2018 Open Enrollment Guide

Transcription

1 2018 Open Enrollment Guide

2 Table of Contents Click on links to access page Welcome to 2018 Open Enrollment...1 Enrollment...2 Road to Wellness...3 Medical Insurance...4 Prescription Drugs Coverage...5 Spousal Clause...5 Teledoc...6 Dental Insurance...7 Vision Insurance...8 Basic Group Life Insurance and Accidental Death & Dismemberment Insurance...9 Voluntary Life Insurance...9 Voluntary Accidental Death & Dismemberment Group Accident Insurance Critical Illness and Specified Disease Pet Insurance Income Protection (Disability Insurance) Flexible Spending Accounts (FSA) This summary is not a legal document and does not replace or supersede the Evidence of Coverage, policy, or the Summary Plan Description. Please refer to the Evidence of Coverage/insurance policy/summary Plan Description for a complete description of the coverage, eligibility criteria, controlling terms, exclusions, limitations, and conditions of coverage. AAA Carolinas reserves the right to terminate, suspend, withdraw, reduce, or modify the benefits described in the Evidence of Coverage/policy/Summary Plan Description in whole or in part, at any time. No statement in this or any other document and no oral representation should be construed as a waiver of this right. This summary is the confidential property of AAA Carolinas

3 Welcome to AAA Carolinas 2018 Open Enrollment! AAA Carolinas strives to maintain a competitive, progressive benefits program that focuses on the services that employees value most. We contract with benefits providers who are market leaders and provide excellent customer service. We encourage you to take the time to educate yourself about your options and choose the best coverage for you and your family. What s New for 2018? New Telemedicine benefit where you can seek care from a board-certified doctor from your smartphone or tablet - and costs you only $20! No increase to Medical Plan premiums or copays; slight adjustment to s New Prescription Drug Plan copays to help with the escalating cost of certain generic and brand-name drugs The 2018 Open Enrollment period will be from November 1st 2017 to November 9th This will be the only time enrollment will be open for you to make your elections. Missing this deadline means you will not be enrolled in any benefits for All full time employees, hired on or before 10/31/17, must complete Open Enrollment. Your 2017 elections will not carry over into Enrollment will be completed through the AAA Carolinas Employee Self-Service Portal at: AAA Carolinas 1

4 Enrollment Open Enrollment Starts: Wednesday, November 1, 9 am Open Enrollment Stops: Thursday, November 9, 12:00 pm Visit Your Ultipro password will be reset to your default password on November 1, 2017 If you need additional login or enrollment assistance, please support@myaaacarolinas.com All employees Ultipro password will be reset to their default password on November 1, UserID: Last name last 4 digits of SS (ex. Smith1234) (first letter of last name should always be capitalized) Password: Birth date (MMDDYYYY) plus last 4 digits of SS (ex ) All full-time employees hired on or before 10/31/2017 must complete Open Enrollment before 12 pm Employee Open Enrollment

5 Road to Wellness Health Assessment Take a short minute online health survey that gives you a snapshot of your current health. You will learn about your potential risks and receive personalized recommendations. BCBSNC will then connect you to resources to assist you in making strides to improve your health. As always, your survey responses are confidential. Coming in Choose to Lose - Weight Loss Program Need a little help achieving your weight loss goal? Participate in the 12 week Choose to Lose program. This holistic program will feature weekly topics to help you achieve a happier, healthier you. You will get assistance setting an appropriate weight loss goal and learn about nutrition, meal planning, and physical activity. Receive accountability to stay on track and have fun while you do it! Information and sign up will be forthcoming. HealthNAV - A Tool for Financial Wellness HealthNAV is a tool that allows you to search for the best care at the right price. You can search for in-network providers and facilities that reduce your out of pocket costs and stretch your dollars further. HealthNAV also allows you to plan for future health care expenses by estimating the cost of care covered by the plan. Visit the BCBS website, on a computer or mobile device to access the HealthNAV tool. AAA Carolinas 3

