Table of Contents. Minimum Essential Coverage (MEC) 1 Accident Insurance 3 Critical Illness Insurance 5 Contact 6

Transcription

1 2015 MEC Benefits Enrollment Guide

2 Alliance Solutions Group is a great place to work at because of the variety of benefits that are available to employees. Alliance Solutions Group is pleased to be able to provide the best benefits to our hard working employees. Please read this Benefit Guide carefully so you understand the value that Alliance Solutions Group benefits offer you as you decide what levels of protection best meet your needs for Table of Contents Minimum Essential Coverage (MEC) 1 Accident Insurance 3 Critical Illness Insurance 5 Contact 6

3 Minimum Essential Coverage Minimum Essential Coverage (MEC) is self-funded and will cover 100% of the 63 CMS listed preventive services. The MEC pays for preventive services only. An employee can avoid being taxed the Individual Mandate coverage penalty by purchasing Minimum Essential Coverage through his/her employer. Beginning in 2014, employees will face a tax of the greater of 1% of adjusted household income or $95 per adult plus $47.50 per child; in 2015, the greater of 2% of adjusted household income or $325 per adult plus $ per child; thereafter, the greater of 2.5% of adjusted household income or $695 per adult plus $ per child. Minimum Essential Coverage Benefits Network Non-Network 15 Preventative Services for Adults 100% 40% 22 Preventative Services for Women 100% 40% 26 Covered Preventative Services for Children 100% 40% PPO Network Multiplan 1

4 Minimum Essential Coverage (con t) What are the Covered Services in Minimum Essential Coverage? 15 Covered Preventive Services for Adults (ages 18 and older) 1. Abdominal Aortic Aneurysm one time screening for age Alcohol Misuse screening and counseling 3. Aspirin use for men ages and women ages to prevent CVD when prescribed by a physician 4. Blood Pressure screening for all adults 5. Cholesterol screening for adults 6. Colorectal Cancer screening for adults starting at age 50 limited to one every 5 years 7. Depression screening for adults 8. Type 2 Diabetes screening for adults 9. Diet counseling for adults 10. HIV screening for adults 11. Immunizations vaccines for adults (Hepatitis A & B, Herpes Zoster, Human Papillomavirus, Influenza (flu shot), Measles, Mumps Rubella, Meningococcal, Pneumococcal, Tetanus, Diptheria, Pertussis) 12. Obesity screening and counseling for all adults 13. Sexually Transmitted Infection (STI) prevention counseling for adults 14. Tobacco Use screening for all adults and cessation interventions 15. Syphilis screening for all adults 23 Covered Preventative Services for Women, Including Pregnant Women 1. Anemia screening on a routine basis for pregnant women 2. Bacteriuria urinary tract or other infection screening for pregnant women 3. BRCA counseling and genetic testing for women at higher risk 4. Breast Cancer Mammography screenings every year for women age 40 and over 5. Breast Cancer Chemoprevention counseling for women 6. Breastfeeding comprehensive support and counseling from trained providers, as well as access to breastfeeding supplies, for pregnant and nursing women. Non-network services will be payable as network services. 7. Cervical Cancer screening 8. Chlamydia Infection screening 9. Contraception: Food and Drug Administration-approved contraceptive methods, sterilization procedures, and patient education and counseling, not including abortifacient drugs 10. Domestic and interpersonal violence screening and counseling for all women 11. Folic Acid supplements for women who may become pregnant when prescribed by a physician 12. Gestational diabetes screening 13. Gonorrhea screening for all women 14. Hepatitis B screening for pregnant women 15. Human Immunodeficiency Virus (HIV) screening and counseling 16. Human Papillomavirus (HPV) DNA Test: HPV DNA testing every three years for women with normal cytology results who are 30 or older 17. Osteoporosis screening over age Routine prenatal visits for pregnant women 19. Rh Incompatibility screening for all pregnant women and follow-up testing 20. Tobacco Use screening and interventions for all women, and expanded counseling for pregnant tobacco users 21. Sexually Transmitted Infections (STI) counseling 22. Syphilis screening 23. Well-woman visits to obtain recommended preventive services 26 Covered Services for Children 1. Alcohol and Drug Use assessments 2. Autism screening for children limited to two screenings up to 24 months 3. Behavioral assessments for children limited to 5 assessments up to age Blood Pressure screening 5. Cervical Dysplasia screening 6. Congenital Hypothyroidism screening for newborns 7. Depression screening for adolescents age 12 and older 8. Developmental screening for children under age 3, and surveillance throughout childhood 9. Dyslipidemia screening for children 10. Fluoride Chemoprevention supplements for children without fluoride in their water source when prescribed by a physician 11. Gonorrhea preventive medication for the eyes of all newborns 12. Hearing screening for all newborns 13. Height, Weight and Body Mass Index measurements for children. 14. Hematocrit or Hemoglobin screening for children 15. Hemoglobinopathies or sickle cell screening for newborns 16. HIV screening for adolescents 17. Immunization vaccines for children from birth to age 18 -doses, recommended ages, and recommended populations vary: Diphtheria, Tetanus, Pertussis, Hepatitis A & B, Human Papillomavirus, Inactivated Poliovirus, Influenza (Flu Shot), Measles, Mumps, Rubella, Meningococcal, Pneumococcal, Rotavirus, Varicells 18. Iron supplements for children up to 12 months when prescribed by a physician 19. Lead screening for children 20. Medical History for all children throughout development Ages: 0 to 11 months, 1 to 4 years, 5 to 10 years, 11 to 14 years, 15 to 17 years. 21. Obesity screening and counseling 22. Oral Health risk assessment for young children up to age Phenylketonuria (PKU) screening in newborns 24. Sexually Transmitted Infection (STI) prevention counseling and screening for adolescents 25. Tuberculin testing for children 26. Vision screening for all children under the age of 5 2

