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City of Frisco 2014 Benefits Overview.

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Presentation on theme: "City of Frisco 2014 Benefits Overview."— Presentation transcript:

1 City of Frisco 2014 Benefits Overview

2 Agenda Healthcare Reform Update Overview of Changes for 2014
Where You Fit In Plan Details Open Enrollment Questions

3 Healthcare Reform Update

4 How Healthcare Reform Impacts You
Individual Mandate for coverage is effective January 1, 2014 Individuals must have coverage or pay a tax penalty (Penalty – the greater of $95 or 1% of household income) City of Frisco benefit-eligible employees are not eligible for a Federal subsidy because you have access to the City of Frisco medical plans Insurance Marketplace Notices were provided by the City of Frisco to all employees City’s medical plan meets all Federal Requirements for affordable premium and essential coverage

5 Overview of Changes for 2014

6 New in 2014 Medical PPO plan designs
The $0 deductible PPO plan will not be an option for 2014 There are still three plan options: $250, $500 and $1500 deductible plans Urgent Care copay increases to $60 Annual Out-of-Pocket Maximum will include Deductibles and Copays for office visits and Rx Lower copays when you see a UHC Premium Physician Short Term Disability (STD) plan for all eligible employees All eligible employees will have a STD plan that pays 40% to $200 per week This plan will pay after 30 days of disability and is paid for by the City Employees will have the option to buy up to 60% benefit to $1,000 per week Long Term Disability (LTD) plan design Plan will move to a 180-day elimination period The LTD plan will coordinate with the STD plan Worksite Benefits UNUM will be the new carrier for Accident and Critical Illness/Cancer plans Tier 1

7 Understanding Healthcare Terms
Deductible – The amount you pay out of your own pocket before your insurance pays (just like your car insurance deductible) Coinsurance – After you have met your deductible, this is the amount/share of the costs you pay for your medical expenses and bills. (For example, on the Medical Plans, the coinsurance is 80% in network. The medical plan pays 80% and you would pay 20%) Copayments – The amount you pay at the time of service in the doctor’s office or at the pharmacy Out of Pocket Maximum – The most you would have to pay in a single year out of your own pocket. This includes deductible, medical and Rx copays and your medical coinsurance. After you meet your Out of Pocket Maximum, the plan pays 100% for the rest of the calendar year. Network Provider – Doctors, hospitals and other health care professionals with whom we have negotiated prices and are part of our network. Also called “in-network” provider or participating provider. Health Insurance can be complicated and at times – hard to understand , even for those of us who do this for a living. I want to briefly go over some terms that you will hear in regards to your health benefits and explain how they’re related to each other. Coinsurance – is the phase of your insurance after you have met your deductible where you are paying either 10% or 20% of all medical expenses. These payments are applied to your out of pocket max. Copayments – When you have an office visit or go to the ER, this is the payment you must make at the time of service. These do not apply towards deductible or out of pocket max Deductible – This is the first phase of your insurance. You must satisfy the annual deductible before entering into the coinsurance portion Out of Pocket – This is the absolute max you will have to pay per year. It is only satisfied by your coinsurance portion. Network Provider – Providers that we have contracted with where you will find the deepest discounts

8 Medical and Pharmacy Updates
NEW: $0 Deductible NOT available NEW: Plan options will be $250, $500, and $1500 deductible NEW: 80% Coinsurance on all plans (you pay 20%) NEW: Out-of-Pocket Max will include deductibles, copay for office visits and Rx Lower Copays ($20 for PCP and $30 for Specialist) when using UnitedHealthcare Physicians Preventive Prescription Drug List available at $0 copay (no change) Select “Over the Counter” Drugs available for $5 Copay (no change) Tier 1 Here is a brief overview of what is changing for the new plan year and what I’ll be covering during the presentation. The main changes you need to be aware of are the additional pharmacy benefits and the new medical plan available.

9 Want Lower Copays? Tier 1 In 2014, you can reduce your copay if you see a Physician: $20 Primary Care Physician / $30 Specialist The UnitedHealth Premium program evaluates doctors for quality and cost efficiency to help you choose a doctor with confidence UnitedHealth Premium doctors: Practice evidence-based care Are more likely to follow new research and clinical trials May have lower surgery repeat rates Proprietary Information of UnitedHealth Group. Do not distribute or reproduce without express permission of UnitedHealth Group.

