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2023 Benefits Enrollment Guide [Annual Open Enrollment]_FINAL Flipbook PDF
2023 Benefits Enrollment Guide [Annual Open Enrollment]_FINAL
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Benefits Enrollment Guide
Plan Year 2023 [Annual Open Enrollment]
Welcome to Your 2023 Benefits Open Enrollment Please take the time to review all of the benefit resources prior to the Annual Open Enrollment period of Monday, October 31, 2022 through Friday, November 18, 2022. Annual Open Enrollment elections for 2023 must be completed no later than 5:00 pm CT Friday, November 18, 2022. This year’s open enrollment period is active which means you are required to make an active plan selection during this year’s Annual Open Enrollment period for 2023 coverage. You will not be automatically defaulted into your current 2022 plan elections if no action is taken. Benefit plan
If no action taken
Medical, Dental, Vision, Accident, Critical Illness, Flexible Spending Accounts (FSA), Health Savings Account (HSA)
If you do not make a plan selection, you will be defaulted to waive coverage. Your next opportunity to enroll in these plans will be January of 2024.
Voluntary Life/AD&D, Voluntary Short & Long Term Disability
If you do not make a plan election for 2023 you will be defaulted to waive coverage. Your next opportunity to enroll in these plans will be January of 2024. If you choose to re-enroll for the 2024 plan year, you may be required to submit evidence of insurability for any elected amount and your election could be denied. Failure to re-enroll for 2023 may result in the forfeiture of guarantee issue amounts.
Basic Life/AD&D plan, MeMD Telehealth (full-time employees only)
These benefits are provided to you at no cost by Caregiver. You will automatically be defaulted into these plans for 2023.
You have two options to complete your enrollment: Schedule a telephonic enrollment with our benefit counselors at AGM who will guide you through the enrollment process (see page 4). Access the self-service benefits portal, bswift® at www.caregiver.bswift.com (see page 5). The choices you make during your enrollment period will remain in effect through Dec. 31, 2023, 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 2023 and he or she is covered under your plan, his or her coverage will end on the last day of their birthday month. This termination of coverage is an IRS-qualified life event which allows your child to elect COBRA coverage, coverage through the Exchange or other group health plan.
Disclaimer: 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 caregiver.bswift.com .
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2023 Highlights
Telehealth
C L I C K TO G O TO A TO P I C :
MeMD gives all full-time employees and their family members 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. See page 8 for details.
Page Eligibility
4
How to Enroll
5
CG Hub Mobile App
8
Telehealth Benefits
9
Medical Benefits (Options 1, 2, 3)
11
Prescription Drug Benefits (Options 1, 2, 3)
13
Medical Benefits (Options 4, 5, 6)
14
Health Savings Accounts (HSA)
20
Medical (options 4,5,6)
Healthcare Flexible Spending Account (FSA)
21
Dependent Care Flexible Spending (DCFSA)
22
Dental Benefits
23
In addition to the three plans administered by Lucent Health, we will continue to offer the three plans administered by Pan-American: Minimum Essential Coverage only (MEC), Limited Basic and Limited Enhanced. More information can be found on pages 12-17.
Vision Benefits
25
Life/AD&D Benefits
26
Short-Term Disability Benefits
27
Long-Term Disability Benefits
28
Accident Benefits
29
Critical Illness Benefits
30
Employee Assistance Program (EAP)
31
401k
32
Payroll Deductions
33
Important Notices
35
Important Contact Information
36
Medical (options 1,2,3) We will continue to offer three plans: the Gold Plan, Silver HSA Plan and Bronze HSA Plan. Our plans will be administered by Lucent Health. All plans will have the same benefit levels as last year. See more on pages 9-11.
Dental Routine dental care is a non-invasive way to catch serious oral health problems before they get out of hand which is why we will continue to offer a dental plan insured by MetLife. Learn more on pages 21-22.
Vision An eye exam helps detect eye problems at their earliest stage — when they're most treatable. That is why we are continuing our partnership with MetLife to provide employees with comprehensive vision care. More information can be found on page 23. 3
Benefits Eligibility Employees • Full-time employees, actively working a minimum of 30 hours per week are eligible for all benefits. • Part-time employees working 20 or more hours per week will be automatically enrolled in Basic Life/AD&D insurance at no cost. Part-time employees are only eligible for the employer sponsored Basic Life & AD&D. Spouse/Domestic Partner • All benefits: Your legally married spouse (same or opposite sex) • Major Medical Benefits (Lucent) only: Your domestic partner 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, in most cases, the fair market value of your DP’s or DP’s children’s (if they are not federal tax dependents) healthcare coverage will be taxable to you as imputed income. This value is determined by the amount that the company pays in premium for DP coverage. This amount raises your taxable gross income. Also, the payroll deductions to cover a DP must be taken on an after-tax basis. 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. 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.
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How to Enroll AGM/bswift®
Open Enrollment is simpler than ever. You can schedule a call with an AGM benefits counselor to walk you through the benefits and your enrollment, or you can access our benefits enrollment system bswift®, where you can complete your own self-service enrollment. You may also download and login to the CG Hub app to access your benefits information, as well as schedule an appointment with AGM or connect to bswift®. Employees can enroll or make changes to current elections by phone Monday, October 31 thru Friday, November 18, 2022 from 8:30 AM - 5:00 PM CT. Please be sure to schedule your telephonic enrollment appointment through the CG Hub app, by going to https://a.flexbooker.com/reserve/caregiverinc#chooseService or by calling 1-844-880-6774
OR If you wish to enroll or waive coverage on your own, access your enrollment portal through the CG Hub app or go to www.caregiver.bswift.com
Please be sure to have all dependent information when calling to enroll (dependent's name, social security number, mailing address and date of birth). IMPORTANT: IMPORTANT: Your email address is required to login to both bswift® and the CG Hub app. Go to: https://myidd.com 1) Enter company email: [email protected] Ex. [email protected] 2) Password: Welcome(first initial)(last initial)! Ex. WelcomeJD! If you have questions about your company email or are unable to access your company email, contact IT at [email protected]. 5
How to Enroll bswift®
1) Go to http://www.Caregiver.bswift.com a. Login using your Caregiver email address. If this is your first time accessing bswift®, your password is your date of birth, using the MMDDYYYY format. (example, if your birthday is 06/14/1975, it would be 06141975.) You will be prompted to change your password.
2) Review your employee information for accuracy (name, SSN, address, etc.) a) If you need to update any information, please make your updates in UKG. The changes will then be updated in bswift®. b) You can return to bswift® to complete your enrollment. c) Click “I agree” at the bottom to continue. 3) Review your family information for accuracy (name, date of birth, SSN, etc.). This is your opportunity to add new dependents or remove dependents. Click “I agree” at the bottom to continue. 4) When walking through your benefits, you can either select “I don’t want this benefit (waive)” to waive the plan, or “View Plan Options” to view more information about the plans being offered to you. Benefits that are 100% paid by Caregiver will be already selected for you without the option to waive.
If you select “I don’t want this benefit (waive)”, simply move onto the next benefit to elect or waive. If you select “View Plan Options”, you will be prompted to choose any dependent(s) that you will be covering for the specified benefit by selecting the checkbox next to their name. Once you have selected your dependent(s), click Continue. The available plan(s) that are offered to you will appear. If there are multiple plans available to choose from, you will have the option to select “View All Plans Side-by-Side”. To enroll in a plan, click “Select”.
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How to Enroll (cont.) bswift®
5) After selecting a plan, you will return to the main enrollment screen. Your total cost per pay period will be visible on the right side of the screen. 6) Once you have completed your benefit selection for all available plan types, click “Continue” at the bottom right of the page. You can click “Save and Finish Later” at any time if you are not ready to complete your benefits enrollment. You can return and make changes to your benefit selection at any time through the open enrollment period. Any changes that are saved but not completed prior to the end of Open Enrollment will NOT go into effect 01/01/2023. 7) Next, you will be prompted to choose your Beneficiaries for applicable plan types. Your dependents will automatically appear on this page; however, you can also add a beneficiary that is not a dependent by clicking “Add New Beneficiary”. Once you have designated your beneficiaries, click “Continue” at the bottom right of the page. 8) From the Confirmation Page, review your benefit selections and click the “I Agree” button at the bottom of the page. You will then click “Complete Enrollment” at the right of the page. Your elections are not valid and will not be transmitted to the insurance vendor until you have completed this step. IMPORTANT: Your enrollment is not complete until you attest that you have completed your benefit elections as shown in the below image.
