Transcript Prescription Drug Co-pay

Stark Carpet Corp
2012
Employee
Benefits
2012 Health Benefits
Open Enrollment Guide
It is time again to review the 2012 Health benefits
for you and your family.
Stark Carpet Corp is pleased to announce we will
continue to offer Aetna Health Plans as our
Medical carrier, but will be making changes to
our Dental coverage. The following
presentation will outline all your options
effective as of February 1, 2012.
Effective: February 1, 2012
You Will Continue To Have
The Following Medical Plans
to Select From
Four (4) Options
With Aetna Health Plans
Plan 1 (High)
Open Access MC (NGP)
Plan 2 (Medium)
Open Access MC (NGP)
Plan 3 (Low)
Managed Choice POS
Plan 4 (Basic Low) Managed Choice POS
Plan 1- Open Access MC
HIGH
provided by Aetna Health Plans
Benefits
In Network
Out of Network
Office Co-pay
$30 Primary
$50 Specialists
Deductible & Coinsurance
Deductible & Coinsurance
Deductible
Single: $500
Family: $1,500
Single: $500
Family: $1,500
Coinsurance %
Coinsurance Maximum
(Includes Deductible)
100%
Single: $500
Family: $1,500
70% / 30%
Single: $3,500
Family: $10,500
Hospital Co-pay (I/P)
Emergency Room Co-pay
$100 Copay after Deductible
$50 (Waived If Admitted)
$100 Copay; Ded & Coins
$50 (Waived If Admitted)
Lifetime Maximum
UCR
Unlimited
N/A
Unlimited
80th Percentile
Prescription Drug
Deductible (Waived for Tier 1)
$100 Per Person
Covered at Network
Pharmacies Only
Prescription Drug Co-pay
(Mail Order: 2x Co-Pay)
Tier 1: $20 Co-pay
Tier 2: $35 Co-pay
Tier 3: $50 Co-pay
(Ded must be met before copays)
Plan 2- Open Access MC
MEDIUM
provided by Aetna Health Plans
Benefits
In Network
Out of Network
Office Co-pay
$30 Primary
$50 Specialists
Deductible & Coinsurance
Deductible & Coinsurance
Deductible
Single: $500
Family: $1,500
Single: $1,000
Family: $3,000
Coinsurance %
Coinsurance Maximum
(Includes Deductible)
100%
Single: $500
Family: $1,500
70% / 30%
Single: $6,000
Family: $18,000
Hospital Co-pay (I/P)
Emergency Room Co-pay
$100 Copay after Deductible
$50 (Waived If Admitted)
Deductible & Coinsurance
$50 (Waived If Admitted)
Lifetime Maximum
UCR
Unlimited
N/A
Unlimited
80th Percentile
Prescription Drug
Deductible (Waived for Tier 1)
$100 Per Person
Covered at Network
Pharmacies Only
Prescription Drug Co-pay
(Mail Order: 2x Co-Pay)
Tier 1: $20 Co-pay
Tier 2: $35 Co-pay
Tier 3: $50 Co-pay
(Ded must be met before copays)
Plan 3- Standard Managed Choice provided by Aetna Health Plans
LOW
Benefits
In Network
Out of Network
Office Co-pay
$30 Primary
$50 Specialists
Deductible & Coinsurance
Deductible & Coinsurance
Deductible
Single: $500
Family: $1,500
Single: $5,000
Family: $10,000
Coinsurance %
Coinsurance Maximum
(Includes Deductible)
100%
Single: $500
Family: $1,500
70% / 30%
Single: $15,000
Family: $40,000
Hospital Co-pay (I/P)
Emergency Room Co-pay
$500 Copay after Deductible
$100 (Waived If Admitted)
$500 Ded & Coinsurance
$100 (Waived If Admitted)
Lifetime Maximum
UCR
Unlimited
N/A
Unlimited
80th Percentile
Prescription Drug
Deductible (Waived for Tier 1)
$100 Per Person
Covered at Network
Pharmacies Only
Prescription Drug Co-pay
(Mail Order: 2x Co-Pay)
Tier 1: $20 Co-pay
Tier 2: $35 Co-pay
Tier 3: $50 Co-pay
