2018 Benefits Overview Springfield

Transcription

1 2018 Benefits Overview Springfield Medical Insurance Blue Cross Blue Shield Option 1 Medical Plan Standard Rates Employee Only: $ Employee + 1: $ Family: $ Non-Smoker-Preferred Rates Employee Only: $ Employee + 1: $ Family: $ Health Savings Account (HSA) - Tax qualified savings account that you use to pay for qualified medical expenses not covered by your HDHP. The company provides an annual contribution and employees can contribute up to the federal limits. Funds will follow you if you leave your employer or change health insurance. Company Annual Contribution: Annual Limit Catch Up contributions Single: $250 Single: $3450 Age 55 and over: $1000 Employee +1 or Family: $500 Employee +1 or Family: $6900 If hired within the Plan Year, company contributions will be pro-rated. Cannot be enrolled in a regular FSA, Non-HDHP medical plan or Medicare and qualify for the HSA. Cannot enroll in HSA account only. Must be enrolled in HDHP medical plan. In-Network Benefits Annual Deductible: $1850 Employee / $3700 Employee+1 or Family After deductible is met, co-insurance begins: 80% of costs are covered for office visits 80% for x-ray and lab 80% for other covered expenses such as hospital and surgical care Free preventive care Free routine check-ups, flu shots, and mammograms, among other services Free access, 24 hours a day, to nurses who can provide health counseling Annual out of pocket maximum for covered expenses, including deductible: $3500 Employee / $6500 Employee+1 or Family Out of Network Benefits Annual Deductible: $3700 Employee / $7400 Employee+1 or Family After deductible is met, co-insurance begins: 60%* of costs covered for office visits 60%* for x-ray and lab 60%* for other covered expenses such as hospital and surgical care *Subject to Reasonable and Customary (R&C) limits based on a physician s usual, actual, & community average charges Annual out of pocket maximum for covered expenses, including deductible: $7000 Employee / $13000 Employee+1 or Family Prescription Drug Benefits All prescription drugs will be subject to deductible and 80% co-insurance. There will be no co-pays. Qualified preventative maintenance prescriptions will be at no cost to you. Note: You may cover an eligible child under medical benefits until the child reaches age 26. Page 1

2 2018 Benefits Overview Springfield Medical Insurance Blue Cross Blue Shield Option 2 Medical Plan Standard Rates Employee Only: $ Employee + 1: $ Family: $ Non-Smoker-Preferred Rates Employee Only: $75.02 Employee + 1: $ Family: $ Health Savings Account (HSA) - Tax qualified savings account that you use to pay for qualified medical expenses not covered by your HDHP. The company provides an annual contribution and employees can contribute up to the federal limits. Funds will follow you if you leave your employer or change health insurance. Company Annual Contribution: Annual Limit Catch Up contributions Single: $500 Single: $3450 Age 55 and over: $1000 Employee +1 or Family: $1000 Employee +1 or Family: $6900 If hired within the Plan Year, company contributions will be pro-rated. Cannot be enrolled in a regular FSA, Non-HDHP medical plan or Medicare and qualify for the HSA. Cannot enroll in HSA account only. Must be enrolled in HDHP medical plan. In-Network Benefits Annual Deductible: $2850 Employee / $5700 Employee+1 or Family After deductible is met, co-insurance begins: 70% of costs are covered for office visits 70% for x-ray and lab 70% for other covered expenses such as hospital and surgical care Free preventive care Free routine check-ups, flu shots, and mammograms, among other services Free access, 24 hours a day, to nurses who can provide health counseling Annual out of pocket maximum for covered expenses, including deductible: $5500 Employee / $11000 Employee+1 or Family Out of Network Benefits Annual Deductible: $5700 Employee / $11400 Employee+1 or Family After deductible is met, co-insurance begins: 50%* of costs covered for office visits 50%* for x-ray and lab 50%* for other covered expenses such as hospital and surgical care *Subject to Reasonable and Customary (R&C) limits based on a physician s usual, actual, & community average charges Annual out of pocket maximum for covered expenses, including deductible: $11000 Employee / $22000 Employee+1 or Family Prescription Drug Benefits All prescription drugs will be subject to deductible and 70% co-insurance. There will be no co-pays. Qualified preventative maintenance prescriptions will be at no cost to you. Note: You may cover an eligible child under medical benefits until the child reaches age 26. Page 2

