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AH4R 2021 Open Enrollment Guide_FINAL Flipbook PDF
AH4R 2021 Benefit Guide_FINAL
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2021
YOUR GUIDE TO BENEFITS
W e l c o m e to Your 2 0 2 1 AH4R Benefits En rollmen t As one component of our total rewards package, we strive to provide offerings that demonstrate our commitment to providing high-quality, affordable and comprehensive benefits. Our role is to ensure we continuously provide information to support your ability to make informed decisions. To that end, this resource, as with all years, will provide details of our benefits offerings, so you can make decisions for you and your family. Your role is to be an informed consumer so that you get the most value from your benefits. Please take the time to review and access all of the benefit resources prior to the Annual Open Enrollment period of October 26, 2020 through November 6, 2020.
Important Reminders •
Open enrollment elections for 2021 must be completed no later than 5:00 pm PST on Friday, November 6, 2020.
•
This year’s open enrollment period is passive, meaning if you do not make any changes during this time, you will remain in the same benefit plans for 2021 that you are currently enrolled in for 2020 with the exception of the Flexible Spending Accounts (FSA). You must re-enroll each plan year for both FSA plans.
•
The choices you make during your enrollment period will remain in effect through Dec. 31, 2021, unless you have a qualified life event — such as a marriage, divorce, or birth or adoption of a child. Remember, you have 30 days from the date of the qualified life event to request a change in your benefit elections.
•
Your children are eligible to be covered under your medical, dental and vision plans until age 26. Note: If your child will turn 26 in 2021 and he or she is covered under your plan, his or her coverage will end on the last day of his or her birthday month.
• This benefit guide includes only a brief summary of the benefit plans and is not intended to be a complete disclosure of the plan qualifications and limitations. The benefit plan contracts must be consulted to determine the exact terms and conditions of coverage. A certificate of coverage will be provided to you upon request. If you wish to review the certificate of coverage prior to enrollment, please refer to the document library available in the bswift® enrollment platform at www.AH4R.bswift.com .
Additional information regarding the benefits offered in this guide can be found online in the bswift® benefits portal. Here, you can access important content, including benefits and plan information, a documents library, and more.
2021 Highlights C L I C K TO GO TO A TOPIC:
MEDICAL Page
Getting Started
4
Frequently Asked Questions (FAQs)
5
Medical Benefits
6
Prescription Drug Benefits
8
What is An Emergency?
12
UnitedHealthcare Tools & Resources
13
Health Savings Account (HSA)
14
Dental Benefits
16
Vision Benefits
18
Healthcare Flexible Spending (HCFSA)
19
Dependent Care Flexible Spending (DCFSA)
20
Life and AD&D Benefits
21
Short-Term Disability Benefits
22
Long-Term Disability Benefits
24
Accident Benefits
25
Critical Illness Benefits
26
Telehealth Benefits
28
Employee Assistance Program (EAP)
29
Healthy Habits Wellness Program
30
Payroll Deductions
31
How to Enroll
34
Mid-Year Plan Changes
38
Will Preparation Service
39
Travel Assistance
40
Work-Life Resources
41
• Notices Important
42
Important Contact Information
43
We will continue to offer three plans administered by UnitedHealthcare: EPO Plan, HDHP/HSA Plan and Bronze Plan. Consider different variables when choosing your medical plan. For example, pay less each month and pay more when you receive care, or vice versa. L earn more on p a g e 6. DENTAL To encourage proper preventive and diagnostic care, we will continue to offer a dental plan administered by UnitedHealthcare. Learn more on p a g e 16. VISION It’s important to have your vision checked on a regular basis to protect your eyesight. That is why AH4R has partnered with UnitedHealthcare to provide employees with comprehensive vision care. More information can be found on p a g e 18. SUPPLEMENTAL LIFE AND AD&D If you need more financial protection than your basic life and AD&D insurance amount, you may be eligible to purchase supplemental life and AD&D insurance up to $500,000. S e e p a g e 21 for details. TELADOC Teladoc gives you access 24 hours, 7 days a week to a doctor through the convenience of your phone through video or mobile app visits all for $0 copay. S e e p a g e 27 for details.
Getting Started WHO IS ELIGIBLE FOR COVERAGE? Employees • Full-time, actively working a minimum of 30 hours per week • Newly hired employees are eligible to enroll in benefits on the first day of the month following 30 days of active employment Spouse/Domestic Partner • Your legally married spouse (same or opposite sex) • Your domestic partner • Refer to page 36 for required documentation Dependent Child(ren) • Any natural child, stepchild or adopted child under 26 years of age, regardless of presence or absence of a child's financial dependency, residency, student status, employment status, marital status, eligibility for other coverage, or any combination of those factors. • A child not listed above who is legally and financially dependent upon you or your spouse is also considered a dependent child, provided proof of dependency is provided with the child’s application. • A dependent child who is medically certified as disabled and dependent upon you or your spouse is also considered a dependent child. Dependent Disability Certification may be required. • Refer to page 36 for required documentation Domestic Partner Coverage • Your contributions to cover a domestic partner are the same as those to cover a legal spouse. However, because of Internal Revenue Code (IRC) restrictions, the fair market value of your DP and/or DP’s children’s (if they are not federal tax dependents) healthcare coverage will be taxable to you as imputed income. Imputed income is determined by the amount that the Company pays in premium for DP coverage and is subject to federal, state and Social Security taxes. This amount raises your taxable gross income. Also, the payroll deductions to cover a DP must be taken on an after-tax basis. (Imputed income is the value of any benefits or services provided to an employee.)
