2018 - 2019 benefits guide · 2018-03-30 · however, by utilizing in-network providers, you will...

2018 - 2019

Benefits Guide

2018 Kass Shuler 2

Welcome to your 2018-2019

Benefit Enrollment!

What’s in the Guide?

Enrollment Process………………………………………..…….3

Medical……...…………………………………………………..4 - 5

Flexible Spending Accounts……………………………….…6

Dental………………………………………………………………….7

Vision……………………………………………………………..……8

Voluntary Benefits………………………………..………9 - 11

Life Insurance……………………………………………….……12

401(k) Retirement Plan……………………………………...13

Additional Benefits & Information…………………..…14

Paid Time Off……………………………………………..…...…15

Important Contacts………..………………………………....16

The financial security and general welfare of our employees is of vital importance to Kass Shuler, P.A. This is why we provide you and your family with an employee benefits package. Our primary objective in selecting these products is quality, insurance company stability, and the opportunity to purchase coverage you might need at competitive prices. The financial impact of medical costs can be severe if you are not properly protected. With this in mind, Kass Shuler, P.A. provides insurance plans to all eligible employees and their families. We urge you to take advantage of the enrollment period so you may better protect yourself and your family against the high cost of medical care. Eligibility You and your dependents are eligible for benefits if you are classified as an active full-time employee working 30 or more hours a week. Your coverage is effective the first of the month following a 60 day waiting period. New hires should enroll after 30 days of employment. You may cover your spouse and your eligible dependent children.

Annual Enrollment “Open Enrollment” is the time of year in which you may enroll, drop, or make changes to your benefits. The benefit choices you make should be tailored to your personal needs. After the open enrollment period ends, you may not add, delete, or change the coverage you have selected for yourself and your dependents until the next open enrollment period, which is held every year in March for an effective date of April 1st. The only exception is if you have a qualifying event. A qualifying event includes, but is not limited to:

• Marriage or divorce • Birth or adoption of a dependent child • Change in custody of a dependent child • Death of a spouse or dependent child

• Your spouse has a change of employment or status affecting benefits coverage

• Your change of employment status • You experience an involuntary loss of other group benefits coverage

**Tobacco Free Workplace**

Kass Shuler, P.A. is taking the initiative to reduce the exposure of employees, visitors and clients to environmental tobacco smoke and tobacco products (including smokeless tobacco). Therefore, we are an entirely tobacco-free workplace. You will receive additional information detailing medical plan surcharges for those who are grandfathered in since 4/1/17 smokers and do not elect to participate in the smoking cessation program offered through Kass Shuler, P.A.

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Enrollment Process Kass Shuler, P.A. provides electronic enrollment through Explain My Benefits. Explain My Benefits provides eligible employees the ability to make group insurance benefit elections and changes online during the annual open enrollment, new hire orientation and qualifying events.

Enrollment has never been easier. Accessible 24 hours a day, information about all of your employee benefits election options, including premiums and carrier contact information, are also available to help you make informed decisions.

You can also log into the Explain My Benefits portal at anytime to review your benefits, access carrier links, update your personal information for yourself and dependents, update your beneficiaries and process qualifying life events.

Reminders

Be sure to review the 2018-2019 Benefit Guide and plan summaries prior to going through the enrollment process.

Be prepared by gathering dependent and beneficiary information (i.e. Social Security Numbers and Dates of Birth).

How to Enroll

Self-Service

Visit www.explainmybenefits.com/kass-shuler, click on the black “Log into Your Benefit System” button and move through the enrollment system at your own pace

Review the posted benefit guide and plan summaries to help you with your benefit decisions.

Be sure to click “submit” at the end of the process and make note of your confirmation number. If you do not receive a confirmation number you have not completed your enrollment and you will not be enrolled in your benefits.

