2015 Medical Plan Options and Enrollment Information

Transcription

1 KEYSOLUTION TM ENROLLMENT GUIDE 2015 Medical Plan Options and Enrollment Information Benefit Effective Date: 01/01/2015 Enrollment Period: 11/11/2014 through 11/28/2014 Enroll by phone at , The call center is open 24/7 Enroll online at any time during enrollment period Administered by Key Benefit Administrators, Inc. PLAN DESIGNED FOR THE EMPLOYEES OF

2 It s time to choose medical coverage or tax penalty? Why must i choose between medical coverage or paying a tax penalty? The Affordable Care Act (ACA) requires all individuals to have at least minimum essential coverage as of January 1, 2014, and beyond. If you do not have this minimum coverage, then you may have to pay a penalty tax. By purchasing a plan with minimum essential coverage through your employer, you can prevent being taxed the Individual Mandate penalty tax. What are the ACA tax penalties for people without the required minimum coverage? The tax penalty is the greater percentage of your adjusted household income or the combined per person penalty of each person in your family. This Individual Mandate tax penalty also increases each year, as shown in the chart below. Year % of Income Per Adult Penalty + Per Child Penalty % or $95 $ % or $325 $ and after 2.5% or $695 $ What exactly is minimum essential coverage as defined by ACA? The government has issued a list of Preventive and Wellness Benefits that must be covered at 100% when obtained from a network provider and 40% from a non-network provider. There are over 60 preventive services in all. These services include immunizations, blood pressure screenings, diabetes and cholesterol screenings, prenatal visits, and more. See the Additional Information section at the end of this Guide for a list of the minimum essential Preventive and Wellness Benefits. TM

3 W HAT COVERAGE IS BEING OFFERED FOR THIS YEAR S ENROLLMENT? Flexicrew Staffi ng Inc. is offering Employees the following coverage which satisfi es the federally mandated minimum essential coverage so you can avoid the ACA tax penalty: MEC Minimum Essential Coverage with Multiplan PPO MVP Minimum Value Plan with Multiplan PPO MVP Preferred Minimum Value Plan, with Multiplan PPO, and standard limited medical benefits W HAT BENEFITS CAN I EXPECT WITH THIS COVERAGE? A MEC plan contains the Preventive and Wellness Benefi ts required by ACA to avoid tax penalties. There are 63 preventive services that are covered at 100% in-network and 40% out-ofnetwork. You can fi nd a full list of these services in the Addtional Information section later in this Guide. An MVP plan not only contains the Preventive and Wellness Benefi ts required by ACA, but it also covers strategically selected medical benefi ts, including a nationally acclaimed patented Chronic Disease Management (CDM) program, prescription drug coverage, and online access to Explanations of Benefits, plan summaries, and much more.* An MVP Preferred plan covers the Preventive and Wellness Benefi ts required by ACA plus strategically selected medical benefi ts, including a nationally acclaimed patented Chronic Disease Management (CDM) program, prescription drug coverage, and online access to Explanations of Benefits and plan summaries. In addition, an MVP Preferred plan includes fully- insured limited medical coverage for benefi ts such as daily inpatient stays, emergency room visits, lab and x-rays, doctor visits, ambulance services, and group term life insurance.* A Limited Medical plan offers additional coverage for services like hospital stays, surgery, anesthesia, accidents, and more. Your coverage also has the Multiplan Preferred Provider Organization (PPO) attached to it. When you use the Multiplan PPO, services covered under your plan will be reimbursed at the higher innetwork percent. Also, all incurred charges will be discounted by Multiplan. So whether your claim is incurred in or out of network, or even if it isn t covered by your plan the charges will still be discounted. *For more MVP information, see the Additional Information section later in this Guide. It contains the ACArequired Preventive and Wellness Benefi ts, a list of CDM's coverage for 25 chronic conditions, and important MVP plan exclusions. Other benefi ts and coverage levels can be found on the Schedule of Benefits beginning on the next page. See the next page for this year's coverage offering.