6 Medical Insurance No changes to what our Medical Insurance will cover No changes to Employee premiums, copays or coinsurance; there are some adjustments to s Remaining with Blue Cross Blue Shield of NC Same 3 plans to choose from (Plan A, B or C) Review Spousal Clause details before enrolling your spouse New - Telemedicine is available through Teladoc vendor for $20 copay New 5-Tier Pharmacy plan design New ID Cards will be issued to all employees enrolled in a medical plan Benefits Overview For a complete outline of benefit coverage, please see the Summary Plan Descriptions located on Oliver. Benefit Coverage In-Network Plan A Plan B Plan C Out-of- Network In-Network Out-of- Network In-Network Out-of- Network Lifetime Benefit Unlimited Unlimited Unlimited Unlimited Unlimited Unlimited Calendar Year Deductible Individual $1,750 $3,000 $1,000 $1,500 $750 $1,000 Family $3,500 $6,000 $2,000 $3,000 $1,500 $2,000 Out-of-Pocket Maximum Individual $5,000 $7,000 $3,500 $6,500 $2,500 $4,500 Family $10,000 $14,000 $7,000 $13,000 $5,000 $9,000 Benefit Percentages Emergency Room Primary Office Visits 70% after 70% after 70% after 50% after 50% after 50% after 80% after $200 co-pay first visit; $300 copay all subsequent visits $30 copay 60% after $200 co-pay first visit; $300 copay all subsequent visits 60% after 85% after $150 co-pay first visit; $300 copay all subsequent visits $25 copay 65% after $150 co-pay first visit; $300 copay all subsequent visits 65% after Teledoc/virtual visit $20 copay Not covered $20 copay Not covered $20 copay Not covered Specialist Office Visits Urgent Care Physical Therapy Chiropractic Surgery-Other than Office 70% after 70% after 70% after 70% after 70% after 50% after 50% after 50% after 50% after 50% after $50 copay 60% after $50 copay 65% after $50 copay $50 copay $50 copay $50 copay $30 copay $30 copay 80% after 60% after 60% after 60% after $25 copay $25 copay 85% after 65% after 65% after 65% after Preventive Care Screenings 100% - no copay 100% - no copay 100% - no copay 100% - no copay 100% - no copay 100% - no copay 2018 Employee Per Pay Period Deduction Plan A Plan B Plan C AAA Pays AAA Pays Bi- Semi- Bi- Semi- Bi- Semi- AAA Pays Weekly Weekly Weekly Weekly Weekly Weekly Employee Only $18.23 $36.46 $39.50 $79.00 $ $33.10 $66.20 $71.71 $ $ $47.41 $94.82 $ $ $ Employee & Spouse $47.89 $95.78 $ $ $ $66.20 $ $ $ $ $94.82 $ $ $ $ Employee & Child(ren) $44.42 $88.84 $96.24 $ $ $58.58 $ $ $ $ $83.92 $ $ $ $ Employee & Family $66.03 $ $ $ $ $87.09 $ $ $ $1, $ $ $ $ $1, Employee Open Enrollment

