Portland Cement Association 2016 Health Insurance Open Enrollment. Benefit Plan Year: January 1 st, December 31 st, 2016

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1 Portland Cement Association 2016 Health Insurance Open Enrollment Benefit Plan Year: January 1 st, December 31 st, 2016

2 WHAT IS OPEN ENROLLMENT? Open enrollment is your once a year opportunity to make changes to your benefit elections. Going forward, your benefits will renew on January 1 st. Outside of open enrollment, you may not be permitted to make any changes to your benefits until the next open enrollment unless you have a Qualifying Event during the benefit year. Qualifying Events include: Birth or Adoption Marriage or Divorce Spouse losing or gaining coverage under their employer s plan If you experience a qualifying event, you will have 30 days from that event to add or drop coverage for you and your dependents under your Employer s plan. 2

3 PORTLAND CEMENT ASSOCIATION 2016 EMPLOYEE BENEFITS Medical Plans: BCBSIL PPO NEW: High Deductible Health Plan with a Health Savings Account Allstate Worksite Plans: Critical Illness Accident Hospital Dental Plan: MetLife PPO Vision Plan: NEW EyeMed Basic Life and AD&D: NEW Prudential Increased benefit from 1x salary to 2x salary up to $500,000 Long Term Disability: NEW Prudential Dependent Life and Voluntary Life: NEW Prudential Special enrollment opportunity 3

4 OPEN ENROLLMENT KEY DATES Open enrollment begins Tuesday, November 17 th Benefit elections are due Tuesday, November 24 th All elections valid for coverage: January 1 st, 2016 to December 31 st,

5 MEDICAL BCBSIL 5

6 MEDICAL: PPO PLAN Network: Participating Provider Organization Benefit In-Network Benefits* Individual Deductible $1,000 Family Deductible $3,000 Individual Out-of-Pocket Max Excludes prescription copays Family Out-of-Pocket Max Excludes prescription copays $1,500 $4,500 Preventive Care Covered at 100% Office Visit (PCP / Specialist) Urgent Care Emergency Room $25 / $50 Copay $50 Copay $150 Copay Inpatient Admission Deductible, then 20% Outpatient Services Deductible, then 20% Prescription Out-of-Pocket Max $1,000 Individual / $3,000 Family Retail Rx (Generic/ Preferred Brand/ Non-Preferred Brand) $10 / $40 / $60 Mail Order Rx (Generic/ Preferred Brand/ Non-Preferred Brand) $20 / $80 / $120 *To see out of network benefits, please review the applicable Benefit Summary or SBC. Should there be a discrepancy between these summaries and the actual plan document, the plan document will govern. 6

7 FLEXIBLE SPENDING ACCOUNTS The IRS allows you to set aside pre-tax dollars to use for qualified health and/or dependent care expenses Elections are annual and funds must be used during the 2016 calendar year. While there is a grace period of 3 months, funds do not roll over for use the following year. Employees will receive a debit card to use for qualified expenses. If you participated in 2015, you will use the same card you already have. Some claims will require you to submit documentation to substantiate the claim. They notify you via when that is needed. If you fail to submit the documentation, your account may be frozen and your claim denied. Medical Flexible Spending Account Can elect up to $2,550 a year Can be used for medical, dental and vision out of pocket expenses. Is an option if you are not enrolled in the PCA HSA plan. Dependent Care Flexible Spending Account Can elect up to $5,000 per household 7

8 MEDICAL: HIGH DEDUCTIBLE HEALTH PLAN WITH HSA Network: Participating Provider Organization Benefit In-Network Benefits* Individual Deductible $2,600 Family Deductible $5,200 Employer HSA Funding (Deposited in January) $250 Individual / $500 Family Individual Out-of-Pocket Max $2,600 Family Out-of-Pocket Max $5,200 Preventive Care Covered at 100% Office Visit (PCP / Specialist) Deductible, then covered at 100% Urgent Care Deductible, then covered at 100% Emergency Room Deductible, then covered at 100% Inpatient Admission Deductible, then covered at 100% Outpatient Services Deductible, then covered at 100% Retail Rx (Generic/ Preferred Brand/ Non-Preferred Brand) Deductible, then covered at 100% Mail Order Rx (Generic/ Preferred Brand/ Non-Preferred Brand) Deductible, then covered at 100% *To see out of network benefits, please review the applicable Benefit Summary or SBC. Should there be a discrepancy between these summaries and the actual plan document, the plan document will govern. 8

9 HSA ELIGIBILITY RULES To be eligible to open and contribute to an HSA, an individual must: Be covered by a high deductible health plan that meets IRS requirements Not be covered by another non-high deductible health insurance Not be enrolled in an Flexible Spending Account (FSA) Not be enrolled in Medicare, TRICARE or Veterans Administration (VA) health benefits Not be claimed as a dependent on someone else s tax return

