Summary of Benefits and Rate Guide

Transcription

1 Summary of Benefits and Rate Guide For plans effective January 1, 2011

2 Table of Contents About 3 6 Dental: Delta Dental of California 4 Vision: VSP 5 Basic Life: Unum 6 Plan Benefits and Enrollment Guidelines Buy-up Option: Unum Voluntary Life 9 Rates Buy-up Option: Unum Voluntary Life 10 Delta Dental SIC Codes Contact Information 12 While the information and rates provided in this guide are believed to be accurate as of the print date, they are subject to change without notice. For the most up-to-date information, contact CoPower or your local LISI representative. The benefit information contained in this booklet is summary in nature. It does not include all services, limitations or exclusions. Please refer to the carrier s Evidence of Coverage or Certificate of Insurance documents for terms and conditions of coverage.

3 One application. One bill. One price. A Simple, Comprehensive Solution for Small Businesses is a simplified package of the most popular ancillary offerings for small businesses. Dental, vision, and life coverages are bundled together in one package that makes it easy to explain and even easier to sell. And the consolidated customer interface through CoPower makes it even easier for your clients to administer. Top quality coverage from recognized ancillary carriers. In, your clients get first-in-class coverage from carriers they trust: Delta Dental of California, VSP, and Unum. Custom-tailored sets of benefits, networks, and pricing. Your clients just choose the option that works best for them: Good, Better or Best. The Good package is the most economical plan, while the Better and Best plans feature increased benefits and orthodontia. These bundled benefit packages consist of the Delta Dental PPO and PPO+Premier plans, VSP Choice plans, and Group Term Life from Unum. All three packages have family tiers, industry loads (some exempt industries), and two rating regions. Effortless administration. When signing up for CoPower ONE, your clients only need to fill out one application, have one point of contact, and get only one bill every month. It is easy to administer and simple to use. The Easiest Way to Have Dental, Vision, and Life Good: Delta Dental PPO with $1,000 In-network Max VSP Choice Network with 12/24/24 Frequency Unum Basic Group Term Life with $15,000 Policy, AD&D, and EAP Better: Delta Dental PPO with $1,500 In-network Max + Ortho VSP Choice Network with 12/12/24 Frequency Unum Basic Group Term Life with $20,000 Policy, AD&D, and EAP Best: Delta Dental PPO+Premier with $2,000 In-network Max + Ortho VSP Choice Network with 12/12/12 Frequency Unum Basic Group Term Life with $25,000 Policy, AD&D, and EAP Delta Dental PPO and Delta Dental PPO+Premier are underwritten by Delta Dental of California; VSP Choice is underwritten by VSP; and Unum Basic Group Term Life is underwritten by Unum Life Insurance Company of America. These companies are financially responsible for their own products. Summary of Benefits & Rate Guide: About 3

4 Dental: Delta Dental of California Great Reasons to Choose Delta Dental PPO Outstanding provider access in California: over 54% dentists are in the PPO network and over 92% in the Premier network. Stable network with 98% dentist retention minimizes disruption in service. Unlike many other dental carriers, Delta Dental covers dental implants under their Major Services. Third Cleaning for Pregnant Women Proactively promotes oral health among pregnant women. Can benefit both the mother and child, and thus, improve their overall health. Why do 54 million enrollees trust their smiles to Delta Dental? Most enrollees stay with Delta Dental year after year, and it s no wonder. Delta Dental sets the industry standard by delivering: More savings. The Delta Dental Difference saves clients and enrollees billions of dollars a year. 1 Because Delta Dental dentists agree to Delta Dental s determination of fees, clients enjoy extensive cost controls and enrollees pay less out-of-pocket. More dentists. Three out of four dentists nationwide are contracted with Delta Dental, so enrollees have convenient access and quality assurance through the nation s largest dentist network. More satisfaction. Clients and enrollees rate Delta Dental more favorably on reputation, value, quality of care, and customer service than any other brand. 2 Delta Dental delivers an exceptional customer experience with their fast and accurate claims processing, ease of use and administration, and personalized service. This means employees will have: No waiting periods for any procedures. No need to fill out any claim forms since Delta Dental directly reimburses dentists. Access to online services, such as eligibility, benefits, claim status, and dentist directories, at About the Delta Dental Classic Plans offers the PPO and PPO+Premier plans from Delta Dental s Classic portfolio. For the Better and Best plans, orthodontics is available to groups as small as five enrolled. 1. Savings due to reduction of premiums or claims liability and patient out-of-pocket costs, as reported by the Delta Dental Plans Association. 2. Based on a nationwide survey, Brand Awareness and Perception Survey, by The Long Group for Delta Dental Plans Association (2008). 4 Summary of Benefits & Rate Guide: Dental: Delta Dental of California

