2 2012 Health Benefits Open Enrollment Guide It is time again to review the 2012 Health benefits for you and your family.Stark Carpet Corp is pleased to announce we will continue to offer Aetna Health Plans as our Medical carrier, but will be making changes to our Dental coverage. The following presentation will outline all your options effective as of February 1, 2012.
3 With Aetna Health Plans Effective: February 1, You Will Continue To Have The Following Medical Plans to Select FromFour (4) OptionsWith Aetna Health PlansPlan 1 (High) Open Access MC (NGP)Plan 2 (Medium) Open Access MC (NGP)Plan 3 (Low) Managed Choice POSPlan 4 (Basic Low) Managed Choice POS
4 HIGH Plan 1- Open Access MC provided by Aetna Health Plans Benefits In NetworkOut of NetworkOffice Co-pay$30 Primary$50 SpecialistsDeductible & CoinsuranceDeductibleSingle: $500Family: $1,500Family: $1,500Coinsurance %Coinsurance Maximum(Includes Deductible)100%Single: $50070% / 30%Single: $3,500Family: $10,500Hospital Co-pay (I/P)Emergency Room Co-pay$100 Copay after Deductible$50 (Waived If Admitted)$100 Copay; Ded & CoinsLifetime MaximumUCRUnlimitedN/A80th PercentilePrescription Drug Deductible (Waived for Tier 1)Prescription Drug Co-pay(Mail Order: 2x Co-Pay)$100 Per Person(Ded must be met before copays)Tier 1: $20 Co-payTier 2: $35 Co-payTier 3: $50 Co-payCovered at Network Pharmacies Only
5 MEDIUM Plan 2- Open Access MC provided by Aetna Health Plans Benefits In NetworkOut of NetworkOffice Co-pay$30 Primary$50 SpecialistsDeductible & CoinsuranceDeductibleSingle: $500Family: $1,500Single: $1,000Family: $3,000Coinsurance %Coinsurance Maximum(Includes Deductible)100%Single: $500Family: $1,50070% / 30%Single: $6,000Family: $18,000Hospital Co-pay (I/P)Emergency Room Co-pay$100 Copay after Deductible$50 (Waived If Admitted)Lifetime MaximumUCRUnlimitedN/A80th PercentilePrescription Drug Deductible (Waived for Tier 1)Prescription Drug Co-pay(Mail Order: 2x Co-Pay)$100 Per Person(Ded must be met before copays)Tier 1: $20 Co-payTier 2: $35 Co-payTier 3: $50 Co-payCovered at Network Pharmacies Only
6 LOW Plan 3- Standard Managed Choice provided by Aetna Health Plans BenefitsIn NetworkOut of NetworkOffice Co-pay$30 Primary$50 SpecialistsDeductible & CoinsuranceDeductibleSingle: $500Family: $1,500Single: $5,000Family: $10,000Coinsurance %Coinsurance Maximum(Includes Deductible)100%Single: $500Family: $1,50070% / 30%Single: $15,000Family: $40,000Hospital Co-pay (I/P)Emergency Room Co-pay$500 Copay after Deductible$100 (Waived If Admitted)$500 Ded & CoinsuranceLifetime MaximumUCRUnlimitedN/A80th PercentilePrescription Drug Deductible (Waived for Tier 1)Prescription Drug Co-pay(Mail Order: 2x Co-Pay)$100 Per Person(Ded must be met before copays)Tier 1: $20 Co-payTier 2: $35 Co-payTier 3: $50 Co-payCovered at Network Pharmacies Only
7 Plan 4- Standard Managed Choice provided by Aetna Health Plans BASIC LOWBenefitsIn NetworkOut of NetworkOffice Co-pay$30 Primary$50 SpecialistsDeductible & CoinsuranceDeductibleSingle: $1,000Family: $3,000Single: $5,000Family: $10,000Coinsurance %Coinsurance Maximum(Includes Deductible)90% / 10%Single: $2,500Family: $7,50070% / 30%Single: $15,000Family: $40,000Hospital Co-pay (I/P)Emergency Room Co-pay$500 Copay after Ded & Coins$100 (Waived If Admitted)$500 Ded & CoinsuranceLifetime MaximumUCRUnlimitedN/A80th PercentilePrescription Drug Deductible (Waived for Tier 1)Prescription Drug Co-pay(Mail Order: 2x Co-Pay)$200 Per Person(Ded must be met before copays)Tier 1: $20 Co-payTier 2: $35 Co-payTier 3: $50 Co-payCovered at Network Pharmacies Only
8 Your Dental Plan Will Be Administered By GUARDIAN INSURANCE COMPANY We Are Pleased To Announce New Changes To The Dental Plans for 2012.Your Dental Plan Will Be Administered ByGUARDIAN INSURANCE COMPANYYou will continue to have a choice to select either aPre-Paid DMO Dental Plan(Network Benefits Only – Must Use A Guardian DMO Provider)OrPPO - NAP 590 QD Dental Plan(Network Benefits – Must Use A Guardian PPO Provider)(Out of Network Benefits – Select A Dentist of your Choice)
9 Dental Benefits provided by Guardian Health Plans Your 2012 Calendar Year Dental Deductible will be….Pre-Paid DMO : Network Only No DeductiblesPPO – NAP590 QD: Network /Out of Network $50 Single/ $150 family (Note: Deductible is Waived for Preventive)Your 2012 Calendar Year Dental Maximum will be….Pre-Paid DMO: Unlimited BenefitsPPO - NAP590 QD: Network $2,000 Per PersonOut of Network $1,500 Per PersonOrtho (Lifetime) Max $1,000 Per Child
