Transcript Slide 1

2012 Open Enrollment
Session
Office of Human Resources & Employee Relations
Kimberly Tarver, HR Manager – Benefits
November 2011
Dental Insurance
BOR MetLife Dental Plan
(INN and OON Benefits)
GC MetLife Dental Plan
(INN and OON Benefits)
Annual Deductible
$50
$50
Plan Maximum per person
$1,200 (per plan year)
$1,500 (per plan year)
Lifetime Maximum Orthodontia $1,000
$1,000
Preventive Care
Cleaning, oral exams
100% Network Rate (INN)
Subject to Balance Billing (OON)*
100% Maximum Allowed Charge (INN)
100% Reasonable/Customary Charge (OON)
Basic Care*
80% Network Rate (INN)
Subject to Balance Billing (OON)
80% Maximum Allowed Charge (INN)
80% Reasonable/Customary Charge (OON)
Restorative Care*
80% Network Rate (INN)
Subject to Balance Billing (OON)
50% Maximum Allowed Charge (INN)
50% Reasonable/Customary Charge (OON)
Orthodontia*
80% Network Rate (INN)
Subject to Balance Billing (OON)
50% Maximum Allowed Charge (INN)
50% Reasonable/Customary Charge (OON)
Dental Insurance Definitions:
BALANCE BILLING: The dollar amount charged by a provider that is in excess of the plan’s allowed amount for
medical/dental care or treatment. Amounts that are balance billed by a provider are the member’s responsibility. Member
costs incurred for balance billing will not apply toward the annual deductible.
NETWORK RATE: The rate that has been negotiated by MetLife for dental services
MAXIMUM ALLOWED CHARGE: The lesser of the amount charged by the Dentist; OR the maximum amount
which the In-Network Dentist has agreed with MetLife to accept as payment in full for the dental service.
REASONABLE/CUSTOMARY CHARGE: The lowest of:
The Dentist’s actual charge for the services or supplies; OR
The usual charge by the Dentist or other provider of the services or supplies for the same or similar services
or supplies; OR
The usual charge of other Dentists or other provider in the same geographic area equal to the 99 th
percentile of charges as determined by MetLife based on charge information for the same or similar services
or supplies maintained in MetLife’s Reasonable and Customary Charge records.
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An example of how the 99th percentile is calculated is to assume one hundred (100) charges for the
same service are contained in MetLife’s Reasonable and Customary charge records. These one
hundred (100) charges would be sorted from lowest to highest charged amount and numbered 1
through 100. The 99th percentile of charges is the charge that is equal to the charge numbered 99.
Dental Insurance Waiting Periods:
BOR MetLife Plan
After enrollment in the plan:
Six (6) month waiting period for orthodontic care.
Two (2) year waiting period for some restorative care
services, i.e. replacement of full dentures
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GC MetLife Plan
After enrollment in the plan:
One (1) year waiting period for basic, restorative, and
orthodontic care
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Vision Insurance:
Frequency of Services
Eye Exam every 12 months
Lenses every 12 months
Frames every 24 months
Co-payments
Eye Exam $10; Contact Exam $55 Lenses $25
Contact Lenses
Medically Necessary; $0 Copay
Elective $115 allowance
Frames
Plan provides $100 allowance
LASIK
Not covered – plan offers discount
Vision Insurance: Plan Exclusions
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Any hospital, surgical or treatment facility, or for
services of an anesthesiologist or anesthetist.
Prescription drugs or pre-medications, whether
dispensed or prescribed.
Medical or surgical treatment of eye, eyes, or
supporting structures
Disability Insurance
Short Term Disability – Guarantee Issue no EOI required
Long Term Disability – EOI required and application due to HR by 5:00 p.m., November 18, 2011
SPECIAL NOTE:
PRE-EXISTING CONDITION LIMITATION: You will be considered to have a Pre-existing
Condition and will be subject to the Pre-existing Conditions Limitation if:
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(1) the disability begins in the first twelve (12) months after your effective date; and
(2) you have received medical Treatment, consultation, care or services, including
diagnostic procedures, or took prescribed drugs or medicines for the Sickness or Injury,
whether specifically diagnosed or not, causing such disability, during the three (3) months
immediately prior to your effective date of insurance.
Weekly Income Benefits will not be paid for a disability caused by; contributed to by; or
resulting from a Pre-existing Condition unless you have been Actively at Work for one (1)
full day following the end of twelve (12) consecutive months from your effective date of
insurance.
