benefits open enrollment october 13 november 4,...

Over the past year, the OCA Benefits team has been working closely with Olympus Scientific Solutions (OSSA) to harmonize the benefits provided to employees of both companies. As a result of this project, a number of benefits for both OCA and OSSA will be changing effective January 1, 2016. Every effort was made to minimize the impact to employees; however, we recognize that some disruption may occur.

While enrollment is generally passive for all employees, everyone is encouraged to review ALL of their personal and benefit information on HRInTouch. With the exception of Health Savings Accounts (HSA) and Flexible Spending Accounts (FSA), employees have been enrolled in the 2016 benefits based upon current enrollments.

Open Enrollment is your once-a-year opportunity to change plans and add or drop eligible dependents from coverage. The only other time you have an opportunity to make changes is when you experience a qualifying life event such as divorce, marriage, birth or adoption of a child, or other “qualifying life event” in 2016. It is also the time when you must specify how much you will contribute to a Flexible Spending Account (FSA) or a Health Savings Account.

Benefit Elections must be completed online through www.OlympusBenefits.HRIntouch.com or call 1-855-294-2820

Tuesday, October 13 – Wednesday, November 4 Note: The website DOES NOT support Internet Explorer 8 or lower. You can use the Compatibility mode.

What You Need to Know…

Make informed decisions by reviewing ALL of your 2016 benefit options, including other medical or dental plans available to you through your spouse or domestic partner’s employer. Compare medical and dental plans and determine which are best for you and your family.

A new PPO medical plan is being offered and all core Olympus medical plans are through United Healthcare. All employees will have imputed income on the Olympus provided LTD coverage. Supplemental Life insurance rates have changed for many levels and are on a Smoker/Non-Smoker basis. OCA employees enrolled in Supplemental Life have been enrolled in the new Smoker/Non-Smoker rates based upon

their Tobacco Certification. You need to review the new rates and the impact on you. OCA employees enrolled in a United Healthcare plan have been automatically enrolled in the new 100% employee paid

NVA vision plan. If you do not want this plan, you must opt out. OSSA employees have been enrolled based upon current enrollment.

Everyone should confirm their dependents and their life insurance beneficiary information. The PTO purchase plan has been eliminated.

BENEFITS OPEN ENROLLMENT

October 13 – November 4, 2015

What’s In This Issue: Medical, Dental & Vision Designs

and Rates

Health Savings and Flexible

Spending Account Information

Life Insurance Coverages and

Rates

Long Term Disability Information

Important Notices

Open Enrollment Checklist

http://www.olympusbenefits.hrintouch.com/

Correction Insert: Benefits Open Enrollment Newsletter for October 13 – November 4, 2015

Medical Plan Designs and Rates

All employees, with the exception of California, Puerto Rico and Hawaii residents, will have a choice of 2 medical plans through United Healthcare (UHC). California employees may also select a Kaiser HMO. Hawaii residents may choose from three HMSA plan offerings and Puerto Rico continues to have Triple S.

United Healthcare Plan Designs – CORRECTION

Preferred Provider Organization (PPO). This is NEW for everyone. Deductibles, coinsurance, out of pocket limits and copays have changed from the current PPO offering for both OCA and OSSA.

The OSSA EPO medical plan is frozen to new participants. No new enrollments (other than dependents) are allowed. If you are currently in the EPO, you are grandfathered for eligibility. United Healthcare will be the plan administrator.

Optum Rx is the provider of prescription drug benefits. Optum utilizes a three (3) tier formulary Prescription Drug List (PDL). The PDL organizes all brand and generic prescription drugs into tiers based on Total Cost Management. The PDL promotes medications with the greatest overall healthcare value, regardless of brand or generic status. Participants are encouraged to review the PDL list available on the United Healthcare website www.myuhc.com for the categorization of your drugs. This list is subject to change throughout the year.

Review the medical plan designs on the separate plan comparison sheet. Hawaii and Puerto Rico employees need to contact Benefits or HRInTouch for the most recent plan summaries.