Return to the system anytime and click your confirmation number to view your confirmation statement.

http://www.explainmybenefits.com/kass-shuler

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Medical Cigna will continue to be Kass Shuler, P.A.’s health care provider for 2018/2019. We will continue to offer a choice of 3 plan designs: Open Access HSA, PPO Choice and a PPO Preferred. This allows you to select the plan that best suits your lifestyle and healthcare spending. For a listing of Cigna participating providers, visit their website at: www.mycigna.com

Cigna Open Access HSA Cigna PPO Choice Plan Cigna PPO Preferred

Coverage In-Network In-Network Non-Network In-Network Non-Network

Deductible (Individual/Family)

$4,000 / $12,000 (If family is enrolled, the Individual deductible and out of pocket no longer

apply. One individual will not have to meet more

than $6,850 in a Calendar year.)

$1,000 / $3,000 $3,000 / $9,000 $500 / $1,500 $2,000 / $6,000

Coinsurance 80% 80% 50% 90% 50%

In-Patient Hospital (Pre-cert Required) Includes: Anesthesia Lab & X-ray based on Facility Network Status

80% after deductible

Facility Charges: $500 copay per

Admission; then 80%

Non-Facility Charges: 80% after deductible

Facility Charges: $1,000 copay per

Admission; then 50%




admission; then 50%


Outpatient Surgery (Pre-cert Required) Includes: Anesthesia Lab & X-ray based on Facility Network Status



Admission; then 80%



Admission; then 50%




admission; then 50%


Emergency Room 80% after deductible $300 copay $200 copay

Urgent Care Visit 80% after deductible $35 copay 50% after deductible $30 copay 50% after deductible

Primary Physician Visit 80% after deductible $25 copay 50% after deductible $20 copay 50% after deductible

Specialist Visit 80% after deductible $35 copay 50% after deductible $30 copay 50% after deductible

Preventive Care 100%, no deductible $0 copay 50% after deductible $0 copay 50% after deductible

Well Woman Care 100%, no deductible $0 copay 50% after deductible $0 copay 50% after deductible

Prescriptions 80% after deductible

Tier 1 - $5 Tier 2 - $25 Tier 3 - $50

Appropriate copay + 50% of the full cost

of prescription

Tier 1 - $10. Tier 2 - $20 Tier 3 - $40

Appropriate copay + 50% of the full cost

of prescription

Mail Order Prescriptions 80% after deductible

3x retail copay, minus $10

N/A 2x retail copay N/A

Max. Out-of-Pocket (Individual/Family)

$6,550 / $13,100 (includes deductible)

($6,850 Ind. w/ Family)

$5,000 / $12,700 Includes ded. & copays

$10,000 / $30,000 Includes ded. & copays

$2,500 / $7,500 (excludes ded.)

$10,000 / $30,000 (excludes ded.)

Lifetime Maximum Unlimited Per Member Unlimited Per Member Unlimited Per Member

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Bi-Weekly Payroll Deductions

Tier HDHP w/ HSA PPO Choice PPO Preferred

Employee Only $24.51 $67.49 $122.22

Employee & Spouse $331.92 $432.32 $521.71

Employee & Child(ren) $276.03 $366.00 $449.08

Family $583.45 $730.84 $848.57

Medical

HSA Contribution Limits The 2018 HSA maximum that may be contributed for Employee Only coverage is $3,450, and the HSA maximum if you cover your spouse and/or any of your dependents is $6,850. 55 or older? You can contribute an additional $1,000 above the IRS annual limit. Each year, the maximum amount you can contribute to your HSA may change, per IRS regulations. It is your responsibility to ensure contributions do not exceed the annual limit. Tax penalties may apply on excess contributions. You should consult your personal tax advisor with questions regarding your HSA and the filing of your taxes.

HSA or FSA If you elect the High Deductible Health Plan (HDHP/HSA) or are planning on electing it April 2018, you are ineligible to participate in the FSA Medical Reimbursement Plan. However, you can join the FSA Dependent Care Reimbursement. If you elect to participate in the FSA Medical Reimbursement Plan for the plan year that begins on January 1, 2018 and ends on December 31, 2018, you will be ineligible to make contributions to an HSA for the entire period, even if you elect to participate in the HDHP on April 1, 2018. You will not be able to contribute to an HSA until January 1, 2019.