9) Once you’ve completed your enrollment, you will have the option to View, Email, or Print a copy of your Confirmation Statement. You can also view your Confirmation Statement at any time by logging into the bswift® system and navigating to My Benefits > Current Benefits.
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Introducing the CG Hub Mobile App Powered by Strive
How to access the app: ENTER EMAIL Open Caregiver & enter the email address that received the welcome email
CHECK EMAIL/TEXT Enter your mobile number & check your email or text for a one-time pin (OTP). It may take a minute to arrive
ENTER OTP Enter the one-time pin into the app where prompted
SET PIN Set a 6-digit pin and login! Everything is now in the palm of your hand
What's in it for you? Build your experience to utilize what's important to you
Prioritize your overall wellbeing & reach your goals
Join your community & access important messages 24/7
Maximize your benefits & make educated decisions
Start building your experience. Download today:
Start building your experience. Download today: 8
Telehealth – Virtual Urgent Care MeMD powered by the CG Hub App
This benefit is offered to ALL full-time Caregiver employees and their families at no additional cost, even if you are not enrolled in a Caregiver Medical plan.
$0 COPAY
OPEN 24 HOURS
SKIP URGENT CARE
DIRECT INTEGRATION
Free for EE's and their dependents. Does not go towards members insurance
Doctors are available 24 hours a day, 365 days a year. at the touch of a button
No need to wait in germy waiting rooms. Treat minor injuries & illnesses virtually
Access directly in app to connect with quality providers and view care instructions.
Available through the CG Hub app:
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Telehealth – Virtual Primary Care (VPC) MeMD powered by the CG Hub App
What is Treated with MeMD’s Solution Virtual Primary Care provides comprehensive diagnosis and treatment for chronic conditions, behavioral health, illness or injury, and gender-specific health concerns. > Illness or Injury > Chronic Care • Acne • Asthma • Allergies • Diabetes • Asthma • Blood pressure • Bites and stings • Crohn’s disease • Body aches • Cystic Fibrosis • Cough/Bronchitis • COPD • Dental pain • Gout • Diarrhea • Autoimmune diseases • Fever/Flu • Migraine • Gout • And more • Lice • Medication refills > Behavioral Health • Migraines • Depression • Nausea • Postpartum • Respiratory infections depression • Sexually transmitted • Anxiety infections • Bipolar disorder • Sprains and strains • ADD/ADHD • And more • Insomnia • Obsessivecompulsive disorder
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> Men’s Health • Erectile dysfunction • Enlarged prostate • Hair loss • Performance anxiety • Premature ejaculation • Prostatitis • Cold sores • Genital herpes • Genital warts • STIs/sexual health • And more > Women’s Health • Initial birth control prescription • Hair loss • Low sex drive • Hot flashes • UTI/bladder infection • STIs/sexual health • Mastitis • Vaginal yeast infections • And more
Get the preventative, ongoing and situational care you need without the financial stress with MeMD’s virtual primary care visits within as little as 24 hours for a
$55 visit fee.
Medical Benefits (Options 1, 2, 3) Lucent Health
Whether you want more choices or more monthly savings, Caregiver offers three unique medical plan options to choose from. 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. As a participant in these plans, you have the freedom to seek care from the provider of your choice. All plans are Value Based Pricing, which means the provider’s payment will be based on a percentage of what Medicare would pay.
GOLD PLAN
SILVER PLAN HSA Compatible
• For this plan you will have copays for physician visits, urgent care visits, and prescription drugs. • For all other services, you will pay 10% after you meet the annual deductible. • This plan has the highest premium cost share of the 3 plans.
• This plan has a lower deductible and a lower out-of-pocket maximum than the Gold Plan. However, unlike the Gold Plan, you will be responsible for meeting your deductible before any services will be reimbursed by the plan. • Under the Silver Plan, your premiums will be lower than the Gold plan and you will have the opportunity to contribute pre-tax dollars into an HSA Account for the 2023 Plan Year. THERE ARE NO COPAYS ON THIS PLAN, AND BENEFITS WILL NOT BE PAID UNTIL YOU HAVE MET THE DEDUCTIBLE.
MOST EXPENSIVE
BRONZE PLAN HSA Compatible • The Bronze HSA Plan has a higher deductible, but once you’ve satisfied your deductible, your expenses are paid at 100%. • This plan has the lowest premium cost share of the 3 plans. • Enrollment in the Bronze plan also allows you the opportunity to contribute pre-tax dollars into an HSA account for the 2023 Plan Year. THERE ARE NO COPAYS ON THIS PLAN, AND BENEFITS WILL NOT BE PAID UNTIL YOU HAVE MET THE DEDUCTIBLE.
LEAST EXPENSIVE
All health plans are Value Based Pricing. This means you need to call Narus Health Concierge to assist with navigating your care with providers. 11
Medical Benefits (Options 1, 2, 3) Lucent Health
Gold Plan
Silver Plan
Bronze Plan
HSA Compatible
HSA Compatible
PPO AND NON-PPO BENEFITS Annual Deductible/Member Coinsurance - Member pays: Individual
$4,000
$3,000
$6,500
Family
$8,000
$6,000
$13,000
10%
20%
0%
Coinsurance
Out-of-Pocket Maximums - Member pays: Individual
$6,500
$5,000
$6,500
Family
$13,000
$10,000
$13,000
Physician and Diagnostic Services - Member pays: Preventive Care
no charge
no charge
no charge
Office Visit (PCP/Specialist)
$25 copay PCP $50 copay Specialist
20% after deductible
0% after deductible
$0 through MeMD
$0 through MeMD
$0 through MeMD
Telemedicine Maternity/ OB-GYN Visits X-rays/Complex Imaging
Preventive Prenatal - $0 Preventive Prenatal - $0 Office Visit - $25 copay Office Visit - 20% after ded Delivery - 10% after deductible Delivery - 20% after deductible 10% after deductible
Preventive Prenatal - $0 Office Visit - 0% after ded Delivery - 0% after deductible
20% after deductible
0% after deductible
Hospital Services - Member pays: Inpatient
10% after deductible
20% after deductible
0% after deductible
Outpatient
10% after deductible
20% after deductible
0% after deductible
Emergency Services - Member pays: Emergency Room
10% after deductible
20% after deductible
0% after deductible
Ambulance
10% after deductible
20% after deductible
0% after deductible
Urgent Care
$50 copay
20% after deductible
0% after deductible
PPO Network Texas and Indiana Employees Only All other states
HealthSmart PPO Network
To find a preferred provider through HealthSmart visit https://providerlookup.healthsmart.com or call (888) 585-3309
PHCS (MultiPlan) PPO Network
To find a preferred provider through PHCS visit www.multiplan.com/lucenthealthphcs or call (888) 585-3309
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 Summary Plan Description (SPD) must be consulted to determine the exact terms and conditions of coverage. The Summary Plan Description (SPD) is available for review in the document library in the bswift® enrollment platform at www.caregiver.bswift.com.
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Prescription Drug Benefits (Options 1, 2, 3) Benecard
It is important to be an informed consumer, especially with your prescription drug options. All three medical plans include prescription drug coverage. With Benecard, you have access to pharmacies nationwide. Silver Plan HSA Compatible
Gold Plan PPO
NON-PPO
PPO
NON-PPO
Bronze Plan HSA Compatible PPO
NON-PPO
PRESCRIPTION DRUGS – Member Pays Tier 1 Retail (generic)
Tier 2 Retail (preferred brand)
Tier 3 Retail (non-preferred brand)
Tier 4 Specialty (30 days)
Mail Order (up to 90 days)
Preventive Drug List Preventive Mail Order
$10 copay
Not Covered
$30 copay
Not Covered
$60 copay
Not Covered
20% to maximum of $10/$30/$60 copay
Not Covered
2x retail copay
Not Covered
Same as retail
Not Covered
2x retail copay
Not Covered
$3 copay after deductible $25 copay after deductible $50 copay after deductible 20% to a maximum of $3/$25/$50 copay 2x retail copay after deductible $3/$25/$50 copay, deductible waived 2x copay, deductible waived
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 or the discounted price of the drug up to your deductible based on the type of prescription you receive, and the plan you’re enrolled in.