5 Vision: VSP Why Choose VSP? VSP s vision plans are good for your clients eyes as well as their wallets! Members don t have to cut coupons or wait for a sale like with retail chains; the savings are already built into the VSP plans. Plus, employees can use their flexible savings account for any out-of-pocket costs, including copays, at a VSP doctor s office. Personalized Care. Establishing a relationship with an eye doctor is important members receive personalized care from a doctor they trust. Since all VSP doctors are privatepractice doctors and they stay in their practices year after year, members don t have to worry at their annual eye exam about seeing a new unfamiliar doctor. Diverse Selection and Services. Members can experience the private-practice difference with a VSP doctor. Products and services from a retail chain are also available from a VSP doctor s office, such as a diverse selection of eyewear, including designer brands, and weekend and evening appointments. Everyone Needs an Annual Eye Exam. Think eye exams aren t necessary because one has 20/20 vision or have had laser vision surgery? Think again. Annual eye exams are important to one s overall health. During a WellVision Exam, a VSP doctor can see differences in their patient s vision and overall eye health. The doctor is also qualified to detect problems and signs of other health conditions, such as diabetes, high blood pressure, and high cholesterol. Great Reasons to Choose VSP Choice VSP members have 35,000 access points in more than 18,000 locations, including suburban and rural locations. VSP provides members with lower out-of-pocket costs through additional discounts, as well as one of the industry s most comprehensive lists of cost-controlled patient options. VSP has approximately 500 staff members dedicated to customer service with 350 serving as Customer Service Representatives. About the VSP Choice Plans VSP Choice is the portfolio of choice in. These are full-service plans that offer comprehensive coverage, choices, and value with competitive rates to members. This network has 24,000 doctors with 35,000 access points nationwide. Summary of Benefits & Rate Guide: Vision: VSP 5

6 Basic Life: Unum Great Reasons to Choose Highlights of Unum s Benefits AD&D 100% benefit for loss of life/ dismemberment, loss of sight/ speech/hearing, quadriplegia Education, repatriation, exposure/disappearance, and seatbelt/airbag benefits EAP Childcare/eldercare referrals Financial planning assistance Life Planning Financial and Legal Resources Impartial, accurate advice Customized service Worldwide Emergency Travel Assistance Emergency medical evacuation Medically supervised transportation home Group Lifestyle Protection Life (Voluntary Life) Voluntary life coverage can be offered by your clients as a buy-up option to their employees, allowing them to obtain additional protection for themselves or their family members. It is available with scaled Guarantee Issue and no participation requirements. Unum Group Term Life Offers Peace of Mind and Helps Protect Families Unum group term life coverage through enables employers to provide a basic level of life insurance to their employees with the opportunity to purchase higher levels of coverage at an affordable price. To enroll, members are not required to undergo a physical exam. This benefit is even portable it gives employees coverage they can keep if they ever leave their employer. Unum group term life plans sold through are accompanied by these value-added coverage and services: Accidental Death and Dismemberment (AD&D). This coverage provides additional benefits to the covered member or their beneficiary in the event of a fatal accident or an accident that results in the loss of their eyesight, speech, hearing, or a limb. Work-Life Balance Employee Assistance Program (EAP). Members have access to master-level consultants who can help with all of life s challenges, including work and personal issues by phone, web, or through face-to-face sessions. Life Planning Financial and Legal Resources. Financial and legal resources, as well as emotional counseling and support are available at no charge to the spouse and beneficiaries if the covered employee is terminally ill or dies. Worldwide Emergency Travel Assistance. Whether traveling for business or pleasure, covered members can get help from guaranteed hospital admission to assistance with prescription replacement with just one phone call in the event of a medical emergency. 6 Summary of Benefits & Rate Guide: Basic Life: Unum

