Coast Enrollment 2020

Annual Enrollment

December 3-12th

CoastMgtBenefits.com

2020 Enrollment

What’s Inside

This guide highlights your benefits. Official plan and insurance

documents govern your rights and benefits under each plan.

For more details about your benefits, including covered

expenses, exclusions, and limitations, please refer to the

individual Summary Plan Description (SPD), plan document,

or certificate of coverage for each plan, which can be found

in our company’s designated office. If any discrepancy exists

between this guide and the official documents, the official

documents will prevail.

Coast Property Management

provides participants and their

eligible dependents a vital program

of benefits designed to keep you

healthy, protect your financial

security, and help you balance your

life at work and home.

Open enrollment is the time for you

to review the coverage that will be

offered by the company beginning

January 1st, 2020 and elect the

benefits that will best meet the

needs of you and your family during

the coming year.

• LBG Advisors Overview

• Medical Plan Highlights

• TPA (Administrator) Overview –

Maestro Health

• Provider/Facility Networks (AMPS)

• Health plan App (HealthJoy)

• Other coverages (dental, vision etc.)

• Next steps

Coast Property Management | 2020 Benefits | 3

LBG Advisors Overview

Our Role

• Design, negotiate & implement all

programs

• Provide on-going education and

support to Coast employees moving

forward

• We are an extension of your HR

Department

Key Facts:

• Member Firm of Benefits Partners

(large national brokerage)

• Located in the Pacific Northwest

• Key support:• Jason Jakobsen- Senior Consultant

• Matt Christensen- Senior

Consultant

• Kris Kirkpatrick- Claims Support

• 877-485-2120


Annual Open EnrollmentDecember 3rd- 12th

DECEMBER DECEMBER

3 12


Changing Your Benefits

General Information:

Certain Qualified Life Events (QLEs) may enable you to change your benefit elections at a time other than during

open enrollment. You can change your benefit elections during the year if you experience a qualified life event. QLEs

include the list below:

Marriage

Divorce, annulment, or legal separation

Birth of your child

Death of your spouse or dependent child

Adoption of/placement for adoption of your child

Termination or commencement of your

spouse’s employment

Change of employment status by you or your spouse, or

another dependent

A significant change in your or your spouse’s health

coverage due to your spouse’s employment

Qualification by the Plan Administrator of a Medical

Child Support Order

Entitlement to Medicare or Medicaid

Dependent satisfies or ceases to satisfy

eligibility requirements

Commencement of or return from an unpaid

leave of absence

A change in the place of residence of you, your spouse,

or your dependent

Your dependent satisfies or ceases to satisfy eligibility

requirements


Who’s Eligible to Enroll

Active, full-time employees scheduled to work at least 30 hours per week

Eligible dependents include:

• Legally married spouse

• Registered domestic partner (must complete an affidavit of Domestic partnership)

• Children up to age 26, regardless of marital, dependent or student status


Making Election in Sync-HR

All Employees Must Login to Sync-HR and select an option:

1. Keep existing benefits in place

2. Change Benefits (add/delete)

3. Decline coverage

Administered by Maestro Health

Network: PHCS / AMPS

RX: Envision RX Options

Medical & RX Plan


Medical Plan Tips

Tip #1: Tell provider you are in-network

with:

• PHCS/MultiPlan Network

• AMPS Prime Network

Tip #2:

• Ask provider to send all invoices to

Maestro Health, contact information

on your benefits card

Tip #3:

• If provider doesn’t know Maestro

health, simply remind them Maestro

Health is the plan claims and billing

administrator. They are not the

insurance company

• You can always call Maestro Health

customer service line to verify benefit

coverage company


How Your Medical & RX Plan Works

Coast Property Management

Medical Network Prescription Benefit Manager

Medical Administrator


Envision – Pharmacy Benefits Manager

Details are included on the health benefits website under the “Prescriptions” tab, at:

coastmgtbenefits.com

General Info:Envision RX Options is the pharmacy benefit manager on your plan.Envision RX Options develops the formulary and can answer questions related to RX coverage.

