benefits focused on you! health and welfare benefits 2012 - 2013
TRANSCRIPT
Benefits Focused on You!
Health and Welfare Benefits 2012 - 2013
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Benefit Basics
Elections you make now will remain in effect through December 31st, 2013
You can only make changes if there is a qualified “Life Event”
Changes must be made within 30 days of experiencing a qualifying event
Review benefits-make selections wisely
Designed to recognize diverse needs
Competitive and comprehensive benefits
Provides plans based on individual needs
Offer plans that provide long-term financial security for you and your family
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Qualifying Events Change in status including marital, employment,
number of dependents and residence
Dependent’s employer’s Open Enrollment
Significant cost or coverage changes
HIPAA special enrollment rights
FMLA special requirements
Changes due to a judgment, decree or court order
Entitlement to Medicare or Medicaid
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BENEFIT In-Network Out-of-Network
Annual Deductible
Single
Family
$1,000
$3,000
$2,000
$6,000
Out-of-Pocket Maximum
Single
Family
$2,500
$5,000
$4,000
$6,000
Office Visit (PCP/Specialist) $25 / $50 Copay 40% after deductible
Preventive Care
Well-Child/Adult Preventive Care
Mammograms/PAP Tests/Physicals
100%
100%
40% after deductible
40% after deductible
Emergency Room $200 Copay $200 Copay
Urgent Care $75 Copay 40% after deductible
Inpatient Hospital Services (Room/Board & Surgery)
20% after deductible 40% after deductible
Prescription Drugs
Retail (up to 31-day supply)
Generic
Preferred Brand
Non-Preferred Brand
Mail Order (up to 90-day supply)
Generic
Preferred Brand
Non-Preferred Brand
*NOTE: If you purchase prescription drugs from an out-of-network pharmacy, you are responsible for any difference between the out-of-network pharmacy charges and the amount paid for the same prescription drug dispensed by an in-network pharmacy.
$10
$30
$50
$25
$75
$125
$10
$30
$50
N/A
N/A
N/A
UHCMEDICAL
MONTHLY DEDUCTIONS
Employee $140.00
Employee & Spouse
$659.45
Employee & Child(ren)
$607.51
Family $1282.78
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The dental plan allows you to use any dentist you want, although there is a network that can be accessed for enhanced benefits.
Visit www.guardianlife.com to locate a participating dentist.
BENEFITGUARDIAN
(In Network)
GUARDIAN
(Out-of-Network)
Annual Deductible – Single Annual Deductible – Family
$25
$75
$50
$150
Preventive Treatment 100% 100%
Basic Treatment 100% 80%
Major Treatment 60% 50%
Orthodontia Not Available Not Available
Calendar Year Maximum Benefit
$2,500
GuardianDENTAL MONTHLY DEDUCTIONS
Employee $16.72
Employee & Spouse $67.27
Employee & Child(ren) $53.38
Family $103.93
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BENEFITGUARDIAN
(In Network)
GUARDIAN
(Out-of-Network)
Exams (every 12 months) $10 Copay $10 Copay
Glasses
Frames (every 24 months)
Single Vision Lenses (every 12 months)
Bifocal Lenses (every 12 months)
Trifocal Lenses (every 12 months)
Lenticular (every 12 months)
$120; 20% discount on amount over $120
$25 copay
$25 copay
$25 copay
$25 copay
Up to $47
Up to $47
Up to $66
Up to $85
Up to $125
Contacts (every 12 months)
Elective & Conventional
Medically Necessary
Up to $120
$25 copay
Up to $105
Up to $210
GuardianVISION MONTHLY DEDUCTIONS
Employee $7.06
Employee & Spouse $12.85
Employee & Child(ren) $12.59
Family $20.32
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BENEFIT COVERAGE
Short Term Disability Benefit begins on the 1st day of injury and 8th day of illness
The benefit pays 50% of your weekly base salary up to a maximum of $1,250 per week
Long Term Disability Benefit begins after 180 days of disability
The benefit pays 40% of your monthly base salary to a monthly maximum of $3,500
Disability (Short Term and Long Term) - Unum
ScripNet provides coverage for basic life, accidental death and dismemberment, short term and long term disability. Once you meet the eligibility requirements, you are automatically enrolled in these benefits at no cost to you.
Basic Life and AD&D - Unum
BENEFIT COVERAGE
Life Benefit 1 times your annual salary
Accidental Death and Dismemberment
1 times your annual salary
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Flexible Spending Accounts
Flexible Spending Accounts (FSA) allow you to set aside pre-tax money from each paycheck to reimburse yourself for eligible healthcare or dependent care expenses. Reimbursements can be requested by completing a claim form and providing proper documentation (e.g., pharmacy receipts, explanation of benefits [EOB]).
Other Company Benefits
•401(K) Savings Plan •AFLAC Benefits •Fitness Center Membership & Weight Programs
ACCOUNT USE FOR CONTRIBUTION
Health Care Spending Most medical, dental and vision care expenses (e.g., copayments, deductibles, eyeglasses)
$2,500 annual maximum
Dependent Care Spending
Dependent care expenses such as after-school programs and elder care programs
$5,000 annual maximum
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Need additional information?
Have a question about one of your benefits?
PLAN ADMINISTRATOR WEBSITE PHONE NUMBER
Medical Benefits UnitedHealthcare www.myuhc.com 866-633-2446
Dental Benefits Guardian www.guardianlife.com 888-600-1600
Vision Benefits Guardian www.guardianlife.com 888-600-1600
Life/AD&D Unum www.unumprovident.com 888-857-0157
Short Term Disability Unum www.unumprovident.com 888-857-0157
Long Term Disability Unum www.unumprovident.com 888-857-0157
Flexible Spending Accounts OptumHealth www.optumhealthfinancial.com 866-898-4584
Benefits Broker Willis www.willis.com 800-874-2244
If there is ever a question about one of these plans, or if there is a conflict between the information in this guide and the formal language of the plan documents, the formal wording in the plan documents will govern.
Please note that the benefits described in this guide may be changed at any time and do not represent a contractual obligation on the part of ScripNet, Inc.