7 Plan Benefits For groups of 5 99 employees Good Better Best In-network Delta Dental PPO Dentists Out-of-network Delta Dental Premier and Non-Delta Dental Dentists In-network Delta Dental PPO Dentists Out-of-network Delta Dental Premier and Non-Delta Dental Dentists In-network Delta Dental PPO Dentists Out-of-network Delta Dental Premier and Non-Delta Dental Dentists Dental Delta Dental PPO Delta Dental PPO+Premier Reimbursement Basis All dentists (in- and out-of-network) are reimbursed at the lesser of the submitted charge or the PPO provider allowed fee. Delta Dental PPO dentists are reimbursed at the lesser of the submitted charge or the PPO provider allowed fee. Delta Dental Premier dentists are reimbursed at the lesser of the submitted charge or the Premier provider allowed fee. Non-contracted dentists are reimbursed at the lesser of the submitted charge or the fee that satisfies the majority of dentists with the same training and geographical area. Calendar Year Max $1,000 $750 $1,500 $1,250 $2,000 $1,500 Deductible $50 $75 $50 $75 $50 $75 For D&P: For D&P: For D&P: For D&P: For D&P: Waived For D&P: Not waived Waived Not waived Waived Not waived Diagnostic & Preventive Services (D&P) 100% 50% 100% 80% 100% 80% Basic, Oral Surgery, Endodontics, and Periodontics 80% 50% 80% 80% Major Services 50% 50% 50% Orthodontics Children Only (Available Not available 50% lifetime max $1,000 50% lifetime max $1,000 to groups 5+ enrolled) Vision VSP Choice Network Annual Copayment $25 exam/$25 prescription glasses $10 exam/$25 prescription glasses $10 exam/$25 prescription glasses Eye Exam Single-vision Lenses Bifocal Lenses Trifocal Lenses Frames Contact Lenses Frequency Covered after copayment $150 allowance $150 allowance up to $45 up to $30 up to $50 up to $65 up to $70 up to $105 Covered after copayment $150 allowance $150 allowance up to $45 up to $30 up to $50 up to $65 up to $70 up to $105 Covered after copayment $150 allowance $150 allowance Eye Exam 12 months 12 months 12 months Lenses 24 months 12 months 12 months Frames 24 months 24 months 12 months Contact Lenses (in lieu of lenses and a frame) 24 months 12 months 12 months up to $45 up to $30 up to $50 up to $65 up to $70 up to $105 Summary of Benefits & Rate Guide: Plan Benefits 7

8 Plan Benefits and Enrollment Guidelines Plan Benefits (continued) Good Better Best Life Unum Basic Group Term Life with AD&D and EAP Policy $15,000 $20,000 $25,000 Voluntary Term Life Insurance. Employers can also offer Unum s Group Lifestyle Protection Life as a buy-up option to their employees. For more information, please refer to the plan benefits, enrollment guidelines, and rates in the following pages. Enrollment Guidelines Good Better Best Group Size/Eligibility Employer Contribution Participation Rate Guarantee Industry Loads Waiting Period for Services Out-of-State Overage Dependents Basic Life Age Reduction Schedule Carve-outs Groups with 5 99 employees Minimum of 5 enrolled DE-9C is required. Groups currently enrolled with Delta Dental or Unum are not eligible for coverage in. In order to maintain enrollment in the program, groups must continue coverage in all three lines of coverage. 75% minimum for employees No minimum for dependents Non-voluntary Minimum of 85% enrollment If employer contributes 100%, 100% participation is required. Employees with dental coverage from another employer s plan can waive coverage even if they do not have other vision coverage. 12 months Yes. Some industries are ineligible. None No more than 50% of primary enrollees may reside outside of California. Dependent children are eligible until age 26 for dental, vision, and life coverage. 65% at age 70 50% at age 75 Only Union/Non-union carve-outs will be allowed. Allowed if non-carved-out employees are either not covered or covered by DeltaCare USA. Carve-out groups will receive Level 2 rates Employees Not eligible Product Combinations Voluntary Orthodontia Open Enrollments Case Submission Deadlines Administrative Fees Not allowed No. No. Open enrollment is not allowed. Varies by month None Available to groups 5+ enrolled Yes, for Better and Best Child only up to age 26 8 Summary of Benefits & Rate Guide: Plan Benefits and Enrollment Guidelines

