Sunshine Employment Resources. Medical Plan Options and Enrollment Information. Enrollment Guide. Administered by Key Benefit Administrators, Inc.

Transcription

1 Enrollment Guide Medical Plan Options and Enrollment Information Administered by Key Benefit Administrators, Inc. PLANS DESIGNED FOR THE EMPLOYEES OF Sunshine Employment Resources

2 Minimum Essential Coverage (MEC) Minimum Essential Coverage covers 100% of the government s listed Preventive and Wellness Benefits when you visit a network provider (40% out-of-network). Self-Insured by your employer, this coverage is required to satisfy your individual mandate under the new healthcare law. As outlined under the new healthcare law, ACA, all individuals must have Minimum Essential Coverage (MEC) beginning January 1, 2014, or pay a penalty tax. Employees can prevent being taxed the Individual Mandate penalty tax by purchasing Minimum Essential Coverage through their employer. If you don t purchase Minimum Essential Coverage (MEC), beginning January 1, 2014, you will face a tax of the greater of 1% of adjusted household income or $95 per adult plus $47.50 per child. In 2015, you will have to pay the greater of 2% of adjusted household income or $325 per adult plus $ per child. Thereafter, the tax will be the greater of 2.5% of adjusted household income or $695 per adult plus $ per child. There are preventive services covered at 100% under the required government list of Preventive and Wellness Benefits when you visit a network provider. The benefits drop to 40% if you use an out-ofnetwork provider. Services covered include immunizations, blood pressure screenings, diabetes and cholesterol screenings, prenatal visits for pregnant women and more. A full list of the covered services is included in this information. Minimum Essential Coverage (MEC) provides first dollar coverage with access to one of the largest national preferred provider organizations (PPO) available with great discount savings for MEC benefits. The network savings can also be used for services not covered by the MEC. You will have access to a simple-to-use web portal for your local or out-of-town provider look up to be sure your provider is in the PPO Network. The MEC comes with a medical ID Card that needs to be presented to your medical provider at your time of service.

3 Covered Preventive Services for Adults (ages 18 and older) 1. Abdominal Aortic Aneurysm one time screening for age Alcohol Misuse screening and counseling 3. Aspirin use for adults aged to prevent Cardiovascular Disease and Colorectal Cancer when prescribed by a physician 4. Blood Pressure screening for all adults 5. Cholesterol screening for adults 6. Colorectal Cancer screening for adults starting at age 50 limited to one every 5 years 7. Depression screening for adults 8. Type 2 Diabetes screening for adults 9. Diet counseling for adults 10. Fall Prevention to include physical therapy and vitamin D supplementation to prevent fall in community dwellings age 65 and older 11. Hepatitis B screening for adults 12. Hepatitis C screening for adults at high risk. 13. HIV screening for all adults 14. Immunization vaccines for adults: Hepatitis A, Hepatitis B, Herpes Zoster, Human Papillomavirus, Influenza (Flu Shot), Measles, Mumps, Rubella, Meningococcal, Pneumococcal, Tetanus, Diphtheria, Pertussis, Varicella 15. Lung Cancer Screening for adults age who smoke 30 packs a year 16. Obesity screening and counseling for all adults 17. Sexually Transmitted Infection (STI) prevention counseling and screening for adults 18. Skin Cancer behavioral counseling for adults to age 24 with fair skin 19. Tobacco Use screening, counseling and cessation interventions for all adults 20. Syphilis screening for all adults Covered Preventive Services for Women, Including Pregnant Women 1. Anemia screening on a routine basis for pregnant women 2. Aspirin for pregnant women at high risk for preeclampsia. 3. Bacteriuria urinary tract or other infection screening for pregnant women 4. BRCA counseling and genetic testing for women at higher risk 5. Breast Cancer Mammography screenings every other year for women age 50 to Breast Cancer Chemoprevention counseling as well as breast cancer testing and medications for women with increased risk for breast cancer 7. Breastfeeding comprehensive support and counseling from trained providers, as well as access to breastfeeding supplies, for pregnant and nursing women. Nonnetwork services will be payable as network services. 8. Cervical Cancer screening 9. Chlamydia Infection screening 10. Contraception: Food and Drug Administration-approved contraceptive methods, sterilization procedures, and patient education and counseling, not including abortifacient drugs 11. Domestic and interpersonal violence screening and counseling for all women 12. Folic Acid supplements for women who may become pregnant when prescribed by a physician 13. Gestational diabetes screening 14. Gonorrhea screening for all women 15. Hepatitis B screening for pregnant women 16. Human Immunodeficiency Virus (HIV) screening and counseling 17. Human Papillomavirus (HPV) DNA Test: HPV DNA testing every three years for women with normal cytology results who are 30 or older 18. Osteoporosis screening over age Routine prenatal visits for pregnant women 20. Rh Incompatibility screening for all pregnant women and followup testing 21. Tobacco Use screening and interventions for all women, and expanded counseling for pregnant tobacco users 22. Sexually Transmitted Infections (STI) counseling 23. Syphilis screening 24. Well-woman visits to obtain recommended preventive services

