2018 Employee Benefits Overview

Transcription

1 2018 Employee Benefits Overview

2 Employee Benefits We recognize that our employees are our most valuable resource and your benefits program is extremely important to North Central Missouri Mental Health Center. Therefore, it is our pleasure to offer our benefits-eligible employees a variety of solutions to help address your benefit needs, as well as the needs of your families. Our employees continue to be the driving force behind our past success and position us well for the future. Thank you for your ongoing commitment as we strive to be the best employer in our industry. We are proud to include all of you as part of the North Central Missouri Mental Health Center family. This summary of benefits is intended only to highlight your benefits and should not be relied upon to fully determine coverage. This plan may not cover all your health care expenses. Please refer to the Certificate of Coverage for a complete listing of services, limitations, exclusions and a description of all the terms and conditions of coverage. Bukaty Companies Service Team Brad Bukaty Benefits Consultant bbukaty@bukaty.com Brad is the primary contact for your benefits program. Kim Romi Client Service Manager kromi@bukaty.com Kim is responsible for day-to-day administrative and service issues including claims, billing, ID card requests, enrollment issues and employee terminations College Blvd. Leawood, KS Phone: Toll-Free: Fax:

3 Rights & Disclosures This information is intended to be shared by employees with their spouse and dependents. Special Enrollment Rights If you are declining enrollment for yourself or your dependents (including your spouse) because of other health insurance or group health plan coverage, you may be able to enroll yourself and your dependents in this plan if you or your dependents lose eligibility for that other coverage (or if the employer stops contributing toward your or your dependents other coverage). However, you must request enrollment within 30 days after your or your dependents other coverage ends (or after the employer stops contributing toward the other coverage). In addition, if you have a new dependent as a result of marriage, birth, adoption, or placement for adoption, you may be able to enroll yourself and your dependents. However, you must request enrollment within 30 days after the marriage, birth, adoption, or placement for adoption. To request special enrollment or to obtain more information contact Bukaty Companies at Woman s Health and Cancer Rights Act (WHCRA) of 1998 Do you know that your plan, as required by the Women s Health and Cancer Rights Act (WHCRA) of 1998, provides benefits for mastectomyrelated services including all stages of reconstruction and surgery to achieve symmetry between breasts, prostheses, and complications resulting from a mastectomy, including lymphedema? Call Bukaty Companies at for more information. COBRA Rights In the Event You Lose Your Health (Medical/Dental/Flex) Coverage A group health plan is required to offer COBRA continuation coverage to you, your spouse and your dependents enrolled in the Plan when a qualifying event occurs that causes loss of group health coverage. Coverage may be available for 18 months up to a maximum of 36 months, depending upon the qualifying event. The employer is required to notify the Plan if the qualifying event is: - Termination (for any reason other than gross misconduct) or reduction in hours of employment of the covered employee - eligible for up to 18 months of continuation coverage - Death of the covered employee - eligible for up to 36 months of continuation coverage - Covered employee becomes entitled to Medicare - eligible for up to 36 months of continuation coverage depending upon date of Medicare entitlement The covered employee or one of the qualified beneficiaries is responsible for notifying the Plan Administrator within 60 days of the occurrence if the qualifying event is: - Divorce or legal separation - eligible for up to 36 months of continuation coverage - A child s loss of dependent status under the Plan - eligible for up to 36 months of continuation coverage. Disability Extension If you or anyone in your family covered under the Plan is determined by the Social Security Administration (SSA) to be disabled and you notify the Plan Administrator in a timely fashion, you and your entire family may be entitled to receive up to an additional 11 months of coverage for a total of 29 months. The disability would have to have started at some time before the 60th day of COBRA continuation coverage and must last at least until the end of the 18-month period of continuation coverage. To obtain the extended coverage, a copy of the SSA disability determination must be received by the Plan Administrator within 60 days after the determination is issued and within the individual s first 18 months of continuation coverage. If SSA determines later the individual is no longer disabled, that individual must notify the Plan Administrator within 30 days after the date of the second determination. Second Qualifying Event If while on 18 months of continuation coverage, family members enrolled in the Plan experience another qualifying event, they may be entitled to an additional 18 months of coverage, for a maximum of 36 months. The extension may be granted if the employee or former employee dies, becomes entitled to Medicare or gets divorced or legally separated, or if the dependent child loses dependent status, but only if the events would have caused the spouse or dependent child to lose coverage under the Plan had the first qualifying event not occurred. When responsibility for notification rests with the covered employee or qualified beneficiary, notice of the qualifying event must be made within 60 days of the occurrence to the company s Plan Administrator. Other Coverage Options Besides COBRA Instead of enrolling in COBRA continuation coverage, there may be other coverage options for you and your family through the Health Insurance Marketplace, Medicaid, or other group health plan coverage options (such as a spouse s plan) through what is called a special enrollment period. Some of these options may cost less than COBRA continuation coverage. You can learn more about many of these options at Questions Questions concerning your Plan or your COBRA continuation coverage rights should be addressed to company s Plan Administrator. For more information about your rights under the Employee Retirement Income Security Act (ERISA), including COBRA, the Patient Protection and Affordable Care Act, and other laws affecting group health plans, contact the nearest Regional or District Office of the U.S. Department of Labor s Employee Benefits Security Administration (EBSA) in your area or visit (Addresses and phone numbers of Regional and District EBSA Offices are available through EBSA s website.) For more information about the Marketplace, visit