Not Covered Not Covered Not Covered Not Covered Not Covered Not Covered Not Covered
0% after deductible 0% after deductible 0% after deductible 0% after deductible 2x retail copay after deductible $3/$25/$50 copay, deductible waived 2x copay, deductible waived
Not Covered Not Covered Not Covered Not Covered Not Covered Not Covered Not Covered
Mail Order Pharmacy (up to a 90- day supply) With mail order prescriptions you can save time and money. How it works. 1. Order up to a 90-day supply of your maintenance medications — ones you take regularly — from Benecard Central Fill Mail Service Pharmacy.
Ask for Generic Drugs You can save money on generic drugs. The FDA requires that generic drugs have the same high quality, strength, purity and stability as brandname drugs. The next time you need a prescription, ask your doctor to prescribe a generic drug when it is available and appropriate.
2. Benecard fills your order and sends it to you. 3. Your medication arrives within two weeks. Three easy ways to set up home delivery: 1. Ask your doctor to call 888.907.0040 get instructions to fax your prescription to expedite the request.
The benefits of mail-order: Save a trip to the pharmacy.
2. MAIL. Logon to www.benecardpbf.com to find the mail order form.
Talk to a pharmacist when you have medication questions. Setup refill reminders
3. PHONE. Call Benecard anytime at 877.723.6005. 13
Medical Benefits (Option 4) Pan American – MEC Only
In addition to the three (3) medical plans administered by Lucent Health, Caregiver also offers three (3) additional limited medical plans administered by Pan American. You may choose either a plan from Lucent Health or one of the plans from Pan-American, not both. What is Minimum Essential Coverage? The MEC plan gives Caregiver employees the ability to elect an affordable means to help cover Preventive Care costs. It will pay 100% of preventive care services when using a PPO provider. That means that you pay nothing out of pocket for access to a variety of medical screenings, exams, and immunizations which may help reduce your risk of developing health conditions in the future and potentially avoid expensive treatment down the road. Difference Between Preventive and Diagnostic Services: A preventive procedure starts with the intent of confirming your good health although you may show no symptoms. Diagnostic services differ in that they are requested in order to identify the cause of a reported health condition. Services are considered Preventive Care when a person: • does not have symptoms indicating an abnormality • has had a screening done within the recommended age and gender guidelines with the results being considered normal • has had a diagnostic service with normal results, after which the physician recommends future preventive care screenings using the appropriate age and gender guidelines • has a preventive service that results in diagnostic care or treatment being done at the same time and as an integral part of the preventive service (e.g. polyp removal during a preventive colonoscopy), subject to benefit plan provisions Services are considered Diagnostic Care when: • services are ordered due to current issues or symptoms(s) that require further diagnosis • abnormal test results on a previous preventive or diagnostic screening test requires further diagnostic testing or services • abnormal test results found on a previous preventive or diagnostic service requires the same test be repeated sooner than the normal age and gender guideline recommendations would require
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Covered Preventive Services for Adults*: • Screenings for conditions such as Type 2 diabetes, depression, cholesterol, blood pressure, HIV, obesity, breast cancer, cervical cancer, pregnancy screenings, STDs, cervical cancer • Counseling for alcohol misuse, diet, obesity, aspirin use, STDs, tobacco use, domestic violence • Immunizations • Preventive Prescription Coverage Covered Preventive Services for Children*: • Screenings for conditions such as autism, vision and hearing, lead, BMI, oral health, behavioral issues, developmental, depression, HIV, obesity, STDs, • Immunizations based on recommended ages and populations. *This is not a complete list, and there are limitations. For a full list of covered services, please see the Pan American Summary Plan Documents.
Medical Benefits (Option 4) Pan American – MEC Only
One of the most valuable benefits included with your benefit package is preventive care coverage which covers 100% of eligible preventive service costs when performed by a PPO provider. That means that you pay nothing out of pocket for access to a variety of medical screenings, exams, and immunizations which may help reduce your risk of developing health conditions in the future and avoid expensive treatment down the road. PPO (member pays)
NON-PPO (member pays)
0% no deductible
100% of all billed charges
0% no deductible
100% of all billed charges
0% no deductible
100% of all billed charges
0% no deductible
100% of all billed charges
COVERED PREVENTIVE SCREENING FOR ADULTS • Abdominal aortic aneurysm (one-time screening for men of specified ages who have ever smoked) • Alcohol misuse • Blood pressure • Cholesterol (for adults of certain ages or at higher risk) • Colorectal cancer (for adults over 50) • Depression • Type 2 diabetes (for adults with high blood pressure) • Hepatitis B (for virus infection in persons with high risk) • Hepatitis C (for infection in persons at high risk) • HIV (for all adults at higher risk) • Lung Cancer (for adults age 55-80 with a 30-pack per year smoking history and who currently smoke or quit within the past 15 years) • Obesity • Tobacco use • Syphilis (for all adults at higher risk)
COVERED PREVENTIVE COUNSELING FOR ADULTS • Alcohol misuse • Aspirin use for men and women of certain ages and cardiovascular risk factors • Diet (for adults with higher risk for chronic disease) • Human Immunodeficiency Virus (HIV) for sexually active women • Obesity • Sexually transmitted infection (STI) prevention (for adults at higher risk) • Tobacco use (including programs to help you stop using tobacco)
COVERED IMMUNIZATIONS FOR ADULTS • • • • • • • • • •
Diphtheria, pertussis, tetanus (DPT) Hepatitis A Hepatitis B Herpes zoster Human papillomavirus (HPV) Influenza (Flu) Measles, mumps, rubella (MMR) Meningococcal (meningitis) Pneumococcal (pneumonia) Varicella (chicken pox)
ADDITIONAL COVERED PREVENTIVE SERVICES FOR WOMEN • Aspirin (low dose as preventive for women who are at high risk for preeclampsia) • Breast Cancer preventive medications for women with increased risk • Contraception (FDA approved and ACA required contraceptive methods, sterilization procedures, and patient education and counseling) • Well-woman visits (recommended preventive services for women under 65) Screenings for: • Breast cancer (mammography every 1 to 2 years for women over 40) • Cervical cancer (for sexually active women) • Chlamydia infection (for younger women and other women at higher risk)
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Medical Benefits (Option 4 cont.) Pan American – MEC Only
PPO (member pays)
NON-PPO (member pays)
ADDITIONAL COVERED PREVENTIVE SERVICES FOR WOMEN (CONTINUED) Screenings for (continued): • Domestic and interpersonal violence • Gestational diabetes (for those at high risk) • Gonorrhea (for all women at higher risk) • Human Immunodeficiency Virus (HIV) (for sexually active women) • Human Papillomavirus (HPV) DNA Test: High risk HPV DNA testing every three years for women with normal cytology results who are 30 or older • Syphilis (for all pregnant women or other women at increased risk) • Osteoporosis (for women over age 60 depending on risk factors) Counseling for: • BRCA: Genetic counseling and testing for women at higher risk of BRCA-related cancer • Breast cancer chemoprevention (for women at higher risk) • Contraception (education and counseling) • Domestic and interpersonal violence • Folic acid supplements (for women of child-bearing ages) • Human Immunodeficiency Virus (HIV) (for sexually active women) • Sexually Transmitted Infections (STI): Counseling for sexually active women
0% no deductible
100% of all billed charges
0% no deductible
100% of all billed charges
Additional services for pregnant women: • Anemia screenings • Bacteriuria urinary tract or other infection screenings • Breast feeding interventions to support and promote breast feeding after delivery • Expanded counseling on tobacco use • Gestational diabetes (screening for women 24 to 28 weeks pregnant) • Hepatitis B counseling (at the first prenatal visit) • Rh incompatibility screening, with follow-up testing for women at higher risk