Contact Info: Envision Help-Desk: (800) 361-4542

Envision BIN – 009893Envision PCN – ROIRX

Plan Numbers: WCST – Base Plan

WCSTBUY – Buy Up PlanWCSTHSA – HSA/HDHP Plan

Maestro Health

Medical Administrator- Maestro Health


TPA: Maestro Health

Maestro Health :Third Party

Administrator

• Process & pay medical claims

• Provide customer service to

employees and providers

• Assist with plan design questions,

what is covered, etc.

• Pre-certify procedures

Maestro Health Customer Service

• Telephone: 800-228-1803

• Email: [email protected]

• Live Chat:

mybenefits.maestrohealth.com

• Hours: 5am-5pm PT


TPA: Maestro Health

Maestro Health :Employee Portal

• Go to

mybenefits.maestrohealth.com

• Click on Register located under

“new members”

• Select your membership type:

Employee or Dependent*

• Complete the registration

information

• Click on Submit

*Note: Due to HIPAA regulation, Employees cannot have access to personal health information on any dependents ages 18 or older. These dependents must register separately and then authorize the employee to access their information


TPA: Maestro Health

Maestro Health :Employee Portal

• Check your EOBs

• Check how much the plan has paid

YTD

• Check recent claims

• In –network vs Out of network

Controlling Healthcare Costs

Physicians Network- PHCS,

Facility, Diagnostic, Out of Network Claims- AMPS


AMPS- Out of Network Cost Containment Service

General Info:Your Health Plan has partnered with Advanced Medical Pricing Solutions (AMPS),

to combat rising healthcare costs for Facility, and OUT OF NETWORK CLAIMS.

FACILITY & OUT OF NETWORK CLAIMS

AMPS handles the negotiations between your

plan and providers / facilities and works with

Maestro to pay a fair price to providers and

facilities that you use for your healthcare.

AMPS will assist plan participants with any balance billing type issues with out of network

claims.

Further details are included on the health benefits website under the AMPS tab, at:



Medical Plan: PHCS/AMPS

Physician Network: PHCS/Multiplan

• Primary network for physicians and

ancillary

• https://www.multiplan.com/webcent

er/portal/ProviderSearch?SiteId=845

24

• PHCS

• AMPS Prime network backs PHCS up

Facility, Diagnostics, Lab, Out of

Network

• AMPS negotiates the best pricing for

the plan on any claim not through

PHCS/Prime

• Make sure to pay your patient

responsibility

• If you get a bill for more than your

patient responsibility: Call AMPS

immediately.

• More info on AMPS is located at

www.CoastMgtBenefits.com


Medical Plan: AMPS

Any claim not through PHCS Network

will be handled by AMPS

This means you can go to any provider

you want and know that the plan will

pay a fair price

AMPS will also make sure that the

billing of your claim is reviewed for

errors!


Medical Plan: AMPS

Facility Billing is out of control

AMPS negotiates a fair price for your

claim

Learn more at: coastmgtbenefits.com

under the AMPS tab


Medical Plan: AMPS: KEY INFO


Medical Plan: AMPS- ADVOCACY

AMPS Patient Advocates will be

notified and reach out with a Welcome

Letter to remind you that we’re here

for you in case of any balance billing.

An experienced Patient Advocate can:• Answer balance billing questions

• Explain the dispute process

• Send you a Balance Bill Kit

• Handle provider communications

Remember: 85-90% of the time there

isn’t an issue with balance billing

Remember To:

Medical Plan App: HealthJoy

https://healthjoy.com/features/


Medical Plan App: HealthJoy

One App for all healthcare needs

• Consult with an online doctor

• Live healthcare concierges

• Quality and cost conscious healthcare

guidance

• Find Lower-cost medication

• Check bills for errors

• Schedule appointments

Mission Control for Your Employee Benefits

• Virtual healthcare assistance

• Centralized benefits access

• On-demand LIVE help

• Save time & money

• 24/7/365

• More information: coastmgtbenefits.com


HealthJoy Set Up Steps

1. You’ll receive a welcome message in two ways possibly: email and text messages to

your smartphone (when supplied by your company). To activate, click the web link in

either message from your smartphone. The link will take you to an activation screen

where you can create an account.

