Employee Benefits Guide

Transcription

1 Employee Benefits Guide 2016

2 Benefit Summary Welcome to MJ Management s Open Enrollment the time where all eligible employees are able to make changes to their benefit elections. Decisions that you make now will be effective July 1, 2016 and will be in place until June 30, 2017 unless you experience a mid-year qualifying change in status (see page 3 for details). All changes must be submitted to Human Resources by June 20, This guide is designed to be a resource for you to obtain high level information about the benefit packages offered by MJ Management Services, Inc. Please carefully review this information and keep it as a reference so you can make the most of your benefits. If you have any questions, please contact Human Resources. Benefits Overview MJ Management is proud to offer a comprehensive benefits package to eligible, employees. The complete benefits package is briefly summarized in this guide book. You will receive plan booklets, which give you more detailed information about each of these programs. For the purpose of medical, prescription drug, dental, and vision benefits, full time is defined as employees working at least 40 hours per week. Full time employee are eligible to enroll their dependents in all lines of coverage. Part time is defined as employees working between 30 and 39 hours per week. Part time employees are only eligible for employee-only medical, prescription drug, and vision benefits. Dependents of part-time employees are not eligible for coverage. You should know that plan participants share the costs of all benefits. Additionally, there are voluntary benefits with reasonable group rates that you can purchase through AFLAC via payroll deductions. This document is an outline of the coverage proposed by the carrier(s), based on information provided by your company. It does not include all of the terms, coverage, exclusions, limitations, and conditions of the actual contract language. The policies and contracts themselves must be read for those details. Policy forms for your reference will be made available upon request. The content of this booklet is intended for use as an easy to read summary only. It does not constitute a contract. Additional limitations and exclusions may apply. For an official description of benefits, please refer to each carrier s official certificate/benefit guide. For more information, please contact the Human Resources Department. The intent of this document is to provide you with general information regarding the status of, and/or potential concerns related to, your current employee benefits environment. It does not necessarily fully address all of your specific issues. It should not be construed as, nor is it intended to provide, legal advice. Questions regarding specific issues should be addressed by your general counsel or an attorney who specializes in this practice area. 2

3 MJ Management Services, Inc. Mid-Year Benefits Changes The MJ Management benefits program lets you design a new benefits package each year during the annual open enrollment period, for an effective date of July 1. Your choices are then locked in for the calendar year as IRS regulations prevent you from changing your benefits during the year unless you experience a family status change. Family status changes include events such as: Marriage, divorce or legal separation The birth or adoption or legal guardianship of a child The death of your spouse or dependent A dependent s loss of eligibility A change in your spouse s employment status or health plan which affects benefits eligibility The open enrollment of your spouse s employer Dependent gain of coverage Dependent loss of coverage under a governmental plan (Medicaid) If one of these events occurs and you want to change your benefit coverage, the event must be consistent with the change. For example, if you have a baby, you may change your medical coverage from employee and spouse coverage to family coverage. However, you may not drop your dental plan option. You must contact Human Resources within 30 days for assistance in all family status change events, including a legal separation or divorce, as coverage will not automatically change. If you do not notify Human Resources within that timeframe, you will have to wait until the next open enrollment period to make your desired changes. Opt-Out Bonus MJ Management will pay an opt-out bonus only to full time employees who choose to opt-out of medical, dental and vision. The opt-out program allows full time employees to waive coverage and receive $1,000 per year ($500 paid on December 15th and $500 paid on June 30th). Part time employees are not eligible for the opt-out bonus. 3

