BENEFITS ENROLLMENT FOR NEW HIRES

Transcription

1 BENEFITS ENROLLMENT FOR NEW HIRES Welcome to Source4Teachers/MissionOne! As a new hire, you are eligible to enroll in Company benefits for the 2016 plan year. How to Enroll You will have two options to complete your enrollment -- either online via the self-service system or by phone with a benefits counselor. You must complete your enrollment within 30 days from the date of your first paycheck to receive benefits. Option 1: Visit Username: Your Identification Number or your Social Security Number Password: The last 4 digits of your Social Security Number. Option 2: Call (Monday Friday, 9 a.m. 6 p.m. EST) You are encouraged to call early in your enrollment window, rather than waiting until the last minute, to reduce your chances of being placed on hold. All new employees MUST complete the enrollment process, either online or by phone, to elect or waive benefits. If you do not participate, you may not receive benefits in Who is Eligible s: All employees who are actively employed with Source4Teachers or 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 numbers 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

2 The Ride of Your Life OPEN ENROLLMENT 16 Benefit Enrollment Guide 2016

3 Medical Minimum Essential Coverage (MEC) Plan 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. Standard Plan Preferred Plan Physician s Office Plan Pays $50 per Day, 6 Days per Person per Year Plan Pays $60 per Day,6 Days per Person per Year Outpatient Diagnostic Lab Plan Pays $75 per Testing Day, 3 Days per Person per Year Plan Pays $75 per Testing Day, 3 Days per Person per Year Outpatient Diagnostic X-ray Plan Pays $75 per Testing Day, 3 Days per Person per Year Plan Pays $75 per Testing Day, 3 Days per Person per Year Advanced Studies - Plan Pays $200 per Testing Day, 3 Days per Person per Year Accidental Injury Care - Plan Pays $300 Maximum per Occurrence Emergency Room Sickness Plan Pays $75 per Day, 4 Days per Person per Year Plan Pays $100 per Day, 2 Days per Person per Year Surgical Daily Inpatient Daily Inpatient Maximum Daily Outpatient Daily Outpatient Minor Outpatient Benefit Maximum Plan Pays $500 per Day, 1 Day per Person per Year Plan Pays $250 per Day Plan Pays $50 per Day 1 Day per Person per Year Plan Pays $500 per Day, 1 Day per Person per Year Plan Pays $250 per Day Plan Pays $50 per Day 1 Day per Person per Year Anesthesia Plan Pays 30% of Surgical Benefit Plan Pays 30% of Surgical Benefit Hospital Indemnity Plan Pays $100 per Day, 500 Day Lifetime Maximum Plan Pays $300 per Day, 500 Day Lifetime Maximum Intensive Care Unit Plan Pays $200 per Day, 30 Days per Person per Year Plan Pays $600 per Day, 30 Days per Person per Year Substance Abuse Mental Illness Skilled Nursing First Health Network AWP Value Rx Plan Pays $50 per Day, 30 Days per Person per Year Included Plan Pays $150 per Day, 30 Days per Person per Year Included New Benefits Discount Program Bi-Weekly Rates + Spouse + Child(ren) Plan Pays 100% of the 63 required preventive services when you utilize a First Health Network provider Bi-Weekly Rates + Spouse + Child(ren) Minimum Essential Coverage (MEC) Plan Standard Plan and Preferred Plan We also offer limited medical benefits through the Standard Plan or the Preferred Plan. $24.65 $53.49 $40.36 $ Preventive Services for Adults 22 Preventive Services for Women 26 Preventive Services for Children $28.58 $47.89 $54.51 $69.88 Minimum Essential Coverage (MEC) Plan + Standard Plan or Preferred Plan You also have the option to enroll in the MEC Plan AND either the Standard Plan or the Preferred Plan. $33.92 $76.68 $57.05 $82.28 Bi-Weekly Rates MEC + Standard MEC + Preferred + Spouse + Child(ren) $53.23 $ $94.87 $ $62.50 $ $ $152.16

