Employee Benefits for Small Businesses

Transcription

1 Employee Benefits for Small Businesses Kavi can help you Enroll, lnsure & Retain employees with: Competitive Pricing Online Billing Consolidated Administration Comprehensive Products Effective January 1, 2018

2 Contents About Kavi Marketplace... 1 Benefits Snapshot... 2 Medical Plan... 3 Dental Plan... 9 Vision Plan...11 Life and AD&D Plan...13 About the Third-Party Administrator...15 About the Managing General Agent...16

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4 About Kavi Marketplace Kavi Marketplace, powered by TailorWell, is a one-stop shop that bundles all the tools necessary for small groups to enjoy great benefits. It is designed to make healthcare interaction easy, with consolidated billing, no administrative fees and an easily accessible online enrollment platform. Product offerings through Kavi include small-group medical plans from Asuris Northwest Health; and large-group dental, vision and life insurance benefits specifically selected from Delta Dental of Washington, VSP Vision Care Inc. and LifeMap Assurance Company. Through Kavi, employers perform their own online administration via a comprehensive, real-time platform, and employees shop and enroll in an online marketplace. Key advantages to Kavi include: online shopping; decision support and enrollment; comprehensive and highly accurate benefits administration; consolidated billing; tools; and a My Benefits employee portal, which allows every Kavi member to have a personalized website with their own benefit selections and cost summary. Through Kavi, Asuris offers comprehensive small-group medical, pharmacy and wellness plans. Asuris is committed to the small-group market, allowing employees to choose from the broad Preferred network, which offers access to any contracted provider across Washington state. Additional benefits are provided by Delta Dental of Washington, the state's leading dental benefits company; VSP Vision Care Inc., the nation's only not-for-profit vision company; and LifeMap Assurance Company, offering specialized Life, AD&D and Voluntary Life products. With several unique plan designs to choose from, employers will be empowered to pick the right combination of benefits to meet their needs, while taking advantage of Kavi's group purchasing power. Kavi products are available for all industries in Washington state, and are distributed to Asuris-appointed and Kavi-accredited producers via the Benefit Resource Hub (the HUB). The HUB provides accredited producers with secure, online access to Washington state's premier health care insurance companies' products. To learn more, please contact your producer or Kavi@BenefitResourceHub.com. KaviMarketplace.com Page 1

5 Benefits Snapshot Medical Plan: Asuris Northwest Health Metallic levels include Platinum, Gold, Silver and Bronze Available to employers with 1-50 employees Rolling 12-month plan year offerings All Asuris community-rated small-group products available Doctor visits available 24/7 over the phone or video chat through Doctor on Demand All plans ACA compliant All taxes/fees included in pricing Six-tier formulary splits generic, brand and specialty categories Embedded wellness program discounts for qualified employee premiums Employee Assistance Program (EAP) embedded on all plans Dental Plan: Delta Dental of Washington Annual maximums from $1,000 to $2,000 Child and adult orthodontia riders (10 or more employees) All plans include the Delta Dental PPO Network All plans feature a $50 / $150 deductible Available to groups with two or more employees Large-group rating Vision Plan: VSP Vision Care Inc. Two plan options with distinct benefit frequencies $10 co-pay for exams Materials allowance and co-pays vary by plan Choice Network included with both plan options Available to groups enrolled in a Kavi medical or dental plan with two or more employees Large-group rating Life and AD&D Plan: LifeMap Assurance Company $15,000 Basic Life/AD&D $25,000 Basic Life/AD&D Voluntary Life Page 2 Kavi@BenefitResourceHub.com

