gulfstream goodwill 2015 benefits overview. what is open enrollment? medical, dental & vision...
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What is Open Enrollment? Medical, Dental & Vision Discount Programs Life & Disability Education
COVERED TOPICS:
Annual opportunity to:
Add or Change coverage
Add or delete dependents
Select Pre-tax deductions
*Open Enrollment is usually held October of each year for changes effective January 1st of the following year.
OPEN ENROLLMENT
Marriage Divorce Legal Separation Birth of Child Change in employment status Dependent ceasing to be eligible Death
Must notify Human Resources within30 days of qualifying event!
QUALIFIED FAMILY STATUS CHANGES
HEALTH INSURANCE – HMO 14 70% (MEDICAL_2)Company/Plan HUMANA OA HMO 14 70%
Physician $40 CO-PAY
Specialist $55 CO-PAY
Adult & Child Wellness Adult Wellness Max
COVERED 100%NO MAX
Mammograms COVERED 100%
Emergency Room - Waived if Admitted $250 CO-PAY
Urgent Care $100 CO-PAY
Independent Clinical Lab DED THEN 100%
Diagnostic Testing / MRI, CAT Scans DED & 70%
Outpatient Surgery - Ambulatory Surgical Center DED & 70%
Provider Services Ambulatory Surgery Center (ASC) DED & 70%
Outpatient Surgery – Hospital DED & 70%
Inpatient Hospital DED & 70%
Provider Services Hospital & ER DED & 70%
Home Health DED & 70%60 VISITS
Outpatient Therapy $55 CO-PAY60 VISITS
Deductible $5000/$10000
Included in Out of Pocket Max YES
Co-Insurance 70%
Maximum Out of Pocket $6250/$12500
Out of Pocket Includes DED, CO-PAY, CO-INS & RX
Prescription $15/35/55/25%
Lifetime Maximum UNLIMITED
HEALTH INSURANCE – HMO 14 70% (MEDICAL_2)
HUMANA HMO $5,000 DEDUCTIBLE
Semi-Monthly Payroll Deduction
Employee $ 50.02
Employee/Spouse $306.09
Employee/Child(ren) $260.00
Employee/Family $557.04
HEALTH INSURANCE – HMO 14 90 (MEDICAL_1)Company/Plan HUMANA HMO 14 90%
Physician $25 CO-PAY
Specialist $40 CO-PAY
Adult & Child Wellness Adult Wellness Max
COVERED 100%NO MAX
Mammograms COVERED 100%
Emergency Room - Waived if Admitted $150 CO-PAY
Urgent Care $75 CO-PAY
Independent Clinical Lab DED THEN 100%
Diagnostic Testing / MRI, CAT Scans DED & 90%
Outpatient Surgery - Ambulatory Surgical Center DED & 90%
Provider Services Ambulatory Surgery Center (ASC) DED & 90%
Outpatient Surgery – Hospital DED & 90%
Inpatient Hospital DED & 90%
Provider Services Hospital & ER DED & 90%
Home Health DED & 90%60 VISITS
Outpatient Therapy $40 CO-PAY60 VISITS
Deductible $2000/$4000
Included in Out of Pocket Max YES
Co-Insurance 90%
Maximum Out of Pocket $6250/$12500
Out of Pocket Includes DED, CO-PAY, CO-INS & RX
Prescription $15/35/55/25%
Lifetime Maximum UNLIMITED
HUMANA HMO $2,000 DEDUCTIBLE
Semi-Monthly Payroll Deduction
Employee $90.54
Employee/Spouse $387.13
Employee/Child(ren) $333.74
Employee/Family $677.78
PAYROLL DEDUCTIONS – HMO 14 90% (MEDICAL_1)
HUMANA HS195
Deductible NONE
Co-Insurance 100%
Dentist COVERED 100%
Specialist CO-PAY APPLIES
Cleanings 1 EVERY 6 MONTHS
Preventive Network Non Network
MOST PROCEDURES COVERED 100%
SOME PROCEDURES HAVE CO-PAYS
Basic Coverage Network Non Network
SOME PROCEDURES COVERED 100%
MOST PROCEDURES HAVE CO-PAYS
Major Coverage CO-PAY APPLIES
Orthodontic Coverage Orthodontic Maximum (Age Limits) CO-PAY APPLIES
Annual Maximum NONE
Dependant Child/Student Age UP TO AGE 26
DENTAL – DMO
Dental Plan HUMANA DMO
Tier Semi-Monthly Payroll Deduction
Employee $7.63
Employee + Spouse $15.25
Employee + Child(ren) $17.16
Family $27.61
DENTAL PAYROLL DEDUCTIONS – DMO HS195
HUMANA PPO 09
Deductible IN: $25/$75OUT: $50/$150
Co-Insurance IN: 100/90/60OUT: 100/80/50
Dentist DED & CO-INS
Specialist DED & CO-INS
Cleanings 1 EVERY 6 MONTHS
Preventive Network Non Network
IN/OUT: DED WAIVED, COVERED 100%
Basic Coverage Network Non Network
IN: DED & 90%OUT: DED & 80%
Major Coverage IN: DED & 60%OUT: DED & 50%
Periodontics & Endodontic Coverage MAJOR
Orthodontic Coverage Orthodontic Maximum (Age Limits)
50%CHILD(REN) UP TO 18$1000 LIFETIME MAX
Annual Maximum $1,500 + 30% AFTER MAX REACHED
Dependant Child/Student Age UP TO AGE 26
DENTAL - PPO
Dental Plan HUMANA PPO 09
Tier Semi-Monthly Payroll Deduction
Employee $17.48
Employee + Spouse $34.96
Employee + Child(ren) $38.46
Family $57.69
DENTAL PAYROLL DEDUCTIONS – PPO 09
VISION CARE
Employee Only $3.26
Employee Plus Spouse $6.52
Employee Plus Child(ren) $5.52
Employee Plus Family $9.11
PAYROLL DEDUCTIONSSemi-Monthly Payroll Deduction
METLIFE
**$10 CO-PAY (EVERY 12 MONTHS)
**$20 CO-PAY Lenses: (EVERY 12 MONTHS)
Frames: (EVERY 24 MONTHS)
NETWORK DOCTOR NON-NETWORK DOCTOR REIMBURSEMENT
PAID IN FULL AFTER CO-PAY UP TO $45 ALLOWANCE
PAID IN FULL AFTER CO-PAY
UP TO $30 SINGLE $50 BIFOCAL
$65 TRIFOCAL $100 LENTICULAR
PAID IN FULL AFTER CO-PAY UP TO $210 ALLOWANCE
UP TO $150 ALLOWANCE UP TO $105 ALLOWANCE
UP TO $150 ALLOWANCE UP TO $70 ALLOWANCE
Mail Order:Right Source 1-800-379-0092
PARTICIPATING PHARMACIES
Hospital Emergency RoomYou may be tempted to go to the emergency room (ER). But, this may not be the best choice. At the ER, true emergencies are treated first. Other cases must wait—sometimes for hours. And, it may cost you more.
