2018 Benefits Guide. Improving Our Wellness Together

Transcription

1 2018 Benefits Guide Improving Our Wellness Together

2 Welcome to your 2018 Benefits Open Enrollment We are honored to present your 2018 Benefit Options! The elections you make during open enrollment will be effective January 1, 2018 through December 31, Muskingum Valley ESC offers you and your eligible family members a comprehensive and valuable benefits program. We encourage you to take the time to educate yourself about your options and choose the best coverage for you and your family. What s in the guide? Open Enrollment Process..3 Medical..4-9 Dental...10 Vision.11 Voluntary Benefits Life Insurance..15 Important Contacts..16 Who is Eligible? Full time W-2 Employees working at least 30 hours each week. When can I Enroll? You may enroll for benefits when you first become eligible, 1st day of the month following date of hire or each year during open enrollment. The benefits you elect will be effective from January 1, 2018 through December 31, If you decline coverage or fail to make an election of a coverage during this open enrollment timeframe, you may not be able to make a new or different election until next year s open enrollment. 2

3 Open Enrollment Process 2018 Muskingum Valley ESC Benefits Guide The benefits you elect during Open Enrollment will be effective January 1, Open Enrollment is the one time per year that you can make changes to your benefits without a qualifying life event. Open Enrollment will be held from Monday, November 27th - Friday, December 1st An enrollment from all full-time, benefit eligible employees will be required during the annual enrollment window in order to receive benefits for the new plan year. We are again partnering with Explain My Benefits, our technology/ benefit communication vendor to assist in our Open Enrollment. This year we will have a self-service online enrollment using the EMB Enroll online system. Options to Enroll Decide which of these three convenient enrollment options best fits your needs: Self-Service - available November 27th - December 1st Visit click on the green Log into Your Benefit System button and move through the enrollment system at your own pace If choosing this option, be sure to click submit at the end of the process and make note of your confirmation number. If you do not receive a confirmation number you have not completed your enrollment and you will not be enrolled for the new plan year. Return to the system anytime and click your confirmation number to view your confirmation statement. Call Center Call the Explain My Benefit Call Center at , Option #1. 9:00am - 5:00pm EST; Monday - Friday during the enrollment period to speak with a benefit counselor one-on-one regarding your benefits. Reminders On-Site Benefit Counselor - November 27th - November 30th Meet with a benefit counselor in person to discuss and help you enroll in your benefits for the upcoming plan year. See the Benefit Resource Website for location schedule and times. When using any of the above options for enrollment: Be sure to review the 2018 Benefit Guide and plan summaries prior to going through any enrollment process Be prepared by gathering dependent and beneficiary information (i.e. Social Security Numbers and Dates of Birth) 3

4 Medical Medical Mutual is partnering with Muskingum Valley Educational Service Center to provide our group medical plan. Dependents You may also elect coverage for your dependents in some circumstances. Eligible dependents may include the following: Your Legal Spouse Dependent Children: Dependent child who is supported primarily by you, and who is incapable of self-sustaining employment by reasons of mental or physical handicap (proof of their condition and dependence must be submitted) Medical - Dependent children up to age 26 regardless of financial dependency, residency, student status, employment or marital status. Coverage ends the last day of the month they turn 26. Individuals may request enrollment for such children within 30 days of receiving this handout. The coverage will be effective 1st of the month following the eligibility period. For more information contact Human Resources. 4

5 Medical 2018 Muskingum Valley ESC Benefits Guide Muskingum Valley ESC SuperMed Plus Plan A Benefits Network Non-Network Benefit Period Dependent Age Limit Overall Annual Benefit Period Maximum January 1st through December 31st 26, Removal at End of Month Unlimited Benefit Period Deductible - Single/Family 1 $1,000/$2,000 $1,000/$2,000 Coinsurance 90% 80% Coinsurance Out-of-Pocket Maximum (Excluding Deductible) - Single/Family $1,000/$2,000 $2,000/$4,000 Physician/Office Services Office Visit (Illness/Injury) 2 $20 co-pay, then 100% 80% after deductible Specialist Visit $40 co-pay, then 100% 80% after deductible Urgent Care Office Visit 2 $50 co-pay, then 100% 80% after deductible Surgical Services in Physician s Office $20 co-pay, then 100% 80% after deductible All Immunizations 100% 80% after deductible Preventative Services 3 Preventive Services, in accordance with state and 3 Federal law 100% 80% after deductible Routine Physical Exams (Age 21 and over) 100% 80% after deductible Well Child Care Services including Exam and Immunizations (Birth to Age 21) 100% 80% after deductible Well Child Care Laboratory Tests (To Age 21) 100% 80% after deductible Routine Vision Exams (including Refraction - Age 21 and over) 100% 80% after deductible Routing Hearing Exam (Age 21 an over) 100% 80% after deductible Routine Mammogram (One per benefit period) 100% 80% after deductible Routine Pap Test (One per benefit period) 100% 80% after deductible Routine Laboratory, X-Rays and Medical Tests (All Ages) 100% 80% after deductible Routine Endoscopic Services (All Ages) 100% 80% after deductible Outpatient Services Surgical Services (other than a physician s office) 90% after deductible 80% after deductible Diagnostic Services 100% 80% after deductible CT Scans, MRI and Nuclear Medicine 90% after deductible 80% after deductible Emergency use of an Emergency Room 4 $150 co-pay, then 100% Non-Emergency use of an Emergency Room 4, 5 $150 co-pay, then 100% $150 co-pay, then 80% 5