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11 doctorondemand.com How it works Connect with our doctors right from your phone, tablet, or computer on demand or by appointment 365 days a year, 24/7. Through live video, our hand-picked doctors review symptoms and medications, perform an exam, and may recommend treatment, including prescriptions and lab work. How we can help Our board-certified doctors treat a wide variety of health conditions, including: Colds & Allergies UTIs Heartburn & Indigestion Eczema & Acne Migraines Prescription Refills * Pink Eye & more Flu What it costs Doctor On Demand video visits cost far less than a trip to the emergency room or urgent care. The cost of your visit is provided up front, so you won t have any surprises after your visit. There are no setup or monthly fees. Doctor On Demand operates subject to state laws. As of August 2017, Doctor On Demand offers Medical care in all 50 states including the District of Columbia. Doctor On Demand is not intended to replace an annual, in-person visit with a primary care physician. *Doctor On Demand physicians do not prescribe Controlled Substances, and may elect not to treat or prescribe other medications based on what is clinically appropriate.

12 Dental Plan Delta Dental of Washington For more than 60 years, we ve always focused on what truly matters healthy smiles. It drives everything we do. We are a founding member of the nationwide Delta Dental Plans Association, and administer dental benefits to over 2.8 million members in state and nationwide, more than any other dental benefits provider. Our unique two-tier Delta Dental PPOSM and Delta Dental Premier networks offer the access to the most quality dentists more than 4,400 in Washington State and more than 152,000 across the country. This is a benefit that no other company can match. Regular dental exams and cleanings are key to keeping your smile healthy. Visit your dentist regularly. They ll keep you on the road to a lifelong, healthy smile. MySmile personal benefits center is your patient portal at DeltaDentalWA.com. It s customized to your benefits information and allows you to: Print your ID card View your coverage Get instant out-of-pocket cost estimates with MySmile Cost Genie Endorse your favorite dentist and help others find theirs Sign up for paperless Explanation of Benefits (EOB) via Have a question? Give us a call at or send an to cservice@deltadentalwa.com. We re happy to help. KaviMarketplace.com Page 9

13 Dental Plan Delta Dental of Washington Plan Feature PPO Plan A Group #03875 PPO Plan B Group #03876 PPO Plan C Group #03877 PPO Plan D Group #03878 Annual Deductible $50 $50 $50 $50 Per Person Family Maximum $150 Annual Maximum $1,000 $1,500 $2,000 $2,000 Class I Diagnostic and Preventive In Out In Out In Out In Out Exams Prophylaxis Flouride 100% 80% 100% 80% 100% 80% 100% 100% X-rays Sealants Class II Restorative In Out In Out In Out In Out $150 $150 $150 Restorations Endodontics Periodontics Oral Surgery 80% 70% 80% 70% 80% 70% 90% 80% Class III Major In Out In Out In Out In Out Crowns Dentures Partials Bridges Implants 50% 40% 50% 40% 50% 40% 50% 50% Ortho Child Only Ortho Family Lifetime Max $1,000 Lifetime Max $1,000 Coverage 50% 50% Annual deductibles are waived on Class I benefits. All Plans are available to groups with 2 or more eligible employees. Optional orthodontia coverage is available to groups with 10 or more eligible employees. Page 10 Kavi@BenefitResourceHub.com

14 Protect your vision with VSP. Get the best in eye care and eyewear with KAVI MARKETPLACE and VSP Vision Care. Why enroll in VSP? We invest in the things you value most the best care at the lowest out-of-pocket costs. Because we re the only national not-for-profit vision care company, you can trust that we ll always put your wellness first. You ll like what you see with VSP. Value and Savings. You ll enjoy more value and the lowest out-of-pocket costs. High Quality Vision Care. You ll get the best care from a VSP provider, including a WellVision Exam the most comprehensive exam designed to detect eye and health conditions. Choice of Providers. The decision is yours to make choose a VSP doctor, a participating retail chain, or any out-of-network provider. Great Eyewear. It s easy to find the perfect frame at a price that fits your budget. Enroll in VSP today. You'll be glad you did. Contact us vsp.com Using your VSP benefit is easy. Create an account at vsp.com. Once your plan is effective, review your benefit information. Find an eye care provider who s right for you. To find a VSP provider, visit vsp.com or call At your appointment, tell them you have VSP. There s no ID card necessary. If you d like a card as a reference, you can print one on vsp.com. That s it! We ll handle the rest there are no claim forms to complete when you see a VSP provider. Choice in Eyewear From classic styles to the latest designer frames, you ll find hundreds of options. Choose from featured frame brands like bebe, Calvin Klein, Cole Haan, Flexon, Lacoste, Nike, Nine West, and more 1. Visit vsp.com to find a Premier Program location that carries these brands. Prefer to shop online? Check out all of the brands at Eyeconic.com, VSP's online eyewear store. KaviMarketplace.com Page 11