BEFORE & DURING OPEN ENROLLMENT Evaluate your coverage options Reflect on your 2020 coverage and whether or not it met your needs Family Protection – Evaluate your supplemental life insurance coverage. Make necessary changes to your beneficiary designations Remember to save or print confirmation of your benefit elections when you enroll in bswift ® If you have an FSA account balance, remember to incur expenses and spend down Review your 2021 HSA contribution amount January 1, 2021 Set up profiles on benefits provider websites and download their mobile apps Review deductions on your first paycheck of 2021 Look for new ID cards in the mail
Eligibility varies between coverages as follows: • Medical, Dental and Voluntary Vision: Children age 26 and older who are physically or mentally incapable of self-support due to physical or mental disability may continue on your health plan. You will be required to provide appropriate documentation of their disability annually. • Voluntary Term Life and Accidental Death and Dismemberment (AD&D): Unmarried dependent children from live birth but less than 26 years of age. 4
Frequently Asked Questions (FAQs) When do benefits go into effect? Elections made during Open Enrollment will be effective January 1, 2021.
What is a participating provider vs a nonparticipating provider? Participating/In-Network Providers (your less expensive option): providers who are contracted to accept the UnitedHealthcare allowable charge as payment in full for their service. You only have to pay your cost share when you visit the doctor, and the provider will collect the remaining amount directly from UnitedHealthcare.
Will I get a new ID card? Employees enrolling in medical or dental for the first time and employees electing to change medical or dental plans will receive new ID cards from UnitedHealthcare and have access to an online temporary ID card by January 1, 2021. UnitedHealthcare does not require an ID card for members to receive vision services. Members simply call an in-network provider and provide the employee’s Social Security Number to schedule an appointment, and the provider will handle the rest.
Non-Participating/Out-of-Network Providers (your most expensive option): nonparticipating providers will not accept the UnitedHealthcare allowable charge as payment in full and they won't normally file claims on your behalf. You will probably be required to pay the full amount to the provider and file a claim directly with UnitedHealthcare for reimbursement. Any charges above the allowable amounts are your responsibility and will not be reimbursed.
When are my elections due and how do I enroll? Open Enrollment for the 2021 plan year begins October 26th. All elections are to be completed in bswift® no later than November 6, 2020.
What is Co-insurance? Co-insurance is the percentage of Allowable Charges for Covered Services for which UnitedHealthcare will pay once the deductible has been met; the remaining percentage is the member’s responsibility.
Can I make changes to my elections during the middle of the plan year? Employees cannot make changes to their elections during the plan year (such as dropping coverage or adding a dependent) unless they experience a qualifying event.
What is the Out-of-Pocket Maximum? The out-of-pocket maximum is the maximum amount of money the Covered Person will pay in a calendar year. PLEASE NOTE: The annual Out-of-Pocket maximum will include all innetwork copays, deductibles, co-insurance and prescription drug copays.
Does UnitedHealthcare offer online access or a mobile app? Yes – get information about your benefits, anytime, anywhere. Use your computer, phone or tablet to access the secure member website, www.myuhc.com. Download the UnitedHealthcare app for free on the App Store® and Google Play®.
Are pre-existing conditions covered under the medical plan? With the recent Affordable Care Act changes, benefits are no longer subject to pre-existing condition exclusions.
Who do I contact with questions? Please address any questions to the Human Resource Department at [email protected].
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Medical Benefits UnitedHealthcare
Whether you want more choices or more monthly savings, AH4R offers three unique medical plan options to meet your individual needs. Consider different variables when choosing your medical plan. For example, would you prefer to pay less each month and pay more when you receive care—or vice versa? The high-level comparison found on the following pages can help.
EPO PLAN As a participant in the EPO Plan, you must choose an innetwork provider when you need covered health services. There are no referrals necessary to see a specialist. You pay a copay for many covered services, while other services might require you to pay a percentage of the costs after your deductible. It is important to remember that there are no out-of-network benefits in an EPO, except for medical emergencies.
HDHP/HSA PLAN
BRONZE PLAN
As a participant in the HDH/HSA Plan you have the freedom to seek care from the provider of your choice. However, you will maximize your benefits and reduce your out-of-pocket costs if you choose an in-network provider. This plan has a higher deductible and out-ofpocket maximum in exchange for lower premiums. The benefit of enrolling in the HDHP/HSA Plan allows you the opportunity to enroll in the HSA Plan to contribute pre-tax dollars up to $3,600 for Single and $7,200 for Family for the 2021 Plan Year.
The Bronze Plan combines many features of the EPO Plan and the HDHP/HSA Plan. Like the EPO Plan, doctor office visits and prescription drugs have copays whereas all other services are subject to the deductible before benefits are payable. In comparison to the HDHP/HSA Plan, the Bronze Plan includes a higher deductible and out-of-pocket maximum. Most importantly, with the Bronze Plan, you still have the freedom to seek care from the provider of your choice.