4 Benefit Summary Medical and Prescription Drug Benefits Insured by Blue Cross Blue Shield of Michigan Comprehensive and preventive healthcare coverage is important in protecting you and your family from the financial risks of unexpected illness and injury. A little prevention usually goes a long way especially in healthcare. Routine exams and regular preventive care provide an inexpensive review of your health. Small problems can potentially develop into large expenses. By identifying the problems early, often they can be treated at little cost. We will be offering a new BCBSM medical plan for 2016 called Simply Blue. Our current medical plan will not be offered in The new Simply Blue plan will continue to be a PPO plan through Blue Cross Blue Shield of Michigan (BCBSM). Some of the differences between the new Simply Blue plan offering and our prior year plan are as follows: The emergency room copay is increased to $150 and is only waived if admitted (the copay will still apply for accidental injuries). Applies deductibles and coinsurance to non-preventative office visit services. Physical, Speech and Occupational therapy is limited to 30 visits per calendar year per member. Chiropractic visits are limited to 12 visits per calendar year per member Non-Network providers are treated as out of the network. The BCBSM PPO network is a national network and you have complete freedom to see any doctor of your choice. If you choose doctors and hospitals in the BCBSM PPO network, your out-of-pocket costs will be lower than if you use other health care providers outside of the network. To find a participating BCBSM PPO provider, visit the website at Below is a high level summary of the medical and prescription drug plans for your reference. Please see the Summary of Benefits and Coverage and/or detailed certificates for further details of plan benefits, limitations and exclusions. Annual Deductible Medical Services In-Network $1,000 per member $2,000 per family Out of Network $2,000 per member $4,000 per family Office Visit (Illness/Injury)* $30 copay 60% after deductible Urgent Care Visit $30 copay 60% after deductible Emergency Room Visit (Waived if admitted)** $150 $150 Preventive Services (routine exams, x-rays/tests, immunizations, well baby care and mammograms) 100% covered Not covered Coinsurance 80% 60% Laboratory, Diagnostic test, x-rays and radiology 80% after deductible 60% after deductible Prenatal care visits 100% (no deductible or copay/ coinsurance) 60% after deductible Postnatal care, delivery and nursery care 80% after deductible 60% after deductible Inpatient Hospital Care- semiprivate room, inpatient physician care, general nursing care, hospital services and supplies Annual Coinsurance Maximum Annual Member Out-of-Pocket Maximum 80% after deductible 60% after deductible $2,500 per member $5,000 per member $5,000 per family $10,000 per family Includes deductible, copays and coinsurance charges for all covered services 4 $6,350 per member $12,700 per family $12,700 per member $25,400 per family

5 Prescription Drug Benefits Insured by Blue Cross Blue Shield of Michigan MJ Management Services, Inc. Our BCBSM plan uses the Express Scripts national network of pharmacies. The BCBSM prescription drug program is run by a continually updated list of FDA-approved medications which may change at any point in the benefit year. As changes are made to the drugs classifications, the required copay to fill a drug may change due to the updates. The goal of this list is to provide members with the greatest therapeutic value at the lowest possible cost. Prescription Drugs In-Network Out of Network Retail Generic Drug (30-day supply) Retail Formulary Drug (30-day supply) Retail Nonformulary Drug (30-day supply) $10 copay $10 copay plus 25% $40 copay $40 copay plus 25% $80 copay $80 copay plus 25% You have a triple-tier drug plan. BCBSM s formulary, a list of covered medicines, is divided into three tiers by drug type. What you pay depends on what tier your drug is in. Tier 1- Generic Drugs made with the same active ingredients, available in the same strengths and dosage forms as brand name drugs. These require the lowest member copay and so are the most cost-effective option for treatment. Tier 2- Formulary (Preferred Brand) Brand name drugs found on the BCBSM formulary list. These drugs are higher in cost than the generics, but have the same effectiveness and safety. Tier 3- Non-Formulary (Non-Preferred Brand) These drugs are more costly than other therapeutic equivalents that are available as either a generic or formulary brand. They may not have a proven record for safety. If your prescription is filled by any network pharmacy and the pharmacist fills it with a generic equivalent drug, you pay only the copay. If you obtain a brand name drug on the BCBSM formulary when a generic equivalent drug is available, you MUST pay the difference in cost between the formulary brand name drug dispensed and the maximum allowable cost for the generic drug plus your copay, regardless of whether you or your doctor requests the brand name drug. If you obtain a nonformulary brand-name drug when a generic equivalent is available, the nonformulary brand-name drug is not a covered benefit. Exception: If your physician requests and receives authorization for a nonformulary brand-name drug with a generic equivalent from BCBSM and writes Dispense as Written or DAW on the prescription order, you pay only your applicable copay. Vision Benefits Insured by Blue Cross Blue Shield of Michigan, Administered by Vision Service Providers Regular eye examinations can not only determine your need for corrective eyewear but also may detect general health problems in their earliest stages. Protection for the eyes should be a major concern to everyone. BCBSM s vision benefit uses the Vision Service Plan (VSP) Choice network, which includes Costco. Remember, while you have access to coverage regardless of your vision provider, you will have significantly better coverage if you use in-network providers. Be sure to ask your current provider if they participate in the network, or locate a new provider of your choice. You may locate more information regarding providers and out-of-network claim forms on the VSP website or call Plan Provisions WellVision Exam (every 12 months) Materials Lenses (every 12 months) Frames (every 24 months) Contacts (every 12 months) In-Network Benefits $5 copay Lenses & Frames OR Contacts in lieu of glasses $10 copay (one copay applies to both lenses & frames) 100% up to $130 frame allowance $10 copay if medically necessary; $130 allowance if elective 5