10 Quality & cost transparency Visit www.mychoicenotchance.com
UnitedHealth Premium® Program Tier 1 Quality & cost transparency • Longest running physician quality and cost efficiency designation program (2005) • National industry, evidence-based and specialty society standards • Evaluate doctors on more than 75 conditions and 300 measures • Physicians who fail to meet quality not eligible for cost efficiency Access • 148 markets and 26 specialties evaluated* • Accounts for more than 80% of all medical costs* • Includes primary care physicians and specialists Broad application Available to members at no additional cost • Integrated into customer service, clinical and online experiences • Benefit designs based on Premium designation To help people make more informed choices about their health care, UnitedHealthcare created the UnitedHealth Premium program. The Premium program evaluates and recognizes doctors who meet standards for quality and cost efficiency. The quality standards are based on evidence-based medicine standards and national industry guidelines. The cost-efficiency criteria are based on local market benchmarks for the efficient use of resources in providing care. Launched in 2005, UnitedHealth Premium is the longest running quality and cost efficiency program. As of January 1, 2014, the program will be available in 148 markets and 41 states. It evaluates doctors in 26 specialties, which account for over 80% of total medical spend. Specialties include family practice, pediatrics, internal medicine, cardiology, orthopedics and OB-GYN, to name a few. The Premium program is available to members at no cost. The designations are available online and are also integrated into our customer service and clinical experiences like NurseLine and Care 24. Some health plans offer incentives to members who see Premium designated doctors and specialists. Members should review their plan documents for more details. Recognition Received the National Committee for Quality Assurance (NCQA) program Physician Quality (PQ) certification and meets the Consumer Purchaser Disclosure Project’s Patient Charter standards Visit *Data as of early 2014. Proprietary Information of UnitedHealth Group. Do not distribute or reproduce without express permission of UnitedHealth Group. 10

11 Low ($250) Deductible Plan
Type of coverage Network benefit Non-network benefit Annual Deductible Out of Pocket $250 per Person/ $500 per Family $1,750 per Person/ $3,500 per Family $500 per Person/ Unlimited per Family Unlimited per Person/ Unlimited per Family Physician’s office services $20 Tier 1 / $40 Non-Tier 1 copayment 40% coinsurance Specialist office visit $30 Tier 1 / $60 Non-Tier 1 copayment Emergency room services $150 copayment Urgent care center services $60 copayment The no deductible plan will also be available next year. With this plan you immediately start in the “coinsurance” phase of your benefits until you hit the out of pocket max. Again, the copays for ER, Specialist and Urgent care have increased. This is the “richest” plan available to employees, but it is also the most expensive in terms of monthly premiums. This may be a good plan for you if you expect to have significant medical costs next year 11

12 Medium ($500) Deductible Plan
Type of coverage Network benefit Non-network benefit Deductible $500 per Person/ $1,000 per Family $1,000 per Person/ Unlimited per Family Out of Pocket $2,750 per Person/ $5,500 per Family Unlimited per Person/ Unlimited per Family Physician’s office services $20 Tier 1 / $40 Non-Tier 1 copayment 40% After deductible Specialist office visit $30 Tier 1 / $60 Non-Tier 1 copayment Emergency room services $150 copayment Urgent care center services $60 copayment For those of you on the $250 deductible plan, this plan will still be available to you in the coming year. The only changes will be an $150 ER copay, and urgent and specialist copays have gone to $40. This plan will have lower premiums than the no deductible plan, so I would encourage you to consider this plan. This is still a very rich plan compared to most out there.

13 High Deductible ($1,500) Plan
Type of coverage Network benefit Non-network benefit Deductible $1,500 per Person/ $3,000 per Family $3,000 per Person/ Unlimited per Family Out of Pocket $3,000 per Person/ $6,000 per Family Unlimited per Person/ Unlimited per Family Physician’s office services $20 Tier 1 / $40 Non-Tier 1 copayment 40% After deductible Specialist office visit $30 Tier 1 / $60 Non-Tier 1 copayment Emergency room services $150 copayment Urgent care center services $60 copayment New for 2012, is a $1500 deductible plan. I would encourage you all to take time to consider electing this plan. The benefit of having the higher deductible is that this plan will cost you the lowest in monthly premiums. If you don’t expect to have many healthcare expenses during the year, or prefer to save your money until your medical expenses hit, this may be a good option for you. Just keep in mind that if you pay higher monthly premiums and don’t wind up using the benefits, you don’t get that money back. If you save money on your premiums monthly , you may have to use that money for medical expenses but you may not in which case you would get to keep it.