IT IS IMPORTANT THAT YOU UNDERSTAND YOU ARE RESPONSIBLE FOR ALL INCURRED EXPENSES UNTIL YOU HAVE MET THE $3,000 INDIVIDUAL/$6,000 FAMILY DEDUCTIBLE. .
MOST EXPENSIVE
LEAST EXPENSIVE
All health plans are PPO network-based. This means you will save money - sometimes a lot of money – if you go to doctors and other providers who participate in the Plan’s PPO network. The three health plans have a large network: • 840,000+ nationwide doctors + healthcare professionals (clinics, labs, care centers, etc.) • 5,700+ nationwide hospitals • 30,000 nationwide pharmacies 6
Medical Benefits UnitedHealthcare
UnitedHealthcare EPO Plan NETWORK ONLY
UnitedHealthcare HDHP/HSA Plan NETWORK
UnitedHealthcare Bronze Plan
NON-NETWORK
NETWORK
NON-NETWORK
ANNUAL DEDUCTIBLE & MEMBER COINSURANCE Individual
$2,000
$3,000
$6,000
$5,000
$10,000
Family
$4,000
$6,000
$12,000
$10,000
$20,000
20%
20%
40%
30%
50%
Coinsurance
OUT-OF-POCKET & LIFETIME MAXIMUM Individual
$5,000
$5,000
$10,000
$6,500
$13,000
Family
$10,000
$10,000
$20,000
$13,000
$26,000
no charge
not covered
no charge
not covered
member pays 20% after deductible
member pays 40% after deductible
$25 copay PCP $50 copay Specialist
member pays 50% after deductible
no charge
no charge
not covered
no charge
not covered
member pays 20% after deductible Free-standing lab: no charge. Hospital: $250 copay member pays 20% + $250 copay
member pays 20% after deductible
member pays 40% after deductible
member pays 30% after deductible
member pays 50% after deductible
member pays 20% after deductible
member pays 40% after deductible
member pays 30% after deductible
member pays 50% after deductible
member pays 20% after deductible
member pays 40% after deductible
member pays 30% after deductible
member pays 50% after deductible
member pays 20% after deductible
member pays 40% after deductible
member pays 30% after deductible
member pays 50% after deductible
member pays 20% after deductible
member pays 40% after deductible
member pays 30% after deductible
member pays 50% after deductible
PHYSICIAN AND DIAGNOSTIC SERVICES Preventive Care
no charge
Office Visit $25 copay PCP (PCP/Specialist) $50 copay Specialist Teladoc Maternity/ OB-GYN Visits Simple X-ray Complex X-ray
HOSPITAL SERVICES Inpatient Outpatient
$250 copay, then member pays 20% after deductible member pays 20% after deductible
EMERGENCY SERVICES Emergency Room
$250 copay, then member pays 20%
member pays 20% after deductible
member pays 40% $250 copay, then 30% member pays 50% after deductible after deductible after deductible
Ambulance
member pays 20% after deductible
member pays 20% after deductible
member pays 40% after deductible
member pays 30% after deductible
member pays 50% after deductible
Urgent Care
$50 copay
member pays 20% after deductible
member pays 40% after deductible
$50 copay
member pays 50% after deductible
PPO NETWORK Idaho Employees All Other Employees
Choice
Choice Plus
Choice Plus
Select
Select Plus
Select Plus
This is only a brief summary of the plan and is not intended to be a complete disclosure of the plan qualifications and limitations. The contract must be consulted to determine the exact terms and conditions of coverage. A certificate of coverage will be available for review in the document library available in the bswift® enrollment platform at www.AH4R.bswift.com .
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Prescription Drug Benefits UnitedHealthcare/OptumRx®
It is important to be an informed consumer, especially with your prescription drug options. All three medical plans include prescription drug coverage. With UnitedHealthcare, you have access to pharmacies nationwide. The Affordable Care Act (ACA) makes certain preventive medications available to you at no cost. The current preventive drug list includes certain aspirin products, contraception, bowel prep products, cholesterol medications, certain vitamin D and folic acid supplements and many smoking cessation products. For a complete list of covered medications refer to the Preventive Drug Care listing found in the bswift® library. UnitedHealthcare EPO Plan
UnitedHealthcare HDHP/HSA Plan
NETWORK ONLY
NETWORK
UnitedHealthcare Bronze Plan
NON-NETWORK
NETWORK
NON-NETWORK
no benefit
$5 copay
no benefit
no benefit
$50 copay
no benefit
no benefit
$75 copay
no benefit
no benefit
2½ times retail copay
no benefit
PRESCRIPTION DRUGS Tier 1 Retail
$5 copay
Tier 2 Retail
$50 copay
Tier 3 Retail
$75 copay
Mail Order
2½ times retail copay
$5 copay after deductible $50 copay after deductible $75 copay after deductible 2½ times retail copay after deductible
Retail Pharmacy Present your medical plan ID card at a participating pharmacy. You will receive up to a 30-day supply of your prescription. You will pay a copay based on the type of prescription you receive.
Try home delivery from OptumRx® With OptumRx®, you can save time and money. How it works. 1. Order up to a 3-month supply of your maintenance medications — ones you take regularly — from OptumRx®.
Ask for Generic Drugs You can save money on generic drugs in most cases. The FDA requires that generic drugs have the same high quality, strength, purity and stability as brand-name drugs. The next time you need a prescription, ask your doctor to prescribe a generic drug when it is available and appropriate.
