Employee Benefits Guide
2017 –2018 201
Contents & Contact Information
BROKER Company Name Broker Contact
M.E. Wilson Company
Alison Leon
Company Phone Number Company Email Address
888-229-8021 Ext. 146 aleon@mewilson.com
MEDICAL Company Name
PAGE 5
Cigna
Company Phone Number Company Web Address
800-Cigna24 (800-244-6224)
www.cigna.com
VIRTUAL VISITS Company Name
PAGE 6
Cigna
Company Phone Number Company Web Address
800-Cigna24 (800-244-6224)
www.cigna.com
HEALTH SAVINGS ACCOUNT Company Name Company Phone Number Company Web Address
PAGE 7
Optum Bank 866-234-8913
www.optumbank.com
DENTAL Company Name
PAGE 8
Cigna
Company Phone Number Company Web Address
800-Cigna24 (800-244-6224)
www.cigna.com
VISION Company Name
PAGE 9
Cigna
Company Phone Number Company Web Address
877-478-7557 www.cigna.com
EMPLOYEE ASSISTANCE PROGRAM Company Name
PAGE 10
UnitedHealthcare 888-451-7986
Company Phone Number Company Web Address
www.liveandworkwell.com
FLEXIBLE SPENDING ACCOUNT Company Name Company Phone Number
PAGE 11
ADP
855-616-0288
Company Web Address
www.myspendingaccount.adp.com
BASIC AND VOLUNTARY LIFE Company Name Company Phone Number Company Web Address
PAGE 12
UnitedHealthcare 888-451-7986 www.myuhc.com
SHORT-TERM AND LONG-TERM DISABILITY Company Name
PAGE 13
UnitedHealthcare 888-451-7986 www.myuhc.com
Company Phone Number Company Web Address VOLUNTARY BENEFITS Company Name Company Phone Number Company Web Address EMPLOYEE ADVOCACY Company Name Company Phone Number Company Web Address
PAGE 14
Allstate
800-521-3535; Greg Benjamin, Agent: 727-480-4531
www.allstate.com
PAGE 15
Health Advocate 866-695-8622
www.healthadvocate.com/members
PAGE 16
DISCLOSURE NOTICES
Benefit Information YOUR BENEFITS PLAN ______ 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.
BENEFIT
WHO PAYS THE COST?
Medical Insurance
______ pays the majority of the employee and dependent costs.
Dental Insurance
______ pays 50% of the employee and dependent costs.
______ offers vision coverage on a voluntary basis. You are responsible for 100% of the cost.
Vision Insurance
Basic Life Insurance and AD&D ______ provides Basic Life for all eligible employees. Voluntary Life Insurance and AD&D Employees may purchase voluntary life insurance at an additional cost. Short and Long Term Disability ______ pays 100% of the cost for employee disability coverage.
Eligibility All regular full-time employees are eligible to join the ______ 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. Eligible dependents include: • Your legal spouse • Your married or unmarried natural children, step-children living with you, legally adopted children and any other children for whom you have legal guardianship, who are: • Under 26 years of age; • A dependent who is older than 26 years of age, but less than 30 years of age may be eligible for medical benefits. To be eligible, a dependent must: • Be unmarried and not have dependents of his or her own; AND • Be a resident of Florida or a student; AND • Not have coverage of their own, or covered under any other plan, including Medicare
WHEN CAN YOU ENROLL?
You can sign up for Benefits at any of the following times: • After completing your initial eligibility period; • During the annual open enrollment period; • Within 30 days of a qualified family-status change. If you do not enroll at one of the above times, you may enroll during the next annual open enrollment period.
BENEFITS AT A GLANCE
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Benefit Information CHOOSING YOUR BENEFITS You are required to actively choose any benefits paid for by ______ or that you pay for or share in the cost of. This is how your part of the cost is automatically taken out of your paycheck: • BEFORE YOUR TAXES ARE CALCULATED – Medical, Dental, Vision, HSA and FSA contributions (if applicable)
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.
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 • Your divorce or legal separation • Birth or adoption of an eligible child • Death of your spouse or covered child • Change in your spouse’s work status that affects his or her benefits • Change in your work status that affects your benefits • Change in residence or work site that affects your eligibility for coverage • Change in your child’s eligibility for benefits • Receiving Qualified Medical Child Support Order (QMCSO)
KEY BENEFIT TERMS Copayment – A flat fee that you pay for medical services, regardless of the actual amount charged by your doctor or another provider. This generally applies to physicians’ office visits and prescription drugs. Deductible – The amount you pay toward medical and dental expenses each year before the plan begins paying benefits. Out of Pocket Maximum – The maximum amount you will pay in deductibles, coinsurance and copayments during the year.
