2017-2018 Benefits Overview
Insurance Contact Information: Ross & Yerger: Lauren Easterling, Amy Ross & Heather Allen (901) 530-1287 Cigna: (800) 244-6224 Sunlife Financial/Assurant : (800) 733-7879 x 7600 Colonial: Todd Turner (601) 941-0079 Michael Norris (601) 594-3377 Telemedicine: MDLive: (888) 726-3171 AmWell: (855) 667-9722 Helpful Links Ben360: https://rossandyerger.employeenavigator.com Company Identifier: KIPP Memphis Cigna: https://mycigna.com Sunlife / Assurant https://assurantemployeebenefits.com/aeb/login/login.fcc Colonial Life: https://apps2.coloniallife.com/memberservices/login/coloniallife Presented by:
Medical Options Cigna Healthcare Low Deductible Plan $500 Deductible Medium Deductible Plan $1500 Deductible High Deductible Plan $3,000 Deductible Medical Benefits In Network Out of Network In Network Out of Network In Network Out of Network Annual Deductible Deductible - Individual Deductible - Family $500 $1,000 $1,500 $3,000 $3000 $6,000 $1,000 $2,000 $3,000 $6,000 $6,000 $12,000 Out of Pocket Maximum Out of Pocket Maximum Out of Pocket Maximum Out-of-Pocket - Individual Out-of-Pocket - Family $2,000 $4,000 $6,600 $13,200 $6,550 $4,000 $8,000 $13,200 $26,400 $13,100 $13,100 $26,200 Coinsurance 80% 60% 80% 60% 90% 70% Physician's Office Physician's Office Physician's Office Physician's Office Office Copay - Primary Care $20 $20 $30 $30 Office Copay - Specialist $40 $40 $50 $50 Urgent Care Copay $75 $75 $75 $75 Telemedicine Copay $20 $20 $30 $30. X-rays, Labs, Etc. (Physician's office) Deductible, then 80% Deductible, then 60% Deductible, then 80% Deductible, then 60% Preventive Care 100% Covered Not Covered 100% Covered Not Covered 100% Covered Not Covered Hospital Services Hospital Services Hospital Services Hospital Services Inpatient Deductible - Per Admit N/A $500 N/A $500 Outpatient Facility Deductible NA $500 NA $500 Emergency Room Copay $150 $150 $350 $350 Inpatient Hospital Services $500 Deductible Then 20% $500 Copay the $1000 Deductible, Then 40% $1,500 Deductible Then 20% $3,000 Deductible, Then 40% Pharmacy Benefits In Network Out of Network In Network Out of Network In Network Out of Network Category 1 (Generic) $10 Not Covered $10 Not Covered Not Covered Category 2 (Preferred Brand) $35 Not Covered $35 Not Covered Not Covered Category 3 (Non-Preferred Brand) $60 Not Covered $60 Not Covered Not Covered Home Delivery (90 Day Supply) 3 x Retail Less $10 Not Covered 3 x Retail Less $10 Not Covered Not Covered Employee Premiums Per Paid Period Premiums Per Paid Period Premiums Per Paid Period Premiums Employee Only $80.00 $65.00 $40.00 Employee + Spouse $200.00 $160.00 $115.00 Employee + Child(ren) $180.00 $145.00 $100.00 Family $280.00 $240.00 $180.00
THE CARE YOU NEED WHEN, WHERE AND HOW YOU NEED IT. Introducing Cigna Telehealth Connection. Choice is good. More choice is even better. Now Cigna provides access to two telehealth services as part of your medical plan AmWell and MDLIVE. Cigna Telehealth Connection lets you get the care you need including most prescriptions for a wide range of minor conditions. Now you can connect with a board-certified doctor via secure video chat or phone, without leaving your home or office. When, where and how it works best for you! Choose when: Day or night, weekdays, weekends and holidays. Choose where: Home, work or on the go. Choose how: Phone or video chat. Choose who: AmWell or MDLIVE doctors. Say it s the middle of the night and your child is sick. Or you re at work and not feeling well. If you pre-register on both AmWell and MDLIVE, you can speak with a doctor for help with: sore throat headache stomachache The cost savings are clear. fever cold and flu allergies rash acne UTIs and more Televisits with AmWell and MDLIVE can be a cost-effective alternative to a convenience care clinic or urgent care center, and cost less than going to the emergency room. And