Medical Rates All medical rates are offered on a 4 tier basis: Employee, Employee + Child(ren), Employee + Spouse or Employee + Family. Child(ren) means one or more child.

A Tobacco Premium applies to employees and/or spouse/domestic partner who use tobacco products and participate in any medical plan sponsored by Olympus. This includes United Healthcare, Kaiser, Triple S and HMSA. The premium is $20 biweekly per person, or $40 if both you and your spouse/domestic partner use tobacco products. Upon enrolling in medical, you will be asked to confirm Yes or No to your tobacco usage. This also applies to the Supplemental Life Insurance.

Norwalk Union: Weekly pay rates are ½ of the rates listed below for the UHC HDHP or Basic PPO Plans.

2016 Bi-Weekly - Below Director Level

Coverage Level UHC HDHP Plan

UHC Basic PPO Plan

Kaiser HMO (CA Only)

UHC EPO

HMSA (Hawaii Only)

Triple S (Puerto Rico)

Employee Only $11.04 $57.23 $46.18 $64.62 $45.00 $37.00

Employee + Child(ren)

$17.08

$114.46

$97.50

$135.69

$135.00 (EE+1 Child only)

$75.00

Employee + SP/DP $36.03 $159.69 $147.79 $142.15 $135.00 $115.00

Family $53.55 $193.85 $219.63 $174.46 $170.00 $145.00

Director & Above and/or > $140,000

Employee Only $13.25 $80.12 $73.89 $90.46 Tobacco Premium -

$20 per employee and/or spouse applies

to all plans.

Employee + Child(ren)

$20.49

$160.25

$153.95

$189.97

Employee + SP/DP $43.23 $223.57 $220.66 $199.02

Family $64.26 $271.38 $326.37 $244.25

High Deductible Healthcare Plan (HDHP) with an annual Olympus contribution to a Health Savings Account (HSA) of $600 for single coverage and $1,200 for all other coverage levels. New for 2016: Your annual deductible remains $2,000

for single coverage and $4,000 for in-network family coverage;

however, your annual total out of pocket maximum has been

changed for 2016. Only one individual in a family needs to

reach a $5,000 single out of pocket limit before the plan pays

100% for that individual. The remaining family members will

be required to reach a total $10,000 maximum before the entire

family has claims paid at 100%.

http://www.myuhc.com/

OLYMPUS MEDICAL PLAN COMPARISON CHART

All locations except Hawaii & Puerto Rico

High Deductible Health Plan

PPO Kaiser HMO (California

Only

Plan Provision In Network Out of Network In Network Out of Network In-Network Only

Annual Deductible

Single: $2,000 Family: $4,000


Single: $500 Family: $1,000


Single: $500 Family: $1,000

Annual Out of Pocket Maximum






Coinsurance 90% 70% 85% 70% 90%

Preventive Care 100% 70% after deductible

100% Not available 100%

Office Visit 90% after deductible

70% after deductible

$25 Primary Care $40 Specialist


$20 Primary Care $20 Specialist

Emergency Room 90% after deductible


$125 Copay then 85% Coinsurance

$125 Copay then 70% Coinsurance

90% after Deductible

Urgent & Convenience

Care



$30 Copay


$20 Copay

Labs, X-rays, Outpatient &

inpatient Surgery





$10 per Encounter

Rehabilitative Services



$40 Copay 70% after deductible

$20 Copay

Retail Pharmacy UP to 30 Day

Supply

Annual deductible must be met

before Rx copays apply

$10 Tier 1 $30 Tier 2 $50 Tier 3

No out of network prescription

benefits

$10 Tier 1 $40 Tier 2

$75 Tier 3


benefits

$10 Generic

$30 Preferred Brand

Mail Order Up to 90 Day Supply

Annual deductible must be met

before Rx copays apply

$20 Tier 1 $60 Tier 2 $100Tier 3


benefits

$20 Tier 1 $80 Tier 2 $150 Tier 3


benefits

$20 Generic

$60 Preferred Brand

Pre Certification Required

Yes for In patient Hospitalizations, Hospice and Home Health, else 50%

coverage penalty

Yes for In patient Hospitalizations, Hospice and Home Health, else 50%

coverage penalty

Yes

Olympus HSA Contribution

Single: $600 Family $1,200

No Contribution

No Contribution

Annual Notice of Post-Mastectomy Coverage

The Women’s Health and Cancer Rights Act of 1998 requires group health plans to cover certain reconstructive surgery following a mastectomy and notify Plan participants and beneficiaries annually. In particular, a plan must offer:

Reconstruction of the breast on which the mastectomy was performed. Surgery and reconstruction of the other breast to produce a symmetrical appearance. Prostheses and treatment of physical complications of all stages of mastectomy, including lymphedemas.

All of Olympus’ medical plans comply with these requirements. Benefits for these items generally are comparable to those provided under our plan for similar types of medical services and supplies. If you would like more information about WHCRA required coverage, you can contact your medical carrier directly.

Important Notice

Dental Plan Designs and Rates

Delta Dental continues to be the dental plan provider. We offer one plan which allows you to use Delta Dental’s PPO and Premier Dentist Networks. Out of Network coverage is available but you are subject to being balanced billed for charges above the reasonable and customary as determined by Delta Dental. An annual deductible applies to all services with the exception of preventive care.

Employees in Hawaii and Puerto Rico are not eligible for the dental as it is available through their medical carrier.

DELTA DENTAL PLAN HIGHLIGHTS

Coverage Area

Covered Services

In Network PPO & Premier

Dentist *

Out of Network Dentist**

Deductibles & Maximums

Preventive Care Oral Exams Teeth Cleaning Sealants

X-rays Child Fluoride

Treatments

100%

100%

None

Basic Restorative Fillings

Extractions Oral Surgery

Periodontics

Bridge/Denture Repair

Root Canal

80%

80%

Annual deductible: $50 per person

$150 maximum per family

Annual Maximum: $2,000 per person

Major Restorative Bridge & Denture Installation

Crowns

Onlays and cast restorations

Inlays

60%

50%

Orthodontia Preliminary examinations,

X-rays

Appliance therapy Monthly active

treatment

60%

50%

$2,000 per person Lifetime

Coverage for children

to age 19

*To find a participating provider visit www.deltadentalins.com and click Find a Dentist **The provider has the right to balance bill you any amount not paid by Delta Dental

Healthcare ID and HSA/FSA Debit Cards

ID cards for the medical, dental and vision plans will be mailed to all new enrollees in early January 2016. This means that OSSA employees will get all new ID cards. If you previously had vision coverage through NVA, you will also get a new card as the old one will no longer be valid.

New debit cards for Optum HSA and United Healthcare FSA accounts will be sent to all new enrollees as well. If you currently have an Optum debit card, it will be reloaded with your newly elected amounts.

Dependents and Beneficiaries

Annual enrollment is a good time to review your covered dependents and Life Insurance beneficiaries. Other than during Open Enrollment, you generally cannot change your covered dependents unless you incur a Qualified Life Event such as marriage, divorce, the birth or adoption of a child or loss of coverage elsewhere. If you add new dependents during this time, you have until November 13, 2015 to complete your Dependent Verification for Open Enrollment. Dependent Verification includes a copy of your most recent tax filing showing your dependent(s), a marriage certificate or a birth certificate. You can update your beneficiaries at any time.

To change your 401k beneficiary, contact Empower at www.Retireonline.com or call 800-345-2345.

2016 Dental Plan Rates

Coverage Level Delta Dental Plan

(Bi-Weekly) Norwalk Union Delta Dental Plan (Weekly)

Employee Only $4.15 $8.60

Employee plus Child(ren)

$7.25 $15.45

Employee plus Spouse or Domestic Partner

$7.40 $18.97

Family $11.35 $26.48

http://www.deltadentalins.com/

http://www.retireonline.com/

NVA Vision Plan Design and Rates

National Vision Administrators (NVA) was selected as the vision provider for all of Olympus. The NVA Vision Plan is a standalone employee benefit. Coverage levels are consistent with the medical and dental plans- Employee only, Employee + Spouse, Employee + Child(ren) and Family.