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Flexible Spending Account (FSA)

How can I save money with an FSA?

You may elect to participate in the Flexible Spending Medical Reimbursement Account and/or the Dependent Care Reimbursement Account. By doing so, you are able to pay for necessary medical, dental and vision benefits or dependent care expenses with before-tax dollars. This results in a significant savings to you. Contributions to your FSA come out of your paycheck before any taxes are taken out. This means that you don’t pay federal income tax, Social Security taxes, and state and local income taxes on the portion of your paycheck you contribute to your FSA. You should contribute the amount of money you expect to pay out of pocket for eligible expenses for the plan period. The amount you elect for the year will be divided into equal amounts and deducted through your payroll before taxes. Your entire elected amount will be available to you for eligible expenses whenever you need it.

Medical Reimbursement Account

The Medical Reimbursement Account is used to reimburse out-of-pocket medical, dental and vision expenses incurred by you and your dependents. This includes your insurance deductibles, co-payments, co-insurance and prescription costs. The maximum that you can contribute to the Medical Reimbursement Account is $2,650.

Dependent Care Reimbursement Account

A Dependent Care Reimbursement Account is used to reimburse expenses related to the care of eligible dependents while you and your spouse work. The maximum that you can contribute to the Dependent Care Reimbursement Account is $5,000 if you are a single employee or married filing jointly, or $2,500 if you are married and filing separately. Claim forms should be submitted to Karen Paskert.

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Dental

We are happy to provide two PPO dental plans with Cigna. PPO’s allow you to see a dentist of your choice. However, by utilizing In-Network providers, you will maximize your benefits while minimizing your out-of-pocket cost. See the Cigna packet for information regarding the ability to “rollover” a portion of your unused Calendar Year Maximum to the next year.

Cigna PPO (Low) Cigna PPO (High)

In-Network Out-of-Network In-Network Out-of-Network

Deductible $50 Individual $150 Family

$100 Individual $300 Family



Calendar Year Maximum $1,000 $1,000 $1,500 $1,500

Basis of Payment Negotiated Fees Fee Schedule Negotiated Fees 90th Percentile of UCR

Deductible Waived

Preventive Services Cleaning & Exam, X-Rays, Fluoride Treatment, Sealants

100% 100% 100% 100%

Deductible Applies

Basic Services Fillings, Oral Surgery, Periodontics, Root Canal, Endodontics

80% 50% 80% 80%

Major Services Dentures, Crowns, Bridges

50% 25% 50% 50%

Waiting Periods Late Entrants Only Late Entrants Only

Bi-Weekly Payroll Deductions

Tier PPO Low PPO High

Employee Only $11.36 $19.89

Employee & Spouse $23.14 $41.46

Employee & Child(ren) $25.67 $46.07

Family $37.47 $62.94

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Vision Cigna is Kass Shuler’s vision carrier.

Cigna Vision In-Network Out of Network Frequency Period **

Exam Copay $10 N/A 12 Months

Exam Allowance (once per frequency period)

Covered 100% after copay Up to $45 12 Months

Materials Copay $25 N/A 12 Months

Eyeglass Lenses Allowance (once per frequency period)

Single Vision Lined Bifocal Lined Trifocal Lenticular Progressive

Covered 100% after Copay Covered 100% after Copay Covered 100% after Copay Covered 100% after Copay

Covered up to bifocal lens amount with 20% savings on difference

Up to $32 Up to $55 Up to $65 Up to $80

12 Months 12 Months 12 Months 12Months

Contact Lenses Allowance (one pair or single purchase per frequency period)

Elective Therapeutic

Up to $130 Covered 100%

Up to $105 Up to $210

12 Months 12 Months

Frame Retail Allowance (once per frequency period)

Up to $130 Up to $71 24 Months

** Your Frequency Period begins on January 1 (Calendar year basis)

Bi-weekly Payroll Deductions

Tier Vision

Employee Only $2.75

Employee & Spouse $5.42

Employee & Child(ren) $4.99

Family $7.67

There are three ways to find a quality eye doctor in your area: 1. Log in to myCigna.com, go to your Cigna Vision coverage page and select

“View Details”. Then select “Find a Cigna Vision Network Eye Care Professional” to search the Cigna Vision Directory.

