2017 EMPLOYEE BENEFITS GUIDE

Transcription

1 2017 EMPLOYEE BENEFITS GUIDE

2 Medical Coverage ImmediaDent offers medical coverage through Blue Cross Blue Shield of Kansas City, a national healthcare company. Members have access to a nationwide network of physicians, hospitals, pharmacies, and facilities in addition to complimentary wellness resources and other tools. Participating providers can be found online by visiting and selecting Find a Doctor in the top right hand corner of the screen. Medical Plan Options BCBSKC medical plans cover services through a combination of copayments, coinsurance and deductible cost sharing arrangements. Under each plan option, referrals to specialists are not required. The deductible does not apply to Preventive Care visits received through in-network providers unless a medical diagnosis is present or discovered during a Preventive Care visit. Please note that all of the plan options utilize the same national network for both medical and prescription drug services. Additional information on how to access retail and mail order prescriptions can be found by logging into your MyBlueKC.com portal. The PPO Plans cover most services at 80% coinsurance in-network after deductible. Office visits, prescription drugs, and urgent care visits are not subject to the deductible and are covered for a copayment. If enrolled in a PPO plan, participants are eligible to enroll in a traditional Flexible Spending Account (FSA) through Empower. The High Deductible Health Plans (HDHP) cover most services at either 80% or 100% in-network coinsurance after meeting the plan deductible. There are no copays for office visits or urgent care. If you are enrolled in a HDHP, you are eligible to enroll in a Health Savings Account (HSA) through Optum Bank. Prescription Drug Tiers Tier 1 medications are typically generic drugs that contain the same active ingredients as brand name drugs and have the lowest copay. Tier 2 and Tier 3 medications are typically brand name drugs. Tier 3 includes medications with an available generic equivalent and new drugs that are being reviewed. A complete Prescription Drug List (PDL) can be found online at Pros Cost when receiving services may be more manageable PPO Cons There is no long term financial savings available to the Member Rx is subject to copays vs. full cost of prescription Employee payroll contributions are higher for PPO plans Lower deductible Pros Eligible to open an HSA which is an employee owned tax advantaged bank account Lower employee payroll contributions HDHP Cons Member is more financially responsible for services Higher deductibles Member must pay the full cost for all services, including prescriptions (no copays) 2

3 Deductible $750 PPO Plan $1,500 PPO Plan $2,600 HDHP $5,000 HDHP Individual $750 $1,500 $2,600 $5,000 Family $2,250 $4,500 $5,200 $10,000 Out-of-Pocket (OOP) Maximum Individual $2,000 $3,500 $4,100 $5,000 Family $6,000 $10,500 $8,200 $10,000 Coinsurance 80% 80% 80% 100% Physician Visits Primary Care Doctor $20 Copay $30 Copay 80% Coin, after Ded 100% Coin, after Ded Specialist $40 Copay $60 Copay 80% Coin, after Ded 100% Coin, after Ded Lab & X-Ray 80% Coin, after Ded 80% Coin, after Ded 80% Coin, after Ded 100% Coin, after Ded Preventive Care Services 100% Covered 100% Covered 100% Covered 100% Covered Emergency Room $100 Copay, 80% Coin, after Ded $100 Copay, then 80%, Coin after Ded 80% Coin, after Ded 100% Coin, after Ded Urgent Care $40 Copay $60 Copay 80% Coin, after Ded 100% Coin, after Ded Inpatient/Hospitalization 80% Coin, after Ded 80% Coin, after Ded 80% Coin, after Ded 100% Coin, after Ded Outpatient Services 80% Coin, after Ded 80% Coin, after Ded 80% Coin, after Ded 100% Coin, after Ded Prescription Drug Benefits Medical Plan Highlights (In-Network Benefits Only) Tier 1/Tier 2/Tier 3 34-Day Retail Supply $10/$30/$50 $10/$30/$50 $10/$30/$50, after Ded 100% Coin, after Ded 102-Day Mail Order Supply $25/$75/$125 $25/$75/$125 $25/$75/$125, after Ded 100% Coin, after Ded Preventive Services Routine Preventive Services are covered at 100% if you see an in-network provider. These services may include: Physician Examinations Mammograms Urinalysis Colorectal Cancer Exams Glucose Screening Immunizations Thyroid Stimulating Hormone Screening Chest X-ray HIV Screening Birth Control (generic only) Electrocardiogram (EKG) Screening for Gestational Diabetes Pelvic Exams and Pap Smears Testing for HPV Employees are encouraged to register at to find providers, review your preferred drug list, access educational tools, track health claims, utilize wellness resources, and much more. Cost per Pay Period $750 PPO Plan $1,500 PPO Plan $2,600 HDHP $5,000 HDHP Employee Only $ $94.50 $49.59 $38.78 Employee + Spouse $ $ $ $ Employee + Child(ren) $ $ $ $ Employee + Family $ $ $ $

