Summary of Insurance and Benefits Offerings Effective March 1, 2017 February 28, 2018

Transcription

1 Summary of Insurance and Benefits Offerings Effective March 1, 2017 February 28, 2018 Table of Contents Health Plan - Examples and Explanations... 2 Healthcare Plan Offerings... 6 Dental Plan Offerings... 7 Vision Plan Offerings... 8 Life Insurance Offerings... 9 Voluntary Long Term Disability Offerings Voluntary Short Term Disability Offerings (k) Retirement Savings Plan...12

2 Precision Global Consulting Health Plan Examples and Explanations In Network vs. Out of Network Coverage An in-network provider is one contracted with the health insurance company to provide services to plan members for specific pre-negotiated rates. An out-of-network provider is one not contracted with the health insurance plan. The plan that you choose will dictate the type of coverage you have, and the rate you pay. Typically, if you visit a physician or other provider within the network, the amount you will be responsible for paying will be less than if you go to an out-of-network provider. Example: Tom has a plan where he has only In-Network coverage and has no Out-of-Network coverage. Tom s Primary Care Physician and Dermatologist are In-Network providers, therefore Tom will be covered for these services. If Tom visits a medical services provider that is Out-of-Network, Tom will be responsible for all the associated healthcare costs from that visit. Example: Janet has a plan with In-Network and Out-of-Network coverages. Janet will be covered no matter where she receives her medical services. However, the deductibles, coinsurance, and co-pays will be different on the services performed Out-of-Network than services performed In-Network. Calendar Year Deductible This is the amount you have to pay in a calendar year before the plan begins to pay out. Note that not all services require you to meet the deductible. For example, there are plans that require you to pay up to the full deductible before Primary Care Physician, Specialist, or other office visits will be covered by insurance. Example: Tom s Calendar Year Deductible is $2,500. Tom has a procedure done at a cost of $4,000. Depending on the insurance plan, Tom will most likely be responsible for covering the first $2,500 out of pocket, and the insurance will pay a portion of the remaining $1,500 according to the co-insurance. If the plan is a co-pay plan, Tom will be responsible for paying a co-pay between $30-$100 after the deductible limit is met. Example: Janet s plan has no Calendar Year Deductible. This means that Janet s plan will begin to pay out for covered services right away, and Janet will only be responsible for co-pay or coinsurance for any covered services. Copay A copay is a fixed amount you pay for a health care service, usually when you receive the service. The amount can vary by the type of service. You may also have a copay when you get a prescription filled. Coinsurance Coinsurance is a health care cost sharing between you and your insurance company. Not all plans have coinsurance (some have copay). It is a split of the cost of the services the number you see is the number the insurance company pays. You pay the remainder. Example: Tom s plan provides 80% co-insurance after a yearly deductible of $1,000 if Tom receives any diagnostic procedures like X-Rays. Tom injures his leg playing soccer and needs an X-Ray done at a cost of $2,000. This means that Tom will be responsible for an out of pocket cost of $1,000 (up to deductible), plus 20% of the remainder which is $1,000. Tom s total expenses for the X-Ray (not including other medical care services) is $1,200. *Note: This assumes that Tom had not previously met his yearly deductible Example: Janet s plan provides for 100% coinsurance after a yearly deductible of $500. Janet sees her dermatologist for a skin rash at a cost of $3,000. Janet will pay out of pocket $500, and her plan will cover the remaining $2,500.