6 Medical Muskingum Valley ESC SuperMed Plus Plan A (Continued) Inpatient Facility Network Non-Network Semi-Private Room and Board 90% after deductible 80% after deductible Diagnostic Services (Labs, X-rays, Medical Tests) 90% after deductible 80% after deductible Professional Services 90% after deductible 80% after deductible Maternity 90% after deductible 80% after deductible Skilled Nursing Facility (60 days per benefit period) 90% after deductible 80% after deductible Additional Services Ambulance 90% after deductible 90% after deductible Durable Medical Equipment including Prosthetics Appliances and Orthotic Devices (Unlimited) 90% after deductible 80% after deductible Home Healthcare (60 visits per benefit period) 90% after deductible 80% after deductible Hospice (360 days, lifetime maximum) 90% after deductible 80% after deductible Organ Transplants 90% after deductible 80% after deductible Private Duty Nursing ($5,000 max per benefit period) 100% 80% after deductible Mental Health and Substance Abuse - Federal Mental Health Parity Inpatient Mental Health & Substance Abuse Services Outpatient Mental Health & Substance Abuse Services Benefits paid are based on corresponding medical benefits Benefits paid are based on corresponding medical benefits Prescription Network Non-Network Generic Preferred Brand Non-Preferred Brand $10 copay - retail (1-31 day supply) $25 copay - retail (32-90 day supply) $25 copay - home delivery (90 day supply) $20 copay - retail (1-31 day supply) $50 copay - retail (32-90 day supply) $50 copay - home delivery (90 day supply) $40 copay - retail (1-31 day supply) $100 copay - retail (32-90 day supply) $100 copay - home delivery (90 day supply) N/A N/A N/A 1 Maximum family deductible. Member deductible is the same as single deductible. 3-month carryover applies. 2 The office visit co-pay applies to the cost of the office visit only. 3 Preventive services include evidence-based services that have a rating of A or B in the United States Preventive Services Task Force, routine immunizations and other screenings, as provided for in the Patient Protection and Affordable Care Act. 4 Co-pay waived if admitted. 5 The co-pay applies to room charges only. All other covered charges are subject to deductible and coinsurance. 6

7 Medical 2018 Muskingum Valley ESC Benefits Guide Muskingum Valley ESC SuperMed Plus Plan B Benefits Network Non-Network Benefit Period Dependent Age Limit Overall Annual Benefit Period Maximum January 1st through December 31st 26, Removal at End of Month Unlimited Benefit Period Deductible - Single/Family 1 $2,000/$4,000 $4,000/$8,000 Coinsurance 90% 70% Coinsurance Out-of-Pocket Maximum (Excluding Deductible) - Single/Family $1,000/$2,000 $2,000/$4,000 Physician/Office Services Office Visit (Illness/Injury) 2 $25 co-pay, then 100% 70% after deductible Specialist Visit $40 co-pay, then 100% 70% after deductible Urgent Care Office Visit 2 $50 co-pay, then 100% 70% after deductible Surgical Services in Physician s Office $25 co-pay, then 100% 70% after deductible All Immunizations 100% 70% after deductible Preventative Services 3 Preventive Services, in accordance with state and 3 Federal law 100% 70% after deductible Routine Physical Exams (Age 21 and over) 100% 70% after deductible Well Child Care Services including Exam and Immunizations (Birth to Age 21) 100% 70% after deductible Well Child Care Laboratory Tests (To Age 21) 100% 70% after deductible Routine Vision Exams (including Refraction - Age 21 and over) 100% 70% after deductible Routing Hearing Exam (Age 21 an over) 100% 70% after deductible Routine Mammogram (One per benefit period) 100% 70% after deductible Routine Pap Test (One per benefit period) 100% 70% after deductible Routine Laboratory, X-Rays and Medical Tests (All Ages) 100% 70% after deductible Routine Endoscopic Services (All Ages) 100% 70% after deductible Outpatient Services Surgical Services (other than a physician s office) 90% after deductible 70% after deductible Diagnostic Services 100% 70% after deductible CT Scans, MRI and Nuclear Medicine 90% after deductible 70% after deductible Emergency use of an Emergency Room 4 $150 co-pay, then 100% Non-Emergency use of an Emergency Room 4, 5 $150 co-pay, then 100% $150 co-pay, then 70% 7

