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2021 Open Enrollment Booklet_Kaniksu Flipbook PDF
Kaniksu Health Services 2021 Open Enrollment Booklet
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Human Resource Office 301 Cedar St. Suite #206 Sandpoint, Idaho 83864
Office: 208.263.7101 kaniksuhealthservices.org
Welcome to 2021 Open Enrollment Open enrollment is a short period each year when you can make changes to your benefits. This guide will outline all the different benefits Kaniksu Health Services offers, so you can identify which offerings are best for you and your family. There will be no plan changes for the 2021 Plan Year. In addition, the monthly rates employees pay for their benefits will remain the same (these rates have not increased since 2011. Elections you make during open enrollment will become effective on January 1, 2021. If you have questions about any of the benefits mentioned in this guide, please don’t hesitate to reach out to Meagan Forge in Human Resources. Once elections are made, you are bound to that choice for the entire plan year unless you experience a “Qualifying Event”. These may include, but are not limited to: • Changes in legal marital status • Birth, adoption, guardianship • Loss of other group coverage ELIGIBILITY › Employees are eligible for benefits if they work 20 hours or more per week. › Coverage for new employees begins on the 1st of the month following your date of hire. › You may enroll your eligible dependents for medical, dental, vision and life insurance. Dependents include your legal spouse, domestic partner (verification required), or your legal dependent children up to age 26.
HOW TO MAKE CHANGES TO YOUR BENEFITS
Enrollment Forms: Enrollment forms must be requested from Human Resources and returned by 11/30/2020 in order to make any changes to your benefits.
Regence Medical Enrollment Form HSA Contribution Form FSA Contribution Form Dental Enrollment Form Vision Enrollment Form Group Life Beneficiary Form * Forms are only required if you are making changes to that specific plan. Forms must be returned to Meagan Forge no later than 11/30/2020.
MEAGAN FORGE Director of Human Resources [email protected] 208.263.7101 ext. 2209
THERESE OSBORNE HR Generalist [email protected] 208.263.7101 ext. 2201
PLAN SUMMARIES & IMPORTANT NOTICES Kaniksu Health Services is required to provide employees with access to important notices such as the Summary of Benefits and Coverage (SBC), Plan Documents, and Special Plan Notices. All documents are available on the company’s employee benefit website. Please refer to the Employee Log-In Instructions to access these documents. A free printed copy of all your plan documents and notices may be obtained by calling The Murray Group at (208) 765-2620. Employee Log-In Instructions 1. Visit murraygr.com and click on the Client Login option 2. Enter kaniksu in the Username box 2
2020 Employee Benefit Guide
This booklet provides only a summary of your benefits. All services described within are subject to the definitions, limitations, and exclusions set forth in each insurance carrier or provider’s contract.
Insurance Premiums Medical - Regence Innova Full Premium
Employee Only Employee & Spouse Employee & 1 Child Employee & 2+ Children Family
Kaniksu Pays
Employee Pays
575.98 719.58 619.88 668.28 779.38
52.62 789.92 278.32 526.72 1097.22
Kaniksu Pays
Employee Pays
481.60 617.70 523.20 569.10 674.50 $95 / Month
0.00 538.60 164.90 346.40 763.20
Full Premium
Kaniksu Pays
Employee Pays
42.23 84.46 82.93 110.87 146.01
42.23 42.23 42.23 42.23 42.23
0.00 42.23 40.70 68.64 103.78
Full Premium
Kaniksu Pays
Employee Pays
628.60 1509.50 898.20 1195.00 1876.60
Medical - Regence HSA Full Premium Employee Only 481.60 Employee & Spouse 1156.30 Employee & 1 Child 688.10 Employee & 2+ Children 915.50 Family 1437.70 Contribution to Health Savings Account:
Dental Employee Only Employee & Spouse Employee & 1 Child Employee & 2+ Children Family
Vision Employee Only Employee & Spouse Employee & 1 Child Employee & 2+ Children Family
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2020 Employee Benefit Guide
6.06 12.13 13.00 13.00 20.74
6.06 5.29 5.21 5.21 4.18
0.00 6.84 7.79 7.79 16.56
This booklet provides only a summary of your benefits. All services described within are subject to the definitions, limitations, and exclusions set forth in each insurance carrier or provider’s contract.
Healthcare Expense Accounts The medical plan you choose to enroll on determines which healthcare expense accounts you are eligible for.