14 Preventive vs. Diagnostic
Preventive Care Diagnostic No symptoms, illness, or history prompting the screening In accordance with age and gender guidelines Symptoms require further diagnosis Previous abnormal test results prompt earlier or more frequent screenings Previous abnormal test results prompt rescreening. Certain services can be done for preventive or diagnostic reasons.  It can be confusing to know the difference. Let’s compare. When a service is performed for preventive screening reasons and is appropriately reported it will be adjudicated under the Preventive Care Services benefit. Preventive services are done on a person who: has not had the preventive screening done before and does not have symptoms or other abnormal studies suggesting abnormalities; or has had screening done within the recommended interval with the findings considered normal; or has had diagnostic services results that were normal after which the physician recommendation would be for future preventive screening studies using the preventive services intervals. has a preventive service done that results in a therapeutic service done at the same encounter and as an integral part of the preventive service (e.g. polyp removal during a preventive colonoscopy), the therapeutic service would still be considered a preventive service. Diagnostic services are done on a person who: has symptoms that require further diagnosis has the service done because abnormalities found on previous studies require further diagnosis had abnormalities found on previous preventive or diagnostic studies that would require the same studies within shortened time intervals from the recommended preventive screening time intervals

15 Pharmacy Costs Retail Mail order Tier 1 $15 Your Cost 1-Month Supply
Lowest Cost PRESENTER NOTE: Customize this slide with specific benefits and gear your talk point to the highlights of the benefit – if you don’t have the Rx benefit information, delete this slide This example gives you a better idea of how your pharmacy benefit works. Notice that copays differ based on the type of drug (the tier indicates a specific category), and the supply received. You can often get three month’s supply of your medication—for the cost of only 2 copayments by ordering by mail. Highest Cost This is the current copayment/coinsurance structure of the plan in effect today. These amounts are subject to change. Proprietary Information of UnitedHealth Group. Do not distribute or reproduce without express permission of UnitedHealth Group. 15

16 Health Care Flexible Spending Account
You can set aside $2,500 to pay or reimburse yourself for eligible health care expenses such as: Doctor’s office visit costs and procedures Eyeglasses, contact lenses and supplies and vision exams Dental treatments, including X-rays, cleanings, fillings and orthodontic treatment Covered prescriptions Over-the-counter (OTC) supplies and equipment Keep your receipts! Because of the health care reform law passed in 2010, OTC medicines and drugs may only be eligible for FSA reimbursement if you have a valid prescription.

17 Dependent Care Flexible Spending Account
Save even more. You can set aside $5,000 to pay or reimburse yourself for eligible dependent care expenses such as: Qualified day care expenses for children under age 13 Adult dependents not capable of caring for themselves Babysitters, day care and day camps may qualify Keep your receipts!

18 Health4Me Information at your fingertips Health plan information
ID card Claims status GPS provider search A personal touch Help with claims Coverage questions Finding a provider Available on iPhone® and Android™ Information at your fingertips: Having your family’s health plan information on your phone means you can conveniently view and share your health plan ID card, check the balance of your HSA account or even look up the status of the claim from your son’s earache. The app uses your smartphone’s GPS to help you find the doctor or facility you need, even in an emergency. A personal touch. And while it’s nice to have the control that Health4Me offers, it’s comforting to know that the app can connect you with helpful, professional people when you need it. Health4Me asks what you need help with, then has a Health Advisor contact you with information.

19 Care24® - EMPLOYEE ASSISTANCE PROGRAM
3 FREE VISITS PER YEAR Call Care24 services about: Legal Issues Relationship Issues Coping with grief and loss Questions to ask your doctor Men’s, women’s and children’s health Prevention Help Finding a doctor Information on medications General Health Information Proprietary Information of UnitedHealth Group. Do not distribute or reproduce without express permission of UnitedHealth Group. 19

20 Questions?

21 City Of Frisco Dental Plans
Your Dental Health Can Affect Your Overall Health 2014 Plans - Assurant DPPO & DHMO

22 DHMO Plan Key Points: Ease of use – no claims to file, deductibles, etc. 1 No Deductibles No waiting periods No Annual Maximums Must select a dentist – each member can have his or her own Easy to understand co-pays (your out of pocket costs) 1Customer may be required to file a claim in some instances. Footnote for prepaid, could have to file a claim

