clc oe presentation 2019 · 2019-06-25 · core life/ad&d insurance no cost to you core...

OPEN ENROLLMENT

2019-20

©Cambridge Consulting Group, LLC. All Rights Reserved.

MY HEALTHMedical | Total Health CareDental | GuardianVision | NA

MY LIFELife and AD&D | GuardianVoluntary STD | GuardianAccident | GuardianCritical Illness | Guardian

MY EXTRASVirtual Visits | Teladoc ‐ THCEAP | GuardianCollege Tuition Program | Guardian

B ENE F I T S O F F E R ED

Helpful Tips To Consider Before You

Enroll

1. Do you plan to enroll an eligible dependent(s)?If so, make sure to have their social security numbers and birthdates available. You cannot enroll yourdependent(s) without this information.

2. Have you recently beenmarried/divorced or had a baby?If so, remember to add or remove any dependent(s) and/or update your beneficiary designation.

3. Did any of your covered children reach their 26th birthday this year?If so, they may no longer be eligible for benefits, unless they meet specific criteria.

ENROLLMENT INSTRUCTIONS

1. Review the information in this guide and benefit plan summaries.

2. Complete an Enrollment Form. **THIS IS MANDATORY** and is due by May 20

3. Return the completed form to Human Resources

4. You will not be allowed to make changes after the open enrollment window closes, unless you experience a qualifying life event.

I M P O R T A N TYou must notify HR and change elections

within 30 days of the event.

WELCOMEBENEFITS MENU | ENROLLMENT

Your Benefit Period

June 1, 2019 – May 31, 2020

©Cambridge Consulting Group, LLC. All Rights Reserved.

ELIGIBILITY OverviewSummary

The chart provided below explains who is eligible for coverage under each benefit plan type:

Individual Medical/Rx Dental Vol

VisionVol

DisabilityVolLife

Accident/CI

You, if full‐time employeeworking a minimum of 30 hours or more per week

Your Spouse

Your eligible ChildAge 20 or 26 if Full‐Time Student



The term ‘child’ refers to any of the following:

A natural (biological) child;

A stepchild;

A legally adopted child;

A foster child;

A child for whom legal guardianship has been awarded to the participant or the participant’s spouse/domestic partner; or

Disabled dependents may be eligible if requirements set by the plan are met.

Life (Qualifying) Event

• Marriage / Divorce

• Birth / Adoption

• Loss / Gain of Coverage

This is the one time of year to make changes, unless you havea Qualifying Life Event, such as you get Married, Divorced,have a Baby, Adopt or you lose other coverage. You have 30days from the date of the event to notify HR to makeappropriate changes.

1

MY HEALTH

MEDICAL, DENTAL, VISION

©Cambridge Consulting Group. All Rights Reserved.

COMMON INSURANCE TERMS

A CONTRIBUTION is the amount you pay forinsurance, using pre‐tax or post‐tax dollars.

A COPAYMENT (COPAY) is a fixed amount you pay toreceive services. Your co‐payment(s) will counttowards your out‐of‐pocket maximum but not yourdeductible. (e.g., $30 for every visit to the doctor),while your insurance company pays the rest.

A DEDUCTIBLE is the amount of money you areresponsible for paying each benefit period before theplan begins to share costs for covered services, withthe exception of preventive care services, which arecovered at 100% In‐Network.

COISURANCE This is your share of the expense ofcovered services after your deductible has been paidwhen the company plan is paying a percentage. Thecoinsurance rate is usually a percentage.

OUT‐OF‐POCKET MAXIMUM (OOPM) is the most youpay per benefit period (typically per calendar year)for health care expenses. OOPM applies todeductibles, flat‐dollar copays and coinsurance for allcovered services – including cost‐sharing amounts forprescription drugs.Once this limit is met, the plan will cover all in‐network services at 100% until the end of the benefitperiod.

*OUT‐OF‐NETWORK Charges are subject toreasonable and customary limitations, which meansyou are responsible for charges over this amount inaddition to separate deductible and coinsurance. It isrecommended to always inquire as to if a provideryou are seeing is participating in‐network.

COMPARE YOURHEALTH PLANS2019 OPTIONS

PLAN OPTIONS INCLUDE:

• Preventive services covered 100%

• Dependents until age 26

• Teladoc Online Visits

• Benefits (deductibles and coinsurance) reset on January 1st

HEALTH BENEFITS THAT PROTECT YOU AND YOUR FAMILY.Eligible employees have the choice of 3 medical plans: 2 HMO and 1 POS. When you elect to participate in one of the medical plans, you will automatically be enrolled in prescription drug (Rx) coverage. The cost of the prescription drug coverage is included in your medical plan premium.

