2012 employee benefits stark carpet corp. 2012 health benefits open enrollment guide it is time...

2012EmployeeBenefits

Stark Carpet Corp

2012 Health BenefitsOpen Enrollment Guide

It is time again to review the 2012 Health benefits for you and your family.

Stark Carpet Corp is pleased to announce we will continue to offer Aetna Health Plans as our

Medical carrier, but will be making changes to our Dental coverage. The following

presentation will outline all your options effective as of February 1, 2012.

Effective: February 1, 2012

You Will Continue To Have The Following Medical Plans

to Select FromFour (4) Options

With Aetna Health Plans

Plan 1 (High) Open Access MC (NGP)

Plan 2 (Medium) Open Access MC (NGP)

Plan 3 (Low) Managed Choice POS

Plan 4 (Basic Low) Managed Choice POS

Plan 1- Open Access MC provided by Aetna Health Plans HIGHHIGH

Benefits In Network Out of Network

Office Co-pay $30 Primary

$50 Specialists

Deductible & Coinsurance


Deductible Single: $500

Family: $1,500

Single: $500

Family: $1,500

Coinsurance %

Coinsurance Maximum

(Includes Deductible)

100%

Single: $500

Family: $1,500

70% / 30%

Single: $3,500

Family: $10,500

Hospital Co-pay (I/P)

Emergency Room Co-pay

$100 Copay after Deductible

$50 (Waived If Admitted)

$100 Copay; Ded & Coins


Lifetime Maximum

UCR

Unlimited

N/A

Unlimited

80th Percentile

Prescription Drug Deductible (Waived for Tier 1)

Prescription Drug Co-pay

(Mail Order: 2x Co-Pay)

$100 Per Person

(Ded must be met before copays)

Tier 1: $20 Co-pay

Tier 2: $35 Co-pay

Tier 3: $50 Co-pay

Covered at Network Pharmacies Only

Plan 2- Open Access MC provided by Aetna Health Plans MEDIUMMEDIUM



$50 Specialists




Family: $1,500

Single: $1,000

Family: $3,000

Coinsurance %

Coinsurance Maximum


100%

Single: $500

Family: $1,500

70% / 30%

Single: $6,000

Family: $18,000







Lifetime Maximum

UCR

Unlimited

N/A

Unlimited

80th Percentile




$100 Per Person


Tier 1: $20 Co-pay

Tier 2: $35 Co-pay

Tier 3: $50 Co-pay


Plan 3- Standard Managed Choice provided by Aetna Health Plans LOWLOW



$50 Specialists




Family: $1,500

Single: $5,000

Family: $10,000

Coinsurance %

Coinsurance Maximum


100%

Single: $500

Family: $1,500

70% / 30%

Single: $15,000

Family: $40,000





$500 Ded & Coinsurance


Lifetime Maximum

UCR

Unlimited

N/A

Unlimited

80th Percentile




$100 Per Person


Tier 1: $20 Co-pay

Tier 2: $35 Co-pay

Tier 3: $50 Co-pay


Plan 4- Standard Managed Choice provided by Aetna Health PlansBASIC LOWBASIC LOW



$50 Specialists



Deductible Single: $1,000

Family: $3,000

Single: $5,000

Family: $10,000

Coinsurance %

Coinsurance Maximum


90% / 10%

Single: $2,500

Family: $7,500

70% / 30%

Single: $15,000

Family: $40,000



$500 Copay after Ded & Coins


$500 Ded & Coinsurance


Lifetime Maximum

UCR

Unlimited

N/A

Unlimited

80th Percentile




$200 Per Person


Tier 1: $20 Co-pay

Tier 2: $35 Co-pay

Tier 3: $50 Co-pay


We Are Pleased To Announce New We Are Pleased To Announce New Changes To The Dental Plans for 2012.Changes To The Dental Plans for 2012.

