Improving Our Wellness Together

Transcription

1 20 Improving Our Wellness Together 15

2 Overview 2 Benefit Guide Content Overview 3 Medical 4-9 Accident 10 Short Term Disability & Cri cal Illness/Cancer 11 Life Insurance & Long Term Care 12 Basic Life & Voluntary Term Life Dental 15 Vision 16 Notes & Ques ons 17 Important Contacts 18

3 Overview 3 WELCOME TO ENROLLMENT FOR YOUR 2015 BENEFITS! Muskingum Valley ESC offers you and your eligible family members a comprehensive and valuable benefits program. We encourage you to take the me to educate yourself about your op ons and choose the best coverage for you and your family. You can find more detailed informa on about your benefits and how to enroll at your Benefit Enrollment Portal at: Enrollment Process! 1. All benefit eligible employees are required to complete the enrollment process whether you are elec ng benefits or waiving all benefits in order to confirm your choices. 2. This year we have moved to an online enrollment process. This new technology, EMB Enroll, will enable a more efficient process to communicate and administer the benefits to our insurance carriers. Employees will self-enroll online and the system will guide you through the benefit offerings. 3. Please be prepared to complete your enrollment with all your demographic and dependent informa on. You will be verifying all this informa on that will be in the system so it is accurate when sent to all the insurance carriers. When can I Enroll? New hire ini al enrollment and annual open enrollment allows for employees of the District to enroll or make changes in any of the plans without a qualifying event. In order to make changes outside of your enrollment period, there would need to be a qualifying event such as the birth of a child, change in marital status, death, or loss of coverage due to no fault of your own. An enrollment applica on must be submi ed to the insurance carrier via the Treasurer s office within thirty-one (31) days of the qualifying event in order for coverage to be effec ve.

4 Medical 4 Medical Mutual is partnering with Muskingum Valley Educa onal 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 condi on and dependence must be submi ed) Medical - Dependent children up to age 26 regardless of financial dependency, residency, student status, employment or mar al 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 effec ve 1st of the month following the eligibility period. For more informa on contact Human Resources.

5 Medical 5 Muskingum Valley ESC SuperMed Plus Plan A Benefits Network Non-Network Benefit Period Dependent Age Limit Pre-Exis ng Condi on Wai ng Period (does not apply to members under the age of 19) Overall Annual Benefit Period Maximum January 1st through December 31st 26, Removal at End of Month Ini al Group Waiver, All Others: 6-9 Unlimited Benefit Period Deduc ble - Single/Family 1 $500/$1,000 $500/$1,000 Coinsurance 90% 80% Coinsurance Out-of-Pocket Maximum (Excluding Deduc ble) - Single/Family Physician/Office Services $750/$1,500 $1,500/$3,000 Office Visit (Illness/Injury) 2 $15 co-pay, then 100% 80% a er deduc ble Urgent Care Office Visit 2 $35 co-pay, then 100% 80% a er deduc ble Surgical Services in Physician s Office $15 co-pay, then 100% 80% a er deduc ble All Immuniza ons 100% 80% a er deduc ble Preventa ve Services 3 Preven ve Services, in accordance with state and Federal law 3 100% 80% a er deduc ble Rou ne Physical Exams (Age 21 and over) 100% 80% a er deduc ble Well Child Care Services including Exam and Immuniza ons (Birth to Age 21) 100% 80% a er deduc ble Well Child Care Laboratory Tests (To Age 21) 100% 80% a er deduc ble Rou ne Vision Exams (including Refrac on - Age 21 and over) 100% 80% a er deduc ble Rou ng Hearing Exam (Age 21 an over) 100% 80% a er deduc ble Rou ne Mammogram (One per benefit period) 100% 80% a er deduc ble Rou ne Pap Test (One per benefit period) 100% 80% a er deduc ble Rou ne Laboratory, X-Rays and Medical Tests (All Ages) 100% 80% a er deduc ble Rou ne Endoscopic Services (All Ages) 100% 80% a er deduc ble Outpa ent Services Surgical Services (other than a physician s office) 90% a er deduc ble 80% a er deduc ble Diagnos c Services 100% 80% a er deduc ble CT Scans, MRI and Nuclear Medicine 90% a er deduc ble 80% a er deduc ble Emergency use of an Emergency Room 4 $100 co-pay, then 100% Non-Emergency use of an Emergency Room 4, 5 $100 co-pay, then 100% $100 co-pay, then 80%

