2020
Benefits
Open
Enrollment
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What we will cover today
• 2020 Plan Choices
• Medical Plan Comparison
• Cigna Resources
• HRA – Changes for 2020
• FSA
• Contributing to your HSA
• Dental
• Vision
• Voluntary Benefits
• Employee Benefit Center
• Open enrollment 2020
• “Ask Emma” decision making assistance for
medical plans
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Open Enrollment
November 8-20
Your opportunity to make changes to your benefit elections:
• Enroll or drop plans
• Enroll or drop dependents
• Update beneficiary information
• Elect additional HSA dollars
• Elect pre-tax flexible spending dollars
• Action Require: You MUST re-enroll in HSA/FSA/DCA each year.
• No Action is required if you are leaving all benefits as is; strong
encouraged to log in and check your enrollments.
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Benefits Reminders!
If your spouse is offered affordable coverage through their employer, they may not
enroll in the Simon Pearce medical plan.
FORM 1095-C
• All employees will receive Form 1095-C by January 31, 2020
• 1095-C shows the months you were offered coverage or covered under the
medical plan
• It's important because you may need this information to prepare your 2019
taxes
• Watch for this form in your mailbox
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Connect with Cigna
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myCigna.comMy Health
Dashboard
Health
AssessmentFind an in-
network
doctor
Care
Management
Apps & activities
MY PLANS MY HEALTH
Incentives*Explanation
of benefits
Pharmacy
tools
Cost and
quality tools
*If offered by your employer.
SUPPORTING YOUR HEALTH
SUMMARY OF ENGAGEMENT AND RESOURCES
Cigna Telehealth services
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Call 1.800.285.4812 to order by phone
* Availability may vary by location and plan type and is subject to change. See vendor sites for details.
** The downloading and use of any mobile app is subject to the terms and conditions of the mobile app and the online stores from which it is
downloaded. Standard mobile phone carrier and data usage charges apply.
Confidential, unpublished property of Cigna. Do not duplicate or distribute. Use and distribution limited solely to authorized personnel. © 2016 Cigna
AmWellforCigna.com*
855-667-9722
MDLIVEforCigna.com*
888-726-3171
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Cigna Healthy Rewards
Weight management – Jenny Craig®
Smoking cessation programs
Hearing care
Fitness club memberships
Alternative medicine – acupuncture, chiropractic care, massage therapy
Mind/body – Yoga Journal and SpaFinderTM and much more
Find under the My Health Tab, in Programs and Resources
Discounts on a full range of health
and wellness programs and services*
Confidential, unpublished property of Cigna. Do not duplicate or distribute. Use and distribution limited solely to authorized personnel. © 2016 Cigna
*Healthy Rewards is a discount program. Some Healthy Rewards programs are not available in all states and programs may be
discontinued at any time. A discount program is NOT insurance, and the customer must pay the entire discounted charge.
Ckit page- RES20666
Helping you stay healthy
Why it’s important to fill your
medication in a 90-day supply
Less likely to miss a dose**
More likely to stay healthy**
Fewer visits to the pharmacy to refill
your medication
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You now have more choice!
Cigna 90 Now
Confidential, unpublished property of Cigna. Do not duplicate or distribute. Use and distribution limited solely to authorized personnel. © 2016 Cigna
Under your employer’s plan, you can choose to
fill your maintenance medications in either a 30-
day or 90-day supply
• If you choose to fill a 30-day supply, you
can use any retail pharmacy in the plan’s
new network.
• If you choose to fill your prescription in a
90-day supply, you have to use a 90-day
retail pharmacy in the plan’s new network,
or Cigna Home Delivery PharmacySM.*
*Plans vary, so some plans may not include Cigna Home Delivery Pharmacy. Please check your plan materials for more information on what
pharmacies are covered under your plan.
**Internal Cigna analysis performed March 2016, utilizing 2015 Cigna national book of business average medication adherence (customer
adherent > 80% PDC), 90-day supply vs. those who received a 30-day supply taking antidiabetics, RAS antagonist and statins. Individual results will vary.
Your new 90-day benefit and pharmacy network
MyCigna.com Mobile site and app deliver
health information on the go
All customers can access
myCigna via mobile device
using internet browser
myCigna mobile app available
Features:
• Find a doctor, dentist, pharmacy or facility
• View, print, and email ID card information
• Search and view claims
• Drug search
• View plan coverage and authorizations
• Organize and manage personal health
information with the Health Wallet
9Confidential, unpublished property of Cigna. Do not duplicate or distribute. Use and distribution limited solely to authorized personnel. © 2015 Cigna
Get help from Cigna now!
