BENEFITS FACT SHEET. Coverage Options 2017 Bi-Weekly Employee Contribution

Transcription

1 BENEFITS FACT SHEET Eligibility Regular, full-time and part-time employees in a budgeted position of 30 hours or more per week. The normal waiting period is 90 days for medical, dental, vision, life insurance, long and short term disability; however, this waiting period is being waived for NPHS benefit eligible employees Employee Premium Contributions NPHS Coverage Begins 11/01/2017 Medical/RX Coverage Options 2017 Bi-Weekly Employee Contribution Co-Pays In-Network Deductible Independence Blue Cross HMO Deductible (East PA) Tier Pre-Tax Doctor Specialist Single Family Single $ Employee & Child $ Employee & Children $ $ 20 $ 40 $1,250 $2,500 Employee & Spouse $ Family $ PPO Flex $500 Single $ Employee & Child $ Employee & Children $ Employee & Spouse $ Family $ $ 20 $ 40 $500 $1,000 PPO Flex $1000 Single $ Employee & Child $ Employee & Children $ Employee & Spouse $ Family $ $ 20 $ 30 $1,000 $2,000 Single $ PPO Flex Employee & Child $ Employee & Children $ Employee & Spouse $ $ 20 $ 40 No deductible in network Family $ o Inpatient Hospitalization Reimbursement for all plans - $250 per day, max $1,250 or deductible/coinsurance owed (the lesser between the two amounts) paid for by NHS Human Services. Contact the Benefits Department if you incur an inpatient hospitalization. Revised 09/17 Page 1 of 6

2 o Prescription for all plans Administered by Aetna Pharmacy 3-tier formulary prescription benefit - $15 for generic, $35 for formulary brand name, $50 for non formulary/non preferred. Preferred Home Delivery Program available. Separate ID card for prescription. o Preventive Care for all plans - covered 100% as per Health Care Reform Dental Insurance Delta Dental Preferred Plan Dental Plan Coverage Tier Bi-Weekly Employee Contribution Delta Dental Single $ 2.15 Employee & Child $ 4.31 Employee & Children $ 4.31 Employee & Spouse $ 4.31 Family $ 4.31 Vision Insurance Administered by Independence Blue Cross through Davis Vision - You will receive an ID card from Independence Blue Cross (through Davis Vision). Vision Plan Coverage Tier Bi-Weekly Employee Contribution Davis Vision Single $ 3.13 Employee & Child $ 6.57 Employee & Children $ 6.57 Employee & Spouse $ 6.57 Family $ 6.57 Guardian Nurses Advocacy service available to benefited employees to help with claims issues, finding a doctor or hospital, coordinating care, etc. Phone Life Insurance, Long and Short Term Disability Disability provided through Hartford Short Term 60% of weekly salary (max $500); Long Term - 60% of monthly salary (max $10,000) Life insurance Hartford 1X annual salary maximum $350,000 Company sponsored No cost to employee Revised 09/17 Page 2 of 6

3 Flexible Spending Accounts Unreimbursed Health Care (up to $2,000) and Dependent Care (up to $5,000) flex accounts offered May enroll within 90-day new hire benefit election period or at open enrollment (prior to January 1 effective date) Administered through ADP Employee Assistance Program Aetna Resources for Living Retirement Plan Universal Eligibility o Regular employees (non 1099) can begin contributions as soon as administratively feasible after hire Matching Eligibility Requirements o One year of service o Must be age 21 o Work 1000 hours in a year Enrollment o All enrollment/changes to your plan will be administered directly through the MassMutual (MM) website, All plan information can be viewed directly on the web. You may also contact MM at If you do not have a PIN, you may push 1-#-# to reach a representative. Contributions Company match 50% of contributions up to 4%. Match will begin the month following one year of employment, 1000 hours worked and 21 years of age. Maximum contribution for employees is 100% of regular pre-tax earnings subject to IRS limits. Enrollment/Contribution changes Can be completed at any time after hire. Enrollment packet will be sent by MassMutual and enrollment is completed online. Retirement Plan Custodian MassMutual o Customer Service Line Retirement Plan Administrator - NFP Retirement Plan Sponsor - NHS Human Services Revised 09/17 Page 3 of 6

