Veritas Management Group EMPLOYEE BENEFITS

Transcription

1 Veritas Management Group EMPLOYEE BENEFITS Benefit plans effective February 1, 2016 January 31, 2017

2 Table of Contents How Benefits Work Benefits Eligibility... 3 Enrollment... 3 Changing Your Benefits During the Year... 3 Health Plans Medical Insurance... 4 Dental Insurance... 6 Vision Insurance... 7 Other Benefit Plans Flexible Spending Accounts... 8 Life and AD&D Insurance... 9 Voluntary Short-Term Disability Insurance Voluntary Benefits Additional Information Benefit Plan Costs Important Contact Information The Veritas Management Group Benefits Package Benefits are an integral part of the overall compensation package provided by Veritas Management Group. Within this Benefits Guide you will find important information on the benefits available to you for the February 1, 2016, through January 31, 2017, plan year. Please take a moment to review the benefits Veritas Management Group offers to determine which plans are best for you. This guide contains only general and summary information; it should not be considered a replacement for the more detailed information set forth in certificates of coverage or master plan documents produced by each insurance company. Every care is taken to assure the accuracy of this guide; however, in the event of any conflict between this guide and information produced by each insurance company, the insurance company s documents will be the final authority. 2

3 Benefits Eligibility Employees scheduled to work at least 30 hours per week are eligible for benefits on the first day of the month following 60 days of employment. Many of the plans offer coverage for eligible dependents, including: Your legal spouse, common law spouse, or civil union partner. Your children to age 26, regardless of student, marital, or tax-dependent status (including a stepchild, legally-adopted child, a child placed with you for adoption, or a child for whom you are the legal guardian). Your dependent children of any age who are physically or mentally unable to care for themselves. Enrollment You can sign up for benefits or change your benefit elections at the following times: Within 31 days of your initial eligibility date (as a newly-hired employee). During the annual benefits open enrollment period. Within 31 days of experiencing a qualifying life event. The choices you make at this time will remain the same through January 31, If you do not sign up for benefits during your initial eligibility period or during the open enrollment period, you will not be able to elect coverage until the following plan year. Changing Your Benefits During the Year Veritas Management Group allows you to pay your portion of the medical, dental, and vision plan costs, and fund the flexible spending accounts, on a pre-tax basis. Thus, due to IRS regulations, once you have made your elections for the plan year, you cannot change your benefits until the next annual open enrollment period. The only exception is if you experience a qualifying life event. Election changes must be consistent with your life event. Qualifying life events include, but are not limited to: Marriage, divorce, or legal separation. Birth or adoption of an eligible child. Death of your spouse or covered child. Change in your spouse s work status that affects his or her benefits. Change in your child s eligibility for benefits. Qualified Medical Child Support Order. To request a benefits change, notify Human Resources within 31 days of the qualifying life event. Change requests submitted after 31 days cannot be accepted. 3

4 Medical Insurance Plan Veritas Management Group offers a PPO plan through Aetna. The plan offers in- and out-of-network benefits, providing you the freedom to choose any provider. The plan uses Aetna s high-performance network called Aetna Whole Health. You will pay less out of your pocket when you choose an Aetna Whole Health network provider. See page 5 for additional information on the network and how to locate an in-network provider. The table below summarizes the key features of the medical plan. The coinsurance amounts listed reflect the amount you pay. Please refer to the official plan documents for additional information on coverage and exclusions. Summary of Covered Benefits Calendar Year Deductible In-Network Aetna AWH OAMC 3000 Out-of-Network Individual/Family $3,000/$6,000 $6,000/$12,000 Calendar Year Out-of-Pocket Maximum Includes deductible, copays, and coinsurance Individual/Family $6,000/$12,000 $12,000/$24,000 Preventive Care Plan pays 100% $75 copay Physician Services Primary Care Physician Specialist Urgent Care Lab/X-Ray Diagnostic Lab/X-Ray High-Tech Services (MRI, CT, PET) Hospital Services Inpatient Outpatient Emergency Room Chiropractic Care Limit of 20 visits per calendar year Physical, Occupational & Speech Therapy Limit of 30 visits per calendar year Prescription Drugs (Up to a 30-day supply) Formulary Generic Formulary Brand-Name Non-Formulary Generic & Brand-Name Specialty Mail Order (Up to a 90-day supply) $35 copay $65 copay $75 copay 20% after deductible 20% after deductible 20% after deductible 20% after deductible $200 copay $65 copay $65 copay $10 copay $40 copay $60 copay 20% up to $ x retail copay $10 copay, then 20% $40 copay, then 20% $60 copay, then 20% Not covered Not covered 4

