Start Your Adventure. Benefit Enrollment Guide BENEFIT ENROLLMENT CENTER

Transcription

1 Start Your Adventure Benefit Enrollment Guide 207 BENEFIT ENROLLMENT CENTER Monday Friday, 0 a.m. 8 p.m. EST Saturday, 0 a.m. 2 p.m. EST ENROLL ONLINE

2 BENEFITSOPENENROLLMENT As a Source4Teachers/MissionOne employee you are eligible to enroll in benefits for the plan year. Employees can choose from four different methods to enroll: Call the Enrollment Center, Online through the Employee Portal, Schedule an appointment with our Convenient Appointment Scheduler, or Receive a Call from benefits counselor. Open Enrollment runs from July 3, 207 to August 25, 207. SCHEDULE AN APPOINTMENT BENEFIT ENROLLMENT CENTER Monday Friday, 0 a.m. 8 p.m. Sat., 0 a.m. 2 p.m. Eastern Time ENROLL ONLINE All employees MUST speak with a benefits counselor to elect or waive benefits. If you do not participate, you will not be eligible to receive benefits until the next open enrollment period. Who iseligible Employees: All Current Employees of Source4Teachers and MissionOne Dependents: Your legal spouse Your children up to age 26 Your children over age 26 who are not able to support themselves due to a physical or mental disability Only those dependents meeting the eligibility requirements can enroll for coverage. Check with your counselor for more information regarding dependent eligibility. What You ll Need: During your enrollment session, you will be asked to provide or verify: Your full name, date of birth, and Social Security number The full names, dates of birth, and Social Security numbers of any dependents you wish to enroll The full name, date of birth, and Social Security number of your life insurance beneficiary Secondary Method of Payment (Credit Card, EFT Bank Draft)

3 Medical Minimum Essential Coverage (MEC) The Minimum Essential Coverage (MEC) Plan provides coverage for preventive and wellness services as required by the federal government. Covered services are listed on the next page. Plan Pays 00% of the 63 required preventive services when you utilize a First Health Network provider Minimum Essential Coverage (MEC) 5 Preventive Services for Adults 22 Preventive Services for Women 26 Preventive Services for Children Basic Advantage Total Plan Plan and Plan 2 Plans include the Minimum Essential Coverages (MEC) OUTPATIENT BENEFITS PLAN PLAN 2 Doctor VisitBenefits: Daily Benefit for a New Patient Office Visit Daily Benefit for an Established Patient Office Visit Daily Benefit for a Consultation Office Visit Daily Benefit for an Emergency Room Doctor Visit RadiologyBenefits: Daily Benefit for a Magnetic Resonance Imaging (MRI) Daily Benefit for a Computerized Tomography (CT) Scan Daily Benefit for all other Radiology Services PathologyBenefits: Daily Benefit for all Pathology Services Wellness Care Visit Benefits: Daily Benefit for an Annual Physical Daily Benefit for a Mammogram Screening Daily Benefit for a Prostate or Cervical Cancer Screening Emergency Room Visit Benefits: Daily Benefit for the treatment of an Accidental Injury Daily Benefit for the treatment of a Sickness $75 per day $60 perday 3 $75 perday $00 perday $40 perday 2 $40 perday 2 $75 perday $35 perday $500 perday 2 3 $75 per day $60 perday 4 $75 perday $75 perday $00 perday $40 perday 4 $40 perday 4 $75 perday $35 perday $500 perday 2 3 Maximum Surgery Benefit Per Procedure 4 $500 perday $750 perday Maximum Anesthesia Benefit 5 $00 perday Prescription Drug Benefits: Daily Benefit per Generic Drug Prescription (filled or refilled) 4 Benefits for covered outpatient surgery are scheduled and range from $4 to $500 under Plan and from $4 to $750 under Plan 2 based on the specific surgical procedure performed. 5 Benefits for covered outpatient anesthesia vary and are equal to 20% of the applicable outpatient surgery benefit. $25 perday 7 $25 perday 2