7 Prescription Drugs Coverage Retail (30 day supply) Tier 1 Plan A In Network Plan B In Network Plan C In Network $10 copay $10 copay Tier 2 $25 copay $25 copay Tier 3 70% after 30% to max of $50 30% to max of $50 Tier 4 50% to max of $150 50% to max of $150 Tier 5 50% to max of $200 50% to max of $200 MAIL ORDER (90 day) Tier 1 $20 copay $20 copay Tier 2 $50 copay $50 copay Tier 3 70% after 30% to max of $100 30% to max of $100 Tier 4 50% to max of $300 50% to max of $300 Tier 5 50% to max of $400 50% to max of $400 Preventive over-the-counter medications and PRESCRIPTION contraceptive drugs and devices as listed at No charge No charge No charge The lowest cost prescription drugs, such as generics, are generally located on the lowest tiers (Tier 1 and Tier 2). Higher cost prescription drugs, such as brand-name prescription drugs are generally located on the higher tiers (Tier 3 and Tier 4). All tiers of the formulary may contain generic and brand name prescription drugs. Specialty drugs are located on the highest tiers of the Plan, even though they may be classified as generic, brand-name, biologic, or biosimilar prescription drugs. *Also see Enhanced 5 Tier C at If you are currently taking a drug that will be impacted by the change to the Enhanced 5 Tier formulary, you will receive a letter from BCBSNC in December. **Please visit BCBSNC s website at or call BCBSNC Customer Service for guidelines on which preventive over-the-counter medications are covered and individuals who may qualify. Spousal Clause Read this if you plan to enroll your spouse in our medical plan If your spouse is offered group insurance coverage at his or her place of employment, he or she must participate in that plan before he or she will be allowed to receive benefits under the AAA Carolinas Health & Welfare Plan. Failure to do so will result in non-payment of claims by our insurance provider. If there is a waiting period from the other carrier, AAA will cover your spouse as primary during this period if you elect family or spouse coverage. Any claims paid due to false statements, will be the responsibility of the employee to pay back and/or health insurance coverage could be canceled. If your spouse is not offered group insurance coverage at his or her place of employment, you may continue to insure your spouse under the AAA Carolinas Health & Welfare Plan. AAA Carolinas insurance would then be your spouse s primary coverage. AAA Carolinas 5

8 Teledoc Teledoc offers easy, stress-free access to board-certified medical doctors (for adults and children) through Video Visits on your smart phone or computer all from the comfort of your own home. Take advantage of their services get prescriptions refilled, keep your family in tip top shape and be prepared for the unexpected! Teledoc Physicians can diagnose, treat and even write prescriptions for nearly any non-emergency medical condition. Plus at a $20 copay per visit, its an smart choice and easy on your wallet. Some of the top reasons to use Teledoc: 1. Coughs, Colds & Sore Throats 2. Flu 3. Pediatric Issues 4. Prescription Refills 5. Sinus & Allergies 6. Nausea & Diarrhea 7. Rashes & Skin Issues 8. Women s Health: UTIs, Yeast Infections 9. Sports Injuries 10. Eye Issues 3 ways to activate and start using in 2018 So it s ready when you need it! Download the Teladoc app on your smartphone or tablet. Go to and click Set Up Account Call Why wait? Average time it takes to see a doctor: Median wait time is just 10 minutes 19 minutes at a doctor s office (40 minutes for total visit) 30 minutes at an urgent care (60 minutes for total visit) 28 minutes at the ER (153 minutes for total visit) Employee Open Enrollment

9 Dental Insurance No changes to what our Dental Insurance will cover No changes to co-pays, s or co-insurance Small increase to employee premiums Remaining with Delta Dental of NC Spousal Clause does not pertain to the dental plan Download the Delta Dental App for ID card, to search for a dentist, and other helpful tools. Dental Coverage Covered Services Amount You Pay Preventive Services: Exams, cleanings, x rays, etc. $0 (insurance pays 100%) Basic Services: Fillings, simple extractions, periodontic & endodontics, etc. Major Services: Crowns, bridges, implants, etc. 20% (insurance pays 80%) after 50% (insurance pay 50%) after Orthodontia Services: Coverage for dependents up to age 19 50% after $50 lifetime $1,500 lifetime maximum Annual Plan Maximum: Per covered individual $1,500 Deductible $25 individual; $75 family 2018 Employee Per Pay Period Costs Weekly Bi-Weekly Semi- AAA Pays Employee $2.83 $5.65 $6.12 $12.24 $18.37 Employee & Spouse $5.36 $10.73 $11.62 $23.25 $34.87 Employee & Child(ren) $7.69 $15.39 $16.67 $33.34 $50.01 Employee & Family $11.30 $22.60 $24.48 $48.96 $73.44 AAA Carolinas 7