Plan Options

1. HMO 3000

2. HMO 1000

3. Point of Service

6©Cambridge Consulting Group. All Rights Reserved.

THC HMO 3000 THC HMO 1000 THC POS

TOTAL HEALTH CARE In‐Network Benefits Only In‐Network Benefits Only THC Network CofinityNetwork

DEDUCTIBLESingle Deductible $3,000 $1,000 $3,000 $1,500Two Person/Family Deductible $6,000 $2,000 $6,000 $3,000

COINSURANCE (applies after deductible is met)Member Cost Share % 0% 0% 0% 25%

MEMBER COPAYMENT(S)Primary Care (PCP) ‐ Office Visit $20 $20 $15 $40Virtual Visit $0 $0 $0Specialist ‐ Office Visit $40 $40 $30 $50Urgent Care Facility $40 $40 $30 $60

Emergency Room Visit $200 $200 $150

OUT‐OF‐POCKET (OOP) MAXIMUMWhat applies to the OOPM Includes Deductibles, Coinsurance, Copays and Pharmacy CopaysSingle Maximum $4,000 $2,000 $3,000Two Person/Family Maximum $8,000 $4,000 $6,000

HEALTH PLANS


PRESCRIPTION DRUGS

Rx Copays HMO 3000 HSA 1350 HSA 3000

TIER 1 $10 $10 $10

TIER 2 $40 $40 $40

TIER 3 $60 $60 $60

TIER 4 + 5 25% 25% 25%

Mail Order(Excludes Specialty Drugs)

2x 2x 2x

Helpful Rx Cost Savings Tools & Tips:

MAIL ORDER ‐ Many drugs are available in a 90 day supply, rather than the 30 day retailsupply. Typically, you will pay less if you choose to get a mail order 90 day supply.

GOOD Rx ‐ There are many tools online that you can use in order to save on prescriptioncosts. One being GoodRx.com, an online Rx database that allows you to find whatpharmacy is the cheapest for your specific prescription. Additionally, you may be able tofind a coupon that will greatly reduce your cost. It is important to remember that many ofthe coupons can only be used outside of your plan (will not count towards yourmaximums).

ASK YOUR DOCTOR – Make sure to ask if there are cost savings alternatives to theprescription they are providing. Many times there are generic or different manufacturersthat will save you money at the pharmacy.

WHERE CAN I FIND A DRUG LIST?Typically, a full listing of covered drugs is found on yourprovider’s website. A drug list, also called a formulary, is a list ofgeneric and brand‐name drugs covered by a health plan.Although a drug may be on the drug list, it might not be coveredunder every plan. Review the plan materials for details onspecific benefits.

You can use drug lists to see if a medication is covered by yourhealth insurance plan. You can also find out if the medication isavailable as a generic, needs prior authorization, has quantitylimits and more.

TRADITIONAL DRUGSTIER 1 (GENERIC) | Lowest copay: Most drugs in this category are generic drugs. Members pay the lowest copay for generics, making these drugs the most cost‐effective option for treatment.

TIER 2 | Higher copay: This category includes preferred, brand name drugs that don't yet have a generic equivalent. These drugs are more expensive than generics, and a higher copay.

TIER 3 | Highest copay: In this category are nonpreferred brand name drugs for which there is either a generic alternative or a more cost‐effective preferred brand. These drugs have the highest copay.

SPECIALTY DRUGSTIER 4 | Lowest specialty drug copay: Tier 4 specialty drugs are generally more effective and less expensive than nonpreferred specialty drugs in tier 5.

TIER 5 | Highest specialty drug copay: These drugs have the highest copay for specialty drugs, usually because there may be a more cost‐effective generic or preferred brand available.

How do I get started?

• Mobile – Download the Teladoc app

• Web – Visit Teladoc.com

• Phone – Call 1‐800‐835‐2362

How much does it cost?

• $0

No crowded waiting rooms. No driving.See a doctor when you need a doctor.

A virtual visit lets you see and talk to adoctor from your mobile device orcomputer. When you use one of the providergroups in our virtual visit network, you havebenefit coverage for certain non‐emergencymedical conditions. Costs must be paid byyou at the time of the virtual visit and willapply toward your deductible and out‐of‐pocket maximum.