COVERED PREVENTIVE SCREENING FOR CHILDREN • Alcohol and drug use (for adolescents) • Autism (for children at 18 and 24 months) • Behavioral issues • Blood pressure (screening for children) • Cervical dysplasia (for sexually active females) • Congenital hypothyroidism (for newborns) • Depression (screening for adolescents) • Developmental (screening for children under age 3, and surveillance throughout childhood) • Dyslipidemia (screening for children at higher risk of lipid disorders) • Hearing (for all newborns) • Height, weight and body mass index measurements • Hematocrit or hemoglobin • Hemoglobinopathies or sickle cell (for newborns) • HIV (for adolescents at higher risk) • Lead (for children at risk of exposure) • Medical history • Obesity • Oral health risk assessment (for young children) • Phenylketonuria (PKU) (newborns) • Tuberculin testing (for children at higher risk of tuberculosis) • Vision (screening as part of physical exam, not separate eye exam)
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Medical Benefits (Option 4 cont.) Pan American – MEC Only
NON-PPO (member pays)
PPO (member pays) COVERED PREVENTIVE SCREENING FOR CHILDREN (CONTINUED) Medications and supplements: • Gonorrhea preventive medication for the eyes of all newborns Counseling for: • Fluoride (prescription chemoprevention supplements for children without fluoride in their water source) • Obesity • Sexually transmitted infection (STI) prevention (for adolescents at higher risk) • Tobacco use (education and counseling to prevent initiation of tobacco use in school-aged children and adolescents) Immunizations: • Diphtheria, pertussis, tetanus (DPT) • Hemophilus influenzæ type b • Hepatitis A • Hepatitis B • Human papillomavirus (HPV) • Inactivated poliovirus • Influenza (Flu) • Measles, mumps, rubella (MMR) • Meningococcal (meningitis) • Pneumococcal (pneumonia) • Rotavirus • Varicella (chicken pox)
0% no deductible
100% of all billed charges
Preventive Care Prescription Drug Coverage* The following chart shows categories of pharmaceuticals available to you at no cost. As lists may change, please note that in order to determine which specific drugs or brands within each of the below categories are covered under your prescription benefits, you will need to contact RxEDO at 1-888-879-7336 or go online to www.rxedo.com for more information. ITEM Aspirin Folic acid supplements
AVAILABILITY Adult men and women 45 years or more Adult women Up to 55 years
COVERAGE Generic, OTC Generic, OTC
Fluoridated drugs
6 months – 5 years
Brand, generic
Tobacco cessation
Adult men and women
• Generic or OTC only on nicotine replacement products • Limit to Generic Zyban
ADDITIONAL COVERED PREVENTIVE SERVICES FOR WOMEN Oral contraceptives
Generic, single source brands
Emergency contraception Injectable contraceptives
Generic, OTC, single source brands Adult women
Generic, single source brands
Transdermal patch
Generic, single source brands
Diaphragm and cervical cap
Generic, single source brands
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Medical Benefits (Options 5, 6) Pan American- PanaMed (Limited Medical + MEC)
Plan 1 - Basic Plan
Plan 2- Enhanced Plan
Minimal Essential Coverage (MEC) Preventive Care 0%, no deductible for PPO services only Plan Pays: $5,000 $2,500 $1,250
Includes all of the benefits shown on pages 12, 13 and 14 Group Term Life (with AD&D for employee only) Member Term Life/Member AD&D Spouse Term Life Children Term Life (6-26 months) Hospital Indemnity Benefit – 60 day calendar year max Must be admitted as an inpatient into a hospital room
Hospital Admission Indemnity Benefit (in addition to Hospital Indemnity Benefit) • One/admission, one/diagnosis when admitted as inpatient in a hospital room. • Benefit will not be payable for the same or related injury or illness. Intensive Care Benefit – 30 day calendar year max Participant is confined in a hospital ICU
0%, no deductible for PPO services only $5,000 $2,500 $1,250
$500 per day
$700 per day
$500 first day
$700 first day
$1,000 per day
$1,400 per day
$250 per day
$350 per day
$250 per day
$350 per day
$250 per day
$350 per day
$60 per day
$75 per day
$45 per day
$45 per day
$100 per day
$100 per day
$400 per day
$400 per day
Substance Abuse – 30 day calendar year max Must be diagnosed and admitted as inpatient into a substance abuse facility Mental Illness – 60 day calendar year max Must be diagnosed/admitted to an impatient mental illness facility Skilled Nursing – 57 day calendar year max Must be admitted in skilled nursing facility following a covered hospital stay of at least 3 days Doctor’s Office Visit – 5 days per calendar year 1 benefit/day if seen by a doctor for illness/injury Outpatient Diagnostic Lab* - 3 days per calendar year Glucose test, urinalysis, CBC, and others Outpatient Diagnostic Radiology* - 2 days per calendar year Chest, broken bones, and others Outpatient Advanced Studies* - 2 days per calendar year CT Scan, MRI, and others
Surgical Benefit – 1 per day per type per calendar year *excluding minor surgical procedures Inpatient - Must be performed due to illness/injury as a hospital inpatient stay $750 per day Outpatient - Must be performed due to an illness/injury at an outpatient $375 per day surgical facility center or hospital outpatient surgical facility Inpatient Anesthesia Benefit – 1 day per type per calendar year Inpatient - 25% of amount paid under the inpatient surgical benefit $187.50 per day $93.75 per day Outpatient - 25% of amount paid under the outpatient surgical benefit Emergency Room Sickness Benefit – 4 days per calendar year Pays one benefit/day for ER services received as a result of an illness
$1,000 per day $500 per day $250 per day $125 per day
$75 per day
$75 per day
Up to $2,500
Up to $2,500
$100 deductible
$100 deductible
Accident Benefit (Per Occurrence) Deductible per accident, per insured Pharmacy Benefit For Prescription questions or drug look-up for Plan 2, go to www.rxedo.com or call 1-888-879-7336.
Discounted Prescriptions
• Generic – pays $15/day, 24 days/calendar year • Brand Name – Discount only
*When hospital confinement is not required, and test is ordered or performed by a doctor. Please see the Pan American Summary Plan Documents and Benefit Guide for additional information about these benefits.
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Medical Benefits (Options 5, 6) Pan American- PanaMed (Limited Medical + MEC)
Connect with a Doctor 24x7 to Diagnose, Treat & Prescribe FOR FREE!
TOP 5 REASONS WE VISIT THE ER OR URGENT CARE ALLERGIES
BRONCHITIS
SINUSITIS
ER: $345 UC: $97
ER: $795 UC: $123
ER: $617 UC: $105
HY:$0 (FREE)
HY:$0 (FREE)
HY:$0 (FREE)
EARACHE
URINARY TRACTINFECTIONS
ER: $400 UC: $110
ER: $940 UC: $108
HY:$0 (FREE)
HY:$0 (FREE) And don’t forgetto
All family members residing in the employee’s household (spouse, children, siblings, parents, etc.) are eligible to use the HealthiestYou telemedicine benefits at no cost even if they are not enrolled in Pan-American benefits.
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Healthiestyou Is Not Health Insurance And We Encourage All Members To Maintain Adequate Insurance From A Responsible Provider. Healthiestyou Is Designed To Complement, And Not Replace The Care You Receive From Your Primary Care Physician. Healthiestyou Physicians Are An Independent Network Of Doctors Who Advise, Diagnose, And Prescribe At Their Own Discretion. Physicians Provide Cross Coverage And Operate Subject To State Regulations. Physicians In The Independent Network Do Not Prescribe Dea Controlledsubstances, Non-therapeuticdrugs And Certain Other Drugs Which May Be Harmful Because Of Their Potential For Abuse. Healthiestyoudoes Not Guarantee That A Prescription Will Be Written.
www.healthiestyou.com | customer service 855-894-9627 | designed with love in scottsdale, az 19
Health Savings Account (HSA) Wex Health
Why should I choose a health savings account (HSA)? An HSA is a benefit that allows you to choose how much of your paycheck you’d like to set aside, before taxes are taken out, for healthcare expenses or use as a retirement savings tool. This plan offers more tax savings than a traditional and Roth 401(k) and IRA, making it a powerful option for diversifying your retirement portfolio. It’s yours Think of your HSA as a personal savings account. Any unspent money in your HSA remains yours, allowing you to grow your balance over time. When you reach age 65, you can withdraw money (without penalty) and use it for anything, including nonhealthcare expenses. Flexibility Save for a rainy day. Invest for your future retirement. Or spend your funds on qualified expenses, penalty free. Easy to use Swipe your benefits debit card at the point of purchase. There is no requirement to verify any of your purchases. We recommend keeping any receipts in case of an IRS audit. Smart savings The HSA’s unique, triple-tax savings means the money you contribute, earnings from investments, and withdrawals for eligible expenses are all tax-free, making it a savvy savings and retirement tool. Investment options You can invest your HSA funds in an interest-bearing account or our standard mutual fund lineup. Savvy investors may opt for a Health Savings Brokerage Account powered by Charles Schwab, giving you access to more than 8,500 mutual funds, stocks and bonds.