4 Tax Advantage Savings Account Options Medical FSA Entire plan year contribution available immediately Upon termination of employment you may only have access to unused funds by electing COBRA Any employee may enroll and can use funds to pay for qualified medical expenses for eligible dependents Receipts must be provided to receive reimbursement HSA Funds only available as deposited Funds stay with you upon termination of employment You must enroll in a Qualified HDHP and can use funds to pay for qualified medical expenses for eligible dependents Receipts must be provided if audited by IRS Flexible Spending Accounts A Flexible Spending Account (FSA) allows you to reduce your taxable income by setting aside pre-tax dollars to pay for qualified medical, dental, vision and dependent care expenses. ImmediaDent s plan is administered through Empower. Medical FSAs allow you to contribute an annual maximum amount of $2,550 to pay for health, dental and vision expenses not reimbursed through insurance. Deductibles, copayments, coinsurance and over-the-counter items (if prescribed) are all examples of eligible expenses. Dependent Care FSAs allow you to contribute up to an annual maximum of $5,000 if married filing jointly or single; $2,500 if you are married filing separately. This account is to pay for expenses associated with the care of children (under age 13) or for a disabled spouse or parent while you work. The account can be used for daycare, preschool, after school care, summer day camp and elder care. Your eligibility to participate in the various types of savings account options depends on your medical plan election. PPO HDHP Medical FSA Yes No Dependent Care FSA Yes Yes Health Savings Account No Yes FSA Expenses Careful planning of your expenses is recommended. Expenses must be incurred during the plan year and remaining funds cannot be carried over to the next plan year. Changes to your contribution elections are not permitted unless you have a qualified life status change. Deadlines Expenses may be incurred until March 31, This means ImmediaDent allows 15 months to incur claims for your annual election. All receipts are due for reimbursement by March 31, FSA Account Access and Claims Submission You may view your account balances, file claims online, or obtain additional information via the Empower website at myflexonline.com. 4

5 2017 HSA Contribution Limits Individual Enrollment $3,400 Family Enrollment $6,750 Health Savings Accounts Your Health Savings Account (HSA) is administered by Optum Bank. A Health Savings Account (HSA) allows you to pay for current health expenses (for you and your family) and save for health expenses on a tax-free basis. You must be enrolled in a HSA-qualified High Deductible Health Plan (HDHP) to be able to open an HSA. Health Savings Accounts are completely employee-owned. Advantages of HSAs Triple Tax Savings. You contribute pre-tax dollars to the HSA. Interest accumulates tax-free and funds are withdrawn tax-free for qualified expenses. Invest the funds and take them with you. Unused account dollars are yours to keep even if you stop working. Additionally, you can invest your HSA funds, so your available health care dollars can grow over time. The money can be used for future out-of-pocket health care expenses. HSA funds can be used for any family member s health care expenses - even if they are not enrolled on the ImmediaDent plan. Funds used for purposes other than to pay for "qualified medical expenses" are taxable as income and also subject to a 20% tax penalty. To be Eligible for an HSA Covered by a HSA-qualified High Deductible Health Plan (HDHP) Not covered by another non-hdhp (including a spouse's plan and/or a General Purpose healthcare FSA set up by you or your spouse) Not enrolled in Medicaid or Medicare Not eligible to be claimed as a dependent on another person's tax return The maximum contributions above include all deposits/contributions made during the calendar year. This amount also includes your Employer s contributions. If you are age 55 and older you are allowed to contribute an additional $1,000 to the above amounts Additional Details Your Health Savings Account (HSA) is your account; the HSA dollars are your dollars. Contributions are made through pre-tax payroll deductions. HSAs are bank accounts, therefore you must have money in the account to make a withdrawal. HSA funds can only be used for tax-dependent children (as well as legal spouse). IRS definition: Under 19 or up to 24 if full time student for at least 5 months of the year. All documentation and receipts must be saved for HSA transactions. The Internal Revenue Service (IRS) administers and can audit Health Savings Accounts. Qualified FSA & HSA Expenses Please refer to IRS Publication 502 for a complete list of eligible medical expenses. In addition to qualified medical expenses, the following insurance premiums may be reimbursed from an HSA: COBRA premiums Health insurance premiums while receiving unemployment benefits Qualified long-term care premiums Any health insurance premiums paid, other than for a Medicare supplemental policy, by individuals ages 65 and over 5