4 Covered Services for Children 1. Alcohol and Drug Use assessments 2. Autism screening for children limited to two screenings up to 24 months 3. Behavioral assessments for children limited to 5 assessments up to age Blood Pressure screening 5. Cervical Dysplasia screening 6. Congenital Hypothyroidism screening for newborns 7. Depression screening for adolescents age 12 and older 8. Developmental screening for children under age 3, and surveillance throughout childhood 9. Dyslipidemia screening for children. 10. Fluoride Chemoprevention to include supplements for children without fluoride in their water source when prescribed by a physician and fluoride varnish to primary teeth through age Gonorrhea preventive medication for the eyes of all newborns 12. Hearing screening for all newborns 13. Height, Weight and Body Mass Index measurements for children. 14. Hematocrit or Hemoglobin screening for children 15. Hemoglobinopathies or sickle cell screening for newborns 16. Hepatitis B screening for adolescents 17. HIV screening for adolescents 18. Immunization vaccines for children from birth to age 18 doses, recommended ages, and recommended populations vary:diphtheria, Tetanus, Pertussis, Hemophilus influenza type B, Hepatitis A, Hepatitis B, Human Papillomavirus, Inactivated Poliovirus, Influenza (Flu Shot), Measles, Mumps, Rubella, Meningococcal, Pneumococcal, Rotavirus, Varicella 19. Iron supplements for children up to 12 months when prescribed by a physician 20. Lead screening for children 21. Medical History for all children throughout development Ages: 0 to 11 months, 1 to 4 years, 5 to 10 years, 11 to 14 years, 15 to 17 years. 22. Obesity screening and counseling 23. Oral Health risk assessment for young children up to age Phenylketonuria (PKU) screening in newborns 25. Sexually Transmitted Infection (STI) prevention counseling and screening for adolescents 26. Skin Cancer behavioral counseling for adolescents age 10 and up who have fair skin 27. Tobacco Use screening, counseling and cessation interventions for children and adolescents 28. Tuberculin testing for children 29. Vision screening for all children under the age of 5 For more information regarding preventive care recommendations and immunizations, visit the websites for the Centers for Disease Control and Preventions or the United States Department of Human Services: This list above summarizes some but not all services. Please reference the US Preventative Service Task Force website for the entire list.

5 MEC/MEC Preferred Covered Benefits Deductible (single/family) Coinsurance (employee portion) Out-of-Pocket Maximum PPO Network Emergency Room Services Inpatient Hospital Services Primary Care Visit to Treat an Injury or Illness Specialist Visit Mental/Behavioral Health and Substance Abuse Disorder Outpatient Services Imaging (CT, PET Scans, MRIs) Rehabilitative Speech Therapy Rehabilitative Occupational and Rehabilitative Physical Therapy Preventive Care/ Screening/Immunization (MEC) Laboratory Outpatient and Professional Services X-rays and Diagnostic Imaging Outpatient Facility Fee Outpatient Surgery Physician/Surgical Services Chronic Disease Management (CDM) Benefit Life AD&D Benefit In-Network You pay $0/$0 You pay 0% You pay $0/$0 Multiplan Network 100% covered * Out of network benefits include a $500 single $1,000 family deductible with a 40% coinsurance and no out of pocket maximum.

6 MEC Fully Insured Indemnity Benefits MEC Preferred Daily Hospital Confinement Benefit Inpatient Surgery Benefit Outpatient Surgery Benefit Outpatient Physician Office Visit Benefit Outpatient Diagnostic Laboratory Tests Benefit Outpatient Diagnostic Tests Benefits Indemnity Prescription Drug Benefit Hospital Admission Benefit $200 per day, 5 days per confinement. 1 confinement per benefit period. $50 per day up to 6 days per benefit period $50 per day up to 3 days per benefit period $50 per day up to 3 days per benefit period $1,000 annual maximum $250 first day of confinement, 1 day per benefit period

7 Weekly Healthcare Budget (employee responsibility) EMPLOYEE EMPLOYEE + SPOUSE EMPLOYEE + CHILD(REN) FAMILY MEC MEC Preferred $10.00 $24.41 $19.17 $45.36 $33.54 $58.38 $42.71 $79.68

