2018-2019 Benefit Summary Your Health Your Decision
Welcome to your 2018-2019 Benefits Enrollment What s in the Guide? Enrollment Process....3 Medical........ 4 gap Plan.....5 Dental.....6 Vision... 7 Voluntary Benefits.. 8-10 Important Contacts. 11 We are honored to present your 2018-2019 Benefit Options! The elections you make during your enrollment will become effective through January 31, 2019. The Palace Group offers you and your eligible family members a comprehensive and valuable benefit program. We encourage you to take the time to educate yourself about your options and choose the best coverage for you and your family. Who is eligible? Employees working at least 30 hours each week and their eligible dependents. When can I Enroll? New hire initial enrollment and annual open enrollment allows for employees to enroll or make changes in any of the plans without a qualifying event. In order to make changes outside of your enrollment period, there would need to be a qualifying event such as the birth or adoption of a child, change in marital status, death, or loss of coverage due to no fault of your own. You must contact HR within thirty-one (31) days of the qualifying event in order for coverage to be effective. For full details of the plans offered and more information about our Benefits Enrollment please visit: http://www.explainmybenefits.com/palace 2
Enrollment Process 2018-2019 The Palace Group Benefit Summary The Place Group provides electronic enrollment through Explain My Benefits. Explain My Benefits provides eligible employees the ability to make group insurance benefit elections and changes online during the annual open enrollment, new hire orientation and qualifying events. Enrollment has never been easier. Accessible 24 hours a day, information about all of your employee benefits election options, including premiums and carrier contact information, are also available to help you make informed decisions. You can also log into the Explain My Benefits portal at anytime to review your benefits, access carrier links, update your personal information for yourself and dependents, update your beneficiaries and process qualifying life events. How to Enroll Self-Service Visit www.explainmybenefits.com/palace, click on the brown Log into Your Benefit System button and move through the enrollment system at your own pace To login, you will need your SSN and birth year: Login Employee ID: SSN# (ex. 123456789) Password Pin: Birth Year (ex. 1980) Review the posted benefit guide and plan summaries to help you with your benefit decisions. Be sure to click submit at the end of the process and make note of your confirmation number. If you do not receive a confirmation number you have not completed your enrollment and you will not be enrolled in your benefits. Return to the system anytime and click your confirmation number to view your confirmation statement. Reminders Be sure to review the 2018-2019 Benefit Guide and plan summaries prior to going through the enrollment process Be prepared by gathering dependent and beneficiary information (i.e. Social Security Numbers and Dates of Birth) 3
Medical *The Annual Deductible, Out-of-Pocket Maximum and Benefit limits are calculated on a calendar year basis. United Healthcare ASO Choice Plus Plan In Network Out-of-Network Annual Deductible* Individual $5,000 $25,000 Family $10,000 $50,000 Coinsurance 60% 50% Annual Out of Pocket Maximum* (Includes Deductible, Coinsurance, Co-pays, and Rx) Individual $6,350 $50,000 Family $12,700 $100,000 Preventive Care Office Visit Covered 100% 50% after Ded. Mammograms Covered 100% Covered 100% Lab, X-Ray or other preventive tests Covered 100% 50% after Ded. Physician Office Visit Primary Care $35 co-pay 50% after Ded. Specialist $55 co-pay 50% after Ded. Diagnostic Labs & Complex Imaging Outpatient Hospital Based Center 60% after Ded. Ambulatory Center $250 co-pay 50% after Ded. Free-standing Diagnostic Center $80 co-pay In Patient and Outpatient Hospital Services, Urgent Care & Walk-In Clinics In-Patient Hospital Services 60% after Ded. 50% after Ded. Outpatient Surgery (Ambulatory Center) $500 co-pay 50% after Ded. Emergency Room $300 co-pay $300 co-pay Urgent Care $50 co-pay 50% after Ded. Prescriptions Tier 1 Tier 2 Tier 3 Specialty Medications $20 $45 $85 20% $20 $45 $85 20% Mail Order (90 day supply) Tier 1 / Tier 2 / Tier 3 $50 / $112.50 / $212.50 Not Covered Go to www.myuhc.com to locate a network provider. Please note that your out-of-pocket costs will be more if you choose to go to an out-of-network provider. ***Dependents to age 26. Coverage terminates at the end of the month in which the dependent turns 26. 4
