benefits open enrollment update · 2020. 10. 1. · annual enrollment for your medical, dental,...

Learning Without LimitsSUMMITACADEMIES.ORG

BENEFITS OPEN ENROLLMENT UPDATE

(EFFECTIVE OCTOBER 1, 2020)

Summit Academy


What is Open Enrollment?

Annual enrollment for your medical, dental, vision and other benefits occurs once a year.

This is the only time during the year that you may make changes to your plans without a Qualifying Event.

If you previously waived coverage, you will have the opportunity to enroll and/or add/delete dependents.

If you experience a Qualifying Event during the year (marriage, divorce, birth of a child, etc.) you will need to notify HR of the change within 30 days of the event. In addition, you may need to submit proof of the qualifying event.

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Goals of our Health Plan

• Summit Academy’s goal for the benefit program is to achieve the following for all eligible employees:

• Competitive plan that provides Valuable Insurance to all enrolled

• Affordable Plan Choices

• A plan that promotes good health and good healthcare decisions

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What to expect - New Benefit Plan Year (eff. 10/1/20)

• We will be offering the following for this upcoming enrollment:

• Two Medical Plan Options – The Performance Plan ($1,500 Deductible) has been eliminated • Classic Plan - $2,500 Deductible• Consumer Plan (w/ HSA) - $3,000 Deductible

• Slight changes to your employee medical premiums • We are proud to remain below average in what we charge for healthcare and we are committed to

doing all we can to provide you quality plans at affordable cost. • By eliminating the Performance Plan, we were able to keep employee costs low while still offering the

other plan options. • There will be a very small change in your current voluntary dental and vision premium contributions.

• Medical Mutual will now be the carrier for all lines of coverage • Medical• Life, Dental & Vision

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Medical Plan OptionsCarrier Medical Mutual Medical Mutual

Plan Name Classic Consumer

Plan Type PPO H.S.A.

General Plan Information In-Network Out of Network In-Network Out of Network

Deductible $2,500/$7,500 $5,000/$15,000 $3,000/$9,000 $4,000/$12,000Coinsurance 20% 40% 0% 30%

Medical OOP Max (incl ded) $5,000/$12,500 $10,000/$25,000 $3,000/$9,000 $6,000/$16,000Office Visits $30/$60 40% after Ded 0% after ded 30% after Ded

Preventive (Annual) 100% 40% after Ded 100% 30% after DedInpatient 20% after Ded 40% after Ded 0% after ded 30% after Ded

Outpatient 20% after Ded 40% after Ded 0% after ded 30% after Ded

Emergency Room $300 copay 0% after ded

Urgent Care $60 copay 40% after Ded 0% after ded 30% after DedTotal OOP Max $5,000/$12,500 Unlimited $3,000/$9,000 Unlimited

RX- Retail $10/$35/$60/$250 max 0% after ded

N/A N/ARx - Mail Service

$20/$70/$120/$500 max 0% after ded

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Pharmacy Program Reminders

• Generic Pharmacy Incentive Program• If a brand name medication is requested by the member or physician when a

generic is available, the brand name copay PLUS the difference between brand and generic cost will apply.

• If a generic is not manufactured, only the brand name copay will apply.

• Home Delivery Pharmacy Incentive Program• If a medication that is available through the mail order program is filled at a retail

pharmacy a fourth time within 180 days, TWICE the normal retail copay will apply.• Notify the prescribing physician that you need to change to mail order through

Express Scripts

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Know your Health Care Basics

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Know before you go!

Telehealth Care Clinic Doctor's office Urgent Care Center Emergency RoomTreatment from a doctor for minor, non-emergency conditions 24/7 with a phone or computer with webcam.

Treats minor medical concerns. Staffed by nurse practitioners and physician assistants. Located in retail stores and pharmacies.

The best place to go for routine or preventive care, to keep track of medications, or for a referral to see a specialist.

For conditions that aren’t life threatening. Staffed by nurses and doctors and usually have extended hours.