4 NHS Human Services IBC Medical Plan Summary - Prescription through Aetna RX Medical Plans Through Independence Blue Cross (IBC) HMO Deductible Summary PPO Flex $500 Summary Plan Highlights In Network - only In Network Out of Network Deductible (contract year) Individual $ 1,250 $ 500 $ 5,000 Family $ 2,500 $ 1,000 $ 15,000 Out of Pocket Max Individual $ 5,000 $ 6,350 $ 15,000 Family $ 10,000 $ 12,700 $ 45,000 Lifetime Plan Maximum Unlimited Unlimited Unlimited Primary Care Physician Office Visit $ 20, no deductible $ 20, no deductible 50% after deductible Specialist Office Visit $ 40, no deductible $ 40, no deductible 50% after deductible Preventive care 100%, no deductible 100%, no deductible 50%, no deductible Pediatric Immunizations 100%, no deductible 100%, no deductible 50%, no deductible Routine Gynocological Exam 100%, no deductible 100%, no deductible 50%, no deductible Mammogram 100%, no deductible 100%, no deductible 50%, no deductible Nutrition Counseling for weight management 100%, no deductible 100%, no deductible 50% after deductible Outpatient Labarotory/Pathology 100%, no deductible 70% after deductible 50% after deductible Maternity Care First OB Visit $ 20, no deductible $ 20, no deductible 50% after deductible Hospital 80% after deductible 70% after deductible 50% after deductible Inpatient Hospital Services 80% after deductible 70% after deductible 50% after deductible Inpatient Hospital Days Unlimited Unlimited 70 Outpatient Surgery 80% after deductible 70% after deductible 50% after deductible Emergency Room 80% after deductible (not waived if admitted) 70% after deductible (not waived if admitted) 70% after deductible (not waived if admitted) Urgent Care $50, no deductible $50, no deductible 50% after deductible Ambulance Emergency 80% after deductible 70% after deductible 70% after deductible Non-Emergency 80% after deductible 70% after deductible 50% after deductible Outpatient X-Ray/Radiology Routine Radiology/Diagnostic $ 40, no deductible 70% after deductible 50% after deductible MRI/MRA, CT/CTA Scan, PET Scan $ 80, no deductible 70% after deductible 50% after deductible Therapy Services Physical and Occupational $ 40, no deductible $ 40, no deductible 50% after deductible Cardiac rehabilitation $ 40, no deductible $ 40, no deductible 50% after deductible Pulmonary rehabilitation $ 40, no deductible $ 40, no deductible 50% after deductible Speech $ 40, no deductible $ 40, no deductible 50% after deductible Orthoptic/pleoptic $ 40, no deductible $ 40, no deductible 50% after deductible Spinal Manipulations $ 40, no deductible $ 40, no deductible 50% after deductible Injectible Medications Standard Injectibles 100%, no deductible 100%, no deductible 50% after deductible Biotech/Specialty Injectibles $ 100, no deductible $ 100, no deductible 50% after deductible Revised 09/17 Page 4 of 6

5 Medical Plans Through Independence Blue Cross (IBC) HMO Deductible Summary PPO Flex $500 Summary Plan Highlights In Network - only In Network Out of Network Chemo/Radiation/Dialysis 80% after deductible 70% after deductible 50% after deductible Outpatient Private Duty Nursing 80% after deductible 70% after deductible 50% after deductible Skilled Nursing Facility 80% after deductible 70% after deductible 50% after deductible Hospice and Home Health Care 80% after deductible 70% after deductible 50% after deductible DME(Durable Medical Equipment) 50% after deductible 50% after deductible 50% after deductible Prosthetics 50% after deductible 50% after deductible 50% after deductible Mental Health Care Outpatient $ 40, no deductible $ 40, no deductible 50% after deductible Inpatient 80% after deductible 70% after deductible 50% after deductible Serious Mental Illness Care Outpatient $ 40, no deductible $ 40, no deductible 50% after deductible Inpatient 80% after deductible 70% after deductible 50% after deductible Substance Abuse Treatment Outpatient $ 40, no deductible $ 40, no deductible 50% after deductible Inpatient 80% after deductible 70% after deductible 50% after deductible Prescription Through Aetna - all plans 3 tier formulary Preferred Brand Name - $35; Preferred Brand Name - $35; NHS Human Services IBC Medical Plan Summary - Prescription through Aetna RX Medical Plans Through Independence Blue Cross (IBC) PPO Flex $1000 Summary PPO Flex Summary Plan Highlights In Network Out of Network In Network Out of Network Deductible (contract year) Individual $ 1,000 (combined in/out of network) $ 0 $ 1,500 Family $ 2,000 (combined in/out of network) $ 0 $ 4,500 Out of Pocket Max Individual $ 4,000 $ 10,000 $ 3,000 $ 10,000 Family $ 8,000 $ 20,000 $ 6,000 $ 30,000 Lifetime Plan Maximum Unlimited Unlimited Unlimited Unlimited Primary Care Physician Office Visit $ 20, no deductible 50% after deductible $ 20 copay 50% after deductible Specialist Office Visit $ 30, no deductible 50% after deductible $ 40 copay 50% after deductible Preventive care 100%, no deductible 50%, no deductible 100% 50%, no deductible Pediatric Immunizations 100%, no deductible 50%, no deductible 100% 50%, no deductible Routine Gynocological Exam 100%, no deductible 50%, no deductible 100% 50%, no deductible Mammogram 100%, no deductible 50%, no deductible 100% 50%, no deductible Nutrition Counseling for weight management 100%, no deductible 50% after deductible 100% 50% after deductible Outpatient Labarotory/Pathology 100%, no deductible 50% after deductible 100% 50% after deductible Maternity Care First OB Visit $ 20, no deductible 50% after deductible $ 20 copay 50% after deductible Hospital 80% after deductible 50% after deductible $ 250/day max 5 days 50% after deductible Revised 09/17 Page 5 of 6

