifocal Trifocal Lenticular
Reimbursed up to $200, depending on type of lenses
$40 Copay
Frames
Every 12 months
$40 Copay provides, $130 Allowance PLUS 30% off cost over the allowance
$200 allowance
Contact Lenses (in lieu of glasses)
Every 12 months
Elective Contact Lenses Preferred Non-Preferred
$40 Copay provides up to 8 boxes $40 Copay provides, $200 allowance
Reimbursed up to $200
Medically Necessary
$40 Copay
Reimbursed up to $200
1 Reimbursable amount, less applicable copay. 2 Lenses benefit listed are for a pair of lenses.
Cost for Coverage Amounts shown are per pay check ( 24 payments/year )
Vision Plan
Employee Only
EE
$ 3.74
Employee + Spouse
ES
$ 7.70
Employee + Child(ren)
EC
$ 6.50
Employee + Family
FAM
$10.46
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LIFE AND AD&D INSURANCE
BASIC LIFE AND AD&D INSURANCE
AMIkids provides all benefit eligible team members with at least a $10,000 Life and Accidental Death & Dismemberment (AD&D) benefit, at NO COST TO YOU! Please be sure to assign your beneficiary at initial eligibility and/or during annual open enrollment and update throughout the year as needed.
Age Reduction Schedule
At age…
The original amount of benefit will reduced by …
65
65%
70
50%
Cost for Coverage Basic Life Insurance and AD&D
Employee Only
EE
$ 0.00 ….. It’s free to you, 100% paid for by AMIkids!
VOLUNTARY LIFE AND AD&D INSURANCE
AMIkids offers you the option to purchase additional Life and AD&D insurance for yourself and your dependents. This coverage is available through United Healthcare.
You may request coverage amounts…
Benefits must be in Increments of….
as low as…
as high as…
$500,000 (not to exceed 5x your annual salary)
Employee
$10,000
$10,000
Spouse 3
$5,000
$150,000
$5,000
Child(ren) 1 2 3
$10,000
$10,000
N/A
1 Cost of Child coverage is same for 1 or more children. 2 Children are eligible from 14 days to 26 years.
What are the GI amounts?
3 You must elect voluntary life insurance for yourself to have dependent coverage. The dependent benefit cannot exceed the employee benefit.
$200,000 (not to exceed 5x your annual salary)
Employee
What is Guarantee Issue (GI)? GI is the maximum benefit you can receive without having to provide proof of good health, Evidence of Insurability (EOI). GI is only available at initial eligibility. If you’re requesting coverage outside your initial eligibility, you must submit EOI to United Healthcare for review (form located on myBenSite – www.mybensite.com/amikids).
Spouse 3
$30,000
Child(ren) 1 2 3
$10,000
Cost for Coverage
Voluntary Life Insurance and AD&D
Employee Spouse Child(ren)
Check out myBenSite to see your and your dependents personalized rates. Premiums will be deducted from your pay after taxes.
The Voluntary Life and AD&D plan includes the ability to take this coverage with you should your employment end. To obtain more information on how to do this, get the forms, and confirm your new premium costs please contact United Healthcare within 31 days of the end of your employment at 1-877-683-8601.
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DISABILITY INSURANCE
EMPLOYER PAID SHORT TERM DISABILITY (more than 2 full year s of employment)
Short Term Disability (STD) may provide you a benefit, should you become temporarily disabled because of a non-work related illness, injury or a condition, like pregnancy. Please note, STD does not provide for any job protected status, job protection may be provided for you by the Family Medical Leave Act (FMLA), if applicable. STD leave runs concurrent with family medical leave if an team member is eligible for both STD and FMLA. • Benefit eligible team members who have completed two full years of continuous employment with no gaps are eligible for employer paid, STD through United Healthcare. That’s STD coverage at NO COST TO YOU ! This benefit may provide you 60% of your weekly base pay, up to 12 weeks. Claims review and benefit amounts / administration is through United Healthcare. There are no pre-existing condition limitations on this policy .
VOLUNTARY SHORT TERM DISABILITY (employed less than 2 year s )
This plan can be purchased on a voluntary basis for those not yet eligible for the company sponsored STD Plan. Benefit eligible team members, employed for less than 2 years are offered Voluntary Short Term Disability through United Healthcare. Elections for STD can be made during the enrollment process, cost for coverage can also be found online. The benefit may pay you 60% of your weekly base earnings, not to exceed $1,500 per week. Benefits begin on the 8 th day from the start of the illness or accident and can pay out up to a 12 week maximum. Please make note of the pre-existing condition limitations, which state disabilities that occur during the first 12 months of coverage (due to a pre-existing condition) are excluded if the condition was diagnosed, treated or prescribed in the 3 months prior to the effective date of coverage.
Cost for Coverage Voluntary Short Term Disability (STD)
Employee
Check out myBenSite to see your personalized rates. Premiums will be deducted from your pay after taxes.
Long Term Disability (LTD) may provide you income protection through monthly benefits should you become unable to work, due to non-work related accident or illness. Benefits under LTD would begin to pay if/when your Short Term Disability benefit is exhausted. AMIkids offers benefit eligible team members the option to purchase Voluntary Long Term Disability through United Healthcare. Claims review and benefit amounts / administration is through United Healthcare. The chart below provides an overview of the plan.
How much does it pay?