2. OptumRx® fills your order and sends it to you. 3. Your medication arrives within 4 to 7 days. Three easy ways to set up home delivery: 1. ePRESCRIBE. Ask your doctor to send an electronic prescription to OptumRx®.
The benefits of home delivery: Save a trip to the pharmacy.
2. ONLINE. Log in to www.optumrx.com and follow the instructions.
Talk to a pharmacist when you have medication questions.
3. PHONE. Call OptumRx® anytime at 4. 888-658-0539, TTY 711.
Setup refill reminders 8
Prescription Drug Benefits UnitedHealthcare/OptumRx®
Tools Managing Your Medications
Frequently asked questions: Filling prescriptions with OptumRx® General Questions:
What is prior authorization? Prior Authorization (PA) means that you must obtain approval for certain medications to be covered by your plan.
What are tiers? The Pharmacy Drug List (PDL) is broken out into sections called tiers. Tiers tell you the amount you pay for your prescription. Tier 1 medications provide the highest overall value with the lowest out-of-pocket costs.
How do I know if the prescribed medication requires prior authorization? Check the PDL on the UnitedHealthcare® app or at www.OptumRx.com . If you see “PA” next to your medication, you need prior authorization. You can also talk to your doctor about whether or not another option could work for you.
Choosing medications in lower tiers may save your money. Your Cost/ Drug Tier Tier 1 Lowest $ Tier 2 Mid-Range $$ Tier 3 Higher $$$
Medication value and coverage
How do I request prior authorization? Your doctor will need to provide information about why you are taking the medication. To start the process you can: 1. Call OptumRx® to request prior authorization. With your permission we will contact your doctor. 2. Ask your doctor to contact OptumRx® directly.
Highest overall value. Mostly generic drugs. Some brand name drugs may be included. Good overall value. Mix of brand name and generic drugs. Lowest overall value. Mostly brand names, some generics. Ask your doctor if a Tier 1 or Tier 2 option could work for you.
If you use a brand medication that has a generic available, you will pay the cost difference between the brand-name drug and the generic drug in addition to your copay or coinsurance. 9
Prescription Drug Benefits UnitedHealthcare/OptumRx®
Managing your prescriptions online OptumRx.com is a fast, easy and secure way to get the information you need to make the most of your pharmacy benefit.
Website homepage
Log in to www.OptumRx.com with your username and password. You can find information to help you better understand and manage your medications. It’s safe and secure. You will need to register as a new user to establish a username and password.
Website features and tools
Once registered you can access the pharmacy section by clickingthe My Prescriptions button to: • Fill new prescriptions via home delivery from OptumRx®
• View order status and claim history
• Search for drug prices and lower-cost alternatives
• Sign up for medication and refill reminders via text message
•
Refill and renew home deliveryprescriptions
• View your real time benefits
•
Transfer retail prescriptions to home delivery from OptumRx®
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Prescription Drug Benefits UnitedHealthcare/OptumRx®
Managing your prescriptions online OptumRx.com is a fast, easy and secure way to get the information you need to make the most of your pharmacy benefit.
My prescriptions dashboard
Once you log in, click on My Prescriptions to see your personalized dashboard. The dashboard makes Tools it easy to access the many tools and features to help manage your medications.
Managing Your Medications
1. Get started Set up home delivery for new prescriptions ortransfer current retail prescriptions to OptumRx®. 2. Refill prescriptions Refill current OptumRx® home delivery prescriptions. All eligible refills will be automatically checked. Deselect any medications you do not want to refill at this time.
4 1
2 5
3. Renew prescriptions Request to renew a home delivery prescription if you are out of refills.
3
4. Order status Check the status of yourhome delivery medication orders.
Note: Some sections are only available if you are logged in to your account. Not all sections of the website are available to all members – access to features and tools are determined by your benefits plan.
5. Quick links Fast access to the most frequently used areas of our website.
You can save time, money and improve your health with home delivery
• Save time – By ordering medications you take regularly online, you make fewer trips to the pharmacy and avoid waiting in line to pick up your medication. • Save money – Depending on your pharmacy plan, you can order up to a 3-month supply of your medication. You pay less with OptumRx®. Orders are shipped via U.S. standard mail at no cost.