Option 1: Regence Innova $2,000 PPO
Option 2: Regence HSA $3,000 Embedded HSA
HEALTH SAVINGS ACCOUNT
FLEXIBLE SPENDING ACCOUNT You can contribute pre-tax funds to your FSA and use the money to pay for your out-of-pocket healthcare expenses including: - Deductibles, Copays, & Prescription Drugs - Dental & Vision Expenses Only $550 of unused FSA funds can be rolled-over to next year, so it is important you elect carefully. IRS FSA Contribution limits for 2021: Annual Minimum: $120 Annual Maximum: $2,750
Employer contributes $95 per month (up to $1140 per year) to Employee’s Health Savings Account. Funds can be used for eligible healthcare expenses or saved. Unused HSA funds roll over year over year. Employees may also elect to contribute to HSA with pre-tax payroll deductions. The maximum HSA contributions that an employee can elect for 2021 are based on your enrollment: 2021 HSA Employee Contribution Limits:
Annual Contribution Maximum
Per Month Deduction
Single Coverage
$2,460
$205.00
Family Coverage
$6,060
$505.00
Age 55+
Additional $1,000 Per Year
*Employees age 65+ are not permitted to contribute to the health savings account. You are also not eligible to contribute if you are enrolled on any other non-HSA qualified health plan.
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2020 Employee Benefit Guide
This booklet provides only a summary of your benefits. All services described within are subject to the definitions, limitations, and exclusions set forth in each insurance carrier or provider’s contract.
Medical Plans Option 1: Regence Innova $2,000 PPO
Option 2: Regence HSA $3,000 Embedded HSA
$2,000 $6,000
$3,000 $5,000
Plan pays 80% / You pay 20%
Plan pays 80% / You pay 20%
Out-of-Pocket Maximum
(Includes Deductible + Coinsurance)
(Includes Deductible + Coinsurance)
Individual Family
$5,500 $11,000
$5,000 $10,000
$30 Copay
Applied to deductible + coinsurance
Covered 100%
Covered 100%
Diagnostic Labs / Imaging
First $400 Covered 100%, then subject to deductible + coinsurance
Applied to deductible + coinsurance
Hospitalization/Maternity
Applied to deductible + coinsurance
Applied to deductible + coinsurance
Covered 80% (deductible waived) 18 visit maximum / per year
Not included
Plan Highlights: Deductible (Calendar Year) Individual Family Coinsurance (In-Network)
Cost-sharing after deductible is met (Once member reaches this, plan will pay 100% for remainder of calendar year)
Physician Office Visit Preventive Care
Spinal Manipulations Pharmacy / RX
$250 Deductible for Brand Name Rx
Generic
$10 Copay (deductible waived)
Preferred Brand Name:
After $250 Rx deductible, $35 copay
Non-Preferred Brand Name:
After $250 Rx deductible, $75 copay
You pay costs up to the medical plan deductible for Tier 1, Tier 2, Tier 3, and Specialty Rx
Employee Only
$52.62
$0.00
Employee & Spouse
$789.92
$538.60
Employee & 1 Child
$278.32
$164.90
Employee & 2 or more Children
$526.72
$346.40
Family
$1097.22
$763.20
Innova PPO vs. Regence HSA Innova PPO
Regence HSA
Members pay flat copays for physician office visits and most prescriptions Members have an upfront $400 benefit for any diagnostic labs or radiology. Plan includes spinal manipulation and acupuncture coverage. Great choice for members who have ongoing medical costs and prefer copays and upfront coverage for services.
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The Regence HSA is a high-deductible health plan. Members receive coverage for medical services once they reach the deductible. Members who participate on the Regence HSA Medical Plan will also have a health savings account which can be used to pay for medical expenses that are applied to their plan’s deductible. Great choice for members with minimal medical expenses each year and want to save money on health insurance premiums.
Both plans include 100% coverage for Preventive Care Services with no copay and no deductible.
2020 Employee Benefit Guide
This booklet provides only a summary of your benefits. All services described within are subject to the definitions, limitations, and exclusions set forth in each insurance carrier or provider’s contract.
