2017 Part-Time New Hire Enrollment

Transcription

1 2017 Part-Time New Hire Enrollment

2 Your Enrollment Window Is Here... In appreciation of your dedicated service SAMPLE is pleased to offer a variety of affordable benefits to our part-time associates. These programs are designed to provide you with coverage that can help you stay healthy, feel secure, and maintain a work/life balance. Please review this enrollment guide so you understand the benefits being offered and can make the right choices for you and your family. Who s Eligible? SAMPLE part-time associates that work at least 16 hours per week and complete 3 continuous months of service are eligible for coverage provided by The American Worker. Associates can enroll their eligible dependents including their spouse and children in coverage. Your Coverage Choices SAMPLE offers eligible part-time associates the following coverage options through The American Worker. All coverage options are offered on a freestanding basis and can be elected individually or in any combination. Minimum Essential Coverage (MEC): Covers all preventive services required by the Affordable Care Act (ACA) - Satisfies the ACA s Individual Mandate so you may not incur a tax penalty while enrolled Supplemental Medical Plans: Coverage for basic healthcare services resulting from an illness or accident - Pay a specific amount per day for covered services including Dr. Visits, Labs, X-rays, Hospital Stays and more - The Supplemental Medical Plans do not satisfy the ACA s Individual Mandate Dental: Plan pays up to $500 per year after a $50 deductible Life and AD&D Insurance: $20,000 of coverage for associates Changing Coverage During the Year You can change your coverage during the plan year only when you experience a Qualifying Life Event (QLE), such as marriage, divorce, birth, adoption, placement for adoption, or loss of coverage. The change must be made within 30 days of the event and the change also must be consistent with the event. Contact your immediate supervisor for a Benefit Change form. Complete the form and send it to the Benefits Department by interoffice mail. Now s Your Chance to Enroll For your convenience you can enroll online or by phone. If you have benefit questions call for assistance. Enrollment Period: You have 120 days from your date of hire to enroll Note: You will need the Name, Social Security Number and Date of Birth of all individuals being enrolled. Online: Visit Phone: Call Click Enroll - Start Here at the top of the page Hours: Monday - Friday, 8 AM - 8 PM ET 2. Under New User? select the Social Security # button 3. Enter your Social Security Number, Date of Birth, and click Continue 4. Create your Username and Password 2 Note: If you do not enroll now, you will not be able to enroll until the next annual open enrollment unless you have a QLE during the year.