Online medical and behavioral care You and your dependents may have access toonline medical services anywhere in the United States. You and your coveredfamily members can see and talk to:

• A doctor for minor illnesses such as a cold, flu or sore throat when your primarycare physician isn’t available

When to use the serviceYou can use it for minor illnesses such as:

• Sinus and respiratory infections• Colds, flu and seasonal allergies• Eye irritation or redness• Strains and sprains• You can even get a prescription from your online doctor if you need it.

VIRTUALVISITS24/7 Online Medical Care


How do I find an In‐Network Provider?This dental plan offers deeper discounts when you visit a provider that is In‐Network. In‐Network providers can be found at guardianaytime.com. Click “Find a Provider” at the top of the page

PREVENTION FIRST!Your dental health is an important part of your overall health. Make sure you take advantage of your preventive dental visits.

Preventive care services are covered at 100% if you visit an In‐Network provider.

PLAN OPTIONS INCLUDE:

• Dependents until age 20 of 26 if a FT Student 2 routine exams per 12 months

PRE‐TREATMENT ESTIMATEIf your dental care is extensive and you want to plan ahead for the cost, you can ask your dentist to submit a pre‐treatment estimate. While it is not a guarantee of payment, a pre‐treatment estimate can help you predict your out‐of‐pocket costs.

DUAL COVERAGEYou might have benefits from more than one dental plan, which is called dual coverage. In this situation, the total amount paid by both plans can’t exceed 100% of your dental expenses. And in some cases, depending on the specifics of the plans, your coverage may not total 100%.

LIMITATIONS AND EXCLUSIONSDental plans are intended to cover part of your dental expenses, so coverage may not extend to your every dental need. A typical plan has limitations such as the number of times you can receive a cleaning each year. In addition, some procedures may be not be covered under your plan, which is referred to as an exclusion.

Guardian PPO Network • Costs More• In and Out‐of‐Network Benefits• Choose any dentist in the Guardian network for the most

savings

1st Commonwealth DHMO Network • Most Savings• Fee Schedule• Must choose a primary care dentist from the network

REVIEW YOURDENTAL PLANThe Dental Plan provides you and your family with comprehensive coveragewhen paying for preventive dental services and treatment for dental careneeds.

• Dentist Search

• Mobile ID Card

• View Coverage & Review Claims


REVIEW YOURDENTAL PLAN

Guardian1st Commonwealth

Guardian PPO

In‐Network Only In‐Network Out‐of‐Network

Deductible – Single/Family (Waived for Preventative ) $5 Office Visit Copay $0 $25/$75

Deductible Waived for Class I Services? No Yes Yes

Class I Services – Diagnostic & Preventative

Routine oral exams, routine cleanings, preventative x‐rays 100% after office copay 100% 100%

Class II Services ‐ Basic Restorative

Endodontic, Periodontic, Fillings, Oral Surgery, General Anesthesia Fee Schedule Office Copay Applies

90% after Deductible

80% afterDeductible

Class III Services – Major Restorative

Bridges, Dentures, Crowns, Inlays & Onlays Fee ScheduleOffice Copay Applies

60% after Deductible 50% after Deductible

Class IV Services ‐ Orthodontia

Benefit $1,000 Savings Child Only50% to a lifetime max of $1,000

Annual Maximum (Per Covered Member) Unlimited $1,000

Waiting Periods None Major Services – 12 months for future enrollees

Maximum Rollover Amount (Applies to PPO Plan Only)

Plan Annual Max Threshold Max Rollover Amount In‐Network Only Max RolloverAmount Max Rollover Account Limit

$1,000 $500 $250 $350 $1,000


REVIEW YOURVISION PLANThe Vision Plan is employee paid and you and your family are covered for eye exams, lenses, and frames every 12 months, after a copay.

Visit www.e‐nva.com for more information on their savings and discounts for members.

Need to locate a participatingIn‐Network provider?Visit www.e‐nva.comOur ever‐growing vision provider network consists of tens of thousands of highly qualified, licensed eye care professionals. The network includes ophthalmologists, optometrists, and opticians, independent practitioners as well as optical retailers.

Out‐of‐Network ReimbursementsYou will pay up front for services when you visit a provider that does not belong to NVA. In order to be reimbursed, you will need to send in a claim form along with an itemized receipt.

