2017 Benefits Guide - gridserver.com
35
2017 Benefits Guide
Transcript of 2017 Benefits Guide - gridserver.com
2017
Benefits Guide
Your 2017 Benefits
Your 2017 Benefits
Benefits Carrier/ Administrator
Website/Email Phone Page
Medical
Medical
Mutual of
Ohio (MMO)
www.medmutual.com 1-800-382-5729
3
Health
Reimbursement
Account
HRA/
Custom
Design
Benefits
www.CustomDesignBenefits.com 1-800-598-2929 6
Dental Dental Care
Plus www.dentalcareplus.com 1-855-343-4263 9
Vision EyeMed www.eyemed.com 1-866-939-3633 11
Long Term
Disability Unum www.unum.com 1-866-679-3054 13
Flexible
Spending
Account
FSA/
Custom
Design
Benefits
www.myflexonline.com 1-800-598-2929 14
Insurance
Broker Support
McGohan
Brabender
Customer
Care Team
Email: customerservice@
mcgohanbrabender.com 1-877-635-5372 15
Employer YMCA
Email:
614-389-3920
614-389-3949 -
EAP Unum
www.lifebalance.net
(username and password are
lifebalance)
1-800-854-1446 -
Waiting Period As a new hire, you are eligible to enroll in the YMCA’s group benefits after your first 30 days. If you wish to enroll yourself and/or dependents onto the plans, you must complete the appropriate forms. Dependent Eligibility In accordance with the Patient Protection and Affordable Care Act, married or unmarried adult children that are the natural, adopted or step child of you or your spouse may be covered under your medical plan until the adult child attains age 26. Domestic Partners are eligible ONLY if you have a legally registered domestic partnership, and your partner meets the spousal coverage requirements.
2
MEDICAL- MMO HDHP/HRA
(In-Network) HDHP/HRA
(Out-of-Network)
Annual Deductible
$2,000 Ind. / $4,000 Fam. $6,000 Ind. / $12,000 Fam.
Type Non-Embedded Non-Embedded
Co-Insurance
(after Deductible)
Plan pays: 80%
You pay: 20%
Plan pays: 60%
You pay: 40%
Max Out-of-Pocket
(Includes Deductibles &
Copays)
$6,550 Single
$13,100 Family
$10,00 Single
$20,000 Family
Coinsurance begins after deductible has been met and these APPLY
to the out of pocket maximum.
Preventive Care
Covered at 100%
Certain services coded as preventive/routine are covered in full.
Services with a diagnostic code will be subject to the deductible and
coinsurance.
Doctor Office Visit Deductible & Co-Ins. Deductible & Co-Ins.
Urgent Care Deductible & Co-Ins. Deductible & Co-Ins.
Emergency Room Deductible & Co-Ins.
Covered as Network Benefit
Inpatient Hospital and
Outpatient Facility
Services
Deductible & Co-Ins. Deductible & Co-Ins.
Prescription Drugs:(Mandatory generic with DAW override applies)
Retail Deductible & Co-Ins.
Deductible & 25% Co-Ins. (Member)
Mail Order Deductible & Co-Ins. Not Covered
This benefit summary is intended to be a brief outline of benefits. Certain services may have limits on the number of visits, days or dollar amounts that will be covered. For a complete listing of benefits, please refer to the Summary
Plan Document (SPD) or Summary Benefits of Coverage (SBC). In the event of a conflict between this description and the group contract, the terms of the group contract will prevail.
Medical
3
Medical
Visit medmutual.com/member to find:
• My Care Compare – cost comparison tool
• Explanation of Benefits (EOB) Statements
• Health Assessment
• Provider Search Tool
• Health and Wellness Programs
• Health Resource Center
Once you are enrolled you can login and register for your account.
You can also download a free mobile app!
