your benefits 2019/20 guide - missiobenefits.com · • claims and billing triage • urgent...

Y O U R B E N E F I T S G U I D E

2019/20

The Missio Nexus Alliance for Benefitswww.MissioBenefits.com

Please note that this benefits guide is a summary of all available plans/programs within the Missio Benefits platform and is intended to provide a general overview. For

details about your organizations specific elections please contact your benefits administer.

http://www.missiobenefits.com/

¹With my whole heart, with my whole life,And with my innermost being,

I bow in wonder and love before You, the Holy God!

²Yahweh, You are my soul’s celebration,How could I ever forget the miracles of kindness You’ve done for me?

³You kissed my heart with forgiveness, in spite of all I’ve done!You’ve healed me inside and out from every disease!

⁴You’ve rescued me from hell and saved my life!You’ve crowned me with love and mercy and made me a king!

⁵You satisfy my every desire with good things!You’ve supercharged my life so that I soar again

Like a flying eagle in the sky!

Psalm 103:1-5

Benefit Basics

Benefit Basics 3

Qualified Life Event 4

Administration/Enrollment 5

Medical/Rx 7

Dental 9

Vision 11

Life & Voluntary Life 12

Short- & Long-Term Disability 12

Voluntary Accident 13

Crisis Response/Evacuation 14

Important Contacts 15

Table of Contents

As an employee within the

Missio Benefits Program, you

are eligible for benefits if you are

a regular full-time employee

working at least 30 hours per

week.

You have 30 days to enroll in

your benefits from your date of

hire. Domestic employee

benefits are effective the first of

the month following 30 days

from the date of hire. Global

employee benefits are effective

on the date of hire.

You may also enroll your eligible

dependents which includes your

legal spouse (opposite sex) and

your dependent children up to

age 26 for most products.

Once your benefit elections

become effective, they remain in

effect until the end of the plan

year or at the end of the month

of employment termination. You

may only change coverage

within 30 days of a qualified life

event or during the annual Open

Enrollment period.

For more information about please contact the Alliance forBenefits HR department at 866.522.5955.

Benefit Full-Time30+ hrs./wk.

Medical/Rx X

Dental X

Vision X

Life X

Voluntary Life X

Short-Term Disability X

Long-Term Disability X

Voluntary Accident X

Crisis Response X

Employee EligibilityUS Waiting Period = 1st of the month following 30 days from date of hire

Global Waiting Period = Date of hire

Generally, you may change your

benefit elections only during Open

Enrollment. However, you may

change your benefit elections

during the year if you experience a

qualified life event, including:

• Marriage

• Divorce or legal separation

• Birth of your child

• Death of your spouse or

dependent child

• Adoption of or placement for

adoption of your child

• Change in employment status

of employee, spouse or

dependent child

• Qualification by the Plan

Administrator of a child support

order for medical coverage

• Entitlement to Medicare or

Medicaid

You must notify Human

Resources within 30 days of the

qualified life event. You will be

asked to provide proof of the life

event. If you do not contact

Human Resources within 30 days

of the qualified event, you will have

to wait until the next Open

Enrollment period to make

changes (unless you experience

another qualified life event).

Qualified Life Events

Benefit Who Pays Tax Treatment

Medical/Rx Employer Selected

Contribution Schedule

Pre-tax

Dental Pre-tax

Vision Pre-tax

Life Employer Pre-tax

Voluntary Life Employee After-tax

Short-Term Disability Employer Selected

Contribution Schedule

After-tax

Long-Term Disability After-tax

Voluntary Accident Employee After-tax

Cost of Your Benefits

For more information about the program please contact the

Alliance for Benefits HR department at 866.522.5955.

Missio Benefits HR Service Center

• 100% of inbound and outbound calls are recorded

• English and Spanish-speaking representatives

• Translation services offered for 180+ languages

• Licensed agents available

Features at a Glance• Password and login assistance

• Technical support

• Benefits education and guidance

• Phone-based enrollment

• Employee advocacy

• Lost card assistance

• Claims and billing triage

• Urgent coverage resolutions

• Life event assistance

How Employees Get in Touch

By email

By phone

By chat

Grand Rapids, Michigan

Salt Lake City, Utah

8 AM to 11 PM ET

Monday - Friday

Locations Hours

Contact Center

How Can the Employee Contact Center Help?Login Assistance

Passwords get lost and security questions get forgotten – but fear not, we’re here to help. In fact,

it’s one of the most common questions we get.

