4 How Healthcare Reform Impacts You Individual Mandate for coverage is effective January 1, 2014Individuals 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 plansInsurance Marketplace Notices were provided by the City of Frisco to all employeesCity’s medical plan meets all Federal Requirements for affordable premium and essential coverage
6 New in 2014 Medical PPO plan designs The $0 deductible PPO plan will not be an option for 2014There are still three plan options: $250, $500 and $1500 deductible plansUrgent Care copay increases to $60Annual Out-of-Pocket Maximum will include Deductibles and Copays for office visits and RxLower copays when you see a UHC Premium PhysicianShort Term Disability (STD) plan for all eligible employeesAll eligible employees will have a STD plan that pays 40% to $200 per weekThis plan will pay after 30 days of disability and is paid for by the CityEmployees will have the option to buy up to 60% benefit to $1,000 per weekLong Term Disability (LTD) plan designPlan will move to a 180-day elimination periodThe LTD plan will coordinate with the STD planWorksite BenefitsUNUM will be the new carrier for Accident and Critical Illness/Cancer plansTier1
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 maxDeductible – This is the first phase of your insurance. You must satisfy the annual deductible before entering into the coinsurance portionOut 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 availableNEW: Plan options will be $250, $500, and $1500 deductibleNEW: 80% Coinsurance on all plans (you pay 20%)NEW: Out-of-Pocket Max will include deductibles, copay foroffice visits and RxLower Copays ($20 for PCP and $30 for Specialist) when usingUnitedHealthcare PhysiciansPreventive Prescription Drug List available at $0 copay (no change)Select “Over the Counter” Drugs available for $5 Copay(no change)Tier1Here 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?Tier1In 2014, you can reduce your copay if you see a Physician:$20 Primary Care Physician / $30 SpecialistThe UnitedHealth Premium program evaluates doctors for quality and cost efficiency to help you choose a doctor with confidenceUnitedHealth Premium doctors:Practice evidence-based careAre more likely to follow new research and clinical trialsMay have lower surgery repeat ratesProprietary 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® ProgramTier1Quality & 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 efficiencyAccess• 148 markets and 26 specialties evaluated* • Accounts for more than 80% of all medical costs* • Includes primary care physicians and specialistsBroad applicationAvailable to members at no additional cost • Integrated into customer service, clinical and online experiences • Benefit designs based on Premium designationTo 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.RecognitionReceived the National Committee for Quality Assurance (NCQA) program Physician Quality (PQ) certification and meets the Consumer Purchaser Disclosure Project’s Patient Charter standardsVisit*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 coverageNetwork benefitNon-network benefitAnnual DeductibleOut of Pocket$250 per Person/$500 per Family$1,750 per Person/ $3,500 per Family$500 per Person/ Unlimited per FamilyUnlimited per Person/ Unlimited per FamilyPhysician’s office services$20 Tier 1 /$40 Non-Tier 1 copayment40% coinsuranceSpecialist office visit$30 Tier 1 /$60 Non-Tier 1 copaymentEmergency room services$150 copaymentUrgent care center services$60 copaymentThe 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 year11
12 Medium ($500) Deductible Plan Type of coverageNetwork benefitNon-network benefitDeductible$500 per Person/$1,000 per Family$1,000 per Person/ Unlimited per FamilyOut of Pocket$2,750 per Person/ $5,500 per FamilyUnlimited per Person/ Unlimited per FamilyPhysician’s office services$20 Tier 1 /$40 Non-Tier 1 copayment40% After deductibleSpecialist office visit$30 Tier 1 /$60 Non-Tier 1 copaymentEmergency room services$150 copaymentUrgent care center services$60 copaymentFor 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 coverageNetwork benefitNon-network benefitDeductible$1,500 per Person/ $3,000 per Family$3,000 per Person/ Unlimited per FamilyOut of Pocket$3,000 per Person/ $6,000 per FamilyUnlimited per Person/ Unlimited per FamilyPhysician’s office services$20 Tier 1 /$40 Non-Tier 1 copayment40% After deductibleSpecialist office visit$30 Tier 1 /$60 Non-Tier 1 copaymentEmergency room services$150 copaymentUrgent care center services$60 copaymentNew 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 CareDiagnosticNo symptoms, illness, or history prompting the screeningIn accordance with age and gender guidelinesSymptoms require further diagnosisPrevious abnormal test results prompt earlier or more frequent screeningsPrevious 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; orhas had screening done within the recommended interval with the findings considered normal; orhas 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 diagnosishas the service done because abnormalities found on previous studies require further diagnosishad 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 CostPRESENTER 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 slideThis 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 CostThis 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 orreimburse yourself for eligible health careexpenses such as:Doctor’s office visit costs and proceduresEyeglasses, contact lenses and supplies and vision examsDental treatments, including X-rays, cleanings, fillings and orthodontic treatmentCovered prescriptionsOver-the-counter (OTC) supplies and equipmentKeep 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 validprescription.