3 2018 Benefits Overview Springfield Medical Insurance Blue Cross Blue Shield Option 3 Medical Plan Standard Rates Employee Only: $75.25 Employee + 1: $ Family: $ Non-Smoker-Preferred Rates Employee Only: $25.25 Employee + 1: $81.89 Family: $ Health Savings Account (HSA) - Tax qualified savings account that you use to pay for qualified medical expenses not covered by your HDHP. The company provides an annual contribution and employees can contribute up to the federal limits. Funds will follow you if you leave your employer or change health insurance. Company Annual Contribution: Annual Limit Catch Up contributions Single: $250 Single: $3450 Age 55 and over: $1000 Employee +1 or Family: $500 Employee +1 or Family: $6900 If hired within the Plan Year, company contributions will be pro-rated. Cannot be enrolled in a regular FSA, Non-HDHP medical plan or Medicare and qualify for the HSA. Cannot enroll in HSA account only. Must be enrolled in HDHP medical plan. In-Network Benefits Annual Deductible: $4500 Employee / $9000 Employee+1 or Family After deductible is met, co-insurance begins: 70% of costs are covered for office visits 70% for x-ray and lab 70% for other covered expenses such as hospital and surgical care Free preventive care Free routine check-ups, flu shots, and mammograms, among other services Free access, 24 hours a day, to nurses who can provide health counseling Annual out of pocket maximum for covered expenses, including deductible: $6500 Employee / $13100 Employee+1 or Family Out of Network Benefits Annual Deductible: $9000 Employee / $18000 Employee+1 or Family After deductible is met, co-insurance begins: 50%* of costs covered for office visits 50%* for x-ray and lab 50%* for other covered expenses such as hospital and surgical care *Subject to Reasonable and Customary (R&C) limits based on a physician s usual, actual, & community average charges Annual out of pocket maximum for covered expenses, including deductible: $13100 Employee / $26200 Employee+1 or Family Prescription Drug Benefits All prescription drugs will be subject to deductible and 70% co-insurance. There will be no co-pays. Qualified preventative maintenance prescriptions will be at no cost to you. Note: You may cover an eligible child under medical benefits until the child reaches age 26. Page 3

4 2018 Benefits Overview Springfield Medical Insurance LEADWELL HM Clinic 850 East Madison Street Springfield, IL As a participant in one of the Horace Mann medical plans, you and your covered dependents (age 6 or older) have the advantage of receiving services from LEADWELL Health & Wellness Center. It s a convenient way to receive many of the same services you would receive from your primary care doctor, but at a very low cost or no cost to you or the Plans. Hours: 6am 6pm LEADWELL provides: Full-time Certified Nurse Practitioner with Physician oversight by Board Certified Physicians Full-time Certified Physical Therapists Medical Referrals Lab Services TravelWell On-site Services Nurse Practioner Diagnosis, Medical Care & Prescriptive Capabilities Wellness Services Occupational Medicine Services On-site Services Diagnosis & Medical Care Severe Sore Throat Sinus Infections Bronchitis Ear Infections Swimmer s Ear Pink Eye Mononucleosis Minor Rashes Ringworm Wound Infections Bladder Infections Insect Bites Sprains and Strains Wart Removal Rapid Lab Tests Onsite Including: Rapid Strep Glucose UTI Drug Screen Pregnancy Urine Dip Total Cholesterol PT/INR Wellness Services Physical Examinations Health Screenings Skin Screenings TB Testing Vaccinations Page 4