10 Dental Benefits provided by Guardian Health Plans (Additional Plan Benefits will be included in Guardian Handbook)Benefits Include…..Pre-Paid DMOPPO – NAP590 QDNetworkNetwork Out of NetworkPreventive & DiagnosticOral Exams / CleaningRoutine X-rays /SealantsFluoride Application / Space MaintainersFee Schedule100%Deductible WaivedBasic Restorative CareNon-Routine X-Rays / FillingsEmergency Care to Relieve PlanPeriodontics / EndodonticsOral Surgery - Simple Extractions90%80%Major Restorative CareOral Surgery –except Simple ExtractionsSurgical Extraction of Impacted TeethBridges, Crowns & Inlays/OnlaysDentures / Repairs60%50%Orthodontia$2500-$2800(Adult & Child(ren)50% For Children
11 Important Information About Your Guardian Dental Plan! If you enroll in the Pre-Paid DMO Dental plan, you will need to select a Guardian DMO Dentist in order to receive care.If you enroll in the PPO - NAP590 QD Dental Plan, it is not necessary for you to select a Guardian PPO Dentist in advance. However, by using a PPO dental provider you will be entitled to discounted fees.If you enroll in the PPO – NAP590 QD Dental Plan and elect to use a dental provider that is not contracted with Guardian, fee payments will be based on Usual & Customary allowances with no discounts.TO LOCATE A DENTAL PROVIDER IN YOUR AREA, PLEASE VISIT GUARDIAN’S WEBSITE AT
12 Life and AD&D Insurance provided by Guardian EmployerPAID BenefitLife Insurance Coverage Levels2 times Annual Salary – Max of $50,000Benefits Are Reduce 50% at Age 70Accidental Death & Dismemberment (AD&D)Levels match Life Insurance coverageAccelerated Life Benefit: Minimum: The Lower of $50,000 or 50% of Death Benefit Maximum: $100,000Includes Waiver of Premium if Totally Disabled prior to Age 60Includes Option for Conversion /Portability prior to Age 70
13 Vision Benefits provided by Vision Service Plans (VSP) Benefits Include…Using A VSP ProviderNon-Participating ProviderExamsCovered in Full after $10 CopayReimbursed Up To $50LensesSingle LensesBifocal LensesTrifocal LensesCovered in Fullafter $25 CopayReimbursed Up To $50Reimbursed Up To $75Reimbursed Up To $100Progressive Lenses (Standard)Covered in Full after $50 CopayFramesUp to $120 AllowanceReimbursed Up To $70Contact Lenses(Fitting & Evaluation)Reimbursed Up To $105Laser Vision Care15% Average Discount or 5% Off Promotional PriceFrequency LimitsExams – 1 Every 12 MonthsFrames or Contacts – 1 Every 24 Months
14 Voluntary Life Insurance provided by Allstate In additional to the Basic Life Insurance, you can also purchase additional Life Insurance through Payroll Deductions.Option 1 - Universal Life:Provides coverage to age 85 with guaranteed cash values.Offers permanent protection with lifetime rate stability.Option to purchase spouse coverage.Option to purchase small amount for children and grandchildren.Policy will pay a portion of the face value to you while you are still living if youare diagnosed with a terminal illness or require long term care.Option 2 - Horizon Term Insurance:Straight death protection with a level death benefit and a premium designed to be level for 20 years.If Interested, please contact Bill Liggan in Human Resources and he will arrange to have an Allstate Representative meet you to review the application process.
15 Voluntary Benefits provided by AFLAC Vol. Short Term DisabilityPersonal Cancer IndemnityAccident Indemnity AdvantageMaximum Benefit DurationChoice of 3 / 6 / 12 / 18 MonthsBenefit Amount:Monthly $500-$5,000 (subject to income requirement)First Occurrence BenefitPays $2,000 for InsuredPays $2,000 for SpousePays $3,000 for ChildrenAccident Emergency Treatment$120 Once per 24-hour period (once per accident / per covered person)Elimination Period for Injury / SicknessEmployee will have a choice ofelecting a 7, 14, 30, 60,90 or180 day periodHospital Confinement BenefitPays $300 per day for first 30 daysBenefit increases to $600 per day after 31st day$1000 per period or $1,500 per covered person if admitted to intensive care unit initially.Benefit IncludesTotal Disability BenefitPartial Disability BenefitTransitional Disability BenefitPolicy is Fully PortableGuaranteed Renewable to Age 70See Brochure for additional benefitsMedical ImagingRadiation & ChemotherapyImmunotherapy BenefitNursing / Skin Cancer Surgery. See Brochure for additional benefitsBenefits IncludesX-RaysAccident Follow Up TreatmentAccident Hospital ConfinementICU ConfinementMajor Diagnostic Exams. See Brochure for additional benefitsPlease contact Bill Liggan in Human Resources for enrollment information.