17 Dependent Care Flexible Spending Account Save even more. You can set aside $5,000 to payor reimburse yourself for eligible dependent careexpenses such as:Qualified day care expenses for childrenunder age 13Adult dependents not capable of caring for themselvesBabysitters, day care and day camps may qualifyKeep your receipts!
18 Health4Me Information at your fingertips Health plan information ID cardClaims statusGPS provider searchA personal touchHelp with claimsCoverage questionsFinding a providerAvailable 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 YEARCall Care24 services about:Legal IssuesRelationship IssuesCoping with grief and lossQuestions to ask your doctorMen’s, women’s and children’s healthPreventionHelp Finding a doctorInformation on medicationsGeneral Health InformationProprietary Information of UnitedHealth Group. Do not distribute or reproduce without express permission of UnitedHealth Group.19
21 City Of Frisco Dental Plans Your Dental Health Can Affect Your Overall Health2014 Plans - Assurant DPPO & DHMO
22 DHMO Plan Key Points:Ease of use – no claims to file, deductibles, etc. 1No DeductiblesNo waiting periodsNo Annual MaximumsMust select a dentist – each member can have his or her ownEasy 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 $0D0150 Comprehensive Exam copay $0D0272 Bitewing X-rays copay $0D1110 Prophylaxis-adult copay $0Total out of pocket $0Crown:D2750 Crown (porcelain fused to high noble metal) copay $275D2950 Core Buildup, including pins copay $75Temporary Filling copay $15Lab Fees copay $ variesTotal out of pocket $565 - $615
24 PPO Plan Key Points Freedom to see any dentist What’s covered? Calendar year max $1500 per personCalendar year deductible $50 individual/$150 familyPreventive 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, implantsOrthodontia $2,000 lifetime benefitDental vs. Indemnity
25 Network dentists can save you* $$ Non-Network DentistExample:$93830%$657$328$938NA$469Average charge for crown**Minus DHA discountActual FeeInsurance pays 50%Claimant paysYou 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.
27 Participating Provider Non-Participating Provider Voluntary Platinum $150$10 Exam CopaymentService/MaterialParticipating ProviderNon-Participating ProviderExaminationPaid in Full (no additional cost to you)Up to: $43.00 Retail ValueWARNING SIGNS FROM VISION EXAMSA comprehensive eye exam can reveal early warning signs to many medical problems including:DiabetesHigh CholesterolCancerMultiple SclerosisThyroid DiseaseRheumatoid ArthritisHypertensionBrain TumorsLupus
28 Participating Provider Non-Participating Provider Voluntary Platinum $150$20 Eyewear CopaymentService/MaterialParticipating ProviderNon-Participating ProviderFrameUp to: $ Retail ValueUp to: $40.00 Retail ValueLenses: (Clear, Standard, Glass, or Plastic)Single Vision (per pair)Paid in FullUp to: $30.00 Retail ValueBifocal (per pair)Up to: $45.00 Retail ValueTrifocal (per pair)Polycarbonate (per pair)Up to: $20.00 Retail Value
29 Participating Provider Non-Participating Provider Voluntary Platinum $150Service/MaterialParticipating ProviderNon-Participating ProviderContact Lenses:ElectiveUp to $200.00Up to: $ Retail ValueMedically RequiredPaid in FullLaser Vision Correction:$ allowance (in or out of network) – in lieu of eyewear benefitNon-Covered Eyewear Discount:discount of 20% from a participating provider’s usual and customary fees for eyewear purchases which exceed the benefit coverage
31 Group Term Life Insurance with Accidental Death & Dismemberment Review of featuresKS 10-10
32 How much insurance do you need? EN-1077How much insurance do you need?People use life insurance to:Pay for their final arrangementsProvide financial protection for those who rely on their incomeIf others rely on your income,use this worksheet to figure outhow much coverage you need.\KS 10-10
33 Basic and Voluntary Life/AD&D Coverage — for you EN-1077Basic and Voluntary Life/AD&D Coverage — for youBasic Life/AD&D Coverage$50,000Voluntary Life/AD&D CoverageMaximum coverage amount - $10,000 increments to $200,000Accidental death & dismemberment – paid in addition to thelife benefit if you or a covered dependent:Die in a covered accidentSuffer a covered dismemberment or disabilityKS 10-10
34 Coverage —for your spouse & dependents Available family coverageWho 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 yourselfto 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 notifiedHuman Resources that your application is approved.