IMPORTANT REMINDER: If you are waiving coverage, under the provisions of the Patient Protection and Affordable Care Act (“Health Care Reform”), the IRS may impose a penalty against you in the form of a monetary tax for any individual who does not maintain continuous medical health coverage beginning in 2014. Under current law, the annual penalty can potentially cost up to $695 per adult/ $347.50 per child to a family maximum of $2,085 or 2.5% of your family income, whichever is greater. These amounts will increase each year. This tax (if owed) could be payable or withheld from you when filing your personal 2017 Income Taxes.
Dependents are eligible to age 26 end of birth month. NEW: Domestic Partners are eligible ONLY if you have a legally registered
domestic partnership, and your partner meets the spousal coverage requirements.
HDHP/HRA MEDICAL PLAN
Rates
Per Pay
38+ hr/wk Employees 25-37 hr/wk Employees
Employee Cost
(30%)
YMCA
Contributions
(70%)
Employee Cost
(30% of EE
Only)
YMCA
Contributions
(70% of EE
Only)
Employee
Only $55.50 $129.50 $55.50 $129.50
Employee &
Spouse 115.31 $269.06 254.88 $129.50
Employee &
Child(ren) 104.44 $243.69 218.63 $129.50
Employee &
Family 164.25 $383.25 418.00 $129.50
4
Medical Plan Definitions: The deductibles for the Medical plan runs on a plan year basis and will reset every July 1st.
The medical plan option has an Non-embedded deductible. This means that the family deductible must be met before the benefits for the family are payable subject to coinsurance. The HRA Health Reimbursement Accounts or Health Reimbursement Arrangements (HRAs) are Internal Revenue Service (IRS)-sanctioned programs that allow an employer to reimburse medical expenses paid by participating employees. Employees are reimbursed tax free for qualified medical expenses up to a maximum dollar amount for a coverage period. HRAs reimburse only those items (i.e. deductibles and co-insurance) agreed to by the employer which are not covered by the company’s selected standard insurance plan. Co-Insurance: The percentage of cost that the plan and you share for covered healthcare expenses. For example, the plan may pay 80% of the cost and you may pay 20%. In this case, 20% is your co-insurance. Your network co-insurance is a percent of the discounted charges that MMO has negotiated.
Enrollment Change Request:
Please remember it is your responsibility when complying with an insurance company’s deadline regarding enrollment or change that impact your group insurance plan. Please contact Human Resources as soon as you think you have an event that might require a change in your group insurance coverage. Most changes and events must be submitted to the carrier within 30 days of the event. Some common events include but not limited to: First time enrollment, adding or terminating a spouse or dependent, enrollment in Medicare, change of address, change in beneficiary.
Medical
5
1
YMCA’s HRA Contribution The YMCA will make a contribution to a Health Reimbursement Account (HRA) for employees who participate in the OhioHealth program. If you choose to participate in OhioHealth program, you can earn dollars that The YMCA will deposit into your HRA account. You will be given a HRA Debit Card in order to pay for prescriptions with monies from your HRA account. One of the core principles of The YMCA’s medical insurance plan is not only to cover healthcare costs, but also to encourage better health and wellness behaviors. To this end, we are rewarding those who participate in the Wellness Program by linking The YMCA HRA contribution to participation and results of a biometric screening. HRA contribution amounts are pro-rated based on the effective date of your medial benefits. See schedule below.
25‐37 hr/wk employees will be eligible to earn up to $750 into their HRA account, and 38+ hr/wk employees will be eligible to earn up to $750/single or $1,500/family into their HRA account by passing the following benchmarks:
Participation in the Biometric Screening Negative Nicotine Test
Blood Pressure ≤ 130/85 Cholesterol ≤ 130 LDL
BMI ≤ 29.9 Blood Glucose ≤ 110
REMEMBER: You must fast (no food) for 10‐12 hours before your appointment. Please drink plenty of water and continue to take any prescription medications.
If you are diabetic, please consult your physician before fasting. Don’t forget to bring a photo ID with you!