4 Covered Services For Adults 1. 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 10. HIV screening for all adults at higher risk 11. 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 12. Obesity screening and counseling for all adults 13. Sexually Transmitted Infection (STI) prevention counseling for adults at higher risk 14. Tobacco Use screening for all adults and cessation interventions for tobacco users 15. Syphilis screening for all adults at higher risk Covered Preventive Services for Women, Including Pregnant Women 1. 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 1 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 10. Domestic and Interpersonal Violence screening and counseling for all women 11. Folic Acid supplements for women who may become pregnant 12. Gestational Diabetes screening for women 24 to 28 weeks pregnant and those at high risk of developing gestational diabetes 13. Gonorrhea screening for all women at higher risk 14. Hepatitis B screening for pregnant women at their first prenatal visit 15. Human Immunodeficiency Virus (HIV) screening and counseling for sexually active women 16. Human Papillomavirus (HPV) DNA Test: high risk HPV DNA testing every three years for women with normal cytology results who are 30 or older 17. Osteoporosis screening for women over age 60 depending on risk factors 18. Rh Incompatibility screening for all pregnant women and follow-up testing for women at higher risk 19. 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 21. 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 1. Alcohol and Drug Use assessments for adolescents 2. Autism screening for children at 18 and 24 months 3. Behavioral assessments for children of all ages; Ages: 0 to 11 months, 1 to 4 years, 5 to 10 years, 11 to 14 years, 15 to 17 years 4. Blood Pressure screening for children: Ages: 0 to 11 months, 1 to 4 years, 5 to 10 years, 11 to 14 years, 15 to 17 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: 1 to 4 years, 5 to 10 years, 11 to 14 years, 15 to 17 years 10. Fluoride Chemoprevention supplements for children without fluoride in their water source 11. Gonorrhea preventive medication for the eyes of all newborns 12. Hearing screening for all newborns 13. Height, Weight and Body Mass Index measurements for children; Ages: 0 to 11 months, 1 to 4 years, 5 to 10 years, 11 to 14 years, 15 to 17 years 14. Hematocrit or Hemoglobin screening for children 15. Hemoglobinopathies or sickle cell screening for newborns 16. HIV screening for adolescents at higher risk 17. Immunization vaccines for children from birth to age 18 - 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 18. Iron supplements for children ages 6 to 12 months at risk for anemia 19. Lead screening for children at risk of exposure 20. Medical History for all children throughout development; Ages: 0 to 11 months, 1 to 4 years, 5 to 10 years, 11 to 14 years, 15 to 17 years 21. Obesity screening and counseling 22. Oral Health risk assessment for young children; Ages: 0 to 11 months, 1 to 4 years, 5 to 10 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 11 months, 1 to 4 years, 5 to 10 years, 11 to 14 years, 15 to 17 years. 26. Vision screening for all children

5 Critical Illness Critical Illness Champion is designed to help you offset the financial impact of a covered critical illness. This insurance provides a lump sum benefit that is paid directly to you, and you can use it any way you wish. Some of the covered critical illnesses include heart attack, stroke, and cancer. A full list of covered conditions, exclusions, and plan terms are available at enrollment. Plan Features: Plan features include guaranteed issue benefits, full portability, level premiums, and no benefit reduction due to age. The Mortgage and Rent Benefit pays a benefit for up to 6 months if you miss 5 or more days from work in any calendar month due to a covered condition. The Health Care Referral Service provides doctor referrals based on your medical needs. The Wellness Benefit pays an annual benefit of $50 per insured individual if a covered health screening test is performed. Rates are calculated based on your age, tobacco status, and the amount of coverage you choose.