Board of Regents CIGNA Life Insurance
Spouse/Child Life: $4.70 = $10,000 per covered member
Supplemental Life: 1X – 5X Salary
EOI may be required for enrollment
SPECIAL NOTE:
You must be enrolled in the supplemental life insurance at
least ten (10) years prior to retirement in order to continue the
benefit into retirement. The maximum benefit in retirement is
$15,000.
Board of Regents CIGNA Life Insurance
CONVERSION POLICY: If you leave the Board of Regents
and would like to convert their life insurance coverage, you
must do so within 30 days of termination. The conversion
insurance may be a type of life insurance currently being
offered for conversion by the insurance company at your age
and in the amount requested. It may not be term insurance
and it may not be for an amount greater than the Life
Insurance Benefits in force under the Policy. Conversion life
insurance will not provide accident, disability or other
benefits.
Board of Regents CIGNA Life Insurance
FREE VALUE ADDED BENEFITS
CIGNA Will Preparation Program: Last Will and Testament; Living Will; Health
Care Power of Attorney; Financial Power of Attorney; Estate Planning Information;
HIPAA Authorization Forms; Online life and disability planning kits; and Funeral
Planning Services
CIGNA Healthy Rewards: Up to 60% discounts on health and wellness services
CIGNA’s Identity Theft Program: Review credit information to determine if identity
theft occurred; Provide identity theft resolution kit and an affidavit for credit bureaus
and creditors; Assist with cancellation and replacement of lost or stolen credit cards
and documents; Help with emergency travel arrangements, translation services and
message relay
CIGNA Living Benefits:
Terminal Illness Benefit – Employees who are considered to have a terminal
illness can qualify to receive 50% of their life benefit up to $250,000.
Critical Illness-Specified Disease – 25% of the coverage in force up to a
maximum benefit of $50,000.
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GC Reliance Standard Life Insurance
Child Life: $4.70 = $10,000 per covered child
Spouse Life: $10,000 to $250,000 in increments of $10,000, not to
exceed 50% of the Employee’s Covered Amount (Premium is based on
spouse’s age)
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Spouses under age sixty (60): Amounts of insurance over $30,000
are subject to our approval of your spouse's proof of good health.
Spouse age sixty (60) and over: Amounts over $10,000 subject
to EOI
Supplemental Life:
1X – 5X Salary; Guaranteed Issue - $300,000
EOI Required for Coverage Amounts over $300,000
GC Reliance Standard Life Insurance
- Conversion: can convert to an individual policy once no
longer employed by GC
- Portability: can continue under the plan for a period of two
(2) years once no longer employed by GC
SPECIAL NOTE:
You must be enrolled in the supplemental life insurance at
least ten (10) years prior to retirement in order to continue
the benefit into retirement. The maximum benefit in
retirement is $15,000.
AFLAC Benefit Options
Cancer Policy:
If you or your covered dependent under the policy is diagnosed with
cancer and receives treatment, AFLAC Cancer Policy pays CASH
benefits directly to you, unless you choose otherwise. This means
you will have additional resources to help with the financial
consequences of cancer that may not be covered by major medical
insurance.
This plan does not have any deductibles or copayments. The plan is
fully portable and guaranteed renewable. There are no network
restrictions – you choose your own medical treatment provider.
AFLAC Benefit Options
Cancer Policy Monthly Premiums:
Age 18 – 35
Age 36 – 45
Age 46 – 55
Age 56 - 70
Individual
$16.12
$22.40
$33.02
$43.56
Single Family
$16.12
$22.40
$33.02
$43.56
Employee + Spouse
$39.90
$42.12
$61.76
$85.68
Family
$39.90
$42.12
$61.76
$85.68
Pre-Tax Deductions
AFLAC Benefit Options
24-Hour Accident Only Insurance:
AFLAC pays CASH benefits directly to you, unless you choose
otherwise, if a covered member’s accidental death, dismemberment,
or injury is caused by a covered accident that occurs on or off the job.
The Accident Policy has:
No deductibles and no copayments
No lifetime limit – policy won’t terminate based on number or
dollar amount of claims paid.
No network restrictions – you choose your own medical
treatment provider.
No coordination of benefits – AFLAC pays regardless of any
other insurance.
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AFLAC Benefit Options
Accident Policy Monthly Premiums:
Individual - $23.58
Single Family - $34.98
Employee + Spouse - $30.56
Family - $45.50
Georgia College AFLAC Representative
Contact Information:
John Collins
Email: [email protected]
Phone: (478) 454-7512
Email [email protected] if you have any
questions about this presentation.