What does it cover? There are thousands of eligible items. The list includes but is not limited to: • Copays, coinsurance, insurance premiums • Doctor visits and surgeries • Over-the-counter medications (first aid, allergy, asthma, cold/flu, heartburn, etc.) • Prescription drugs • Birthing and Lamaze classes • Dental and orthodontia • Vision expenses, such as frames, contacts, prescription sunglasses, etc.
Can I enroll? You must be enrolled in a high-deductible health plan (HDHP) in order to enroll in the HSA. You’re not eligible if: • You’re claimed as a dependent on someone else’s taxes. • You’re covered by another plan that conflicts with the HDHP, such as Medicare or TriCare • You are enrolled in a medical flexible spending account (FSA) or enrolled in your spouse’s medical flexible spending account (FSA) or select health reimbursement arrangements (HRAs) The 2023 annual contribution limit is: • Single coverage - $3,850 • Family coverage - $7,750 If you’re 55 years of age or older, you are eligible to make an annual catch-up contribution, which lets you contribute an additional $1,000 on top of the above annual contribution limits. 20
Flexible Spending Accounts (FSAs) Wex Health
TRADITIONAL HEALTHCARE FLEXIBLE SPENDING ACCOUNT (FSA) You may participate in the 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 expenses such as medical, dental, and vision costs for you, your spouse, and your eligible dependents as long as they are claimed as dependents on your federal tax return. The maximum amount you can elect for 2023 is $3,050. IMPORTANT: You cannot participate in a traditional Healthcare FSA if you are currently making contributions to a Health Savings Account (HSA). USE IT OR LOSE IT Be conservative in your estimate. Because the IRS has a “Use It or Lose It” rule in place for FSAs, funds not spent by the end of a plan year will not be returned to you or carried over to the next year.
You can incur expenses through March 15, 2024 and must file claims by March 31, 2024. ACCESS YOUR BENEFITS ANYTIME, ANYWHERE Get instant notifications on the status of your claims File a claim and upload documentation in seconds using your phone’s camera Scan an item’s bar code with your phone’s camera to determine if it’s an IRS eligible expense Check your balance and view account activity
REIMBURSEMENT DOCUMENTATION REQUIREMENTS Approved documentation for medical expenses, required by the IRS, is a receipt or statement containing, all of the following: name of provider, date(s) of service within the plan year, an eligible type of service, or product and dollar amount.
NOTE: An Explanation of Benefits VERIFYING YOUR WEX BENEFITS DEBIT CARD EXPENSES
(EOB) from your insurance provider is ideal for substantiating claims.
For medical care purchases made with your Wex Benefits Debit Card, the IRS requires the expense be verified. Some of those purchases can be verified electronically at the point of purchase, so there’s no need for additional substantiation. They include: • Copays in doctors’ offices • Copays in pharmacies • Some vision copays • Some over the counter (OTC) items
SUBMITTING DOCUMENTATION: There are several ways to submit documentation:
Certain debit card transactions may need to be substantiated. To find out which specific expenses are eligible, view the eligibility list at www.wexinc.com/insights/benefits-toolkit/eligible-expenses/
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Online, at www.wexinc.com, you can easily upload your receipts and other documents.
Download the Wex Health app to access plan information, file claims, send receipts, and more:
Dependent Care FSA Wex Health
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 or children over age 13 who are incapable of self-care. 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. Please note: Dependent Care funds must be contributed to your account before you can spend them. BIG SAVINGS POTENTIAL Let’s say you enroll and contribute $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: You may contribute up to $5,000 per year if you are married and filing a joint return, or if you are a single parent. If you are married and filing separately, you may contribute up to $2,500. 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). 22
Dental Benefits MetLife – Low Plan
Caregiver offers two dental plan options: The Low plan is a great option if you’re dentist is a PPO dentist with MetLife, and most of your care is preventive. The High plan (next page) offers more reimbursement if your dentist is Non-PPO. The High plan has coverage for Major Restorative services, orthodontia for children, and a higher calendar year maximum benefit. Benefit
PPO
NON-PPO $50 individual $150 family
Annual Deductible (does not apply to Coverage A) Coverage A – Diagnostic and Preventive Services • Oral Examinations (1 per 6 months) • Routine Prophylaxis (cleaning; 1 per 6 months) • Fluoride application (up to age 14) • Full Mouth X-Rays (1 series per 60 months) • Bitewing X-Rays (1 time per 12 months) Coverage B – Basic & Restorative • Sealants/Space Maintainers for eligible dependent children (up to age 14) • Restorative Services: amalgam and composite fillings • Prefabricated Crowns • General Anesthesia • Periodontal Maintenance • Consultations • Emergency Palliative Treatment • Harmful Habit Appliances Coverage C – Major Restorative
Covered at 100%
Covered at 100%
Covered at 100%
Covered at 100%
Not Covered
Not Covered
$500 per person
Annual Maximum Benefit
*NON-PPO - Maximum Allowable Charge For covered services provided by a Non-PPO dentist, the amount payable will be based on a pre-determined fee schedule. You may be billed for the difference between this allowable charge and the amount billed by the dentist. Non-PPO charges on this plan will be more expensive than on the High Plan. On either plan, the member will receive the biggest savings by going to a PPO provider. Pre-Determination of Benefits To assist you in managing your total costs, MetLife offers what’s called "pre-determination of benefits." Dentists may submit their treatment plan to MetLife for review and estimation of coverage before procedures are started. MetLife advises the patient, and the dentist of what services are covered and what the payment would be. The actual payment for these pre-determined services depends on eligibility, any plan limitations, coordination of benefits and the remaining maximum at the time services are performed. 23
Dental Benefits MetLife – High Plan
Benefit
PPO
Annual Deductible (does not apply to Coverage A) Coverage A – Diagnostic and Preventive Services • Oral Examinations (1 per 6 months) • Routine Prophylaxis (cleaning; 1 per 6 months) • Fluoride application (up to age 14) • Full Mouth X-Rays (1 series per 60 months) • Bitewing X-Rays (1 time per 12 months) • Sealants/Space Maintainers for eligible dependent children (up to age 14) Coverage B – Basic & Restorative • Fillings • Extractions • Complex Oral Surgery • Periodontal Maintenance • Emergency Palliative Treatment • Consultations Coverage C – Major Restorative • Crowns/Inlays/Onlays • Endodontic Services • Periodontic Services • Dentures/Bridges • Implants • General Anesthesia
NON-PPO $50 individual $150 family
Covered at 100%
Covered at 100%
Covered at 80%
Covered 80%
Covered at 50%
Covered at 50%
50% 50% $1,000 lifetime $1,000 lifetime maximum maximum $1,000 per person Annual Maximum Benefit *Non-PPO - Reasonable & Customary (R&C) For covered services provided by a Non-PPO dentist, the amount payable will be determined using an 90% R&C schedule. In other words, MetLife determines what 90% of the providers in the area (zip code) are charging for a service, and that is the amount that MetLife will pay toward the service. You may be billed for the difference between this charge and the amount billed by the dentist. Orthodontia Services (children up to age 19)
Non-PPO charges on this plan will be less expensive than on the Low Plan. On either plan, the member will receive the biggest savings by going to a PPO dentist. Pre-Determination of Benefits To assist you in managing your total costs, MetLife offers what’s called "pre-determination of benefits." Dentists may submit their treatment plan to MetLife for review and estimation of coverage before procedures are started. MetLife advises the patient, and the dentist of what services are covered and what the payment would be. The actual payment for these pre-determined services depends on eligibility, any plan limitations, coordination of benefits and the remaining maximum at the time services are performed. 24
Vision Benefits MetLife
Vision exams are an important part of your overall wellness and health. Consider the advantages of the retail cost of eyeglasses and contact lenses when deciding to enroll in our vision plan. PPO (MetLife Vision Network, utilizing the VSP Choice Network)
NON-PPO Reimbursement
Frequency
Eye Exam
$10 copay
up to $45
every 12 months
Materials/Eyewear
$25 copay
n/a
every 12 months
Lenses • Single vision • Lined bifocal • Lined trifocal
$25 copay $25 copay $25 copay
up to $30 up to $50 up to $65
every 12 months
$150 allowance + 20% off balance
up to $70
every 24 months
Benefit
Frame Allowance Contact Lenses - conventional (in lieu of lenses & frame)
$150 allowance
up to $105
every 12 months
Contact Lenses - necessary (in lieu of lenses & frame)
covered in full
up to $210
every 12 months
Contact Lenses Fitting/Follow-Up (standard)
Up to $60 copay
no benefit
every 12 months
PPO network value added features: • Additional lens enhancements: In addition to standard lens enhancements, enjoy an average 20-25% savings on all other lens enhancements. • Savings on glasses and sunglasses: Get 20% savings on additional pairs of prescription glasses and nonprescription sunglasses, including lens enhancements. At times, other promotional offers may also be available. • Laser vision correction: Savings averaging 15% off the regular price or 5% off a promotional offer for laser surgery including PRK, LASIK and Custom LASIK. This offer is only available at MetLife participating locations. Additional features and benefits can be found in the MetLife summary plan document.