3 Max Out of Pocket Deductible Out-of-Pocket Limit is the maximum amount of money you may pay for medical services in a calendar year. Out-ofpocket limit may not include deductible depending on insurers definition of the term. The maximum amount of money you may spend for health care services also may vary whether they are in or out of network. Example: Tom s plan has a Maximum Out of Pocket Deductible of $6,000. Tom gets into a terrible car accident and his recovery costs $150,000. Regardless of the dollar figure, the most Tom will pay out of pocket in the calendar year is $6,000. Note that if Tom s plan does not have Out-of-Network coverage, and Tom is treated by an Out-of-Network provider, Tom will be responsible for the entire $150,000. Annual Lifetime Maximum The Affordable Care Act prohibits health plans from putting annual or lifetime dollar limits on most benefits you receive. The Annual and Lifetime Maximums are a dollar limit on what insurance would spend for your covered benefits during the entire time you were enrolled in that plan. You were required to pay the cost of all care exceeding those limits. Gatekeeper A gatekeeper is a health insurance term used to describe the person in charge of a patient's treatment. Anyone who receives health insurance coverage in the form of a managed care plan, specifically a Health Maintenance Organization (HMO) plan, is assigned a gatekeeper or allowed to choose one. A gatekeeper's duty primarily is to manage a patient's treatment. This means that the gatekeeper is in charge of authorizing the patient's referrals, hospitalizations, and lab studies. When a patient falls ill or needs to be referred to a specialist, the patient contacts the gatekeeper who, in turn, refers the patient to doctors and specialists within the plan network. Any plans that require a gatekeeper will require you to contact your PCP whenever you need a referral to see a specialist. Plans without a gatekeeper allow you to contact the specialist directly. Example: Tom s plan is a Gatekeeper plan. Tom develops an extreme ear pain and needs to see an Ear, Nose, and Throat Doctor. Tom must first contact/schedule to see his Primary Care Physician, and must be referred to a specialist, before the plan will cover his treatment. If Tom contacts an ENT Doctor before a referral is given, Tom will be responsible for the entire cost of the treatment, even if the ENT is In-Network and the treatment is medically necessary. PCP Office Visits This is the amount that will be covered under your plan for visits to your primary care physician. For plans with copay, you will pay the copay amount, and usually nothing towards the deductible. For plans with coinsurance, you will typically be responsible for paying up to the deductible, then a split with the insurance company. Example: Tom s plan has a yearly $500 deductible with a 90% coinsurance after deductible for PCP visits. Tom visits his PCP in January for a cough at a cost of $800. Tom will be responsible for the first $500, and 10% of $800. Tom s total out of pocket expenses will be $580. In September, Tom visits his PCP complaining of constant headaches and the cost of the treatment is $500. Tom is responsible for $50 of the cost because he has already met his deductible for the year. Example: Janet s plan has a yearly deductible of $1,000, with a $40 copay for PCP visits. Janet visits her PCP and is treated for a sore throat at a cost of $1,000. Because Janet s copay is unaffected by the deductible, Janet will pay $40 only for the treatment.

4 Specialist Office Visits While your primary care doctor performs routine checkups and is generally the overseer of your healthcare, a specialty doctor or specialist addresses particular types of illness or specific parts of your body. If, for instance, you come down with a urinary tract infection, you may need to see a urologist. Or if your bad back starts acting up, you may want to see an orthopedic specialist. The same rules apply as your PCP visits regarding coinsurance and copay, depending on your plan. Preventative Care Most health plans cover a series of preventative services, like screenings and shots, at no cost to you when administered by a provider In-Network. These may include services like Blood Pressure Screening, Cholesterol Screening, HIV Screening, Immunizations, Counseling, and Flu Shots. Diagnostic Procedures Preventive care and diagnostic medical care both play an important part in keeping you as healthy as possible. But, sometimes the difference between the two isn t clear. Diagnostic medical care involves treating or diagnosing a problem you re having by monitoring existing problems, checking out new symptoms, or following up on abnormal test results. Outpatient Ambulatory Surgery Outpatient care is medical service provided that does not require a prolonged stay at a facility. This can include routine services such as checkups or visits to clinics. Even more involved procedures such as surgical procedures, so long as they allow you to leave the hospital or facility on the same day, can still be considered as outpatient care. Many surgical services, rehabilitation treatments, as well as mental health services are available as outpatient services. Outpatient care tends to be less expensive, since it is often less involved and does not require a patient's continued presence in a facility, which uses up less of the hospital or medical clinic's resources. In-Patient Hospital Admission Inpatient care generally refers to any medical service that requires admission into a hospital. Inpatient care tends to be directed towards more serious ailments and trauma that require one or more days of overnight stay at a hospital. For the purposes of healthcare coverage, health insurance plans require you to be formally admitted into a hospital for a stay for a service to be considered inpatient. This means a doctor has to write a note to give the order to admit you, so if you were in the emergency room and were asked to stay overnight for Medical Observation, it does not make you an inpatient. ER Copay This is the amount you will pay when visiting an Emergency Room for Emergency services. If you are admitted as an in-patient, then the ER Copay fees are waived and you will be responsible for the In-Patient Hospital Admission Copay. Urgi-Center This is the amount you will pay when visiting an Urgent Care Center instead of a PCP or other medical services provider.