Medical gap Plan 2018-2019 The Palace Group Benefit Summary The APL gap plan can help offset your out-of-pocket expenses including deductible, co-insurance and co-pays, and services not covered in your group health coverage for hospitalization and outpatient surgery. This policy is portable via COBRA. If you elect Medical coverage, you will be automatically enrolled in the employee only gap plan, regardless of the coverage tier of your medical coverage. You may add your eligible dependents to your gap coverage ONLY if they are enrolled in The Palace Group medical plan. Maximum In-Hospital Benefits In-Hospital Benefits In-Hospital Benefits $4,000 per covered person per calendar year. Maximum of $12,000 per calendar year for all covered persons combined. Benefits include in-hospital confinement, ambulance and in-hospital treatment for mental or emotional disorder (subject to a maximum of 30 days of mental or emotional disorder treatment per covered person per calendar year). All benefits are subject to the inhospital benefit maximum. Outpatient Benefits Maximum Outpatient Benefits Outpatient Benefits $500 per covered person per calendar day for covered outpatient services. Covered outpatient services include hospital emergency room, urgent care facility, surgery in a hospital outpatient facility or freestanding outpatient surgery center, diagnostic testing in a hospital outpatient facility or MRI facility, physical therapy facility, ambulance and outpatient treatment for mental or emotional disorder (subject to a maximum of 30 days of mental or emotional disorder treatment per covered person per calendar year). All benefits are subject to the in-hospital benefit maximum. Covered Outpatient Services Hospital Emergency Room Urgent Care Facility Outpatient Surgery Diagnostic Testing Physical Therapy Facility Outpatient Treatment for a Mental or Emotional Disorder in a Hospital Outpatient Facility Payable up to the maximum outpatient benefit, subject to the emergency room per occurrence deductible, as shown above. Payable up to the maximum outpatient benefit, after satisfaction of any applicable outpatient deductible as stated in the outpatient policy above. Outpatient surgery in a hospital outpatient facility or freestanding outpatient surgery center. Payable up to the maximum outpatient benefit, after satisfaction of any applicable outpatient deductible as stated in the outpatient policy above. Diagnostic testing in a hospital outpatient facility or MRI facility. Payable up to the maximum outpatient benefit, after satisfaction of any applicable outpatient deductible as stated in the outpatient policy above. Payable up to the maximum outpatient benefit, after satisfaction of any applicable outpatient deductible as stated in the outpatient policy above. Maximum of 30 days of treatment per covered person per calendar year. Payable up to the maximum outpatient benefit, after satisfaction of any applicable outpatient deductible as stated in the outpatient policy above. Bi-Monthly Payroll Deductions Employee Employee & Spouse Employee & Children Family $0.00 $17.04 $18.31 $35.35 5
Dental 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 Palace Group dental benefit plan through Cigna. Plan Cigna Dental HMO Cigna Dental PPO In-Network Only In-Network Out-of-Network Calendar Year Deductible None $50 / $150 $50 / $150 Annual Maximum N/A $1,500 $1,500 Preventative Services Oral examinations, routine cleanings, x-rays, fluoride treatment, space maintainers Basic Services Fillings only $5 office visit fee $0 Preventative Services Oral examinations, routine cleanings, x-rays, fluoride treatment, space maintainers Basic Services Filings, root canals, periodontal, oral surgery, repairs 100% No Deductible Deductible Applies 20% 20% 40% Major Services Crowns, bridges, dentures, root canals, oral surgery, extractions, periodontal