4 Medical INPATIENT HOSPITAL BENEFITS PLAN PLAN 2 Hospital Room & Board Benefits: Daily Benefit for the Treatment of Mental & Nervous Conditions Daily Benefit for the Treatment of Alcohol & Substance Abuse Daily Benefit for the Treatment of All Other Covered Conditions Hospital Admission Benefit For Specified Conditions: Daily Benefit for Cancer (Malignant Neoplasm) Daily Benefit for Heart Attack (Myocardial Infarction) Daily Benefit for Heart Disease Daily Benefit for Accidental Injury Daily Benefit for Stroke (Cerebrovascular Accident - CVA) $00 perday 25 $00 perday 25 $00 perday 90 $2,000 per day $,500 per day $,000 per day $,000 per day $,000 per day $00 perday 25 $00 perday 25 $300 perday 90 $2,000 per day $,500 per day $,000 per day $,000 per day $,000 per day Daily Benefit for Childbirth $,000 per day $,000 per day Maximum Surgery Benefit Per Procedure 2 $500 per day $750 per day Maximum Anesthesia Benefit 3 $00 per day $50 per day The Hospital Admission Benefit is payable for either Heart Attack or Heart Disease during a coverage year, but not both. 2 Benefits for covered inpatient surgery are scheduled and range from $9 to $500 under Plan and from $9 to $750 under Plan 2 based on the specific surgical procedure performed. 3 Benefits for covered inpatient anesthesia vary and are equal to 20% of the applicable inpatient surgery benefit. Weekly Rates PLAN PLAN 2 Employee $24.48 $29.97 Employee + Spouse $48.28 $59.87 Employee + One Child $39.39 $47.63 Employee + Children $64.92 $78.8 Family $83.40 $0.85