5 Accident Insurance AccidentAdvance Underwritten by Transamerica Life Insurance Company Accidents are a part of everyday life, but are you prepared for the added financial burden? If you have a serious accident, you ll want extra cash to help with your increased expenses. Accident insurance pays benefits you can use for medical bills and other out-of-pocket expenses or for any other purpose, including paying your mortgage or other bills. Your medical coverage may not take care of all of the added expenses you ll have after an accident. Highlights of the policy include: Individual and family coverage available Guaranteed Issue underwriting is available Premiums collected through the convenience of payroll deduction Wellness Benefit: after a 30-day waiting period, a $50 benefit is payable per calendar year for one annual health screening test Fully portable The policy pays benefits for the following injuries: Burns Lacerations Eye injury Brain concussion Coma Paralysis Ruptured Discs, torn knee cartilage and more This is a brief summary of AccidentAdvance, Accident Insurance underwritten by Transamerica Life Insurance Company, Cedar Rapids, Iowa Policy form series CPACC100 and CCACC100. Forms and form numbers may vary. This coverage may not be available in all jurisdictions. Limitations and exclusions apply. Refer to the policy, certificate and riders for complete details. EBD ARASGBG

6 Accident Insurance AccidentAdvance (con t) Underwritten by Transamerica Life Insurance Company Limitations and Exclusions We will not pay benefits for losses caused by or as a result of a covered person: Driving any taxi for wage, compensation or profit; Mountaineering, parachuting or hang gliding: Voluntarily taking, administering, absorbing or Inhaling polson, gas or fumes; Alcoholism or drug addiction: Participating in any sport or sporting activity for wage, compensation, profit, or racing any type of vehicle in an organized event; Traveling in or descending from any vehicle or device for aerial navigation, except as a fare paying passenger in an aircraft operated by a commercial airline (other than a charter airline) on a regularly scheduled passenger trip; War, or any act of war, whether declared or undeclared; Participating in any activity or event, including the operation of a vehicle, while intoxicated or under the influence according to the laws of the jurisdiction in which the accident occurred; Participating in a riot, civil commotion, civil disobedience or unlawful assembly; Committing, attempting to commit, or taking part in a felony or assault or engaging in an illegal occupation; Intentionally self-inflicting bodily injury or attempting suicide while sane or insane; Any loss incurred while on active duty status in the armed forces. If you notify us of such active duty, we will refund any premiums paid for any period for which no coverage is provided as a result of this exception. Termination of Insurance Subject to the Portability Option, insurance coverage on the employee will end on the earliest of: the date of his or her death; the date he or she ceases to be eligible for coverage; the last date for which premium payment has been made to us, subject to the grace period; the date he or she terminates employment; the date the group master policy terminates; the date he or she sends us a written notice to cancel coverage. The insurance coverage on a dependent will cease on the earliest of: the date of the employee's death; the date the employee's coverage terminates; the last date for which premium payment has been made to us, subject to the grace period; the date the dependent no longer meets the definition of dependent; the date the certificate is modified so as to exclude dependent coverage; the date the employee sends us a written notice to cancel coverage on a dependent EBD ARASGBG