“How do I?” QuestionsYour enrollment system is intuitive and easy to use, but that doesn’t mean help isn’t needed

sometimes. We’re happy to help when you need it.

Advocacy and Benefits HelpWhether help is needed to select, understand or correctly use the products that have already been

selected, we have a staff of experts waiting on call.















By email

By phone

By chat



8 AM to 11 PM ET

Monday - Friday

Locations Hours

Contact Center






















By email

By phone

By chat



8 AM to 11 PM ET

Monday - Friday

Locations Hours

Contact Center






















By email

By phone

By chat



8 AM to 11 PM ET

Monday - Friday

Locations Hours

Contact Center








“Than you for calling the Alliance for Benefits

HR Departmenthow may I help you?”

866-522-5955

Administration & Enrollment

www.plansource.com 3

Getting Started So you’re ready to enroll in your employer provided benefits! The new PlanSource enrollment experience will help

you do just that, in an intuitive, educational and fun way.

Before you begin enrolling in your benefits, please make sure you have the following items.

• Social Security Number (SSN) for all legal dependents you wish to enroll in any coverage.

• Date of Birth (DOB) for all legal dependents you wish to enroll in any coverage

• Beneficiary Information for Life Insurance, which includes your beneficiaries’ name(s), DOB(s) and SSN(s)

Log in to PlanSource Before you can do anything in the PlanSource system, you must first log in with your username and password.

1. Type or paste this link into your web browser’s search bar: https://benefits.plansource.com/

2. On the login page, type your username and password.

3. If this is the first time you are using this site follow the instructions below for your user name and

Password. Your Username consists of:

a. First initial of your First Name

b. First six characters of your Last Name

c. Last four (4) digits of your SSN

Example: John Employee, whose SSN is 000-00-1234, would have a login of JEMPLOY1234.

Your Password is your birthdate in the format YYYYMMDD. Example: a birthdate of February 7, 1975 would look

like this: 19750207.

First time users will be prompted to select a new password. (Note: Every year during Open Enrollment your

password will reset back to your birthdate in the YYYYMMDD format.) If you forgot your password, click “Forgot

your password.” If you have no email address on file for this process, contact your account manager.

Welcome Screen From this screen you will be able to begin your enrollment, make changes to your benefits, see your benefits

summary, and review benefit plan information among other resources. First we will go through the enrollment

process; later in this document we will review steps to update enrollment information.

Open Enrollment Instructions To enroll in benefits, go to: www.plansource.com/login . Login Page Enter your username and password.

Username: Your username is the first initial of your first name, up to the first six letters of your last name, and the last four digits of your SSN.

For example, if your name is Taylor Williams, and the last four digits of your SSN are 1234, your username would be twillia1234.

Password: Your initial password is your birthdate in the YYYYMMDD format.

So, if your birthdate is June 4, 1979, your password would be 19790604. The first time you log in, you will be prompted to change your password.

Dashboard On the dashboard page, select “Enroll – Annual” to begin.

Please confirm your specific Open Enrollment dates with your employer.

For help with the enrollment process please contact the Alliance for Benefits HR Department at 866.522.5955

Missio Benefits offers a choice

of three domestic medical plan

options so you can choose the

plan that best meets your needs

- and those of your family.

Each plan includes

comprehensive health care

benefits, including free

preventative care services and

coverage for prescription drugs.

Plan Provisions

PPO Plan(plan 1)

HSA Plan #1(plan 2)

HSA Plan #2(plan 3)

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

Network In-Network Out-of-Network

Annual Deductible (Single Coverage/Family) $1,000 / $2,000 $2,000 / $4,000 $2,000 / $4,000 $4,000 / $8,000 $3,500 / $7,000 $7,000 / $14,000

Out-of-Pocket Maximum(Single Coverage/Family) $4,000 / $8,000 $10,000 /

$20,000 $4,000 / $8,000 $12,000 / $24,000 $6,750/ $13,500 $13,500 /

$27,000

Lifetime Maximum Unlimited Unlimited Unlimited

Coinsurance % Tiered 50% Tiered 50% 75% 50%

Preventative Care 100% Ded; 50% 100% Ded; 50% 100% Ded; 50%

TeleHealth $10 copay Not Covered Ded; $10 copay Not Covered Ded; $10 copay Not Covered

Primary Physician Office Visit $20 copay Ded; 50% Ded; 85% Ded; 50% Ded; 75% Ded; 50%

