We Make it Easy to Provide Your Employees With a Complete Benefits Package.

Transcription

1 This coverage is not insurance and the Idaho AGC Self-funded Benefit Trust does not participate in the state Guarantee Association. We Make it Easy to Provide Your Employees With a Complete Benefits Package. This benefit summary prepared by IDAGCBR2018

2 2 11 The Idaho Associated General Contractors is a full-service, member driven trade association representing the full range of commercial construction In Idaho, spanning to every corner of the state. Idaho AGC Membership Benefits Include: The state s only statewide online plan room and network or physical plan rooms Innovative and competitively priced health plan Affordable retirement alternatives Multiple networking events aimed at strengthening relationships within the industry Lobbying-on the local, state, and federal levels Safety and environmental training programs Special discounts on multiple services including-cell phones, shipping and the purchase of supplies and new vehicles from nationally recognized leaders and a well-developed network of local suppliers The Idaho AGC is governed by a Board of Directors including a five-member Executive Committee and representatives from General Contractors, Specialty Contractors and Supplier/Associate members. Much of the day-to-day functions of the Idaho AGC are carried out by committees made up of members from all membership classifications including the Highway, Building and Legislative committees. The Idaho AGC supports an active chapter of the Construction Leadership Council and student chapters at Boise State University and Brigham Young University Idaho. The Idaho AGC operates the Idaho. AGC Education Foundation and Idaho AGC Health Trusts. In addition it participates in the Northwest AGC Retirement Plan, Idaho Transportation Coalition, Idaho Association of Commerce and Industry, and multiple other coalitions. Gain a competitive advantage through a health plan designed specifically for the construction industry and support your business. The combination of the Idaho AGC membership and a competitive health coverage program is a smart choice for employers and their employees. We offer medical, dental, vision, life and shortterm disability and EAP benefits. Let us take the burden off of you by ensuring your plan is compliant with the ever changing landscape of health insurance requirements. For a no-obligation quote or to learn more about our services, contact us at or visit Blue Cross of Idaho, a non-profit mutual insurance company based in Meridian, Idaho is a leader in delivering innovative health insurance products, services and information to more than 821,000 members. For 72 years, the company has advocated on behalf of its members to ensure they have access to high-quality healthcare at the lowest possible cost. It also serves the people of Idaho through support of community organizations programs and events that promote good health. Blue Cross of Idaho is an independent licensee of the Blue Cross and Blue Shield Association. For more information, visit Delta Dental of Idaho is the leading dental benefits carrier in the state, providing quality, affordable dental plans. We offer the best-in-class customer service with real dental experts answering calls in 13 seconds or less. Delta Dental members have access to the country s most extensive network of dentists and over 356,000 dental offices available nationwide. For more information, visit Who to Contact for a Quote Idaho AGC Health Plan gsinclair@idahoagc.org Online: Your broker Call us for a referral to an appointed AGC Broker Notes

3 10 3 Optional Accident Insurance Accident insurance coverage provides a cash benefit when an insured is injured due to a covered Accident. Available to all employees in an eligible class, from age 17 to 80. Employees may purchase Optional Accident Insurance. Employers deduct the premium for the Optional Insurance from the employee s paycheck. Benefit Amount Cash benefit based on service or injury type. See schedule for specific details. Employee Assistance Plan (EAP) Provided by BPA Health Benefits are available to the employee and all immediate family members. Up to 3 sessions per incident per benefit year. Premium is included in medical rates. Issues include: Personal Stress, anxiety, depression, grief, drug or alcohol use Relationship Marriage, separation or divorce, family, parenting, domestic abuse Work Anger management, job change, co-worker conflicts, ethics Legal & Financial Wills, budgeting, financial planning, divorce, identity theft protection and recovery Providing personalized eye care for you and your family; Offering an annual eye exam and wide selection of affordable and stylish eyewear; Exclusive member savings on Lasik, TruHearing services and more. Lincoln Financial Group partners with the Idaho AGC to provide financial protection in life s tough times. Members of the AGC have access to life insurance provided by the organization along with the opportunity to purchase additional life insurance coverage. As a member you also have access to paycheck protection by way of Short Term Disability. BPA Health is a Boise, Idaho behavioral health and managed services company that connects people to services to make lives better, organizations more effective and communities stronger. Working throughout the Northwest and Nationally, BPA Health helps people address problems that adversely impact their personal relationships, job performance, health and overall wellbeing. For more information, visit or call For more information contact Idaho AGC Health Plan at or gsinclair@idahoagc.org jlarsen@idahoagc.org For more information, contact Tina Taylor at or tina.taylor@bpahealth.com