2. You’ll be taken to a web page asking you to create an 8 character password.

3. After you create a password, we’ll ask you to add family members. Adding family

members is free, and we encourage you to invite all members of your immediate

family that are over 18 years old. They will get access to all the same services including

access to free healthcare Concierges and online doctors.

4. The final step is to download, install and log into the HealthJoy app. The app is

available for Android, iPhone, and iPad and requires an Internet connection. Just click

the download button at the end of the setup process and will be taken to our app

within your smartphone’s app store.

After you download the HealthJoy app, all you need to do is log in to the app with the

email address where you received your invitation and the password you created. JOY,

your virtual healthcare assistant, will welcome you to the app. You can start using the app

within seconds.

Benefits

Medical & RX Plan Information


Healthcare Definitions

No Network – Coverage extends to any licensed provider in the

United States. Our plans are designed to give you the freedom to

use the healthcare provider of your choice.

Preventive Care Services – These are services that are generally

linked to routine wellness exams and screenings. Non-preventive

services are those that are considered treatment or diagnosis for

an illness, injury, or other medical condition. Preventive care is

covered at 100% in-network.

Annual Deductible – The amount of money you must first pay

out of pocket before your plan begins paying for services covered

by coinsurance is your Annual Deductible. After you meet your

deductible, the plan pays for a percentage of eligible expenses

(coinsurance) until you meet your out-of-pocket maximum.

Copayments and Coinsurance – A copayment

(or copay) is the fixed dollar amount you pay at the time of

service. In some cases, you may be responsible for coinsurance

after the copay is made. Coinsurance is the percentage of

covered expenses shared by you and the plan. In some cases,

coinsurance is paid after you meet a deductible.

For example, the Basic Plan pays 85% of the covered charge after

your Annual Deductible (if applicable). You are responsible for

paying the remaining 15% coinsurance and any of the deductible

that may apply to the claim.

Maximum Out of Pocket Amount – Your plan provides a stated

maximum annual cost for you and your covered dependents. It

includes amounts your pay for your deductible, coinsurance,

pharmacy and co-payments. Once you reach this limit, your plan

covers 100% of your eligible claims expenses for the rest of the

year.


Healthcare Definitions continued

Summary Plan Description (SPD) – The SPD is an important

document that defines the terms and care offered by the medical

plan. The booklet describes who is eligible and when coverage

terminates. It offers definitions for important terminology found

within the contract to help you better understand the coverage

afforded by the plan design. The Summary Plan Description also

provides a list of specifically excluded services, procedures and

conditions as well as describing your rights to appeal decisions that

you disagree with.

Health Plans are legally obligated by The Employee Retirement

Income Security Act (ERISA) to provide participants SPDs for each

benefit plan offered by the health plan.


Medical Plan Comparison (PPO vs. HSA)

In Network Benefit Comparison (see SBC’s posted at

CoastMgtBenefits.com for more details and out-of-

network benefits)PPO-500 PPO-1000 H.S.A.