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What is an Emergency? Deciding Where to Go COMPARE CARE OPTIONS Average Cost Doctor’s Office Your doctor knows your medical history best 24/7 Nurseline Virtual Visits Have a live doctor visit by phone or video 24 hours a day, 7 days a week Retail Clinic Convenient, lowcost care in stores and pharmacies Urgent Care Not an emergency but needs immediate attention Emergency Room For serious or lifethreatening symptoms
$ FREE
Average Wait Time
18 minutes
13 Minutes
$$ $$$
• • • •
15 minutes
16-24 Minutes
4 hours, 7 minutes
Fever, cold and flu Sore throat Minor burns Stomachache
• Allergies • Asthma • Colds and flu
• Ear infections • Anxiety or depression • Stress management
• Minor injuries or pain • Flu shots • Skin problems
• Colds and flu • Sore/strep throat • Allergies
• Migraine/headache • Animal bites • Cuts that need stitches • Back pain • Sprains/strains • • • •
Chest pain/stroke Seizures Head/neck injuries Heart attack
Know How to Tell Urgent Care Centers and Freestanding ERs Apart Freestanding ERs: • Have the word “Emergency” in their name or on the building • Are not attached to and may not be affiliated with a hospital • Bill separately for the ER and the doctor, even if the care you need is minor
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• Ear or sinus pain • Physicals • Shots • Minor allergic reactions
Registered nurses are on call to answer your health questions 24 hours a day, 7 days a week, in English or Spanish
29 seconds
FREE
$
Examples of Health Issues
• Fainting/dizziness, weakness • Uncontrolled bleeding • Problem breathing • Broken bones
UnitedHealthcare Tools myuhc.com
Tools myuhc.com
All your health plan information in one place. How convenient is that? myuhc.com is your personalized member website to help you access and manage your medical, dental and vision plan details 24/7. Find and price care. Find a provider and get personalized estimates for the services in your network, including doctors, dentists, hospitals, labs and convenience and urgent care clinics. For minor health concerns, register for a Virtual Visit** and pay $50† or less to see a doctor on your smartphone, tablet or computer. See what’s covered. Easily see what your plan covers and how much it costs for common services, including preventive care visits, urgent care visits, flu vaccines, chiropractic services and more. You also have access to your plan documents, member handbook, required notices and welcome materials. Check your plan balances. Get quick access to review the status of your deductible, coinsurance and out-of-pocket limit. Access claim details. View your claims history and easily see how your claim was processed, what your plan covered and what you may owe your provider. You can also access and submit claims forms and pay your provider directly online.
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Sign up in minutes at www.myuhc.com today. • Easily access and manage your plan details. • Dependents over age 18 can create their own accounts. • Have your health plan ID card handy.
Health Savings Account (HSA) O p t u m B a n k ®/ U n i t e d H e a l t h c a r e
Introduction to Health Savings Accounts
A health savings account (HSA) allows you to save money for qualified medical expenses that you’re expecting, such as contact lenses or monthly prescriptions, as well as unexpected ones — for this year and the future.
Why have an HSA?
You own it The money is yours until you spend it, even deposits made by others, such as an employer or family member. You keep it, even if you change jobs, change health plans or retire. Tax savings HSAs help you plan, save and pay for health care, all while saving on taxes. • The money you deposit is federal income tax-free. • Savings grow tax-free. • Withdrawals for qualified medical expenses are also income tax-free. It’s not just for doctor visits Once you’ve contributed to your account, you can use the funds in your HSA to pay for qualified medical expenses such as: • Dental care, including extractions and braces • Vision care, including contact lenses, prescription sunglasses and LASIK surgery • Prescription medications • Chiropractic services • Acupuncture Save for the future Your HSA rolls over from year to year, so you can continue to grow your savings and use it in the future - even into retirement.
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Contribution limits There are contribution limits, set by the Internal Revenue Service (IRS) and adjusted annually. The 2021 contribution limits are: • $3,600 - Single • $7,200 - Family • You are eligible to contribute an additional $1,000 if you’re 55 or older.
Health Savings Account (HSA) O p t u m B a n k ®/ U n i t e d H e a l t h c a r e
Managing Your HSA: Helpful Online Tools Once you’ve opened a health savings account (HSA) with Optum Bank ® , you have access to a number of tools and resources, making it easy to manage your account online. They can help you use your HSA today and help plan for the future. www.optumbank.com Log in to your account anywhere, any time to: • Pay bills to physicians, dentists or other health care providers • Reimburse yourself • Set up and manage account alerts • Upload and store receipts • Check monthly statements • Download account forms • Update your email address or change your mailing address • Manage investment activity
HSA calculators Visit www.optumbank.com for calculators that can help you manage your HSA now and in the future. • Find out your maximum contribution limit based on your plan type (individual or family), your age and amount that your employer contributes to your account. • Calculate your yearly tax savings based on how much you plan to contribute to your HSA. Contribution tracker Log in to your account at www.optumbank.com to find out what your contribution limits are. See how much you have contributed to your HSA year-todate, and how much more could be contributed according to your plan coverage (individual or family) with the contribution tracker. Optum Bank® debit MasterCard® Use the Optum Bank® Health Savings Account Debit Mastercard to: • Pay on-the-spot at a doctor’s office, pharmacy or other health care facility. • Pay a bill you receive from a doctor or other provider. • Withdraw funds from an ATM to reimburse yourself for expenses you paid out-ofpocket.
Health Savings Checkup Wondering how much money you will need for health care expenses in retirement? Take the Optum Health Savings Checkup at www.healthsavingscheckup.com. Answer a few questions about your health, your HSA activity and retirement goals, and you will receive a personalized snapshot of your potential health care expenses in retirement. It will show you how much Medicare will cover, what your predicted HSA balance will cover and how much more you might need to plan on saving. You’ll also get ideas to help you stay healthy, spend less and save more.