15 Your VSP Vision Benefits Summary VSP Coverage Effective Date: 01/01/2018 KAVI MARKETPLACE and VSP provide you with a choice of affordable vision plans choose the plan that's right for you. Plan A Benefit WellVision Exam VSP Provider Network: VSP Choice Description Copay Your Coverage with a VSP Provider Focuses on your eyes and overall wellness Every 12 months $10 Plan B Benefit WellVision Exam VSP Provider Network: VSP Choice Description Copay Your Coverage with a VSP Provider Focuses on your eyes and overall wellness Every 12 months Prescription Glasses $25 Prescription Glasses $40 Frame Lenses Lens Enhancements Contacts (instead of glasses) Diabetic Eyecare Plus Program Extra Savings $130 allowance for a wide selection of frames $150 allowance for featured frame brands 20% savings on the amount over your allowance $70 Costco frame allowance Every 24 months Single vision, lined bifocal, and lined trifocal lenses Polycarbonate lenses for dependent children Every 24 months Standard progressive lenses Premium progressive lenses Custom progressive lenses Average savings of 20-25% on other lens enhancements Every 24 months $130 allowance for contacts; copay does not apply Contact lens exam (fitting and evaluation) Every 24 months Services related to diabetic eye disease, glaucoma and age-related macular degeneration (AMD). Retinal screening for eligible members with diabetes. Limitations and coordination with medical coverage may apply. Ask your VSP doctor for details. As needed Included in Prescription Glasses Included in Prescription Glasses Frame Lenses $150 allowance for a wide selection of frames $170 allowance for featured frame brands 20% savings on the amount over your allowance $80 Costco frame allowance Every 24 months Single vision, lined bifocal, and lined trifocal lenses Polycarbonate lenses for dependent children Every 12 months Standard progressive lenses $10 Included in Prescription Glasses Included in Prescription Glasses $55 $55 $95 - $105 Premium progressive lenses $95 - $105 $150 - $175 Lens Custom progressive lenses $150 - $175 Enhancements Average savings of 20-25% on other lens enhancements Every 12 months Up to $60 $20 Contacts (instead of glasses) Diabetic Eyecare Plus Program $150 allowance for contacts; copay does not apply Contact lens exam (fitting and evaluation) Every 12 months Services related to diabetic eye disease, glaucoma and age-related macular degeneration (AMD). Retinal screening for eligible members with diabetes. Limitations and coordination with medical coverage may apply. Ask your VSP doctor for details. As needed Up to $60 Glasses and Sunglasses Extra $20 to spend on featured frame brands. Go to vsp.com/specialoffers for details. 20% savings on additional glasses and sunglasses, including lens enhancements, from any VSP provider within 12 months of your last WellVision Exam. Retinal Screening No more than a $39 copay on routine retinal screening as an enhancement to a WellVision Exam Laser Vision Correction Average 15% off the regular price or 5% off the promotional price; discounts only available from contracted facilities Your Coverage with Out-of-Network Providers Visit vsp.com for details, if you plan to see a provider other than a VSP network provider. Exam... up to $45 Frame... up to $70 Single Vision Lenses... up to $30 Lined Bifocal Lenses...up to $50 Lined Trifocal Lenses...up to $65 $20 Progressive Lenses...up to $50 Contacts...up to $105 Coverage with a participating retail chain may be different. Once your benefit is effective, visit vsp.com for details. Coverage information is subject to change. In the event of a conflict between this information and your organization s contract with VSP, the terms of the contract will prevail. Based on applicable laws, benefits may vary by location. 1 Brands/Promotion subject to change Vision Service Plan. All rights reserved. VSP, VSP Vision care for life, and WellVision Exam are registered trademarks of Vision Service Plan. Flexon is a registered trademark of Marchon Eyewear, Inc. All other company names and brands are trademarks or registered trademarks of their respective owners. Page 12 Kavi@BenefitResourceHub.com