IN‐NETWORKChoice Network PROVIDER

PLAN FEATURESVision Exam $20 copayCOVERED SERVICES – LENSES / FRAMESSingle Lenses $20 copayBifocals $20 copayTrifocals $20 copay

Frames $130 retail allowance20% discount off balance over $130

COVERED SERVICES

Contact Lenses $130 retail allowance(you are responsible for amounts over the allowance)

BENEFIT FREQUENCYExams Once every 12 MonthsLenses Once every 12 MonthsFrames Once every 24 Months

Contacts Once every 12 Months(contacts in lieu of frames/lenses)

IncludedDependent children to the age of 19or 25 if a FT Student

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MY LIFELIFE, DISABILITY, ACCIDENT, CRITICAL ILLNESS


Core Life/AD&D InsuranceNo Cost to you

CORE LIFE/AD&D Company Paid Benefit ‐ Provided to you at no cost.

Coverage Amount Flat $10,000 Benefit

Accidental Death and Dismemberment (AD&D) AD&D principal sum amount is equal to the amount of life insurance.

Benefit Reduction Schedule

Your insurance will reduce to:– 35% of the original amount at age 65– 25% of the original amount at age 70– 15% of the original amount at age 75– 10% of the original amount at age 80

ADDITIONAL PLAN PROVISIONS

Portability If your employment ends or your retire, you may be eligible to continue your term insurance at group rates.

Conversion When coverage ends under the plan, you can convert to an individual permanent life policy without evidence of insurability.


Vol. Life Insurance• The purpose of term life insurance is to replace your income should you pass away. If you have people counting on your income, term

life insurance (income replacement insurance) is the cheapest way to insure that liability.

OPTIONAL LIFE/AD&D Voluntary Benefit ‐ Employee is responsible for 100% of the cost.

Cost of Coverage Premiums are based on age‐rated tables and paid by the employee everypay period through a payroll deduction. These premiums are post‐tax and benefits payable are tax‐free.

Coverage Options Employee CoverageChoice of 4 options:$25,000$50,000$75,000$100,000

Spouse CoverageChoose 50% of the employee amount up to $50,000

Dependent CoverageCovers children 14 days to 23 years or 25 if a FT StudentChoose 10% of the employeeAmount up to $10,000

Do I have to take a health exam to get coverage?

If you and your dependents enroll in coverage at your initial eligibility date, you may apply for up to the Guaranteed Issue amounts without medical questions at hire date onlyIf you do not enroll when first eligible, or for any increases, you (and/or your spouse) will need to complete Proof of Good Health

Guaranteed Issue(New Hire Only)

Employee$100,000

Spouse$10,000

Dependent$10,000

ADDITIONAL PLAN PROVISIONS

Portability If your employment ends or your retire, you may be eligible to continue your term insurance at group rates.

Conversion When coverage ends under the plan, you can convert to an individual permanent life policy without evidence of insurability.

Benefit Reduction Schedule

Employee Coverage Will Reduce To:– 35% at age 65– 25% at age 70– 15% at age 75– 10% at age 80

Spouse Coverage:Coverage will term at age 70


Voluntary Disability InsuranceLine of Coverage Benefit

Short‐Term Disability

100% Employee

Paid

Weekly Benefit: Percent of Pay 60%

Weekly Benefit: Benefit Maximum $750

Benefits Payable on: 1st day for Illness / 7th day for an Accident

Benefit Duration: 26 Weeks

Plan limits a 2‐week maximum for any disabilities caused by a pre‐existing condition

A pre‐existing condition is defined as seeking treatment or care, including doctor consultation within 3 months prior to the effective date and will be excluded for 12 months

Evidence of Insurability REQUIRED for late enrolleesNOT Required for New Hires


Accident InsuranceOptional Benefits for You and your Family

Accident Insurance is offered to all employees as a voluntary benefit. You are responsible for 100% of the cost of coverage.

Accident InsuranceA serious injury can cost you a lot of money – not only in medical bills but in things like income from lost work hours. Some injuries are minor, but others are debilitating and require significant medical care. If you get hurt, accident insurance pays you money that you can use to cover personal expenses, bills, and out‐of‐pocket medical costs.

Who Gets Paid?You get paid. When you have a covered accident or injury, your health insurance company pays your doctor or hospital, but your accident insurance company pays you.