Investments are not FDIC insured, are not guaranteed by Optum Bank ® , and may lose value. Mutual fund investment options are made available through the services of an independent investment advisor and shares are offered through Devenir, LLC, a registered broker-dealer. Orders are accepted to effect transactions in securities only as an accommodation to HSA owner. Optum Bank ® is not a broker-dealer or registered investment advisor, and does not provide investment advice or research concerning securities, make recommendations concerning securities, or otherwise solicit securities transactions. Health savings accounts (HSAs) are individual accounts offered or administered by Optum Bank ® , Member FDIC, and are subject to eligibility requirements and restrictions on deposits and withdrawals to avoid IRS penalties. State taxes may apply. Fees may reduce earnings on account. This communication is not intended as legal or tax advice. Federal and state laws and regulations are subject to change. © 2017 Optum, Inc. All rights reserved. PR1557 66355-062017
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Dental Benefits UnitedHealthcare
DEDUCTIBLE Individual Family BENEFIT MAXIMUM Non-Orthodontic Services Orthodontic Services
NETWORK
NON-NETWORK
$50
$50
$150
$150
$1,500 per person per calendar year $1,500 per person per lifetime
$1,500 per person per calendar year $1,500 per person per lifetime
PREVENTIVE SERVICES (not subject to deductible) Periodic Oral Exam member pays $0 (limited to 2 per 12 months) Prophylaxis member pays $0 (limited to 2 per 12 months) Fluoride Treatment (for children under age 16; member pays $0 2 treatments per 12 months) Sealants (for children under age 16; member pays $0 1 per molar per 36 months) Space Maintainers (for children under age 16; member pays $0 1 per 60 months) Bitewing X-rays member pays $0 (1 series per calendar year) Panoramic/Full Series X-ray member pays $0 (1 per 36 months) BASIC RESTORATIVE SERVICES Amalgam, Resin & Composite member pays 20%, after deductible Restorations Endodontics (root canal therapy, pulpotomy, member pays 20%, after deductible pulpal therapy/debridement) Periodontics (gingivectomy, gingivoplasty, scaling/ member pays 20%, after deductible root planing) ORAL SURGERY Biopsy, simple extractions, surgical member pays 20%, after deductible extractions Anesthesia, intravenous sedation member pays 20%, after deductible MAJOR RESTORATIVE SERVICES Crowns, Onlays/Inlays member pays 50%, after deductible Dentures and bridges ORTHODONTIC SERVICES (adult and child) Fixed or removable appliance
member pays 20%, no deductible member pays 20%, no deductible member pays 20%, no deductible member pays 20%, no deductible member pays 20%, no deductible member pays 20%, no deductible member pays 20%, no deductible member pays 20%, after deductible member pays 20%, after deductible member pays 20%, after deductible
member pays 20%, after deductible member pays 20%, after deductible member pays 50%, after deductible
member pays 50%, after deductible
member pays 50%, after deductible
member pays 50%, no deductible
member pays 50%, no deductible
*MAXIMUM ALLOWABLE CHARGE The Maximum Allowable Charge (MAC) refers to the nationally established allowance for a procedure or service. The member is responsible for any balance billing. 16
Dental Benefits
UnitedHealthcare (available to California employees only) DHMO (California Only) In-Network Only DEDUCTIBLE Individual
None
Family
None
BENEFIT MAXIMUM Non-Orthodontic Services
Unlimited
Orthodontic Services
See below
PREVENTIVE SERVICES (not subject to deductible) Periodic Oral Exam (limited to 2 per 12 months)
Member pays $0
Prophylaxis (limited to 2 per 12 months)
Member pays $0
Fluoride Treatment (for children under age 16; 2 treatments per 12 months)
Member pays $0
Sealants (for children under age 16; 1 per molar per 36 months)
Member pays $0
Space Maintainers (for children under age 16; 1 per 60 months)
Member pays $25 copay (fixed) Member pays $35 copay (removable)
Bitewing X-rays (1 series per calendar year)
Member pays $0
Panoramic/Full Series X-ray (1 per 36 months)
Member pays $0
BASIC RESTORATIVE SERVICES Member pays $0 - $55 depending on complexity
Amalgam, Resin & Composite Restorations
Member pays $0 - $295 depending on complexity Member pays $30 - $325 depending on complexity
Endodontics (root canal therapy, pulpotomy, pulpal therapy/debridement) Periodontics (gingivectomy, gingivoplasty, scaling/root planning )
ORAL SURGERY Member pays $0 - $225 depending on complexity Member pays $0 - $70 depending on complexity
Biopsy, simple extractions, surgical extractions Anesthesia, intravenous sedation
MAJOR RESTORATIVE SERVICES Crowns, Onlays/Inlays
Member pays $85 - $1,185 depending on complexity
Dentures and bridges
ORTHODONTIC SERVICES (adult and child) Member pays up to $1,895 depending on complexity
Fixed or removable appliance
IMPORTANT • The first step in using your new plan is to select a primary care dental group. All of your dental services must be coordinated by this group, so it is important to do this when you first become a plan member. You can easily find a listing of providers in your dental network at www.myuhcdental.com. Each family member can select his or her own dental Provider Group from our directory. You can change your dental Provider Group by simply calling Member Service before the 20th of any month. You will be assigned to your new dental Provider Group by the 1st of the following month. • Take your UnitedHealthcare Dental ID card with you to your office visit. • All you pay is the copayment required for the covered service, and you’re on your way. There are no bills, no claim forms. • If your dentist recommends treatment that is not covered under your plan, or you elect services or materials that are not covered under your plan, you will have to pay more out-of-pocket expenses. (Consult your plan booklet for a complete list of covered services and their copayments.) This is only a brief summary of the plan and is not intended to be a complete disclosure of the plan qualifications and limitations. The dental contract must be consulted to determine the exact terms and conditions of coverage. A certificate of coverage will be provided to you upon enrollment in the plan. If you wish to review the certificate of coverage prior to enrollment, please refer to the document library available in the bswift® enrollment platform at www.AH4R.bswift.com .