4 4 9 Benefits Overview Since 1986, the Idaho AGC Health Plan has offered stable and secure health care benefits to all Idaho AGC members. We work closely with federal and state regulators to ensure our plan meets all requirements and provides the best possible value for our members. We take the burden off your shoulders by ensuring the AGC plan benefits are compliant with the rapidly changing insurance landscape. Benefit Plans Offered Medical Dental Vision Life Insurance Accidental Death & Dismemberment (AD&D) Insurance Optional Life Core Short-Term Disability Optional Short-Term Disability Buy-up Optional Accident Employee Assistance Program (EAP) Eligibility To qualify as a group, an Employer must have a minimum of two full-time employees. An eligible employee is one that has completed their probationary period and is actively working 30 or more hours per week. Eligible dependents include legal spouse, children under age 26 and disabled children of any age. Basic Life and Accidental Death & Dismemberment (AD&D) Insurance Life Insurance Beneficiaries will receive a lump-sum payment if the employee dies while their employer participates in the AGC Health Plan. Premium for Basic Life insurance of $25,000 is included in the medical rates. Spouse/Child Life Insurance $5,000 for spouse and children, 14 days but less than 26 years of age (unmarried). Premium is included in medical rates. Accidental Death and Dismemberment (AD&D) Insurance Accidental Death and Dismemberment (AD&D) insurance provides payment to you or your beneficiaries if you lose a limb or die in an accident. Premium for AD&D insurance of $25,000 is included in the medical rates. This coverage is in addition to your company-paid life insurance described above. Optional Life Employees may purchase life insurance in addition to the company-provided coverage. They may also purchase life insurance for their dependents if they purchase additional coverage for themselves. Employees are guaranteed coverage (up to $100,000 and up to $50,000 for your spouse) without answering medical questions if they enroll when they are first eligible. Employee Up to $100,000 in increments of $25,000 Spouse Up to $50,000 (limited to 50% of employee amount) in increments of $5,000 Children $2,000 Core Short-Term Disability Insurance (STD) Short-Term Disability (STD) insurance is included for all employees enrolled in the Idaho AGC Health Plan. The coverage replaces a portion of lost income in the event of a covered accident, sickness, and includes partial disability and portability. Benefits begin on the 15th day of any injury, hospitalization, or illness and can continue for up to 13 weeks. Benefit Amount 100% of weekly salary up to $125 per week. Optional Buy-Up Short-Term Disability Insurance (STD) In addition to Core Short-Term Disability Insurance, employees may purchase additional Short-Term Disability coverage. The amount of coverage that may be purchased is determined by the employee s annual income. Employers deduct the premium for the optional insurance from the employee s paycheck. All full-time employees earning a minimum of $26,000 annually: Benefit Amount $200 per week All full-time employees earning a minimum of $43,333 annually: Benefit Amount $400 per week

5 8 5 Dental Benefits Administered by Delta Dental of Idaho Good oral care enhances overall physical health, appearance, and mental well-being. Problems with teeth and gums are common and easily treated health problems. Keep your teeth healthy and your smile bright with the Idaho AGC dental benefit plan. Employees may choose to receive services from a PPO or Premier Network provider. An employee s out-of-pocket expenses are generally less when receiving services from a PPO provider. Annual Deductible Individual/Family Included in Deluxe Plans Only Dental Benefits PPO Premier $50/$150 $50/$150 Annual Benefit Maximum $1,000 $1,000 Preventive Dental Services (cleanings, exams, x-rays) 100% 80% Our Services Benefit Advocacy Your employee s benefits are a large part of their compensation package. When an employee or their family members needs to use those benefits it can, in some cases be a confusing process. Whether finding a network provider, explaining an explanation of benefits versus the provider s billing statement, or how to file a disability claim the healthcare maze can be confusing to participants. We help you: Explanation of benefits Locating a provider Ordering ID cards Compliance Today s changing regulatory environment creates ongoing risks for your organization. We provide guidance and expertise to help you: Improve compliance Mitigate risk Make timely, informed business decisions by presenting complex information in a way that is understandable and Actionable. Basic Dental Services (fillings, root canals, extractions, minor oral surgery) 80% 80% Resolving claims issues Enrollment questions Major Dental Services (crowns, onlays, bridges, dentures) Orthodontic Services 50% 50% Delta Dental of Idaho Subscribers and their eligible dependents can receive a discounted fee for adult and child orthodontia treatment if they obtain services form a Delta Dental Discount Program orthodontist in Idaho. Vision Insurance Administered by VSP Regular eye examinations can not only determine your need for corrective eyewear but also may detect general health problems in their earliest stages. Protection for the eyes should be a major concern to everyone. in Plans Included in Deluxe Plans Only Vision Benefits (Any VSP Provider) Out-of-Network Reimbursement Eye Exam once every 12 months $10 copayment Up to $45 allowance Lenses once every 12 months Single Vision Lenses $20 copayment Up to $30 allowance Lined Bifocal Lenses $20 copayment Up to $50 allowance Lined Trifocal Lenses $20 copayment Up to $65 allowance Frames once every 24 months Covered up to $150 allowance Up to $70 allowance Consolidated Billing Offering a comprehensive employee benefits package means working with a variety of carriers and vendors. Each has different accounting and invoicing methods that result in hours of reconciliation work. The Idaho AGC Health Plan prepares a single consolidated monthly billing statement. COBRA Administration The rules and regulations governing COBRA are complex and, for most employers, confusing and time consuming. However, non-compliance may result in costly regulatory penalties assessed by both the IRS and the Department of Labor. Our experienced, knowledgeable staff makes regulatory compliance easy. At no additional cost, our full-service COBRA administration guarantees compliance with all State and Federal regulations. Contact Lenses once every 12 months if you elect contacts instead of lenses/frames Up to $60 copayment covered up to $150 allowance Up to $105 allowance