If you have a covered injury, accident insurance can help you pay for things like:

Emergency Room Visits Ambulance Transportation Emergency Helicopter Transportation Hospital Admissions & Per Diem Charges Intensive Care &Rehabilitation Unit Care Diagnostic Exams Follow‐up Treatments Physical Therapy


Critical Illness InsuranceOptional Benefits for You and your Family

Critical illness Insurance is offered to all employees as a voluntary benefit. You are responsible for 100% of the cost of coverage.

Critical Illness InsuranceHow would you pay your bills if you were suddenly diagnosed with cancer and couldn’t work? Critical illness insurance doesn't’ pay your medical bills. It pays you if you’re diagnosed with a covered illness. You can spend the money on whatever you want.It’s kind of like “life insurance for the living.”

What’s Covered?Critical illness can vary widely from one another. Some may focus on a single specific diagnosis, while others may provide you with coverage for a range of possible diagnoses, such as:

What is the Cost of Critical Illness Insurance?Depending on your age, and how much coverage you want, the cost of critical illness insurance can vary significantly.

More DetailsPre‐Existing Condition Limitation: Benefits for a pre‐existing condition (defined as a sickness or injury, or symptoms of one, whether diagnosed or not, for which you received medical treatment, consultation, care or services, including diagnostic measures, took prescribed drugs or medicine, or had been prescribed medicine or drugs to be taken in the 3 months prior to your effective date) will not be paid during the first 12 months the policy is in force.

With Critical illness Insurance, you can indicate the level of coverage you would like to receive. Depending on the details of the plan you choose, some conditions may result in a maximum payout while others may result in only a partial payout. Some conditions may not be covered at all.

Health Assessment Benefit:$50

Coverage Available:• $5,000/$10,000 Employee• $2,500/ $5,000 Spouse

3

MY EXTRASVALUE ADDED BENEFITS

College Tuition BenefitIncluded with your Guardian coverage is a college tuition benefit. As the cost of college continue to rise faster than inflation andmedical cost, Guardian is helping families keep up by providing this benefit in arrangement with SAGE College Tuition Benefit.

• Members enrolled in a Guardian plan earn $2,000 in annual Tuition Rewards®.

• One Tuition Reward point = $1 in tuition reduction.

• Tuition Rewards can be used at over 380 institutions

• Colleges participate as a way to boost their student enrollment

• Members can share the benefit with eligible relatives, including children, nieces, nephews, step‐children

and grandchildren, subject to certain restrictions. Listing the name of the person who will benefit would be

helpful for Guardian to send e‐mail reminders

• No Cash Value and benefits are not awarded retroactively

• Once enrolled, you will receive notice prior to 8/24 in the child’s junior and senior year to go into the website

and gift your Reward points

No state universities –Private colleges: Alma,

Albion, Universityof Detroit, Lawrence

Tech, Madonna, Hillsdale and many

more

See your Benefit Booklet (page 5) for website information to

enroll!

Enrollment MUST be completed by 5/30/2019

ALL voluntary benefits can be used to collect the 2,000 Tuition Reward Points every year.

CLC benefits include Voluntary Dental, Short‐Term Disability, Life/AD&D, Critical Illness and Accident Insurances

Employee Assistance Program

Guardian Life Insurance Co. EAP

Balancing your work and home is not always easy. With WorkLifeMatters, your confidential employee assistance program through Guardian and Integrated Behavioral Health (IBH), you don’t have to face life’s challenges alone. WorkLifeMatters provides support and guidance for matters that range from personal issues you might be facing to providing information on everyday topics that affect your life.

• College Planning• Financial Aid Resources• Career Development• Balancing Work & Home Life• Anxiety & Depression• Drugs & Alcohol• Grief & Loss• Relationship Issues

• Basic Tax Planning• Credit & Debt• Immigration• Legal Forms• Retirement Planning• Will Making• Adoption Assistance• Day Care & Elder Care

Have You Ever?• Needed your will prepared or updated• Been overcharged for a repair or paid an unfair bill• Had trouble with a warranty or defective product• Signed a contract• Received a moving traffic violation• Had concerns regarding child support • Worried about being a victim of identity theft• Been concerned about your child’s identity• Worried about entering personal information on‐line• Feared the security of your tax and/or medical information

See Jeremy to enroll

QUESTIONS

Thank You

?

clc oe presentation 2019 · 2019-06-25 · core life/ad&d insurance no cost to you core...

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