the cost of a phone or online visit is the same or less than with your primary care provider. Remember, your telehealth services are only available for minor, non-life threatening conditions. In an emergency, dial 911 or go to the nearest hospital. AmWell and MDLIVE are only available for medical visits. For covered services related to mental health and substance abuse, you have access to the Cigna Behavioral Health network of providers. Go to Cignabehavioral.com to search for a video telehealth specialist Call to make an appointment with your selected provider Telehealth visits with Cigna Behavioral Health network providers cost the same as an in-office visit. Choose with confidence. AmWell and MDLIVE are both quality national telehealth providers, so you can choose your care confidently. When you can t get to your doctor, Cigna Telehealth Connection is here for you. Register for one or both today so you ll be ready to use a telehealth service when and where you need it. AmWellforCigna.com* 855-667-9722 MDLIVEforCigna.com* 888-726-3171 Signing up is easy! Set up and create an account with one or both AmWell and MDLIVE Complete a medical history using their virtual clipboard Download vendor apps to your smartphone/mobile device**
Dental & Vision Options Plans Offered By: Dental Option 1 $1,000 Annual Maximum Dental Option 2 $2,000 Annual Maximum Annual Deductible Deductible - Individual Deductible - Family Benefit Levels Type I - Diagnostic & Preventive Type II- Basic Services Type III- Major Services Type IV- Orthodontia for Children Maximum Benefits Annual Maximum (Types I - III) Lifetime Maximum for Orthodontia Late Entrant Waiting Periods Type II & III Expenses Reimbursement Usual & Customary Reimbursement Employee Premiums Employee Only Employee + Spouse Employee + Child(ren) Family In Network Out of Network In Network Out of Network $50 $150 Benefit Levels 100% 100% 80% 80% 50% Not Covered Maxium Benefits $1,000 Not Covered Waiting Period 12 Months (Waived for employees who enroll when they are initally eligible) Reimbursement Percentile Network Reimbursement 90th Percentile Network Reimbursement 90th Percentile Per Pay Period Premiums $4.00 $10.00 $13.00 $50 $150 Benefit Levels 60% 50% Maxium Benefits $2,000 $1,000 Waiting Period 12 Months (Waived for employees who enroll when they are initally eligible) Reimbursement Percentile Per Pay Period Premiums $8.00 $18.00 $24.00 $18.00 $34.00 Plan Offered By: Frequency Eye Exam & Lenses Frames Copays Eye Exam Frames Contact Lenses Reimbursement Single Vision Lenses Necessary Contact Lenses Elective Contact Lenses Eyewear Exam Employee Premiums Employee Only Employee + Spouse Employee + Child(ren) Family In Network Vision Option Out of Network 1 Exam Every 12 Months 1 Pair of Frames Every 24 Months Copayments $10 Plan Pays Up to $45 $20 Plan Pays Up to $70 Up to $60 Plan Pays Up to $105 Reimbursements 100% After Copay Up to $30/Pair 100% After Copay Up to $65 Per Pair Up to $150/Pair Up to $105/Pair Up to $150/Pair + 20% Discount On Additional Charges Up to $70/Pair 100% After Copay Plan Pays Up to $45 Per Pay Period Premiums $3.79 $6.06 $6.18 $9.97
Group Life & Long Term Disability Plan offered by: Life Insurance Benefits Provided by KIPP Memphis Benefit Accidental Death Benefit Reductions Portability 2 Times Annual Earnings Up to $50,000 2 Times Annual Earnings Up to $50,000 Benefits Reduce to 65% at age 65 Benefits Reduce to 50% at age 70 This policy is portable if you leave KIPP Memphis. That means you have the option to continue the benefit after employment ends. Contact Lincoln for details. Plan offered by: Long-Term Disability Benefits Provided by KIPP Memphis Elimination Period Benefit Percentage Maximum Monthly Benefit Benefit Duration 180 Days 60% $5,000 For as long as you remain disabled, or until you reach your Social Security Normal Retirement Age, whichever is sooner.