23 Sample DHMO Treatment Plan copays
Cleaning visit: Office Visit copay $0 D0150 Comprehensive Exam copay $0 D0272 Bitewing X-rays copay $0 D1110 Prophylaxis-adult copay $0 Total out of pocket $0 Crown: D2750 Crown (porcelain fused to high noble metal) copay $275 D2950 Core Buildup, including pins copay $75 Temporary Filling copay $15 Lab Fees copay $ varies Total out of pocket $565 - $615

24 PPO Plan Key Points Freedom to see any dentist What’s covered?
Calendar year max $1500 per person Calendar year deductible $50 individual/$150 family Preventive Services 100% Routine oral exams, routine cleanings (frequency limitations may apply) General Services 80% Fillings, x-rays, oral surgery, extractions, endodontics (root canals, etc.), periodontics (treatment of gums) Major Services 50% Crowns, bridgework, dentures, implants Orthodontia $2,000 lifetime benefit Dental vs. Indemnity

25 Network dentists can save you* $$
Non-Network Dentist Example: $938 30% $657 $328 $938 NA $469 Average charge for crown** Minus DHA discount Actual Fee Insurance pays 50% Claimant pays You could save $141 by going to a DHA dentist!! *This example is for illustrative purposes only. Cost of dental procedures may differ depending on location or dental provider. Savings may also differ in cases when deductibles apply or if the DHA-Premier dentist’s discount differs from 30% **Based on Assurant Employee Benefits’ 2010 claims data for Union Security Insurance Company and Union Security Life Insurance Company of New York. Figures have been rounded to the nearest dollar.

26 City of Frisco

27 Participating Provider Non-Participating Provider
Voluntary Platinum $150 $10 Exam Copayment Service/Material Participating Provider Non-Participating Provider Examination Paid in Full (no additional cost to you) Up to: $43.00 Retail Value WARNING SIGNS FROM VISION EXAMS A comprehensive eye exam can reveal early warning signs to many medical problems including: Diabetes High Cholesterol Cancer Multiple Sclerosis Thyroid Disease Rheumatoid Arthritis Hypertension Brain Tumors Lupus

28 Participating Provider Non-Participating Provider
Voluntary Platinum $150 $20 Eyewear Copayment Service/Material Participating Provider Non-Participating Provider Frame Up to: $ Retail Value Up to: $40.00 Retail Value Lenses: (Clear, Standard, Glass, or Plastic) Single Vision (per pair) Paid in Full Up to: $30.00 Retail Value Bifocal (per pair) Up to: $45.00 Retail Value Trifocal (per pair) Polycarbonate (per pair) Up to: $20.00 Retail Value

29 Participating Provider Non-Participating Provider
Voluntary Platinum $150 Service/Material Participating Provider Non-Participating Provider Contact Lenses: Elective Up to $200.00 Up to: $ Retail Value Medically Required Paid in Full Laser Vision Correction: $ allowance (in or out of network) – in lieu of eyewear benefit Non-Covered Eyewear Discount: discount of 20% from a participating provider’s usual and customary fees for eyewear purchases which exceed the benefit coverage

30 Monthly Premiums - Voluntary Participation
Voluntary Platinum $150 Frequency: Vision Examination Once Each 12 Months Frame Lenses Contact Lenses Monthly Premiums - Voluntary Participation Employee only $6.80 Employee + Spouse $11.60 Employee + Child(ren) $12.26 Employee + Family $18.39

31 Group Term Life Insurance with Accidental Death & Dismemberment
Review of features KS 10-10

32 How much insurance do you need?
EN-1077 How much insurance do you need? People use life insurance to: Pay for their final arrangements Provide financial protection for those who rely on their income If others rely on your income, use this worksheet to figure out how much coverage you need. \ KS 10-10

33 Basic and Voluntary Life/AD&D Coverage — for you
EN-1077 Basic and Voluntary Life/AD&D Coverage — for you Basic Life/AD&D Coverage $50,000 Voluntary Life/AD&D Coverage Maximum coverage amount - $10,000 increments to $200,000 Accidental death & dismemberment – paid in addition to the life benefit if you or a covered dependent: Die in a covered accident Suffer a covered dismemberment or disability KS 10-10

34 Coverage —for your spouse & dependents
Available family coverage Who can have it? Spouse- Increments of $10,000 up to $250,000 Available with purchase of employee coverage; your spouse may be required to answer a few health questions. Child- Option of $5,000 or $10,000 Available with purchase of employee coverage for eligible children, step-children, legally adopted children and grandchildren, ages 14 days through 26 years. KS 10-10

35 Evidence of Insurability
You must complete this form: if you declined this benefit in the past and now want to buy this coverage for yourself to increase the coverage you currently have ($250,000 is the maximum allowed total). if you declined this coverage in the past for your spouse and now want to buy this coverage for your spouse. You must send this form to UNUM no later than October 21st for review. Your coverage is not effective until UNUM has notified Human Resources that your application is approved.