5 2018 Benefits Overview Springfield Dental Insurance DENTAL INSURANCE - Enhanced (MetLife) Employee Only: $7.17 Employee + 1: $14.36 Family Coverage: $24.15 In-Network Benefits 100% of PDP* Fee - Preventive Care (no deductible) Annual deductible of $50 Individual / $150 Family for Basic Restorative & Major Services Annual Maximum Benefit - $2,000 per person After deductible is satisfied: 100% of PDP Fee for Preventative Services (Oral Examinations, X-Rays) 80% of PDP Fee for Basic Restorative (Fillings, Extractions, Root Canal) 50% of PDP Fee for Major Services (Bridges, Dentures) *PDP (Preferred Dentist Program) fee is a negotiated rate which is typically 10%-30% below average fees in your area. When you use a participating dentist, you are only responsible for the difference between MetLife s benefit payment amount and the PDP fee. Out of Network Benefits 100% of R&C* Fee - Preventive Care (no deductible) Annual deductible of $50 individual / $150 Family for Basic Restorative & Major Services Annual Maximum Benefit - $2,000 per person After deductible is satisfied: 100% of R&C Fee for Preventative Services (Oral Examinations, X-Rays) 80% of R&C Fee for Basic Restorative (Filings, Extractions, Root Canal) 50% of R&C Fee for Major Services (Bridges, Dentures) There are no orthodontia benefits with this plan. *R&C (Reasonable & Customary) charges are based on a dentist s usual, actual, & community average charges. Note: You may cover an eligible child under dental benefits until the child reaches age 26. SALARY REDUCTION OF MEDICAL, DENTAL and VISION PREMIUM Medical, Dental and Vision premiums are automatically deducted on a salary reduction (pre-tax) basis. This means that you cannot change or stop your deductions during 2018 unless you have a qualified life event change. After-tax deduction of premiums must be specifically requested. Qualified life event changes will need to be documented within 31 days of the event to qualify within the Plan Year. Page 5

6 2018 Benefits Overview Springfield Dental Insurance DENTAL INSURANCE - Premier (MetLife) Employee Only: $7.17 Employee + 1: $14.60 Family Coverage: $26.44 In-Network Benefits 100% of PDP* Fee - Preventive Care (no deductible) Annual deductible of $25 Individual / $75 Family for Basic Restorative & Major Services Annual Maximum Benefit - $2,500 per person After deductible is satisfied: 100% of PDP Fee for Preventative Services (Oral Examinations, X-Rays) 80% of PDP Fee for Basic Restorative (Fillings, Extractions, Root Canal) 50% of PDP Fee for Major Services (Bridges, Dentures) *PDP (Preferred Dentist Program) fee is a negotiated rate which is typically 10%-30% below average fees in your area. When you use a participating dentist, you are only responsible for the difference between MetLife s benefit payment amount and the PDP fee. Out of Network Benefits 100% of R&C* Fee - Preventive Care (no deductible) Annual deductible of $25 individual / $75 Family for Basic Restorative & Major Services Annual Maximum Benefit - $2,500 per person After deductible is satisfied: 100% of R&C Fee for Preventative Services (Oral Examinations, X-Rays) 80% of R&C Fee for Basic Restorative (Filings, Extractions, Root Canal) 50% of R&C Fee for Major Services (Bridges, Dentures) *R&C (Reasonable & Customary) charges are based on a dentist s usual, actual, & community average charges. Orthodontia $1500 per person lifetime maximum benefit Note: You may cover an eligible child under general dental benefits until the child reaches age 26 and/or orthodontia benefits up to age 19. SALARY REDUCTION OF MEDICAL, DENTAL and VISION PREMIUM Medical, Dental and Vision premiums are automatically deducted on a salary reduction (pre-tax) basis. This means that you cannot change or stop your deductions during 2018 unless you have a qualified life event change. After-tax deduction of premiums must be specifically requested. Qualified life event changes will need to be documented within 31 days of the event to qualify within the Plan Year. Page 6