4 MEC & Limited Medical Schedule of Benefits Minimum Essential Coverage Plan Name PPO Network MEC Multiplan Preventive Services Network Non-Network Minimum Essential Coverage Required by ACA to avoid individual tax penalty. See the Additional Information section of this Guide for covered services. 100% 40%

5 MVP Schedule of Benefits Plan Name MVP MVP Preferred PPO Network Multiplan Multiplan Limited Benefits Minimum Essential Coverage Network Non-Network Network Non-Network % Covered for Wellness and Preventive Benefits Required by ACA to avoid individual tax penalty. See the Additional Information section of this Guide for covered services.. 100% 40% 100% 40% Minimum Value Benefits Network Non-Network Network Non-Network Deductible Individual / Family $0/$0 $500/$1,000 $0/$0 $500/$1,000 Coinsurance 100% 40% 100% 40% Out-of-Pocket Maximum Individual / Family $1,850/$12,700 N/A $1,850/$12,700 N/A Emergency Room Services - Covers emergency room services including hospital facility and physician charges. For MRIs performed during emergency room visit, a separate copay will not be applied. If surgery, PT, or DME is required during emergency room visit, they will be covered under emergency room benefit. Primary Care Visit to Treat an Injury or Illness - Covers all physician visits including offi ce, outpatient, and inpatient charges. Copays apply to physician visit charge only, and do not include other services rendered at time of visit. Anesthesia benefi t pays 20% of Surgery benefit. Specialist Visits - Covers physician visits in offi ce, as outpatient, or as inpatient. Copays apply to visit charge only and do not include other services rendered at time of visit. Imaging - Covers charges for CT, PET scans, MRIs, and the charges for related supplies. Laboratory Outpatient and Professional Services - Covers professional components of labs, including offi ce, outpatient, and inpatient charges. A copay will apply to each lab charge. X-rays and Diagnostic Imaging - Covers the professional components of labs, including the offi ce, outpatient, and inpatient charges. A copay will apply to each x-ray or imaging charge. Chronic Disease Management (CDM) - See the Benefi t Details section of this Guide for all covered 25 chronic conditions and their minimum standards of care. Employee Term Life - Except for groups domiciled in CA, CT, HI, NJ, NY Fully-Insured Limited Medical Indemnity Benefits $400 copay $400 copay $400 copay $400 copay $15 copay Ded/Coins $15 copay Ded/Coins $25 copay Ded/Coins $25 copay Ded/Coins $400 copay Ded/Coins $400 copay Ded/Coins $50 copay Ded/Coins $50 copay Ded/Coins $50 copay Ded/Coins $50 copay Ded/Coins 100% Ded/Coins 100% Ded/Coins Generic Prescription Drugs $15 copay Ded/Coins $15 copay Ded/Coins Preferred Brand Drugs $25 copay Ded/Coins $25 copay Ded/Coins Non-Preferred Brand Drugs $75 copay Ded/Coins $75 copay Ded/Coins Mail-order Drugs 2.5 x copay Ded/Coins 2.5 x copay Ded/Coins $10,000 $10,000 Daily In-Hospital - 31 days per confi nement $500 / Day Inpatient Surgical Benefi t - 1 day per year Outpatient Surgical Benefi t - 1 day per year Minor Outpatient Surgical Benefi t - $500 / Day $250 / Day $50 / Day Anesthesia - 20% of Surgical Benefi t Accident - 5 days per year Hospital Admission - 1 day per year ICU - 31 days per year Critical Illness - Life AD&D - $300 / Day of accident treatment $1,000 / Admission $500 / Day $5,000 Benefit $10,000 Benefit