3 Minimum Essential Coverage (MEC) Plan* The MEC Plan provides 100% in-network coverage for all preventive care services required by the Affordable Care Act (ACA). This plan is not comprehensive health insurance. It covers only preventive services and does not provide coverage for illnesses or accidents. The ACA s Individual Mandate requires most Americans to have coverage that meets certain criteria. The MEC Plan provides the minimum amount of coverage that meets the ACA s requirements, so you and your covered dependents may not have to pay the Individual Mandate penalty while enrolled in the plan. The 2017 Individual Mandate penalty is the greater of: 2.5% of household income OR $695 per adult and $ per child under 18 (up to a maximum of $2,085). The Summary of Benefits and Coverage (SBC) for the MEC Plan is available at Associate Only Associate + 1 Family First Health Network First Health has over 490,000 provider locations nationwide. To locate a network provider, visit or call Members must use a First Health provider for services to be covered. The MEC plan does not provide any out-of-network coverage. Plan Features The plan includes 100% in-network coverage for all ACA-required preventive and wellness services. There s no cost to you for covered services provided in-network. Covered Services The following is an overview of services covered by the MEC Plan. The U.S. Preventive Services Task Force periodically updates the list and sets the requirements such as age, gender, or health conditions for services to be covered. For a current list including all requirements for services to be covered, visit Plan limitations and exclusions apply. All Adults $8.07 $13.58 $16.94 Screenings: Abdominal Aortic Aneurysm, Alcohol Misuse, Blood Pressure, Cholesterol, Colorectal Cancer, Depression, Diabetes (Type 2), Hepatitis B, Hepatitis C, HIV, Lung Cancer, Obesity, Syphilis, Tobacco Use Counseling: Alcohol Misuse, Diet, Obesity, Sexually Transmitted Infection Prevention, Tobacco Use Immunizations: Diphtheria, Hepatitis A, Hepatitis B, Herpes Zoster, Human Papillomavirus (HPV), Influenza (Flu Shot), Measles, Meningococcal, Mumps, Pertussis, Pneumococcal, Rubella, Tetanus, Varicella (Chickenpox) Other: Aspirin Use to Prevent Cardiovascular Disease Women Including Pregnant Women or Women Who May Become Pregnant Screenings: Anemia, Breast Cancer Mammography, Cervical Cancer, Chlamydia Infection, Domestic and Interpersonal Violence, Gonorrhea, HIV, Human Papillomavirus (HPV), Osteoporosis, Rh Incompatibility, Sexually Transmitted Infection, Syphilis, Tobacco Use, Urinary Tract, or Other Infections Counseling: Breast Cancer Genetic Testing (BRCA), Breast Cancer Chemoprevention, Breastfeeding, Contraception, Domestic and Interpersonal Violence, Gestational Diabetes, HIV Other: Breastfeeding Supplies for Pregnant and Nursing Women, FDA Approved Contraceptive Methods, Folic Acid Supplements, Well-woman Visits for Recommended Services Children Screenings: Autism, Blood Pressure, Cervical Dysplasia, Depression, Developmental, Dyslipidemia, Hearing, Hematocrit or Hemoglobin, Lead, Hemoglobinopathies or Sickle Cell, Hepatitis B, HIV, Hypothyroidism, Obesity, Phenylketonuria, Sexually Transmitted Infection, Tuberculin, Vision Assessments: Alcohol and Drug Use, Behavioral, Oral Health Risk Counseling: Obesity, Sexually Transmitted Infection Prevention Immunizations: Diphtheria, Tetanus, Pertussis, Haemophilus Influenzae Type B, Hepatitis A, Hepatitis B, Human Papillomavirus (PVU), Inactivated Poliovirus, Influenza (Flu Shot), Measles, Meningococcal, Pneumococcal, Rotavirus, Varicella (Chickenpox) Other: Fluoride Chemoprevention Supplements, Gonorrhea Preventive Medication for the Eyes of Newborns, Height, Weight and Body Mass Index (BMI) Measurements, Iron Supplements, Medical History * Massachusetts residents: This plan does not meet the individual health coverage requirements & does not satisfy the individual mandate in your state. 3

4 Supplemental Medical Plans The American Worker supplemental medical plans provide affordable coverage with no deductibles or coinsurance. Your acceptance in the plan is guaranteed, and there are no pre-existing condition limitations or medical questions to answer. The chart below displays the amount the plan pays per covered person per calendar year, unless otherwise indicated. Supplemental Medical Plans Overview Doctor s Office Visits Outpatient Diagnostic Labs Outpatient Diagnostic X-rays Outpatient Advanced Studies BASIC VALUE ELITE $50 per day, 6 days per person $50 per testing day, 4 days per person $50 per testing day, 2 days per person $50 per day, 6 days per person $75 per testing day, $75 per testing day, $75 per day, 6 days per person $125 per testing day, Accidental Injury Care Not covered Up to $500 per occurrence Up to $1,000 per occurrence Surgical Inpatient Procedure $500 per day $500 per day $1,000 per day Inpatient Maximum 1 day per person 1 day per person 1 day per person Outpatient Procedure $250 per day $250 per day $500 per day Outpatient Minor Procedure $50 per day $50 per day $100 per day Outpatient Maximum 1 day per person 1 day per person 1 day per person Hospital Indemnity Intensive Care Unit Substance Abuse Skilled Nursing Facility Mental Health Prescription Drug Coverage $200 per day, 500-day lifetime maximum $400 per day, 60 days per person per stay $200 per day, 500-day lifetime maximum $400 per day, 60 days per person per stay What You Pay for Each 30-Day Prescription at a Network Pharmacy $500 per day, 500-day lifetime maximum $1,000 per day, $250 per day, $250 per day, 60 days per person per stay $250 per day, Preferred Generic $10 copay $10 copay Preferred Brand-Name New Benefits Neighborhood Pharmacy Discount Program $30 copay $30 copay Non-Preferred Generic or Brand-Name Discounts only Discounts only Maximum Monthly Prescription Drug Benefit Life and AD&D Insurance Not applicable $250 per person $250 per person Associate $5,000 $5,000 $5,000 Spouse (Life Only) $2,500 $2,500 $2,500 Child (Life Only) $1,250 $1,250 $1,250 Associate Only $8.30 $17.35 $26.79 Associate + 1 $16.01 $35.21 $56.32 Family $17.48 $41.68 $ The supplemental medical plans: (a) are not a substitute for minimum essential health coverage under the Affordable Care Act (ACA), (b) do not qualify as minimum essential coverage under the ACA, and (c) do not satisfy the ACA s Individual Mandate.