36 Value-added features Life Planning Financial & Legal
EN-1077 Value-added features Life Planning Financial & Legal Resources counseling services Comprehensive, personalized financial plan with 12 months of follow up Personalized service through a toll- free telephonic counseling session with specially trained Ceridian counselors. No sales pitches! Available to survivors or to insured individuals if terminally ill KS 10-10

37 Short -Term Disability Insurance
An overview of the benefits EN-1545 (03-12) 37

38 What would you do if your paycheck stopped tomorrow?
How would you pay the bills if you were disabled? A disability could last for weeks, months or even longer. Would you: Be able to rely on your savings? Borrow from friends or family? Depend on your credit cards? Would medical insurance, workers’ compensation or social security disability cover your earnings if you became disabled? The answer is NO in most cases.

39 It’s important to know your policy’s definition of disability.
You are disabled when Unum determines that: You are limited from performing the material and substantial duties of your regular occupation due to sickness or injury; and You have a 20% or more loss in weekly earnings due to the same sickness or injury

40 How much coverage can you have?
Base Policy: If you meet the definition of disability, you would be eligible to receive a weekly benefit equal to 40% of your basic weekly earnings, up to a maximum of $200 per week. This benefit is paid for by the City of Frisco for every benefits-eligible employee. Buy-Up Policy: If you meet the definition of disability, you would be eligible to receive a weekly benefit equal to 60% of your basic weekly earnings, up to a maximum of $1,000 per week. You can choose to buy 20% additional benefit, for a total weekly benefit of 60%. What is the elimination period? 30 days Your benefit amount What else do I need to know: If you are disabled, you may receive a benefit for up to 22 weeks.

41 Long-Term Disability Insurance
An overview of the benefits Suggested introduction: Hello. My name is _________. I’m a benefits representative with Unum, and I’m here to tell you about a valuable financial protection benefit that’s available to you as a [Company Name] employee . It’s called long term disability insurance. Your HR department wants to make sure you understand enough about this benefit to decide whether it is right for you. So I will spend the next few minutes…. - Giving you an overview of the plan… - Explaining how you can benefit from this coverage - And answering any questions you may have I want you to know one important thing: I do not work on commission -- so there’s no pressure for you to buy anything. My goal today is to provide you with the knowledge you need to make an informed decision about disability insurance. Are there any questions before I begin? Transition statement – Before we talk about long term disability insurance, let me introduce you to Unum, the benefits provider that [employer name] has chosen to offer this valuable coverage to you. EN-1544 (7-12) 41

42 A disability could last for weeks, months or even longer.
Could you pay your bills for months without a paycheck? Most people can’t afford it. Would you: Be able to access money you have saved? Borrow from friends or family? Run up credit card debt? Would other insurance help? Most often it does not. Medical insurance doesn’t replace lost income. Workers’ compensation only covers job-related issues. Social Security disability only helps if your disability is terminal or is expected to last at least a year. Speaker Notes: Think about how much sick time and vacation time you may have. If you had to miss months of work, you would be without a paycheck once those days are used up. Unum has asked people how they would make ends meet. Very few have enough money in savings to fall back on, especially since the Recession. Some said they’d have to rely on family or friends to loan them money, or even run up their credit cards. Some people mistakenly think their health benefits or a government program can help if you need an absence for this kind of temporary “disability.” But that’s usually not the case. [Go over “would other insurance help” bullet points] That’s why long term disability insurance is a valuable safety net for most people. That’s why your employer has made this benefit available through Unum. Transition statement: Let’s talk about how disability insurance works.