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Life and AD&D Benefits MetLife
Employer Paid Basic Life and AD&D Insurance Caregiver provides basic term life insurance including AD&D equal to $10,000 for all full-time and part-time employees. Coverage will end upon an employee’s separation of employment and may be converted to an individual life insurance policy. Voluntary (not employer paid) Life and AD&D Insurance If you need more financial protection than your basic term life and AD&D insurance amount, you can purchase voluntary life and AD&D insurance equal to the lesser of five times your annual earnings or $250,000. If you are required to provide EOI, your supplemental voluntary life coverage will not go into effect until the coverage amount you elected is approved by MetLife. Voluntary (not employer paid) Life and AD&D Insurance
Employee
Spouse
Child(ren)
• Purchase coverage in increments of $10,000 to a maximum of $250,000, not to exceed 5 times your annual earnings. • Guarantee Issue: • New Hires: eligible to elect up to $150,000 without evidence of insurability (EOI) • Late entrants: requires evidence of insurability (EOI) for any elected amount • Current Participants: During annual open enrollment periods, if you have not been previously denied coverage, you may increase your current coverage by $10,000 without providing evidence of insurability (does not apply to spouse or child(ren) elections) • Purchase coverage for your spouse in $5,000 increments to a maximum of $150,000 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: requires evidence of insurability (EOI) for any elected amount • Purchase coverage for your children in increments of $2,000 to a maximum of $10,000 • Guarantee Issue: proof of good health is not required
If You Are Age 70 Or Older: If You are age 70 or older on your effective date of insurance, the amount of your Employer Paid Basic Life and AD&D Insurance will be reduced according to the following schedule. The same coverage reduction table applies to the Voluntary Life and AD&D insurance also. Age
Reduces to a % of the original amount
70
65%
75
50%
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. You can change your beneficiary designation at any time during the year in bswift®. What is AD&D? Accidental Death and Dismemberment (AD&D) insurance provides specified benefits to you in the event of a covered accidental bodily injury that directly causes dismemberment (i.e., the loss of a hand, foot or eye). In the event that your death occurs due to a covered accident, both the life and the AD&D benefit would be payable. 26
Voluntary Short-Term Disability MetLife
What is Group Short-Term Disability Coverage? 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. You may use this money however you would like. 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?
Evidence of Insurability (EOI)
All active full-time employees working a minimum of 30 hours per week 60% of your weekly earnings to a maximum benefit amount of $1,250 • For disabilities caused by a non-occupational accidental injury or illness = 14 days • Maximum benefit period = 11 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. Please note that this limitation may impact claims related to pregnancy. If you previously waived coverage for short-term disability and wish to enroll for 2023, you will be required to submit evidence of insurability (EOI). Please note that pre-existing conditions limitations will apply for your first 12 months of coverage.
Day 1
Week 11
Day 14 Waiting period
ATO/PTO (if available)
Short-Term Disability benefits paid
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Return to work or transition to Long- Term Disability
Voluntary Long-Term Disability MetLife
What is Group Long-Term Disability Coverage? Long-term disability insurance protects your financial security if you become unable to work due to a lengthy illness or injury for more than three months. Payroll deductions for this benefit are taken on a post-tax basis, therefore any benefit received would not be taxable and will not be reported on your W-2 as gross income. How can disability benefits be used? When your claim is approved, you will receive monthly benefits to replace part of your income based on your coverage level. You may use this money however you would like. Below are a few examples of how your LongTerm Disability benefits could be used, depending on how much coverage you have: • Rent or mortgage payment • Groceries and utilities • Car payment • Medical bills and recovery expenses What is the difference between the High and Low LTD Plan? The Low Plan pays benefits for 2 years if you’re under age 60, while the High Plan pays benefits up to your Social Security normal retirement age. ELIGIBILITY & COVERAGE Low Plan
High Plan
All active full-time employees working a minimum of 30 hours per week
All active full-time employees working a minimum of 30 hours per week
60% of your monthly earnings to a maximum benefit amount of $10,000
60% of your monthly earnings to a maximum benefit amount of $10,000
90 consecutive days
90 consecutive days
Definition of Disability
You are not able to earn more than 80% of pre-disability earnings at your own occupation for any employer
During the waiting period and 24 months following your disability, you are unable to earn more than 80% of pre-disability earnings at your own occupation; After this period, you are unable to earn more than 60% of pre-disability earnings from any employer that you are reasonably qualified
How long will benefits last?
Lesser of 2 years or Reducing Benefit Duration for workers age 60 and older
The later of Social Security Normal Retirement Age or a Reducing Benefit Duration for workers age 60 and older
Who is eligible? What amount of coverage am I eligible for? What is the waiting period?
Are there pre-existing limitations? Evidence of Insurability (EOI)
Pre-existing conditions include any physical/mental condition, whether diagnosed/undiagnosed, resulting from an injury/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. If you previously waived coverage for long-term disability and wish to enroll for 2023, you will be required to submit evidence of insurability (EOI). Please note that pre-existing conditions limitations will apply for your first 12 months of coverage.
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Accident Benefits MetLife
Accident insurance can soften the financial impact of an accidental injury by paying a benefit to you to help cover the unexpected out-of-pocket costs related to treating your injuries. Benefits from these plans are paid directly to you. Coverage is also available for your spouse and dependents. LOW PLAN METLIFE PAYS YOU
HIGH PLAN METLIFE PAYS YOU
Fractures
Up to $3,000
Up to $6,000
Dislocations
Up to $3,000
Up to $6,000
Burns
Up to $5,000
Up to $10,000
Cuts/Lacerations
Up to $200
Up to $400
Emergency Dental Benefit
Up to $100
Up to $200
Blood and Plasma
Up to $300
Up to $400
$200 ground/$750 air
$300 ground/$1,000 air
Emergency Care
$50
$200 - $300
Physician Follow-Up
$75
$100
Therapy Services (includes physical therapy)
$15
$25
Complex Imagery
$100
$200
Medical Appliances/Prosthetic Device
Up to $1,000
Up to $1,500
Paralysis
Up to $10,000
Up to $50,000
Up to $1,000
Up to $2,000
Up to $200
Up to $400
Up to $1,000
Up to $2,000
$25,000 / $12,500 / $5,000
$50,000 / $25,000 / $10,000
$10,000
$50,000
BENEFIT TYPE INJURIES
MEDICAL SERVICES AND TREATMENT Ambulance
HOSPITAL COVERAGE Admission Confinement (per day) Intensive Care ACCIDENTAL DEATH Employee / Spouse / Child: DISMEMBERMENT, LOSS AND PARALYSIS Dismemberment, Loss & Paralysis
See the MetLife summary plan documents for additional information, details, and exclusions.