Preventive Care Preventive care and early detection are important for your long-term health. Both Medical Plan Options through Kaniksu Health Services cover Preventive Services at 100%, with no copays, deductibles, or out-of-pocket costs. In addition to your annual wellness visit, the following list of services are covered 100% as part of your Preventive Care: (services must be billed as preventive by your provider’s office in order to be covered 100%) Annual Preventive Services for Men, Women, and Children: • Abdominal aortic aneurysm one-time screening for men of specified ages who have ever smoked • Alcohol misuse screening and counseling • Blood pressure screening • Cholesterol screening for adults of certain ages or at higher risk • Colorectal cancer screening for adults 50 to 75 • Depression screening • Diabetes (Type 2) screening for adults 40 to 70 years who are overweight or obese • Diet counseling for adults at higher risk for chronic disease • Hepatitis B screening Hepatitis C screening for adults at increased risk, and one time for everyone born 1945–1965 • HIV screening for everyone ages 15 to 65, and other ages at increased risk • Immunization vaccines for adults & children— doses, recommended ages, and recommended populations vary: •Diphtheria •Meningococcal •Hepatitis A •Mumps •Hepatitis B •Pertussis •Herpes Zoster •Pneumococcal •Human Papillomavirus (HPV) •Rubella •Influenza (flu shot) •Tetanus •Measles •Varicella (Chickenpox) • Lung cancer screening for adults 55-80 at high risk for lung cancer because they’re heavy smokers or have quit in the past 15 years • Statin preventive medication for adults 40 to 75 at high risk • Tobacco use screening for all adults and cessation interventions for tobacco users • Tuberculosis screening for certain adults without symptoms at high risk Specific Preventive Services for Women • Birth Control (contraceptives) methods and devices: See full list for details • Breast cancer genetic test counseling (BRCA) for women at higher risk • Breast cancer mammography screenings every 1 to 2 years for women over 40 • Breastfeeding equipment and supplies • Cervical cancer screening • Pap test (also called a Pap smear) every 3 years for women 21 to 65 • Human Papillomavirus (HPV) DNA test with the combination of a Pap smear every 5 years for women 30 to 65 who don’t want a Pap smear every 3 years • Chlamydia infection screening for younger women and other women at higher risk • Diabetes screening for women with a history of gestational diabetes who aren’t currently pregnant and who haven’t been diagnosed with type 2 diabetes before • Domestic and interpersonal violence screening and counseling for all women • Gonorrhea screening for all women at higher risk • HIV screening and counseling for sexually active women • Osteoporosis screening for women over age 60 depending on risk factors • Rh incompatibility screening follow-up testing for women at higher risk • Sexually transmitted infections counseling for sexually active women
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• For a more comprehensive list of preventive services, go to: www.regence.com 6
2020 Employee Benefit Guide
This booklet provides only a summary of your benefits. All services described within are subject to the definitions, limitations, and exclusions set forth in each insurance carrier or provider’s contract.
Dental
Delta Denta l of Ida ho
PROVIDER NETWORK Annual Deductible (Individual / Family)
PPO
PREMIER
$25 / $75
$25 / $75
Plan Pays:
Plan Pays:
Preventive Care (Exam, cleanings, x-rays)
100%
80%
Basic Procedures (Fillings, extractions, root canal)
80%
70%
50%
40%
$1,250
$1,000
50% up to $1,000 lifetime max
50% up to $1,000 lifetime max
Major Procedures (Crowns, bridges, dentures) Annual Maximum Benefit (Per Member) Orthodontic Services (children under 19 only)
Visit www.deltadentalid.com to view network providers, claims, and member discounts
Vision
Employee Only
$0.00
Employee & Spouse
$42.23
Employee & 1 Child
$40.70
Employee & 2+Children
$68.64
Family
$103.78
United Her ita ge VSP
PROVIDER NETWORK
VSP Provider
Coverage
Upfront Benefits at VSP Provider’s Office:
Annual Eye Exam
Covered 100% after $10 Copay
Lenses (every 12 months)
$25 Copay
Single vision, lined bifocal, lined trifocal, polycarbonate for children
Covered 100% Member copays: Standard: $55 / Premium: $95-$105 Custom: $150 - $175 20-25% savings on lens enhancements Covered up to $130 $70 Costco frame allowance
Progressive Lenses Standard / Premium / Custom Frames (every 24 months) Contact Lenses (instead of frames) Other VSP Benefits:
Dental Monthly Employee Cost
Covered up to $130 every 12 months • •
Vision Monthly Employee Cost Employee Only
$0.00
Employee & Spouse
$6.84
Employee & 1 Child
$7.79
Employee & 2+Children
$7.79
Family
$16.56
Retinal Screening: No more than $39 copay Laser Vision Correction: 15% discount at contracted facilities
You do not need a card to access your VSP benefits. Simply give your Eye Clinic your Name and DOB. Dependents covered on vision will be accessed under the Employee’s Information. FIND VSP PROVIDERS AT: WWW.VSP.COM
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2020 Employee Benefit Guide
This booklet provides only a summary of your benefits. All services described within are subject to the definitions, limitations, and exclusions set forth in each insurance carrier or provider’s contract.
