Zimmer Biomet NW -...
Transcript of Zimmer Biomet NW -...
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Employee Benefit Guide
Plan Year: 8/1/2017—7/31/2018
www.ZBNWBenefits.com
Zimmer Biomet NW
Employee Benefits Guide
Valorie Ramaley
Director HR/ Finance [email protected] T: 800.321.6992 x.1003
Broker Contact Info
LBG Advisors LLC
Matt Christensen
T: (425) 778-2800
Employer Contact Info
Table of Contents
Employee Benefits Guide Introduction 3
Group Plan Coverage Eligibility 4
Employee Benefit Contacts 5
Network Information 6
Medical Benefits Summary 7
Prescription Drug Plan Summary 8
Dental Benefits Summary 9
Life Insurance Information 10
Vision 11
Coordination of Benefits 12
Section Page
Employee Benefits Guide
Employee Benefits Guide Introduction
This benefits guide is meant to be an aid to help you
better understand the Zimmer-Biomet NW benefits
package and how to utilize it when you need to.
Zimmer-Biomet NW has retained the services of LBG
Advisors, LLC to help design the plan and assist em-
ployees in understanding how to use the plan.
This booklet will briefly highlight the major points of
the benefit plan Zimmer-Biomet NW sponsors and it
is not intended to replace your detailed insurance con-
tract or other insurance provider coverage booklets.
The information is provided for informative,
illustrative and comparative purposes only and should
be used for ‘casual’ reference. Your actual benefits are
subject to the terms and conditions of each insurance
carrier’s actual contract.
We at LBG Advisors, LLC are here for you and your
dependents and available to answer any questions you
may have regarding your benefits and coverage.
Please do not hesitate to contact us and use our
services if you have need.
Broker/Consultant Info:
LBG Advisors, LLC
4100 194th St SW, Suite 380
Lynnwood, WA 98036
Toll Free: (877) 485-2120
Fax: (877) 396-4283
Visit us at :
www.lbgadvisors.com
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Group Plan Coverage Eligibility
Employee Benefit Guide
Determining Eligibility Employees and their dependents are eligible for coverage on the first of
the month following the waiting period of 30 days of employment.
How Do You and Your Dependents
Become Covered?
To become a covered person, you must complete and sign an enroll-
ment form within the first 31 days of the employer’s eligibility waiting
period as designated above. If you are adding a dependent after your
initial enrollment, you must complete and sign a new enrollment form
or an enrollment change form. You can obtain these forms from your
HR Department.
Plan Coverage Deadlines
Benefit enrollments and enrollment changes must be made either a)
during the annual open enrollment period (the month of November
before the plan year renews on January 1st), or b) within 31 days of the
end of the waiting period after one is hired full-time, or c) within 31 days
of a qualifying event.
Qualifying Events
1. A change in the employee’s legal marital status (includes marriage,
death of a spouse, divorce, legal separation, and annulment) as well as
change in status of domestic partners.
2. A change in the employee’s number of dependents (includes a new
birth, a new legal adoption or legal placement for adoption, and the
death of a child).
3. Loss or gain of other coverage.
If you have any other questions about plan eligibility,
deadlines, or qualifying events please ask your
HR Department.
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Employee Benefits Guide
To the right is a table showing the
contacts for employees listed by
plan component.
If you have questions regarding
your benefits, bills, or another re-
lated matter, please first call the
appropriate toll-free customer ser-
vice number.
If you have tried contacting your
plan and still cannot get resolution
to your issue, please call or email
LBG Advisors at :
Phone: 877-485-2120
Email: [email protected]
Cell: (206) 228-4587
Benefits Contact Overview:
Employee Benefits Contacts
Medical
Administrates the medical cover‐
age. Call this number for claims
help/customer service or if you
have any questions about the de‐
tails of your medical coverage and
claims information.
Meritain Health
(800) 925‐2272
(800) 566‐9311
www.MyMeritain.com
Local Medical Network
Provides the preferred provider net-
work for In-Network provider use. Call
this number for claims customer ser-
vice or if you have any questions about
the details of your provider network.