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Medical Plans
• Simon Pearce is offering the choice of three (3) plans:
• Gold Level Plan
• Silver Level Plan
• Bronze Level Plan
• You and your dependent must enroll in the same plan.
Because Simon Pearce is offering you affordable coverage that is better
than minimal essential coverage, you are not eligible for a subsidy for
an Exchange plan if you purchase coverage as an individual.
Getting and staying healthy is
important. Most plans include 100%
coverage for designated preventive
care services received in-network,
such as:*
• Screenings for blood pressure,
cholesterol and diabetes
• Testing for colon cancer
• Clinical breast exams and
mammograms
• Pap tests
Preventive care
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Plan Summaries
Gold Plan w/HRA Funding
Enrolled as
an Individual
Enrolled as a EE
+Spouse,
Child(ren) or
Family
$1,800 Deductible
$3,600 Deductible
Simon Pearce
Funding
$750
Simon Pearce
Funding
$1,500
You pay the
next $1,050
You pay the
next $2,100
After the deductible is met, the employee pays 20% of the cost up to a
$2,500 or $5,000 out of pocket max.
All Rx Copays (30-Day Retail) - $5/20/40
How the Gold Plan/HRA Works
at the Doctor’s
Don’t pay at the time of service!
Track your deductible and HRA balance in you myCigna website or
app.
HRA funds may not be used for prescriptions, dental or vision
expenses.
You receive a bill in
the mail for any
coinsurance owed.
Pay bill with your
Cigna issued HRA
card.
• You will receive an HRA debit card from Cigna to pay for expenses in
2020
• Claims will no longer be automatically paid by Cigna; you will need to
use your debit card to pay claims.
• Prescriptions are still not covered by the HRA.
• Any remaining HRA balances (up to $1,125/$2,250) from 2019 will
rollover on January 1st.
• Claims incurred in 2019 but processed in 2020 may be paid with HRA
funds, depending on availability
Changes to the HRA for 2020
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Silver Plan w/ HSA Funding
Enrolled as an
Individual
Enrolled as a
EE +Spouse,
Child(ren) or
Family
$2,800 Deductible
$5,600 Deductible
Simon Pearce
Funding
$520*
Simon Pearce
Funding
$1,040/$1,560*
You pay the
next $2,280
You pay the next
$4,560/4,040
• After the deductible is met, the employee pays 20% of the cost up to a
$5,000 or $10,000 out of pocket max.
• Preventive Rx: Co-Insurance 40%
• Non-Preventive Rx: Deductible, then Co-Insurance 40%
• An employee can also contribute to their HSA. This is a bank account,
so only funds deposited are available for use.
• *HSA funding is prorated for date of hire, funds are deposited per pay
period
• Office visits (primary care and specialist) - $50 copay
• Emergency Room and Urgent Care - $250 copay
• Prescriptions are a $5/$20/$40 copay at a retail pharmacy
• For all other medical claims, pay 40% of the cost up to a
$7,150/$14,300 out of pocket max.
• This plan pairs well with an employee funded Flexible Spending
Account (FSA) which allows for pre-tax contributions to be used
towards qualified expenses.
Bronze Plan
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Ask Emma will ask you a few questions and:
• Help you understand your anticipated medical usage for 2020
• Ask questions about your appetite for out of pocket expense vs.
premium savings
• Weigh the options and decide which plan best suits your specific
benefit and needs
Ask Emma - Decision Support
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HRA vs. HSA – What’s the Difference?
HRA HSA
Gold Plan Silver Plan
Simon Pearce owns the account YOU own the account
Medical onlyMedical, Dental, Vision (or save
it for retirement)
Only SP contributes
$750 and $1,500
Both you & SP can contribute
$20, $40, $60 per paycheck-SP
IRS Limits: $3,550/$7,100
Cap on funds ($1,875/$3,750) All funds rollover, unlimited
No interest Earns interest
Remains with Simon Pearce
if you leave or change medical
plans
Take it with you if you leave
Simon Pearce
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Flexible Spending Account (FSA)
• Administered by HealthEquity in 2020
• You can elect up to $2,700
• Plan Year: 1/1/2020 – 12/31/2020
• Pre-tax money, contributed through payroll deductions
• Up to $500 can roll into 2021, remainder is forfeited if not used
• Eligible expenses:
o Medical & Rx expenses
o Dental Expenses
o Vision Expenses
o Limited Over the Counter
o No medical if you contribute to your H.S.A. in 2020
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FSA vs. LFSA – What’s the Difference?
