Goodwill 2018 Benefits Overview BELOW IS A BRIEF OUTLINE OF IN-NETWORK BENEFITS For additional details and Out of Network benefits, please refer to the Summary Plan Descriptions at www.mokangoodwill.org/benefit. Blue Cross Blue Shield of Kansas City: PPO Medical Plans Eligible for employees working 30+ hours per week. Preferred-Care Blue Network PPO 2000 Premium Plan PPO 6500 Value Plan Deductible: Individual $2,000 $6,500 Deductible: Family $6,000 $13,000 Member Co-Insurance 100% 100% Out-of-Pocket Maximum: Individual $2,000 $6,500 Out-of-Pocket Maximum: Family $6,000 $13,000 Preventive Care Covered at 100% Covered at 100% Office Visit (PCP / Specialist) $30 Copay / $60 Copay Deductible Urgent Care $60 Copay Deductible Emergency Room Deductible Deductible Hi Tech Diagnostics (MRI, MRA, etc.) Deductible Deductible Inpatient Hospital Deductible Deductible Outpatient Hospital Deductible Deductible Retail Prescriptions: Tier 1/ Tier 2/ Tier 3 $10 / $30 / $50 $12 for tier 1/Deductible for Tier Mail Order Prescriptions: Tier 1/ Tier 2/ Tier 3 $30 / $90 / $150 2 and 3 $30 for tier 1/Deductible for Tier 2 and 3 Health Risk Assessment Incentive Visit A Healthier You on www.mokangoodwill.org/benefits to take your Health Risk Assessment today for the opportunity to reduce your monthly premiums by $25 each month. You and your covered spouse may complete this assessment. Out of Pocket Maximum includes deductible, coinsurance, and copayments. Ameriflex: Flexible Spending Account You can reallocate your annual compensation to pay for eligible health costs that may not be covered by your benefit plan and/or dependent care expenses. In essence, you will be paying for these expenses on a pre-tax basis. This is a voluntary plan and the amount you designate as your Annual Salary Reallocation should be conservative. Participants can roll over up to $500 of unused FSA dollars to the next year. Medical Expenses: Set aside up to $2,650 pre-tax to pay for unreimbursed qualified healthcare expenses Dependent Care Expenses: Set aside up to $5,000 (or $2,500 if married filing separately) for qualified dependent care Delta Dental of Kansas: Dental Plan Premier & PPO Networks Preventive 100% Deductible: Individual $50 (applies to Basic & Major only) Deductible: Family $150 (applies to Basic & Major only) Basic 80% Major 50% Annual Benefit Maximum $1,000 per person Orthodontia 50% (Lifetime max $1,000) Includes orthodontic appliances and treatment, interceptive and corrective, for dependent children under age nineteen (19).
SunLife: Vision Plan VSP Signature Network Frequency Benefit Examination Every 12 months $10 Copay Single Vision Lenses Every 12 months $25 Copay Lined Bifocal Lenses Every 12 months $25 Copay Line Trifocal Lenses Every 12 months $25 Copay Frames Every 24 months $130 Allowance, 20% off balance over $130 Contact Lenses Every 12 months $130 Allowance Lasik Discount Once Per Lifetime 15% off retail price, 5% off promotional price USAble: Voluntary Life and Accidental Death & Dismemberment Life and AD&D Coverage $10,000 for employee only Life and AD&D Coverage $25,000 for executive class All Life and AD&D amounts are subject to an age reduction schedule. MetLife: Voluntary Life and Accidental Death & Dismemberment Eligible for employees working 30+ hours per week. Benefit Increments Guarantee Issue Maximum Employee Coverage Up to 5 times base salary $10,000 $150,000 $500,000 Spouse Coverage Up to 50% of employee coverage $5,000 $50,000 $250,000 Child(ren) coverage Up to 50% of employee coverage for amounts of $1,000,$2,000, $4,000, $5,000 or $10,000 To purchase Spouse &/or Child(ren) coverage, you must have coverage on yourself. Guarantee Issue is applicable at initial eligibility only. MetLife: Voluntary Short Term Disability Eligible for employees working 30+ hours per week. Elimination Period 14 th day Accident or Sickness Short Term Disability Benefit 60% of weekly earnings to a maximum of $1,000 Benefit Duration 11 Weeks Short Term disability includes a pre-existing condition clause. SunLife: Voluntary Accident and Critical Illness Type of Plan Accident Insurance Coverage: Off the Job (Including Wellness Benefit) Critical Illness Insurance Coverage: (Including Wellness Benefit) Benefit Fixed benefits based on the type of injury & treatment received. Pays cash dollars directly to you regardless of medical insurance benefits. $50 per year wellness benefit for each covered individual for a covered health screening. Lump sum benefit (depending on the level of coverage selected) upon diagnosis of a critical illness; Heart Attack, Stroke, Cancer. Pays cash dollars directly to you regardless of medical insurance benefits. $50 per year wellness benefit for each covered employee and spouse for a covered health screening.