Urgent Care Ded; 85% Ded; 50% Ded; 80% Ded; 50% Ded; 75% Ded; 50%

Specialist Office Visit Ded; 80% Ded; 50% Ded; 80% Ded; 50% Ded; 75% Ded; 50%

Emergency RoomNon Direct Admission

Direct AdmissionDed; 75% Ded; 50% Ded; 75% Ded; 50% Ded; 75% Ded; 50%

Inpatient Hospital Services Ded; 80% Ded; 50% Ded; 80% Ded; 50% Ded; 75% Ded; 50%

Outpatient Hospital Services Ded; 80% Ded; 50% Ded; 80% Ded; 50% Ded; 75% Ded; 50%

Retail Prescription Drugs Preventative Generics

GenericBrand (preferred)

Brand (non-preferred)

Retail / Mail100% / 100%

85% / 90%75% / 80%65% / 70%

Not Covered


Ded; 85% / 90%Ded; 75% / 80%Ded; 65% / 70%

Not Covered


Ded; 85% / 90%Ded; 75% / 80%Ded; 65% / 70%

Not Covered

This is a summary of coverage; please refer to your summary plan description (SPD) for the full scope of coverage. In-network services are based on negotiated charges; out-of-network services are based on reasonable & customary (R&C) charges and employees may be responsible for balance billing.

Domestic Medical/Rx

This is a summary of coverage; please refer to your summary plan description (SPD) for the full scope of coverage. In-network services are based on negotiated charges; out-of-network services are based on reasonable & customary (R&C) charges and employees may be responsible for balance billing.

Plan Provisions

100% Plan(plan 4)

90% Plan(plan 5)

80% Plan(plan 6)

Non-US US Non-US US Non-US US

Annual Deductible (Single Coverage/Family) $0 / $0 $1,000 / $2,000

$2,000 / $4,000 $500 / $1,000 $2,000 / $4,000$4,000 / $8,000 $1,000 / $2,000 $3,500 / $7,000

$7,000 / $14,000

Out-of-Pocket Maximum(Single Coverage/Family) $0 / $0

$4,000 / $8,000$10,000 / $20,000

$1,000 / $2,000 $4,000 / $8,000$12,000 / $24,000 $2,000/ $4,000

$6,750/ $13,500$13,500 / $27,000

Lifetime Maximum Unlimited Unlimited Unlimited

Coinsurance % (in/out) 100% Tiered / 50% 90% Tiered / 50% 80% 75% / 50%

Preventative Care 100% 100% 100% 100% 100% 100%

TeleHealth 100% $10 copay $10 copay Ded; $10 copay $10 copay Ded; $10 copay

Primary Physician Office Visit 100% $20 copay 90% Ded; 85% 80% Ded; 75%

Urgent Care 100% Ded; 85% 90% Ded; 80% 80% Ded; 75%

Specialist Office Visit 100% Ded; 80% 90% Ded; 80% 80% Ded; 75%

Emergency RoomNon Direct Admission

Direct Admission100% Ded; 75% 90% Ded; 75% 80% Ded; 75%

Inpatient Hospital Services 100% Ded; 80% 90% Ded; 80% 80% Ded; 75%

Outpatient Hospital Services 100% Ded; 80% 90% Ded; 80% 80% Ded; 75%

Retail Prescription Drugs Preventative Generics

GenericBrand (preferred)

Brand (non-preferred)

100%


85% / 90%75% / 80%65% / 70%

90%


Ded; 85% / 90%Ded; 75% / 80%Ded; 65% / 70%

80%


Ded; 85% / 90%Ded; 75% / 80%Ded; 65% / 70%

Missio Benefits offers a choice

of three global medical plan

options so you can choose the

plan that best meets your needs

- and those of your family.

Each plan includes

comprehensive health care

benefits, including free

preventative care services and

coverage for prescription drugs.

Global Medical/Rx

Regular dental exams can help

you and your dentist detect

problems in the early stages

when treatment is simpler and

costs are lower. Keeping your

teeth and gums clean and

healthy will help prevent most

tooth decay and periodontal

disease, and is an important

part of maintaining your medical

health.

Your Cigna Dental plan offers in

and out-of-network benefits in

the PPO Plan.