For immediate treatment of critical injuries or illness. Open 24/7. If a situation seems life-threatening, call 911 or go to the nearest emergency room.

› Colds and flu› Rashes› Sore throats› Headaches› Stomachaches› Fever› Allergies› Acne› UTIs and more

› Colds and flu› Rashes or skin conditions› Sore throats, earaches,sinus pain› Minor cuts or burns› Pregnancy testing› Vaccines

› General health issues› Preventive care› Routine checkups› Immunizations andscreenings

› Fever and flu symptoms› Minor cuts, sprains,burns, rashes› Headaches› Lower back pain› Joint pain› Minor respiratory symptoms› Urinary tract infections

› Sudden numbness, weakness› Uncontrolled bleeding› Seizure or loss of consciousness› Shortness of breath› Chest pain› Head injury/major trauma› Blurry or loss of vision› Severe cuts or burns› Overdose

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How about the Consumer Plan?

HSA 101An Overview of Health Savings Accounts

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How about the Consumer Plan?

• The Consumer Plan offers the ability to have a Health Savings Account (HSA).

• HSA’s allow participants to save money for out of pocket expenses tax free and roll it over for years to come.

• Reasons to consider this plan include:• Lowest employee premium• Lowest Out of Pocket Maximum of all plans• Ability to save and rollover tax free savings for future out of pocket expenses

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HSA is made up of two parts:

QUALIFIED HIGH DEDUCTIBLE MEDICAL PLAN• Protection from major costs • Annual deductible• Lower premium• 100% preventive care• Network and non-network

coverage options• Personal support and online

resources

HEALTH SAVINGS ACCOUNT (HSA)• Owned by you, the employee• Used for eligible medical and

pharmacy bills• Helps pay deductible• Triple tax savings• Not “use it or lose it”• Portable

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HSA Eligibility:

• Yes! IF you are:– Covered by a High Deductible Health Plan = Consumer

Plan – NOT covered by other non-permitted health insurance– NOT enrolled in Medicare– NOT claimed as a dependent on another’s tax return

• Children cannot establish their own HSAs; however, • Spouses can establish their own HSAs, if eligible

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Contributions into an HSA:

Summit Academy contributes into your HSA $500 / single or $1,000 / family

Contributions are not subject to income tax

You may contribute to your HSA through pretax payroll deduction. This payroll deduction can be changed (increased, decreased, or stopped) at anytime.

You may fund your account directly through the medical plan’s HSA banking provider at no cost, or at another banking institution of your choice.

IRS GuidanceMaximum Contribution Limits *

2020 2021Individual $3,550 $3,600

Family $7,100 $7,200

* Eligible individuals who are aged 55 or older may contribute an additional $1,000 per year in “catch-up” contributions until they enroll in Medicare.

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How HSA claims are paid:

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HSA Eligible Expenses:

AcupunctureAlcoholism TreatmentAmbulanceAnesthetistsArch SupportsBlood TestsBracesContact LensesChiropractic VisitsCrutchesDental Treatments/X-RaysDentures

Diagnostic TestingDrug Addiction Therapy EyeglassesHearing AidesInsulin TreatmentsLab Tests

Oral SurgeryOrgan TransplantOrthopedic ShoesOxygen & equipmentPhysician Services

Physiotherapist ServicesPostnatal TreatmentsPrenatal CarePrescription DrugsPsychiatrist ServicesSplintsTherapy EquipmentVaccinesVasectomy

WheelchairsX-Rays

***This is just a partial list of the eligible HSA expenses. Please visit the IRS website & Publication 502 www.IRS.com for a complete listing.