Calendar Year Deductible (CYD) $500 (EE)/ $1500

(FAM)

$1,000 (EE)/

$3,000 (FAM)

$1,400 (EE)/

$2,800 (FAM)

Out-of-Pocket Maximum (Includes Medical Copays, Pharmacy

copays, deductible and coinsurance)$2500 (EE)/$7500

(FAM)

$5,000 (EE)/

$12,700(FAM)

$5,000 (EE)/

$12,700(FAM)

Preventive Services

(Office Visit/Lab/X-ray/Childhood Immunizations) Covered at 100% Covered at

100%

Covered at 100%

Physician Visits:

Primary/Specialist/Chrio $25 co-pay $30 co-pay Deductible/ Then

20%

Urgent Care: $55 co-pay per visit $60 co-pay per

visit

Deductible/ Then

20%

ER Services $200 co-pay $250 co-pay Deductible/ Then

20%

Rx Retail (Generic/Pref/Non-Pref/Specialty)

Mail order 2x amount listed $5/$25/$50/20% to

$150

$5/$25/$50/20

% to $150

Deductible/ Then

5/25/50/20% to

150

Facility Fee (e.g. Hospital Room) 20% Co-Ins 20% Co-Ins Deductible/ Then

20%


Prescription Benefit Summary

Prescription Drugs 30 day supply retail

(PPO 500/1000 Plans)

30 day supply retail (HSA Plan)

Tier 1 Generic $5 co-pay

(x 2 for 90 day mail)

After deductible is satisfied

$5 co-pay


Tier 2 Preferred $25 co-pay



$25 co-pay


Tier 3 Non-Preferred $50 co-pay



$50 co-pay


Tier 4 Specialty 20% co-insurance to $150 After deductible is satisfied

20% co-insurance to $150

*Out of network reimbursed at 50% of network rate after co-pay


Did U know?

Urgent Care vs Emergency Care

Urgent Care ($55/60) vs.

ER ($200/$250)

Look-up Urgent Care in

directory before you need.

Use MeMD for Telehealth

Through HealthJoy App!

URGENT CARE EMERGENCY CARE

Ear infection Severe chest pain

Back pain Heavy bleeding

Sprains and strains Poisoning

Most minor cuts &

fractures

Major trauma

Colds & other minor

respiratory problems

Loss of consciousness

Health Savings Accounts

HSA Accounts


HSA Account

A Health Savings Account (HSA):

• Set aside a portion of your paycheck—before taxes—into an account

• Rolls from year to year• It is your account – even if you leave Coast• Help you pay for qualified medical expenses for you

and your dependents!• It can also help you plan for future medical expenses• Reduces Taxable Income (w2 decrease through

payroll / tax form if direct contribution)*• Funds may be invested in mutual funds yielding tax

free earnings* (details to be provided by new H.S.A. administrator – min balance $2,000)

• Can use funds for dependent expenses even if they are not your health plan

* LBG Advisors are not tax advisors. Please consult your tax advisor for details.

Administrator- IntegraFlex/NueSynergy

HSA Administration

• Participant Customer Service Phone:

(855) 345-9151

• Participant Account Questions Email:

[email protected]

• Claims Fax: (855) 673-6711

• Claims Submission Email:

[email protected]


HSA Account: Details

You are not eligible to contribute to H.S.A if:

• If you are claimed as a dependent on someone else’s taxes

• You are covered by any other health insurance policies that are not considered High-Deductible Health Plans (HDHPs)

• You are currently on Medicare (previous H.S.A. funds can pay Medicare premiums A/B)

• If you participate in an unlimited FSA or HRA through your employer or your spouse’s employer, (Limited or Dependent FSA is allowed with H.S.A)

• You and your spouse can each have an HSA if you both have high deductible coverage. If you have family HDHP coverage (Min deductible $1350 individual or $2700 family), the maximum contribution is split equally unless you and your spouse agree on a different division.

The list later in this PowerPoint shows common examples of qualified medical expenses. Complete lists of eligible and non-eligible expenses can be found in IRS Publication 502, which can be ordered from the IRS by calling 1-800-TAX-FORM (1- 800-829-3676) or by visiting www.irs.gov.