10 Vision Insurance NO INCREASE to employee premiums No changes to what our Vision Insurance will cover No changes to employee co-pays, s or co-insurance Remaining with Superior Vision Log into to print off your ID Card. Vision Coverage Covered Services Eye Exam (annually) In-Network Coverage 100% after $10 copay Materials $0 Standard Lenses (annually) Single vision Bifocal Trifocal Lenticular 100% after $10 copay 100% after $10 copay 100% after $10 copay 100% after $10 copay Frames Every 24 months $10 co-pay or $130 allowance Contact Lenses (annually) Medically Necessary 100% after $10 copay Cosmetic/Elective Standard Up to $120 Standard Contact Fitting Fee 100% after $25 copay Specialty Contact Lens Fitting Fee Up to $50 Out-of-Network Coverage Also available Allowances, see Open Enrollment portal for additional coverage 2018 Employee Per Pay Period Costs Weekly Bi-Weekly Semi- AAA Pays Employee $1.80 $3.61 $3.91 $7.82 $0.00 Employee & Spouse $3.54 $7.08 $7.67 $15.33 $0.00 Employee & Child(ren) $3.57 $7.14 $7.74 $15.48 $0.00 Employee & Family $5.33 $10.66 $11.55 $23.09 $ Employee Open Enrollment

11 Basic Group Life Insurance and Accidental Death & Dismemberment Insurance AAA Carolinas provides full-time employees the equivalent of their annual salary in group life insurance and pays the full cost of this benefit (maximum of $200,000). Voluntary Life Insurance If your are currently enrolled in this benefit with Cigna, you will automatically be re-enrolled for Individual Employee Maximum (subject to EOI)* $500,000 or greater than 10x salary Spouse 50% of employee election or $250,000 Dependent Children In order to enroll, increase or cancel this benefit $10,000 (see age limitations) To Enroll: You must complete the Evidence of Insurability application located in the Open Enrollment Portal before 11/30/ To Cancel: Send to Note: If you are not In Active Service on the date insurance would otherwise go into effect, it will be effective on the date you return to Active Service. If an eligible Spouse or Dependent Child is: 1. an inpatient in a hospital, hospice, rehabilitation or convalescence center, or custodial care facility; or 2. confined to his or her home under the care of a Physician on the date insurance would otherwise be effective, it will be effective on the date he or she is no longer an inpatient in these facilities or confined at home. Please refer to the group policy located on Oliver for full details. *Evidence of insurability (EOI) will be required for any increase made during open enrollment or for late entrants (if you didn t enroll when you were first hired). New amounts will not be in effect until EOI is approved AAA Carolinas 9

12 Voluntary Accidental Death & Dismemberment Employee Only AD&D Coverage Covers employee only Family AD&D Coverage Covers employee, spouse and dependent children Minimum Coverage $10,000 Minimum Coverage $10,000 Maximum Coverage $500,000 Maximum Coverage $500,000 In increments of $10,000 In increments of $10,000 Partial List of Covered Losses Type of Loss Loss of Two or More Hands or Feet Loss of Sight of Both Eyes Loss of One Hand or One Foot and Sight in One Eye Loss of Speech and Hearing (in both ears) Loss of Thumb and Index Finger of the Same Hand Loss of all the Toes of the Same Foot Benefit Amount 100% of the Principal Sum 100% of the Principal Sum 100% of the Principal Sum 100% of the Principal Sum 25% of the Principal Sum 20% of the Principal Sum Employee Open Enrollment