Employee Maximum HRA Fund Amount
38+ Single or All Tiers 25-37 hr/wk EEs
All Other 38+ Tiers of Coverage
July 1, 2017 $750.00 $1,500.00
August 1, 2017 $687.50 $1,375.00
September 1, 2017 $625.00 $1,250.00
October 1, 2017 $562.00 $1,125.00
November 1, 2017 $500.00 $1,000.00
December 1, 2017 $437.50 $875.00
January 1, 2018 $375.00 $750.00
February 1, 2018 $312.50 $625.00
March 1, 2018 $250.00 $500.00
April 1, 2018 $187.50 $375.00
May 1, 2018 $125.00 $250.00
June 1, 2018 $62.50 $125.00
Fasting is recommended, but not required. Please drink plenty of water and continue to take any prescription medications. Don’t forget to bring a photo ID with you! The screening is a full blood draw. Covered Spouses/Domestic Partners of 38+ hr/wk staff enrolled on the health plan must participate in the biometric screening in order to earn the maximum HRA contribution dollars for family coverage. Please note that the benchmark standards are more lenient than the National Institute of Health standards. It is our intent to make them achievable by most (if not all) employees who are seeking proper medical care and live a non-sedentary lifestyle. The YMCA is partnering with OhioHealth to administer the program, manage appeals or give alternatives if necessary. Examples of typical appeals include: pregnancy, abnormally high blood pressure because of "white coat syndrome", or receipt of treatment by a physician that directly resulted in a high score.
Health Reimbursement Account
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
Custom Design Benefits Your employer, YMCA of Central Ohio, is sponsoring a Health Reimbursement Account (HRA) to help cover certain expenses not covered by your primary insurance. Your HRA is administered by Custom Design Benefits. About your HRA Your HRA covers in and out of network deductible expenses and coinsurance up to the amount of your wellness benefits earned and HRA balances that rollover.
Pharmacy The HRA debit card is set up to be used only for prescriptions that apply to your deductible and/or coinsurance. When you pick up your prescription just hand the pharmacist your card to pay your responsibility up to the amount of your HRA benefit. If you are enrolled in the FSA your HRA funds will be loaded on the same debit card. If you did not have your card with you at the pharmacy you can always submit a claim using the method described below.
Paying for medical services You should not pay your provider at the point of service; ask them to process the claim through MMO in order to capture the negotiated discounts. Once you have your Explanation of Benefits (EOB) for the service, you can submit a claim to received your HRA dollars. • Complete the HRA claim form (customdesignbenefits.com/members/hra) then • Scan/Email, Fax or Mail your primary insurance EOB showing year to date totals
with the HRA claim form to: Custom Design Benefits FAX : 513-598-2901 5589 Cheviot Road EMAIL : [email protected] Cincinnati, OH 45247 Custom Design Benefits will send you a reimbursement for the amount due which is then used to pay your healthcare expenses. We issue reimbursements on a weekly basis. Using this process, you should have the HRA funds in hand before you receive an invoice from your provider. You can also choose to pay the provider and file the HRA claim for reimbursement after the fact.