6 Dental Plan ImmediaDent offers dental insurance through Guardian. Services In-Network Out-of-Network Deductible None Annual Maximum $2,000 Preventive Services Exams Cleanings Fluoride Dental Plan Highlights 100% Voluntary Vision Plan VSP provides comprehensive vision coverage through a national network that includes more than 54,000 points of access which includes providers as well as retail locations such as Costco and Visionworks. Services received out-of-network through a nonparticipating provider are paid based on an allowance schedule and members are responsible for costs that exceed the plan allowance. Participating providers can be located online by visiting or by calling X-Rays Basic Services Fillings Crown Repair Bridge Repair Denture Repair Major Services Periodontics Endodontics Bridge Dentures Crowns Employee Only No Coverage 100% 50% Cost per Pay Period $4.62 VSP Vision Care Plan In-Network Eye Exam $20 Copay Lenses Single Vision $20 Copay Lined Bifocal Lined Trifocal Frames $130 Allowance, then 20% Discount Contact Lenses Elective: $130 Allowance (Instead of Glasses) Frequency Exam Once per 12 Months Lenses Once per 12 Months Frames Once per 24 Months Contact Lenses Once per 12 Months Employee + Spouse Employee + Child(ren) Employee + Family $9.23 $11.54 $16.15 Cost per Pay Period Employee Only $3.53 Employee + Spouse $5.65 Employee + Child(ren) $5.77 Employee + Family $9.30 6

7 Basic Employee Life & AD&D ImmediaDent provides you a Life and Accidental Death and Dismemberment (AD&D) benefit of $10,000. Voluntary Employee Life & AD&D Benefit: You may elect additional Life & AD&D coverage in increments of $10,000. Minimum: $10,000 Maximum: The lesser of 5 times your annual earnings or $500,000. Guaranteed Issue for New Hires: $130,000. Amounts in excess of $130,000, or if election is after you are no longer a new hire, will require completion of a health statement (Evidence of Insurability - EOI). Voluntary Spouse Life & AD&D Benefit: You may elect additional Life & AD&D coverage in increments of $5,000 and you must also have Voluntary Employee Life & AD&D coverage Minimum: $5,000 Maximum: Lesser of $500,000 or 100% of the Employee s Voluntary Life & AD&D coverage Guaranteed Issue for New Hires: $25,000. Amounts in excess of $25,000, or if election is after you are no longer a new hire, will require completion of a health statement (Evidence of Insurability - EOI). Voluntary Child Life & AD&D Benefit: You may elect additional Life & AD&D coverage in increments of $2,000 and you must also have Voluntary Employee Life & AD&D coverage Minimum: $2,000 Maximum: Live birth to 14 days: $1, days to age 19 (or 26 if full-time student): Lesser of $10,000 or 100% of Employee s supplemental coverage Guaranteed Issue for New Hires: $10,000 No Evidence of Insurability is required Rates Life & AD&D insurance is expressed as a rate per $1,000 of insurance. Employee How to Calculate Life & AD&D Premium To calculate Life & AD&D Insurance premium take the elected amount per $1,000 of coverage multiplied by the monthly rate: Benefit Volume * Rate / $1,000 = Monthly premium Example: Assuming your election is $100,000 of coverage and you are 32 years old: $100,000 x $0.083 / $1,000 = $8.30 per month Spouse <25 $0.069 $ $0.074 $ $0.083 $ $0.105 $ $0.136 $ $0.197 $ $0.294 $ $0.434 $ $0.659 $ $1.119 $ $1.971 $ $3.822 $3.822 Child Rates per $1,000 Child Rate per $1,000 $0.195 Disability Insurance What is Disability Insurance? Disability insurance can help replace a portion of your income during a disability to help you pay your bills and help maintain your current lifestyle. It helps by protecting you and your income if a sickness or accidental injury kept you from working. Why You Should Consider Disability Insurance While most people typically insure their lives and other assets like homes or automobiles, many overlook the need to protect one of their most valuable assets their ability to work and earn a living. When Disability strikes, your ability to earn an income becomes interrupted, however, your monthly bills continue. There is an approximately 1 in 4 chance of being disabled for today s 20 year olds. 7