Plan ProvisionCigna Dental (Plan 1) Cigna Dental (Plan 2)

DPPO Plan DPPO PlanIn-Network / Out-of-Network In-Network / Out-of-Network

Annual deductible(Individual/Family) $50 / $150 $100 / $200

Annual maximum (per person) $2,000 $1,500

Diagnostic and preventative care:Includes cleanings, fluoride treatments,

sealantsand x-rays

100% / 100% 100% / 100%

Basic Services: Includes fillings,

periodontics, scaling and root planning, and oral

surgery

90% / 90% 80% / 80%

Major Services:Includes crowns, bridges

and full and partial dentures

60% / 60% 50% / 50%

Orthodontics:Children to age 19

50% to $1,500/person lifetime max

50% to $1,000/person lifetime max

Cigna Dental PPO plans are

insured and/or administered

by Cigna Health and Life

Insurance Company

(CHLIC) or Connecticut

General Life Insurance

Company (CGLIC). This

plan uses the national

Cigna DPPO network.

Domestic Dental

Regular dental exams can help

you and your dentist detect

problems in the early stages

when treatment is simpler and

costs are lower. Keeping your

teeth and gums clean and

healthy will help prevent most

tooth decay and periodontal

disease, and is an important

part of maintaining your medical

health.

Your Aetna Dental plan offers

benefits on a global (indemnity)

and domestic (PPO) basis to

make sure that you have the

care you need anywhere in the

world.

Plan ProvisionAetna Dental (Plan 1) Aetna Dental (Plan 2)

Indemnity Plan Indemnity PlanIn-Network / Out-of-Network In-Network / Out-of-Network

Annual deductible(Individual/Family) $50 / $150 $100 / $200

Annual maximum (per person) $2,000 $1,500

Diagnostic and preventative care:Includes cleanings, fluoride treatments,

sealantsand x-rays

100% / 100% 100% / 100%

Basic Services: Includes fillings,

periodontics, scaling and root planning, and oral

surgery

90% / 90% 80% / 80%

Major Services:Includes crowns, bridges

and full and partial dentures

60% / 60% 50% / 50%

Orthodontics:Children to age 19 50% to $1,500 lifetime max 50% to $1,000 lifetime max

Aetna Dental plans are

insured and/or administered

by Aetna Life Insurance

Company, Aetna Dental,

Inc. This plan uses the

national Aetna PPO network

in the United States.

Global Dental

BenefitVision (Plan 1) Vision (Plan 2)

In-Network Benefit Description Copay Frequency In-Network Benefit

Description Copay Frequency

Well Vision Exam

Focuses on eyes and

overall wellness$10 Copay

Every 12

months

Focuses on eyes and

overall wellness$20 Copay

Every 12

months

Prescription Glasses See below $20 Copay See below See below $35 Copay See below

Frames

ü $150 allowance for

wide selection of

frames


featured frame

brands

ü 20% savings on

amount over

allowance

Included in

Prescription

Glasses

Every 12

months


wide selection of

frames


featured frame brands

ü 20% savings on

amount over

allowance

Included in

Prescription

Glasses

Every 24

months

Lenses

ü Single vision, lined

bifocal & lined

trifocal lenses

ü Polycarbonate

lenses for

dependent children

Included in

Prescription

Glasses

Every 12

months

ü Single vision, lined

bifocal & lined trifocal

lenses

ü Polycarbonate lenses

for dependent children

Included in

Prescription

Glasses

Every 12

months

Lens Enhancements

ü Standard

Polycarbonate

ü Photochromatic

Lenses

ü Anti-Reflective

Coating

ü Ultraviolet Coating

$33

$31-$82

$43-$85

$16

Every 12

months

ü Standard

Polycarbonate

ü Photochromatic

Lenses

ü Anti-Reflective

Coating

ü Ultraviolet Coating

$33

$31-$82

$43-$85

$16

Every 12

months

Contacts (Instead of glasses)

$150 allowance for

contactsUp to $60

Every 12

months

$100 allowance for

contactsUp to $60

Every 12

months

Extra Savings

Glasses and Sunglassesü VSP offers 20% off any amount above the retail allowance for frames.

ü 20% off additional complete pairs of prescription glasses and/or prescription sunglasses.

Laser VisionCareü VSP offers an average discount of 15% off or 5% off a promotional offer for LASIK, custom LASIK and PRK. The maximum out-

of-pocket per eye for participants is $1,800 for LASIK and $2,300 for custom LASIK using Wavefront technology, and $1,500 for

PRK. In order to receive the benefit, a VSP provider must coordinate the procedure.