6 KEYSOLUTION WHAT ARE MY COSTS FOR THIS COVERAGE? TM Voluntary Employee Contribution Rates MEC MVP MVP Preferred Employee $12.63 $21.32 $35.30 Employee + Spouse $18.33 $44.43 $73.26 Employee + Child(ren) $37.74 $43.43 $64.22 Family $43.45 $67.79 $ Weekly Rates Your employer is paying a portion of your premium. The above rates represent just your portion of the cost. Rates assume cost is currently and will continue to be remitted in advance of the effective date. Rates include administration fee for continuation. HOW AND WHEN CAN I ENROLL FOR THIS COVERAGE? The effective date for this coverage is 01/01/2015. The enrollment period is 11/11/2014 through 11/28/2014. New Employees are eligible for benefits after they have worked long enough to meet their company's eligibility requirement. Flexicrew Staffing Inc. 's eligibility requirement is 90 days. If you have worked long enough to be eligible for benefits, and you work the required number of 30 hours per week, you are eligible to sign up for this coverage. Benefit staff designated by Flexicrew Staffing Inc. can answer your enrollment questions and provide any forms you may need to fill out to elect coverage. To enroll over the phone, call , The call center is open 24/7. To enroll online, go to anytime day or night during the enrollment period to sign up for coverage. Enroll by contacting BeneTrac at The call center is open and staffed 24/7. You can also enroll through internet access at Your user name is the first six letters of your last name and the last four digits of your social security number. Your password is the last four digits of your social security number. Frequently Asked Questions»

7 FREQUENTLY ASKED QUESTIONS KEYSOLUTIONTM H O W D O I K N O W I ' M E L I G I B L E T O E N R O L L F O R T H I S C O V E R A G E? All Employees who have worked long enough to meet their company's eligibility requirement, and who work the required minimum number of 30 hours per week, are eligible to enroll. Eligible dependents include spouses and children or stepchildren, under age 26. C A N I S I G N U P F O R C O V E R A G E AT A N Y T I M E? Provided you are eligible for this coverage, you can enroll per the instructions given on the previous page under How and When Can I Enroll for This Coverage. If you do not elect coverage as explained, you will not be able to enroll until the next open enrollment period unless you experience a qualifying event. W H AT I F I W A N T M O R E B E N E F I T S T H A N T H I S C O V E R A G E O F F E R S? Because the coverage offered is not a Major Medical plan, it may not be for everyone. Individuals are free to go to the marketplace and purchase broader coverage if needed. However, a subsidy may not be available if the plan your employer has made available meets the ACA Affordability provisions. H O W A R E M Y P R E M I U M S P A I D? Premiums will be taken through payroll deductions. If you miss a payroll deduction as a result of absence or lack of work, you risk being terminated from the plan. If terminated, you will not be eligible to re-enroll until the next open enrollment period unless you experience a qualifying event. C A N I C A N C E L C O V E R A G E AT A N Y T I M E? When premiums are paid with pre-tax dollars through payroll deductions as part of a Section 125 Savings Plan, you will not be able to change these elections until the next annual enrollment period, unless you have a qualifying event. However, when premiums are paid with post-tax dollars, you can cancel coverage at any time. I F I D O E N R O L L, H O W D O I U S E M Y B E N E F I T S? After enrollment, our claims administrator, Key Benefi t Administrators (KBA), will send you a benefit kit and an ID card. Simply present this ID card to your provider at the time of service. This card contains all the information your provider needs to submit your claims to KBA for processing. You can also use the information on this card to contact KBA for any questions you might have. KBA's contact information and website are on the back of this Guide. I S T H E R E A N Y T H I N G I S H O U L D P A Y S P E C I A L AT T E N T I O N T O S O I K N O W A B O U T S E R V I C E S T H AT A R E N O T C O V E R E D? Be sure to read the MVP exclusions listed in the Additional Information section at the back of this Guide. Note especially MVP exclusions regarding inpatient hospitalization, outpatient surgical centers and charges, specialty drugs such as chemotherapy, and mental health and substance abuse. W H E N W I L L K B A S E N D M E A B E N E F I T K I T A N D I D C A R D? KBA will mail your benefit kit and ID card soon after you have enrolled and your first payment has been made. W H AT O T H E R I N F O R M AT I O N I S A V A I L A B L E T O M E S O I U N D E R S T A N D M Y C O V E R A G E? For further details on the coverage being offered by Flexicrew Staffi ng Inc., see the Additional Information section of this Guide.