6 Medical 6 Muskingum Valley ESC SuperMed Plus Plan A (Con nued) Inpa ent Facility Semi-Private Room and Board 90% a er deduc ble 80% a er deduc ble Diagnos c Services (Labs, X-rays, Medical Tests) 90% a er deduc ble 80% a er deduc ble Professional Services 90% a er deduc ble 80% a er deduc ble Maternity 90% a er deduc ble 80% a er deduc ble Skilled Nursing Facility (60 days per benefit period) 90% a er deduc ble 80% a er deduc ble Addi onal Services Ambulance 90% a er deduc ble 90% a er deduc ble Durable Medical Equipment including Prosthe cs Appliances and Ortho c Devices (Unlimited) 90% a er deduc ble 80% a er deduc ble Home Healthcare (60 visits per benefit period) 90% a er deduc ble 80% a er deduc ble Hospice (360 days, life me maximum) 90% a er deduc ble 80% a er deduc ble Organ Transplants 90% a er deduc ble 80% a er deduc ble Private Duty Nursing ($5,000 max per benefit period) 100% 80% a er deduc ble Mental Health and Substance Abuse - Federal Mental Health Parity Inpa ent Mental Health & Substance Abuse Services Outpa ent Mental Health & Substance Abuse Services Benefits paid are based on corresponding medical benefits Benefits paid are based on corresponding medical benefits 1 Maximum family deduc ble. Member deduc ble is the same as single deduc ble. 3-month carryover applies. 2 The office visit co-pay applies to the cost of the office visit only. 3 Preven ve services include evidence-based services that have a ra ng of A or B in the United States Preven ve Services Task Force, rou ne immuniza ons and other screenings, as provided for in the Pa ent Protec on and Affordable Care Act. 4 Co-pay waived if admi ed. 5 The co-pay applies to room charges only. All other covered charges are subject to deduc ble and coinsurance.

7 Medical 7 Muskingum Valley ESC SuperMed Plus Plan B Benefits Network Non-Network Benefit Period Dependent Age Limit Pre-Exis ng Condi on Wai ng Period (does not apply to members under the age of 19) Overall Annual Benefit Period Maximum January 1st through December 31st 26, Removal at End of Month Ini al Group Waiver, All Others: 6-9 Unlimited Benefit Period Deduc ble - Single/Family 1 $1,000/$2,000 $1,250/$2,500 Coinsurance 90% 70% Coinsurance Out-of-Pocket Maximum (Excluding Deduc ble) - Single/Family Physician/Office Services $1,000/$2,000 $1,250/$2,500 Office Visit (Illness/Injury) 2 $25 co-pay, then 100% 70% a er deduc ble Urgent Care Office Visit 2 $35 co-pay, then 100% 70% a er deduc ble Surgical Services in Physician s Office $25 co-pay, then 100% 70% a er deduc ble All Immuniza ons 100% 70% a er deduc ble Preventa ve Services 3 Preven ve Services, in accordance with state and Federal law 3 100% 70% a er deduc ble Rou ne Physical Exams (Age 21 and over) 100% 70% a er deduc ble Well Child Care Services including Exam and Immuniza ons (Birth to Age 21) 100% 70% a er deduc ble Well Child Care Laboratory Tests (To Age 21) 100% 70% a er deduc ble Rou ne Vision Exams (including Refrac on - Age 21 and over) 100% 70% a er deduc ble Rou ng Hearing Exam (Age 21 an over) 100% 70% a er deduc ble Rou ne Mammogram (One per benefit period) 100% 70% a er deduc ble Rou ne Pap Test (One per benefit period) 100% 70% a er deduc ble Rou ne Laboratory, X-Rays and Medical Tests (All Ages) 100% 70% a er deduc ble Rou ne Endoscopic Services (All Ages) 100% 70% a er deduc ble Outpa ent Services Surgical Services (other than a physician s office) 90% a er deduc ble 70% a er deduc ble Diagnos c Services 100% 70% a er deduc ble CT Scans, MRI and Nuclear Medicine 90% a er deduc ble 70% a er deduc ble Emergency use of an Emergency Room 4 $100 co-pay, then 100% Non-Emergency use of an Emergency Room 4, 5 $100 co-pay, then 100% $100 co-pay, then 70%