Goodwill 2018 Rate Grids Supplement to Benefit Overview MetLife: Voluntary Life and AD&D Premiums Employee Life and AD&D Semi-Monthly Premiums Premiums are based on the employee's age on each policy anniversary Benefit in 000 s thru 29 30-34 35-39 40-44 45-49 50-54 55-59 60-64 65-69 70+ Age $20 1.24 1.44 1.74 2.14 3.34 5.14 8.54 14.24 26.84 43.34 $30 1.86 2.16 2.61 3.21 5.01 7.71 12.81 21.36 40.26 65.01 $40 2.48 2.88 3.48 4.28 6.68 10.28 17.08 28.48 53.68 86.68 $50 3.10 3.60 4.35 5.35 8.35 12.85 21.35 35.60 67.10 108.35 $60 3.72 4.32 5.22 6.42 10.02 15.42 25.62 42.72 80.52 130.02 $70 4..34 5.04 6.09 7.49 11.69 17.99 29.89 49.84 93.94 151.69 $80 4.96 5.76 6.96 8.56 13.36 20.56 34.16 56.96 107.36 173.36 $90 5.58 6.48 7.83 9.63 15.03 23.13 38.43 64.08 120.78 195.03 $100 6.20 7.20 8.70 10.70 16.70 25.70 42.70 71.20 134.20 216.70 $110 6.82 7.92 9.57 11.77 18.37 28.27 46.97 78.32 147.62 238.37 $120 7.44 8.64 10.44 12.84 20.04 30.84 51.24 85.44 161.04 260.04 $130 8.06 9.36 11.31 13.91 21.71 33.41 55.51 92.56 174.46 281.71 $140 8.68 10.08 12.18 14.98 23.38 35.98 59.78 99.68 187.88 303.38 $150 9.30 10.80 13.05 16.05 25.05 38.55 64.05 106.80 201.30 325.05 Coverage available up to $500,000 depending on employee salary. To calculate rate, multiply available rate by your desired election amount or contact Human Resources. AD&D cost required in all available Life Insurance policies. Spouse Life and AD&D Semi-Monthly Premiums Premiums are based on the employee's age on each policy anniversary Benefit in 000 s Thru 29 30-34 35-39 40-44 45-49 50-54 55-59 60-64 65-69 70-74 $5 0.31 0.36 0.44 0.54 0.84 1.29 2.14 3.56 6.71 10.84 $10 0.62 0.72 0.87 1.07 1.67 2.57 4.27 7.12 13.42 21.67 $15 0.93 1.08 1.31 1.61 2.51 3.86 6.41 10.68 20.13 32.51 $20 1.24 1.44 1.74 2.14 3.34 5.14 8.54 14.24 26.84 43.34 $25 1.55 1.80 2.18 2.68 4.18 6.43 10.68 17.80 33.55 54.18 $30 1.86 2.16 2.61 3.21 5.01 7.71 12.81 21.36 40.26 65.01 $35 2.17 2.52 3.05 3.75 5.85 9.00 14.95 24.92 46.97 75.85 $40 2.48 2.88 3.48 4.28 6.68 10.28 17.08 28.48 53.68 86.68 $45 2.79 3.24 3.92 4.82 7.52 11.57 19.22 32.04 60.39 97.52 $50 3.10 3.60 4.35 5.35 8.35 12.85 21.35 35.60 67.10 108.35 Coverage available up to 50% of employee elected amount. To calculate rate, multiply available rate by your desired election amount or contact Human Resources. AD&D cost required in all available Life Insurance policies. Age Child Amount for Voluntary Life $1,000 $5,000 $10,000 Child Life and AD&D Premium 0.145 0.73 1.46 *Employee must also be enrolled in coverage to elect for Child Life and AD&D.