13 Group Accident Insurance Accident insurance can help cover the extra costs that can occur when you, your spouse or your children suffer a covered injury like those that can happen during a game of pick-up basketball or when your kids go rollerblading. This coverage is offered through UNUM. Wellness Benefit One common test, including cholesterol tests, stress tests, chest x-rays, pap smears, colonoscopies, etc. Covered Injuries $50 per calendar year Benefit Amount Ruptured disc $800 Dental work, emergency Extraction $100 Crown $300 Eye Injury $300 Emergency and Hospitalization benefits Ambulance (ground, once per accident) $400 Air ambulance $1,500 Emergency room treatment $150 Physician follow-up visit (up to 2 per accident) Primary care physician $75 Specialist $75 Urgent Care Facility $75 Therapy services (up to 10 per accident) Occupational therapy $25 Speech therapy $25 Physical therapy $25 Fractures Open Up to $7,500 Closed Up to $3,750 Dislocations Open Up to $6,000 Closed Up to $3,000 Concussion $150 Coma $10,000 Knee Cartilage Torn $750 Exploratory $150 Hospitalization Hospital Admission (admission or intensive care admission once per covered accident) $1,000 Intensive Care Admission (same as above) $1,500 Hospital Confinement (per day up to 365 days) $200 Intensive Care Confinement (per day up to 15 days) $400 AAA Carolinas 11

14 Critical Illness and Specified Disease Employee Coverage Option: $10,000 Child(ren) automatically covered at 25% of employee amount Spouse Coverage Option: $5,000 Wellness Benefit: Pays $75 per calendar year for one common test, including cholesterol tests, Stress tests, Chest X-rays, Pap Smears, Colonoscopies. If you currently have this benefit, please remember to file for this Wellness Benefit Claim by December 31, You can do this by calling UNUM at This coverage is offered through UNUM Category Specified Disease Percentage of Benefit Amount Coronary Artery Bypass Surgery 25% Maximum Percentage of Benefit Amount for Category Base Covered Conditions - 1 Heart Attack 100% Stroke 100% Down Syndrome 100% Benign Brain Tumor End Stage Renal (Kidney) Failure Major Organ Failure 100% Base Covered Conditions - 2 Base Covered Conditions - 3 Blindness Cerebral Palsy Cystic Fibrosis Spina Bifida Coma Occupational HIV Permanent Paralysis Cleft Lip/Palate 100% 100% 100% 100% Cancer Conditions Carcinoma in Situ 25% Cancer 100% 100% Don t Miss This Chance Evidence of insurability (EOI) will not be required if you enroll during this open enrollment period. However, in future enrollments an EOI will be required. If you are currently enrolled in Group Accident and/or Critical Illness and Specific Disease with UNUM, you must elect this benefit again to remain enrolled in Employee Open Enrollment

15 Pet Insurance Choose a plan that works for you and your pet Coverage is provided for accidents, illnesses, and preventive care This coverage is offered through Nationwide petinsurance.com/aaacarolinas PLEASE NOTE: You can get a quote and/or enroll in this benefit anytime by calling or visiting petinsurance.com/aaacarolinas. My Pet Protection with Wellness My Pet Protection Accidents, including poisonings and allergic reactions Injuries, including cuts, sprains and broken bones Common illnesses, including ear infections, vomiting and diarrhea Serious/chronic illnesses, including cancer and diabetes Hereditary and congenital conditions Surgeries and hospitalization X-rays, MRIs and CT scans Base Covered Conditions Prescription medications and therapeutic diets Wellness exams Preventive dental cleaning Vaccinations Spay/neuter Flea and tick prevention Heartworm testing and prevention Routine blood tests Just like all other pet insurers, we don t cover pre-existing conditions. However, we go above and beyond with extra features such as emergency boarding, lost pet advertising and more. Plus, both plans have a low $250 annual and a generous $7,500 maximum annual benefit. AAA Carolinas 13