Your Dental Plan Will Be Administered ByGUARDIAN INSURANCE COMPANY

You will continue to have a choice to select either a

Pre-Paid DMO Pre-Paid DMO Dental PlanDental Plan((Network Benefits Only – Must Use A Guardian DMO Provider)Network Benefits Only – Must Use A Guardian DMO Provider)

OrOr

PPO - NAP 590 QDPPO - NAP 590 QD Dental Plan Dental Plan(Network Benefits – Must Use A Guardian PPO Provider)(Network Benefits – Must Use A Guardian PPO Provider)(Out of Network Benefits – Select A Dentist of your Choice)(Out of Network Benefits – Select A Dentist of your Choice)

Dental Benefits provided by Guardian Health Plans

Your 2012 Calendar Year Dental Deductible will be….

Pre-Paid DMO : Network Only No Deductibles

PPO – NAP590 QD: Network /Out of Network $50 Single/ $150 family

(Note: Deductible is Waived for Preventive)

Your 2012 Calendar Year Dental Maximum will be….

Pre-Paid DMO: Unlimited Benefits

PPO - NAP590 QD: Network $2,000 Per Person Out of Network $1,500 Per Person Ortho (Lifetime) Max $1,000 Per Child

Dental Benefits provided by Guardian Health Plans(Additional Plan Benefits will be included in Guardian Handbook)

Benefits Include….. Pre-Paid DMO PPO – NAP590 QD

Network Network Out of Network

Preventive & Diagnostic

Oral Exams / Cleaning

Routine X-rays /Sealants

Fluoride Application / Space Maintainers

Fee Schedule 100%

Deductible Waived

100%

Deductible Waived

Basic Restorative Care

Non-Routine X-Rays / Fillings

Emergency Care to Relieve Plan

Periodontics / Endodontics

Oral Surgery - Simple Extractions

Fee Schedule

90% 80%

Major Restorative Care

Oral Surgery –except Simple Extractions

Surgical Extraction of Impacted Teeth

Bridges, Crowns & Inlays/Onlays

Dentures / Repairs

Fee Schedule 60% 50%

Orthodontia $2500-$2800

(Adult & Child(ren)

50% For Children 50% For Children

Important Information About Your Important Information About Your Guardian Dental Plan!Guardian Dental Plan!

• If you enroll in the If you enroll in the Pre-Paid DMOPre-Paid DMO Dental plan, you will need to select a Dental plan, you will need to select a Guardian DMO Dentist in order to receive care. Guardian DMO Dentist in order to receive care.

• If you enroll in the If you enroll in the PPO - NAP590 QDPPO - NAP590 QD Dental Plan, it is not necessary for you to Dental Plan, it is not necessary for you to select a Guardian PPO Dentist in advance. However, by using a PPO dental select a Guardian PPO Dentist in advance. However, by using a PPO dental provider you will be entitled to discounted fees. provider you will be entitled to discounted fees.

• If you enroll in the If you enroll in the PPO – NAP590 QDPPO – NAP590 QD Dental Plan and elect to use a dental Dental Plan and elect to use a dental provider that is not contracted with Guardian, fee payments will be based on Usual provider that is not contracted with Guardian, fee payments will be based on Usual & Customary allowances with no discounts.& Customary allowances with no discounts.

TO LOCATE A DENTAL PROVIDER IN YOUR AREA, PLEASE VISIT TO LOCATE A DENTAL PROVIDER IN YOUR AREA, PLEASE VISIT GUARDIAN’S WEBSITE AT GUARDIAN’S WEBSITE AT www.glic.com..

http://www.glic.com/

Life and AD&D Insurance provided by Guardian

EmployerPAID Benefit

Life Insurance Coverage Levels

2 times Annual Salary – Max of $50,000

Benefits Are Reduce 50% at Age 70

Accidental Death & Dismemberment (AD&D)

Levels match Life Insurance coverage

--------------------------------------------------------------------------------------

Accelerated Life Benefit: Minimum: The Lower of $50,000 or 50% of Death Benefit Maximum: $100,000