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Critical Illness Benefits MetLife
BENEFIT PAYMENT Your Initial Benefit provides a lump-sum payment upon the first diagnosis of a Covered Condition. Your plan pays a Recurrence Benefit equal to the Initial Benefit for the following Covered Conditions: Heart Attack, Stroke, Coronary Artery Bypass Graft, Full Benefit Cancer and Partial Benefit Cancer. A Recurrence Benefit is only available if an Initial Benefit has been paid for the Covered Condition. There is a Benefit Suspension Period between Recurrences. The maximum amount that you can receive through your Critical Illness Insurance plan is called the Total Benefit and is 2 times the amount of your Initial Benefit. This means that you can receive multiple Initial Benefit and Recurrence Benefit payments until you reach the maximum of 200 percent. Please refer to the table below for the percentage benefit amount for each Covered Condition. COVERED INDIVIDUAL
INITIAL BENEFIT AMOUNT
Employee
COVERED CONDITION
Choose $5,000 increments up to $20,000
Spouse
50% of the Employee’s Benefit Amount
Child(ren)
50% of the Employee’s Benefit Amount
INITIAL BENEFIT
RECURRENCE BENEFIT
100% of benefit amount
50% of your benefit amount
Partial Benefit Cancer
25% of your benefit amount
12.5% of your benefit amount
Heart Attack
100% of your benefit amount
50% of your benefit amount
Stroke
100% of your benefit amount
50% of your benefit amount
Coronary Artery Bypass Graft
100% of your benefit amount
50% of your benefit amount
Kidney Failure
100% of your benefit amount
no benefit
Alzheimer’s Disease
100% of your benefit amount
no benefit
Major Organ Transplant
100% of your benefit amount
no benefit
22 other listed conditions
25% of your benefit amount
no benefit
Full Benefit Cancer
Health Screening – Submit proof to MetLife of a wellness screening from the MetLife approved list of screening/prevention measures (such as an annual physical). MetLife will review and if approved, they will pay you $50. New Entrant Pre-Existing Condition Limitation: 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 6 months prior to your effective date of coverage. Benefits for a pre-existing condition are not payable for your first 12 months of coverage. Does not apply to Heart Attack or Stroke. See the MetLife summary plan documents for additional information, details, and exclusions.
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Employee Assistance Program (EAP) LifeWorks through MetLife
Life doesn’t always go as planned. We can help you and your family, those living at home, get professional support and guidance to make life a little easier. Our Employee Assistance Program (EAP) is available to all employees enrolled in the Company paid Life and AD&D plan. This program provides you with easy to use services to help with the everyday challenges of life — at no additional cost to you. Expert advice for work, life, and your well-being The program’s experienced counselors provided through LifeWorks — one of the nation’s premier providers of Employee Assistance Program services — can talk to you about anything going on in your life, including: Family: Going through a divorce, caring for an elderly family member, returning to work after having a baby Work: Job relocation, building relationships with co-workers and managers, navigating through reorganization Money: Budgeting, financial guidance, retirement planning, buying or selling a home, tax issues Legal Services: Issues relating to civil, personal and family law, financial matters, real estate and estate planning Identity Theft Recovery: ID theft prevention tips and help from a financial counselor if you are victimized Health: Coping with anxiety or depression, getting the proper amount of sleep, how to kick a bad habit like smoking Everyday Life: Moving and adjusting to a new community, grieving over the loss of a loved one, military family matters, training a new pet
Does the program have any limitations? While we offer a broad range of services, we may not cover all services you may need. Your Employee Assistance Program does not provide: • Inpatient or outpatient treatment for any medically treated illness prescription drugs • Treatment or services for intellectual disability or autism • Counseling services beyond the number of sessions covered or requiring longer term intervention • Services by counselors who are not LifeWorks providers • Counseling required by law or a court, or paid for by Workers’ Compensation
Convenient and confidential help when you want it, how you want it Your program includes up to 5 phone or video consultations with licensed counselors for you and your eligible household members, per issue, per calendar year. You can call 1-888-319-7819 to speak with a counselor or schedule an appointment, 24/7/365. When you call, just select “Employee Assistance Program” when prompted. You’ll immediately be connected to a counselor. If you’re simply looking for information, the program offers easy to use educational tools and resources, online and through a mobile app. There is a chat feature so you can talk with a consultant to guide you to the information you are looking for or help you schedule an appointment with a counselor.
Phone: 1-888-319-7819
Online: metlifeeap.lifeworks.com username: metlifeeap password: eap 31
Mobile App username: metlifeeap password: eap
Retirement - 401k John Hancock
To help prepare for the future, Caregiver sponsors a 401(k) plan through John Hancock. Take advantage of an excellent opportunity to invest in your future by participating in the Caregiver 401(k) plan. You can begin investing into your 401(k) account once you enroll. Participation Requirements: • You must be at least 20 ½ years old. • You must work at least 1,000 hours per year. • You are eligible to enroll on the first of the month following 30 days of employment. Your Contributions: • Tax deferred contributions up to 100% of your compensation, subject to the annual maximum amount allowed by law ($20,500 in 2023). • Catch-up contributions for employees 50 years of age and older (up to $6,500 in 2023). • Changes to contribution amount can be made anytime by submitting a completed change form. • Rollovers from other eligible plans are allowed at any time. Withdrawals: • Money can be withdrawn from your account in the event of retirement, termination of employment, death, disability or financial hardship • The plan may also allow for pre-retirement and/or early retirement withdrawals; refer to the plan document for specific details on the options permitted by your plan including any age and/or service requirements Note: Any taxable withdrawal you receive that is not rolled over to another qualified plan or IRA will be included as par of your taxable income and be subject to federal income tax withholding. If the withdrawal is made before age 59½, it may be subject to an additional 10% penalty. State and local taxes may also apply. Loans: • You may qualify to borrow a portion of your account balance. • You can borrow up to 50% of your account balance to a maximum of $50,000, subject to limitations. • The minimum amount of any loan is $1,000. • Only one loan can be outstanding at any time.
Enrollment Options: Getting started is easy! Contract Number: 46911 Enrollment Access Number: 002527
Your enrollment options: Online: Register at www.johnhancock.com/myplan Phone: 855-JHENROLL (543-6765)
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Payroll Deductions 52 Weekly or 26 Bi-Weekly Deductions
Major Medical – Lucent Health Bronze Plan
Silver Plan
Gold Plan
Weekly
Bi-Weekly
Weekly
Bi-Weekly
Weekly
Bi-Weekly
Employee Only
$49.62
$99.23
$70.38
$140.77
$94.62
$189.23
Employee + Spouse
$136.15
$272.31
$155.77
$311.54
$263.08
$526.15
Employee + Child(ren) Employee + Family
$81.92 $188.08
$163.85 $376.15
$121.15 $215.77
$242.31 $431.54
$165.00 $383.08
$330.00 $766.15
MEC & Limited Medical – Pan American MEC Only
Plan 1 + MEC
Plan 2 + MEC
Weekly
Bi-Weekly
Weekly
Bi-Weekly
Weekly
Bi-Weekly
Employee Only
$2.64
$5.28
$11.98
$23.96
$22.15
$44.30
Employee + Spouse
$5.15
$10.31
$29.03
$58.07
$52.12
$104.25
Employee + Child(ren) Employee + Family
$6.73 $10.22
$13.45 $20.44
$24.84 $45.25
$49.68 $90.49
$40.78 $75.88
$81.55 $151.75