6 Benefit Summary Dental Benefits Insured by Guardian Benefit Design Annual Deductible Annual Benefit Maximum Class I Services: Preventive Dental Services (cleanings, exams, x-rays) In Network Member Share None $1,000 per member for covered Class I, II & III services 100% covered Class II Services: Basic Dental Services (fillings, root canal therapy, oral surgery) Covered at 75% Class III Services: Major Dental Services (extractions, crowns, inlays, onlays, bridges, dentures, repairs) Class IV Services: Orthodontia Services (covered to age 19) Covered at 50% 50% to $1,000 lifetime maximum Good oral care enhances overall physical health, appearance and mental well-being. Problems with the teeth and gums are common and easily treated health problems. Keep your teeth healthy and your smile bright with the MJ Management dental benefit plan. The plan offered is a PPO plan which means you can choose to obtain services from an in-network provider or an out-of-network provider. Your money will go farther in network because you are not responsible for charges exceeding the reduced PPO fee. If you receive treatment from an out-of-network dentist you may be balance billed and/or be required to pay the provider in full and submit to Guardian for reimbursement. We encourage you to contact your dental provider and inquire if they participate in the Guardian PPO network. You can also check the Guardian website at or call Life and Accidental Death & Dismemberment Insurance Insured by Guardian Life insurance provides financial security for the people who depend on you. Your beneficiaries will receive a lump sum payment of one times your annual earnings up to $50,000 if you die while employed by MJ Management. Accidental Death and Dismemberment (AD&D) insurance provides payment to you or your beneficiaries if you lose a limb or die in an accident. MJ Management provides AD&D coverage of one times your annual earnings up to $50,000. This coverage is in addition to your life insurance described above. YOU CAN T TAKE IT WITH YOU SO MAKE SURE IT GOES TO THE RIGHT PEOPLE Open Enrollment is an excellent time to review & update your beneficiaries. Don t forget to look at your designations for all of your benefits basic life insurance, voluntary life insurance, voluntary AD&D, and 401(k). If you have had a change in your family or are unsure of your current life insurance beneficiary designation, we urge you to complete and submit a new beneficiary designation form. If you want your minor child (or children) to be your beneficiary(ies), you should discuss your plans with your legal advisor. Neither the plan nor the insurer will pay benefits directly to a minor child. Benefits from the plan such as life insurance must to be paid to an adult, such as a guardian, or to a trust established for the benefit of your child. Your legal advisor can help you determine the best way to accomplish this. Short Term Disability Insurance Insured by Guardian The Short Term Disability (STD) insurance is a valuable benefit designed to replace a portion of your income when you are unable to work because of a non-work related injury or illness. STD coverage provides income replacement when you are disabled from an accident or illness for up to 6 weeks. The STD benefit amount is 66 2/3% of your weekly earnings up to a $500 weekly benefit maximum. 6