Providers include many national chains such as VisionWorks, LensCrafters and Sears as well as many local opticians and doctors. While many chains participate, you cannot assume all of the chain’s locations participate. Confirm or find a Participating Provider, in addition to other helpful information, by visiting www.e-nva.com and click on ‘Find a Provider’. Use account number 12150001.

OCA and OSSA employees have been enrolled in the new standalone vision plan based upon their current United Healthcare or VSP enrollment. If you do not want this benefit, you must actively opt out through OlympusBenefits.HRIntouch.com or by calling the Benefits Hotline at 855-294-2820.

NVA Vision Benefit Highlights All Locations except Puerto Rico

Plan Provision Frequency Participating Provider Non Participating Provider

Examination Once every 12 months Covered 100% Reimbursed up to $50

Lenses

Once every 12 months

Standard Glass or Plastic Covered 100%

Single Vision $50

Bifocal $75 Trifocal & Lenticular $100

Frames Once every 24 months Covered up to $130 Retail Up to $70

Contact Lenses - in lieu of Lenses

Once every 12 months

Elective - up to $130 Retail Medically Necessary - up to 100% with Prior

Authorization

Daily Wear $20

Extended Wear $30

EyeEssential Discount – For services if you exhaust the basic frequency and benefit level:

Examinations Member cost Retail less $10

Not Applicable

Contact Lens Evaluation Fitting

Not Applicable

Retail less 10%

Lenses

Single Vision $35 Bifocal $55

Trifocal & Lenticular $70 Frame

Contacts: Conventional Contacts: Disposable

Retail less 35%

Retail less 15% Retail less 10%

Annual Enrollment Checklist:

Review this newsletter and plan descriptions at www. OlympusBenefits.HRIntouch.com

Attend a Benefits Fair if one is available at your location Decide which benefits and coverage levels will best fit your needs

Print a confirmation of your elections when you complete your enrollment

Look for new ID cards (if applicable) in early January

2016 NVA Vision Plan Rates

Coverage Level Bi-weekly Rate

Employee Only $2.14

Employee plus Children

$5.57

Employee plus Spouse or

Domestic Partner

$4.28

Family $6.85

http://www.e-nva.com/


Health and Flexible Savings Plan Accounts

Health Savings Account (HSA)

Employees who enroll in High-Deductible Health Plan have the option to enroll in a HSA. Employees that open an account through OptumBank will receive an annual Olympus HSA contribution of $600 for employee-only coverage and $1,200 for all other levels of coverage. Contributions are made by January 31st provided you have opened an account with OptumBank.

You may also add to your account through payroll deductions. If you are currently enrolled in the OptumBank HSA you will need to enroll again during this Open Enrollment to have your HSA continue in 2016. These deductions can be changed at anytime throughout the year.

If you already have a personal HSA, you can still open one with OptumBank. Just be sure the total amount you contribute to both accounts, plus all company contributions, does not exceed the 2016 contribution maximum.

Note: You cannot open an HSA if you are enrolled in secondary coverage such as through a spouse’s plan that is not a qualified HDHP. Employee payroll deductions will not begin until an account has been opened with OptumBank.

Flexible Spending Accounts (FSA)

Optum administers all the Flexible Spending Accounts: Healthcare FSA – You can use the Healthcare FSA to pay for eligible expenses related to medical, dental or vision for

you and your dependents regardless of whether or not they are covered by an Olympus plan. You cannot enroll in this FSA is you are enrolled in an HDHP.

Limited-Use Healthcare FSA – You can enroll in this FSA if you are enrolled in a HDHP. Funds may be used to pay for eligible expenses related to dental or vision ONLY for you and your dependents, regardless of whether or not enrolled in the Olympus HDHP.