16 Basic Life and AD&D LifeMap Assurance Company Group Basic Life and AD&D (Employer Paid) Option 1: $15,000 in Basic Life with matching AD&D Option 2: $25,000 in Basic Life with matching AD&D Guarantee Issue: All amounts elected are guarantee issue Affordable Rates: Because this is a Kavi-sponsored benefit, you buy coverage for lower rates than a typical individual policy Disability Waiver: Should you become totally disabled, you will not have to pay your Voluntary Life premium as long as you meet the requirements under the Waiver of Premium provision Voluntary Life and AD&D (Employee Paid) Flexible Benefits: from $20,000 to $100,000 (in increments of $20,000) Participation Requirement: The greater of 10 lives or 20 percent participation Guarantee Issue: $40,000 for employees when enrolled within 31 days of initial eligibility Step-Up Guarantee Issue: If you enroll for at least $10,00 when you are first eligible, you may increase your benefit amount during annual/open enrollment, up to $40,000 Affordable Rates: Because this is a Kavi-sponsored benefit, you buy coverage for lower rates than a typical individual policy Disability Waiver: Should you become totally disabled, you will not have to pay your Voluntary Life premium as long as you meet the requirements under the Waiver of Premium provision Accelerated Benefit: A portion of benefit can be paid before death if diagnosed with terminal illness Conversion: Option of converting to individual Portability: Benefit can be ported to continue under group coverage KaviMarketplace.com Page 13

17 LIFEMAP: Helping people live in the moment and plan for the future. Headquartered in Portland, Oregon, LifeMap is a life and disability insurance company that offers additional benefits, such as dental, vision and short term medical coverage to provide members with financial protection and access to care. People do business with us because of our high-value products, easy-to-understand language and personalized service. We provide thoughtful guidance to help people choose the coverage they need at different stages of their lives. At LifeMap, we encourage you to get out and enjoy life, do what you love to do knowing that you re protected every step of the way. LIFEMAP s MIssIon LifeMap is dedicated to serving customers through all of life s transitions. We deliver financial protection and peace of mind with simplicity, education and innovation. LifeMap gives people confidence to live life to its fullest. FInAncIAL RAtIng AM Best Rating: A- (Excellent) As of December 2013, LifeMap s Risk Based Capital exceeds the NAIC s acceptable levels by over three times and is in line with industry averages for other ancillary carriers. LifeMap does not have investments in mortgage-backed securities. LIFEMAP PRoDUcts LifeMap has products that cover people no matter where they are in life. We offer coverage for individuals and families, plus a wide range of options for employer groups, including companysponsored and employee-paid plans. Talk to us today about: Life Insurance Accidental Death and Dismemberment Coverage Short Term Disability Coverage Long Term Disability Coverage Critical Illness Coverage Accident Coverage Dental Plans Vision Coverage Short Term Medical Insurance Individual Accident and Critical Illness Coverage give us a call to learn more about LifeMap Assurance company LifeMapco.com 1 (800) lm/ LifeMap Page 14 Kavi@BenefitResourceHub.com