7 MJ Management Services, Inc. Flexible Spending Account Administered by Aflac You can save money on your healthcare and/or dependent day care expenses with an FSA. These accounts enable you to set aside a predetermined dollar amount in an account to cover eligible out-of-pocket health care and dependent day care expenses. Always save your receipts in case of claims substantiation or IRS audit. Please be sure to carefully estimate your 2016 expenses as any unused funds at the end of the year will be forfeited. In addition, you cannot change the amount you contribute during the year or stop contributing, unless you have a qualified family status change. FSA enrollment is required each plan year, meaning you must make a new election each year to participate in both of the following types of accounts: Health Care Spending Account You can elect to contribute up to $2,500 for to be for eligible health care expenses as defined by the IRS. Examples of eligible expenses are: Payments made by you to cover deductible, copay and/or coinsurance expenses for medical, dental, vision and doctor s prescribed medications (you cannot be reimbursed for over the counter medications unless you have a prescription from your physician) Any other health care expense you could deduct on your federal income tax form (see IRS Publication 502) with the exception of contributions paid towards insurance premiums Dependent Care Spending Account You and your spouse may contribute up to $5,000 per year of pre-tax dollars to a Dependent Care Spending Account. If you are married and file separate tax returns, the maximum contribution is $2,500, but in no event can you and your spouse jointly contribute more than $5,000. While the Dependent Care Spending Account works much like the Health Care Spending Account, it is an entirely separate account with its own rules and procedures. Keep in mind that any expense reimbursed through your Dependent Care Spending Account cannot also be claimed for an IRS child care credit when you file your tax return. Consult your tax advisor to determine what approach is best for you. Eligible dependents are children under age 13 for whom you claim as dependents on your federal income tax return. Other family members such as disabled children and elderly parents who are unable to care for themselves and for whom you claim as dependents on your tax return may also be eligible. When you submit a claim for reimbursement, you must include the provider s tax identification number (usually the Social Security number for individual day care providers). 24/7 Online Healthcare Administered by Amwell Effective July 1, 2016 BCBS will begin a new partnership with Amwell, allowing you access to fast, convenient, affordable online health care 24 hours a day, seven days a week, wherever you are in the U.S* for your standard office visit copay Follow the registration steps below, then just choose an available doctor, click and go no referral needed. It s as simple as using your mobile device or computer to meet with a doctor face-to-face. You can use Amwell, American Well s award-winning and easy-to-use online health care technology, for minor, nonemergency illnesses, such as: Sinus and respiratory infections Vomiting Colds, flu and seasonal allergies Diarrhea Urinary tract infections Headache Strains and sprains Pinkeye Rashes Important: You may be charged incorrectly if you don t enter your plan information and service key. If you already have an Amwell account, log in and enter your plan information and service key, too. Enroll for free, there is NO monthly fee. Make sure to create accounts for your spouse and dependent children over 18 or add your under 18 dependents to your Amwell account so that they can have access to a variety of board certified doctors anytime, also. When you need care, you will choose the doctor that suites your needs best. no appointment needed At the end of your visit, you ll get a full report to share with your family doctor or other health care providers. *Some states may restrict access to full services, find the current service access map at: info.americanwell.com/where-can-i-see-a-doctor-online 7

8 Contact Information If you have specific questions about a benefit plan, please contact the administrator listed below, or your local human resources department. Benefit Administrator Phone Website/ Medical PPO BCBSM /7 Online Health Care Amwell Hour Nurse Line BCBSM BLUE (2583) Prescription Drug Express Scripts Vision BCBSM (VSP) Dental Guardian Life/Accidental Death & Guardian Dismemberment Short-term Disability Guardian Flexible Spending Accounts Aflac