5 Prescription Coverage These are the amounts you will be paying for prescriptions to treat illness. Prescriptions are delegated to three tiers. The amount of copay you will be responsible for is dependent on the type of medication that you need. Note that some plans require you to meet the deductible before you can pay copay for your prescription medication. Example: Tom s healthcare plan has a prescription coverage at $10/$35/$60 copay after a $1,500 deductible. Tom develops a serious infection and his medication costs him $300/bottle. Tom needs to take 1 bottle a week for 2 months for a total cost of $2,400 (8 treatments). Tom will be responsible to pay for the first $1,500 worth of medication (5 treatments), and will pay the copay per bottle on the remaining bottles. If the copay is $10 for the Tier1 Medication, Tom s total out of pocket costs for the prescription is $1,530 Example: Janet s healthcare plan has a prescription coverage at $10/$15/$25 and does not require her to meet the deductible before the plan pays out. Janet gets a terrible rash and requires a very expensive Tier 3 topical ointment for 1 month. The ointment costs $400 per tube, and lasts for 1 week. Even though the total cost of the prescription is $1,600, Janet is only responsible for $100 of copay ($25 x 4 tubes).

6 Plan Provisions Calendar Year Deductible (Single/Family) Silver 12-HSA $3000 Precision Global Consulting Summary of Healthcare Offerings Provided by Cigna Effective Date: March 1, 2017 Gold HSA $2000 Platinum 12-OAP $500 In-Network Out of Network In-Network Out of Network In-Network Out of Network $3,000/$6,000 $6,000/$12,000 $2,000/$4,000 $4,000/$8,000 $500/$1,000 $1,000/$2,000 *If you have a family contract, the entire family deductible must be met before deductible will be considered satisfied for any single family member. Coinsurance 80% 60% 90% 70% 80% 60% Max Out-of-Pocket (Including Deductible) $6,000/$12,000 $12,000/$24,000 $5,000/$10,000 $12,000/$24,000 $6,000/12,000 $12,000/$24,000 Note: All copayments, deductible, & coinsurance (medical & RX) paid for in-network covered services contribute to the in-network, out-of-pocket max Annual & Lifetime Maximum Unlimited Unlimited Unlimited Gatekeeper (Yes or No) No No No Preventative Care (Adult/Child) 100% N/A 100% N/A 100% N/A PCP Office Visits Co-Pay 80% after deductible 60% after deductible 90% after deductible 70% after deductible $20 copay 60% after deductible Specialist Office Visits Co-Pay 80% after deductible 60% after deductible 90% after deductible 70% after deductible $40 copay 60% after deductible Diagnostic Procedures (Labs, X-rays & Imaging Services) Complex imaging at 80% after deductible. All others at 100% with deductible waived. 60% after deductible Complex imaging at 90% after deductible. All others at 100% with deductible waived. 70% after deductible Complex imaging at 80% subject to deductible. All others at 100% with deductible waived. 60% after deductible In-Patient Hospital Admission Copay: 80% after deductible 60% after deductible 90% after deductible 70% after deductible 80% after deductible 60% after deductible Outpatient Professional Services 80% after deductible 60% after deductible 90% after deductible 70% after deductible 80% after deductible 60% after deductible ER Copay (Waived if admitted) 80%, after deductible 90% after deductible $100 copay Urgi-Center 80% after deductible 60% after deductible 90% after deductible 70% after deductible $50 copay 60% after deductible Telehealth services 80% after deductible N/A 90% after deductible N/A $10 copay N/A Rx copays (Tier 1/Generic; Tier 2/Brand Name & Tier 3/Specialty) $15/$35/$60 copay after deductible N/A $15/$35/$60 copay after deductible Prescription Coverage Rx Deductible Subject to medical deductible Subject to medical deductible None N/A Rx Annual Maximum Unlimited Unlimited Unlimited N/A Rate Summary (monthly premium) $15/$35/$50 copay Mail Order Copay $38/$88/$150 copay with a 90-day supply after deductible $38/$88/$150 copay with a 90-day supply after deductible $38/$75/$125 copay with a 90-day supply Student/Dependent Age Dep to age 26 (e nd of month) Dep to age 26 (e nd of month) Dep to age 26 (e nd of month) Employee Only $375 $450 $510 Employee/Spouse $787 $941 $1,072 Employee/Child(ren) $656 $784 $894 Full Family $1,143 $1,366 $1,558 N/A