Dependent Daycare FSA – Contributions may be used to pay for eligible expenses related to child care or adult dependent care expenses for qualified dependents that are necessary for you and your spouse to work, look for work or attend school full-time.

2016 Flexible Spending Accounts and Limits

Account Coverage for Limit Healthcare FSA Eligible expenses related to medical, dental, vision, and Rx. $2,550

Limited-Use FSA Eligible expenses related ONLY to dental or vision for you or your dependents.

$2,550

Dependent Daycare FSA

Eligible child or adult dependent care. Child expenses limited for care up TO age 13. Child(ren) or adults must be tax dependent upon you.*

$5,000

*You are limited to $5000 if filing a joint tax return or are a single parent and $2500 if married and filing taxes separately.

New for 2016: Healthcare FSA $500 Carryover Provision

Beginning in the 2016 plan year, you will be able to carryover up to $500 of unused funds in your Limited-Use or Healthcare FSA from 2016 into your 2017 FSA.

This provision does not apply to the Dependent Daycare FSA.

The current OCA and OSSA rules for filing 2015 claims and/or grace periods have not changed.

2016 Health Savings Account Limits

Maximum Contribution

Single Family

$3,350 $6,750

Catch-up Contribution (55+)

$1,000 $1,000

Reminders:

You must be enrolled in a High Deductible Health Plan to contribute.

These limits are inclusive of any contributions by Olympus, including the Wellness Incentive.

Life Insurance & Long Term Disability

Example: $48,000 annual pay: Monthly pay = $4,000

CIGNA is the carrier for all of our life insurance coverages and long term disability. Rates for all coverages – supplemental, voluntary AD&D and Child Life have changed. The employee and spouse/domestic partner coverages are based upon smoker/non-smoker status.

Current OCA supplemental life participants have been enrolled to either the smoking or non smoking rates based upon their medical plan Tobacco Certification Question. OSSA participants are being enrolled based upon their current enrollment in supplemental life insurance.

Warning: If you are a smoker and you fail to confirm this through the Tobacco Certification question, CIGNA has the right to deny any benefits payable under the plan.

Anyone requesting an increase in their supplemental amounts may be subject to Evidence of Insurability (EOI) by CIGNA.

Long Term Disability (LTD) – Tax Free Through CIGNA Effective January 1, 2016, the current LTD benefits provide 60% of your annual salary, or Annual Benefits Base Rate (“ABBR”) for certain sales representatives up to a maximum of $10,000 per month. Additionally, this will become a tax free benefit as you will pay “imputed income” beginning with your first 2016 pay. By paying imputed income, this simply means that if you pay taxes now then your LTD benefit will be tax free and available to you at a significantly higher amount should you need this benefit.

Norwalk Union Employees are not eligible for this benefit.

Monthly Covered Benefit = $4,000 x 60% = $2,400 Monthly imputed income = $2,400/100 x.227 = $5.45 Bi-weekly imputed income = ($5.45 X12)/26 = $2.52

Olympus Corporation of the Americas Health and Welfare Plan: Notice of Privacy Matters

The Olympus Corporation of the Americas Health and Welfare Plan (“Plan”) provides health benefits to eligible employees of Olympus Corporation of the Americas (and participating affiliates) and their eligible dependents as described in the summary plan description for the Plan. The Plan creates, receives, uses, maintains and discloses health information about participating employees and dependents in the course of providing these health benefits. The Plan is required by law to provide notice to participants of the Plan’s duties and privacy practices with respect to covered individuals’ protected health information, and has done so by providing to Plan participants a Notice of Privacy Practices, which describes the ways that the Plan uses and discloses PHI.

A copy of Plan’s Notice of Privacy Practices is available on Olympus Corporation of the Americas’ internal website, or request a copy be sent to you via mail or email. You may contact: Compliance Department, Olympus Corporation of the Americas, 3500 Corporate Parkway, Center Valley, PA 18034-0610, (484) 896-4472; [email protected]

This Notice describes how to obtain a copy of the Plan’s Notice of Privacy Practices, which describes the ways that the Plan uses and discloses your Protected Health Information (PHI).