8 Medical 8 Muskingum Valley ESC SuperMed Plus Plan B (Con nued) Inpa ent Facility Semi-Private Room and Board 90% a er deduc ble 70% a er deduc ble Diagnos c Services (Labs, X-rays, Medical Tests) 90% a er deduc ble 70% a er deduc ble Professional Services 90% a er deduc ble 70% a er deduc ble Maternity 90% a er deduc ble 70% a er deduc ble Skilled Nursing Facility (60 days per benefit period) 90% a er deduc ble 70% a er deduc ble Addi onal Services Ambulance 90% a er deduc ble 70% a er deduc ble Durable Medical Equipment including Prosthe cs Appliances and Ortho c Devices (Unlimited) 90% a er deduc ble 70% a er deduc ble Home Healthcare (60 visits per benefit period) 90% a er deduc ble 70% a er deduc ble Hospice (360 days, life me maximum) 90% a er deduc ble 70% a er deduc ble Organ Transplants 90% a er deduc ble 70% a er deduc ble Private Duty Nursing ($5,000 max per benefit period) 100% 70% a er deduc ble Mental Health and Substance Abuse - Federal Mental Health Parity Inpa ent Mental Health & Substance Abuse Services Outpa ent Mental Health & Substance Abuse Services Benefits paid are based on corresponding medical benefits Benefits paid are based on corresponding medical benefits 1 Maximum family deduc ble. Member deduc ble is the same as single deduc ble. 3-month carryover applies. 2 The office visit co-pay applies to the cost of the office visit only. 3 Preven ve services include evidence-based services that have a ra ng of A or B in the United States Preven ve Services Task Force, rou ne immuniza ons and other screenings, as provided for in the Pa ent Protec on and Affordable Care Act. 4 Co-pay waived if admi ed. 5 The co-pay applies to room charges only. All other covered charges are subject to deduc ble and coinsurance.

9 Medical 9 HEALTHCARE TERMS Co-pay: A specific dollar amount that you must pay for a specific service at the me when you receive the service. Deduc ble: A dollar amount you are responsible for before the plan will make any benefit payments. Each year, your deduc ble starts over (January 1st), in addi on, you are only responsible for sa sfying your deduc ble one me 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 a er your deduc ble has been sa sfied. Out-of-Pocket Maximum: The maximum amount you will be required to pay for your benefits, a er which the plan will pay 100% of covered expenses. Your deduc ble, 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 $36.80 $31.48 Employee & Spouse $ $ Employee & Child(ren) $ $79.87 Employee & Family $ $144.26

10 Voluntary Benefits through Trustmark 10 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 If a claim is made the benefits are paid directly to you, not to a hospital or to a doctor Benefits are above and beyond and completely separate from medical insurance and other benefits Level premiums Rates do not increase with age Guaranteed Renewable Designed to provide addi onal cash flow to assist with out of pocket medical costs and other bills The four Voluntary Benefits offered through Trustmark are an Accident Plan, Short-Term Disability, Cri cal Illness/Cancer and Life Insurance with Long Term Care. ACCIDENT PLAN The Accident Insurance pays benefits if you are injured in a covered accident on or off the job. 24 hours/7 days week coverage Money is paid directly to you for: Disloca ons, fractures, tendon/ligament tears Burns and s tches Hospitaliza on Medical expenses & various medical treatments, doctor visits, etc Wellness Benefit Included: Promotes good health among employees and their families as health and wellness benefits offset the costs of going to the doctor for rou ne physicals, immuniza ons, and health screening tests regardless of other coverage. (60 day wai ng period for the wellness benefit) Wellness Benefit: $50 per insured (maximum of 2 visits per individual or 10 visits per family) SEMI-MONTHLY PAYROLL DEDUCTIONS Employee Employee Employee & Spouse & Children Family $10.40 $16.20 $25.40 $31.17

11 Voluntary Benefits through Trustmark 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 Underwri ng for Ini al Offering Only Guaranteed Issue: Up to $3,000 monthly benefit If you previously waived this benefit, you must answer a few health ques ons and be approved for coverage. Pays 60% of salary up to $3,000 per month 7 day elimina on (wai ng) 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 At your individual enrollment session your Benefit Counselor will show you pricing based on your policy needs. See brochure for full details CRITICAL ILLNESS/CANCER PLAN Cri cal Illness/Cancer is a benefit that will pay you a lump sum of money if you are diagnosed with a cri cal illness, heart a ack, internal cancer or stroke. The cash benefit is provided upon the first diagnosis of a covered condi on to help you with associated costs and beyond. Special Underwri ng for Ini al 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 ques ons and be approved for coverage. Regardless of other coverage in force, the benefit is paid out in a full lump sum. 11 Examples of covered condi ons: Invasive Cancer, Heart A ack, 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 Cri cal Illness/Cancer Policy and Trustmark pays up to $100 for each insured. Each covered person will get one immuniza on or one screening test per calendar year. (60 day wai ng 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 Op on that provides a second cash payment in the event a covered person is diagnosed with a different condi on or illness. Pays an addi onal 100% of the original benefit. Rates This benefit is customized by each employee so rates vary, but can start as li le as a few dollars a week. Please speak to a Benefit Counselor to customize your plan and rates. See brochure for more details.