Includes Waiver of Premium if Totally Disabled prior to Age 60

Includes Option for Conversion /Portability prior to Age 70

Vision Benefits provided by Vision Service Plans (VSP)

Benefits Include… Using A VSP Provider Non-Participating Provider

Exams Covered in Full after $10 Copay Reimbursed Up To $50

Lenses

Single Lenses

Bifocal Lenses

Trifocal Lenses

Covered in Full

after $25 Copay

Reimbursed Up To $50



Progressive Lenses (Standard) Covered in Full after $50 Copay Reimbursed Up To $75

Frames Up to $120 Allowance

after $25 Copay Reimbursed Up To $70

Contact Lenses

(Fitting & Evaluation) Up to $120 Allowance Reimbursed Up To $105

Laser Vision Care 15% Average Discount or 5% Off Promotional Price

Frequency Limits

Exams – 1 Every 12 Months

Frames or Contacts – 1 Every 24 Months

Voluntary Life Insurance provided by Allstate

In additional to the Basic Life Insurance, you can also purchase additional Life Insurance through Payroll Deductions.

Option 1 - Universal Life:

• Provides coverage to age 85 with guaranteed cash values. • Offers permanent protection with lifetime rate stability. • Option to purchase spouse coverage.• Option to purchase small amount for children and grandchildren.• Policy will pay a portion of the face value to you while you are still living if you are diagnosed with a terminal illness or require long term care.

Option 2 - Horizon Term Insurance:• Straight death protection with a level death benefit and a premium designed to be level for 20 years.

If Interested, please contact Bill Liggan in Human Resources and he will arrange to have an Allstate Representative meet you to review the application process.

Voluntary Benefits provided by AFLAC

Vol. Short Term Disability Personal Cancer Indemnity Accident Indemnity Advantage

Maximum Benefit Duration

Choice of 3 / 6 / 12 / 18 Months

Benefit Amount:

Monthly $500-$5,000 (subject to income requirement)

First Occurrence Benefit

Pays $2,000 for Insured

Pays $2,000 for Spouse

Pays $3,000 for Children

Accident Emergency Treatment

$120 Once per 24-hour period (once per accident / per covered person)

Elimination Period for Injury / Sickness

Employee will have a choice of

electing a 7, 14, 30, 60,90 or

180 day period

Hospital Confinement Benefit

Pays $300 per day for first 30 days

Benefit increases to $600 per day after 31st day

Hospital Confinement Benefit

$1000 per period or $1,500 per covered person if admitted to

intensive care unit initially.

Benefit Includes

Total Disability Benefit

Partial Disability Benefit

Transitional Disability Benefit

Policy is Fully Portable

Guaranteed Renewable to Age 70

See Brochure for additional benefits

Benefit Includes

Medical Imaging

Radiation & Chemotherapy

Immunotherapy Benefit

Nursing / Skin Cancer Surgery. See Brochure for additional benefits

Benefits Includes

X-Rays

Accident Follow Up Treatment

Accident Hospital Confinement

ICU Confinement

Major Diagnostic Exams. See Brochure for additional benefits

Please contact Bill Liggan in Human Resources for enrollment information.

What is an Flexible Spending Account (FSA)?

Flexible Spending Accounts provides you with tax relief for un-reimbursed

medical and dependent day-care cost. FSAs enable you to utilize pre-tax

dollars and save Federal, FICA, and in most cases , State taxes when paying

for eligible expenses not covered by the traditional insurance plan.

Flexible Spending Account provided by Ameriflex


Your Flexible Spending & Dependent Care dollars are deposited through regular payroll deductions.

You estimate how much you spend annually on expenses that qualify to be paid from your flex account, then enroll.

You May Elect Amounts up to…

$5,000 for Flexible Spending (FSA) Expenses

The annual amount you elect for the FSA is available on the first day and through-out the plan year.

$5,000 ($2,500 if single) for Dependent Care Expenses

Dependent Care (DCSA) is available as your contributions are deposited in the account.