7 Life Insurance Basic Life Insurance (HMLIC) Horace Mann provides Basic Life Insurance at no cost to you. All employees are covered at $50,000. Coverage reduces at age 65 to 65% and reduces at age 70 to 50% Accidental Death & Dismemberment (AD&D) Company Paid (HMLIC) Horace Mann provides AD&D Insurance at no cost to you. All employees are covered at $50,000. Coverage reduces at age 65 to 65% and reduces at age 70 to 50% Supplemental Life Insurance (HMLIC) RATES PER AGE $1,000 Less than 25 $ $ $ $ $ $ $ $ $ $ or older $1.03 In addition to company provided Basic Life, you can elect to purchase Supplemental Life coverage at group rates. Premiums are based on your age and will change in the month you attain the next age range. The level you select cannot exceed 6 times your current salary Coverage reduces at age 65 to 65% and reduces at age 70 to 50% You can purchase coverage at these levels: $10,000 $200,000 $25,000 $250,000 $50,000 $300,000 $75,000 $400,000 $100,000 $500,000 $150,000 Page 7

8 Life Insurance Dependent Life Insurance You can purchase coverage for your spouse at these levels: Spouse (HMLIC) OPTION SPOUSE A $10,000 B $20,000 Option A: $1.50 Option B: $3.00 If you and your spouse are both employed, you both qualify for coverage and are therefore not eligible to cover your spouse. If you have dependent children, only one can cover your dependent children. Coverage reduces at age 65 to 65% and reduces at age 70 to 50% Dependent Life Insurance Child (HMLIC) Option A: $0.90 Option B: $1.80 You can purchase coverage for your children at these levels: OPTION CHILDREN A $ 5,000 B $10,000 Premiums are fixed regardless of the number of children covered Cover children up to age 26 If you and your spouse are both employed, you both qualify for coverage and are therefore if you have dependent children, only one can cover your dependent children. Page 8

9 Life Insurance Accidental Death & Dismemberment (AD&D) Employee Paid (HMLIC) Coverage Single Family $10,000 $0.15 $0.24 $25,000 $0.38 $0.60 $50,000 $0.75 $1.20 $75,000 $1.13 $1.80 $100,000 $1.50 $2.40 $150,000 $2.25 $3.60 $200,000 $3.00 $4.80 $250,000 $3.75 $6.00 You can elect AD&D insurance for yourself (Employee only Coverage) or for you and your spouse/child(ren) (Family coverage) Employee Only: $10,000 $100,000 $25,000 $150,000 $50,000 $200,000 $75,000 $250,000 Family Coverage Employee is covered at 100% amount elected Other coverage based on your family structure: o Spouse Only: 50% of the employee amount elected o Spouse and child(ren): 40% and 10% of the employee amount elected o Child(ren) Only: 15% of the employee amount elected Premiums are fixed regardless of the number of children covered If you and your spouse are both employed, you both qualify for coverage and are therefore not eligible to cover your spouse. If you have dependent children, only one can cover your dependent children. Cover children up to age 26 Coverage reduces at age 65 to 65% and reduces at age 70 to 50% Page 9

10 Short Term Disability Short Term Disability (MetLife) When you need to miss work for an extended time due to an illness or accident, short-term disability insurance replaces a percentage of your income for a certain number of weeks. Horace Mann provides coverage at no cost to you. You are eligible for benefits 1 st of month after 6 months of service 14 calendar day elimination period before benefits begin Benefits paid at a percentage of 66.67% of base salary up to a maximum of $5,000 per week Up to 13 weeks of coverage Page 10

11 Long Term Disability Basic LTD (Met Life) Horace Mann provides coverage at no cost to you You are eligible beginning 1 st of the month after 1 year of service as long as you are actively at work on your anniversary date Short Term Disability (STD) must be exhausted before benefits begin. Benefits paid at 50% of annual base salary up to a maximum of $10,000 per month or $120,000 per year. This coverage also includes rehabilitation and death benefits. Review your Certificate of Coverage for more details. Met Life is the administrator of this plan and is responsible for processing claims and paying any benefits due. Supplemental LTD Semi-Monthly Premium (Per $100 is covered): 10% Additional Coverage: $0.08 In addition to company provided Basic LTD, you can elect to purchase Supplemental LTD coverage at group rates. You are eligible to participate 1 st of month after 1 year of service as long as you are actively at work on your anniversary date Short Term Disability (STD) must be exhausted before benefits begin You can purchase additional 10% coverage (for a total benefit of 60%) up to a maximum of $10,000 per month or $120,000 per year Page 11