(Ded must be met before copays)
Plan 4- Standard Managed Choice
provided by Aetna Health Plans
BASIC LOW
Benefits
In Network
Out of Network
Office Co-pay
$30 Primary
$50 Specialists
Deductible & Coinsurance
Deductible & Coinsurance
Deductible
Single: $1,000
Family: $3,000
Single: $5,000
Family: $10,000
Coinsurance %
Coinsurance Maximum
(Includes Deductible)
90% / 10%
Single: $2,500
Family: $7,500
70% / 30%
Single: $15,000
Family: $40,000
Hospital Co-pay (I/P)
Emergency Room Co-pay
$500 Copay after Ded & Coins
$100 (Waived If Admitted)
$500 Ded & Coinsurance
$100 (Waived If Admitted)
Lifetime Maximum
UCR
Unlimited
N/A
Unlimited
80th Percentile
Prescription Drug
Deductible (Waived for Tier 1)
$200 Per Person
Covered at Network
Pharmacies Only
Prescription Drug Co-pay
(Mail Order: 2x Co-Pay)
Tier 1: $20 Co-pay
Tier 2: $35 Co-pay
Tier 3: $50 Co-pay
(Ded must be met before copays)
We Are Pleased To Announce New
Changes To The Dental Plans for 2012.
Your Dental Plan Will Be Administered By
GUARDIAN INSURANCE COMPANY
You will continue to have a choice to select either a
Pre-Paid DMO Dental Plan
(Network Benefits Only – Must Use A Guardian DMO Provider)
Or
PPO - NAP 590 QD
Dental Plan
(Network Benefits – Must Use A Guardian PPO Provider)
(Out of Network Benefits – Select A Dentist of your Choice)
Dental Benefits provided by Guardian Health Plans
Your 2012 Calendar Year Dental Deductible will be….
Pre-Paid DMO :
Network Only
No Deductibles
PPO – NAP590 QD:
Network /Out of Network
$50 Single/ $150 family
(Note: Deductible is Waived for Preventive)
Your 2012 Calendar Year Dental Maximum will be….
Pre-Paid DMO:
Unlimited Benefits
PPO - NAP590 QD:
Network
Out of Network
Ortho (Lifetime) Max
$2,000 Per Person
$1,500 Per Person
$1,000 Per Child
Dental Benefits provided by Guardian Health Plans
(Additional Plan Benefits will be included in Guardian Handbook)
Benefits Include…..
Pre-Paid DMO
Network
Preventive & Diagnostic
Oral Exams / Cleaning
Routine X-rays /Sealants
Fluoride Application / Space Maintainers
Basic Restorative Care
Non-Routine X-Rays / Fillings
Emergency Care to Relieve Plan
Periodontics / Endodontics
Oral Surgery - Simple Extractions
Fee Schedule
PPO – NAP590 QD
Network
Out of Network
100%
Deductible
Waived
100%
Deductible
Waived
90%
80%
Fee Schedule
Major Restorative Care
Oral Surgery –except Simple Extractions
Surgical Extraction of Impacted Teeth
Bridges, Crowns & Inlays/Onlays
Dentures / Repairs
Fee Schedule
60%
50%
Orthodontia
$2500-$2800
50% For Children
50% For Children
(Adult & Child(ren)
Important Information About Your
Guardian Dental Plan!
• If you enroll in the Pre-Paid DMO Dental plan, you will need to select a
Guardian DMO Dentist in order to receive care.
• If you enroll in the PPO - NAP590 QD Dental Plan, it is not necessary for you to
select a Guardian PPO Dentist in advance. However, by using a PPO dental
provider you will be entitled to discounted fees.
• If you enroll in the PPO – NAP590 QD Dental Plan and elect to use a dental
provider that is not contracted with Guardian, fee payments will be based on Usual
& Customary allowances with no discounts.
TO LOCATE A DENTAL PROVIDER IN YOUR AREA, PLEASE VISIT
GUARDIAN’S WEBSITE AT www.glic.com.