4 Keep Us Informed of Status Changes It is very important that you keep your Plan Administrator informed of address changes and other personal data changes for you and/or dependents who are or may become qualified beneficiaries on any of the company s group benefits. Changes should be reported to the Plan Administrator. A detailed explanation of COBRA rights and procedures is available in the Plan s Summary Plan Description. Premium Assistance under Medicaid and the Children s Health Insurance Program (CHIP) If you or your children are eligible for Medicaid or CHIP and you re eligible for health coverage from your employer, your state may have a premium assistance program that can help pay for coverage, using funds from their Medicaid or CHIP programs. If you or your children aren t eligible for Medicaid or CHIP, you won t be eligible for these premium assistance programs but you may be able to buy individual insurance coverage through the Health Insurance Marketplace. For more information, visit If you or your dependents are already enrolled in Medicaid or CHIP and you live in a State listed below, contact your State Medicaid or CHIP office to find out if premium assistance is available. If you or your dependents are NOT currently enrolled in Medicaid or CHIP, and you think you or any of your dependents might be eligible for either of these programs, contact your State Medicaid or CHIP office or dial KIDS NOW or to find out how to apply. If you qualify, ask your state if it has a program that might help you pay the premiums for an employer-sponsored plan. If you or your dependents are eligible for premium assistance under Medicaid or CHIP, as well as eligible under your employer plan, your employer must allow you to enroll in your employer plan if you aren t already enrolled. This is called a special enrollment opportunity, and you must request coverage within 60 days of being determined eligible for premium assistance. If you have questions about enrolling in your employer plan, contact the Department of Labor at or call EBSA (3272). If you live in one of the following States, you may be eligible for assistance paying your employer health plan premiums. You should contact your State for further information on eligibility. KANSAS Medicaid Website: Phone: MISSOURI Medicaid Website: Phone: Lifetime limit The lifetime limit on the dollar value of benefits under your group health plan no longer applies. Individuals whose coverage ended by reason of reaching a lifetime limit under the plan are eligible to enroll in the plan. Individuals have 30 days from the date of this notice to request enrollment. For more information contact Bukaty Companies at Premium Only Plan I agree that all group health benefits I enroll in will automatically be ran through a Premium Only Plan and that my salary will be reduced by the amount I pay for group health benefits. I understand this may reduce my potential Social Security benefits. I realize I can change this election only during the election period prior to any plan year or if there has been a qualifying change in my family s status, employment, or group health care coverage.

5 Medical: BlueCross BlueShield of Kansas City You are eligible to participate in the medical benefits plan on the first of the month following 60 days. Eligible dependents may also participate; eligible dependents include your legal spouse and/or dependent child(ren) to age 26. The following tables will give you an overview of how the plans work and what your responsibilities are. For questions concerning your medical benefits, a claim, to identify a network provider, or if you have questions concerning your prescription drug coverage please contact Kim Romi or Brad Bukaty at , BlueCross BlueShield of Kansas City at or visit Network Out-of-Network Deductible Individual/Family (per calendar year) $3000/$6000 $3000/$6000 Out-of-Pocket Max per Family Member (deductible & all copays apply) $3000/$6000 $6000/$12000 Individual/Family (per calendar year) Co-insurance, Amount that Blue Cross covers 100% 20% Preventive and Routine Care $0, Covered in Full (see details on website) EE pays full amount, applied to Ded Office visit (PCP/Specialist) $40 EE pays full amount, applied to Ded X-ray and Lab Services (Diagnostic) EE pays full amount, applied to Ded EE pays full amount, applied to Ded Allergy Injections EE pays full amount, applied to Ded EE pays full amount, applied to Ded Retail Pharmacy Drug Coverage Tier 1/ Tier 2/ Tier 3 /Tier 4 $15/$70/$110/$200 EE pays full amount, applied to Ded Inpatient Hospital Care EE pays full amount, applied to Ded. EE pays full amount, applied to Ded Outpatient Hospital Care EE pays full amount, applied to Ded EE pays full amount, applied to Ded Urgent Care $40 EE pays full amount, applied to Ded Emergency Room (copay waived if admitted) EE pays full amount, applied to Ded EE pays full amount, applied to Ded Durable Medical Equipment EE pays full amount, applied to Ded EE pays full amount, applied to Ded Physical therapy, occupational therapy (40 Visit calendar year max) and speech therapy EE pays full amount, applied to Ded EE pays full amount, applied to Ded (20 visit max) Outpatient Mental Health/Substance abuse office visit EE pays full amount, applied to Ded EE pays full amount, applied to Ded Routine vision exam $20 copay Annual Maximum Unlimited Unlimited