8 Medical Muskingum Valley ESC SuperMed Plus Plan B (Continued) Inpatient Facility Semi-Private Room and Board 90% after deductible 70% after deductible Diagnostic Services (Labs, X-rays, Medical Tests) 90% after deductible 70% after deductible Professional Services 90% after deductible 70% after deductible Maternity 90% after deductible 70% after deductible Skilled Nursing Facility (60 days per benefit period) 90% after deductible 70% after deductible Additional Services Ambulance 90% after deductible 70% after deductible Durable Medical Equipment including Prosthetics Appliances and Orthotic Devices (Unlimited) 90% after deductible 70% after deductible Home Healthcare (60 visits per benefit period) 90% after deductible 70% after deductible Hospice (360 days, lifetime maximum) 90% after deductible 70% after deductible Organ Transplants 90% after deductible 70% after deductible Private Duty Nursing ($5,000 max per benefit period) 100% 70% after deductible Mental Health and Substance Abuse - Federal Mental Health Parity Inpatient Mental Health & Substance Abuse Services Outpatient Mental Health & Substance Abuse Services Benefits paid are based on corresponding medical benefits Benefits paid are based on corresponding medical benefits Prescription Network Non-Network Generic Preferred Brand Non-Preferred Brand $10 copay - retail (1-31 day supply) $25 copay - retail (32-90 day supply) $25 copay - home delivery (90 day supply) $20 copay - retail (1-31 day supply) $50 copay - retail (32-90 day supply) $50 copay - home delivery (90 day supply) $40 copay - retail (1-31 day supply) $100 copay - retail (32-90 day supply) $100 copay - home delivery (90 day supply) N/A N/A N/A 1 Maximum family deductible. Member deductible is the same as single deductible. 3-month carryover applies. 2 The office visit co-pay applies to the cost of the office visit only. 3 Preventive services include evidence-based services that have a rating of A or B in the United States Preventive Services Task Force, routine immunizations and other screenings, as provided for in the Patient Protection and Affordable Care Act. 4 Co-pay waived if admitted. 5 The co-pay applies to room charges only. All other covered charges are subject to deductible and coinsurance. 8

9 Medical 2018 Muskingum Valley ESC Benefits Guide Healthcare Terms Co-pay: A specific dollar amount that you must pay for a specific service at the time when you receive the service. Deductible: A dollar amount you are responsible for before the plan will make any benefit payments. Each year, your deductible starts over (January 1st), in addition, you are only responsible for satisfying your deductible one time per year. Coinsurance: A method of cost-sharing between the member and the insurance carrier for your benefit expenses. If you have 30% coinsurance, then you pay 30% of your eligible expenses and the carrier pays the remaining 70%. The coinsurance begins after your deductible has been satisfied. Out-of-Pocket Maximum: The maximum amount you will be required to pay for your benefits, after which the plan will pay 100% of covered expenses. Your deductible, coinsurance and in some instances co-pays apply towards your Out-of-Pocket Maximum. Semi-Monthly Payroll Deductions SuperMed Plan A SuperMed Plan B Employee Only $47.31 $44.53 Employee & Spouse $ $ Employee & Child(ren) $ $ Employee & Family $ $