7 Precision Global Consulting Summary of Dental Offerings Provided by Effective Date: March 1, 2017 Plan Provisions Low Plan High Plan In Network Out of Network In Network Out of Network Network PPO N/A PPO N/A Annual Deductible/Individual $50 $50 $50 $50 Annual Deductible/Family $150 $150 $150 $150 Waived for Preventive Yes Yes Yes Yes Annual Plan Maximum $1000 $750 $3,000 $2,000 Coinsurance Diagnostic and Preventive 100% 50% 100% 100% Basic Services 80% 50% 80% 80% Major Services 50% 50% 50% 50% Orthodontia Orthodontia - Deductible N/A N/A $0 $0 Orthodontia Coinsurance N/A N/A 50% 50% Orthodontia - Adult Lifetime Maximum N/A N/A $2,000 $2,000 Orthodontia - Child Lifetime Maximum N/A N/A $2,000 $2,000 Rate Single Employee + Spouse Employee + Child(ren) Family $20.00 $42.04 $47.72 $73.07 $50.00 $97.92 $ $189.30

8 Precision Global Consulting Summary of Vision Offering Provided by / VSP Effective Date: March 1, 2017 Plan Provisions VSP Choice Network In Network Out of Network Copayment Exam $10 copay $45 allowance Standard Premium Copay not to exceed $60 Applied to allowance for the contact lenses Materials $25 copay N/A Frequency of Services Vision Exam 12 Months 12 Months Lenses 12 Months 12 Months Frames 24 Months 24 Months Contact Lenses 12 Months 12 Months Must Choose Lenses or Contacts Yes Yes Basic Lenses Single $25 copay $30 allowance Bifocal $25 copay $50 allowance Trifocal $25 copay $65 allowance Frame $150 allowance after $20 copay, then 20% off amount over the allowance Contacts $70 allowance Elective $150 allowance after copay $105 allowance Medically Necessary Single Employee + Spouse Employee + Child(ren) Family Covered in full after $25 copay Rates $7.00 $14.35 $16.70 $26.00 $210 allowance *VSP has agreements established with some Participating Retail Chain Providers that may also provide benefits for this covered service. Up to an $80 allowance is given for a wide selection of frames from Costco.

9 Precision Global Consulting Summary of Ancillary Offerings Provided by Effective Date: March 1, 2017 Life Insurance Plans Supplemental Life - Employee Supplemental Life - Spouse Life Schedule Increments of $25,000 Increments of $5,000 Life Maximum Benefit $500,000 Guaranteed Issue Under Age 70: $150,000 Age 70 and over: $10,000 The Lesser of 50% of the employee s election or $100,000 Under Age 70: $30,000 Age 70 and over: $10,000 Rates Supplemental Life - Child Flat Amount: $1,000, $2,000, $4,000, $5,000, or 10,000 The Lesser of 50% of the employee s election or $10,000 $10,000 Life Rate per $1,000 AD&D Rate per $1,000 Age Band Scale Age Band Scale Age Band Scale

10 Voluntary Long Term Disability Voluntary LTD Monthly Benefit Percentage 60% Maximum Monthly Benefit $10,000 Duration of Benefits Under Age 62 To age 65 Duration of Benefits at Age months Age months Age months Age months Age months Age months Age months Age months Age months Elimination Period 180 days Drug/Alcohol Limitation 24 months Mental/Nervous Limitation 24 months Pre-Existing Condition Clause 3/12 < Rate Per $100 $0.100 $0.100 $0.120 $0.160 $0.260 $0.360 $0.540 $0.630 $0.670 $0.610 $0.470 $0.230

11 Voluntary Short Term Disability Voluntary STD Plan Disabilities must be solely and directly caused by sickness, injury, or pregnancy. You cannot perform the majority of the substantial and material duties of your own job. You are Definition of Disability performing the duties of your own job on a modified basis and lose at least 20% of the income you earned before becoming disabled. You are performing the duties of any other job and lose at least 20% of the income you earned before becoming disabled. Benefit % 60% Maximum Weekly Benefit Lesser of 60% of salary or $2,000 Minimum Weekly Benefit $15 Date Benefits Begin Accident 8 days Sickness 8 days Benefit Duration 26 weeks Rate per $10 <19 $ $ $ $ $ $ $ $ $ $ $ $0.550

12 PGC Retirement Program Offering PGC is pleased to offer its eligible employees the opportunity to start saving for retirement. PGC prides itself on choices and freedom, keeping with that spirit, we are proud to now provide a unique offering: A company 401(k) plan administered by John Hancock and Platinum 401K. The Precision Global Consulting 401(k) Plan powered by Platinum 401K and John Hancock Investments Highlights and Limitations: You can deduct your 401(k) contribution pre-tax, allowing you to reduce your taxable income today while putting money away for your future You may be able to borrow money against your 401(k) plan, allowing you to have a rainy-day fund for unforeseen expenses for you and your family With John Hancock s Investment platform, you will have full control to dictate your appetite for risk and your target retirement date. If you require guidance, licensed professionals are willing and able to offer guidance, and can help you position yourself to make the best choices for your lifestyle If you are over 50 years old, you can make an annual catch-up payment of $6,000. For 2017, the maximum allowable elective referrals you can make to your 401(k) plan is $18,000. If you are over 50 years old, you can make $24,000 in deferrals Eligibility Requirements: Plan Costs and Fees: Support: The employee must be at least 21 years of age on the eligibility date The employee will become eligible to join on the first of the month following 30 days of employment. (Eg: start Date May 15, Eligible July 1) The employee must have earned below $120,000 through PGC in their previous year of employment There is a flat fee of $7 per quarter / $28 per year that will be automatically deducted from your 401(k) account that is serviced by John Hancock Investments John Hancock will charge you between 1.25% and 1.67% of all funds managed You will encounter an average mutual fund fee of 0.40% Loan originations will be subject to a $100 fee per loan Distributions, withdrawals, or account closures will be subject to a $100 fee PGC and John Hancock Investments are available to provide you support when enrolling into retirement benefits. For financial advice on how to invest you can also have your financial advisor get in touch with Platinum 401K directly. To learn more about the 401(k), please contact PGC at contractorcare@pgcgroup.com or visit For more information, please refer to your John Hancock enrollment kit and Summary Plan Description for more information on plan fees and other details.