Employees:

• Control HSA disbursements (not a reimbursement program)

• Will receive a debit card for HSA funds or can use bill-pay feature online

• Will be responsible to save all receipts for tax audit purposes

• If you are disabled or reach age 65, you can receive non-medical distributions without penalty, but you must report the distribution as taxable income (similar to traditional 401k)

• $3.00 monthly admin fee built into total rate

Annual Funding Limits

• 2020 Limit $3,550 Individual

• 2020 Family Limit $7100

• If over 55, add $1,000 to limits above

There are certain restrictions that may prevent joining H.S.A. Plan


HSA: Eligible Expenses- Keep your Receipts!

Acne treatment*AcupunctureAllergy & Sinus medication*Antacids*Antibiotic ointment*Anti-diarrheal*Antifungal foot cream*Anti-gas medication*Anti-itch cream/gel*Antiseptic* Asthma treatment*Bandages/gauzeBirthing classes or LamazeBlood pressure monitor Braces (knee, ankle, wrist)Breast pumpBurn cream*Chiropractic servicesCoinsurance Cold/hot packCold sore treatment*

Cold/cough medication*Compression stockingsContacts & solutionsCopaysCPAP machineCrutchesDeductiblesDental services Diabetic suppliesDiaper rash ointment*Digestive Aids*Drug addiction treatmentEar wax removal kits*Eye dropsFeminine Anti-Fungal/Anti-Itch*First Aid KitFlu shotsGroup therapyHearing aids & suppliesHemorrhoid medication*Hormone therapyHospital fees

HumidifiersImmunizations*Incontinence supplies Individual counselingInsect bite treatment*Lab workLactation ConsultantLactose intolerance pills*Laser eye surgeryLaxative*Lice treatment products*Massage therapyMedical records Motion sickness relief*Nasal stripsNaturopathic visitsOrthodontiaOrthotic insertsOxygen and equipmentPain relievers*Parasitic treatment*Physical exams

Physical therapy Pregnancy testPrenatal vitaminsPrescription drugsPrescription glassesReading glassesRespiratory TreatmentsSaline nasal spraySleep Aids & Sedatives*Sleep deprivation treatmentSmoking cessation products*Smoking cessation programs Speech therapyStool softener*ThermometerThroat lozenges*Vision careWalker Wart treatment*Wheelchair & repairX-rays

Things that are hygienic

or cosmetic in nature are

not eligible

Some Items that are

hygienic:

Toothbrushes

Toothpaste

Toiletries

Some items that are

cosmetic:

Veneers

Teeth whitening /

bleaching

Cosmetic Surgery

Delta Dental

Dental Plan


Dental Plan: PPO Plans

General Info:In 2020 your dental plan will be renewing with Delta DentalSee coastmgtbenefits.com for details, disclaimers & disclosures.

Calendar Year Benefits In-Network Base-Plan In-Network Buy-Up

Deductible $50(EE) /$150 (FAM)

(Class II/III only)

$50(EE) /$150 (FAM)

(Class II/III only)

Preventive Care (Class I) 100%

(deductible does not apply)

100%

(deductible does not apply)

Basic Care (Class II) 80% 90%

Major Care (Class III) 50% 60%

Annual Maximum $2,000 / person $2,500 / person

Child Ortho n/a $1,000 lifetime

Vision Plan- VSP

Vision Plan


VSP Vision Plan

General Info:In 2020 your vision plan will be with VSP

Large U.S. network of providers

Private practitioners and major retail centers

Eye exams, frames, lenses, and contacts

See coastmgtbenefits.com for details, disclaimers & disclosures.Co-Pay $10 Routine Exam / Frames

Eye Exam 1 routine exam per year

100% after $10 co-pay

Hardware (glasses) Frames Up to $150 every year

Lenses 100% Every year

Contacts Up to $150 every year

Visit 1 PCY

Network VSP (www.vsp.com)

Life, AD&D- Lincoln

Life, AD&D


Basic Life and AD&D

Please see reference documents below- must be enrolled in medical plan to receive life

insurance benefit

Current Enrollees

• Flat $15,000 per employee

• Employee must be enrolled in medical coverage to receive this benefit

• Benefits terminate at retirement

• Non-portable

Customer Service Center: (800) 423.2765 Press

“Option One” for claims. Press “Option Two”

for administration and other questions.