18 About the Platform TailorWell Simple. Choice. TailorWell was founded on the premise that the process of selecting, enrolling in and managing benefits should be easy and valuable for employees, employers, brokers and carriers. Founded in Seattle, WA, TailorWell, through the Kavi Marketplace, is the only private exchange in the market that can be sold by benefits brokers as a turnkey, outsourced solution to employers. Focused on Consumers TailorWell assembled a team of the nation s top consumer technology and benefits experts to create a comprehensive private exchange solution. We created a marketplace of consumer-friendly products and services, historically available only to large employers, and make them available to mid- to smaller- sized employers. The online marketplace experience is supported by a robust administration platform that helps employers manage all aspects of employee benefits. Key Advantages of TailorWell Private Exchange Solution Online shopping, decision support and enrollment. The consumer-friendly, online marketplace is designed to be familiar to anyone who shops online. Comprehensive benefits administration. Employers are supported with everything they need to efficiently manage their benefits program eligibility, enrollment, status changes, payroll deduction, COBRA or Continuation of Coverage, and consolidated billing. TailorWell s technology is integrated and operates in real time so that any changes to employee data or products are reflected immediately in everything from the user experience to the employer bill. Consolidated billing. Employers have online access to a consolidated bill for all their benefit products and services. This bill is always current. Payments are made electronically or by check and TailorWell pays each carrier and vendor. Frequent data exchange. Eligibility data is provided electronically to carriers in an aggregate file every two weeks (standard) or more often when requested. The quality and frequency of our data exchange results in less latency and fewer errors. My Benefits employee portal. Every TailorWell member receives a personalized website with their own benefit selections and cost summary. This becomes the dashboard by which employees manage their benefits and receive communications, new offers and notifications about the benefits they have selected. Customer service. Customer service agents use the same platform as employers and employees so support is clear, consistent, accurate and fast. The numbers to call for help with the Kavi Marketplace appear on the employer and employee web sites. At TailorWell we help employers offer their employees more benefits options, while streamlining the benefits administration process. In today s competitive marketplace, employers rely on TailorWell to help them effectively recruit and retain employees. Employees receive an intuitive, supported way to make personal benefits choices that best reflect their needs and the needs of their families. KaviMarketplace.com Page 15

19 About the Managing General Agent Advanced Professionals Insurance & Benefit Solutions Insurance & Benefit Solutions Advanced Professionals Insurance & Benefit Solutions 1201 Third Avenue, Suite 1600 Seattle, WA Advanced Professionals Insurance & Benefit Solutions manages several Association Health Plans, smallemployer community-rated products, as well as large group-underwritten products. The team is committed to offering innovative solutions and unparalleled service. Through various marketplaces, Advanced Professionals Insurance & Benefit Solutions provides accredited producers with access to a comprehensive array of affordable healthcare products and services designed to meet the specific needs of their clients. Driving Advanced Professionals Insurance & Benefit Solutions success are two powerful and complementary components: technology and service. The Benefit Resource Hub (the HUB) is a web-based system uniquely designed for our wholesale model. The HUB not only provides efficient, one-stop electronic proposal submission capabilities, it also offers secure access to forms, benefit summaries and related resources specific to each trust. The team is committed to a two-day turnaround on the nearly 25,000 proposal requests received annually from more than 1,000 accredited producers across the state. The team not only delivers these proposals, but also handles the processing of all new business and renewals. Advanced Professionals Insurance & Benefit Solutions is a dedicated team which, with more than 50 years of combined trust management experience, is a dynamic group of professionals accustomed to the everchanging health insurance environment. Your Advanced Professionals Insurance & Benefit Solutions team will assist with: Rate and product design assessment on behalf of employers and accredited producers Producer presentations and training Marketplace benchmarking Value-driven strategies Marketing High-level claim and service issues General advocacy for credentialed producers and companies Advanced Professionals Insurance & Benefit Solutions takes pride in its ability to thrive in a fast-paced environment. Combining a creative approach with a do-what-it-takes attitude is what differentiates this team from the competition. Page 16 Kavi@BenefitResourceHub.com

20 Services and access provided by: Kavi Marketplace KaviMarketplace.com Program management provided by: Insurance & Benefit Solutions Advanced Professionals Insurance & Benefit Solutions 1201 Third Avenue, Suite 1600 Seattle, WA Phone: Kavi Marketplace Brochure Last Modified 01/30/18