12 Flexible Spending Accounts Flexible Spending Accounts (FSA) COMBINATION Combination FSA (Available for those enrolled in a $1,850, $2,850 and $4,500 Deductible plans and HSA) Begins as a Limited Health FSA plan where reimbursements can only be for dental, vision and preventive care. Once a participant has met the IRS statutory deductible of $1,300 single and $2,600 family, then it is converted to a general purpose Health FSA and certain qualified medical expenses can also be reimbursed. Expenses can be reimbursed via direct deposit to your bank account Eligible expenses for you and your dependents include: 1. Unreimbursed dental and vision costs such as co-pays and deductibles 2. Preventive care (annual physicals, screenings, immunizations, well-visits, flu shots) Eligible expenses for you and your dependents Only After IRS Deductible is met: 1. Medical coinsurance/ Copays/Deductibles 2. Mental health expenses 3. Chiropractic expenses Elect up to $2650 per year Flexible Spending Account (FSA) Dependent Care Account (DCFSA) Flexible Spending Account Available only to employees who do NOT elect a Horace Mann-sponsored medical plan or do NOT enroll in an HSA. Flexible Spending Account expenses can be reimbursed via direct deposit to your bank account Eligible expenses for you and your dependents include: Unreimbursed medical, dental, and vision costs such as co-pays and deductibles Over the counter (OTC) medications such as antacids, allergy medications, pain relievers, and cold medicines purchased without a doctor s prescription Eligible expenses for you and your dependents still exclude: Vitamins, dietary supplements, cosmetics and toiletries Elect up to $2650 per year Dependent Care Account Dependent Care Account expenses can be reimbursed via direct deposit to your bank account Eligible expenses are dependent day care costs incurred so that you and your spouse can work or attend school Elect up to $5000 per year ($2500 if you and your spouse file separate income tax returns) Page 12

13 Met Law 2018 Benefits Overview Springfield Group Legal Plan Semi-Monthly Premium: $10.05 If you elect this voluntary plan, it covers you, your spouse and dependents for the same semi-monthly premium. You can elect in and out of this coverage on an annual basis as your needs change. MetLaw can give you easy access to experienced; participating attorneys, plus you receive a wide range of covered legal services at an affordable price. Participation in MetLaw includes access to a nationwide network of more than 9,000 participating attorneys who can provide you with a wide range of personal legal services. Some of the services provided include: Purchase, Sale or Refinancing of a Primary Residence Wills and Estate Planning Deed Preparation and Immigration Assistance Debt Matters and Identity Theft Defense Civil Litigation Defense Unlimited phone and/or office consultations for virtually any personal legal matter For more information, visit or contact the benefit counselors toll-free at Page 13

14 Critical Illness Insurance Critical Illness Insurance Critical Illness Insurance Semi-Monthly Rates - $15,000 Age Employee Emp + Spouse Emp + Child Family >25 $ 2.39 $ 4.77 $ 5.86 $ $ 2.54 $ 5.11 $ 5.96 $ $ 3.49 $ 7.05 $ 6.91 $ $ 4.94 $ $ 8.36 $ $ 7.42 $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ Supplemental medical insurance can help protect you from significant or unexpected out-of-pocket expenses. Critical illness insurance helps protect against the financial impact of certain illnesses, such as heart attack, cancer, and more. You receive a lump-sum benefit that you can use however you see fit. There are levels of dollar amounts that you can purchase under this program. You have the option of $15,000 or $30,000. You can cover yourself, yourself and spouse, yourself and child(ren) or family. Semi-Monthly Rates - $30,000 Age Employee Emp + Spouse Emp + Child Family >25 $ 4.77 $ 9.54 $ $ $ 5.07 $ $ $ $ 6.98 $ $ $ $ 9.87 $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ Page 14