5 Medical Insurance Plan Aetna Whole Health Aetna Whole Health is a new way of looking at health care. As an Aetna medical plan member, you have access to a network of health care providers that practice team-based care. Led by your primary care doctor, your nurses, doctors, therapists, and other health care providers will work together and with you to help keep you healthy. We encourage you to choose a primary care doctor to lead your care team. This doctor gets to know you and your medical history. You will see your doctor whenever you are sick and for your annual wellness exam, including preventive screenings. Your doctor can also help you find care programs tailored to your needs, guide you on important health decisions, and direct your care across other specialties and facilities in your network. To find a provider in Colorado: Visit Type Primary Care Provider in the Who or what are you looking for? box. Enter your ZIP code in the Where? box. Scroll to the Aetna Whole Health plans and choose (CO) Aetna Whole Health Colorado Front Range from the Select a Plan drop down menu. To find a provider in Arizona: Visit Type hospital in the Who or what are you looking for? box. Enter your ZIP code or city and state in the Where? box. Choose either (AZ) Arizona Care Network OR (AZ) Banner Health Network from the Aetna Whole Health Select a Plan drop down menu. Preventive Care The Aetna medical plan covers in-network preventive care at 100%. This includes routine screenings and checkups, as well as counseling to prevent illness, disease, or other health problems. Talk to your primary care physician to find out which screenings, tests, and vaccines are right for you, when you should get them, and how often. Please be aware that you will be responsible for the cost of any non-preventive care services you receive at your preventive care exam. Learn more about preventive care at You won t have to pay anything no deductible, copay, or coinsurance for preventive services when: You get them from a doctor or other health care provider in the Aetna network. The main purpose of your visit is to get preventive care. Women s Preventive Care Services Due to health reform, the medical plan offers additional no-cost preventive care/services for women. Health Reform Law Individual Mandate You and your family members are required to have health insurance or pay a penalty to the government. If you don t have coverage in 2016, you ll have to pay a penalty of $695 per adult and $ per child, or 2.5% of your income (whichever is greater). The fee increases every year. Some people may qualify for an exemption to this fee. The Veritas Management Group medical plans meet all of the health reform law requirements to satisfy your individual mandate. Veritas Management Group pays a substantial amount of your coverage. The amount you pay for Veritas Management Group coverage is deducted from your paycheck on a pre-tax basis. If you are covered by any of the following in 2016, you will meet the individual mandate requirements: the Veritas Management Group medical plan, your parent s or spouse s employer plan, an individual policy, a government plan such as Medicare, Medicaid, CHIP, TRICARE, or veterans coverage, student health coverage, state highrisk pool coverage, or coverage for non-u.s. citizens provided by another country. Learn More Learn more about the health reform law requirements at 5

6 Dental Insurance Plan Veritas Management Group offers a dental insurance plan through Delta Dental of Colorado. Locate a Delta Dental provider at PPO Plus Premier Plan The PPO Plus Premier Plan provides in- and out-of-network benefits, allowing you the freedom to choose any dentist. The amount you pay varies based on whether you see a Delta Dental PPO dentist, Delta Dental Premier dentist, or out-ofnetwork (non-participating) dentist. You will pay less out of your pocket when you see a Delta Dental PPO dentist. Delta Dental PPO and Premier dentists file claims directly with Delta Dental and accept Delta Dental s reimbursement in full. When you see a PPO or Premier dentist, you will only be responsible for your deductible and coinsurance, as well as any charges for non-covered services up to Delta Dental s approved amount. If you choose to see an out-of-network dentist, you will incur additional out-of-pocket expenses, and you will be billed the total amount the dentist charges (called balance-billing). When you see a Delta Dental PPO or Premier dentist, you are protected from balance-billing. The table below summarizes the key features of the dental plan. The coinsurance amounts listed reflect the amount you pay. Please refer to the official plan documents for additional information on coverage and exclusions. Summary of Covered Benefits Calendar Year Deductible Delta Dental PPO Plus Premier Delta Dental PPO Delta Dental Premier Non-Participating Individual/Family $50/$150 Calendar Year Benefit Maximum $1,000 Preventive Care Oral exams, cleanings, x-rays Basic Services Minor restorative (fillings) Major Services Endodontics, periodontics, oral surgery, crowns, dentures, implants Plan pays 100% 20% after deductible Orthodontia Services (to age 19) 50% Orthodontia Lifetime Maximum $1,500 6