6 Medical Plans Through Independence Blue Cross (IBC) PPO Flex $1000 Summary PPO Flex Summary Plan Highlights In Network Out of Network In Network Out of Network Inpatient Hospital Services 80% after deductible 50% after deductible $250/day max 5 days 50% after deductible Inpatient Hospital Days Unlimited 70 Unlimited 70 Outpatient Surgery 80% after deductible 50% after deductible $ 125 copay 50% after deductible Emergency Room $ 40 copay (waived if admitted), no deductible $ 100 Copay (copayment not waived if admitted) Urgent Care $ 20, no deductible 50% after deductible $ 50 copay 50% after deductible Ambulance Emergency 80% after deductible 80% after in network deductible 100% 100%, no deductible Non-Emergency 80% after deductible 50% after deductible 100% 50% after deductible Outpatient X-Ray/Radiology Routine Radiology/Diagnostic 80% after deductible 50% after deductible $ 40 copay 50% after deductible MRI/MRA, CT/CTA Scan, PET Scan 80% after deductible 50% after deductible $ 80 copay 50% after deductible Therapy Services Physical and Occupational $ 20 visit 1-30 $ 30 visit % after deductible $ 40 Copay 50% after deductible Cardiac rehabilitation $ 20, no deductible 50% after deductible $ 40 Copay 50% after deductible Pulmonary rehabilitation $ 20, no deductible 50% after deductible $ 40 Copay 50% after deductible Speech combined with PT/OT 50% after deductible $ 40 Copay 50% after deductible Orthoptic/pleoptic $ 30, no deductible 50% after deductible $ 40 Copay 50% after deductible Spinal Manipulations $ 30, no deductible 50% after deductible $ 40 Copay 50% after deductible Injectible Medications Standard Injectibles 100% 50% after deductible 100% 50% after deductible Biotech/Specialty Injectibles $ 100, no deductible 50% after deductible $ 100 copay 50% after deductible Chemo/Radiation/Dialysis 80% after deductible 50% after deductible 100% 50% after deductible Outpatient Private Duty Nursing 80% after deductible 50% after deductible 80% 50% after deductible Skilled Nursing Facility 80% after deductible 50% after deductible $125/day max 5 days 50% after deductible Hospice and Home Health Care 80% after deductible 50% after deductible 100% 50% after deductible DME(Durable Medical Equipment) 80% after deductible 50% after deductible 80% 50% after deductible Prosthetics 80% after deductible 50% after deductible 80% 50% after deductible Mental Health Care Outpatient $ 30, no deductible 50% after deductible $ 40 Copay 50% after deductible Inpatient 80% after deductible 50% after deductible $250/day max 5 days 50% after deductible Serious Mental Illness Care Outpatient $ 30, no deductible 50% after deductible $40 Copay 50% after deductible Inpatient 80% after deductible 50% after deductible $250/day max 5 days 50% after deductible Substance Abuse Treatment Outpatient $ 30, no deductible 50% after deductible $ 40 Copay 50% after deductible Inpatient 80% after deductible 50% after deductible $250/day max 5 days 50% after deductible Prescription Through Aetna - all plans 3 tier formulary Preferred Brand Name - $35; Preferred Brand Name - $35; Revised 09/17 Page 6 of 6