Open Enrollment Helpful Hints: Once logged in, you will see the Welcome page. 1. Select Start Benefits to elect the desired Medical coverage. 2. You will be taken to your Personal Information screen. Verify your Personal Information and make whatever corrections, if any, which need to be made. *Always SAVE your changes* 3. Verify and/or Add Dependents * SAVE your changes* 4. Chose the level of Medical Coverage you desire. If a dependent is not showing, go back to the dependent information area and input the dependent. If all dependents that should be enrolled are displayed, simply select them at the top and the cost will change, based on your coverage needs. * SAVE & Continue or if you decline, select why* 5. If you would like, you may choose the compare option and the system will show you a comparison when 2 or more plans exist. The first column shows your current election. The next 2 columns will show you the comparisons.
6. At ANY time, you can click on the company logo and it will take you back to your home screen. 7. You must Agree to the changes on the summary screen or your selections will not be committed. Other system areas - From the Home Screen: 1. Under Profile you can add or update your personal information, dependents, contact information, etc. 2. Under Benefits, you can review your benefits a. Enrollment Summary will show your enrollments. b. Under, Add or Adjust Coverage you will be able to request/enter life events. 3. Under Resources, you can access the company Employee Directory and Documents. **Please be aware the any phone numbers you input will be displayed in the employee directory.* Please note - We will periodically publish News and Articles and these will link to this area. 4. Compliance Documents, that are loaded for your organization, will display on your employee dashboard.
Financial protection that fits your needs With Colonial Life products: Coverage is available for your spouse and eligible dependent children (with most plans). Benefits are paid directly to you, unless you specify otherwise. You can continue coverage when you retire or change jobs, with no increase in premiums (with most plans). You may receive benefits regardless of any insurance you may have with other companies (with most plans). Everyone s benefit needs are different. That s why it s important to choose the benefits that are right for your personal situation. Complete this page and bring it to your personal, 1-to-1 benefits counseling session. At the session, you ll learn how these products fit into your overall benefits package and how they can help protect what you ve worked so hard to build. Disability insurance Helps replace a portion of your income to help make ends meet if you become disabled from a covered accident or covered sickness. Accident insurance Helps offset unexpected medical expenses, such as emergency room fees, deductibles and co-payments that can result from a fracture, dislocation or other covered accidental injury. Life insurance Enables you to tailor coverage for your individual needs and helps provide financial security for your family members. Cancer insurance Helps offset the out-of-pocket medical and indirect, non-medical expenses related to cancer that most medical plans don t cover. This coverage also provides a benefit for specified cancer-screening tests. Critical illness insurance Supplements your major medical coverage by providing a lump-sum benefit you can use to pay the direct and indirect costs related to a covered critical illness, which can often be expensive and lengthy. Hospital confinement indemnity insurance Provides a lump-sum benefit for a covered hospital confinement or a covered outpatient surgery to help with co-payments and deductibles that are not covered by most major medical plans. Fill in the following information and bring with you to your Colonial Life benefits counseling session. Name Date Department/Location Phone Email ColonialLife.com These coverages may not be available in all states; product benefits vary by state. Policies have exclusions and limitations that may affect benefits payable. For cost and complete details, please see your Colonial Life benefits counselor. 2015 Colonial Life & Accident Insurance Company, Columbia, SC Colonial Life insurance products are underwritten by Colonial Life & Accident Insurance Company, for which Colonial Life is the marketing brand. 3-15 42868-33