services $12 - $620 Major Services Crowns, dentures, bridges, inlays/onlays 50% 60% Orthodontia Not Covered Orthodontia Lifetime Max: $1,000 Children up to age 19 50% 60% Bi-Monthly Payroll Deductions Plan Employee Employee + 1 Dep. Employee + Family DHMO $8.12 $14.32 $21.23 DPPO $20.74 $36.34 $56.41 Go to www.cigna.com to locate an in-network provider. Please note that your out-of-pocket costs may be more if you choose to go to an out-of-network provider. ***Dependents to age 26. Coverage terminates at the end of the month in which the dependent turns 26. *For services provided by an out-of-network dentist, Cigna Dental will reimburse according to the Contracted Fee Schedule but the dentist may balance bill up to their usual fees. 6
Vision 2018-2019 The Palace Group Benefit Summary Regular eye examinations cannot only determine your need for corrective eyewear, but also may detect general health problems in their earliest stages. Protection for your eyes should be a major concern to everyone. Offered through EyeMed. Vision Care Services In-Network Out-of-Network Exam (every 12 months) $10 Copay Up to $40 reimbursement Frames (every 24 months) Contact Lenses Fit & Follow-up Standard Premium Contact Lenses (every 12 months) Conventional Disposable $0 Copay; $120 allowance; 20% off balance over $120 $40 10% off retail $0 Copay, $120 allowance, 15% off balance over $120 $0 Copay, $120 allowance, plus balance over $120 Up to $84 reimbursement Bi-Monthly Employee Employee & Spouse Employee & Children* Family* Payroll Deductions $2.81 $5.35 $5.63 $8.27 N/A N/A Up to $120 reimbursement Up to $120 reimbursement Medically Necessary $0 Copay, Paid-in-Full Up to $210 reimbursement Plastic Lenses (every 12 months) Single Vision Bifocal Trifocal Lenticular Standard Progressive Premium Progressive Tier 1 Premium Progressive Tier 2 Premium Progressive Tier 3 Premium Progressive Tier 4 $25 Copay $25 Copay $25 Copay $25 Copay $90 Copay $110 Copay $120 Copay $135 Copay $90 Copay, 20% off charge less $120 allowance Up to $30 reimbursement Up to $50 reimbursement Up to $70 reimbursement Up to $70 reimbursement Up to $50 reimbursement Up to $50 reimbursement Up to $50 reimbursement Up to $50 reimbursement Up to $50 reimbursement Retinal Imaging Up to $39 N/A Additional Pair of Glasses Lasik or PRK Hearing Care 40% off and a 15% discount on conventional lenses 15% off retail price or 5% off promotional price 40% off hearing exams and discounted hearing aids ***Dependents to age 26. Coverage terminates at the end of the month in which the dependent turns 26. 7
Voluntary Individual Benefits What are Voluntary Benefits? Voluntary Benefits are offered to strengthen your overall benefits package. You customize the benefit based on your needs and affordability. Available to all Full-time eligible employees. Ownership Policies are fully portable and belong to you if you leave the Palace Group, price and plan benefits remain the same Benefits are payroll deducted Cash benefits are paid directly to you, not to a hospital or to a doctor Benefits are paid regardless of any other coverage you may have Level premiums Rates do not increase with age Guaranteed Renewable Designed to provide additional cash flow to assist with out of pocket medical costs and other bills The Voluntary Benefits offered are Accident, Cancer, Short Term Disability, Hospital Indemnity and Term Life through Allstate. Allstate Accident The Accident Insurance helps pay for the unexpected expenses that can result from an accident. On and off-the-job coverage (24/7) Sports related injuries covered also Money is paid directly to you for (please see brochure for a complete list of benefits): Accident Medical Expenses: $600 Hospitalization: $2,000 admission, $800 per day Major Diagnostic Exam: $100 Accident ICU Benefit: $1,600 per day Fractures: up to $8,000 EE/$4,000 SP/$2,000 CH Dislocations: up to $8,000 EE/$4,000 SP/$2,000 CH Accident Follow-up Treatment: $200 per day Outpatient Physician s Treatment Benefit: $50 See brochure for more details Bi-Monthly Employee Employee & Spouse Employee & Children* Family* Payroll Deductions $7.26 $13.44 $12.30 $18.48 8 *Dependents up to age 26. Coverage terminates at the end of the month in which the dependent turns 26.