7 Summary of Covered Benefits In-Network EyeMed Vision Plan Out-of-Network Eye Exam (every 12 months) $10 copay $40 allowance Standard Plastic Lenses (every 12 months) Single/Bifocal/Trifocal $15 copay $30/$50/$70 allowance Frames (every 24 months) $130 allowance + 20% off balance $91 allowance Contact Lenses (every 12 months in lieu of lenses and frames) Elective Vision Insurance Plan Veritas Management Group offers a vision insurance plan through EyeMed. You have the freedom to choose any vision provider. However, you will maximize the plan benefits when you choose a network provider. Locate an EyeMed network provider at The table below summarizes the key features of the vision plan. Please refer to the official plan documents for additional information on coverage and exclusions. Medically Necessary $130 allowance + 15% off balance Plan pays 100% $130 allowance $210 allowance Laser Vision Correction 15% off retail or 5% off promo Not covered 7

8 Flexible Spending Accounts Veritas Management Group offers two flexible spending account (FSA) options the health care FSA and the dependent care FSA which allow you to pay for eligible health care and dependent care expenses with pre-tax dollars. The FSAs are administered by Rocky Mountain Reserve. Log into your account at to: view your account balance(s), calculate tax savings, view eligible expenses, download forms, view transaction history, and more. How Does an FSA Work? You decide how much to contribute to each FSA on a plan year basis up to the maximum allowable amounts. Your annual election will be divided by the number of pay periods and deducted evenly on a pre-tax basis from each paycheck throughout the year. You will receive a debit card from Rocky Mountain Reserve, which can be used to pay for eligible health care expenses at the point of service. If you do not use your debit card, or if you have dependent care expenses to be reimbursed, submit a claim form and a bill or itemized receipt from the provider to Rocky Mountain Reserve. Keep all receipts in case Rocky Mountain Reserve requires you to verify the eligibility of a purchase. Health Care FSA The health care FSA allows you to set aside money from your paycheck on a pre-tax basis (before income taxes are withheld) to pay for eligible out-of-pocket expenses, such as deductibles, copays, and other health-related expenses, that are not paid by the medical, dental, or vision plans. Over-the-counter (OTC) medications are not eligible for reimbursement without a prescription. The health care FSA maximum contribution is $2,550 for the plan year. Dependent Care FSA The dependent care FSA allows you to set aside money from your paycheck on a pre-tax basis for day care expenses to allow you and your spouse to work or attend school full time. Eligible dependents are children under 13 years of age, or a child over 13, spouse, or elderly parent residing in your house who is physically or mentally unable to care for himself or herself. Examples of eligible expenses are day care facility fees, before- and after-school care, and in-home babysitting fees (income must be reported by your care provider). You may contribute up to $5,000 to the dependent care FSA for the plan year if you are married and file a joint return or if you file a single or head of household return. If you are married and file separate returns, you can each elect $2,500 for the 2016 plan year. Things to Consider Before Contributing to an FSA: For the health care FSA, at the end of the plan year, you can roll over $500 from your health care FSA to use in future years. Any amount in excess of $500 will be forfeited. (Also applies to limited purpose health care FSA). Dependent care FSA dollars are use it or lose it (no roll over allowed). However, you have an additional two and a half months to incur and be reimbursed for expenses after the end of the plan year. You cannot take income tax deductions for expenses you pay with your FSA(s). You cannot stop or change your FSA contribution(s) during the plan year unless you experience a qualifying life event. 8

9 Life and AD&D Insurance Life and accidental death and dismemberment (AD&D) insurance is an important element of your income protection planning, especially for those who depend on you for financial security. For your peace of mind, Veritas Management Group provides basic life and AD&D insurance to all benefits-eligible employees at no cost. You have the option to purchase supplemental life and AD&D insurance. Beneficiary Designations Please be sure to keep your beneficiary designations up to date. Basic Life and AD&D Insurance Veritas Management Group automatically provides basic life and AD&D insurance through Unum to all benefits-eligible employees at no cost. If you die as a result of an accident, your beneficiary would receive both the life benefit and the AD&D benefit. Employee life benefit: $50,000. Employee AD&D benefit: $50,000. Supplemental Life and AD&D Insurance Veritas Management Group provides you the option to purchase supplemental life and AD&D insurance for yourself, your spouse, and your dependent children through Unum. You must purchase supplemental coverage for yourself in order to purchase coverage for your spouse and/or dependents. Supplemental life rates are age-banded (listed on page 11). Benefits will reduce to 65% at age 65 and to 50% at age 70. If you elect coverage when first eligible, you may purchase up to the guarantee issue amount(s) without completing a statement of health (evidence of insurability). If you do not enroll when first eligible, and choose to enroll during a subsequent annual open enrollment period, you will be required to submit evidence of insurability for any amount of coverage. Coverage will not take effect until approved by the carrier. Employee: $1,000 increments up to $500,000 or 5x annual earnings, whichever is less. Guarantee issue: $150,000. Spouse: $1,000 increments up to $500,000 or 5x annual earnings, whichever is less; not to exceed 100% of the employee s election. Guarantee issue: $25,000. Dependent children: $1,000 increments up to $10,000; not to exceed 100% of the employee s election. Guarantee issue: $10,000. 9