If you fail to notify Human Resources within 30 days of a family status change, you will be required to wait until the next annual enrollment period to make benefit changes unless you have another family status change. WHEN COVERAGE ENDS Coverage will stop on the last day of the month in which employment with the company ends.
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BENEFITS AT A GLANCE
Medical Insurance
______ offers three medical plans through Cigna. To find participating providers go to www.cigna.com and click on “Find a Doctor,” then follow the prompts to complete the search. The provider network for all three plans is “Open Access Plus.” The chart below provides a brief overview of the medical plans. This chart is intended only to highlight the benefits available
and should not be relied upon to fully determine your coverage. If the below illustration of benefits conflicts in any way with the Summary Plan Description (SPD), the SPD shall prevail. It is 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.
VALUE
ENHANCED
HDHP
IN-NETWORK: Plan Year or Calendar Year Basis Deductible (Individual / Family)
Calendar Year $--.--/ $--.-- 80% / 20% $--.-- / $--.--
Calendar Year $--.-- / $--.-- 90% / 10% $--.-- / $--.--
Calendar Year $--.-- / $--.-- 100% / 0% $--.-- / $--.--
Coinsurance
Maximum Out-of-Pocket (Individual/Family)
Maximum Out-of-Pocket Includes
Deductible, Coinsurance & Copayments
Deductible, Coinsurance & Copayments
Deductible
Lifetime Maximum PREVENTIVE CARE: Wellness
Unlimited
Unlimited
Unlimited
Immunizations Mammography/Colonoscopy COPAYMENTS: Referral Required Cigna Telehealth Connection Office Visits Consultations for Illness or Injury
Covered 100%
Covered 100%
Covered 100%
No
No
No
$25
$20
Up to $40
$25 Copayment $50 Copayment
$20 Copayment $40 Copayment
Deductible Deductible Deductible Deductible Deductible Deductible
Specialist Visits Inpatient Hospital Outpatient Surgery Emergency Room
Deductible & Coinsurance Deductible & Coinsurance
Deductible & Coinsurance Deductible & Coinsurance
$250 Copayment $75 Copayment
$250 Copayment $75 Copayment
Urgent Care
OUTPATIENT DIAGNOSTIC SERVICES: Independent/Freestanding Lab and simple x-rays
Covered 100%
Covered 100%
Deductible
PRESCRIPTIONS:
Tier 1: $10 Copay Tier 2: $35 Copay Tier 3: $60 Copay
Tier 1: $10 Copay Tier 2: $35 Copay Tier 3: $60 Copay
Covered 100% after Annual Deductible
Retail (30 day supply)
OUT-OF-NETWORK Deductible (Individual / Family)
$--.-- / $--.-- $--.-- / $--.--
$--.-- / $--.-- $--.--/ $--.-- 80% / 20% Enhanced
$--.-- / $--.-- $--.-- / $--.--
Maximum Out-of-Pocket (Individual/Family)
Coinsurance
60% / 40%
80% / 20%
Bi-weekly Payroll Deductions
Value $ --.-- $--.-- $--.-- $--.--
HDHP $ --.--
Employee Only
$ --.-- $--.-- $--.-- $--.--
Employee + Spouse Employee + Child(ren)
$--.-- $--.-- $--.--
Family
1 No one in the family is eligible for benefits until the family deductible is satisfied.
HEALTHESYSTEMS BENEFITS AT A GLANCE BENEFITS AT A GLA CE
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Virtual Visits Cigna Telehealth Connection
To access Cigna Telehealth Connection
When you don’t feel well, or your child is sick, the last thing you want to do is leave the comfort of home to sit in a waiting room. Now, you don’t have to. A virtual visit lets you see and talk to a doctor from your mobile device or computer without an appointment. Most visits take about 10-15 minutes and doctors can write a prescription, if needed, that you can pick up at your local pharmacy.
Log into www.cigna.com and choose from provider sites where you can register for a virtual visit. After registering and requesting a visit, you will pay your portion of the service costs according to your medical plan, and then you will enter a virtual waiting room. During your visit, you will be able to talk to a doctor about your health concerns, symptoms and treatment options.