2. Don’t have access to myCigna.com? Go to Cigna.com and click on the orange Find a Doctor tab at the top. Then select “Vision Directory”, for routine eye exams and eyewear services, from the Other Directories listed below.

3. Prefer the phone? Call the toll-free number found on your Cigna insurance card and talk with a Cigna Vision customer service representative.

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Voluntary Benefits What are Voluntary Benefits?

Voluntary Benefits are offered to strengthen your overall benefits package. You customize the benefit based on need and affordability.

• Ownership - Policies are fully portable and belong to you if you leave your employer, same price and same plan

• Benefits are payroll deducted

• Cash benefits are paid directly to you, not to a hospital or a doctor

• Benefits are paid regardless of any other coverage you may have

• Level premiums - Rates do not increase with age

• Guaranteed Renewable

• Designed to provide additional cash flow to assist with out-of-pocket medical costs and other bills The Voluntary Benefits are being offered through Trustmark and Transamerica.

Trustmark Accident Plan A plan, through Trustmark Insurance, that helps pay for the unexpected expenses that result from an accident. On and off the job coverage (24 hours per day, 7 days a week) Family coverage available Sports related injuries covered as well Just a few examples of benefits included in the plan:

• Emergency Room Visits - $150

• Hospitalization - $3,200 admission benefit, $500 per day benefit

• Fractures - up to $15,000

• Dislocations - up to $12,000

• Accident Follow-up Treatment - $200

• Wellness Benefit - $100 per insured, twice each year

See brochure for a complete list of benefits.

Employee Employee & Spouse Employee & Child(ren)* Family*

Bi-Weekly Deductions

$9.60 $14.96 $23.44 $28.78

*Dependents up to age 26 can be covered regardless of student status.

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Voluntary Benefits

Trustmark Critical Illness Critical Illness coverage is a benefit that will pay you a lump sum of money if you are diagnosed with a critical illness, heart attack or stroke. The cash benefit is provided upon the first diagnosis of a covered condition to hep you with associated costs and beyond.

Guaranteed Issue for New Hires ONLY $10,000 Employee Only

If you previously waived this benefit, you must answer a few health questions and be approved for coverage.

Regardless of other coverage in force, this benefit is paid out in a full lump sum. Examples of covered conditions: Heart Attack, Stroke, Renal (Kidney) Failure, Blindness, ALS (Lou Gehrig’s Disease), Major Organ Transplant, Paralysis of Two or More Limbs, Coronary Artery Bypass Surgery (25% benefit) A Health Screening Benefit is included in your policy and Trustmark pays up to $100 for each insured. Each covered person will get one screening test per calendar year.

Examples of health screenings:

• Low Dose Mammography • Pap Smear

• Stress Test • Colonoscopy

• Serum Cholesterol • Prostate Specific Antigen

• Bone Marrow • Chest X-ray

Rates This benefit is customized by each employee so rates vary, but can start as little as a few dollars a week. See brochure for more details.

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Voluntary Benefits

Transamerica Cancer Plan The Cancer Plan will pay benefits to you if you are diagnosed with cancer. This plan pays you directly. Some benefits pay by the day or treatment, while others reimburse you for expenses you incur. Either way, it can be a source of financial support just when you and your family need it most! Just a few examples of the benefits included in the plan:

• Initial Diagnosis - $3,000

• Hospital Confinement - $200 per day

• Surgery - up to $3,000 (inpatient), up to $4,000 (outpatient)

• Radiation & Chemotherapy - $10,000 per 12 month period

• Bone Marrow and/or Stem Cell - $10,000 per 12 month period

An Annual Cancer Screening Benefit is included in your policy and Transamerica pays $100 for each insured. Each covered person will get one cancer screening test per calendar year.