9 Plan Benefits, Enrollment Guidelines, and Rates Buy-up Option: Unum Voluntary Life Plan Benefits and Enrollment Guidelines Unum Group Lifestyle Protection Life Benefits, AD&D, and EAP Employee Spouse Child (Covers all children up to age 26) Group Size employees employees employees Standalone Requires the employee to have Basic Life in place Requires the employee to have Voluntary Life in place Requires the employee to have Voluntary Life in place Contribution 100% employee-paid 100% employee-paid 100% employee-paid Participation None required None required None required Guarantee Issue 2 9 employees: $10, employees: $30, employees: $80,000 All group sizes: $10,000 All group sizes: $6,000 Amounts Available $10,000 increments $5,000 increments $6,000 is the only option Maximum Amount Lesser of $100,000 or five times earnings Lesser of $100,000 or 100% of employee s voluntary life amount $6,000 per child Age Reduction Schedule 65% at age 70 50% at age 75 65% at age 70 50% at age 75 Not applicable Rates Southern California Region Los Angeles, Orange, San Diego, San Bernardino, Riverside, Ventura, and Central Valley ZIP codes 932, 933, , 952,953, Northern California Region Alameda, Contra Costa, Marin, Santa Clara, San Francisco, San Mateo, and other areas of California not otherwise mentioned Level 1 Level 2 Level 1 Level 2 Good Single $45.00 $50.00 $45.00 $50.00 Two-Party $77.00 $89.00 $80.00 $94.00 Three-Party+ $ $ $ $ Better Single $55.00 $63.00 $55.00 $63.00 Two-Party $98.00 $ $ $ Three-Party+ $ $ $ $ Best Single $75.00 $85.00 $75.00 $85.00 Two-Party $ $ $ $ Three-Party+ $ $ $ $ Note: Rates are effective January 1, 2011, through December 31, Summary of Benefits & Rate Guide: Plan Benefits, Enrollment Guidelines, and Rates 9

10 Rates and Delta Dental SIC Codes Rates Unum Voluntary Life Employee and Spouse Per $1,000 Unum Group Lifestyle Protection Life with AD&D and EAP Age Band Rate <25 $ $ $ $ $ $ $ $ $ $ $ $9.66 Child Per $1,000 Unum Group Lifestyle Protection Life with AD&D and EAP Age Band Rate Up to age 26 $0.33 Delta Dental Standard Industrial Classification (SIC) Codes Delta Dental SIC Codes Level 1 Eligible Industries SIC Code(s) Eligible Industries SIC Code(s) Advertising (except Misc., not classified #7319) Hospitals Agriculture, Forestry, and Fishing (except seasonal employees) Independent Auto Repair and Services Auto Rental Agencies Laundry/Garment Services and Shoe Repair Services /7251 Automobile Parking Services 7521 Manufacturing (except Jewelry Manufacturing) Building Maintenance/Equipment Rental Manufacturing (Chemicals, Allied, and Other) Collection Agencies and Credit Reporting Services Mining, Oil, and Gas Extraction Communication (Radio, Telephone, TV/Radio, and Broadcasting) Miscellaneous Repair (Welding, etc.) Community Services Organizations/Social Services News Syndicates 7383 Computer Programming and other Computer Services Photofinishing Labs 7384 Construction Contractors Printing and Publishing Summary of Benefits & Rate Guide: Rates and Delta Dental SIC Codes

11 Delta Dental SIC Codes Delta Dental SIC Codes Level 1 Eligible Industries SIC Code(s) Eligible Industries SIC Code(s) Direct Mailing, Reproduction, and Secretarial Services Disinfecting and Pest Control Services 7342 Retail Public Administration (Cities, Counties, Police, etc.) , , , , Public Education (except Private Schools) Private Schools (Elementary and High School) 8221 Electrical Repair (Radio, TV, A/C, and Refrigerator) Security Systems, Detectives, and Armored Cars Engineering and Management Services Transportation Finance (Banks, Securities, and Credit Agencies) Utilities Funeral Services and Crematories 7261 Wholesale Trade Furniture Repair/Re-upholstery 7641 Delta Dental SIC Codes Level 2 Eligible Industries SIC Code(s) Eligible Industries SIC Code(s) Advertising (Miscellaneous, not classified) 7319 Medical Groups and Automobile Dealerships Photographic Studios 7221 Amusement, Recreation, and Entertainment Restaurants Hotels Tax Return Preparation Services and Miscellaneous Personal Services Insurance Carriers/Brokers Real Estate Jewelry Manufacturing Religious Organizations (Administration and Management Staff only) Legal Watch, Clock, and Jewelry Repair Ineligible Industries SIC Code(s) Ineligible Industries SIC Code(s) Associations and Trusts ; Professional Employer Organizations (PEO) 7361 Beauty and Barber Shops Private Households 8811 International Affairs 9721 Partnerships No SIC Dental Offices, Dental Labs, and Medical Labs 8021, 8071, and 8072 Seasonal Employees (Christmas/Part-time Help) No SIC Employment Agencies Seasonal Employees (Agriculture) Groups with high turnover Varies Miscellaneous Services not classified elsewhere 8999 Miscellaneous Business Services 7389 Summary of Benefits & Rate Guide: Delta Dental SIC Codes 11

12 Carrier Contact Information Delta Dental of California VSP Unum CPE-005 6/11

13 For plan administration, contact CoPower at: 1600 W. Hillsdale Blvd. San Mateo, CA T: F: For sales, contact LISI at: LISI (5474)