Aetna Choice POS II Network
(800) 343-3140
http://www.aetna.com/dse/
search?site_id=mymeritain
Prescription Coverage
Administrates the prescription drug
services. They also administrate the
mail order program, useful if you are
on maintenance drugs.
Magellan Health Services
(800) 424-5828
www.magellanhealth.com
Healthcare Plan Consultants
Oversees the benefits plan as a whole.
If you do not receive satisfaction from
any of the above company’s customer
service systems, please call us.
LBG Advisors, LLC
Matt Christensen, Lead Advisor
Kris : Client Services x 303
Stacie : Client Services x 314
Toll Free: (877) 485-2120
www.lbgadvisors.com
Life Insurance Guardian
888-600-1600
Dental
Administrates the dental plan. Call
this number for claims customer ser-
vice or if you have any questions about
the details of your provider network.
Guardian
888-600-1600
Vision Guardian / VSP
888-600-1600
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Employee Benefits Guide
Other Info:
• Networks can change frequently and
providers can enter or exit a network
yearly (or even in the middle of the
year).
• The table to the right shows the
networks currently in place on your
benefit plan
• Please confirm network participation
with the network and your provider
• In network benefits are typically
better than out of network benefits
Please see provider insurance booklets and
Summary Plan Description (SPD) for the
detailed benefit description and exclusions. This
guide is not a guarantee of coverage or benefits.
Summary Plan Description supersedes any
information found in this employee benefits
guide.
This is only a partial illustration or overview of
the policy and is not a legal document.
Local and Out of Area Networks
Your plan has contracted with a different network based on
locations to customize the networks for the best selection of
preferred providers and hospitals .
Outside of Washington the network used will be Aetna National
Network.
To determine if a provider is in the network you can call the net-
work directly or visit the website. Patients will receive the highest
level of benefits available when a preferred provider is utilized
instead of a provider who is not.
Urgent Care Services
Urgent care facilities can often treat urgent needs without all of the has-
sle of the emergency room for a lower co-pay than the hospital.
Emergency Services—Out of Area Services
When you are out of service areas and need emergency care, simply go to
the nearest emergency facility and get the necessary care. These types of
services are considered In-Network as to the benefit levels for necessary
emergency services provided at any hospital.
Your Preferred Provider Organization (PPO)
PPO Network Overlay
PPO– Local network based on
location Aetna POS II Network
Washington
1 (800) 343-3140
www.aetna.com
PPO - Outside of Your State
Access:
Services rendered within the PPO
Network enjoy the highest levels of
benefits. Use this network if you are
outside WA area and need non-
emergency care.
Aetna
www.Aetna.com
Phone: 800-343-3140
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Employee Benefits Guide
Quick Notes:
Your medical insurance plan is
administrated by Meritain.
The PPO plan design carries a per
person calendar year deductible of
$500 and a individual maximum
out-of-pocket of $2,000 (both
figures assume Network Provider
use)
The coinsurance level begins after
the deductible has been reached,
again assuming you are using a
Network Provider. See percentages
in table to the right.
New H.S.A. as of 8/1/17 – deductible
must be satisfied before copay and
coinsurance applies. Preventative
still covered 100%
Please see provider insurance booklets and
Summary Plan Description (SPD) for the
detailed benefit description and exclusions. This
guide is not a guarantee of coverage or benefits.
Summary Plan Description supersedes any
information found in this employee benefits
guide.
This is only a partial illustration or overview of
the policy and is not a legal document.