10 Dental Muskingum Valley Educational Service Center provides Dental Insurance through Dentemax/CoreSource for all eligible employees and their dependents at no cost to the employee. This benefit is 100% employer paid. Locate a Dentist within the Dentemax network at www2.dentemax.com Dentemax PPO Benefits In Network Calendar Year Deductible Individual / Family $25 / $75 Annual Maximum $1,000 Class I - Preventative & Diagnostic Services Exams, Cleanings, X-Rays, etc. Plan pays 100% Deductible is waived. Class II - Basic Restorative Services Fillings, Simple extractions, Periodontics, Root Canals, etc. 80% covered Class III - Major Restorative Services Crowns, Dentures, Fillings, etc. Class IV - Orthodontics Orthodontic Lifetime Maximum 50% Covered $1,000 $1,000 *Dependents can be covered to 26 regardless of student status. Coverage terminates at the end of the month in which the dependent turns

11 Vision 2018 Muskingum Valley ESC Benefits Guide Muskingum Valley Educational Service Center provides Vision Insurance through VSP for all eligible employees and their dependents at no cost to the employee. You may use any provider you wish, but your benefits are higher when you use a participating provider. You may locate a provider at Benefit is 100% employer paid. Benefit Participating Provider Non-Participating Provider (Reimbursement) Frequency Vision Exam Glasses $20 Co-pay Up to $ Months Contacts (exam & fitting) Up to $60 Co-pay Lenses (single/bifocal/trifocal) $20 Co-pay Single - up to $30.00 Lined bifocal - up to $50.00 Lined trifocal up to $ Months Frames $130 Allowance Up to $ Months Contacts (in lieu of glasses) $150 Allowance Up to $ Months *Dependents can be covered to 26 regardless of student status. Coverage terminates at the end of the month in which the dependent turns

12 Voluntary Benefits What are Voluntary Benefits? Voluntary Benefits are being offered to strengthen your overall benefits package. You customize the benefit based on need and affordability. Ownership Policies are fully portable and belong to you if you leave your employer, same price and same plan Benefits are payroll deducted Cash benefits are paid directly to you, not to a hospital or to a doctor Benefits are paid regardless of any other coverage you may have Level premiums Rates do not increase with age Guaranteed Renewable Designed to provide additional cash flow to assist with out of pocket medical costs and other bills The Voluntary Benefits offered through Trustmark are an Accident Plan, Short-Term Disability, Critical Illness/Cancer and Life Insurance with Long Term Care. Trustmark Accident Plan A plan that helps pay for the unexpected expenses that result from an accident On and off the job coverage = 24 hours per day, 7 days a week Family coverage available Sports related injuries covered as well Just a few examples of benefit included in the plan: Emergency Room Visits - $150 Hospitalization - $1,000 admission benefit, $200 per day benefit Fractures - up to $5,000 Dislocations - up to $4,000 Wellness Benefit - $50 (2x per year per insured) See brochure for a complete list of benefits Semi-Monthly Employee Employee & Spouse Employee & Children Family Payroll Deductions $10.41 $16.20 $25.40 $ *Dependents up to age 26 can be covered regardless of student status.

13 Short Term Disability Trustmark s Short Term Disability is designed to provide income to you and your family when you cannot work due to an illness or injury. Special Underwriting for Initial Offering Only Guaranteed Issue: Up to $3,000 monthly benefit If you previously waived this benefit, you must answer a few health questions and be approved for coverage. Pays 60% of salary up to $3,000 per month 7 day elimination (waiting) period, 6 month benefit period Pregnancy covered as any other illness Premium stays the same as long as you own the policy. The premium does not increase with age 2018 Muskingum Valley ESC Benefits Guide Your individual rate will be calculated for you in the electronic enrollment system. See brochure for full details. Critical Illness/Cancer Plan Critical Illness/Cancer is a benefit that will pay you a lump sum of money if you are diagnosed with a critical illness, heart attack, internal cancer or stroke. The cash benefit is provided upon the first diagnosis of a covered condition to help you with associated costs and beyond. Special Underwriting for Initial Offering Only Guaranteed Issue: $10,000 employee / $5,000 spouse / $1,000 children If you previously waived this benefit, you must answer a few health questions and be approved for coverage. Regardless of other coverage in force, the benefit is paid out in a full lump sum. Examples of covered conditions: Invasive Cancer, Heart Attack, Stroke, Renal (Kidney Failure), Blindness, ALS (Lou Gehrig s Disease), Major Organ Transplant, Paralysis of Two or More Limbs, Coronary Artery Bypass Surgery (25% benefit), Carcinoma In Situ (25% benefit) A Health Screening Benefit is included in your Critical Illness/Cancer Policy and Trustmark pays up to $100 for each insured. Each covered person will get one immunization or one screening test per calendar year. (60 day waiting period for this benefit) Examples of health screenings: Low dose mammography Pap smear Stress test Colonoscopy Serum Cholesterol Prostate specific antigen Bone Marrow Chest X-ray Also included is a Double Benefit Option that provides a second cash payment in the event a covered person is diagnosed with a different condition or illness. Pays an additional 100% of the original benefit. Rates This benefit is customized by each employee so rates vary, but can start as little as a few dollars a week. Your specific rate will be calculated for you in the electronic enrollment system. 13