USE IT…

Don’t LOSE IT!Unused balances may not be paid to you in cash or used in a later year.

So estimate what you think you will need for your expenses.

NOTE: If you were enrolled in the FSA for 2011 and want to continue, you must make a new election for 2012.



How Are Qualified Expenses Paid?

By…

• using the “AmeriFlex Convenience Card” – this is a Master Card debit card providing electronic access to your FSA Funds.

OR…• submit a Claim Form – if merchant does not accept the

“AmeriFlex Convenience Card”.

Note: AmeriFlex may need additional information, including receipts to verify eligibility of the expense and to comply with IRS Rules. Save all receipts, then fax

or mail them promptly if requested!.

• Co-pays, deductibles, and other payments you are

responsible for under your medical plan

• Prescriptions (ONLY PRESCRIBED BY PHYSICIAN)

• Dental & Eye care expenses

• Chiropractic treatments

• Prescribed Weight - Loss Programs

• Daycare expenses for dependents, so you can work

and much more…

Expenses That Qualify For Payment With Flex Dollars


Online Website Access – Take A Tour

Register Your Secure Website For Each Carriers Aetna Medical: www.aetna.comGuardian Dental: www.guardiananytime.comVSP Vision: www.vsp.comAmeriflex FSA: www.flex125.com

On Your Secure Website, you will find:

24 Hours a day - Access to Your Claims & Benefits

Insurance information - To become an informed consumer.

Personalized tools - Request Forms & ID Cards – Look for Participating ProvidersYou can do it online - 24 hours a day, 7 days a week - from wherever you have Internet access.

http://www.aetna.com/

http://www.guardiananytime.com/

http://www.vsp.com/

http://www.flex125.com/

Completion of Your Health Benefits Enrollment

IMPORTANT INFORMATION

THERE ARE TWO WAYS TO MAKE YOUR

ENROLLMENT ELECTION FOR 2012

1. HR CONNECTION - ONLINE

If you provided a Email Address (either a Stark Email or Personal Email), you can go online to www.hrconnection.com and make your elections. No Paper Documents will be necessary. (Instruction Sheet will be available)

2. PAPER ENROLLMENT

If you do not have an Email Address, you may complete a Paper Enrollment and submit to Bill Liggan in Human Resources. (Enrollment Packages will be available)

http://www.hrconnection.com/

• If enrolling through HR Connection, please be sure to make your election for each plan and include any addition or changes you may want during this open enrollment. (No paper form will be required if enrolling online)

• If you will be using a paper form, please print all information clearly.

• Include All Social Security Numbers. (Yours & Your Dependents)(This is for enrollment process only. You will be assigned a Member Identification Number for Privacy Requirements)

• Be sure to include all your dependents dates of birth.

• Sign & Date your application.

• Return completed enrollment form to Human Resources by January 20, 2012.

NOTE: ONCE YOU ARE ENROLLED IN THE HEALTH BENEFITS FOR 2012, YOU WILL NOT BE ABLE TO MAKE ANY CHANGES UNTIL THE NEXT PLAN ANNIVERSARY UNLESS YOU HAVE A QUALIFYING EVENT!

Completion of Your Health Benefits Enrollment

IMPORTANT INFORMATION

Service & AdvocacyCo-Pilot Benefits Advocacy

CoPilotTM is an employee advocacy program from Pilot Employee Benefits designed to assist employees with all aspects of enrollment

as well as any claims or coverage issues that may arise.

The CoPilotTM service card contains instructions for you to obtain assistance with any of the benefit plans. Pilot works for you and is

there to help you receive the benefits of your plans.

If you have any questions regarding your benefits, please contact our employee service program, CoPilotTM,

Call (800) 794-1215

QUESTIONS?

2012 employee benefits stark carpet corp. 2012 health benefits open enrollment guide it is time...

Documents

copay tier

coinsurance maximum

ded coinsurance

copays tier

aetna health plans plan

network pharmacies

low managed choice pos

medium open access mc