12 Voluntary Benefits through Trustmark 12 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 life me. It pays a higher death benefit during your working years when expenses are high and you need maximum protec on. The Universal Life with Long Term Care is priced to remain the same cost to you un l 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 Restora on feature included. Coverage available for spouse and children as well. Special Underwri ng for Ini al 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 ques ons 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 A er Age 70 $100,000 Benefit Restora on: 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 li le as a few dollars a week. Please speak to a Benefit Counselor to customize your plan and rates.

13 Term Life Insurance 13 Basic Term Life and Accidental Death & Dismemberment Muskingum Valley Educa onal Service Center provides Basic Life insurance through Assurant Life Insurance Company for all eligible employees at no cost to the employee. The Basic Life insurance benefit is $25,000. Muskingum Valley Educa onal Service Center also provides Accidental Death & Dismemberment (AD&D) insurance which pays in addi on to the Basic benefit when loss occurs as a result of an accident. Voluntary Supplemental Life Muskingum Valley Educa onal Service Center employees may elect to purchase addi onal Life Insurance on a voluntary basis through Assurant Life Insurance Company via payroll deduc on. Employee You may elect life insurance in increments of $10,000 to the lesser of 5 mes your annual salary or $500,000, whichever is less. One Time Guaranteed Issue Amount for New Hire Employees only $180,000 (Not to exceed 5x annual salary) If you elect Voluntary Life Insurance for yourself, you also have the opportunity to elect coverage for your spouse and/or children. Spouse Child(ren) You may elect life insurance in increments of $5,000 not to exceed half of the employee s elected amount up to a maximum of $250,000. One Time Guaranteed Issue Amount for New Hire Employees only $50,000 Coverage in the amount of up to $10,000 can be elected for all children from birth through the age of 19 (25 if a full me student and unmarried). One Time Guaranteed Issue Amount for New Hire Employees only $10,000

14 Term Life Insurance 14 COSTS FOR TERM LIFE INSURANCE Age Band Employee Semi-Monthly Rate per $10,000 *Spouse Semi-Monthly Rate per $5,000 <20 $.13 $ $.23 $ $.24 $ $.35 $ $.47 $ $.72 $ $.99 $ $1.92 $ $3.66 $ $5.34 $ $9.08 $ $16.23 $ $59.79 $38.49 *Rates are based on Spouse Age Child Semi-Monthly Rate $10,000 - $.91 Example: A 36 year old female, Sally, wants to purchase $50,000 of term life insurance..47 x 5 = $2.35 _ Semi-Monthly rate per $10,000 # of units/$10,000 payroll deduc on

15 Dental 15 Muskingum Valley Educa onal Service Center provides Dental Insurance through Dentemax/CoreSource for all eligible employees and their dependents at no cost to the employee. Locate a Den st within the Dentemax network at www2.dentemax.com Plan Dentemax PPO In Network Calendar Year Deduc ble Individual / Family $50 / $150 Annual Maximum $1,000 Class I - Preventa ve & Diagnos c Services Exams, Cleanings, X-Rays, etc. Class II - Basic Restora ve Services Plan pays 100% Deduc ble is waived. 80% covered Fillings, Simple extrac ons, Periodon cs, Root Canals, etc. Class III - Major Restora ve Services 50% Covered Crowns, Dentures, Fillings, etc. Class IV - Orthodon cs $1,000 Orthodon c Life me Maximum $1,000 Benefit is paid by your employer. *Dependents can be covered to age 25 if a full me student.

16 Vision 16 Muskingum Valley Educa onal 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 par cipa ng provider. You may locate a provider at Benefit is paid by your employer. Benefit Par cipa ng Provider Non-Par cipa ng Provider (Reimbursement) Frequency Vision Exam Glasses $20 Co-pay Up to $ Months Contacts (exam & fi ng) 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

17 Notes & Ques ons 17

18 Important Contacts 18 Medical Mutual of Ohio Coresource (Dental) VSP (Vision) Assurant ALR Insurance Human Resources Explain My Benefits Trustmark Benefits claims help Rena Ridenour Chris ne Wagner chris Debbie Kimball , Op on 2 service@explainmybenefits.biz Benefit Guide Descrip on Please Note: This guide is designed to provide an overview of the coverages available. It is not a Summary Plan Descrip on (SPD). Official plan and insurance documents from the carriers govern your rights and benefits, including covered benefits, exclusions and limita ons. If any discrepancy exists between this guide and the official documents, the official documents will prevail.