FSA(Flexible Spending Account)
LFSA(Limited Purpose Flexible
Spending Account)
Medical, Dental, Vision
expensesDental & Vision only expenses
Cannot be used with an HSA Can be used with an HSA
• You need to keep receipts to substantiate your claims
• Match the receipt with your Explanation of Benefits
• You will be asked to show proof that your claim was for a
qualified expense
• You must re-elect this benefit each year - this will NOT
roll-over
Using your FSA
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Dependent Care Account (DCA)
If you have kids under 13:
• Pre-tax money, contributed through payroll deductions
• Pay as you go, can only spend what you have contributed
• “Use it or Lose it”
• Eligible Expenses : Custodial care of dependents while
employee is at work
• Maximum $5,000 annual contribution
• You must re-elect this benefit each year - this will NOT roll-over
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Dental Plan
Plan Coverage Level
Preventive 100%
Cleanings 2
Deductible $25/$75
Basic 80%
Major 50%
Annual max $1,500
Ortho (children) 50%
Ortho Max $1,000
Carryover Yes
• Delta Dental National Network
• Carryover Benefit of $250 per
member
• Maximum of $3,000
• Health through Oral Wellness
(HOW) Program
• Remember, your ID card will
only have the employee’s name
on it
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Vision Insurance
• Employees do not need to be enrolled in the medical plan to enroll in
the Vision coverage in 2020
• Plan includes additional discounts for other eye services and for costs
above the frame allowance
• Low rates, great benefit!
Eye Exam Every Calendar Year
Lenses Every Calendar Year
Frames Every Other Year
Allowance $130
Co-pays for
exams/materials
$10/$25
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100% Company Paid Benefits
• Life Insurance and Accidental Death through Reliance
Standard
o 1x Base + Incentive W2 earnings up to $50,000
o 2x for an accident
• Long Term Disability Insurance through Reliance Standard
o 60% of Base + Incentive W2 earnings up to $5,000
per month
• Employee Assistance Program (EAP) through ACI
o 3 visits for work or non-work issues
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Travel Assistance – 100% Company Paid
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ID Theft – 100% Company Paid
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Employee Voluntary BenefitsLife Insurance enrollment and changes require the approval of an
Evidence of Insurability
Voluntary Life & AD&D Insurance (100% employee funded; age rated premiums)
• Can purchase up to $500,000 of coverage, not to exceed 5x employee earnings, with
evidence of insurability
Dependent Life Insurance (100% employee funded; age rated premiums)
• Can purchase up to $250,000 of coverage, not to exceed 100% of employee’s
coverage, with evidence of insurability
Pre-Ex Clause, no EOI Needed
Short Term Disability Insurance (100% employee funded; age rated premiums)
• Ability to purchase 60% of your weekly earnings, up to $750 per week
• Benefits begin on the 1st day of an accident or injury and the 8th day of a sickness
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Employee Voluntary Benefits
No EOI needed
Critical Illness (100% employee funded; age rated premiums)
• A way to cover deductible or other out of pocket expenses when receiving a major
diagnosis
• Provides a lump sum benefit upon diagnosis of a critical illness such as heart attack,
stroke, cancer, and organ failure
• Purchase, in $5,000 increments, coverage up to $50,000; guarantee issue amount is
$15,000
• Ability to purchase coverage for dependents
• Paid on a post tax basis, so any benefit received is tax-free
• Wellness benefit of $75
Accident Insurance (100% employee funded)
• Pays out a dollar amount based type of injury from an accident and care received
• Another way to cover deductible or out of pocket expenses
• Benefit is paid out tax free
Wellness Benefit
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For employees enrolled on the Accident Insurance
and/or Critical Illness:
Get a preventative screening, file a claim, and
receive a check for $75 from Reliance Standard!
bSwift Open Enrollment
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• Log in to review and make changes to your 2020 benefits
• You must re-elect Flexible Spending and Dependent Care every year.
• Action is necessary for HSA/FSA/DCA enrollment. You must reenroll
in these benefits annually.
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Simon Pearce Employee Benefit Center
• Website contains all the details of your full, comprehensive benefits package and
other great tools and resources
• New URL for the Employee Benefit Center – see your benefit booklet for details
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Questions?
Top Related