2017-2018 Employee Benefits Package ENROLLMENT ELECTIONS EFFECTIVE: N O V E M B E R 1, 2 0 1 7 - O C T O B E R 3 1, 2 0 1 8 TBC- FISHERBROYLES OE 2017-2018
Medical Plan- W2 In-Network In-Network In-Network Calendar Year Deductible $1,500/Single $3,000/Single $6,550/Single $3,000/Family $6,000/Family $13,100/Family Aetna Coinsurance 100% 80% 100% Out of Pocket $6,850/Single $6,850/Single $6,550/Single Calendar Year Maximum $13,700/Family $13,700/Family $13,100/Family (Excludes deductible) Physician Services Office Visit $25 Copay $30 Copay Deductible Applies Specialists $50 Copay $60 Copay Deductible Applies Routine Physicals 100% 100% 100% Inpatient Hospital Services Facility Deductible Applies; Deductible Applies; Deductible Applies; Physician Services 100% 80% 100% Outpatient Hospital Services Facility Deductible Applies; Deductible Applies; Deductible Applies; Physician Services 100% 80% 100% Emergency Room $400 Copay $250 Copay then 20% Waived if admitted Waived if admitted Deductible Applies Urgent Care $75 Copay $75 Copay Deductible Applies Prescription Drugs Generic $3/$15 $3/$20 Brand $35 $45 Deductible Applies Non Formulary $65 $75 Specialty 20%/$250 Maximum 30%/$250 Maximum Mail Order (90 Days) 2.5 x Copay 2.5 x Copay Monthly Employee Cost Employee Only $633.48 $483.19 $260.77 Employee plus Spouse $1,527.76 $1,227.15 $782.31 Employee plus Child(ren) $1,393.61 $1,115.56 $704.08 Employee plus Family $2,287.87 $1,859.52 $1,225.63
What is a Health Savings Account (HSA) A banking account that allows you to save for current and future medical expenses, available to pay medical, dental, and vision expenses not covered by insurance. You must be enrolled in the OAMC 6550 EQHD plan to qualify for an HSA account. This account can be opened at the bank of your choice. By going online to the bank s website and completing the Open HSA Account forms. Make yourself familiar with any fee schedules associated with the account. HSA s allow you to rollover $ s from year to year. There is no use it or lose it rule. Contributions will be deducted from your income when you file your tax returns. distributions for qualified expenses are tax free. Who is eligible to contribute to an HSA? o An employee insured by a Consumer Driven Health Plan o Not enrolled in Medicare or Medicaid o Not eligible to be claimed as a dependent on another s tax return 2017 2018 Individual Max Contribution $3,400 Individual Max Contribution $3,450 Family Max Contribution $6,750 Family Max Contribution $6,900 Over age 55, individual catch-up contribution of $1,000 annually.
Telemedicine This service is covered 100% by FisherBroyles and available for employees and partners who enroll in the company sponsored medical plan through Aetna. Tele-Consult with a licensed physician who can diagnose common medical conditions and prescribe medications 24/7 Access including weekends & holidays Available to you and your family members even if you are not covered under the medical plan Avoid doctor s office visits and wait times Convenient when you need a prescription or refill Enroll up to 5 dependents at no cost to you Register online at www.teladoc.com and call 800-362-2667
Dental Plan Calendar Year Deductible Applies to Basic and Major Services Only Sunlife Dental PPO Plan $50 per person Calendar Year Maximum Preventive Services Deductible Waived: Oral Evaluation X-rays Bitewings & Full Mouth Cleanings Sealants Basic Services Deductible Applies: Simple Extractions Space Maintainers Fillings Periodontal Maintenance Major Services Deductible Applies: Crowns Bridges Dentures General Anesthesia Orthodontics Out of Network Reimbursement $1,500 Preventive services are excluded from Calendar Year Maximum 100% Reimbursement 80% Reimbursement 50% Reimbursement N/A 90th Percentile To find a dentist near you, go to www.sunlife.com/findadentist Enter your group id (5486902) OR Select Assurant Dental Network under the PPO Option Monthly Employee Cost Employee Only $43.13 Employee + Spouse $85.23 Employee + Child(ren) $91.90 Employee + Family $138.35
Dental Plan
Vision Plan Vision Exam Sunlife Vision Plan $10 Copay Every 12 Months Lenses Frames $25 Copay (Lenses and Frame) Every 12 Months $130 Allowance for the frame of your choice and 20% off the amount over your allowance Every 24 Months Monthly Employee Cost Employee Only $8.33 Employee + Spouse $16.13 Employee + Child(ren) $16.93 Employee + Family $26.89 Elective Contact Lenses $130 allowance for a contact lens exam (fitting/evaluation/materials) Every 12 Months Medically Necessary Contact Lenses Covered in Full when specific benefit criteria are satisfied To find a vision provider near you, go to www.vso.com OR call 800.877.7195 Your group number is 5486902
Vision Plan
Income Protection- Long Term Disability Eligible Members Long Term Disability All active, full time employees (except seasonal, temporary, or contract workers) who work at least 30 hours per week Primary Monthly Benefit 60% or your predisability earnings up to $10,000 Benefit Amount/Definition of Earnings Elimination Period Primary monthly benefit less other income sources/ Base Wage 90 Days Own Occupation Period To age 65 This is a voluntary benefit. Please refer to next slide for instructions on how to calculate your LTD rates. Age Rate Under 25 0.14 25-29 0.26 30-34 0.37 35-39 0.49 40-44 0.75 45-49 1.06 50-54 1.28 55-59 1.65 60-64 1.57 65-69 0.68 70 and over 0.33
Enrollment Instructions To log on the new website, go to https://workforcenow.adp.com. The first time you log on, you must complete the registration process by clicking Register Here. If you are returning to the site, you ll need to enter your user ID and password and click Log In. You will need your registration code before you begin. FisherBroyles code is: FSHBROYLES-1234 Please note if already registered for the Portal; employees need to sign on with their ADP userid and password
Questions? ADP Enrollment Assistance? 1-844-711-2094 Benefits Questions? The Benefit Company Jordan Bochniak jbochniak@benefitcompany.com Sloane Murray smurray@benefitcompany.com claimshelp@benefitcompany.com OR 800-837-0650