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http://www.irs.com/


Additional HSA Education:

Text 833-534-0263 and type in HSA

or

Click on the link below to watch the HSA education video

or copy the link below to your browser on your computer!

https://player.vimeo.com/video/123312007

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https://player.vimeo.com/video/123312007


Additional Tips:

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My Health Plan:

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My Care Compare:

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MMO Nurse Line Program:

Available 24/7

Trained registered nurses

Immediate triage

Timely intervention

Longitudinal record

Telephonic access

Secure messaging

Translation services

NCQA & URAC Accredited

One-third of participants planning a visit to the ER

who called Nurse Line were successfully redirected to

appropriate services1

Helpful

50 percent of participants changed their pre-call

decision to seek care after speaking with a nurse1

Impactful

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Voluntary Dental (Medical Mutual)

Carrier Medical Mutual

Network PPO

Network Non-Network

Deductible:

Per Person $50/$150 $50/$150

Co-insurance

Preventive 100% 100%

Basic 80% 80%

Major 50% 50%

Orthodontia Not Covered Not Covered

Annual Max. $1,250 $1,250

Ortho Lifetime Max. Not Covered Not Covered

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Deductible Credit: • Members who have met

their MetLife dental deductible for 2020 will receive credit on the MMO plan.

• MMO will begin processing credits after October 1st and we will aim to have these completed by November.


Voluntary Vision (Medical Mutual)Carrier Medical Mutual (VSP Network)

Network Non-NetworkProfessional Fees

Co-pay $10 copay

Eye Exam Covered in Full Up to $45 allowance

Materials (Lenses & Frames)Co-pay $25 copay N/A

Single Lenses 0% after copay Up to $30 allowanceBifocal Lenses 0% after copay Up to $50 allowanceTrifocal Lenses 0% after copay Up to $65 allowance

Frames $130 allowance then 20% off balance Up to $70 allowance

Elective Contacts $130 allowance Up to $105 allowanceService Frequency

Exam 12 monthsLenses 12 months

Contacts 12 months (in lieu of lens and frame)

Frames 24 months

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Life/AD&D (Medical Mutual)

• Summit Academy provides all full-time eligible employees with company paid life insurance • $20,000 Life and Accidental Death & Dismemberment

• Beneficiary can be changed at any time

• Benefits reduce by 35% at age 65 and by 50% at age 70

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Voluntary Life/AD&D (Medical Mutual)

• All full-time eligible employees can elect additional life insurance • 100% Employee paid• Age banded rates • Employee Benefit:

• $25,000 to $500,000 (in $25,000 increments) not to exceed 5x annual salary• Spouse Benefit:

• $5,000 to $100,000 (in $5,000 increments) not to exceed 50% of the Employee amount• Rate based on Employee’s age

• Child Benefit (up to age 26): • $10,000 benefit option

• Guarantee Issue Amounts: Does not apply to those currently enrolled electing the same amount of coverage • Employee - $150,000• Spouse - $30,000• Child - $10,000

• Evidence of Insurability Form will need to be completed for any amount over the Guaranteed Issue• Exceptions:

• Currently enrolled employees increasing their amount by $25,000 • Currently enrolled spouses increasing their amount by $5,000

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Medical Mutual ID Cards

• Medical Mutual ID Cards will be issued for all enrolled employees • ID Cards will be generated based on plan election and

coverage• Ex. Member has Medical (Single), Dental (Single) and Vision (Single) = 2 cards

(Medical, and Dental/Vision) • Ex. Member has Medical (Single), Dental (Single), and Vision (Family) = 3 cards

(Medical, Dental, Vision)

• Members can download the MMO Mobile app to view their card(s)• Search for “MedMutual” in the App Store or Google Play

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Final Reminders

Annual Enrollment Window: August 28th through September 8th

Expect instructions from HR regarding open enrollment.

Your deadline to enroll is September 8th so that we can get you properly enrolled in PayCor by October 1st.

Remember to show your Pharmacists and Providers the new MMO ID card as of October 1st.

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Thank you

• We will continue to work hard to ensure that we provide competitive, affordable healthcare to you and your families.

• Go to www.MySummitBenefits.org to review plan options and learn more about the benefits available:

• Medical• Dental• Vision• Life• Wellness

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benefits open enrollment update · 2020. 10. 1. · annual enrollment for your medical, dental,...

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