14 Trustmark Universal Life with Long Term Care Universal Life with Long Term Care includes both a death benefit and a living benefit. Trustmark Universal Life with Long Term Care is a permanent life insurance that is designed to match your needs throughout your lifetime. It pays a higher death benefit during your working years when expenses are high and you need maximum protection. The Universal Life with Long Term Care is priced to remain the same cost to you until age 100. The death benefit reduces at age 70 when the need for life insurance typically decreases. The Living Benefit, Long Term Care never reduces and is 4% of the original death benefit per month for up to 25 months. If you use the Long Term Care benefit, your death benefit amount does not reduce due to the Benefit Restoration feature included. Coverage available for spouse and children as well. Special Underwriting for Initial Offering Only Guaranteed Issue (Employee Only) The lesser of the face amount purchased by $16 per week or $200,000 If you previously waived this benefit, you must answer a few health questions and be approved for coverage. Life with Long Term Care example: $100,000 Death Benefit Long Term Care Benefit (LTC): Pays a monthly benefit equal to 4% of your death benefit for up to 25 months. Before Age 70 $100,000 After Age 70 $100,000 Benefit Restoration: Restores the death benefit that is reduced to pay for LTC. Total Maximum Benefit: Long Term Care Benefits may double the value of your insurance $100,000 $33,333 $200,000 $133,333 Rates This benefit is customized by each employee so rates vary, but can start as little as a few dollars a week. Your specific rate will be calculated for you in the electronic enrollment system. 14

15 Basic Life and AD&D 2018 Muskingum Valley ESC Benefits Guide Muskingum Valley Educational Service Center provides Basic Life insurance through Assurant Life Insurance Company for all eligible employees at no cost to the employee. All eligible employees should enroll in this life insurance. The Basic Life insurance benefit is $25,000. Muskingum Valley Educational Service Center also provides Accidental Death & Dismemberment (AD&D) insurance which pays in addition to the Basic benefit when loss occurs as a result of an accident. Voluntary Supplemental Life Muskingum Valley Educational Service Center employees may elect to purchase additional Life Insurance on a voluntary basis through Assurant Life Insurance Company via payroll deduction. Employee Spouse Child* Benefit Schedule Increments of $10,000 Increments of $5,000 Flat $10,000 Maximum Benefit $500,000 (not to exceed 5x Annual Salary) $250,000 (not to exceed 50% of employee amount) Minimum Benefit $10,000 $5,000 N/A Guarantee Issue (initial offering only) Age Band $180,000 (not to exceed 5x Annual Salary) Monthly Rates for Voluntary Term Life Employee Semi-Monthly Rate per $1,000 N/A $50,000 $10,000 Spouse Semi-Monthly Rate per $1,000** Child Semi- Monthly Rate <20 $0.13 $0.13 $ $0.23 $ $0.24 $ $0.35 $ $0.47 $ $0.72 $ $0.99 $ $1.92 $ $3.66 $ $5.34 $ $9.08 $ $16.23 $ $59.79 $38.49 *Coverage terminates at the end of the month in which the dependent turns 26. **Rates based on Spouse Age. 15

16 Important Contacts Vendor Phone Number Website Medical Medical Mutual of Ohio Dental Coresource Vision VSP Basic & Supplemental Life Assurant Voluntary Benefits Trustmark Insurance Broker ALR Insurance Human Resources Trustmark Benefits Claims Help Explain My Benefits Rena Ridenour Laurel Paul Christine Wagner x1104 Debbie Kimball x , Option 3 r.ridenour@alrins.com l.paul@arlins.com christine.wagner@mvesc.org deborah.kimball@mvesc.org service@explainmybenefits.biz 16

17 Benefit Guide Description Please Note: This guide is designed to provide an overview of the coverages available. It is not a Summary Plan Description (SPD). Official plan and insurance documents from the carriers govern your rights and benefits, including covered benefits, exclusions and limitations. If any discrepancy exists between this guide and the official documents, the official documents will prevail.