Life and AD&D Insurance provided by Guardian
Life Insurance Coverage Levels
2 times Annual Salary
Employer
PAID Benefit
– Max of $50,000
Benefits Are Reduce 50% at Age 70
Accidental Death & Dismemberment (AD&D)
Levels match Life Insurance coverage
-------------------------------------------------------------------------------------Accelerated Life Benefit: Minimum: The Lower of $50,000 or 50% of Death Benefit
Maximum:
$100,000
Includes Waiver of Premium if Totally Disabled prior to Age 60
Includes Option for Conversion /Portability prior to Age 70
Vision Benefits provided by Vision Service Plans (VSP)
Benefits Include…
Exams
Using A VSP Provider
Non-Participating Provider
Covered in Full after $10 Copay
Reimbursed Up To
$50
Covered in Full
after $25 Copay
Reimbursed Up To
Reimbursed Up To
Reimbursed Up To
$50
$75
$100
Covered in Full after $50 Copay
Reimbursed Up To
$75
Up to $120 Allowance
after $25 Copay
Reimbursed Up To
$70
Up to $120 Allowance
Reimbursed Up To
$105
Lenses
Single Lenses
Bifocal Lenses
Trifocal Lenses
Progressive Lenses (Standard)
Frames
Contact Lenses
(Fitting & Evaluation)
Laser Vision Care
Frequency Limits
Exams – 1 Every 12 Months
Frames or Contacts – 1 Every 24 Months
15% Average Discount or 5% Off Promotional Price
Voluntary Life Insurance provided by Allstate
In additional to the Basic Life Insurance, you can also purchase additional Life
Insurance through Payroll Deductions.
Option 1 - Universal Life:
•
•
•
•
•
Provides coverage to age 85 with guaranteed cash values.
Offers permanent protection with lifetime rate stability.
Option to purchase spouse coverage.
Option to purchase small amount for children and grandchildren.
Policy will pay a portion of the face value to you while you are still living if you
are diagnosed with a terminal illness or require long term care.
Option 2 - Horizon Term Insurance:
• Straight death protection with a level death benefit and a premium designed to be
level for 20 years.
If Interested, please contact Bill Liggan in Human Resources and he will arrange to
have an Allstate Representative meet you to review the application process.
Voluntary Benefits provided by AFLAC
Vol. Short Term Disability
Personal Cancer Indemnity
Accident Indemnity Advantage
Maximum Benefit Duration
First Occurrence Benefit
Accident Emergency Treatment
Choice of 3 / 6 / 12 / 18 Months
Benefit Amount:
Monthly $500-$5,000 (subject to
income requirement)
Pays $2,000 for Insured
Pays $2,000 for Spouse
Pays $3,000 for Children
$120 Once per 24-hour period (once
per accident / per covered person)
Elimination Period for Injury / Sickness
Hospital Confinement Benefit
Hospital Confinement Benefit
Employee will have a choice of
electing a 7, 14, 30, 60,90 or
180 day period
Pays $300 per day for first 30 days
Benefit increases to $600 per day
after 31st day
$1000 per period or $1,500 per
covered person if admitted to
intensive care unit initially.
Benefit Includes
Benefit Includes
Benefits Includes
Total Disability Benefit
Partial Disability Benefit
Transitional Disability Benefit
Policy is Fully Portable
Guaranteed Renewable to Age 70
See Brochure for additional benefits
Medical Imaging
Radiation & Chemotherapy
Immunotherapy Benefit
Nursing / Skin Cancer Surgery. See
Brochure for additional benefits
X-Rays
Accident Follow Up Treatment
Accident Hospital Confinement
ICU Confinement
Major Diagnostic Exams. See
Brochure for additional benefits
Please contact Bill Liggan in Human Resources for enrollment information.
Flexible Spending Account
provided by Ameriflex
What is an Flexible Spending Account
(FSA)?
Flexible Spending Accounts provides
you with tax relief for un-reimbursed
medical and dependent day-care cost.
FSAs enable you to utilize pre-tax
dollars and save Federal, FICA, and in
most cases , State taxes when paying
for eligible expenses not covered by the
traditional insurance plan.
Flexible Spending Account
provided by Ameriflex
Your Flexible Spending & Dependent Care dollars are
deposited through regular payroll deductions.