8 Additional Information MEC Preventive and Wellness Benefits A list of the minimum essential coverage required by ACA 15 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 men ages and women ages to prevent CVD when prescribed by a physician 4. Blood Pressure screening 5. Cholesterol screening for adults 6. Colorectal Cancer screening for adults starting at age 50 limited to one every 5 years 7. Depression screening 8. Type 2 Diabetes screening 9. Diet counseling 10. HIV screening 11. Immunizations vaccines (Hepatitis A & B, Herpes Zoster, Human Papillomavirus, Influenza (flu shot), Measles, Mumps Rubella, Meningococcal, Pneumococcal, Tetanus, Diptheria, Pertussis, Varicella) 12. Obesity screening and counseling 13. Sexually Transmitted Infection (STI) prevention counseling 14. Tobacco Use screening and cessation interventions 15. Syphilis screening 22 Covered Preventive Services for Women, Including Pregnant Women 1. Anemia screening on a routine basis for pregnant women 2. Bacteriuria urinary tract or other infection screening for pregnant women 3. BRCA counseling and genetic testing for women at higher risk 4. Breast Cancer Mammography screenings every year for women age 40 and over 5. Breast Cancer Chemo Prevention counseling for women 6. Breastfeeding comprehensive support and counseling from trained providers, as well as access to breastfeeding supplies, for pregnant and nursing women. 7. Cervical Cancer screening 8. Chlamydia Infection screening 9. Contraception: Food and Drug Administration-approved contraceptive methods, sterilization procedures, and patient education and counseling, not including abortifacient drugs 10. Domestic and interpersonal violence screening and counseling for all women 11. Folic Acid supplements for women who may become pregnant when prescribed by a physician 12. Gestational diabetes screening 13. Gonorrhea screening 14. Hepatitis B screening for pregnant women 15. human Immunodeficiency Virus (HIV) screening and counseling 16. Human Papillomavirus (HPV) DNA Test: HPV DNA testing every three years for women with normal cytology results who are 30 or older 17. Osteoporosis screening over age Rh Incompatibility screening for all pregnant women and follow-up testing 19. Tobacco Use screening and interventions and expanded counseling for pregnant tobacco users 20. Sexually Transmitted Infections (STI) counseling 21. Syphilis screening 22. Well-woman visits to obtain recommended preventive services* *Includes routine prenatal visits for pregnant women. 26 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 Chemo Prevention supplements for children without fluoride in their water source when prescribed by a physician 11. 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. HIV screening for adolescents 17. Immunization vaccines for children from birth to age 18; doses, recommended ages, and recommended populations vary: Diphtheria, Tetanus, Pertussis, Hepatitis A & B, Human Papillomavirus, Inactivated Poliovirus, Influenza (Flu Shot), Measles, Mumps, Rubella, Meningococcal, Pneumococcal, Rotavirus, Varicella, Haemophilus influenzae type b 18. Iron supplements for children up to 12 months when prescribed by a physician 19. Lead screening for children 20. 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 21. Obesity screening and counseling 22. Oral Health risk assessment for young children up to age Phenylketonuria (PKU) screening in newborns 24. Sexually Transmitted Infection (STI) prevention counseling and screening for adolescents 25. Tuberculin testing for children 26. Vision screening for all children under the age of 5