7 Critical Illness Insurance CriticalAssistance Advance Underwritten by Transamerica Life Insurance Company CriticalAssistance Advance can help budget-conscious families who may not be able to withstand financial shock of an unexpected illness by providing a lump sum payment if an insured individual is initially diagnosed with one of several critical conditions. Important features to the policy: Individual and family coverage available Employee benefit amount is available up to $30,000 in $10,000 increments, and dependent benefit amount is 50 percent of the employee s elected benefit The Guaranteed Issue amount is $30,000 Fully portable No waiting period Some covered illness include: heart attack, stroke, major organ transplant surgery, coma, invasive cancer, burns (3rd degree or 50% coverage) and much more Additional Benefit Riders include: Wellness Benefit Rider (Critical Illness Screening Benefit) - Pays an annual $50 benefit. Your plan will pay the selected amount per calendar year for each covered person when a charge is incurred for one of the following Critical Illness tests: biopsy, blood test for triglycerides, bone marrow testing, breast ultrasound, blood test for ovarian cancer, blood test for breast cancer, chest x-ray, colonoscopy, Pap test, thermography and more. Limitations and Exclusions We do not cover losses caused by, or as a result of: 1. Conditions other than those due to a covered Critical Illness. 2. The Covered Person s participation in or attempt to commit a felony or engaging in an illegal occupation. 3. The Covered Person intentionally causing self-inflicted injury. 4. The Covered Person committing or attempting to commit suicide, whether sane or insane. 5. The Covered Person s involvement in any period of armed conflict. 6. Surgeries performed outside the United States or its Territories. Under no condition will we pay any benefits for losses incurred prior to the Effective Date. No benefit is payable for a Critical Illness that is diagnosed during the Waiting Period. If the date of diagnosis of a specified Critical Illness occurs during the Waiting Period, you have the following options. 1. You may return the Certificate for a full refund of premium and fees; or 2. You may continue payment of premiums in the event you or another Covered Person is diagnosed with one of the other specified Critical Illnesses while coverage is in force. This is a brief summary of CriticalAssistance Advance, Critical Illness Insurance underwritten by Transamerica Life Insurance Company, Cedar Rapids, Iowa. Policy form series CPCI0400 and CCCI0400. Forms and form numbers may vary. This coverage may not be available in all jurisdictions. Limitations and exclusions apply. Refer to the policy, certificate and riders for complete details. Termination of Insurance Coverage will cease for a Covered Person when 100% of the Lifetime Maximum Benefits has been paid for that Covered Person. Subject to the Portability Option, your insurance will cease on the earliest of: 1. The date of your death; 2. The date on which you cease to be eligible for coverage; 3. The last date for which premium payment has been made to us, subject to the Grace Period; 4. The date on which you terminate employment; 5. The date the Policy terminates, subject to the Portability Option; or 6. The date you send us a written notice that you want to cancel coverage. The insurance on a Dependent will cease on the earliest of: 1. The date of your death; 2. The date your coverage terminates; 3. The last date for which premium payment has been made to us, subject to the Grace Period; 4. The date the Dependent no longer meets the definition of Dependent; 5. The date the Certificate is modified so as to exclude Dependent coverage; or 6. The date you send us a written notice that you want to cancel coverage on your Dependent. We may have the right to deny the benefits of any Covered Person who submits a fraudulent claim under the Certificate. EBD ARASGBG

8 Contact List Plan Carrier Phone Number Website Minimium Essential Coverage Key Benefit Administrators (MEC) Product Carrier Phone Number Website Accident Transamerica Life Critical Illness Insurance Company EBD ARASGBG