10 HSA OVERVIEW Prescriptions Health Savings Account (HSA) allows you to contribute pretax dollars into a savings account for use on eligible health care expenses Office Visits Qualified expenses include deductibles, coinsurance, prescription drugs, dental care and vision care Medical plan premiums are not eligible for reimbursement. Hospital Services Dental expenses Claims for covered health care services can be paid from the HSA with check or debit card until the balance is spent 2016 HSA Contribution Limits $3,350 Individual* $6,750 Family* Vision expenses $1,000 Catch-up Contributions are allowed for individuals age 55 and older * Limits are inclusive of employer contributions 10

11 HSA HIGHLIGHTS You can use the money in the account to pay for medical expenses for yourself, spouse and children, even if they are not covered under the HDHP plan You own the account No use it or lose it rules you keep your contributions if you leave the company or change plans Balance remaining in account at year end rolls over to the following year Account earns interest and can be invested, over minimum balances Additional form needs to be filed with your income taxes You can change your paycheck contributions as needed You will only have access to the amount that is in your account at the time of a claim. You can reimburse yourself for out of pocket expenses once your account contains the funds for reimbursement Note: Carefully evaluate your own personal health and financial situation before deciding on your HSA contributions. Review the health care expenses you've had previously and consider what expenses you expect to incur in the upcoming plan year 11

12 CLAIMS EXAMPLE: LARGE CLAIMANT Total Cost Under PPO $1,000 Plan: Rx: (4x $ x $10) = $320 (Applied to Rx OPX) Office Visits: (8 x $25) = $200 Wellness/preventive Visits: (1x $0) = $0 Inpatient Surgery (1 X $50,000) = $1,300 ($1,500 Out of Pocket Maximum met) Annual Premium: = $1,908 Annual EE Total Cost: = $3,728 Total Cost Under HSA Plan: Rx: (4x $ x $5)* = $320 Office Visits: (8 x $150)** = $1,200 Wellness/preventive Visits: (1x $0) = $0 Inpatient Surgery (1 X $50,000) = $1,080 ($2,600 Deductible met) Employer HSA Contribution = -$250 Annual Premium: = $1,596 Annual EE Total Cost: = $3,946 Scenario: Single Coverage 4 Preferred and 16 Generic Prescriptions 8 Primary Care Office Visits 1 Wellness (routine) visit 1 inpatient surgery ($50,000) *Assumes generic script costs $5 and preferred costs $60 because participant incented to search for inexpensive prescriptions **Assumes office visit costs $150 per visit 12

13 CLAIMS EXAMPLE: MINIMAL CLAIMS (TYPICAL USER) Total Cost Under PPO $1,000 Plan: Rx: (4x $10) = $40 (applied towards Rx OPX) Office Visits: (2 x $20) = $40 (Applied towards OPX) Wellness/preventive Visits: (1x $0) = $0 Knee X-ray (1 X $85) = $85 (Applied towards ded.) Annual Premium: = $1,908 Annual EE Total Cost: = $2,073 Total Cost Under HSA Plan: Rx: (4x $5)* = $20 (Applied towards ded.) Office Visits: (2 x $150)** = $300 (Applied towards ded.) Wellness/preventive Visits: (1x $0) = $0 Knee X-ray (1 X $85) = $85 (Applied towards ded.) Employer HSA Contribution = -$250 Annual Premium: = $1,596 Scenario: Single Coverage 4 Generic Prescriptions 2 Primary Care Office Visits 1 Wellness (routine) visit 1 Knee X-Ray at hospital Annual EE Total Cost: = $1,751 (If you full funded your HSA, you still have $2,195 left for 2017) *Assumes generic script costs $5 because participant incented to search for inexpensive prescriptions **Assumes office visit costs $100 per visit 13

14 HOW DOES IT WORK? Maximize your contributions Annual Difference between the PPO and HSA Employee Only Employee + Spouse Employee + Child(ren) Family Annual PPO Premium Costs $1,908 $4,740 $4,536 $7,680 Annual HSA Premium Costs $1,596 $4,152 $3,996 $6,780 HSA Annual Difference in Premium $312 $588 $540 $900 Plus the HSA Employer Contribution For the same cost, this will be funded in your Health Savings Account! $250 $500 $500 $500 $562 $1,088 $1,040 $1,400 14

