Gulfstream Goodwill2015

Benefits Overview

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

EMPLOYER PAYS

1 X ANNUAL INCOMELIFE INSURANCE & AD&D

$200,000 Max.

EMPLOYER PAID LIFE

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

VOLUNTARY LIFE INSURANCE RATESSemi-Monthly Deductions

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

WORLDWIDE TRAVEL ASSISTANCE ANDIDENTY THEFT PROTECTION FOR YOU AND YOUR FAMILY

Contact your Human Resources Representative for more information:

Staci Hooper-PowellDirector of Human Resources

(P) 561-848-7200(E) hpowell@gulfstreamgoodwill.com