16 Income Protection (Disability Insurance) If you are currently enrolled in this benefit through Cigna, you will automatically be re-enrolled for Evidence of insurability (EOI) will be required for any new election made during open enrollment or for late entrants (if you didn t enroll when you were first hired). New amount will not be in effect until EOI is approved. Short Term Disability Benefit Begin Benefits Duration Percentage of Income Replaced Maximum Benefit Payable 8th day For a maximum of 13 weeks 60% of weekly income $500 weekly Pre-existing Condition Limitation 3/12 Long Term Disability Benefits Begin Benefits Duration (see policy on Oliver for maximum benefit period) Percentage of Income Replaced Maximum Benefit Payable 91st day To age 65 or Social Security Normal Retirement Age 50% of monthly income or 60% of monthly income under Buy Up option $3,000 monthly or $7,500 monthly under Buy Up option Pre-existing Condition Limitation 3/12 TO ENROLL IN THIS BENEFIT TO CANCEL THIS BENEFIT Disability - Age Based Rates Short-Term Disability Age Rate per $10/STD benefit Round all numbers to the nearest whole number 1. Enter your Weekly Earnings 2. Multiply the amount in line 1 by Find your aged based rate from the above table 4. Multiply the amount on line 2 by the line 3 To Enroll: You must complete the Evidence of Insurability application located in the Open Enrollment Portal before 11/30/ f261b-e8e c5-5fee5ecbad33 support@myaaacarolinas.com before 11/30/17 to cancel benefit Long-Term Disability Age Rate per $100/LTD benefit Under Round all numbers to the nearest whole number 1. Enter your monthly Earnings (amount can t exceed $3,000) 2. Enter your aged based rate from the above table 3. Multiply the amount on line 1 by the line 2 4. Divide the amount on line 3 by 100 (monthly) 5. Divide the amount on line 4 by 10 (monthly) Employee Open Enrollment

17 Flexible Spending Accounts (FSA) Health Care FSA This account is for healthcare expenses You may set aside money to pay for out-of-pocket health care expenses for yourself and your dependents. (These dependents must be claimed on your federal income tax return to qualify). Enrollment in the health plan is not required to participate in the FSA. Health Care FSA Debit Card If you enroll in the Health Care FSA, you will use a Flores Debit Card to pay for eligible health care expenses at participating merchant locations. By using the Flores Debit Card, you do not have to file for reimbursement on your Health Care FSA claims. However, you may be asked to provide your receipt. You will be able to view and manage your Debit Card account on the Flores participant website, You should keep your receipts and invoices for payments made with your Flores Debit Card, as you may be required to provide documentation to Flores to verify the eligibility of certain transactions. If requested, you may submit your documentation to Flores by uploading it to your online account, using the e-receipt mobile application, or sending it by fax or mail. If this is the first time enrolling in the Health Care FSA, you will receive a Flores Debit Card at your home address in a plain white envelope. If you already have a debit card, and the card is less than three years old, you will not receive a new debit card and your new election amount will be loaded onto the card effective January 1, If you are newly enrolling, or your card is three years old, you will receive a new Debit Card. $500 Health Care FSA Rollover AAA Carolinas has adopted the IRS rule to allow a participant to rollover the remaining funds in their Health Care FSA, up to $500, to the following plan year. This reduces your risk of forfeiting unused money you have contributed. The rollover feature does not impact your FSA maximum elections. If the full $500 were to rollover into the following plan year, and you elected to contribute the full $2,650 in that year, you would have a total of $3,100 available for reimbursement of eligible healthcare expense that year. The rollover feature does not apply to the Dependent Care FSA. Dependent Care FSA This account can NOT be used for the healthcare expenses of your dependents You can set aside money to pay for dependent care expenses so long as you (and your spouse) work or attend school fulltime. Eligible expenses, as determined by the IRS, are paid to qualified providers for the care of children under the age of 13 or other dependents not capable of self-care. (These dependents must be claimed on your federal income tax return.) Health Care Dependent Care Minimum Annual Savings $100 $100 Maximum Annual Savings $2,650 $5,000 Rollover Option (if you don t spend all your savings) BENNY Card (credit card to pay for qualified expenses) Yes, up to $500 Can You Change or Enroll Anytime of the Year Not without a Qualifying Event Not without a Qualifying Event Pre-tax Savings Yes Yes Annual Amount Available on January 1, 2018 Yes No, is reimbursement only Visit to access worksheets to help you calculate how much YOU should save in You can also access this link at support@myaaacarolinas.com. Yes No No AAA Carolinas 15

18 What makes us, us