And, it’s part of your health benefits.
Conditions commonly treated through a virtual visit Doctors can diagnose and treat a wide range of non-emergency medical conditions, including:
Bladder infection/ UTI
Bronchitis Sore throat Stomach ache
Cold/Flu
Diarrhea
Cough
Migraine/headaches
Pink eye
Sinus Problem
Rash
Choice is good. More choice is even better. Cigna provides access to two telehealth services as part of your medical plan - AmWell and MDLIVE. Register for one or both today so you will be ready to use a telehealth service when and where you need it.
AMWellforCigna.com
MDLIVEforCigna.com
000-000-0000
000-000-0000
To learn more, log into
HEALTHESYSTEMS BENEFITS AT A GLANCE BENEFIT AT A GLANCE
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Health Savings Account (HSA)
What is a Health Savings Account (HSA)? It is an interest-bearing account created to help you pay medical expenses. The funds in your HSA can be used to help pay your deductible, coinsurance and any qualified medical expenses not covered by your health plan (including dental and vision expenses). All of the money you contribute is tax deductible when used to pay for qualified medical expenses. An HSA is your account. It goes with you if you change jobs or when you retire. Only employees enrolled in the High Deductible Health Plan (HDHP) are eligible to contribute to a Health Savings Account.
2017 IRS ANNUAL MAXIMUM HSA CONTRIBUTION LIMITS Employee Only $ --.--
Family
$ --.--
Catch-up amount for employees 55 years or older
Additional $ --.-- annually
Health Savings Account – Eligible Expenses
• Acupuncture • Alcohol and drug dependency treatment • Ambulance • Artificial limbs • Breast reconstruction surgery (mastectomy-related) • Dental expenses (exams, cleanings, X-rays, root canals, bridges, etc.) • Diagnostic fees • Doctor fees (including Chiropractic services) • Drugs - prescription and over the counter (when ordered by a physician) • Eyeglasses and exams, contact lenses & solutions, laser surgery
• Fertility enhancements • Hearing aids and batteries • Hospital and laboratory fees • Long-term care (medical expenses and premiums) • Nursing home • Physical and speech therapies • Psychiatric care • Smoking-cessation programs and products • Vasectomy • Weight-loss program (to treat a specific disease diagnosed by a physician)
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BENEFITS AT A GLANCE
Dental Insurance
______ offers dental coverage through Cigna. The PPO Dental Plan allows you to use in-network or out-of-network dentists. To find participating in-network dentists, go to www.cigna.com and click on “Find a Doctor.” If out-of-network dentists are used, you will be responsible for paying the difference between Cigna’s allowed amount and what the dentist may charge, also known as “balance billing.” The chart below provides a brief overview of the plan.
DENTAL PPO PLAN In-Network
Out-of Network 1
Calendar Year Deductible Individual
$--.-- $--.-- $--.--
$--.-- $--.-- $--.--
Family
Annual Maximum
Diagnostic & Preventive Exams Cleanings Fluoride X-Rays Sealants Regular Restorative Services Fillings Extractions - Single Tooth Endodontics (Root Canal) Periodontics (Gum Disease) Major Services Crowns
Covered in full
Covered in full
Covered 80% after deductible
Covered 80% after deductible
Bridges Dentures Orthodontia
Covered 50% after deductible
Covered 50% after deductible
50% $1,000 lifetime maximum per person
50% $1,000 lifetime maximum per person
(Children under the age of 19)
1 Subject to balance billing. Please refer to your plan document for specific details.
EMPLOYEE PAYS PER PAY PERIOD
Employee Only
$ --.-- $--.-- $--.-- $--.--
Employee + Spouse Employee + Child(ren)
Family
HEALTHESYSTEMS BENEFITS AT A GLANCE BENEFIT AT A GLANCE
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Vision Insurance ______ offers vision coverage through Cigna. The Cigna vision plan allows you the flexibility to see any provider. You receive the highest level of benefit when you receive services from a participating provider. To find participating in-network providers, go to www. cigna.com and click on “Find a Doctor.” Below is a list of the reimbursement schedule.