How to Access Your HRA Balance PHONE 866-598-2939 Toll-free, 24/7 access to account balance and reimbursement information 800-598-2929 Customer Service - hours are Monday – Friday, 8:00am to 5pm EST ONLINE www.CustomDesignBenefits.com or myflexonline.com
Paying for claims with HRA
26
DENTAL Dental Care Plus (DCP)
High Plan 1: Dental Plan Summary
Low Plan 2: Dental Plan Summary
Type 1 (See Below) 100% 100%
Type 2 80% 50%
Type 3 50% 50%
Deductible
$50 individual /$100 family Calendar Year
Type 2& 3 Waived Type 1
$50 individual /$100 family Calendar Year
Type 2& 3 Waived Type 1
Maximum (Per person) $1,000 per calendar year
$1,000 per calendar year
Dental
Type 1 Type 2 Type 3
Routine Exam (2 per benefit period)
Bitewing X-rays (2 per benefit period)
Full Mouth/Panoramic X-rays (1 in 3 years) Periapical X-rays Cleaning (2 per benefit period) Fluoride for Children 18 and under (1 per benefit period) Sealants (age 13 and under) Space Maintainers Pre-Diagnostic Test (age 35 and over) (1 in 2 years)
Restorative Amalgams Restorative Composites Endodontics (nonsurgical) Endodontics (surgical) Periodontics (nonsurgical) Periodontics (surgical) Denture Repair Simple Extractions Complex Extractions Anesthesia
Onlays Crowns (1 in 5 years per tooth) Crown Repair Implants Prosthodontics (fixed bridge; removable complete/partial dentures) (1 in 5 years)
Orthodontia: HIGH PLAN / CHILD ONLY
Plan Benefit 60%
Lifetime Maximum (per
person) $2,000
Waiting Period None
Dual Option:
27
Dental
Coverage Tier
38+ hr/wk
High Plan Low Plan
38+ Employee Cost Per Pay
38+ YMCA Contrib. Per
Pay
38+ Employee Cost Per Pay
38+ YMCA Contrib. Per
Pay
Employee Only $4.50 $10.50 $2.37 $5.52
EE + One $9.21 $21.49 $4.86 $11.33
Family $12.44 $29.04 $7.71 $17.99
Coverage Tier
25-37 hr/wk
High Plan Low Plan
25-37 Employee
Cost Per Pay
25-37 YMCA Contrib. Per
Pay
25-37 Employee
Cost Per Pay
25-37 YMCA Contrib. Per
Pay
Employee Only $4.50 $10.50 $2.37 $5.52
EE + One $20.20 $10.50 $10.67 $5.52
Family $30.98 $10.50 $20.18 $5.52
Dental Rates:
Dependent children are eligible to age 19, to age 24 if a full time student.
28
Vision
EyeMed Effective Date: 7/1/2017
Network: Insight Out of Network Member Reimbursement up to:
Exam $10 copay $40 Frames $0 copay; $150 allowance,
20% off balance over $150 $105
Contact Lenses
Conventional $0 copay; $150 allowance, 15% off balance over $150
$150
Disposable $0 copay; $150 allowance, plus balance over $150
$150
Medically Necessary $0, Paid-In-Full $210 Standard Plastic Lenses
Single Vision $10 copay $30 Bifocal $10 copay $50 Trifocal $10 copay $70 Lenticular $10 copay $70
*Lens Option participant costs vary by prescription, option chosen and retail locations. Dependent children are eligible to age 19, to age 24 if a full time student
Lens Options (participant cost) EyeMed Insight Network Out of Network Member
Reimbursement up to: Progressive Lenses
Standard Progressive $75 copay $50
Premium Progressive Tier 1 $95 copay $50
Premium Progressive Tier 2 $105 copay $50
Premium Progressive Tier 3 $120 copay $50
Premium Progressive Tier 4 $75 copay, 20% off charge less $120 Allowance
$50
Photochromis $75 No Benefit Tint (Solid & Gradient) $15 No Benefit UV Treatment $15 No Benefit Standard Plastic Scratch Coating
$15 No Benefit
Standard Polycarbonate $40 No Benefit Anti-Reflective Coating
Standard $45 No Benefit Tier 1 $57 No Benefit Tier 2 $68 No Benefit Tier 3 20% off Retail Price No Benefit
Rates per Pay Employee Only (EE) $3.55 EE + 1 Dependent $6.75
EE + 2 or more Dependents $9.91
29
Vision
Eye Care Plan Participant Service EyeMed features the money-saving eye care when services are utilized In-Network. Customer service is available to plan participants through EyeMed’s well-trained and helpful service representatives. Call or go online to locate the nearest EyeMed network provider, view plan benefit information and more. EyeMed Call Center: 1-866-939-3633 Locate a EyeMed provider at: www.eyemed.com View plan benefit information at: www.eyemed.com Section 125 This plan is provided as part of the Policyholder's Section 125 Plan. Each employee has the option under the Section 125 Plan of participating or not participating in this plan. If an employee does not elect to participate when initially eligible, he/she may elect to participate at the Policyholder's next Annual Election Period. This form is a benefit highlight, not a certificate of insurance. This policy has exclusions, limitations, reductions of benefits, and terms under which the policy may be continued in force or terminated. Please contact The Standard [or your employer] for additional information, including costs and complete details of coverage.