8 KEMPER BENEFITS Employee Benefit Guide for the employees of Sunshine Employment Resources Limited Benefit Medical Insurance Plan* With health insurance rates continuing to increase annually, the value of a Kemper Benefits Limited Benefit Medical insurance plan makes it a great choice. Imagine the implications of a medical emergency with no financial assistance. The protection and affordability of a Kemper Benefits Limited Benefit Medical insurance plan provides the right option for the right price. Limited Benefit Medical Insurance plan highlights: No health questions and guaranteed coverage No deductibles or coinsurance making it easy to use Hospital admission & confinement and Outpatient diagnostic lab test Outpatient physician office visit, Prescription drug benefits and Emergency Room for injuries Vision Insurance Plan At Kemper Benefits, we understand that reliable vision coverage helps bring peace of mind and a feeling of well-being for you and your family. The Kemper Benefits Vision insurance plan offers a solution for you and provides benefits for vision care services and materials. The advantages of the Kemper Benefits Vision insurance plan design ensures that you have the ability to find the care you need, and the value you desire. Vision Insurance plan highlights: A comprehensive eye exam for each covered member A large, nationwide network of optometrists, ophthalmologists and retail chain locations with more than 25,000 providers Standard spectacle lenses with an option for specialty lenses Contact lenses with allowance or covered-in-full if medically necessary * The Kemper Benefits Limited Benefit Medical insurance plans are not minimum essential coverage under the federal Affordable Care Act. KB-BS-SS (10/16)

9 Dental PPO Insurance Plan Though oral health is often taken for granted, regular dental visits are shown to minimize unscheduled work absence and be a key indicator for underlying health problems. Oral diseases, which range from cavities to oral cancer, cause pain and disability for millions of Americans each year. A Kemper Benefits Dental PPO insurance plan is an important part of a complete health package. Dental PPO Insurance plan highlights: Covers routine exams, cleanings, x-rays and fillings Network dentists have contracted to provide services at negotiated fees to keep out-of-pocket costs lower Sealants and extractions Weekly Rates Employee Employee + Spouse Employee + Children Employee + Family Limited Benefit Medical $14.41 $26.19 $24.84 $36.97 Vision $1.58 $2.97 $3.25 $4.19 Dental $5.01 $10.04 $10.98 $16.01 To learn more about these important benefits, visit To enroll online starting November 1 st, go to Login is M , Password is Password123 Enrollment is open November 1, November 15, Policies issued by: Reserve National Insurance Company, A Kemper Life and Health Company, Oklahoma City, Oklahoma, and Fidelity Security Life Insurance Company (FSL), Kansas City, Missouri. (Not affiliated with Kemper Corporation. Reserve National Insurance Company Policy Form Number Series:DP-12. Form numbers may vary by state. Kemper Benefits, kemperbenefits.com, is part of Kemper Corporation (NYSE: KMPR), a diversified insurance holding company, with subsidiaries that provide an array of products to the individual and business markets. Kemper s underwriting companies are rated A- (Excellent) for financial strength and ability to meet policyowner obligations by A.M. Best Company, a leading insurance rating authority. Kemper Corporation s underwriting company for the Kemper Benefits voluntary worksite life, accident and health insurance products is Reserve National Insurance Company, which is responsible for the underwriting risks, financial and contractual obligations and support functions associated with the products it issues. Kemper Corporation is not responsible for the products of any of its underwriting companies. A dental PPO helps a policyholder obtain dental care at an affordable price by contracting with dentists in its network. Policyholders should check with the provider before scheduling appointments or receiving any services to confirm the provider participates in the Maximum Care Dental PPO Network. See the dental plan coverage schedule for details, exclusions and limitations. Fidelity Security Life Insurance Company Group Master Policy Nos: LM-159/160 & MG-158/159/160- & IP-102/VC-113. Policy Form Number Series: M-6012/M-9114 & M-9134/9135 & M-6015 & M Form numbers may vary by state. Fidelity Security Life Insurance Company is the insurance company underwriting the Kemper Benefits Gap, Hospital Indemnity, Limited Medical and Outpatient Prescription Drug plans. FSL is located in Kansas City, Missouri, and has been rated A- (Excellent) based on an analysis of financial position and operating performance by A.M. Best Company, an independent analyst of the insurance industry. For the latest rating, access This is only a summary of products and services offered. Actual offerings may vary by group size and other underwriting considerations, and are subject to state insurance law, and the benefits/provisions as described may vary due to such law. All products are subject to the terms, conditions, limitations and exclusions of the specific policy. Please see the specific policy and certificate for details. Policies are not available in all states. The Kemper Benefits Limited Benefit Medical insurance plans are not minimum essential coverage under the federal Affordable Care Act All rights reserved.

10 Customer Service Contacts KEYSOLUTION TM MEC AND MVP Administered by KBA Claims: Key Benefit Administrators, Inc. PO BOX 129, Fort Mill, SC, PPO NETWORK Offered through Key Benefit Administrators, Inc. Multiplan PPO Network or