Medical Benefits Summary‐
Medical Benefits Summary (PPO)
ZB NW Participant
Deductibles per Calendar
Year*
PPO- $500 / $1500 (In network)
H.S.A $1300/ $2600 (In network)
Out-of-Pocket Maximum per
Calendar Year
PPO— $2,000 / $6.000 (In-Network)
H.S.A—$2,600 / $6,000 (In-Network)
Covered Services In‐Network Provider Non‐Network
Provider
Primary Care $20 copay 40% co-insurance
Professional Office Visits $35 copay 40% co-insurance
Preventative Care 100% Covered
(No Copay) 40% co-insurance
LAB and XRAY – 20% co-insurance 40% co-insurance
Inpatient Hospital Stay 20% co-insurance 40% co-insurance
Outpatient Surgery 20% co-insurance 40% co-insurance
Facility Fee/ Hospital Stay 20% co-insurance 40% co-insurance
Prenatal/ Postnatal 20% co-insurance 40% co-insurance
Emergency Room Services $100 co-pay + 20% co-
insurance 40% co-insurance
Urgent Care $40 copay 40% co-insurance
Ambulance Service 20% co-insurance 20% co-insurance
Most Other Covered Expenses 20% co-insurance 40% co-insurance
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Employee Benefits Guide
Quick Notes:
Your prescription Drug Program is
administered by Magellan Health
Services.
Contact Magellan at: 800-424-5828
www.magellanhealth.com
Please talk to your doctor about
using generic alternatives to brand
name drugs.
Please also talk to your doctor
about using Over The Counter
(OTC) drugs.
A full formulary is available from
Magellan Health Services.
Please see provider insurance booklets and
Summary Plan Description (SPD) for the
detailed benefit description and exclusions. This
guide is not a guarantee of coverage or benefits.
Summary Plan Description supersedes any
information found in this employee benefits
guide.
This is only a partial illustration or overview of
the policy and is not a legal document.
Prescription Drug Program
Prescription Drug Program Summary
Rx Benefit
Tier 0:
OTC
Tier 1:
Generic
Tier 2:
Preferred
Brand Name
Tier 3:
Specialty
Retail Pharmacy
34 Day Supply
$5 co-
pay $25 copay $50 copay
20% copay
Up to max $400
per fill
Mail Order Phar-
macy
90 Day Supply
$15 co-
pay
$75 copay
$150 copay
20% copay
Up to max $400
per fill
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Employee Benefits Guide
Quick Notes:
Your Dental Benefits are
administered by Guardian
888-600-1600 Group # 00541304.
Staying in network may make your
total annual max benefit stretch
further.
Please remember to have your
dentist Pre-Authorize any large
procedure before you have that
procedure done.
Please see provider insurance booklets and
Summary Plan Description (SPD) for the
detailed benefit description and exclusions. This
guide is not a guarantee of coverage or benefits.
Summary Plan Description supersedes any
information found in this employee benefits
guide.
This is only a partial illustration or overview of
the policy and is not a legal document.
Dental Benefits Summary
Dental Benefits ‐ Guardian
Annual Max. Benefit $1,500 per member
Orthodontia Lifetime Benefit
(Dependent Children only) $1,000 per member
Dental Benefit Coinsurance Levels
Class A
Preventive Services
100%
Oral Evaluations
Prophylaxis and Fluoride
Bitewings (adult/child)
Sealants
All Other X-Rays-Panoramic 1 every 5
years
Class B
Basic Services
80%
Consultations
General Anesthesia
Fillings and Restorations
Oral Surgery
Simple and Surgical Extractions
Root Canal
Deductible: $50 individual -$150 family
Class C
Major Services
50%
Bridges and Crowns
Dentures and Implants
Inlays and Onlays
Deductible: $50 individual -$150 family
Class D
Orthodontia
50%
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Employee Benefits Guide
Quick Notes:
The group term life coverage is
provided by the Guardian
Please see provider insurance booklets and
Summary Plan Description (SPD) for the
detailed benefit description and exclusions. This
guide is not a guarantee of coverage or benefits.
Summary Plan Description supersedes any
information found in this employee benefits
guide.
This is only a partial illustration or overview of
the policy and is not a legal document.
Ancillary Group Coverage:
Life Insurance Information
Guardian
Life ‐ AD&D
Basic Life Coverage
Amount
Your Basic Life coverage amount is $10,000, $20,000, or
$50,000 depending on your employee class. See human
resource department for additional details.