Examples of cancer screenings:

• Mammogram • Pap Smear

• Ultrasounds • Colonoscopy

• Biopsy • Prostate Specific Antigen

• Bone Marrow Testing • CEA, CA125 Testing

Employee Employee & Spouse Employee & Child(ren)* Family*

Bi-Weekly Deductions $13.26 $23.82 $15.10 $23.82

*Dependents up to age 26 can be covered regardless of student status.

Trustmark Short Term Disability This policy is designed to provide income to you and your family when you cannot work due to an illness or injury.

Guaranteed Issue for New Hires ONLY Up to $3,000 monthly benefit


• Pays a maximum of 60% of salary up to $3,000 per month with the flexibility to elect a lower percentage of salary for a lower premium

• 14 day elimination period, 3 month benefit period

• Pregnancy covered as any other illness

• Premium stays the same as long as you own the policy. The premium does not increase with age.

Rates This benefit is customized by each employee so rates vary. Your options and rates will be presented to you in the enrollment system.

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Life Insurance

Basic Term Life and AD&D Kass Shuler, P.A. provides, at no cost to you, a $30,000 Life/AD&D Insurance benefit through Cigna. All full time employees are eligible. In the event of your death, this benefit is paid to your designated beneficiary.

Trustmark Universal Life with Long Term

Care

Universal Life with Long Term Care includes both a death benefit and a living benefit. • Trustmark Universal Life with Long Term Care is a

permanent life insurance policy that is designed to match your needs throughout your lifetime. It pays a higher death benefit during your working years when expenses are high and you need maximum protection.

• The policy is priced to remain the same cost to you until age 100.

• The death benefit reduces at age 70 when the need for life insurance typically decreases.

• The Living Benefit, Long Term Care, never reduces and is 4% of the original death benefit per month for up to 25 months.

• If you use the Long Term Care benefit, your death benefit amount does not reduce due to the Benefit Restoration feature included.

• Coverage available for spouse and children as well.

Guaranteed Issue for New Hires ONLY (Employee ONLY)

The lesser of the face amount purchased by $16 per week or $200,000


Rates This benefit is customized by each employee so rates vary, but can start as little as a few dollars a week.

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401(k) Retirement Plan

One of the easiest ways to save for your retirement is with the Kass Shuler, P.A. 401(k) Plan. If you enroll, the plan has the convenience of having your contributions automatically deducted from your paycheck reducing your taxable income. The amount contributed to your 401 (k) plan is not taxed. Your contributions—plus earnings—are taxed only when withdrawn from the plan (subject to IRS regulations). Alternatively, you may elect to treat all or any portion of your deferrals as “Roth deferrals”. Roth deferrals do not reduce your taxable income when made so that you still pay taxes on the amount contributed as a Roth deferral. However, if you take a “qualified distribution” of your Roth deferrals, you will not be taxed on any amounts attributable to those Roth deferrals. Employees can contribute up to $18,500 and an additional $6,000 if you are over 50 years of age. Kass Shuler, P.A. will match your contribution on a dollar for dollar basis up to $1,000 each year. Eligibility All employees age 21 and over, who have completed 6 months of service with the firm. Enrollment Dates January 1, April 1, July 1 and October 1 of each year Change Dates You may change your rate of saving as of any January 1 or July 1. You may stop saving at any time. You will receive an Individual Account Statement on the Vanguard site showing all activity in your account quarterly. Request Hardship and Distribution on your Vanguard site: https://my.vanguardplan.com

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Additional Benefits & Information

Employee Assistance Program (EAP) • Employee Assistance Program is available to all

employees working 30 or more hours per week.

• This valuable benefit offers confidential counseling and referrals, elder and child care resources, and legal and financial consultation.