36 Value-added features Life Planning Financial & Legal EN-1077Value-added featuresLife Planning Financial & LegalResources counseling servicesComprehensive, personalized financial plan with 12 months of follow upPersonalized 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 illKS 10-10
37 Short -Term Disability Insurance An overview of the benefitsEN-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 orsocial security disability cover your earnings if youbecame 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; andYou 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 daysYour benefit amountWhat 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 benefitsSuggested 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 haveI 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; andYou have a 20% or more loss of monthly earnings due to the sickness or injury; andYou 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 LTIPUse the second definition for 1-year, 2- year or 3-year regular occ with residualRegular 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 disabledunless regular care will not improve the disabling condition(s) or will not prevent aworsening 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 amountYour monthly LTD benefit amount equals 60 % of your basic monthly earnings to a maximum of $5,500As 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 daysBenefitDurationImportantthings 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 offsets44
45 Can other benefits reduce my disability benefits? Your disability benefit may be reduced by the amount of other incomereplacement you receive for the same disability, such as benefits fromSocial Security, workers’ compensation.*An example of how the amount of benefit may be reduced or offset byincome from other sources:Individual’s weekly pre-disability earnings: $3,000Long term disability benefit percentage: x 60%Unreduced maximum benefit: $1,800Less Social Security disability benefit per month:... $900Less state disability income benefit per month: $300Monthly long term disability benefit: $600Your 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 offsets45
46 Worldwide emergency travel assistance is included with this benefit For travel:Anywhere in the world24-hour phone access to:Pre-qualified medical providersAccess to western-style medicineAmbulance and air ambulanceLost/stolen medication replacement…and moreCovers:Business and personal travelFamily membersEnroller 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 AccidentInsuranceAn overview of the benefitsEN-1604 (06-13)47
48 Why Do You Need Accident Insurance? An accidental injury can bust your budgetAccident 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 storyRob 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 benefitofferingsHere’s how Rob’s plan helped:$400 ambulance benefit1$150 emergency room benefit2$100 fractured toe$150 two follow up visits$100 crutchesIf Rob was more seriously injured, this plan could:Pay a catastrophic benefit up to $100,0003Cover loss of sight, hearing, paralysis, etc.Pay a death benefit of $50,000 if he dies due to an accidentBenefit 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 benefitofferingsHow accident insurance worksHow it protectsPays a lump-sum benefit based on type of injury sustained and treatment neededCovered injuries include broken bones, cuts, burns, eye injuries, ruptured discs, coma, etc.Benefit can be used however you choose49
50 Additional coverage options Wellness BenefitEach covered individual will automatically receive the health screening benefit rider, which can pay $50 annual for a covered health screening test1.Covered tests include:ColonoscopyMammographyPap smearSkin cancer biopsyPSA (blood test for prostate cancer)Serum cholesterol test to determine LDL and HDL levelsStress test on a bicycle or treadmill¹Not available in all states
51 Available family coverage The benefitofferingsAvailable family coverageEmployee coverageAccident insurance is offered to all eligible employees who are actively at work¹.Spouse coverageSpouses between the ages of 17 and 64. Must live in the United StatesChild coverageCoverage 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 AmericaGroup Critical Illness InsuranceAn overview of the benefitsEN-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 coversDiagnostic testsTransportation to health facilitiesPrivate nursing or home health careAlternative or experimental treatmentsHealth insurance may not cover:If you are ill and can’t work, how would you pay for everyday expenses such as:MortgageCar paymentCredit card paymentsHousehold expensesDependent 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 costBecause 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 AdvantagesA benefit can be paid for each covered conditionEmployee-paid coverage is portableDependent children are automatically covered at 25% of the employee benefit amountAdditional diagnosis benefitMultiple payouts automatically included in the plan designEach condition payable once per lifetime per covered individualAdditional 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 benefitofferingCovered conditionsBlindness Benign brain tumorCoronary artery bypass surgery* End-stage renal (kidney) failureHeart attack Major organ failureStroke*Covered conditions due to injuryComa Permanent paralysisOccupational HIVOptional cancer coverageCancer Carcinoma in situ**Specific childhood conditionsCerebral palsy; cleft lip or palate; cystic fibrosis; Down syndrome; spinabifidaPA – 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 benefitEach 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:ColonoscopyMammographyPap smearSkin cancer biopsyPSA (blood test for prostate cancer)Chest X-raysStress test on a bicycle or treadmill1 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 tumorHeart attackComaStrokeA benefit payout of 100%12 months must elapse between occurrences of the same condition
60 Family coverage options Who can have it?BenefitEmployees who are actively at work$5,000 to $50,000 in $1,000 incrementsChildren 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
62 Employee Self-Service (ESS) Log inUser name: your first initial, last name and employee numberIf 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 timeDates 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.AvailabilityThis 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 employeesBasic AD&DDeath must result from accidentTMRS Death Benefit1X your annual salaryIf retired, $7,500Supplemental AD&D BenefitPolice 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 youAnswering questions about your health insuranceAssist with pricing estimates for Medical, Rx, Dental and Vision servicesHelp you to reconcile your medical billsAssisting your dependents even if on a different benefit planWe are working to offer some Webinars
66 Compass Health Services All your information is confidentialCompass does not receive any money for recommending a doctor, lab, hospital, etc.Medical advice is not providedYour 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 checkCall the City of Frisco Benefits Center to complete your enrollment if you elect the Unum Accident or Critical Illness benefitsEnrollment Deadline: 12 Noon, Monday, Oct. 21stfrom workhttps://ess.friscotexas.gov from home