Group Life Insurance Ba sic Life Insur a nce Employer-Paid Basic Life Insurance Employee
Spouse
Death Benefit:
1x Base Annual Earnings to a maximum of $200,000
$2,000
AD&D Benefit:
Equal to Life Benefit
N/A
Child(ren)* (birth – 6mo)
(6mo – age 26)
$100
$2,000
N/A
Reduction in Coverage Due to Age – Benefits reduce to the following percentage and terminate at retirement. Benefits reduce to 65% at age 65, to 50% at age 70 & over. The percentage reduction is based on original coverage prior to any reductions at the Employee’s birthdate.
Accidental Death & Dismemberment: (AD&D) Payable when an insured employee suffers a loss as a result of an accidental bodily injury or death sustained in an accident.
*Child(ren) must be unmarried and financially dependent upon you to be eligible for life insurance.
Volunta r y Insur a nce Options Supplemental Life and AD&D Insurance Short Term Disability Long Term Disability (Class 1 Only) *See HR if you wish to make changes to the plans listed above.
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2020 Employee Benefit Guide
This booklet provides only a summary of your benefits. All services described within are subject to the definitions, limitations, and exclusions set forth in each insurance carrier or provider’s contract.
Additional Benefits Va ca tion Lea ve Accr ua l a nd Use It is the intent of Kaniksu Health Services to establish policies regarding administering leave accrual that ensures consistent application for all employees based on FTE and position.
Tier & Length of Service
1.0 FTE Annual Accrual
Hourly Accrual Rate
Allowable Annual Carry-Over
Tier 1 0-3 Years
80 Hours
.0385/hrs. worked
40 Hours
Tier 2 3-5 Years
120 Hours
.0577/hrs. worked
60 Hours
Tier 3 5+ Years
160 Hours
.0769/hrs. worked
80 Hours
Sick Lea ve Accr ua l a nd Use It is the intent of Kaniksu Health Services to establish policies regarding administering sick leave accrual that ensures consistent application for all employees.
Annual Accrual
Cap: Max Accrual
64 Hours
128 Hours
Utilizing Sick Pay: • You may take sick pay in 1 hour increments or greater. • You may use sick pay for the following: • When the employee or a minor dependent is ill and you are unable to come to work • When the employee or a minor dependent has a Doctor’s appointment to address an illness or health concern • When the employee has a medical appointment which interferes with the ability to come to work. Employees should get preapproval from their manager. • If you have a long time illness or are going out on maternity or paternity leave Sick pay is not to be used: • In lieu of vacation pay if an employee is out of vacation time • If an employee is subject to a delay in their travel plans and cannot make it to work • For wellness-like appointments, hair-cuts, personal training, non-medical massage, etc. • To make up hours if they are asked to shorten their shift due to low census Requesting a Doctor’s note: • Management may request a doctor’s note to verify the absence was due to illness. • Employees are permitted 3 separate absence occurrences within a 90 day period. Four or more separate absence occurrences within a 90 day period may result in discipline up to and including dismissal.
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2020 Employee Benefit Guide
This booklet provides only a summary of your benefits. All services described within are subject to the definitions, limitations, and exclusions set forth in each insurance carrier or provider’s contract.
Employee Assista nce Pr ogr a m (EAP) What is the EAP? It’s a service that helps you deal with the challenges you face in any of your many roles: employee, parent, spouse, child, friend, partner and even consumer. What does the EAP provide? • Up to four (4) confidential face-to-face counseling sessions for almost any issue, such as; • parenting problems, • relationship issues, • anxiety and work stress • This is available for employees and any of their household family members (regardless of benefit plan enrollment).
866.750.1327
Call: Company ID:
RBH34275
Online Resources Available at: MyRBH.com
Benefit Conta ct Infor ma tion Carrier Name
Website
Phone Number
The Murray Group
Murraygr.com
208.765.2620
Regence BlueShield of Idaho
Regence.com
888.367.2112
HealthEquity/ FSAs & HSAs
HealthEquity.com
866.346.5800
Delta Dental of Idaho
Deltadentalid.com
800.356.7586
VSP Vision Plan
Vsp.com
800.877.7195
United Heritage Life
Unitedheritage.com
800.830.1140
RBH / EAP
MyRBH.com
(866) 750-1327
Access Plan Information and Benefit Notices Online Kaniksu Health Services is required to provide employees with access to important notices such as the Summary of Benefits and Coverage (SBC’), Plan Documents, and Special Plan Notices. All of these documents are available on the company’s employee benefit website. A free printed copy of all your plan documents and notices may be obtained by calling The Murray Group at 208.765.2620. 10
2020 Employee Benefit Guide
› Go to www.murraygr.com › Click on +Client Login › Enter Guest Key: kaniksu
This booklet provides only a summary of your benefits. All services described within are subject to the definitions, limitations, and exclusions set forth in each insurance carrier or provider’s contract.