30
Additional Options
Additional Glasses 40% off
Any item not covered on the plan (including non-prescription sunglasses)
20% off
Lasik 15% off retail price or 5% off promotional
price
Hearing Care Amplifon Hearing Health Care Network: 40% off hearing exams and a low price guarantee
on discounted hearing aids
You may choose to put your own pre-tax funds (payroll deducted) into a Flexible Spending Account (FSA) to cover qualified medical, dental, vision, qualified over-the counter items and dependent care expenses. The maximum amount that can be set aside in a Medical Expense Account is $2,550. An additional $5,000 can be set aside in a Dependent Care Account. Custom Design Benefits is the FSA provider and they offer a debit card to access FSA funds. For more information about FSAs, visit www.customdesignbenefits.com and click on the FSA + HRA link. Accessing Your FSA You will have several easy ways to access your FSA account and funds:
• Use the take care© card to pay your provider with a quick swipe and submit your receipts within 30
days. For FSA card transactions that do not automatically substantiate according to IRS guidelines, members will receive letters asking them to provide additional documentation for substantiation.
• Pay your provider directly and submit the and file a manual claim form with documentation and receipt
when you are ready for your reimbursement . You can file online, from the MyFlex mobile app, via fax or via mail. • Pay your provider, turn in your receipt and have the fund transferred directly into your bank account • Keep track of expenses online at MyFlexOnline (www.myflexonline.com) You must complete the FSA enrollment form even if you are declining/waiving the opportunity to set aside
pre-tax funds for the coming year. Once you determine your annual election for your FSA, you may not alter it after the plan year begins unless you experience a Qualifying Event.
You are able to roll over up to $500 of unused funds into the next plan year!
• Acupuncture • Alcohol Treatment • Ambulance • Artificial limbs/teeth • Braces • Chiropractor
• Christian Science practitioner’s fees
• Contact lenses & solution • Co-payments • Costs for physical or mental
illness • Crutches • Dental Services • Dentures • Diagnostic tests & labs • Dietary supplements
prescribed by a doctor • Drug & Medical supplies
(syringes, needles, etc.) • Eyeglasses*
• Eye examinations • Eye surgery (cataracts,
LASIK, etc. • Hearing devices & batteries • Hospital bills • Insulin • Laboratory tests
• Laser eye surgery
• Medical supplies • Obstetrical expenses
• Orthodontia (braces) • Orthopedic devices • Oxygen • Physician fees & co-payments • Prescription Drug Medications • Psychiatric care • Psychological services & care • Rental of Medical Equipment • Routine physicals & tests • Smoking cessation drugs* • Smoking cessation programs • Sunglasses* • Surgical services & fees • Weight loss programs or OTC
drugs (if associated with specific
disease)* • Wheelchair • Vitamins* • X-rays
*If prescribed by a doctor or may
require a doctor’s letter of medical necessity
Ineligible Expenses for the FSA
• Cosmetic surgery & procedures • Dental bleaching • Marriage or family counseling • Over-the-counter items, drugs or • medications that are not medically • necessary or prescribed by a doctor • Premiums you or your spouse pay for • insurance • Weight loss for general health or • Appearance
Remember, you are responsible to keep your receipts and to only use your FSA for qualified expenses. This list illustrates eligible expenses, and the IRS reserves the right to edit the list at anytime.