5 Additional Supplemental Medical Plan Features These plan features are included in the cost of the supplemental medical plan you choose. First Health Network Members have access to the First Health Provider Network, which offers savings on physician and hospital services. The supplemental medical plans pay the same benefit amount whether you visit a First Health or out-of-network provider, but you can minimize your out-of-pocket costs by using First Health providers. To find a provider, visit or call member services at Prescription Drug Coverage If you enroll in the Value or Elite supplemental medical plans, you automatically receive prescription drug coverage through RxEDO. When you take your prescription ID card to a pharmacy that participates in the RxEDO network, you ll pay: $10 for a 30-day supply of preferred generic drugs $30 for a 30-day supply of preferred brand-name drugs The plan covers prescription drugs in the RxEDO Preferred Drug List. For non-preferred drugs, the plan offers discounts only. There is a maximum monthly benefit of $250 per person. To review the Preferred Drug List, visit If you have questions about your benefits, call New Benefits Neighborhood Pharmacy Discount Program If you enroll in the Basic supplemental medical plan, you have access to the Neighborhood Pharmacy Discount Program provided by New Benefits, Ltd. This program provides discounts on prescription drugs when you use pharmacies that are part of the network. The pharmacy network has more than 60,000 pharmacies including national and regional chains as well as independent pharmacies. Visit to look up drug prices or locate a participating pharmacy. Medical Bill Saver TM : Can help lower out-of-pocket costs on medical or dental bills over $400 through provider negotiation. Medical Health Advisor 2 : Access to Personal Health Advocates that assist in resolving insurance claim and billing issues. Nurseline TM and Personal Counseling Services In addition, members will receive discounts on the following services or supplies at participating providers. Lab and Imaging 3 Hearing Vision Durable Medical Equipment Diabetic Supplies Vitamins Chiropractic Care The American Worker plans are underwritten by Nationwide Life Insurance Company. The First Health Network, RxEDO, and New Benefits programs are not insured by Nationwide and are provided by separate vendors. First Health and New Benefits are discount-only programs. 1 Teladoc is not available to residents of Arkansas or Idaho. 2 Health Advisor does not replace health insurance, provide medical care, or recommend treatment. 3 Savings may vary based on geographic location, provider selected, and procedure performed. The lab network portion of this benefit is not available in MA, MD, ND, NE, NJ, NY, RI, or SD. Discount Benefits are administered by New Benefits, Ltd. Note: Pharmacy discounts are not insurance and are not intended as a substitute for insurance. New Benefits Discount Health Savings Program These programs can help reduce out-of-pocket expenses and provide savings on a variety of services that promote healthy living. Detailed information on all programs will be provided after enrollment. Teladoc 1 : 24/7/365 access to a network of U.S. board-certified doctors that will diagnose, treat, and prescribe medication, when necessary, over the phone for medical issues including cold or flu symptoms, allergies, bronchitis, and more. 5

6 Dental Coverage Brushing, flossing, and regular preventive care will help you keep a bright, healthy smile. This affordable Dental coverage will help you maintain a consistent overall health and will allow you to visit any provider for service. Dental Benefits Overview Calendar Year Maximum Calendar Year Deductible Covered Services Type I Services: Preventive and Diagnostic Oral Exams, Cleanings, X-Rays, Fluoride Treatments, etc. Type II Services: Basic Treatment Fillings, Extractions, Oral Surgery, Endodontics, Periodontics, Sealants, Root Canal, etc. Type III Services: Major Treatment Crowns, Dentures, Inlays, Onlays, Bridges, etc. Orthodontia Services Braces for Children to age 19 Orthodontia Lifetime Maximum $500 per covered member $50 per covered member Coinsurance Covered at 80% (U&C charges) Covered at 80% (U&C charges) Covered at 50% (U&C charges) Covered at 50% (U&C charges) $250 per covered member Associate Only $5.11 Associate + 1 $11.23 Family $13.79 Life and AD&D Insurance Life and accidental death and dismemberment insurance can help your loved ones during a difficult time. This plan can help ease the financial burden and protect the future of those that depend on you the most. SAMPLE provides you the opportunity to purchase a package of life insurance and accidental death and dismemberment benefits for you and your family. Life Insurance and AD&D Overview Associate Life and AD&D Coverage Associate Life Insurance $20,000 Associate AD&D $20,000 Dependent Life Insurance Spouse $2,500 Child $1,250 Infant (10 days to 6 months) $200 Associate Only $2.25 Associate + 1 $2.53 Family $2.88 6