LTD Bi-weekly imputed income is equal to (Monthly Covered Benefit Amount/$100) x .227 = Monthly Income

(Monthly Income * 12 Months)/26 = Bi-weekly income

mailto:[email protected]

HIGHLIGHTS OF THE COMBINED OCA & OSSA BENEFITS PLATFORM

Online Enrollment www.OlympusBenefits.HRInTouch.com is your one stop for enrolling in benefits, reviewing your benefits anytime, viewing your dependents, or making changes due to a Life Event. You may also enroll or have questions answered by calling 855-294-2820.

Medical & RX Coverage United Healthcare is the plan provider for all our core medical plans. Prescription coverage is through Optum Rx. These plans are not available to residents of Hawaii or Puerto Rico.

Kaiser HMO is also available to anyone living or working in California. Hawaii citizens may select from HMSA plans, and citizens of Puerto Rico may select Triple S coverage.

Dental Coverage One plan, through Delta Dental, provides access to both Delta Dental Premier and PPO providers for in-network benefits.

Vision Coverage The Olympus Vision Plan is offered through National Vision Administrators (NVA). It is a standalone employee vision assistance plan. Vision is not part of the United Healthcare plans.

Medical, Dental & Vision Rate Tiers With the exception of Hawaii medical, all rates are on a 4 tier basis. Tiers are Employee Only, Employee + Child(ren), Employee + Spouse and Family. Child(ren) means one or more children are covered. Directors and above pay more for their coverages.

Disability and Life Insurance Coverage CIGNA will be the vendor for our life insurance, short term disability and long term disability coverages.

Employee Assistance Plan (EAP) A full service EAP is provided through Optum. This is a no cost benefit for all employees.

Flexible Spending (FSA) & Health Savings Accounts (HSA) United Healthcare and OptumBank, respectively, provide services for the FSA and HSA

Paid Time off (PTO) The total amount of paid time off is consistent between all Olympus US companies.

How To Enroll In Benefits Click on www.OlympusBenefits.HRIntouch.com to being your enrollment for 2016 benefits.

If enrolling your spouse or domestic partner and/or children, please have their dates of birth and social security numbers readily accessible before beginning the enrollment process.

Logging In For The First Time: 1. Click on “Register or Reset your Account” 2. Verify your identity to Begin

Social Security Number Last name Date of Birth

3. Create a Username and Password

ENROLL NOW! 1. Once inside the Open Enrollment section, you will be

prompted through a series of screens. You must complete each section, Medical, Dental, Life, Disability, etc., even if you wish to waive benefits.

2. Dependent Information – to add a dependent, enter their information in the My Dependents section.

3. Summary of your Benefits – the final step will allow you to review your benefit elections. If you need to make changes, click on the “View/Edit information” link. It is recommended that you keep a copy of this Confirmation for your records. You can return to this website to review and edit your enrollment anytime during Open Enrollment.

Carrier Contacts

Benefit

Carrier

Customer Service Medical & Prescription

United Healthcare

Phone: 800-242-1817 Group #: 704389 Web: www.myuhc.com

Kaiser (CA) Kaiser HMO Phone: 800-464-4000 Group # (No. CA): 38131 Group # (So. CA): 225362 Web: www.kaiserpermanente.org

Flexible Spending Accounts

United Healthcare

Phone: 800-242-1817 Group # 704389 Web: www.myuhc.com

Health Savings Account

Optum Bank

Phone: 800-791-9361 Group: 704389 Web: www.optumbank.com

Dental Delta Dental

Phone: 800-932-0783 Group #: 09001 Web: www.deltadentalins.com

Vision NVA Phone: 800-672-7723 Group #: 12150001 Web: www.e-nva.com

EAP Optum Phone: 866-248-4096 Access Code: Olympus Web: www.live andworkwell.com




http://www.kaiserpermanente.org/


http://www.optumbank.com/

http://www.deltadentalins.com/

http://www.e-nva.com/

benefits open enrollment october 13 november 4,...

Documents