IMPORTANT! Since January 1, 2011, Over-the-counter expenses
MUST have supporting documentation (prescription or physician’s
statement) to be considered a qualified FSA expense. Keep records
in case of audit!
Flexible Spending Account
31
Qualified FSA Expenses
Life & Long Term Disability
Provided by the YMCA at no charge to you
Life Insurance: The YMCA of Central Ohio provides Basic Group Life insurance through MetLife for all employees working over 25 hours per week. Your benefit amount is equal to your base annual earnings. The coverage also includes an Accidental Death & Dismemberment provision, which will pay an additional benefit if you should perish in an accident or become dismembered.
Long Term Disability Protection Should an injury or illness last longer than 90 days, the Long Term Disability policy provide by the YMCA will provide an income replacement benefit of 60% of your base monthly earnings to a maximum of $6,825 per month. If you become permanently disabled the benefit will continue to age 65*. The plan includes a 24 month benefit limitation on certain conditions. Please see your certificate of coverage.
*After age 65, claims are paid out by reducing benefit
duration, see certificate for schedule
Long Term Disability
Monthly Benefit 60% of Pre-disability Earnings
Monthly Benefit Maximum
$6,825
Minimum Benefit $100
Elimination Period 90 Days
Duration of Benefits To Age 65*
32
Customer Care Team If you have a question or issue come up with one of your benefits, call the appropriate carrier using the phone number provided on the back of your identification card. If your initial contact with the carrier does not reach a desired resolution, contact the McGohan Brabender Customer Care Team at 1-877-635-5372 for advocacy assistance. Individual Coverage Needing coverage for individuals such as dependents, students, early retirees, unemployed or self-employed individuals, etc.? Contact Information Greg Pfander Phone: 937-293-1600 E-mail: [email protected] Medicare We provide Medicare-eligible individuals with the knowledge, guidance and choice they need to select a Medicare plan that is right for them. We provide access to a “Medicare Marketplace” that includes multiple leading insurance carriers and plans, ensuring that individuals get the most value for their health care dollars. Contact Information RetireMED®iQ Program Phone: 844-388-6565 www.retiremed.com/mb Financial Assistance We can meet your financial goals through funding for higher-education, personal retirement planning, establishing brokerage accounts, asset consolidation, individual life insurance, long-term care insurance, and wealth transfer. Contact Information McGohan Brabender Financial Phone: 800-293-2347 E-mail: [email protected] Prescriptions Search for the cheapest price for your generic drugs at www.medtipster.com/mb
Additional Services at McGohan Brabender
33
34
COMPASS
How compass takes care of you:
UNDERSTAND YOUR BENEFITS
Receive guidance in understanding your benefits throughout the year.
FIND A GREAT DOCTOR
Find the best doctors, dentists & eye-care professionals in your area and
network that meet your preferences & healthcare needs.
GET HELP WITH MEDICAL BILLS
Have your medical bills reviewed to make sure you are not overcharged.
SAVE MONEY ON MEDICAL CARE
Get price comparisons before receiving care. Depending on doctor, hospital or
facility, costs can vary by hundreds or thousands of dollars—even in-network.
PAY LESS FOR PRESCRIPTIONS
Let Compass compare medication prices and explore lower cost options for
you.
To visit / register go to www.compassphs.com OR contact you HealthPro Consultant:
TRISTAN OPIE
Healthcare Redefined.
[email protected] 800.513.1667
1
To Do List
STEPS TO COMPLETE ENROLLMENT
Benefits Election Form (2017‐2018)
www.ymcacolumbus.org/benefits FSA Election Form
You MUST complete both the Benefit Election Form & FSA election form even is you are waiving coverage
YMCA Spousal/Domestic Partner Affidavit
If Electing Medical Coverage and participating in the Wellness Program:
You & your covered spouse/ domestic partner (FT) should
participate in the OhioHealth biometric screenings by calling 614-566-WORK to schedule your appointment.
35