10 Voluntary Short-Term Disability Insurance Veritas Management Group provides you the option to purchase short-term disability (STD) insurance through Unum. STD insurance is designed to help you meet your financial needs if you become unable to work due to an illness or injury. Benefit: 60% of base weekly pay up to $1,000. Elimination period: 14 days. Benefit duration: Up to 11 weeks. Voluntary Benefits Voluntary Accident Insurance Veritas Management Group provides you the option to purchase voluntary accident insurance through Unum. Voluntary accident insurance provides coverage for a wide variety of accidental injuries, including broken bones, concussions, and burns, and covered events such as medical treatment or hospitalization due to an accident. If you elect coverage for yourself, you can also elect to cover your spouse and/or dependent children. Please refer to the official plan documents for rates and a full list of covered injuries and expenses. Voluntary Critical Illness Insurance Veritas Management Group provides you the option to purchase voluntary critical illness insurance through Unum. Critical illness insurance can help with the treatment costs of covered critical illnesses, such as cancer, a heart attack, or a stroke. This plan provides a lump sum benefit upon the diagnosis and treatment of a covered illness. If you elect coverage for yourself, you can elect coverage for your spouse and dependent children. Please refer to the official plan documents for rates and a full list of covered conditions and benefits. 10

11 Benefit Plan Costs Medical, Dental, and Vision Insurance Listed below are the monthly costs for medical, dental, and vision insurance. The amount you pay for coverage is deducted from your paycheck on a pre-tax basis. Coverage Level Aetna AWH OAMC 3000 Delta Dental Plan EyeMed Vision Plan Employee Only $96.00 $15.02 $6.37 Employee + Spouse $ $25.76 $12.09 Employee + Child(ren) $ $30.27 $12.73 Employee + Family $ $45.00 $18.71 Supplemental Life/AD&D and Short-Term Disability Costs Listed below are the monthly rates for supplemental life/ad&d and short-term disability insurance. The amount you pay for supplemental life/ad&d and short-term disability insurance is deducted from your paycheck on a post-tax basis. Spouse life rates are based on the spouse s age. Age Supplemental Life Rates Employee and Spouse Rate Per $1,000 of coverage <20 $ $ $ $ $ $ $ $ $ $ $ $ $7.00 Child Rate* Per $1,000 of coverage $0.100 Children to age 19, or 26 if full-time student Age Supplemental STD Rates Employee Rate Rate per $10 <20 $ $ $ $ $ $ $ $ $ $ $ $1.27 Supplemental AD&D Rates Employee Per $1,000 of coverage $0.015 Spouse Per $1,000 of coverage Child* Per $1,000 of coverage $0.015 $0.015 *The child rate is for all eligible dependents not per dependent. 11

12 EMPLOYEE BENEFITS Benefit plans effective February 1, 2016 January 31, 2017 Important Contact Information If you have any questions regarding your benefits or the material contained in this guide, please contact Human Resources. Provider/Plan Policy Number Contact Number Website Medical Aetna Prescription Drugs Aetna Retail: Mail Order: Dental Delta Dental of Colorado Vision EyeMed Flexible Spending Accounts Rocky Mountain Reserve Life and AD&D Insurance Unum Voluntary Short-Term Disability Insurance Unum Voluntary Accident and Critical Illness Insurance Unum RMRVER Life/AD&D: Vol Life/AD&D: R This summary of benefits is not intended to be a complete description of the terms and Veritas Management Group insurance benefit plans. Please refer to the plan document(s) for a complete description. Each plan is governed in all respects by the terms of its legal plan document, rather than by this or any other summary of the insurance benefits provided by the plan. In the event of any conflict between a summary of the plan and the official document, the official document will prevail. Although Veritas Management Group maintains its benefit plans on an ongoing basis, Veritas Management Group reserves the right to terminate or amend each plan, in its entirety or in any part at any time. Images 2015 istock. All rights reserved. 12