Go to the ER for:• Heavy bleeding• Large open wounds• Sudden change in vision• Chest pain• Sudden weakness or trouble talking• Major burns• Spinal injuries• Severe head injury• Difficulty breathing• Major broken bones
VSURGENCY EMERGENCYUrgent Care
Sometimes, you may need care fast. But, your Primary Care Physician may be unavailable. You may want to try an urgent care center. They can treat many minor ailments. Chances are you won’t have to wait as long as at the ER. You may pay less, too.
An Urgent Care Center can help with:• Sprains• Strains• Minor broken bones (example: finger)• Minor infections• Small cuts• Sore throats• Rashes• Colds• Flu
WHERE TO GO…AND WHEN
Computed tomography (CT) scan, also called CAT scan Magnetic resonance imaging (MRI) Magnetic resonance angiography
(MRA)Bone mineral density (BMD) or
bone density scanUltrasound scanning, also called
sonography Nuclear medicine studies Fluoroscopy studies
Advantages of using a freestanding facility:No long wait for an appointment
No wait, or only a short wait, on the day of your appointment
Lower copayment or coinsurance than you'd pay at a hospital-based facility
Diagnostic imaging can be expensive. With many health plans, you could save on out-of-pocket costs by having the study done at a freestanding facility.
In addition to standard X-rays, diagnostic imagingstudies include:
VSHospitals Free Standing Facilities
EDUCATION
$4 Prescription
What canyou do?Ask the doctor orpharmacist if anFDA-approvedgeneric equivalent is available.
Top Usage: • Heart Disease• Diabetes• Cholesterol• Depression
VSBrand Name Generic Drug
EDUCATION
BENEFIT SUMMARY• Coverage is available in $25,000, $50,000, $75,000 & $100,000
increments up to 5 X’s annual salary• Minimum Coverage: $25,000• Maximum Coverage: $125,000• Employees age 70 and older, maximum benefit is $50,000
GUARANTEED ISSUEUp to $125,000 for Employees under age 70
Employees ages 70-74, reduce 40% or $50,000Age 75, reduce to 25% or $31,250
Spouse up to $10,000
Note: It is recommended that the designated beneficiary be Age 18 or older
VOLUNTARY LIFE INSURANCE
BENEFIT SUMMARY Elimination period (When Benefits Are Payable)
• 15TH Day of Injury• 15TH Day of Illness• 11 Week Maximum • 60% of Income ($1,000 Weekly Maximum)
Premium is 100% paid by the employee post-tax (after-taxes) benefits are tax-free.
Pre-Existing Conditions – 3/12 Look back
SHORT-TERM DISABILITY (STD)
BENEFIT SUMMARY• LTD is designed to assist the employee during a prolonged
period of absence due to an illness or injury after 90 days of disability
• Maximum Monthly Benefit Amount:– 60% of the employee’s monthly salary up to $6,000
• Maximum Benefit Period:– To 65 years of age or when eligible for social security
retirement
LONG-TERM DISABILITY (LTD)
BENEFIT SUMMARY
• Elimination Period:– 90 Days
• The Premium is paid 100% by the Employee– Post-Tax (After Tax Deduction)– Benefits are Tax-Free– Benefits are paid out Monthly
• Pre-Existing Conditions – 3/12 Look back
LONG-TERM DISABILITY (LTD)
WORLD WIDE THROUGH LINCOLN FINANCIAL
Travel Assistance includes:
Medical Evacuation and Repatriation
Lost Luggage Service
Replacement Assistance for Lost or Stolen Travel Documentation
Legal services and Translation Services
TRAVEL ASSISTANCE
EMPLOYEE CONNECTEmployee Connect is available 24 hours a day, seven days a week with support, guidance and resources.
Features:• Counseling Sessions• 24 x 7 x 365 Telephone and Web Access• Confidentiality• Family• Workplace Stress• Emotional Well-Being• Grief & Loss• Mental Health• Addiction
EMPLOYEE ASSISTANCE PROGRAM - EAP
Contact your Human Resources Representative for more information:
Staci Hooper-PowellDirector of Human Resources
(P) 561-848-7200(E) hpowell@gulfstreamgoodwill.com
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