Basic AD&D Cover‐
age Amount
For a covered accidental loss of life, your Basic AD&D
coverage amount is equal to your Basic Life coverage
amount. For other covered losses, a percentage of this
benefit will be payable.
Benefits and Features
Waiver of Premium If you become totally disabled while insured under this
plan and under age 60, and complete a waiting period of
180 days, your Basic and Additional Life Insurance may
continue without premium payment until age 65 pro-
vided you give us satisfactory proof that you remain to-
tally disabled.
Accelerated Benefit If you become terminally ill, you may be eligible to re-
ceive up to 75 percent of your combined Basic and Addi-
tional Life benefit to a maximum of $500,000.
Portability If your insurance ends because your employment termi-
nates, you may be eligible to buy portable group insur-
ance coverage.
Conversion If your insurance ends or reduces, you may be eligible to
convert your life insurance to an individual life insur-
ance policy without submitting proof of good health.
Age Reductions Basic Life and AD&D insurance coverage amounts re-
duce by 35 percent at age 65 and by 50 percent at age
70.
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Employee Benefits Guide
Quick Notes:
You do not need a member card.
Just tell provider you have Metlife
Vision.
Members can go to any licensed
vision specialist and receive cover-
age. Just remember your benefit
dollars go further when you stay in
network.
Costco Optical Available (see grid)
Walmart or Sam’s club will process
claims even though they are out of
network.
Members receive additional 20%
savings on amount that you pay
over allowance (some locations
may not participate– check with
customer service)
See Vision Tab on benefits website
for full details , official insurance
provider document., and out of
network reimbursement amounts.
Ancillary Group Coverage:
Vision Coverage Information
Guardian / VSP
Vision
Provider Search VSP.com
Phone: 888-600-1600
Benefits and Features
Eye Exam
(once every 12 mon)
Exam, dilation, prescription, and refraction for glasses.
Covered in full after $10 copay.
Retinal Imaging Up to $39 copay on routine retinal screening when
performed by a private practice provider.
Frames
(once every 24 mon)
Allowance up to $130 after $25 copay.
Costco Frames $70 Allowance after $25 copay.
Standard Corrective
Lenses (once every
12 months)
Single vision, lined bifocal, lined trifocal, lenticular.
Covered in full after $25 Copay.
Standard Lens
Enhancements
(once every 12
months)
Polycarbonate (child up to 18) and UV Coating. Covered in full after $25 copay.
Contacts
(once every 12 mon)
Contact fitting and evaluation. Covered in full with max copay of $60. Elective Lenses $130 allowance Necessary Lenses: Covered in full after eyewear copay.
Coverage Termina‐
tion
Coverage will terminate when you terminate employment
with this policyholder or at your retirement.
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The Zimmer‐Biomet NW benefit plan is the
“primary” insurance for the employee.
If a spouse or dependent has other medical cov-
erage through an employer or other source, that
“plan” is the primary insurance to the spouse or
dependent.
The Zimmer‐Biomet NW plan does offer coor-
dination of benefits as a secondary payer to de-
pendents that have primary medical coverage
through an employer or other source.
If an employee has “secondary” coverage
through a spouse, dependent upon the plan de-
sign of the spouse’s coverage, they may be able
to submit an “Explanation of Benefits” (EOB) to
the spouses coverage for coordination of bene-
fits if the spouse's plan allows.
Coordina�on of Benefits
Employee Benefits Guide Please see provider insurance booklets and Summary Plan Description (SPD) for the detailed benefit description and exclusions.
This guide is not a guarantee of coverage or benefits.
Summary Plan Description supersedes any information found in this employee benefits guide.
This is only a partial illustration or overview of the policy and is not a legal document.
LBG Advisors does not provide coverage . While this guide is believed to be accurate as of the date of first use. Plan designs, coverages and
vendors may change during or at the end of the plan year.
Please consult your HR department for updates to your plan and coverage.
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