Dental - MetLife Low Plan Employee Only Employee + Spouse Employee + Child(ren) Employee + Family
High Plan
Weekly
Bi-Weekly
Weekly
Bi-Weekly
$2.19 $4.37 $4.68 $6.25
$4.37 $8.74 $9.37 $12.50
$5.25 $11.85 $13.16 $18.35
$10.50 $23.69 $26.31 $36.70
Vision - MetLife Employee Only Employee + Spouse Employee + Child(ren) Employee + Family
Weekly
Bi-Weekly
$1.33 $2.53 $2.67 $3.92
$2.67 $5.06 $5.33 $7.83
Voluntary Life/AD&D Rates*1 (post tax, based on employee age) – Weekly AGE
< 25
25-29
30-34
35-39
40-44
45-49
50-54
55-59
60-64
65-69
70+
Rate per $1000
$.011
$.013
$.018
$.020
$.022
$.033
$.051
$.095
$.145
$.280
$.453
Child Rate per $1000
AD&D Rate per $1000
$.056
$.005 EE/$.0007 SP/$.007 CH
Voluntary Life/AD&D Rates*1 (post tax, based on employee age) – Bi-Weekly AGE
< 25
25-29
30-34
35-39
40-44
45-49
50-54
55-59
60-64
65-69
70+
Rate per $1000
$.022
$.026
$.036
$.040
$.044
$.066
$.101
$.190
$.291
$.559
$.907
Child Rate per $1000
$.112
AD&D Rate per $1000
$.009 EE/$.014 SP/$.015 CH
*bswift® will confirm the maximum benefit amount you are eligible for including the bi-weekly or weekly payroll deduction amount. 1Rates may vary slightly due to rounding
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Payroll Deductions 52 Weekly or 26 Bi-Weekly Deductions
Voluntary Short-Term Disability Rates* AGE
< 30
30-34
35-39
40-44
45-49
50-54
55-59
60-64
65-69
70+
Rate per $10 of benefits – Weekly
$.30
$.34
$.28
$.22
$.20
$.18
$.22
$.28
$.34
$.38
Rate per $10 of benefits – Bi-Weekly
$.60
$.68
$.55
$.44
$.40
$.37
$.44
$.55
$.68
$.76
Voluntary Long-Term Disability Rates* (post tax) – Rate per $100 of covered payroll AGE
< 25
25-29
30-34
35-39
40-44
45-49
50-54
55-59
60-64
65-69
70+
Low Plan – Weekly
$.016
$.025
$.044
$.067
$.102
$.129
$.164
$.196
$.201
$.180
$.152
Low Plan – Bi-Weekly
$.03
$.05
$.09
$.13
$.20
$.26
$.33
$.39
$.40
$.36
$.30
High PlanWeekly
$.032
$.051
$.088
$.134
$.203
$.258
$.328
$.392
$.402
$.360
$.305
High Plan – Bi-Weekly
$.07
$.12
$.20
$.30
$.46
$.59
$.75
$.90
$.92
$.83
$.70
Accident Plans – MetLife *1 Low Plan
High Plan
Weekly
Bi-Weekly
Weekly
Bi-Weekly
Employee Only
$1.41
$2.81
$2.62
$5.25
Employee + Spouse
$2.86
$5.72
$5.42
$10.85
Employee + Child(ren)
$2.84
$5.68
$5.34
$10.68
Employee + Family
$3.56
$7.12
$6.69
$13.38
Critical Illness – MetLife* Non-Tobacco Rates per $1,000 AGE
Employee Only BiWeekly
EE + Spouse
EE + Children
Tobacco Rates per $1,000 EE + Family
Employee Only
EE + Spouse
EE + Children
EE + Family
Weekly
BiWeekly
Weekly
BiWeekly
Weekly
BiWeekly
Weekly
BiWeekly
Weekly
BiWeekly
Weekly
BiWeekly
Weekly
BiWeekly
Weekly
< 25 $0.166
$0.08
$0.305
$0.15
$0.323
$0.16
$0.457
$0.23
$0.198
$0.10
$0.351
$0.18
$0.355
$0.18
$0.508
$0.25
25–29 $0.171
$0.09
$0.318
$0.16
$0.328
$0.16
$0.475
$0.24
$0.212
$0.11
$0.378
$0.19
$0.365
$0.18
$0.535
$0.27
30–34 $0.212
$0.11
$0.388
$0.19
$0.369
$0.18
$0.540
$0.27
$0.282
$0.14
$0.494
$0.25
$0.438
$0.22
$0.651
$0.33
35–39 $0.272
$0.14
$0.489
$0.24
$0.429
$0.21
$0.642
$0.32
$0.388
$0.19
$0.669
$0.33
$0.545
$0.27
$0.826
$0.41
40-44 $0.374
$0.19
$0.655
$0.33
$0.531
$0.27
$0.812
$0.41
$0.568
$0.28
$0.969
$0.48
$0.725
$0.36
$1.126
$0.56
45-49 $0.522
$0.26
$0.905
$0.45
$0.674
$0.34
$1.062
$0.53
$0.826
$0.41
$1.408
$0.70
$0.983
$0.49
$1.565
$0.78
50-54 $0.706
$0.35
$1.232
$0.62
$0.863
$0.43
$1.389
$0.69
$1.158
$0.58
$1.989
$0.99
$1.311
$0.66
$2.146
$1.07
55-59 $0.942
$0.47
$1.666
$0.83
$1.098
$0.55
$1.823
$0.91
$1.574
$0.79
$2.765
$1.38
$1.731
$0.87
$2.922
$1.46
60-64 $1.320
$0.66
$2.354
$1.18
$1.477
$0.74
$2.511
$1.26
$2.243
$1.12
$3.983
$1.99
$2.400
$1.20
$4.140
$2.07
65-69 $1.925
$0.96
$3.434
$1.72
$2.082
$1.04
$3.591
$1.80
$3.323
$1.66
$5.917
$2.96
$3.480
$1.74
$6.074
$3.04
70+ $2.986
$1.49
$5.155
$2.58
$3.138
$1.57
$5.312
$2.66
$5.220
$2.61
$9.000
$4.50
$5.377
$2.69
$9.152
$4.58
*bswift® will confirm the maximum benefit amount you are eligible for including the bi-weekly or weekly payroll deduction amount. 1Rates may vary slightly due to rounding
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Important Notices Federal laws require that Caregiver provide you with certain notices that inform you about your rights regarding eligibility, enrollment and coverage of health care plans. These notices, SPDs and plan amendments, will be available through the bswift® benefits portal. You can request printed copies of these documents from the HR department. NOTICE HIPAA Privacy Notice
WHAT IT MEANS FOR YOU Describes your rights to health privacy.
Describes when you can enroll for coverage when you have previously declined coverage. Provides a list of states that have premium assistance Premium Assistance Under Medicaid and CHIP programs to help you pay for medical coverage if you are unable to afford health care coverage premiums. If you or a family member is faced with a health condition Family and Medical Leave Act (FMLA) that causes you to miss work, you may be able to take up to 12 weeks of job-protected time off under the FMLA. Summarizes important information about your health Summary of Benefits and Coverage (SBC) coverage options in a standard format to help you compare each option. Describes protections for mothers and their newborn Newborns’ and Mothers’ Health Protection Act children relating to the length of their hospital stays following childbirth. Women’s Health and Cancer Rights Act of Provides information regarding a woman’s rights after a 1998 mastectomy. Prohibits employers from requesting or requiring genetic Genetic Information Non-Discrimination Act of information of an individual or family member of the 2008 (GINA) individual, except as specifically allowed by the law. Prohibits group health plans from terminating the coverage of a dependent child who has lost student Michelle’s Law status as a result of a medically necessary leave of absence. Provides details about how COBRA can provide ongoing Consolidated Omnibus Budget Reconciliation health benefits after coverage ends under certain Act (COBRA) conditions. The key purpose of this notice is to advise you that the prescription drug coverage you have under the Caregiver Your Prescription Drug Coverage and Health and Welfare Plan is expected to pay out, on Medicare average, at least as much as the standard Medicare prescription drug coverage will pay in 2023 (This is known as “creditable coverage.”). Provides basic information about individual health Health Insurance Marketplace Coverage insurance options that will be available through the Options Marketplace (also referred to as Exchanges) beginning in 2014. Special Enrollment Rights
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Important Contacts
BENEFIT PLAN
Enrollment Assistance Telehealth Medical Benefits
PROVIDER
PHONE NUMBER
WEB ADDRESS
AGM Enrollment Services
844.880.6774
https://a.flexbooker.com/reserve/ag m#chooseService
MeMD
N/A
Access through the CG Hub App
Lucent Health #100545
Narus 888.585.3309
https://mylucenthealth.com or [email protected]
888.907.0070
[email protected] https://www.benecardpbf.com/
888.585.3309
www.narushealth.com/concierge
800.999.5382
https://www.mypalic.com/
866.451.3399
www.wexinc.com
866.451.3399
www.wexinc.com
800.438.6388
http://mybenefits.metlife.com
800.438.6388
http://mybenefits.metlife.com
800.438.6388
http://mybenefits.metlife.com
800.438.6388
http://mybenefits.metlife.com
800.438.6388
http://mybenefits.metlife.com
800.438.6388
http://mybenefits.metlife.com
800.438.6388
https://metlifeeap.lifeworks.com/
#46911, Enrollment Access #002527
855.543.6765
www.johnhancock.com/myplan
bswift®
N/A
Username: Caregiver email Initial PW: Birthday - MMDDYYYY
N/A
833.297.6647
[email protected]
Benecard Pharmacy Benefits
Member Concierge MEC & Limited Medical Benefits Health Savings Accounts (HSAs) Flexible Spending Accounts (FSAs) Dental Benefits Vision Benefits Life/AD&D Benefits Disability Benefits Accident Benefits Critical Illness Benefits Employee Assistance Program (EAP) 401k Retirement Savings
Enrollment Portal Caregiver HR
RxBIN: 014179, Rx PCN: 9743, RxGRP: 10116
Narus Health (concierge for Lucent Health Plan Members)
Pan American #SE231 Wex Health #20271
Wex Health #20271
MetLife #05986045
MetLife #05986045
MetLife #05986045
MetLife #05986045
MetLife #05986045
MetLife #05986045
LifeWorks John Hancock
36
www.caregiver.bswift.com