7 Other Important Information This enrollment guide provides an overview of the benefit plans for which you are eligible through SAMPLE. Brief descriptions of important plan features are included to assist you in your decision making process. The enrollment guide does not provide a complete or legal description of the benefit plans. If there is a discrepancy between the enrollment guide and the official plan documents, the plan documents govern. Exclusions and limitations apply to all plans. Making Elections - Pretax Deduction Disclaimer When you elect coverage, you agree that: I hereby elect to participate in benefits made available under the Internal Revenue Code Section 79, 105, 106, 125, and these sections as amended. I understand that any eligible payroll deductions for benefits will automatically convert to pretax status. I understand that by participating in benefits my Social Security benefits may be reduced since premiums for many benefits will be deducted before my salary is taxed. This election will remain in effect for the entire plan year. My election CANNOT be changed during the plan year in accordance with the Internal Revenue Service guidelines unless a qualifying event occurs. Qualifying events include: marriage, divorce, legal separation, death of spouse, birth or legal adoption of a child, death of a child, or spousal change of employment affecting insurance coverage. Supplemental Medical Plans Supplemental medical plans are fixed indemnity plans, and they are not intended or recommended to replace any comprehensive program of insurance in which you currently participate or intend to participate. They are not designed to replace or provide major medical coverage. Supplemental medical plan insurance benefits are offered by Nationwide Life Insurance Company. The supplemental medical plans are not a substitute for minimum essential health coverage under the Affordable Care Act (ACA), do not qualify as minimum essential coverage under ACA, and do not satisfy the ACA s individual mandate. Minimum Essential Coverage (MEC) Plan This plan is designed to provide plan participants with minimum essential coverage under the federal income tax rules. This plan is designed so that plan participants may enroll in this plan and may not have to pay a federal individual income tax penalty. However, while you are enrolled in this plan, you may not be eligible for a federal tax credit though a federal or state exchange. If you do not enroll in this plan but enroll in a marketplace plan, you may be eligible for a federal tax credit that lowers your monthly premium or reduces certain cost-sharing. State Restrictions Massachusetts residents are eligible for supplemental medical plans and the MEC Plan, but neither of these plans meet the individual health coverage requirements, nor will not satisfy the individual mandate that you have health insurance in your state. The Discount Health Savings Program is NOT insurance. The plan is not insurance coverage and does not meet the minimum creditable coverage requirements under the Affordable Care Act or Massachusetts M.G.L.c. 111M and 956 CMR It contains a 30-day cancellation period, provides discounts only at the offices of contracted health care providers, and each member is obligated to pay the discounted medical charges in full at the point of service. The range of discounts for medical or ancillary services provided under the plan will vary depending on the type of provider and medical or ancillary service received. Members shall receive a reimbursement of all periodic membership fees if membership is canceled within the first 30 days after the effective date. Arkansas and Tennessee residents: A refund of all fees will be issued if membership is canceled within the first 30 days. Discount Medical Plan Organization: New Benefits, Ltd., Attn: Compliance Department, PO Box , Dallas, TX , (800) Website to obtain participating providers: mymemberportal.com. Teladoc is not available to AR and ID residents Teladoc, Inc. All rights reserved. Teladoc and the Teladoc logo are registered trademarks of Teladoc, Inc. and may not be used without written permission. Teladoc does not replace the primary care physician. Teladoc does not guarantee that a prescription will be written. Teladoc operates subject to state regulation and may not be available in certain states. Consults are not available outside of the U.S. Teladoc does not prescribe DEA controlled substances, non-therapeutic drugs and certain other drugs which may be harmful because of their potential for abuse. Teladoc physicians reserve the right to deny care for potential misuse of services. Teladoc phone consultations are available 24 hours a day, seven days a week while video consultations are available during the hours of 7 a.m. to 9 p.m., seven days a week. 7