43 Know your plan’s definition of disability
It’s important to understand what is covered. You are limited from performing the duties required of your regular occupation due to sickness or injury; and You have a 20% or more loss of monthly earnings due to the sickness or injury; and You are under the regular care of a physician. Does this plan cover mental disability? Disabilities due to mental illness and disabilities based primarily on self-reported symptoms have a limited payment period of 24 months per lifetime. Such benefits would continue beyond 24 months only if you are institutionalized or hospitalized as a result of the disability. Enroller Notes: [Choose the appropriate definition of disability based on the plan design. Avoid getting into specific claim scenarios. Each claim will be reviewed base on it’s own merits. Use the First definition for LTIP Use the second definition for 1-year, 2- year or 3-year regular occ with residual Regular care language must be added if MO is the situs state: ] [You must be under the regular care of a physician in order to be considered disabled unless regular care will not improve the disabling condition(s) or will not prevent a worsening of the disabling condition.] [Refer to slide.] Speaker notes: Your policy has a “definition of disability” that sets the guidelines for when the policy pays benefits. [Go over slide definition of disability.] 43

44 What is the Plan Design? Your benefit amount Your monthly LTD benefit amount equals 60 % of your basic monthly earnings to a maximum of $5,500 As long as you continue to meet the definition of disability, your LTD benefits are payable up to age 65. If you are over the age of 60 on the date of your disability, your maximum period of payment will occur according to the schedule specified in your contract. What is the elimination period? 180 days Benefit Duration Important things to consider [Enroller Note: Please select the appropriate text based on the case you are enrolling. Delete any text that doesn’t apply. ] Transition statement: It’s important to consider that if you qualify for benefits under other plans for one disability, this may affect the total benefit you get from Unum. Let’s take a look…. *Please refer to your policy certificate for the full list of offsets 44

45 Can other benefits reduce my disability benefits?
Your disability benefit may be reduced by the amount of other income replacement you receive for the same disability, such as benefits from Social Security, workers’ compensation.* An example of how the amount of benefit may be reduced or offset by income from other sources: Individual’s weekly pre-disability earnings: $3,000 Long term disability benefit percentage: x 60% Unreduced maximum benefit: $1,800 Less Social Security disability benefit per month:... $900 Less state disability income benefit per month: $300 Monthly long term disability benefit: $600 Your disability benefit may be reduced by the amount of other income replacement benefits you receive for the same disability, such as benefits from Social Security, or if you have an on-the-job accident that qualifies for workers’ compensation coverage. And, just like your paycheck, your disability check may have some taxes deducted, but it depends on how the coverage is paid. Taxation (under current tax laws): If you pay your premiums with post-tax dollars, your benefits will not be taxed. If you pay your premiums with pre-tax dollars, your benefits will be taxed. If you share the cost of premium payments with your employer, a portion of your benefits will be taxed. Transition Statement: that you have an understanding of when you receive benefits, let’s talk about how long can you receive them... *Example above illustrates how at least two common reductions would reduce the maximum benefit the individual would receive (benefit percent and amounts are for illustration purposes only and may not be representative of your plan). Please refer to your policy certificate for the full list of offsets 45

46 Worldwide emergency travel assistance is included with this benefit
For travel: Anywhere in the world 24-hour phone access to: Pre-qualified medical providers Access to western-style medicine Ambulance and air ambulance Lost/stolen medication replacement…and more Covers: Business and personal travel Family members Enroller Notes: [Please delete benefits that don’t apply to your specific case.] Worldwide emergency travel assistance services is available at any time - You don’t have to be disabled to use this service. If you travel more than 100 miles from home or in a foreign country, for business or pleasure, Assist America's global network of professionals will provide a full range of emergency services 24 hours a day, 365 days a year. Some of these services include medical consultation and evaluation by Western trained, English-speaking physicians, a hospital admission guarantee, emergency prescription services, legal referrals and lost luggage assistance. Worldwide emergency travel assistance services are provided by Assist America, Inc. These services are available with selected Unum insurance offerings. Exclusions, limitations and prior notice requirements may apply, and service features, terms and eligibility criteria are subject to change. The services are not valid after termination of coverage and may be withdrawn at any time. Please contact your Unum representative for full details. Assist America pays for all assistance services it provides. Medical expenses such as prescriptions or physician, lab or medical facility fees are paid by the employee or the employee’s health insurance.