• You will have immediate access to a professional EAP Counselor by telephone or in person.

• Access to a wide array of resources via their website such as Child and Elder care information, Reference Libraries, Legal & Financial Resources, Webinars, Self-Improvement Programs and Healthcare Link.

All of this is offered at no charge to you. In-person counseling for 1 to 3 sessions per issue, per year is available as well as 24/7 telephonic support for immediate needs. Toll Free: 1-800-538-3543 Web Address: www.cignabehavioral.com/cgi

Did You Know? You can get certain generic medications for less and $5 a month. Select retail pharmacy chains are now offering generic medications at low costs, even FREE. There is no need to show your medical card for the savings…just go to your local pharmacy and ask about their generic medication program.

Kmart Publix Winn Dixie*

$15 Free $4 $10

90 day supply Up to 14 day supply Up to 30 day supply 90 day supply

Certain Generic Med. 8 Oral Antibiotics Over 400 Generic Med. Over 400 Generic Med.

*Must be a Reward Card Customer

Target Walgreens*

$4 $10 $12.99

Up to 30 day supply 90 day supply 90 day supply

Over 300 Generic Med. Over 300 Generic Med. Over 300 Generic Med.

*Annual enrollment fee will apply

WalMart/Sam’s Club

$4 $10

Up to 30 day supply 90 day supply

Over 350 Generic Med. Over 350 Generic Med.

*This is not part of the medical insurance policy and will not be applied to any out-of-pocket insurance expenses. The above is only a summary of each pharmacy discount and is subject to change. Please contact your local pharmacy for detailed information.

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Paid Time Off (PTO) All regular full-time and part-time employees regularly scheduled to work a minimum of 20 hours per week are eligible for PTO. The amount of PTO is based on your length of service with the Firm as shown below. If you work fewer than 40 hours per week, your PTO hours will be prorated accordingly.

40 Hours

Credited Years of Service Bi-weekly Accrual Rate Maximum Annual Accrual Maximum F-T Days (8 hrs) CAP

0-3 years of service 4.62 hours 120 hours 15 days 150

After 3 years of service 6.15 hours 160 hours 20 days 200



After 20 year of service 280 hours 35 days 340

Maximum hours that you can carryover = 80 hours Cap at 125% of “Maximum Annual Accrual” One time bonus of 40 hours of PTO in your 20th year of service + every 5 years thereafter. Not to be included in the cap.

30 Hours






After 20 year of service 210 hours 255

Maximum hours that you can carryover = 80 hours Cap at 125% of “Maximum Annual Accrual”

20 Hours






After 20 year of service 140 hours 170

Maximum hours that you can carryover = 80 hours Cap at 125% of “Maximum Annual Accrual”

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Important Contacts

Vendor Phone Number Website

Medical Cigna

866-494-2111 www.mycigna.com

Dental, Vision & Life Cigna

800-Cigna24 800-244-6224

www.mycigna.com

Employee Assistance Program Cigna

800-538-3543 www.cignabehavioral.com/cgi

Voluntary Benefits Trustmark Transamerica

800-918-8877 888-763-7474

www.trustmarksolutions.com www.transamericaemployeebenefits.com

Voluntary Benefits Claims Help Explain My Benefits

888-734-6937, Option 3

[email protected]

HIPPA Notice of Privacy Practices can be found online at www.mycigna.com. Click on “Privacy Notices & Security” at the very bottom of the homepage. If you do not have access to the internet and wish to have a copy of the Privacy Notice, please contact Paula St. Clair for benefit assistance. Information on Kass Shuler, P.A. Benefits: SharePoint Site: Departments Payroll & Benefit Site Benefit Documents

Benefit Guide Description

Please Note: This guide provides information regarding the Kass Shuler, P.A. benefit

program. Not all plan provisions, limitations, and exclusions are included in this publication.

In the event of any conflict between the information contained in this publication and the plan provisions, the Plan Documents and

insurance contracts will govern.