VISION PPO PLAN In-Network
Out-of Network
Routine Eye Exams
$10 Copayment
Reimbursed up to $25
Reimbursed from $40 to $100 depending on type of lenses
Lenses
$25 Copayment
Frames
$130 allowance after $25 copayment
Reimbursed up to $71
One pair or single purchase per frequency Up to $110 (Allowance applied toward cost of supplemental contact lens professional services (including the fitting and evaluation) and lens materials. Non-selection contacts: up to a $105 allowance
Contact Lenses
Reimbursed up to $98
Frequency Exam
Once every 12 months Once every 12 months Once every 24 months
Lenses or contact lenses
Frames
EMPLOYEE PAYS PER PAY PERIOD
Employee Only
$--.-- $--.-- $--.-- $--.--
Employee + Spouse Employee + Child(ren)
Family
HEALTHESYSTEMS BENEFITS AT A GLANCE BEN FITS AT A GLANCE
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Employee Assistance Program
Employee Assistance Program (EAP)
Life is stressful, and sometimes the constant challenges can become overwhelming. When you have unresolved problems, it can take a serious toll on both your work and home life. To help you through difficult times, we offer a Member Assistance program as part of our long-term disability plan. The program offers members and their families personal and confidential support that’s available 24 hours a day, 7 days a week. With just one call, you can get the following types of assistance:
• • • •
Counseling services
Help with financial and legal issues
Family support
Help with relationships, coping and depression
Convenient, confidential support. The Member Assistance program provides confidential support whenever you need it at no cost to you. The program includes the following services: • Toll-free Member Assistance line: Phone access to a master’s-level counselor, 24 hours a day, 7 days a week. To reach Member Assistance, call 1-877-660-3806. • 24/7 access to liveandworkwell.com : Online access to an interactive website that provides tools and information to help enhance your work, health and life. There are two ways to login:
1. Create your own user name and password under “Members: Login or Register;” OR 2. Use the access code “LTDEAP” under “Guest Access.”
• Referrals for face-to-face counseling: Referrals to a national network of licensed and certified clinicians for up to three sessions • Legal services: Free 30-minute telephone or in-person consultation with an attorney for help with legal concerns (an attorney may be retained for ongoing services at a 25% discounted rate) • Referral to helpful resources: Referrals to community resources from a database of more than 100,000 contacts Maintaining your privacy and confidentiality is of utmost importance. All records, referrals and evaluations are kept private and confidential in accordance with federal and state laws.
BENEFITS AT A GLANCE
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Flexible Spending Account
Flexible Spending Account (FSA)
WHAT IS A FLEXIBLE SPENDING ACCOUNT? A Flexible Spending Account enables you to set aside a predetermined dollar amount in an account to cover eligible out-of-pocket health care and dependent day care expenses throughout the year. IRS rules allow you to contribute to your account(s) through payroll deduction on a pre-tax basis (before federal income tax & social security) reducing your taxable income. The dollars set aside in a Flexible Spending Account are actually worth more because they are tax-free. As a participant, you pay no taxes on the contributions or the withdrawals. Any unused money left in the account at the end of the year will be forfeited. Please be conservative with your elections.
2017 FLEXIBLE SPENDING ACCOUNT MAXIMUMS
Health Care
Dependent Care
Monies can be put aside to pay for non-covered medical, dental or vision expenses up to a maximum of $---.--. Employees and eligible dependents do not need to participate in the ______ medical, dental or vision plans to participate in the health care reimbursement account. For those employees who participate in the Health Savings Account Medical Plan, you are not eligible to participate in the FSA plan at this time.
Monies can be put aside for reimbursement for dependent daycare expenses incurred for children under the age of 13. The annual maximum per family $--.--. Dependent Care Reimbursement Account & the Federal Tax Credit You have the option to take either a tax credit on your federal income tax return for your dependent care expenses or receive pretax reimbursement of expenses through the reimbursement account. You cannot use the reimbursement account and the federal tax credit for the same expenses.
HEALTHESYSTEMS BENEFITS AT A GLANCE BENEFIT AT A GLANCE
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Basic and Voluntary Life Insurance
Basic Life Insurance
______ provides life insurance to all active full time employees at no cost to the employee. The chart below provides an overview of the plan.
BASIC LIFE INSURANCE
Employee Benefit Amount Age Reduction Schedule
1x annual salary to a maximum of $300,000
65%@age 65, 40%@age 70, 25%@age 75, 15%@age 80
Accidental Death & Dismemberment (AD&D)
Included Equal to basic life amount
Portability and Conversion
Included
Voluntary Life And AD&D Insurance
______ offers you the option to purchase voluntary life and AD&D for yourself and for your eligible dependents. The chart below provides an overview of the plan.