6 6 7 Medical Plan Options Administered by Blue Cross of Idaho Comprehensive and preventive healthcare coverage is important to protect you and your family from the financial risks of unexpected illness and injury. A little prevention usually goes a long way especially in healthcare. Routine exams and regular preventive care provide an inexpensive review of your health. Small problems can potentially develop into large expenses. By identifying the problems early, often they can be treated at little cost. Comprehensive healthcare also provides peace of mind. In case of an illness or injury, you and your family are covered with an excellent medical plan through Idaho AGC. Idaho AGC offers you a choice of six (6) PPO medical plans, two (2) prescription drug options and one (1) High Deductible Health Plan. With the PPO, you may select where you receive your medical services. If you use in-network providers, your costs will be less.* $1,000 Deductible Plan $1,500 Deductible Plan $2,500 Deductible Plan $3,000 Deductible Plan $4,500 Deductible Plan $3,000 High Deductible Health Plan Annual Deductible Individual/Family In-Network Out-of-Pocket Maximum Individual/Family (includes copays, coinsurance and prescription drugs) In-Network Out-of-Network In-Network Out-of-Network In-Network $1,000/$2,000 $1,500/$3,000 $2,500/ /$5,000 $3,000/$6,000 $4,500/$9,000 $3,000/$6,000 $6,500/$13,000 $13,000/26,000 $6,500/$13,000 $13,000/$26,000 $6,500/$13,000 Coinsurance You pay 25% You pay 25% You pay 25% Office Visits Preventive Services Emergency Services Maternity and/or Involuntary Complications of Pregnancy copay for hospital visit, then you pay 25% visit, then you pay 45% after visit, then you pay 25% PRESCRIPTION DRUGS COVERAGE IN & OUT-OF-NETWORK (*denotes participant cost after ) visit, then you pay 45% after visit, then you pay 25% Option 1 Option 2 Option 1 Option 2 Option 1 Option 2 Option 1 Option 2 Option 1 Option 2 Deductible No Deductible $250 Deductible No Deductible $250 Deductible No Deductible $250 Deductible No Deductible $250 Deductible No Deductible $250 Deductible Preferred Generic Drugs $7 Copayment $10 Copayment $7 Copayment $10 Copayment $7 Copayment $10 Copayment $7 Copayment $10 Copayment $7 Copayment $10 Copayment Non-Preferred Generic Drugs $7 Copayment $10 Copayment $7 Copayment $10 Copayment $7 Copayment $10 Copayment $7 Copayment $10 Copayment $7 Copayment $10 Copayment Preferred Brand Name Drugs 30% 30% up to $50/Rx* 30% 30% up to $50/Rx* 30% 30% up to $50/Rx* 30% 30% up to $50/Rx* 30% 30% up to $50/Rx* Non-Preferred Brand Name Drugs 50% 50% up to $100/Rx* 50% 50% up to $100/Rx* 50% 50% up to $100/Rx* 50% 50% up to $100/Rx* 50% 50% up to $100/Rx* Preferred Specialty Drugs 30% 30% up to $225/Rx* 30% 30% up to $225/Rx* 30% 30% up to $225/Rx* 30% 30% up to $225/Rx* 30% 30% up to $225/Rx* Non-Preferred Specialty Drugs 50% 50% up to $275/Rx* 50% 50% up to $275/Rx* 50% 50% up to $275/Rx* 50% 50% up to $275/Rx* 50% 50% up to $275/Rx* *This summary describes general features of this program: all provisions of the Group Master Plan apply to this program. Out-of-Network In-Network Out-of-Network In-Network Out-of-Network In-Network Out-of-Network $13,000/$26,000 $5,000/$10,000 $10,000/$15,000 $6,500/$13,000 $13,000/$26,000 $6,500/$13,000 You pay 25% You pay 25% visit, then you pay 45% after 25% 45% after specifically listed 25% 45% after Subject to Deductible & Coinsurance Subject to Deductible & Coinsurance specifically listed 25% Combined In and Out-of-Network Subject to Deductible & Coinsurance 45% after Prescription drugs are subject to the medical, coinsurance and outof-pocket.