Customer Service Center Hours of Operation:

Monday through Thursday, 7 a.m. – 7 p.m.

Central Time Friday, 7 a.m. – 5 p.m. Central

Time

Email us at: [email protected] for any claims

questions. [email protected] for

administration and other questions.

Email address to submit disability claims is:

[email protected]

Visit us at: Lincoln4Benefits.com for real-time

information and benefit administration.


Employee Assistance Program

• Emotional/mental health

• Parenting/family issues

• Marital/relationship difficulties

• Workplace Issues

• Substance abuse

• Other – dependent care, legal issues, health problems

The EmployeeConnect Plus program

providers assistance with personal and

work- related concerns.

Call toll-free 888-628-4824 or 855-327-4463 (24 hrs/day), or visit us online at

www.GuidanceResources.com

(Register with Web ID "Lincoln" and select

Hoban as employer)


Next Steps


Next Steps

Login to Sync-HR to confirm, decline, or change benefits

If you select H.S.A. option, please setup an H.S.A. bank account

complete payroll deduction information (see H.S.A. tab on

website)

For more information please contact HR or LBG Advisors

Visit www.coastmgtbenefits.com


Required Notices

• Notice of HIPAA Special Enrollment Rights

• Wellness Program Disclosure Notice of Alternative

Standard

• Medicare Part D Notice

• Children’s Health Insurance Program

(CHIP) Notice

• Grandfather Status

• Notice of Patient Protection Provisions

• COBRA Notice

• Medical Child Support Order Notice

• Women’s Health and Cancer Rights Act

• Summary of Benefits and Coverage

• Mental Health Parity and Addiction Equity Act

(MHPAEA) Notice

The U.S. government requires companies offering certain employee benefit plans to inform

covered participants and their dependents about laws/provisions that affect the

governance and/or coverage within those plans.

The company has full details available for you concerning the following laws/provisions

listed below:

Summaries of each can be found in the Your Required

Notices brochure. For complete information and more

detailed explanations about any of these notices,

contact Liza Spooner, Human Resources. Also, from time

to time, you may receive detailed explanations directly

from the company via letter or email.

These can be found on the trust web site at:



Contact

Coast Property ManagementLynette Jacobson | V.P. Human Resources

PH: 425.339.3638

E: Lynette Jacobson [email protected]

Medical & Vision QuestionsCustomer Service (Claims/Pre-Cert) :

800.228.1803

Submit Claims to:

Maestro Health

P.O. Box 1178

Matthews, NC 28106https://mybenefits.maestrohealth.com/#/

Prescriptions – Envision RX Option

(800) 361-4542Dental- Delta Dental

Contact Info: 800-554-1907

Facility, Balance Bill, and Out of

Network Support

AMPS

(800) 425-9373

Basic Life & AD&D

(800) 423.2765

Lincoln4Benefits.com

Employee Assistance Program

Employee Connect Plus

888-628-4824

www.GuidanceResources.com

HSA Administration

IntegraFlex/Nue Synergy

(855) 345-9151

https://integra-flex.com/coastmgt

Vision

VSP-800-877-7195

www.vsp.com


Your LBG Advisors Service Team

Dedicated Service

Claims Issues/Questions

Kris Kirkpatrick

877-485-2120 ext. 303 [email protected]

Benefit Consultants:

Matt Christensen

877-485-2120 ext. 309

[email protected]

Jason Jakobsen

877-485-2120 ext. 306

[email protected]

Thank You!

LBG Advisors, LLCLocal 425.778.2800 / TF: 877.485.2120

http://www.lbgadvisors.com

[email protected] or [email protected]

*All information in this Power Point is for illustrative purposes only.

Please consult full SPD’s for full details. This presentation is not a guarantee of coverage.

Coast Enrollment 2020

Documents

Transcript of Coast Enrollment 2020