Voluntary Individual Benefits Allstate Cancer Plan The Cancer Plan will pay benefits to you if you are diagnosed with cancer. This plan pays you directly. Some benefits pay by the day or treatment, while others reimburse you for expenses you incur. Either way, it can be a source of financial support just when you and your family need it most! Just a few examples of benefits included in the plan: Initial Diagnosis - $3,000 Hospital Confinement - $300 per day Surgery - up to $3,000 Radiation & Chemotherapy - $10,000 per 12 month period 2018-2019 The Palace Group Benefit Summary Bone Marrow and/or Stem Cell - $5,000 per 12 month period New or Experimental Treatment - $5,000 per 12 month period An Annual Cancer Screening Benefit is included in your policy and Allstate pays $100 for each insured. Each covered person will get one cancer screening test per calendar year. Examples of Cancer Screenings: Mammogram Prostate-Specific Antigen Test (PSA) Pap Smear Chest X-ray Bone Marrow Testing Bi-Monthly Payroll Deductions Employee Employee & Spouse Employee & Children* Family* $12.12 $20.38 $20.38 $20.38 Allstate Hospital Indemnity Hospital Indemnity is a policy that pays a specified amount for each day a covered person is confined to the hospital and provides benefits for a range of other medical situations. First Day Hospital Confinement Benefit Pays the first day a covered person is confined in a hospital Daily-In Hospital Benefit Pays each day a covered person is confined to a hospital Intensive Care Hospital Benefit Pays each day a covered person is confined to an ICU Unit Surgical & Anesthesia Benefit $1,000 Maximum: 1 day per confinement/1 day per calendar year $200 per day Maximum: 30 days per confinement $200 per day Maximum: 30 days per calendar year Inpatient or Outpatient Surgery $12.50 - $500, depending on surgery Anesthesia 25% of surgical benefit Bi-Monthly Payroll Deductions Employee Employee & Spouse Employee & Children* Family* $12.42 $32.11 $21.52 $35.04 9
Voluntary Individual Benefits Allstate Short Term Disability As an employee of The Palace Group, you are able to enroll in Short Term Disability (STD) coverage. STD coverage supplements your lost wages should you be unable to work due to an illness, injury or pregnancy. STD coverage begins after missing the specific elimination period below due to a medically certified reason. Benefit are payable up to the specific benefit duration period below. Elimination Period for sickness, accident or pregnancy: Maximum Benefit Period: 7 days or 14 days 6 Months Weekly Benefit: The lesser of 60% of your monthly earnings to a maximum benefit of $5,000 Pre-Existing Condition: Anything you received medical treatment, advice or consultation, care or services including diagnostic measures, or had drugs or medicine prescribed or taken in the 12 months prior to your insurance effective date will not be covered for the first 12 months of the policy. Rates: This benefit is customized by each employee. Your specific rate will be calculated for you in the electronic enrollment system. Allstate Term to 100 Life Insurance There is no way to know what will happen tomorrow, but there is a way to help ensure you are protected against the unexpected. Buying life insurance is a decision that should not be put off. Prudent financial planning can help protect you and your family s future. The amount of term life insurance you may need will depend on your specific situation and the reasons for buying the policy. Guaranteed level premiums Individual and family coverage available Accelerated Death Benefit for Terminal Illness/Condition Fully portable 10 Special Underwriting for Initial Offering Guaranteed Issue $20 per week up to $150,000 (whichever is less) - Employee $8 per week up to $100,000 (whichever is less) - Spouse $20,000 - Children Rates: This benefit is customized by each employee so rates vary, but can start as little as a few dollars a week. Your specific rate will be calculated for you in the electronic enrollment system.
Important Contacts 2018-2019 The Palace Group Benefit Summary Vendor Phone Number Website Medical United Healthcare gap Plan American Public Life Dental Cigna Vision Eyemed Voluntary Benefits Allstate Allstate Benefits Claims Help Explain My Benefits 877-844-4999 www.myuhc.com 800-256-8606 www.ampublic.com 800-244-6224 www.mycigna.com 866-939-3633 www.eyemedvisioncare.com 800-521-3535 www.allstateatwork.com 888-734-6937, Option 3 service@explainmybenefits.biz HR Contacts Andrea Rodriguez Nancy Huynh 305-270-7033 786-924-2641 andrea@thepalaceus.com nancyh@thepalaceus.com 11
Benefit Guide Description Please Note: This guide provides information regarding The Palace Group benefit program. More detailed information is available form the plan documents and administrative contacts. The plans and policies stated in this information are not a contract or a promise of benefits of any kind, and therefore, should not be interpreted as such.