5 Covered Services For Adults. Abdominal Aortic Aneurysm one-time screening for men of specified ages who have ever smoked 2. Alcohol Misuse screening and counseling 3. Aspirin use for men and women of certain ages 4. Blood Pressure screening for all adults 5. Cholesterol screening for adults of certain ages or at higher risk 6. Colorectal Cancer screening for adults over Depression screening for adults 8. Type 2 Diabetes screening for adults with high blood pressure 9. Diet counseling for adults at higher risk for chronic disease 0. HIV screening for all adults at higher risk. Immunization vaccines for adults - doses, recommended ages, and recommended populations vary: Hepatitis A,Hepatitis B, Herpes Zoster, Human Papillomavirus, Influenza (Flu Shot), Measles, Mumps, Rubella,Meningococcal, Pneumococcal, Tetanus, Diphtheria, Pertussis, Varicella 2. Obesity screening and counseling for all adults 3. Sexually Transmitted Infection (STI) prevention counseling for adults at higher risk 4. Tobacco Use screening for all adults and cessation interventions for tobacco users 5. Syphilis screening for all adults at higher risk Covered Preventive Services for Women, Including Pregnant Women. Anemia screening on a routine basis for pregnant women 2. Bacteriuria urinary tract or other infection screening for pregnant women 3. BRCA counseling about genetic testing for women at higher risk 4. Breast Cancer Mammography screenings every to 2 years for women over Breast Cancer Chemoprevention counseling for women at higher risk 6. Breastfeeding comprehensive support and counseling from trained providers, as well as access to breastfeeding supplies, for pregnant and nursing women 7. Cervical Cancer screening for sexually active women 8. Chlamydia Infection screening for younger women and other women at higher risk 9. Contraception: Food and Drug Administration-approved contraceptive methods, sterilization procedures, and patient education and counseling, not including abortifacient drugs 0. Domestic and Interpersonal Violence screening and counseling for all women. Folic Acid supplements for women who may become pregnant 2. Gestational Diabetes screening for women 24 to 28 weeks pregnant and those at high risk of developing gestational diabetes 3. Gonorrhea screening for all women at higher risk 4. Hepatitis B screening for pregnant women at their first prenatal visit 5. Human Immunodeficiency Virus (HIV) screening and counseling for sexually active women 6. Human Papillomavirus (HPV) DNA Test: high risk HPV DNA testing every three years for women with normal cytology results who are 30 or older 7. Osteoporosis screening for women over age 60 depending on risk factors 8. Rh Incompatibility screening for all pregnant women and follow-up testing for women at higher risk 9. Tobacco Use screening and interventions for all women, and expanded counseling for pregnant tobacco users 20. Sexually Transmitted Infections (STI) counseling for sexually active women 2. Syphilis screening for all pregnant women or other women at increased risk 22. Well-woman visits to obtain recommended preventive services Covered Preventive Services for Children. Alcohol and Drug Use assessments for adolescents 2. Autism screening for children at 8 and 24 months 3. Behavioral assessments for children of all ages; Ages: 0 to months, to 4 years, 5 to 0 years, to 4 years, 5 to 7 years 4. Blood Pressure screening for children: Ages: 0 to months, to 4 years, 5 to 0 years, to 4 years, 5 to 7 years 5. Cervical Dysplasia screening for sexually active females 6. Congenital Hypothyroidism screening for newborns 7. Depression screening for adolescents 8. Developmental screening for children under age 3, and surveillance throughout childhood 9. Dyslipidemia screening for children at higher risk of lipid disorders; Ages: to 4 years, 5 to 0 years, to 4 years, 5 to 7years 0. Fluoride Chemoprevention supplements for children without fluoride in their water source. Gonorrhea preventive medication for the eyes of all newborns 2. Hearing screening for allnewborns 3. Height, Weight and Body Mass Index measurements for children; Ages: 0 to months, to 4 years, 5 to 0 years, to 4 years, 5 to 7 years 4. Hematocrit or Hemoglobin screening for children 5. Hemoglobinopathies or sickle cell screening for newborns 6. HIV screening for adolescents at higher risk 7. Immunization vaccines for children from birth to age 8 - doses, recommended ages, and recommended populations vary: Diphtheria, Tetanus, Pertussis, Haemophilus influenzae type b, Hepatitis A, Hepatitis B, Human Papillomavirus, Inactivated Poliovirus, Influenza (Flu Shot), Measles, Mumps, Rubella, Meningococcal, Pneumococcal, Rotavirus, Varicella 8. Iron supplements for children ages 6 to 2 months at risk for anemia 9. Lead screening for children at risk of exposure 20. Medical History for all children throughout development; Ages: 0 to months, to 4 years, 5 to 0 years, to 4 years, 5 to 7 years 2. Obesity screening and counseling 22. Oral Health risk assessment for young children; Ages: 0 to months, to 4 years, 5 to 0 years. 23. Phenylketonuria (PKU) screening for this genetic disorder in newborns 24. Sexually Transmitted Infection (STI) prevention counseling and screening for adolescents at higher risk 25. Tuberculin testing for children at higher risk of tuberculosis; Ages: 0 to months, to 4 years, 5 to 0 years, to 4 years, 5 to 7 years. 26. Vision screening for allchildren

6 Dental Source4Teachers/MissionOne offers dental coverage to you and your dependents. Plan highlights are outlined below. Types of Charges Covered by the Plan Percent of Charges the Plan Pays Waiting Period of Continuous Enrollment Before Plan Pays Checkups & RoutineCleaning 80% None BitewingX-Rays 80% None Sealants (forchildren) 80% None Fluoride Treatments (for children) 80% None Space Maintainers (for children) 80% None Fillings 60% 3Months Crown & BridgeRepair 60% 3Months DentureRepair 60% 3Months OralSurgery 60% 3Months Endodontics (root canal & pulpal therapy) 60% 3Months Periodontics (treatment of gums) 50% 2Months Crowns & Bridges 50% 2Months Dentures 50% 2Months Dental Weekly Rates Employee Only $4.45 Employee + Family $2.75