You estimate how much you spend annually on expenses that
qualify to be paid from your flex account, then enroll.
You May Elect Amounts up to…
$5,000 for Flexible Spending (FSA) Expenses
The annual amount you elect for the FSA is available on the first day and
through-out the plan year.
$5,000 ($2,500 if single) for Dependent Care Expenses
Dependent Care (DCSA) is available as your contributions are deposited in
the account.
Flexible Spending Account
USE IT…
Don’t LOSE IT!
Unused balances may not be paid to you
in cash or used in a later year.
So estimate what you think you will need
for your expenses.
NOTE: If you were enrolled in the FSA
for 2011 and want to continue, you must
make a new election for 2012.
provided by Ameriflex
Flexible Spending Account
provided by Ameriflex
How Are Qualified Expenses Paid?
By…
• using the “AmeriFlex Convenience
Card” – this is a Master Card debit card providing
electronic access to your FSA Funds.
OR…
• submit a Claim Form – if merchant does not accept the
“AmeriFlex Convenience Card”.
Note: AmeriFlex may need additional information, including receipts to verify
eligibility of the expense and to comply with IRS Rules. Save all receipts, then fax
or mail them promptly if requested!.
Flexible Spending Account
provided by Ameriflex
Expenses That Qualify For Payment With Flex Dollars
• Co-pays, deductibles, and other payments you are
responsible for under your medical plan
• Prescriptions (ONLY PRESCRIBED BY PHYSICIAN)
• Dental & Eye care expenses
• Chiropractic treatments
• Prescribed Weight - Loss Programs
• Daycare expenses for dependents, so you can work
and much more…
Online Website Access – Take A Tour
Register Your Secure Website For Each Carriers
Aetna
Guardian
VSP
Ameriflex
Medical:
Dental:
Vision:
FSA:
www.aetna.com
www.guardiananytime.com
www.vsp.com
www.flex125.com
On Your Secure Website, you will find:
24 Hours a day - Access to Your Claims & Benefits
Insurance information - To become an informed consumer.
Personalized tools - Request Forms & ID Cards – Look for Participating Providers
You can do it online - 24 hours a day, 7 days a week - from wherever you have Internet access.
Completion of Your Health Benefits Enrollment
IMPORTANT INFORMATION
THERE ARE TWO WAYS TO MAKE YOUR
ENROLLMENT ELECTION FOR 2012
1. HR CONNECTION - ONLINE
If you provided a Email Address (either a Stark Email or Personal Email), you
can go online to www.hrconnection.com and make your elections. No Paper
Documents will be necessary. (Instruction Sheet will be available)
2. PAPER ENROLLMENT
If you do not have an Email Address, you may complete a Paper Enrollment
and submit to Bill Liggan in Human Resources. (Enrollment Packages will be
available)
Completion of Your Health Benefits Enrollment
IMPORTANT INFORMATION
•
If enrolling through HR Connection, please be sure to make your election for
each plan and include any addition or changes you may want during this
open enrollment. (No paper form will be required if enrolling online)
•
If you will be using a paper form, please print all information clearly.
•
Include All Social Security Numbers. (Yours & Your Dependents)
(This is for enrollment process only. You will be assigned a Member Identification Number for
Privacy Requirements)
•
Be sure to include all your dependents dates of birth.
•
Sign & Date your application.
•
Return completed enrollment form to Human Resources by January 20, 2012.
NOTE: ONCE YOU ARE ENROLLED IN THE HEALTH BENEFITS FOR 2012, YOU WILL NOT BE ABLE
TO MAKE ANY CHANGES UNTIL THE NEXT PLAN ANNIVERSARY UNLESS YOU HAVE A
QUALIFYING EVENT!
Service & Advocacy
Co-Pilot Benefits Advocacy
CoPilotTM is an employee advocacy program from Pilot Employee
Benefits designed to assist employees with all aspects of enrollment
as well as any claims or coverage issues that may arise.
The CoPilotTM service card contains instructions for you to obtain
assistance with any of the benefit plans. Pilot works for you and is
there to help you receive the benefits of your plans.
If you have any questions regarding your benefits, please contact our
employee service program, CoPilotTM,
Call (800) 794-1215
QUESTIONS?