The vision plan covers routine eye exams and also pays for all or a portion of the cost of glasses or

contact lenses if you need them.

Domestic Vision

Founded in 1955, VSP offers world-

class products and services to eye

care professionals, employers, and

more than 80 million members. VSP

Vision Care is the largest vision benefits

company in the United States..

Life insurance is an important

part of your financial security,

especially if others depend on

you for support. Accidental

Death & Dismemberment

(AD&D) insurance is designed

to provide a benefit in the event

of accidental death or

dismemberment.

Missio Benefits provides five

Basic life insurance options for

our member missions: Flat

$10k, Flat $25k, Flat $50k, Flat

$100k and 1x annual earnings

to $100k. We also offer a

dependent life program as well

as a additional Voluntary Life of

5 times annual basic earnings,

up to $500,000 maximum

benefit with $150,000

Guaranteed Issue (GI). You can

also purchase up to $500,000 of

Voluntary Life Insurance for

your spouse ($25,000 GI) and

up to $10,000 of GI coverage on

your children.

Please see the summary plan

description for more details.

This coverage replaces a portion of your

income when you can’t work because of a

qualifying disability. Even if you’re healthy

now, it’s important to protect yourself and

the people who count on your income. This

insurance can help you pay the bills when

you’re unable to work.

Short-Term Disability:

Covers 50% or 60% of your weekly pre-

disability earnings on a pre-tax basis, up to

a $2,000 weekly maximum. Benefits begin

after 14 days of injury or illness and

continue for 13 weeks.

Long-Term Disability:

Covers 50% or 60% of your monthly pre-

disability earnings on a pre-tax basis, up to

a $5,000 monthly maximum. Benefits start

after 90 days and continue up until Social

Security Normal Retirement Age (SSNRA).

Short-Term & Long-Term Disability

Before they retire, 1 in 3 Americans entering the workforce today will become disabled.

1Facts From LIMRA, 2013 Disability Insurance Awareness Month, LIMRA

Basic Life & Voluntary Life

Nobody plans to have an

accident, and most people

don’t budget for one, either.

Accident insurance helps cover

out-of-pocket expenses

medical insurance won’t cover.

Examples of Accident

insurance covered benefits

include, but are not limited to:

ü Eye injury

ü Laceration

ü Skin graft

ü Bone fracture

ü Dislocation

ü Exploratory or Repair

Surgery

ü Critical Care Unit

Admission/Confinement

ü Hearing Devices

ü Therapy Services

ü Lodging

ü Transportation

ü Seatbelt Benefit

ü Airbag Benefit

ü Helmet Benefit

ü Repatriation Benefit

Additionally, this plan will pay

you and your enrolled family

members for making healthy

decisions such as getting your

annual preventative screenings

($50 per year per person).

Voluntary Accident Insurance

Crisis Response/Evacuation

Our Crisis Response/Evacuation program is a best-in-class, fully-insured program with no benefit maximums. This program is provided to all Domestic & Global employees enrolled in a Missio Benefits healthcare plan at no additional cost. Spouse and Dependent coverage is also available - please ask your organization's plan administer for details.

Plan Contact Phone Number Website

Alliance for Benefits HR Department 866-522-5955 www.missiobenefits.com

Domestic Medical/Rx Cigna 800.244.6224 www.cigna.com

Global Medical/Rx Aetna 800.231.7729 www.aenta.com

Domestic Dental Cigna 800.244.6224 www.cigna.com

Global Dental Aetna 800.231.7729 www.aenta.com

Domestic Vision VSP 800.877.7195 www.vsp.com

Life & Voluntary Life Unum 866.679.3054 www.unum.com

Short- & Long-Term Disability Unum 866.679.3054 www.unum.com

Voluntary Accident Unum 866.679.3054 www.unum.com

Crisis Response/Evacuation Focus Point International24hr Crisis Response Center (CRC) 619.717.8549 www.focuspointintl.com

Important Contacts

This benefit summary provides selected highlights of The Missio Benefits Program. Any discrepancies between

information provided throughout this summary and the actual terms of the policies, contracts and plan documents are

governed by the terms of these policies, contracts and plan documents.

Please note that this benefits guide is a summary of all available plans/programs within the Missio Benefits platform and is intended to provide a general overview. For details

about your organizations specific elections please contact your benefits administer.

B e n e f i t s G u i d e

2019/20

your benefits 2019/20 guide - missiobenefits.com · • claims and billing triage • urgent...

Documents