9 Additional Information MVP Chronic Disease Management Chronic Diseases and the minimum standards of laboratory and diagnostic procedures covered by MVP plans Chronic Disease Asthma Atherosclerosis (Peripheral Vascular Disease) Atrial Fibrillation Chronic Obstructive Pulmonary Disease Chronic Renal Insufficiency Congestive Heart Failure Coronary Artery Disease Diabetes Epilepsy Human Immunodeficiency Virus Infection Hyperlipidemia Hypertension Hyperthyroidism Hypothyroidism Metabolic Syndrome Multiple Sclerosis Parkinson s Disease Polymyalgia Rheumatica Pre-diabetes Pulmonary Hypertension (unrelated to COPD) COPD WITH PULMONARY HYPERTENSION/ COR Pulmonale Rheumatoid Arthritis Sleep Apnea Chronic Venous Thrombotic Disease Ulcerative Colitis (Inflammatory Bowel Disease) Services *Spirometry *Lipid Panel *EKG, *Prothrombin times *Spirometry *Creatinine, *Complete blood count (CBC), *Electrolytes, *Urine protein, *Serum calcium, *Serum phosphorus, *Lipid panel *BUN, *Creatinine, *Potassium *Lipid panel, *EKG, *Cholesterol *Glycohemoglobins, *Microalbumin, *Lipid panel *T-Cell/CD-4 counts, *PPD, *HIV quantifications, *Complete blood count (CBC), *Pap smear (women only) *Lipid panel, *Cholesterol *Thyroid stimulating hormone (TSH), *Thyroxine (T4) *Thyroid stimulating hormone (TSH), *T4 *Lipid panel, *Glucose FBS or Hemoglobin A1c (HgbA1c) *Erythrocyte sedimentation rate (ESR) or C-reactive protein (CRP) *Complete blood count (CBC) *Lipid panel, *Glucose FBS or Hemoglobin A1c (HgbA1c) *Spirometry, *12 months of supplemental 02 Tx *Complete blood count (CBC) *Complete blood count (CBC), *LFT *The services listed above are the standard laboratory and diagnostic procedure for each chronic disease.

10 A d d i t i o n a l I nf o r m at io n MVP Exclusions E x c l u s i o n s a n d l imitati o n s t o a n m v p p l a n There are Exclusions applicable to the Minimum Value Benefits listed on the MVP Schedule of Benefits in this Guide... per the list below. If you choose an MVP plan, a plan document with detailed descriptions of all exclusions will be made available to you after enrollment. Please refer to this plan document for Exclusion details. 1. Hospital inpatient services are not covered under the Minimum Value Benefits of an MVP-only plan. Hospitalization is available only under an MVP Preferred or Preferred Plus plan. 9. Charges that are not for the care or treatment of an accident or illness except as specifically provided for in this plan. 10. Treatment made necessary as the result of illegal use of narcotics or use of hallucinogens in any form unless prescribed by a physician or as provided herein. 2. Ambulatory Surgical Center services are not covered. 3. Specialty drugs are not covered. 4. Mental/Behavioral Health and Substance Abuse Disorder Outpatient services are not covered with the exception of services covered under the plan s MEC benefits. 5. Rehabilitation Speech Therapy services are not covered. 6. Rehabilitative Occupational and Rehabilitative Physical Therapy services are not covered. 7. Skilled Nursing Facility services are not covered. 13. Investigatory and experimental treatment, services, and supplies. 8. Outpatient Surgery Physician/Surgical services are not covered. 14. Organ transplants. *Please refer to your plan document for a detailed description of all exclusions. 11. Treatment made necessary by or a disability arising from war, declared or undeclared, or any act of war. An act of terrorism will not be considered an act of war, declared or undeclared. 12. Treatment or services provided by anyone other than a healthcare provider as defined herein unless specifically stated in the plan.

11 KEYSOLUTION TM Customer Service Contacts KEYSOLUTION ACA-COMPLIANT PLANS Administered by KBA Claims: Key Benefit Administrators, Inc. PO Box 129, Fort Mill, SC Website: kba.keyfamily.com PPO NETWORK Offered through Key Benefit Administrators, Inc. Multiplan PPO Network or E N R O L L M E N T I N F O R M AT I O N Enrollment Period: 11/11/2014 through 11/28/2014 Enroll by phone at , The call center is open 24/7. Enroll online at: