New Employee Benefits Orientation Diocese of Lafayette What is the definition of Benefits Eligible? You are eligible for coverage if you are an active, 30 hours/week employee. Employees who are employed at or greater are eligible for diocesan benefits. Diocesan benefits include retirement, health, dental, vision, life and disability, and Aflac. Can I enroll my family members? You may enroll the following family members: Your lawful spouse Your child(ren) up to age 26 - with the exception of Incapacitated Dependent see your plan document for more information Proof of dependent eligibility is required. Dependents will not be enrolled if we cannot verify the dependent s eligibility. 1
Dependent Eligibility Documentation: To add dependent(s) to your plan, please provide copy (not original) as follows: Documentation to add spouse: Copy of Marriage License/Certificate Documentation to add child(ren): Copy of Birth Certificate(s) Proof of legal guardianship or custody papers Qualified medical child support order Cafeteria Plan for Pre-Tax Premiums: The portion of your premiums paid through payroll deduction are processed on a pre-tax basis, unless you advise otherwise. Should you receive tax-free benefits under this Plan, the amount of contributions you make to SS as well as your employer s contribution to SS will be reduced. Check with your tax advisor for information about your specific situation. Cafeteria Plan You must re-enroll in the Cafeteria / Flexible Spending* Plan annually. Plan year runs January 1 through December 31. Premiums processed through Cafeteria plan cannot be changed unless there is a Qualifying Life Event. (For example spouse s new job offers family coverage and employee elects to drop family from diocesan insurance.) *at participating locations 2
Pre-Tax Deductions Include: Diocesan health, dental and vision premiums Aflac premiums (Cancer, Critical Care/SP Health; Accident; Hospital and Intensive Care) Non-ROTH personal retirement contributions Flexible Spending Account contributions * *at participating locations Making changes during Open Enrollment What is Open Enrollment? Opportunity for changes to benefit elections for the upcoming plan year. When is Open Enrollment? Occurs annually, during the months of November and December. Changes take effect January 1. Coverage elections remain in effect until the next Open Enrollment period unless you experience a Qualifying Life Event. Qualifying Life Events Change in marital status Birth or adoption of a child Death of your spouse or dependent Change in your spouse s employment Dependent child reaches age 26 Qualifying Life Event changes must be submitted, in writing with proper documentation, to your local Benefits Coordinator within 31 days of the event. The change in coverage must be related to the event. 3
Benefits Enrollment MUST BE completed within 31 days from your start date/date of benefits eligibility. A Social Security Number is required for each enrolled dependent. What happens if you do not enroll for benefits within your 31-day eligibility period? You must wait until the next annual Open Enrollment period (November & December) to complete a benefits election; OR Have a particular event in your life that enables you to change coverage. Effective Date of Benefits Contracted school teachers are covered effective September 1. For all other employees, coverage becomes effective on the first day of the month following hire date. For contracted school teachers who complete their contract year, coverage is in effect through August, regardless of renewal/non-renewal of contract. For all other employees, coverage terminates on last day of the month in which employee is terminated. For Life, LTD and STD, coverage becomes effective 30 days from hire date. Health Insurance 4
Benefits offered through a PPO Plan Benefits are offered through a PPO Plan (Preferred Provider Organization). With a PPO plan, you have access to both in- and out-ofnetwork providers: in-network providers (those for whom we have a PPO contract) out-of-network providers (no PPO contract). Greater cost savings by using in-network providers. BCBS is the largest healthcare network in the nation. What is a Deductible and Out of Pocket Maximum Annual Deductible - the amount you have to pay for health care services before your health plan coverage kicks in. Out-of-pocket Maximum - a limit on the amount you pay out of your pocket towards eligible covered health care expenses each plan year. This protects you from financial exposure due to catastrophic health events. Plan Year January through December. When you use IN-NETWORK providers You are responsible for all costs up to your annual in-network deductible amount ($650). (January December) For eligible covered expenses, after you satisfy the deductible, a 20% co-payment is required for eligible benefits (office visits, urgent care, etc.) and the plan pays the remaining 80% of eligible benefits. When your co-pays for eligible covered expenses reach the annual out-of-pocket maximum ($1,950), the plan pays 100%. 5
When you use OUT-OF-NETWORK providers You are responsible for all costs up to your annual deductible amount ($650). (January December) For eligible covered expenses, after you satisfy the deductible, a 40% co-payment is required for eligible benefits (office visits, urgent care, etc.) and the plan pays the remaining 60% of eligible benefits. Out-of-network charges DO NOT APPLY toward the out-ofpocket maximum and are NEVER paid at 100%. Going out-of-network results in higher out-of-pocket costs $650 $650 $1,950 CVS/Caremark Pharmacy Benefits Pharmacy benefits are included with your medical plan. More than 66,000 network pharmacies to choose from. Plan uses a 3-Tier Formulary (in-network pharmacy) and offers options for purchasing a 90-day supply of maintenance medication 6
Generic Drugs.............................. $10 Brand Name Drugs; Generic Not Available...... $20 Brand Name Drugs; Generic Available......... $40 Prior Authorization Program for Prescriptions Program promotes the proper use of certain medications. If your doctor prescribes a medication included on the Prior Authorization list, he/she must get prior approval before the plan will cover the medication. For maximum benefits, please follow all guidelines for filling prescriptions. Step Therapy Program for Prescriptions Step Therapy is the practice of beginning drug therapy for a medical condition with the most cost-effective and safest drug therapy and progressing to other more costly or risky therapy, only if necessary. The aims are to control costs and minimize risks. 7
BCBS Member ID Card www.myhealthtoolkitla.com BENEFITS & CLAIMS Displays selected member/family deductible and out-of-pocket payment status QUICK LINKS Provides fast access to tools most often used by members. FINANCIAL INFO Status of member/family financial accounts 1.SITE NAVIGATION 2.BENEFITS & CLAIMS 3.QUICK LINKS 4. FINANCIAL INFO 8
Dental/Vision There are two benefit levels for the dental and vision plans: base and buy-up. Eligible employees enrolled in diocesan health insurance are offered diocesan BASE dental and BASE vision coverage as part of their health insurance package, at no cost to the employee. Employees may purchase, at their expense, additional buyup benefits. Benefits offered through a PPO Employees enrolled in either the base or buy-up plans have the option of selecting a dentist or eye doctor of his/her choice from either the PPO network or a non-network doctor. When you receive treatment from a Humana PPO dentist or eye doctor, your costs will be reduced. Non-network providers can bill you for charges above the amount covered by your plan. Also, the coinsurance level will apply to the maximum allowable fee. 9
Dental Coverage For both, base and buy-up: Calendar Year Deductible: $50 (Individual) $150 (Family) Annual Maximum: $1,000 Orthodontia Services Members of either plan may be able to receive up to a 20% discount if they visit an orthodontist from the Humana Dental PPO Network. BASE Plan covers Preventative services at 90% BUY-UP Plan covers Preventative services at 100% Dental Base Plan vs. Buy-Up Plan BASE PLAN Covers Preventative services at 90% (no deductible) BUY-UP Covers Preventative services at 100% (no deductible) Covers Basic services at 40% (after deductible) Major services may receive discount Covers Basic services at 50% (after deductible) Major services 25% (after deductible) Vision Coverage Access to a huge network, including LensCrafters, Pearle Vision, Sears Optical, Target Optical, and JC Penney Optical. Cost Savings out of pocket cost is based on wholesale pricing for frames, avoiding high retail markups. Choice you have access to exclusive lines of designer frames, such as Ralph Lauren, Oakley, Dolce & Gabana, Ray- Ban. Coverage levels vary for the base and buy-up plans. 10
Vision Base Plan vs. Buy-Up Plan BASE PLAN (PPO) Exam with dilation - $10 copay Lenses (single/bifocal/ trifocal) 20% retail discount Frames 20% retail discount Contact lens (evaluation and fitting) 15% discount BUY-UP (PPO) Exam with dilation 100% after $15 copay Lenses (single/bifocal/ trifocal) 100% after $20 copay Frames $50 wholesale allowance Contact lens (evaluation and fitting) 100% (medically necessary) Vision Eye Glass Frame Allowance Since your wholesale allowance is $50.00, this frame is covered in full whether you get it at Dr. Smith s office OR at the ABC Vision Store! Wholesale cost of frame: $56.95 Your wholesale frame allowance: $50 Difference: $6.95 Amount you pay: $6.95 x 2 = $13.90 Since your wholesale allowance is $50.00, you will pay only $13.90 whether you get it at Dr. Smith s office OR at the ABC Vision Store. 11
Dental & Vision For additional information on coverage and to view the differences in the base and buy-up plans, view the Humana Dental and Vision brochures provided on the diocesan website http://www.diolaf.org/benefits-overview. Once enrolled, you can also visit the following websites to learn more about your plans: For dental, visit www.mycompbenefits.com For vision, visit www.humanavisioncare.com Retirement Plan Retirement Plan All 30-Hour benefits eligible employees can participate in the Diocesan Retirement Plan. The plan is a tax deferred 403(b) retirement benefit administered by OneAmerica. Local Investment Advisors Cornerstone Financial Group. Location contributes a percentage of employee s gross salary each month. Employees have the opportunity to make personal contributions through payroll deduction, but are NOT required to do so. All contributions are 100% vested. 12
Retirement Plan The plan allows you to contribute pre-tax or after-tax (Roth) deductions or a combination of both. The value of your account depends on how much is contributed and how well the investments perform. At retirement, you receive the balance in your account, reflecting the contributions and investment gains or losses. Regularly review your quarterly statements. Be sure to keep beneficiaries up to date. Retirement Plan 2017 IRS 403(b) Annual Retirement Contribution Limits Maximum Limit $18,000 Catch-up (Age 50+) $6,000 Retirement Plan Once enrolled in the plan, you can access/manage your account by visiting www.diolafretire.org 13
Personalized investment advice is available to participants by contacting our local advisors: Cornerstone Financial Group, Inc. 213 N. College Road Lafayette, LA 70506-4230 (337) 233-6066 Life, LTD &STD Insurance Life Insurance Long Term/Short Term Disability These are optional benefits, with coverage through The Hartford. Employee is responsible for the premium, through payroll deduction.* New employees have 30 days after date of hire to sign up with effective date being first of the month following 30 days of eligible employment. If coverage is waived at hiring, employee is considered a late applicant and becomes subject to approval based on health questionnaire. * Dependent upon location 14
Life insurance benefit is 1 ½ times annual salary (can be converted to individual policy upon termination). Long-term disability insurance pays 66 2/3, $5,000 max monthly, coordinated with social security, etc. (elimination period, 6 months). Short-term disability insurance pays according to weekly earnings/option (elimination period, 14 days). Specific questions regarding these benefits should be directed to the plan administrator: Trae Brashear or Kathy Ebey (337) 247-9717 Cancer, Critical Care, Accident & Hospital 15
The following optional benefits are offered through Aflac. Premiums are processed through payroll deduction. Cancer Care Indemnity Insurance Critical Care Protection Accident Only Insurance Hospital Advantage Critical Illness Benefit Rider Cancer Indemnity Policy Pays a cash benefit upon initial diagnosis of a covered cancer Critical Care Protection A lump sum benefit is paid upon diagnosis of certain covered serious health conditions, such as a heart attack or stroke Hospital Confinement Indemnity Pays a cash benefit for (covered) hospital confinement, rehab, emergency room Accident-Only Insurance In the event of an unexpected (covered) injury, Aflac pays a cash benefit directly to you Eligible plans will pay a wellness benefit for routine medical exams Critical Illness Benefit Rider Can be attached to select policies to enhance/boost your benefits. Rider pays a specific amount when you are diagnosed with a covered event. 16
AFLAC REPRESENTATIVES: Lisa Newsom at 337-802-2468 or Patrick Newsom at 225-505-2030 Summary Benefits enrollment paperwork must be submitted (whether you are enrolling OR waiving coverage) at a New Employee Benefits Enrollment Session: Cafeteria Plan Participation Form BCBS Membership Application (Health Insurance) Humana Benefits Enrollment Form (Dental/Vision) One America Participant Enrollment Form (Retirement) Hartford Life/Long-term Disability Enrollment Form Hartford Short-term Disability Enrollment Form Aflac (New Employee Information Form) 17