7 Vision Source4Teachers/MissionOne offers vision coverage to you and your dependents. Plan highlights are outlined below. Exam Services Benefits through a VSP Network Provider Comprehensive WellVision Exam covered in full* Routine retinal screening covered after a no more than $39 copay Lenses Glass or plastic single vision, lined bifocal, lined trifocal, or lenticular lenses are covered in full* Lens Enhancements Most popular lens enhancements are covered after a copay, saving our members an average of 20-25% Lens Enhancement Anti-reflective coating Polycarbonate Progressive Photochromic Scratch-resistant coating Single Vision $4 $3 N/A $70 $7 Multifocal $4 $35 $55 $82 $7 Prices above reflect standard lens enhancement selections; premium or custom lens enhancements may also be available at an additional cost. Polycarbonate lenses for children are covered in full Frame Frames covered in full* up to the retail allowance of $50. Costco Optical allowance of $0 is equivalent to the frame allowance at VSP doctor locations and participating retail chains. Members who select a featured frame brand, including Anne Klein, bebe, Calvin Klein, Flexon, Lacoste, Nike, Nine West and more, will receive an extra $20 toward their frame allowance Featured frame brands and promotion subject to change, promotion doesn t apply to Costco Optical. 20% off any amount above the retail allowance Members can choose from virtually any frame on the market Additional Pairs of Glasses Within 2 months of exam: 20% off unlimited additional pairs of prescription glasses and/or nonprescription sunglasses from any VSP doctor Get up to $0 back Members can save big with VSP exclusive mail-in rebates on eligible popular contact lens brands from Bausch + Lomb and CooperVision. $500 savings on LASIK Members can save up to $500 on LASIK at NVision Eye Centers and TLC Laser Eye Centers. Save up to $2,500 With Exclusive Member Extras, members can save more than $2,500 with special offers and rebates through VSP and other leading industry partners. Learn More Visit vsp.com/specialoffers.

8 Vision Elective Contact Lenses Contact lens exam (fitting and evaluation): Standard and Premium fits are covered in full after copay. Member receives 5% off of contact lens exam services and member's copay will never exceed $60 Prescription contact lens materials are covered in full up to the retail allowance of $30 (in lieu of frame & lenses) Members can choose from any available prescription contact lens materials VSP Diabetic EyeCare Plus ProgramSM VSP Laser VisionCare SM Program Additional coverage for members with diabetic eye disease, glaucoma or age-related macular degeneration $20 copay per visit Discounts average 5-20% off or 5% off a promotional offer for laser surgery, including PRK, LASIK, Custom LASIK, and IntraLase Discounts are only available from VSP-contracted facilities. Also custom LASIK coverage only available using wavefront technology with the microkeratome surgical device, other LASIK procedures may be performed at an additional cost to the member. Low Vision Pre-approved low vision supplemental testing covered every two years 75% coverage for approved low vision aids, up to $,000 (less any amount paid for supplemental testing) every two years Out-of- Network Schedule We offer a generous reimbursement schedule for services from other providers Exam Single Vision Lenses Lined Bifocal Lenses Lined Trifocal Lenses Frame Elective contact lenses (in lieu of lenses and frame) $45 $30 $50 $65 $70 $05 Vision Weekly Rates Employee Only $.58 Employee + $3.6 Employee + Family $5.08

9 Life & Disability Term Life Plan with Accidental Death Benefit Plan provides $20,000 of term life coverage for you, with an additional matching $20,000 in the event of accidental death. Your benefits reduce by 50% when you reach age 70. Your benefits will be paid in equal shares to members of the first surviving beneficiary class, as follows: spouse; children; parents; brothers and sisters; or, if none, your estate. If you sign up for this benefit, you can add term life coverage for your spouse and each child (older than 6 months) in the amount of $5,000. Coverage amount for children 6 months of age or younger is $500. Spouse coverage ends at age 70. You are the beneficiary for spouse and child term life coverage. Term life benefits are not payable for death during the first 2 years of coverage if due to suicide or attempted suicide. Short-Term Disability Plan* Plan provides weekly benefits for up to 26 weeks of disability. The amount paid is 50% of base pay, up to a maximum of $25 per week. Disability must be due to a sickness or an injury from an accident that happens while you are covered. You must become totally disabled while covered and, if due to an injury, within 90 days of the date of the accident. If you are hospitalized, the benefits are payable immediately; otherwise, the benefits begin after a 4-day elimination period. Benefits reduce by 50% when you reach age 70. * STD coverage is only available to you. There is no dependent coverage available. Term Life Weekly Rates Employee $.50 Employee + Family $.90 Short Term Disability Weekly Rates Employee $3.50