6 Delta Dental of Missouri Maintaining good dental health by getting regular checkups may prevent you from having major expenses later. The dental plan covers routine checkups and just about any other type of dental work you might need. You are eligible for benefits on the first of the month following 60 days of employment. Eligible dependents may also participate. Eligible dependents include your legal spouse who does not have coverage available through their employer and/or dependent child(ren) under the age of 26, not eligible as a subscriber under another dental plan. To identify participating premier dentists, you may call Delta Dental of MO. at or visit Premier Plan Deductible Annual Maximum Preventive Services Basic Services Major Services $50 per person $1,000 per covered person Covered at 100% Network Providers (100% Non-Network) Covered at 80% Network Providers (80% Non-Network) Covered at 50% Network Providers (50% Non-Network) Basic Life AD&D: US Able Coverage is provided by the company and is effective on the first of the month following 60 days of employment. Life/AD&D Amount Reduction Schedule $30,000 Benefit Benefits reduce by 35% at age 65; by 35% at age 70. Coverage terminates at retirement. Voluntary Life: US Able (Employee Paid on top of above mentioned Basic Life amount) New hires currently becoming eligible may elect the following: Employee Spouse Children Up to $100,000 w/no medical questions Up to $25,000 w/ no medical questions $10,000 w/no medical questions Vision Insurance: United Healthcare Employee Only Employee/Spouse Employee/Children Family Monthly Premium $4.80 $10.10 $11.85 $17.48 See next page for benefits.

7 Vision Benefit Summary Customer Service: (800) Provider Locator: (800) Plan V1012 NETWORK NON-NETWORK Comprehensive Vision Exam $10 Copay Up to $40 Materials - Eyeglass Lenses/Eyeglass Frames or Contact See below $25 Copay¹ Lenses Frequencies - Based on last date of service Exam Lenses Frames Once every 12 months Once every 12 months Once every 24 months COVERED SERVICES Pair of Lenses (for Eyewear) NETWORK NON-NETWORK Standard single vision lenses Covered in full after applicable copay¹ Up to $40 Standard lined bifocal lenses Up to $60 Standard lined trifocal lenses Includes standard scratch-resistant Up to $80 Standard lenticular lenses coating Up to $80 Lens options such as progressive lenses, tints, UV, and anti-reflective coating may be available at a discount at participating providers. Frames You will receive a retail frame allowance toward the purchase of any frame at a network provider. For frames that exceed your allowance, you may receive an additional 30% discount on the overage (available only at participating providers and may exclude certain frame manufacturers). Contact Lenses² $130 Retail Frame Allowance Up to $45 (after applicable copay ¹ ) Covered contact lens selection Up to 4 boxes of contact lenses plus Up to $105 the fitting/evaluation fees and up to It is important to note the covered contact lens selection two follow-up visits are covered-in-full may vary by provider but does include the most popular brands on the market today.³ A complete list can be (after applicable copay ¹ ) found by visiting our website Non-selection contacts You receive an allowance which is applied toward the fitting/evaluation fees and purchase of contact lenses outside the covered contact lens selection. Necessary contact lenses {@Bullet} Necessary contact lenses 4 Up to $105 (material copay is waived) Covered in full after applicable copay¹ Up to $105 Up to $210 1 The material copayment will apply once if frames and lenses, or contact lenses in lieu of eyewear, are purchased at the same time at a network provider. 2 Contact lenses are in lieu of eyeglass lenses and/or eyeglass frames. 3 Coverage for Covered Contact Lens Selection does not apply at Walmart or Sam's Club locations. The allowance for non-selection contact lenses will be applied toward the fitting/evaluation fee and purchase of all contacts. 4 Necessary contact lenses are determined at the provider's discretion for one or more of the following conditions: Following cataract surgery without intraocular lens implant; to correct extreme vision problems that cannot be corrected with eyeglass lenses and/or eyeglass frames; with certain conditions of anisometropia, keratoconus, irregular corneals/astigmatism, aphakia, facial deformity, or corneal deformity. If your provider considers your contacts necessary, you should ask your provider to contact UnitedHealthcare concerning the reimbursement that UnitedHealthcare will make before you purchase such contacts.

8 2018 North Central Missouri Mental Health Enrollment Form Employee Information Employee s Name Address Street City State Zip Code SSN Date of Birth Date of Hire Home Phone ( ) Marital Status Single Married Open Enrollment New Hire Dependent Information (If Dependent is to be enrolled) Coverage Options Benefit Employee Only Employee + Spouse Employee + Child(ren) Family Waive Medical: Blue Cross Blue Shield Dental: Delta Dental of MO Vision: United Healthcare Basic Life/AD&D: US Able $30,000 Voluntary Employee Paid Add l Life Employee Signature SEE Benefits Website I hereby authorize my employer to deduct the appropriate premium contributions from payroll based on my benefit election choices. Employee Signature: Date: / / Life Beneficiary Information Primary Beneficiary(ies) Name (Last, First, MI) Address SSN Birth Date Percentage Secondary Beneficiary(ies) Name (Last, First, MI) Address SSN Birth Date Percentage