VOLUNTARY LIFE AND AD&D INSURANCE
Increments of $10,000 up to a maximum of 5x salary or $300,000, whichever is less. No evidence of insurability up to a maximum of $100,000 (newly eligible employees only). Increments of $5,000 up to a maximum of 50% of employee amount or $50,000, whichever is less. No evidence of insurability up to a maximum of $20,000 (newly eligible dependents only).
Employee Only
Employees Under Age 65
Spouse
Spouses Under Age 65
Benefit Reduction Schedule
65%@age 65, 40%@age 70, 25%@age 75, 15%@age 80
Children
Increments of $2,000 up to a maximum of $10,000.
Voluntary Life Life Rates per $1,000 of benefit (Spouse rate is based on employee’s age)
AGE:
<25 25-29 30-34 35-39 40-44 45-49 50-54 55-59 60-64 65-69 70-74
Employee --.--
--.-- --.--
--.-- .--.--
--.-- --.--
--.-- --.--
--.-- --.--
--.-- --.--
--.-- --.--
--.-- --.--
--.-- --.--
--.-- --.--
Spouse
--.--
Child(ren) --.-- Voluntary Life and AD&D Rates Life Rates per $1,000 of benefit (Spouse rate is based on employee’s age) AGE: <25
25-29 30-34 35-39 40-44 45-49 50-54 55-59 60-64 65-69 70-74
Employee --.--
--.-- --.--
--.-- --.--
--.-- --.--
--.-- --.--
--.-- --.--
--.-- --.--
--.-- --.--
--.-- --.--
--.-- --.--
--.-- --.--
Spouse
--.-- --.--
Child(ren)
HEALTHESYSTEMS BENEFITS AT A GLANCE BENEFIT AT A GLANCE
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Short and Long Term Disability Insurance
Short Term Disability
______ provides short term disability insurance to all active full-time employees, at no cost to the employee. The chart below provides an overview of the plan.
SHORT TERM DISABILITY
Benefit Percentage
60% of basic earnings
Maximum Weekly Benefit Elimination Period Duration of Benefit Definition of Earnings
$2,000 per week
Benefits commence on the 1st day for an accident and 8th day of sickness
90 days / 13 weeks
Base Salary
Long Term Disability
______ provides long term disability insurance to all active full-time employees, at no cost to the employee. The chart below provides an overview of the plan.
LONG TERM DISABILITY
Benefit % of Monthly Covered Payroll
60% of basic earnings
Monthly Maximum Elimination Period Benefit Duration Definition of Earnings
$6,000 per month
Benefits commence on the 91st day
Social Security Normal Retirement Age (SSNRA)
Base Salary
HEALTHESYSTEMS BENEFITS AT A GLANCE BENEFITS AT A GLANCE
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Voluntary Benefits Employees may choose to enroll in a variety of supplemental coverages available through Allstate. A broad selection of employer- sponsored products is available to enhance your benefit package and meet your individual needs. Following are some of the benefits available to you: Accident Coverage – These plans help cover the unexpected expenses resulting from covered accidents. Hospital Income Coverage – Hospital Income plans pay specific benefits such as admissions to the hospital. This can be used to help fill the gaps caused by most major medical plans (co-payments and deductibles). Critical Illness – The Critical Illness plan pays a lump sum upon diagnosis of a covered critical illness for you to use where it’s needed most. It can help pay coinsurances, deductibles, caregivers, special medical equipment, loss of income and extra living expenses. Cancer – Cancer policies pay specific benefits if there is a diagnosis of cancer.
HEALTHESYSTEMS BENEFITS AT A GLANCE BENEFITS AT A GLANCE
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Employee Advocacy ______ also provides employees who are enrolled in the company medical plan access to Health Advocate. Health Advocate is your healthcare go to when you have questions about bills, finding the right clinical care, or if you just want to talk with a healthcare advocate about a condition. Your Health Advocate benefit covers all eligible employees, their spouses, dependent children, parents and parents-in-law.
healthadvocate.com/video/ memberadvocacy.html WATCH THE VIDEO
HEALTHESYSTEMS BENEFITS AT A GLANCE BENEFIT AT A GLANCE
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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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