16 What is an Flexible Spending Account (FSA)? Flexible Spending Account provided by AmeriflexWhat is an Flexible Spending Account (FSA)?Flexible Spending Accounts provides you with tax relief for un-reimbursed medical and dependent day-care cost. FSAs enable you to utilize pre-tax dollars and save Federal, FICA, and in most cases , State taxes when paying for eligible expenses not covered by the traditional insurance plan.
17 Flexible Spending Account provided by Ameriflex Your Flexible Spending & Dependent Care dollars are deposited through regular payroll deductions.You estimate how much you spend annually on expenses that qualify to be paid from your flex account, then enroll.You May Elect Amounts up to…$5,000 for Flexible Spending (FSA) ExpensesThe annual amount you elect for the FSA is available on the first day and through-out the plan year.$5,000 ($2,500 if single) for Dependent Care ExpensesDependent Care (DCSA) is available as your contributions are deposited in the account.
18 Flexible Spending Account provided by Ameriflex USE IT…Don’t LOSE IT!Unused balances may not be paid to you in cash or used in a later year.So estimate what you think you will need for your expenses.NOTE: If you were enrolled in the FSA for 2011 and want to continue, you must make a new election for 2012.
19 Flexible Spending Account provided by Ameriflex How Are Qualified Expenses Paid?By…using the “AmeriFlex Convenience Card” – this is a Master Card debit card providing electronic access to your FSA Funds.OR…submit a Claim Form – if merchant does not accept the “AmeriFlex Convenience Card”.Note: AmeriFlex may need additional information, including receipts to verify eligibility of the expense and to comply with IRS Rules. Save all receipts, then fax or mail them promptly if requested!.
20 Expenses That Qualify For Payment With Flex Dollars Flexible Spending Account provided by AmeriflexExpenses That Qualify For Payment With Flex DollarsCo-pays, deductibles, and other payments you areresponsible for under your medical planPrescriptions (ONLY PRESCRIBED BY PHYSICIAN)Dental & Eye care expensesChiropractic treatmentsPrescribed Weight - Loss ProgramsDaycare expenses for dependents, so you can workand much more…
21 Online Website Access – Take A Tour Register Your Secure Website For Each CarriersAetna Medical:Guardian Dental:VSP Vision:Ameriflex FSA:On Your Secure Website, you will find:24 Hours a day - Access to Your Claims & BenefitsInsurance information - To become an informed consumer.Personalized tools - Request Forms & ID Cards – Look for Participating ProvidersYou can do it online - 24 hours a day, 7 days a week - from wherever you have Internet access.
22 Completion of Your Health Benefits Enrollment IMPORTANT INFORMATIONTHERE ARE TWO WAYS TO MAKE YOURENROLLMENT ELECTION FOR 2012HR CONNECTION - ONLINEIf you provided a Address (either a Stark or Personal ), you can go online to and make your elections. No Paper Documents will be necessary. (Instruction Sheet will be available)PAPER ENROLLMENTIf you do not have an Address, you may complete a Paper Enrollment and submit to Bill Liggan in Human Resources. (Enrollment Packages will be available)
23 Completion of Your Health Benefits Enrollment IMPORTANT INFORMATIONIf enrolling through HR Connection, please be sure to make your election for each plan and include any addition or changes you may want during this open enrollment. (No paper form will be required if enrolling online)If you will be using a paper form, please print all information clearly.Include All Social Security Numbers. (Yours & Your Dependents)(This is for enrollment process only. You will be assigned a Member Identification Number for Privacy Requirements)Be sure to include all your dependents dates of birth.Sign & Date your application.Return completed enrollment form to Human Resources by January 20, 2012.NOTE: ONCE YOU ARE ENROLLED IN THE HEALTH BENEFITS FOR 2012, YOU WILL NOT BE ABLE TO MAKE ANY CHANGES UNTIL THE NEXT PLAN ANNIVERSARY UNLESS YOU HAVE A QUALIFYING EVENT!
24 Co-Pilot Benefits Advocacy Service & AdvocacyCo-Pilot Benefits AdvocacyCoPilotTM is an employee advocacy program from Pilot Employee Benefits designed to assist employees with all aspects of enrollment as well as any claims or coverage issues that may arise.The CoPilotTM service card contains instructions for you to obtain assistance with any of the benefit plans. Pilot works for you and is there to help you receive the benefits of your plans.If you have any questions regarding your benefits, please contact our employee service program, CoPilotTM,Call (800)
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