6 Dental Source4Teachers/MissionOne offers dental coverage to you and your dependents. Plan highlights are outlined below. Calendar Year Maximum Dental Plan Plan pays up to $500 per covered member Deductible $20 per visit Covered Services Waiting Period Coinsurance Preventive and Diagnostic Services Exams, X-Rays, Cleanings, Fluoride for Children, Space Maintainers None Covered at 100% (U&C Charges) Basic Treatment Sealants for Children, Restorative Amalgams and Composites, Endodontics, Periodontics, Denture Repair, Simple/Complex Extractions, Anesthesia Major Treatment Onlays, Crowns, Crown Repair, Prosthodontics Bi-Weekly Rates + Spouse + Child(ren) 3 months 12 months $8.81 $22.02 $15.85 $23.77 Covered at 60% (U&C Charges) Covered at 50% (U&C Charges)

7 Vision Source4Teachers/MissionOne offers vision coverage to you and your dependents. Plan highlights are outlined below. VSP Choice Network Vision Plan Out-of-Network Deductibles $10 exam / $25 eye glass lenses or frames 1 Annual Eye Exam Up to $45 Lenses (per pair) Single Vision Bifocal Trifocal Lenticular Contact Lenses Fit and Follow Up Exam Elective Medically Necessary 15% discount Up to $105 Up to $30 Up to $50 Up to $65 Up to $100 No benefit Up to $105 Up to $210 Frames Up to $105 2 Up to $70 Frequencies Exam / Lens / Frame Bi-Weekly Rates + Spouse + Child(ren) Based on Date of Service 12 Months / 12 Months / 24 Months $4.04 $7.98 $7.44 $ Deductible applies to a complete pair of glasses or frames, whichever is selected. 2. The Costco allowance will be the wholesale equivalent.

8 Life & Disability Lifetime Benefit Term Life Lifetime Benefit Term Life provides valuable life insurance protection through age 120! You can elect coverage up to $100,000, and premiums are guaranteed not to increase through age 100. Plan Features: Premiums are guaranteed not to increase through age 100. No medical exams required. Issuance of coverage depends upon answers to a few health questions. Provides paid-up death benefit values after only ten years, so if you decide to stop paying premiums at some time in the future, you are guaranteed paid-up coverage of a reduced amount. Flexible! You have the option to continue your coverage at the same premium or elect paid-up insurance coverage of a reduced amount after ten years with no further premium payments Guaranteed! Fully portable you own it and take it with you when you leave your employment. Rates are calculated based on your age, tobacco status, and the amount of coverage you choose. Income Protector Short Term Disability Short Term Disability helps replace a portion of your income if a covered injury or illness keeps you out of work. The benefit can help cover out-of-pocket expenses and make up for lost wages. After you are declared disabled and out of work for 14 days for an accident or sickness (elimination period), you will receivea benefit of $200 per month for cash sickness states (NY, NJ, RI, CA, HI) or $400 per month for other states. Plan Features: Plan features include guaranteed issue benefits and full portability. Workers Compensation, Social Security Disability Income or other sources do not reduce the benefits paid at the time of claim. Own occupation during first 24 months of disability, any occupation after 24 months. Insured is considered totally disabled if unable to perform material duties of own occupation. Premiums are waived after 14 days of total disability after elimination period. Partial Recovery Benefit pays up to 90 days following a total disability if the insured returns to work and earns less than 75% of pre-disability earnings. The policies or their provisions may vary or be unavailable in some states. The policies have exclusions and limitations which may affect any benefits payable.

9 Accident Accidents happen. You can t always prevent them, but you can take steps to reduce the financial impact. Accident is designed to help cover the out-of-pocket medical expenses and extra bills that can follow a covered accident. The policy pays a benefit directly to you not a doctor or hospital and you can use the money however you choose. Benefit amounts are based on the type of injury and treatment needed. Covered injuries and accident-related expenses include: Ambulance Physical therapy Fractures and dislocations Hospitalization X-rays Transportation and lodging Plan Features: Plan features include guaranteed issue benefits, full portability, and no exclusions for pre-existing conditions. Plan includes a Sports Package, which pays 25% higher benefits when injuries are a result of certain organized sports up to $1,000 per person, per year. The First Accident Benefit pays out $100 immediately, when you report your first claim for covered accident benefits. This $100 benefit is paid in addition to all other benefits you are eligible for. The Rehabilitation Package pays benefits for both admission and confinement in a rehabilitation center. And for people who prefer to recover at home, they will receive a daily Recovery benefit to help with their transition. Speak with a benefits counselor for detailed information on the plan and costs. The policy or its provisions may vary or be unavailable in some states. The policy has exclusions and limitations which may affect any benefits payable.