15 MEDICAL PLAN OPTIONS SIDE BY SIDE COMPARISON Benefit Individual Deductible Family Deductible Employer HSA Funding Individual OPX Family OPX Preventive Care Office Visit (PCP/Specialist) Urgent Care Emergency Room Inpatient Admission Outpatient Services Rx OPX Retail Rx Copays PPO Plan In-Network Benefits* $1,000 $3,000 n/a $1,500 $4,500 Covered at 100% $25 / $50 Copay $50 Copay $150 Copay Deductible, then 20% Deductible, then 20% $1,000 Individual / $3,000 Family $10 / $40 / $60 High Deductible Health Plan In-Network Benefits* $2,600 $5,200 $250 Employee / $500 Family $2,600 $5,200 Covered 100% Deductible, then covered at 100% Deductible, then covered at 100% Deductible, then covered at 100% Deductible, then covered at 100% Deductible, then covered at 100% N/A Deductible, then covered at 100% *To see out of network benefits, please review the applicable Benefit Summary or SBC. Should there be a discrepancy between these summaries and the actual plan document, the plan document will govern. 15

16 MEDICAL SEMI-MONTHLY COST COVERAGE TYPE Employee Employee & Spouse Employee & Child(ren) Family PPO $79.50 $ $ $ High Deductible Health Plan $66.50 $ $ $

17 HOW TO FIND AN IN-NETWORK PROVIDER OR HOSPITAL Go online to BCBSIL.COM and click Find a Doctor Call Customer Service at the number on the back of your ID Card OR talk with your Physician s Office 17

18 VOLUNTARY WORKSITE PRODUCTS ALLSTATE 18

19 ALLSTATE BENEFITS PCA offers Allstate Accident, Critical Illness and Hospital coverage for eligible employees through payroll deduction Employees can voluntarily purchase coverage for themselves and eligible dependents (spouse and children) New coverage and changes to existing coverage effective 01/01/16 Completed application is necessary to apply for coverage or change existing coverage Anyone hired prior to 01/01/15 will need to complete an application form with EOI questions to complete To enroll in one of these plans, please see HR for a form 19

20 ALLSTATE WORKSITE OVERVIEW When someone experiences a serious health event, they can be impacted financially in many ways. These include: Out-of-pocket medical expenses Reduced income from being disabled or taking off work Nonmedical costs associated with the event, such as travel, eating out and having to hire help for your home At a time when the family should focus on recovery from the medical event, increased expenses and reduced income can create a strain on the family budget as the monthly bills continue. With Allstate: Your family receives cash benefits paid directly to you, regardless of other insurance in place You can use those funds for any need you may have 20

21 VOLUNTARY ACCIDENT PLAN Off-the-job accidental injury protection for the employee and covered family members Indemnity benefits for initial and on-going treatment of injuries Benefits paid for ER treatment, diagnostic testing, follow-up treatment, physical therapy and more Daily hospitalization benefits for hospital stays and surgical benefits Accidental Death and Dismemberment benefits are also included Claim example: Policyholder is involved in a car accident and is air lifted to the hospital. Air Ambulance - $900 Hospitalization - $1,500 Thoracic Surgery - $2,000 3-Day Hospital Stay - $900 Medicine - $10 Physician Treatment - $150 Emergency Room - $300 Follow-Up Treatment - $100 Total Benefit Amount - $5,860 $100 outpatient Physician s benefit This benefit is available when a covered person is treated by a physician outside of a hospital for any cause (not only due to an accident) This benefit is limited to 2 visits per covered person per calendar year not to exceed 4 visits per calendar year for family coverage Should there be a discrepancy between these summaries and the actual plan document, the plan document will govern. 21

22 VOLUNTARY CRITICAL ILLNESS PLAN Lump sum benefit paid following the diagnosis of a covered critical illness Employee benefit amounts available: $10,000 or $20,000 Dependent child(ren) are covered at 50% of the employee s benefit at no additional premium Covered dependents (spouse and/or child) are eligible for 50% of employee benefit amount. Covered Critical Illness: 100% payout for Invasive Cancer, Heart Attack, Stroke, Major Organ Transplant, End Stage Renal Failure, Benign Brain Tumor, Coma, Complete Blindness, Complete Loss of Hearing and Paralysis 25% payout for Coronary Artery Bypass Surgery, Carcinoma in Situ, Advanced Alzhemeir s Disease and Advanced Parkinson s Disease Claim example: Policyholder is enrolled in a CI policy with $10,000 of coverage Policyholder is diagnosed with an internal cancer on Policyholder files a claim with Allstate and receives a $10,000 claim check $50 wellness benefit is available per calendar year per covered person Eligible wellness benefits include biopsy for skin cancer, blood test for triglycerides, bone marrow testing, echocardiogram, mammogram, pap smear and stress test on a bike or treadmill. See Allstate packet for other covered wellness benefits Coverage is available on a guarantee-issue basis for newly eligible employees. Existing employees must answer a series of yes or no health questions on the application to determine if they qualify for coverage. Should there be a discrepancy between these summaries and the actual plan document, the plan document will govern. 22