USAble: Voluntary Life Premiums USAble All Staff Coverage: Voluntary Life and AD&D $10,000 of coverage $1.60 semi-monthly deduction $25,000 of coverage $4.00 semi-monthly deduction MetLife: Short Term Disability Premiums MAXIMUM WEEKLY BENEFIT AGE SCHEDULE WITH SEMI-MONTHLY DEDUCTION <44 45-49 50-54 55-59 60+ $100 2.70 2.55 2.90 3.80 4.15 $150 4.05 3.83 4.35 5.70 6.23 $200 5.40 5.10 5.80 7.60 8.30 $250 6.75 6.38 7.25 9.50 10.38 $300 8.10 7.65 8.70 11.40 12.45 $350 9.45 8.93 10.15 13.30 14.53 $400 10.80 1.20 11.60 15.20 16.60 $450 12.15 11.48 13.05 17.10 18.68 $500 13.50 12.75 14.50 19.00 20.75 $550 14.85 14.03 15.95 20.90 22.83 $600 16.20 15.30 17.40 22.80 24.90 $650 17.55 16.58 18.85 24.70 26.98 $700 18.90 17.85 20.30 26.60 29.05 $750 20.25 19.13 21.75 28.50 31.13 $800 21.60 20.40 23.20 30.40 33.20 $850 22.95 21.68 24.65 32.30 35.28 $900 24.30 22.95 26.10 34.20 37.35 $950 25.65 24.23 27.55 36.10 39.43 $1,000 27.00 25.50 29.00 38.00 41.50 *Coverage available up to 60% of your weekly income. Coverage is rounded to the nearest $50. SunLife: Accident Premiums Semi-Monthly Accident Premiums Employee Only $7.94 Employee & Spouse $10.40 Employee & Child(ren) $12.29 Family $14.75
SunLife: Critical Illness Premium
Goodwill 2018 Benefits Overview PTO Grid for 2018 Years of Service PTO A PTO B PTO C 0 0 3.69 4.27 1 2.15 3.69 4.27 2 2.15 5.23 5.81 3 2.15 5.23 5.81 4 2.15 5.23 5.81 5 2.15 6.77 7.35 6 2.15 6.77 7.35 7 2.15 6.77 7.35 8 2.15 8.31 8.89 9 2.15 8.31 8.89 10 2.15 9.23 9.81 Part-Time Employees (after one year of service) Full-Time Employees Retail Management (with required 45 hour work week) Type of Coverage Employee Semi-Monthly Rates Medical: PPO 2000 Premium Plan Employee Only $61.63 Employee & Spouse $141.75 Employee & Child(ren) $117.10 Family $172.57 Medical: PPO 6500 Value Plan Employee Only $24.59 Employee & Spouse $56.56 Employee & Child(ren) $46.72 Family $68.86 Dental: Employee Only $13.71 Employee & Spouse $26.72 Employee & Child(ren) $25.57 Family $38.99 Vision: Employee Only $3.95 Employee & Spouse $7.86 Employee & Child(ren) $8.46 Family $12.48 CONTACT INFORMATION Blue Cross Blue Shield of Kansas City Delta Dental of Kansas SunLife USAble MetLife Ameriflex New Directions Behavioral Health Contact for questions about benefits and enrollments Contact for questions about claims, issues, and coverage Medical Dental Vision, Voluntary Benefits Basic Life/AD&D Voluntary Life/AD&D, Disability Flexible Spending Account Employee Assistance Program (816) 842-7425 Extension 252 benefits@mokangoodwill.org www.mokangoodwill.org/benefits Nathan Johnson (913)643-4146 njohnson@trussadvantage.com Kara Vincent (913)754-5927 kvincent@trussadvantage.com 888-989-8842 or 816-395-2950 www.bluekc.com 800-733-5823 www.deltadentalks.com 800-733-7879 www.assurantemployeebenefits.com 800-370-5856 www.usablelife.com 800-638-5433 www.metlife.com 888-868-3539 www.myameriflex.com 800-528-5763 www.ndbh.com This is a brief description of your benefits. If a discrepancy exists, benefits outlined in the carrier certificate will prevail.