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Vision Benefits UnitedHealthcare NETWORK
NON-NETWORK
FREQUENCY
Eye Exam
$10 copay
up to $40
every 12 months
Materials/Eyewear (either glasses or contacts allowed per frequency)
$10 copay
n/a
every 12 months
Standard Correct Lenses • Single vision • Lined bifocal • Lined trifocal • Lenticular Standard Lens Enhancements • Ultraviolet coating • Anti-reflective coating • Polycarbonate • Progressive • Scratch-resistant coating • Tints • Photochromic
covered in full after copay
up to $40 up to $60 up to $80 up to $180 every 12 months
discounts may apply
Applied to the allowance for the applicable corrective lens
Frame Allowance
$130 allowance
up to $45
every 12 months
Contact Lenses - elective (in lieu of lenses & frame)
$150 allowance
up to $105
every 12 months
covered in full after copay
up to $210
every 12 months
Contact Lenses - necessary (in lieu of lenses & frame) VALUE-ADDED FEATURES Additional Pairs of glasses
Laser Vision Correction
How to Locate a Network Provider
20% off additional pairs of prescription eyeglasses or contact lenses at certain participating network providers. Laser vision correction from QualSight® LASIK.* • Receive 40% – 50%** off laser vision correction plus discounts on newer technologies such as Custom Bladeless (all laser) LASIK. • Over 1,000 locations nationwide. • Visit https://uhc.qualsight.com/ or call 1-855-321-2020 Go to www.myuhcvision.com 1) Look for the “Provider Quick Search” box in the upper right-hand corner of the screen 2) Enter your search options (zip, city, state, etc.) Or dial 1.800.839.3242 to use the UnitedHealthcare Interactive Voice Response (IVR) system.
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Healthcare Flexible Spending Account (FSA) UnitedHealthcare
TRADITIONAL HEALTHCARE FLEXIBLE SPENDING ACCOUNT(FSA) You may participate in the Traditional Healthcare FSA which allows you to set aside a portion of your salary before taxes, to pay for qualified healthcare expenses. You may use these funds to pay for eligible medical, dental, and vision expenses for you, your spouse, and your eligible dependents as long as they are claimed as dependents on your federal taxreturn. The required minimum election is $250. The maximum amount you can elect for 2021 is $2,750. IMPORTANT: You cannot participate in a traditional Healthcare FSA if you are currently making contributions to a Health Savings Account (HSA). However, you may participate in a Limited Purpose FSA as discussed below. LIMITED PURPOSE FLEXIBLE SPENDING ACCOUNT (LPFSA) The limited purpose FSA is a flexible spending account that only reimburses for eligible dental and vision expenses. The LPFSA is available to employees who are enrolled in the HSA plan. The maximum amount you can elect for 2021 is $2,750. USE IT OR LOSE IT Be conservative in your estimate. The IRS has a “Use It or Lose It” rule in place for FSAs. Funds not spent by the end of a plan year (December 31st) are at risk of being forfeited. Note: The AH4R FSA plan includes a “grace period” allowing you to incur expenses through March 15th of the following year while using the unspent funds from the prior year to pay for them. Using your F S A is easy. Automatic payment Direct deposit: Reimbursement can be deposited directly into your personal bank account. Online claim form: easily submit your claims at www.myuhc.com to get reimbursed from your FSA Learn more at www.welcometouhc.com/fsa
Take charge of your FSA. With myuhc.com.com and the UnitedHealthcare mobile app, it’s easy to manage your FSA account. Submit claims Track account balances Receive direct deposit for fast reimbursements
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The MasterCard® Healthcare Spending Card Your FSA comes with this handy debit card, which makes it easy to pay for services from your FSA.
Dependent Care Flexible Spending Account (FSA) UnitedHealthcare
DEPENDENT CARE ACCOUNT (DCA) A Dependent Care Flexible Spending Account (DCA) is a benefit that lets employees set aside pre-tax dollars to help pay for dependent care. Contributing to this type of account reduces taxable income and spreads the benefits of pre-tax dollars throughout the year, helping you save 30 percent or more on your dependent care costs. DEPENDENT CARE FLEXIBLE SPENDING ACCOUNT ELIGIBILITY Funds can be used to pay for childcare for children under age 13 when they’re claimed as qualifying dependents. To be eligible for the Dependent Care FSA, you and your spouse (if applicable) must be employed, or your spouse must be a full-time student or looking for work. BIG SAVINGS POTENTIAL Let’s say you enroll and contribute the $5,000 per year into a Dependent Care FSA (which is the maximum allowed by the IRS) and pay the average American tax rate of 29.8 percent. By putting that money aside before paying taxes on it rather than allowing the funds to be taxed, you’d save nearly $1,500 for the year! Note: The limit is $2,500 per person per year for married couples who file taxes separately.