23 VOLUNTARY HOSPITAL PLAN Hospital confinement coverage for covered accidents and sicknesses Indemnity benefits for first day hospital confinement, daily hospital confinement and intensive care daily hospital confinement Claim example: Policyholder is involved in a car accident hospitalized for three days. First day Hospital Confinement Benefits - $ days in the hospital - $200 Total Benefit Amount - $1,300 Currently there 9 employees enrolled in this plan. We need 18 employees from PCA and CTLGroup to be on the plan to continue to offer it in

24 ALLSTATE: ONGOING SERVICE Filing a claim: Accident Complete an Allstate claim form and provide necessary and appropriate supporting documentation. For example - emergency room report, x-ray/major diagnostic exam report, hospital admission and discharge paperwork, etc. Critical Illness Complete an Allstate claim form and provide necessary and appropriate supporting documentation. For example - office notes, medical records, information regarding pre-existing conditions, etc. Hospital Complete attachment Allstate Hospital Claim Form entirely and provide supporting documentation. Include your certificate number on the claim form. Attach a copy of your itemized hospital bill providing the diagnosis, the type of room and board accommodations (including any days in ICU) along with the admission and discharge dates. 24

25 DENTAL METLIFE 25

26 DENTAL PLANS Network: PDP Benefit Calendar Year Deductible Calendar Year Maximum Preventive Services Includes oral exams and cleanings Basic Services Includes simple extractions Major Services Includes crowns and dentures Orthodontia Coverage for children up to age 19 PPO Plan In/Out of Network* $50 / $150 family max $1,250 per person Covered at 100%,* 2xs per year Deductible, then 20%* Deductible, then 50%* 50% Lifetime Orthodontia Maximum $1,000 per child up to age 19 *While benefits are available out of network, MetLife discounted prices on services are only available in-network. Should there be a discrepancy between these summaries and the actual plan document, the plan document will govern. 26

27 DENTAL SEMI-MONTHLY COST COVERAGE TYPE PPO Employee $7.50 Employee & Spouse $15.00 Employee & Child(ren) $20.00 Family $

28 VISION NEW: EYEMED 28

29 VISION PLAN Network: Insight Network Exam: Lenses or Contact Lenses: Frames: Eye Exam Single, Bifocal or Trifocal Lenses Frames Conventional Contacts Disposable Contacts Frequency In-Network Benefits* Once every 12 months Once every 12 months Once every 24 months $10 Copay $25 Copay $130 allowance, then 20% off remaining balance $130 allowance, then 15% off remaining balance $130 allowance *To see out of network benefits, please review the benefit guide or the benefits summary. Should there be a discrepancy between these summaries and the actual plan document, the plan document will govern. 29

30 VISION SEMI-MONTHLY COST COVERAGE TYPE Vision Employee $3.31 Employee & Spouse $6.30 Employee & Child(ren) $6.63 Family $

31 LIFE AND AD&D AND DISABILITY NEW: PRUDENTIAL 31

32 EMPLOYER SPONSORED LIFE AND AD&D AND DISABILITY Basic Life/AD&D Company pays 100% of the premium for your Basic Life and AD&D coverage NEW: Benefit is 2x salary up to a $500,000 max (increased from 1x salary) Benefit reduces by 50% at age 70 Long Term Disability Company pays 100% of the premiums for your Long Term Disability coverage Your benefit covers 60% of your monthly earnings up to a $15,000 monthly maximum Benefits begin after 90 days Should there be a discrepancy between these summaries and the actual plan document, the plan document will govern. 32

33 DEPENDENT AND VOLUNTARY LIFE AND AD&D Voluntary Dependent Life: $2.41/month $10,000 spouse benefit $2,000 child(ren) benefit for children 14 days to 19, up to 26 for un-married fulltime students Employee Voluntary Life and AD&D: see rate table for cost May be elected in increments of $10,000 up to 7x your annual salary up to a $500,000 max Special Enrollment Opportunity: receive up to the Guarantee Issue amount of $150,000 with no medical questions asked Any coverage amounts over the Guaranteed Issue amount are subject to underwriting approval and will require the completion of an Evidence of Insurability form Employees are responsible for paying 100% the Voluntary Dependent Life and Voluntary Employee Life and AD&D premiums 33

34 OPEN ENROLLMENT REMINDERS All open enrollment elections must be made by November 24 th Every benefits eligible employee must: Login to ADP to elect their 2016 benefits For those who want to enroll in an Allstate plan or change their current election, please complete an applicable Allstate election form All elections are valid for coverage January 1 st, 2016 December 31 st,