15 VPI Pet Insurance VPI Pet Insurance VPI Pet Insurance provides coverage for veterinary expenses related to accidents and illnesses. Policies are available for dogs, cats, birds, reptiles and other exotic pets. Semi-Monthly Premium: Optional CareGuard wellness coverage is also available for dogs and cats, providing reimbursement for the preventive Met Life provides rate quotes care necessary to keep pets healthy year after year. based on your pet. Enroll online anytime. The rates given at that time will include your group discount. During enrollment, you will be asked for the following information: Home or primary telephone number Name Address address Name of your pet Pet s species (canine, feline, etc.) Pet s date of birth Pet s sex Pet s breed Pet s color Medical questions about pet s current and past health, medications and date of last veterinary visit. Preferred animal hospital (note: policyholders are free to use any veterinarian) Payment information/plan* *Premium is payroll deducted and therefore applications approved between the 1st and the 15th of the month become effective on the 1st of the following month. Applications approved from the 16th through the end of the month become effective on the 1st of not the following month, but the month thereafter. Example: May 1 approval = June 1 effective date May 16 approval = July 1 effective date Page 15

16 Met Life Vision Plan Met Life Vision PPO Plan In-Network Benefits Eye Exam $10 co-payment Eyewear $25 co-payment o Base lenses covered in full less Eyewear co-pay Employee Only: $3.91 o Lens Options vary from $0 co-pay up to $55.00 co-pay Employee + 1: $7.32 Family Coverage: $10.43 Frame Allowance o Covered in full up to $130 allowance less Eyewear co-pay Contact Lenses o Fitting and Evaluation: Co-pay will not exceed $60.00 o Necessary: Covered in full less the Eyewear co-pay o Elective: Covered up to $130 allowance Out of Network Benefits Eye Exam No co-pay; Covered up to $45 allowance Eyewear No co-pay o Base lenses: Single Vision: Covered up to $30 allowance Lined Bifocal: Covered up to $50 allowance Lined Trifocal: Covered up to $65 allowance Lenticular: Covered up to $100 allowance o Lens Options: Standard progressive covered up to $50 allowance; all others not covered Frame Allowance o Covered in full up to $70 allowance Contact Lenses o Fitting and Evaluation: Not covered o Necessary: Covered up to $105 allowance o Elective: Covered up to $210 allowance Frequency Eye Exam 1 per 12 months Base Lenses 1 pair per 12 months Frames 1 pair per 24 months Contact Lenses 1 pair per 12 months **Either glasses (Base Lenses & Frames) or Contact Lenses allowed per frequency Note: You may cover an eligible child until the child reaches age 26. Page 16

17 Accident Plan / Hospital Indemnity Plan Accident Insurance Plan Accident Insurance Plan Semi-Monthly Premium: Employee Only: $3.37 Employee + Spouse: $5.06 Employee + Child $6.45 Family Coverage $8.31 Supplemental medical insurance can help protect you from significant or unexpected out-of-pocket expenses. Accident Insurance supplements your medical plan by providing cash benefits in cases of accidental injuries. You can use this money to help pay for uncovered medical expenses, such as your deductible or coinsurance, or for ongoing living expenses, such as your mortgage or rent. Hospital Indemnity Plan Hospital Indemnity Plan Semi-Monthly Premium: Employee Only: $ 6.89 Employee + Spouse: $10.63 Employee + Child $13.66 Family Coverage $17.49 Supplemental medical insurance can help protect you from significant or unexpected out-of-pocket expenses. Hospital Indemnity Plan provides supplemental payments that you can use to cover expenses that your medical plan may not cover for hospital stays. Page 17

18 Identity Theft Plan PrivacyArmor Plus PrivacyArmor Plus offers employees a comprehensive, proactive identity theft defense. InfoArmor s proprietary technology makes identity theft protection more than enough to help fight 21 st century crime. Semi-Monthly Premium: Some of the services provided include: Employee Only: $4.98 Family Coverage $8.98 Identity Monitoring CreditArmor Tri-Bureau Credit Monitoring Monthly Credit Score Tracking Internet Surveillance Digital Identity WalletArmor Social Media Reputation Monitoring Privacy Advocate Remediation $25,000 Identity Theft Insurance Policy Solicitation Reduction Page 18