WEIGHING THE TAX CREDIT The IRS offers a tax credit to those who have childcare or dependent care expenses. You can’t enroll in pre-tax benefits and apply for the tax credit with the same funds. However, the tax credit is $6,000 per year for two or more children, which is $1,000 more than a Dependent Care Flexible Spending Account's annual limit. It’s possible to apply the tax credit to the difference of what you put into dependent care and the tax credit. For example, if you’re putting $5,000 into the account, that would leave $1,000 that you can apply the tax credit to before you’ve reached the $6,000 ceiling for the credit.
IMPORTANT Unlike the healthcare FSA, the total funds you contribute annually to a dependent care FSA are not immediately available at the beginning of the plan year. Dependent care FSA funds are deposited over 26 pay periods, therefore you only have access to the funds that have been deposited into your account. 20
Life & Accidental Death Benefits Prudential
EMPLOYER PAID BASIC LIFE AND AD&D INSURANCE AH4R provides basic term life insurance including accidental death & dismemberment equal to one-half your base annual earnings to a maximum of $250,000. Base annual earnings do not include commissions, bonuses, overtime pay, shift differential pay or any other earnings. Coverage will end upon an employee’s separation of employment and may be converted to an individual life insurance policy. SUPPLEMENTAL LIFE AND AD&D INSURANCE In addition to the Basic Term Life and AD&D Insurance provided by AH4R, employees have the option to purchase additional Term Life and AD&D Insurance described below. Follow this link to learn more about the need for life insurance: www.prudential.com/mos-life. SUPPLEMENTAL TERM LIFE/AD&D
Employee
• Purchase coverage in increments of $10,000 to a maximum of $500,000, not to exceed 5 times your annual earnings. • Guarantee Issue: • New Hires: eligible to elect up to $210,000 without proof of good health. • Late entrants: all elections are subject to proof of good health; evidence of insurability (EOI) is required. • Current Participants: During annual enrollment periods, if you have not been previously denied coverage, you may increase your current coverage in $10,000 increments not to exceed $50,000 without providing evidence of insurability (EOI) up to the guarantee issue amount of $210,000. • Benefit Reduction Schedule: 33% @ age 65, 55% @ age 70, 70% @ age 75, 80% @ age 80, 85% @ age 85, 90% @ age 90
Spouse
• Purchase coverage for your spouse in $5,000 increments to a maximum of $250,000 not to exceed 50% of your own election amount. • Guarantee Issue: • New Hires: eligible to elect up to $50,000 without proof of good health. • Late entrants: all elections are subject to proof of good health; evidence of insurability (EOI) is required. • Current Participants: During annual enrollment periods, if you have not been previously denied coverage, you may increase your current coverage in $5,000 increments not to exceed $10,000 without providing evidence of insurability (EOI) up to the guarantee issue amount of $50,000. • Benefit Reduction Schedule: 33% @ age 65, 55% @ age 70, 70% @ age 75, 80% @ age 80, 85% @ age 85, 90% @ age 90
Dependent Child(ren)
• Choose from $1,000, $5,000 or $10,000 in coverage for your children, not to exceed 50% of your own election amount. • Coverage begins at 14 days and continues to age 26 if unmarried. • Guarantee Issue: proof of good health not required.
You must provide your beneficiary designation for this coverage during enrollment. If you elect any beneficiaries under the age of 18, the benefit amount will be put into an interest-earning account until the individual turns 18. If your spouse is not being designated as a beneficiary, certain community property states will require completion of a Spousal Consent Form. The IRS requires that AH4R report the value of any company-paid life insurance coverage over $50,000 on your W-2. This value, called imputed income, is subject to federal, state and Social Security taxes. 21
Voluntary Short-Term Disability Prudential
What is Group Short-Term Disability Coverage? Group Short-Term Disability Coverage provides you with benefits to replace part of your paycheck when you can’t work because of a sickness or injury. Short-Term Disability coverage is intended to provide financial protection for a disability lasting just a few weeks. Below are a few examples of how your ShortTerm Disability benefits could be used, depending on how much coverage you have: • Everyday expenses, such as groceries, utilities, house payments and car payments • Medical bills and recovery expenses • Support services during your recovery What are some common causes of a disability? • Pregnancy/childbirth • Heart Disease • Accidental injury • Cancer • Back injuries • Tendonitis
• Rotator cuff surgery • Arthritis • Carpal tunnel syndrome
ELIGIBILITY & COVERAGE Who is eligible? What amount of coverage am I eligible for? What is the waiting period?
Are there pre-existing limitations?
All active full-time employees working a minimum of 30 hours per week 60% of your weekly earnings to a maximum benefit amount of $1,500 • For disabilities caused by a non-occupational accidental injury or illness = 7 days • Maximum benefit period = 12 weeks Pre-existing conditions include any physical or mental condition, whether diagnosed or undiagnosed, resulting from an injury or sickness for which you received physician’s advice or treatment within 3 months prior to your effective date of coverage. Benefits for a pre-existing condition are not payable for your first 12 months of coverage.
Follow this link to learn more about the need for disability insurance: www.prudential.com/mos-disability Day 1
Week 13
Day 8 Waiting period
Short Term Disability benefits paid
PTO/ sick time (if available)
Return to work or transition to Long- Term Disability
VOLUNTARY SHORT-TERM DISABILITY AGE