8 The Guardian offers this one-time open enrollment opportunity for Voluntary Life, STD and LTD benefits for new hires or newly eligible employees. You can enroll in the Voluntary Life and AD&D benefits up to the guaranteed issue amount, listed above, for you and your dependents, or you can enroll in the LTD or STD benefits without providing evidence of insurability. Voluntary Short Term Disability Short Term Disability is compensation protection offered as a benefit you may elect and pay for with after-tax contributions. Benefit: 60% of weekly earnings to a maximum of $1,500 per week. Benefits Begin: On the 8 th day of your accident or sickness Benefit Duration: up to 12 weeks Rates Short Term Disability insurance is expressed as a rate per $10 of weekly benefit. Rates per $10 <25 $ $ $ $ $ $ $ $ $ $1.140 How to Calculate Short Term Disability Premium To calculate Short Term Disability premium you multiply your salary by 60% to determine your benefit amount. Then divide the benefit amount by 52 to determine the weekly benefit. The weekly benefit is multiplied by the rate and divided by $10: Example: Assuming you are 32 years old and make $35,000 per year: $35,000 x 60% = $21,000 $21,000 / 52 = $ $ x $0.73 / $10 = $29.48 per month Voluntary Long Term Disability Long Term Disability is compensation protection offered as a benefit you may elect and pay for with after-tax contributions. Benefit: 60% of monthly earnings to a maximum of $10,000 per month. Benefits Begin: The later of 90 days or the date your Short Term Disability benefit end if enrolled. Maximum Benefit: To the later of age 65 or your Social Security Normal Retirement Age (SSNRA) Rates Long Term Disability insurance is expressed as a rate per $100 of monthly payroll Rates per $100 <25 $ $ $ $ $ $ $ $ $ $ $1.06 How to Calculate Long Term Disability Premium To calculate Long Term Disability premium divide your annual salary by 12 to determine your monthly salary. The monthly salary is then multiplied by the applicable rate and divided by $100: Example: Assuming you are 32 years old and make $35,000 per year: $35,000 / 12 = $2, $2, x $0.47 / $100 = $13.71 per month Enrollment in disability insurance does not guarantee payment of benefits. Each disability will be reviewed and certified for validity and duration. 8

9 Glossary Employee Assistance Program Balancing your work and home is not always easy. With WorkLifeMatters, your confidential employee assistance program through Guardian and Integrated Behavioral Health (IBH), you don t have to face life s challenges alone. WorkLifeMatters provides support and guidance for matters that range from personal issues you might be facing, to providing information on everyday topics that affect your life. WorkLifeMatters can offer support with: Education Admissions testing & procedures Adult re-entry programs Dependent Care & Care Giving Adoption assistance Before/after school programs Day care & elder care Legal & Financial Basic tax planning Legal forms and will making Personal legal Working Smarter Balancing work and home life Career & training development Lifestyle & Fitness Management Anxiety and depression Divorce and separation Drugs and alcohol EAP Access User name: Matters Password: wlm am-8pm, M-F (EST) Emergency access 24/7 Claim - a request by you, or your health care provider, for the insurance company to pay for medical services. Coinsurance - the amount you pay to share the cost of covered services after your deductible has been paid, usually a percentage. For example, if the insurance company pays 80% of the claim, you pay 20%. Copay - A flat fee you pay for certain medical expenses (e.g., $10 for every visit to the doctor), while your insurance company pays the rest. Deductible - the amount of money you must pay each year to cover eligible medical expenses before your insurance policy starts paying. Disability Insurance - Insurance that can replace a portion of your income if a sickness or accidental injury prevents you from working Network - the group of doctors, hospitals, and other health care providers that the insurance company contracts with to provide services at discounted rates. Out-of-Pocket Max - The most you pay during the plan year before the plan starts to pay 100% for covered benefits, includes deductibles, coinsurance, & copayments. Premium - the amount you or your employer pays each month for insurance coverage. Prescription Drug List (PDL) - a list of prescription medications covered by the plan. Rx Drug Tiers - Tier 1 medications are typically generic drugs that contain the same active ingredients as brand name drugs and have the lowest copay. Tier 2 and Tier 3 medications are typically brand name drugs. Tier 3 includes medications with an available generic equivalent and new drugs that are being reviewed. Benefits Enrollment Benefits enrollment will occur through BeneTrac. You will recieve information regarding how to enroll in a separate document. The effective date of benefits is the first day of the month following 30 days of employment for new hires. For status changes, benefits are effective on the first day of the month following the status change. 9

10 Disclaimer The information in this Enrollment Guide is presented for illustrative purposes and is based on information provided by the employer. The text contained in this Guide was taken from various summary plan descriptions and benefit information. While every effort was taken to accurately report your benefits, discrepancies, or errors are always possible. In case of discrepancy between the Guide and the actual plan documents the actual plan documents will prevail. This is not a guarantee of benefits or payment. All services are subject to any limitations or exclusions specified in the plan documents. All information is confidential, pursuant to the Health Insurance Portability and Accountability Act of If you have any questions about your Guide, please contact Human Resources. Created by Holmes Murphy & Associates