47 An overview of the benefits
Group Accident Insurance An overview of the benefits EN-1604 (06-13) 47

48 Why Do You Need Accident Insurance?
An accidental injury can bust your budget Accident insurance can pay a benefit directly to you if you suffer a covered injury. It can offset the high cost of co-pays, deductibles and other expenses your medical insurance doesn’t cover. Rob’s story Rob bought a new bike so he could lose a few pounds — but he lost his balance instead. He was diagnosed with a torn knee ligament and a broken toe. Rob had one lucky break — his accident insurance paid him $900! The benefit offerings Here’s how Rob’s plan helped: $400 ambulance benefit1 $150 emergency room benefit2 $100 fractured toe $150 two follow up visits $100 crutches If Rob was more seriously injured, this plan could: Pay a catastrophic benefit up to $100,0003 Cover loss of sight, hearing, paralysis, etc. Pay a death benefit of $50,000 if he dies due to an accident Benefit amounts are for illustration purposes only. Actual benefit amounts can change depending on actual plan design and situs state. 1 In CT, there is a $500 benefit payable for outpatient emergency room medical care for accidental ingestion of a controlled substance. 2 In CA and CT, no ground or air ambulance benefit is payable. 3 In ME, catastrophic benefits amounts vary.

49 How accident insurance works
The benefit offerings How accident insurance works How it protects Pays a lump-sum benefit based on type of injury sustained and treatment needed Covered injuries include broken bones, cuts, burns, eye injuries, ruptured discs, coma, etc. Benefit can be used however you choose 49

50 Additional coverage options
Wellness Benefit Each covered individual will automatically receive the health screening benefit rider, which can pay $50 annual for a covered health screening test1. Covered tests include: Colonoscopy Mammography Pap smear Skin cancer biopsy PSA (blood test for prostate cancer) Serum cholesterol test to determine LDL and HDL levels Stress test on a bicycle or treadmill ¹Not available in all states

51 Available family coverage
The benefit offerings Available family coverage Employee coverage Accident insurance is offered to all eligible employees who are actively at work¹. Spouse coverage Spouses between the ages of 17 and 64. Must live in the United States Child coverage Coverage is available to children, stepchildren, and legally adopted children newborn to 26 years* who depend on the employee for support. *In GA, IL and ND, child coverage is available newborn until their 27th birthday. 1 Being “actively at work” means that on the day the employee applies for coverage, he/she is working at one of his/her company’s business locations, or is working at a location where he/she is required to represent his/her company. If he/she is applying for coverage on a day that is not a workday, then he/she will be considered actively at work if he/she meets this definition as of the last scheduled workday. Employees are not considered actively at work if their normal duties are limited or altered due to their health, or if they are on a leave of absence. 51

52 Why purchase accident insurance coverage?
No health questions to answer for the base plan. If you apply, you automatically receive the base plan. Your coverage is portable, so you take it even if you leave the company or retire. Unum will bill you directly for the same premium. Premiums are conveniently deducted from your paycheck. Family coverage available.

53 Group Critical Illness Insurance
Underwritten by: Unum Life Insurance Company of America Group Critical Illness Insurance An overview of the benefits EN-1197 (8-11) (03/2013) 53

54 Health insurance typically covers
Why buy critical illness insurance? The costs for care and treatment of a critical illness. Health insurance typically covers Diagnostic tests Transportation to health facilities Private nursing or home health care Alternative or experimental treatments Health insurance may not cover: If you are ill and can’t work, how would you pay for everyday expenses such as: Mortgage Car payment Credit card payments Household expenses Dependent care

55 Could your wallet survive a serious illness?
Critical illness insurance can help you keep your finances in check, by providing a benefit when the expenses of a serious illness start to add up. Lisa’s story: Lisa was planning her daughter’s wedding when a stroke disrupted her plans. Thanks to her critical illness coverage, Lisa was able to afford the out-of-pocket costs her medical insurance didn’t cover. Lisa’s critical illness insurance helped cover the cost Because she had selected a benefit amount of $20,000, her plan paid her that amount in a lump sum, regardless of what she spent. Lisa could use it for her out-of-pocket costs and to help pay the bills while she was unable to work. Lisa was able to focus on her goal for recovery: to dance at her daughter’s wedding!