10 Critical Illness About in every 6 healthcare dollars is spent on cardiovascular disease.* Chances are you know someone who s been diagnosed with a critical illness such as cancer, a heart attack (myocardial infarction), or stroke. You can t help but notice the strain it s placed on the person s life both physically and emotionally. What s not so obvious is the impact on that person s personal finances. While the person is busy getting well, the bills may continue to pile up. WOULD YOU HAVE THE MONEY TO COVER THE OUT-OF-POCKET EXPENSES SUCH AS: Transportation to a distant medical facility. Specialized treatment costs. Living expenses like rent, mortgage, and utility bills. Aflac pays cash benefits directly to you, unless you choose otherwise. This means that you will have added financial resources to help with medical costs or ongoing living expenses. Aflac group critical illness insurance plans** are designed to provide you with cash benefits, such as the following: Pays a lump sum benefit for a covered critical illness: cancer, heart attack, and stroke. ENROLL TODAY Ask your Aflac agent how group critical illness insurance can help you. Remember, we re always by your side, and you re always under our wing. *Business Pulse, Heart Health Infographic, 206 CDC Foundation **This is a brief product overview only. Products and benefits vary by state and may not be available in some states. Plan design and optional benefits are selected at the employer level. The plan has limitations and exclusions that may effect benefits payable. Refer to the plan for complete details, limitations, and exclusions. In Arkansas, Policy CAI2800AR or C200AR. In New York, Policy AF2800NY. In Oklahoma, Policy CAI2800OK or C200OK. In Oregon, CAI2800OR or C200OR. In Pennsylvania, CAI2800PA 2-0 or C200PA. In Texas, CAI2800TXrev or C200TX. In Virginia, CAI2800VA or C200VA. Continental American Company is not aware of whether any employees receive benefits from Medicare, Medicaid, or a state variation. If any employees or dependents are subject to Medicare, Medicaid, or a state variation, any and all benefits under this plan could be assigned. This means that any such employees may not receive any of the benefits in the plan. As a result, employees should please check the coverage in all health insurance policies those employees already have or may have before such employees buy this insurance to verify the absence of any assignments or liens. Notice to Consumer: The coverages provided by Continental American Company (CAIC) represent supplemental benefits only. They do not constitute comprehensive health insurance coverage and do not satisfy the requirement of minimum essential coverage under the Affordable Care Act. CAIC coverage is not intended to replace or be issued in lieu of major medical coverage. It is designed to supplement a major medical program. *Rates are based off of age and will be provided at the time of application

11 Accident What would the financial impact of an injury mean to you? Are you prepared for high medical costs in addition to everyday household expenditures and lost wages? Out- of-pocket expenses associated with an accident are unexpected, but an accident s impact on your finances and your wellbeing certainly can be reduced. Aflac is here to help. If you have an accident, major medical insurance will help with many medical expenses, but you could be left with out-ofpocket expenses. You could also lose pay while you re out of work. And you can be sure that the bills will keep coming. Aflac pays cash benefits directly to you, unless you choose otherwise. This means that you will have added financial resources to help with medical costs or ongoing living expenses. Aflac group accident insurance plans are designed to provide you with cash benefits throughout the different stages of care, such as the following: Emergency treatment Hospital admission Intensive care unit Ambulance transportation Travel expenses to distant treatment centers Everyday living expenses, like your rent or mortgage, utility bills, groceries, and more Ask your Aflac agent how group accident insurance can help you. Remember, we re always by your side, and you re always under our wing. Accident Weekly Rates Employee Only $3.06 Employee + Spouse $5.33 Employee + Children $7.4 Employee + Family $9.69

12 Whole Life Aflac group whole life insurance helps take care of your loved ones immediate and future needs if you should pass away. Immediate needs can include burial/funeral expenses, uninsured medical costs and current bills and debts. Future needs could include income replacement, education plans, ongoing family obligations, emergency funds, and retirement expenses. This plan also builds cash value. Aflac pays cash benefits directly to you, unless otherwise assigned. This means that your family will have added financial resources to help with ongoing living expenses. Aflac group whole life insurance plans** are designed to provide you with cash benefits such as the following: Up to $300,000 of Whole Life coverage Waiver of premium Accidental death benefit Accelerated benefit ENROLL TODAY Ask your Aflac agent how Whole Life can help you. Remember, we re always by your side, and you re always under our wing.