Deductions per year: 24 These rates were prepared on 7/28/2017 and are valid for 90 days. Group Disability for TN AAA Risk Class l Off-Job Accident and Off-Job Sickness 6 Month Benefit Period Applicable to policy forms GDIS-P & GDIS-C ELIMINATION PERIOD ISSUE AGE $1,000* $1,500* $2,000* $2,500* $3,000* 7 days Accident/7 days Sickness 17-49 $15.35 $23.03 $30.70 $38.38 $46.05 50-64 $20.25 $30.38 $40.50 $50.63 $60.75 65-74 $26.35 $39.53 $52.70 $65.88 $79.05 14 days Accident/14 days Sickness 17-49 $10.70 $16.05 $21.40 $26.75 $32.10 50-64 $13.50 $20.25 $27.00 $33.75 $40.50 65-74 $18.00 $27.00 $36.00 $45.00 $54.00 *monthly benefit amount Accident 1.0 for TN l On/Off-Job Accident Coverage Applicable to policy forms ACCIDENT 1.0-HS and ACCIDENT 1.0-NS ISSUE AGE NAMED INSURED EMPLOYEE & SPOUSE ONE-PARENT FAMILY TWO-PARENT FAMILY Preferred with health screening 0-80 $10.58 $14.49 $16.34 $20.24 Cancer Assist for TN l with $100 Health Screening Benefit $5,000 Initial Diagnosis Benefit Applicable to policy form CanAssist COVERAGE LEVEL ISSUE AGE NAMED INSURED EMPLOYEE AND SPOUSE ONE-PARENT FAMILY TWO-PARENT FAMILY Level 1 17-75 $12.80 $20.55 $13.13 $20.88 Level 2 17-75 $14.58 $23.18 $14.98 $23.58 Level 3 17-75 $17.08 $28.45 $17.55 $28.93 Level 4 17-75 $21.55 $35.95 $22.10 $36.50 Medical Bridge 3000 for TN Applicable to policy form MB3000 l $1,500 Hospital Confinement Benefit, and Outpatient Surgical Procedure Benefit with a calendar year maximum of $2,500 ISSUE AGE NAMED INSURED EMPLOYEE & SPOUSE ONE-PARENT FAMILY TWO-PARENT FAMILY 17-49 $13.20 $28.35 $22.53 $34.33 50-59 $18.28 $39.05 $27.20 $44.30 60-64 $23.83 $51.93 $33.40 $56.30 65-74 $29.90 $65.03 $41.83 $70.50 Page 1 of 3 Underwritten by Colonial Life & Accident Insurance Company See page 2 for Important Notice
(Continued...) Critical Illness 1.0 for TN l with Subsequent Diagnosis Coverage, Health Screening Benefit Non-Tobacco Rates Applicable to policy form CI-1.0 ISSUE AGE NAMED INSURED EMPLOYEE & SPOUSE ONE-PARENT FAMILY TWO-PARENT FAMILY $10,000 17-24 $2.28 $3.45 $2.28 $3.45 25-29 $2.63 $4.05 $2.63 $4.05 30-34 $3.03 $4.70 $3.03 $4.70 35-39 $4.23 $6.50 $4.23 $6.50 40-44 $5.03 $7.70 $5.03 $7.70 45-49 $6.53 $10.00 $6.53 $10.00 50-54 $8.33 $12.80 $8.33 $12.80 55-59 $10.28 $15.75 $10.28 $15.75 60-64 $12.73 $19.55 $12.73 $19.55 65-70 $14.43 $22.15 $14.43 $22.15 Tobacco Rates ISSUE AGE NAMED INSURED EMPLOYEE & SPOUSE ONE-PARENT FAMILY TWO-PARENT FAMILY $10,000 17-24 $2.78 $4.25 $2.78 $4.25 25-29 $3.43 $5.25 $3.43 $5.25 30-34 $4.28 $6.60 $4.28 $6.60 35-39 $5.93 $9.10 $5.93 $9.10 40-44 $7.68 $11.80 $7.68 $11.80 45-49 $9.88 $15.15 $9.88 $15.15 50-54 $12.43 $19.05 $12.43 $19.05 55-59 $15.78 $24.25 $15.78 $24.25 60-64 $18.98 $29.15 $18.98 $29.15 65-70 $21.68 $33.35 $21.68 $33.35 Whole Life 1000 for TN l Adult Base Plan Paid-Up at Age 65 Non-Tobacco Rates ISSUE AGE $10,000 $25,000 $50,000 25 $5.65 $11.87 $22.23 35 $8.00 $17.74 $33.98 45 $13.84 $32.36 $63.21 Applicable to policy forms ICC07-WL-NGPO-65, ICC07-WL-NGPO-95, ICC08-WL-GPO-65, ICC08-WL-GPO-95, WL-NGPO-65, WL-NGPO-95, WL-GPO-65, WL-GPO-95, ICC16-WL1000J and WL1000J Tobacco Rates ISSUE AGE $10,000 $25,000 $50,000 25 $7.05 $15.38 $29.25 35 $10.78 $24.70 $47.90 45 $17.60 $41.75 $82.00 Important Notice Insurance coverage has exclusions and limitations that may affect benefits payable. For a complete description of benefits, limitations and exclusions, please refer to an outline of coverage, sample policy/certificate, proposal description or see your Colonial Life benefits counselor. Coverage type, benefits and rates vary by state. Coverage may Page 2 of 3 Underwritten by Colonial Life & Accident Insurance Company See page 2 for Important Notice