56 Group Critical Illness Plan Benefits
Advantages A benefit can be paid for each covered condition Employee-paid coverage is portable Dependent children are automatically covered at 25% of the employee benefit amount Additional diagnosis benefit Multiple payouts automatically included in the plan design Each condition payable once per lifetime per covered individual Additional benefits payable for diagnosis of another critical illness if separated by 90 days or more and medically unrelated

57 Group Critical Illness Plan Benefits
The benefit offering Covered conditions Blindness  Benign brain tumor Coronary artery bypass surgery*  End-stage renal (kidney) failure Heart attack  Major organ failure Stroke* Covered conditions due to injury Coma  Permanent paralysis Occupational HIV Optional cancer coverage Cancer  Carcinoma in situ** Specific childhood conditions Cerebral palsy; cleft lip or palate; cystic fibrosis; Down syndrome; spina bifida PA – Permanent paralysis is not a covered condition. CA, IN and MN – Occupational HIV is not a covered condition. FL – Portability is not available ID, NH – Outline of coverage provided at time of application. GA, CA, ME, TX – Comprehensive Health coverage is required. * In NH Stroke is call Severe Stroke. Also, Coronary artery bypass surgery and Carcinoma y situ for children is covered at 100% of the employee’s payable benefit amount. **100% of the benefit payable for each covered condition, with the exception of coronary artery bypass surgery and carcinoma in situ, which are paid at 25% of the purchased benefit amount. Please see policy definitions for complete details about these covered conditions. 57

58 Wellness benefit Each covered individual will automatically receive the wellness benefit, which can pay $50 per calendar year per insured individual1 if a covered health screening test is performed. Screening tests include, but are not limited to: Colonoscopy Mammography Pap smear Skin cancer biopsy PSA (blood test for prostate cancer) Chest X-rays Stress test on a bicycle or treadmill 1 Insured individuals are eligible for benefits 30 days after the effective date of coverage.

59 Recurrence benefit This benefit can provide:
An additional payout for a second occurrence of: A benign brain tumor Heart attack Coma Stroke A benefit payout of 100% 12 months must elapse between occurrences of the same condition

60 Family coverage options
Who can have it? Benefit Employees who are actively at work $5,000 to $50,000 in $1,000 increments Children newborn to age 26, regardless of marital or student status. All eligible children are automatically covered at 25% of the employee benefit amount (no additional cost) Eligible children are covered for the same conditions as the employee and some specific childhood conditions. Diagnosis must occur after the child’s coverage effective date. Spouse ages 17 through 64 with purchase of employee coverage $5,000 to $30,000 in $1,000 increments

61 Employee Enrollment

62 Employee Self-Service (ESS)
Log in User name: your first initial, last name and employee number If you forgot your password, enter your user name and click on FORGOT PASSWORD to retrieve your hint, then follow the instructions and the link to have a temporary password issued. You can also contact HR for assistance. Adding Dependents for the first time Dates of birth and social security numbers are required. You will also need to provide proof of dependency (marriage certificate; birth or adoption certification; etc.) to HR. Availability This site is unavailable every Thursday at 10:00 p.m. – 5:00 a.m. for maintenance.

63 NEW FOR 2014 Worksite Benefits – Accident and Critical Illness
Payroll deductions for all AFLAC policies will end 12/31/2013. If you want to keep your AFLAC policy/policies, you must contact Dennis Esarte, AFLAC rep., to arrange payment directly to AFLAC. You may keep any AFLAC policies you currently have and elect the UNUM Worksite Benefits. If you elect the UNUM Accident or Critical Illness benefits, you must call the City of Frisco Benefits Center at to complete your enrollment within the deadline. Otherwise, your election will be considered invalid and will be cancelled.

64 Additional Benefits paid by City of Frisco
Basic Life $50,000 for all benefits-eligible employees Basic AD&D Death must result from accident TMRS Death Benefit 1X your annual salary If retired, $7,500 Supplemental AD&D Benefit Police Officers and Firefighters only $100,000 policy

65 Compass Health Services
A Compass Health Pro can assist you with: Finding a quality doctor/scheduling the appointment for you Answering questions about your health insurance Assist with pricing estimates for Medical, Rx, Dental and Vision services Help you to reconcile your medical bills Assisting your dependents even if on a different benefit plan We are working to offer some Webinars

66 Compass Health Services
All your information is confidential Compass does not receive any money for recommending a doctor, lab, hospital, etc. Medical advice is not provided Your Health Pro is available by phone or Monday-Friday 8:00 am – 6:00 pm

67 REMINDERS Benefits effective Jan. 1-Dec. 31
Deductions begin Jan. 3, 2014 pay check Call the City of Frisco Benefits Center to complete your enrollment if you elect the Unum Accident or Critical Illness benefits Enrollment Deadline: 12 Noon, Monday, Oct. 21st from work https://ess.friscotexas.gov from home


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