60% of monthly base earnings
Is there a maximum to the monthly benefit?
Yes, 60% of your monthly base earnings cannot exceed $6,000.
Benefits commence after 90 days from disability (designed to begin as eligible STD pay is ending).
When would the LTD pay begin?
If you become disabled prior to age 62, benefits are payable to age 65 or Social Security Normal Retirement Age (SSNRA)
What’s the duration of the benefit?
Any Health condition that prevents you from doing your “Own Occupation”. Meaning the disability prevents you from performing at least one of the material duties of your regular occupation during the first 24 months of disability and after 24 months are unable to perform all the material duties of any gainful occupation.
What’s the definition of disability?
Please make note of the pre-existing condition limitations, which state disabilities that occur during the first 12 months of coverage (due to pre-existing condition) are excluded if the condition was diagnosed, treated or prescribed in the 3 months prior to the effective date of coverage.
Cost for Coverage
Voluntary Long Term Disability (LTD)
Employee
Check out myBenSite to see your personalized rates. Premiums will be deducted from your pay after taxes.
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RETIREMENT BENEFITS
AMIKIDS PENSION PLAN
After two years of employment, you may be eligible for the company sponsored pension plan. This retirement account is funded 100% by your AMIkids employer. Contributions are made based on years of service, see below for contribution schedule.
Contribution Schedule
Years of service
% of Salary
More than 2 years, but less than 10 years
5%
10 years or more
15%
These contributions COST YOU NOTHING , it’s FREE money into a retirement account that you own! Each plan year in which a contribution is provided, and in which you are an eligible participant, an allocation will be made into your account automatically.
You have 100% vested interest in your account once you are eligible for participation
Hardship withdrawals and loans are not permitted from the pension plan. Please contact the payroll department with any questions relating to the pension.
VOLUNTARY 403(b) RETIREMENT SAVINGS PLAN
To help prepare you for the future, AMIkids offers a 403(b) savings retirement plan through Fidelity Investments. This plan is 100% funded by you via PRE-TAX payroll deductions. AMIkids does not contribute to your 403(b) as it sponsors AMIkids Pension Plan (if you are an eligible participant).
Once you enroll directly with Fidelity Investments you must notify your Business Manager or the Benefits Specialist to begin payroll deductions. Per your contribution request, AMIkids will forward these deductions to Fidelity Investments.
With this plan, you can save a portion of your pay on a pre-tax basis (federal and most state income taxes are deferred on amounts contributed), up to $19,000 in 2019. Taxes are also deferred on your investment earnings within the plan.
An additional deferment is available to employees age 50 and over which must be made by December 31st. These employees can defer up to $6,000 in addition to their regular contribution amount, for a combined total contribution limit of $25,000 in 2019.
You are always 100% vested in your contributions!
Please contact Fidelity Investments with any questions relating to your 403(b).
WHEN CAN I START CONTRIBUTING?
You are eligible for the 403(b) so long as you’re working 30+ hours per week, you may start contributing immediately and you may sign up at anytime! To set up your account, contact Fidelity directly at 800-343-0860 using Group # 64688.
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VOLUNTARY BENEFITS
AMIkids offers you the option to enroll in voluntary benefits through United Healthcare. As these benefits are voluntary, you pay 100% of the cost for coverage for yourself and any dependents (spouse and/or child(ren)).
ACCIDENT INSURANCE
The Accident plan helps lessen the financial impact of out-of-pocket medical costs related to an accident by paying you a lump sum benefits for over 50 covered injuries and treatments.
These include, but are not limited to: • ER visits •
Physical therapy
• • • •
Follow-up doctor visits Broken bones and burns
Emergency dental work Knee ligament injuries
• • •
Ambulance Dislocations
Chiropractor
There is no total maximum amount for benefits payments! You may file multiple claims for multiple covered incidents and it includes catastrophic accident benefits.
No health questions are required to enroll, meaning this plan is guaranteed issue. Additionally, there are NO pre-existing limitations.
You may access the cost for coverage through myBenSite. Premiums will be deducted from your pay after taxes .
CRITICAL ILLNESS INSURANCE (includes Cancer)
This benefit pays you a lump sum benefit when you, or a covered dependent, experience a covered critical illness. These include but are not limited to following conditions.
Heart attack or Stroke
Blindness
• • • • •
• •
Coma
Occupational HIV
Kidney or major organ failure
• Coronary bypass surgery (25% covered) • Cancer
Benign brain tumor Permanent paralysis
No health questions are required to enroll, meaning this plan is guaranteed issue. Additionally, there are NO pre-existing limitations.
You may access the cost for coverage through myBenSite. Premiums will be deducted from your pay after taxes .
HOSPITAL INDEMNITY INSURANCE
This plan helps lessen the financial impact of out-of-pocket medical costs related to a covered hospital stay, with pre-defined benefit amounts. Even if the cost of the claim is less than the pre-defined benefit, the full pre-defined benefits will be paid to you directly.
Pre-defined benefits include, but are not limited to:
Hospital Admission
$1,500 per insured person per calendar year
Hospital Confinement
$200 per day (limits may apply) $200 per day (limits may apply)
Hospital ICU Confinement
No health questions are required to enroll, meaning this plan is guaranteed issue. Additionally, there are NO pre-existing limitations.
You may access the cost for coverage through myBenSite. Premiums will be deducted from your pay after taxes .
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