2What is Open Enrollment? Medical, Dental & Vision Discount Programs Covered topics:What is Open Enrollment?Medical, Dental & VisionDiscount ProgramsLife & DisabilityEducation
3Annual opportunity to: Add or Change coverage Add or delete dependents OPEN ENROLLMENTAnnual opportunity to:Add or Change coverageAdd or delete dependentsSelect Pre-tax deductions*Open Enrollment is usually held October of each year for changes effective January 1st of the following year.
4Must notify Human Resources within 30 days of qualifying event! Qualified Family Status ChangesQUALIFIED FAMILY STATUS CHANGESMarriageDivorceLegal SeparationBirth of ChildChange in employment statusDependent ceasing to be eligibleDeathMust notify Human Resources within30 days of qualifying event!
5Health insurance – HMO 14 70% (Medical_2) Company/PlanHUMANA OA HMO 14 70%Physician$40 CO-PAYSpecialist$55 CO-PAYAdult & Child Wellness Adult Wellness MaxCOVERED 100% NO MAXMammogramsCOVERED 100%Emergency Room - Waived if Admitted$250 CO-PAYUrgent Care$100 CO-PAYIndependent Clinical LabDED THEN 100%Diagnostic Testing / MRI, CAT ScansDED & 70%Outpatient Surgery - Ambulatory Surgical CenterProvider Services Ambulatory Surgery Center (ASC)Outpatient Surgery – HospitalInpatient HospitalProvider Services Hospital & ERHome HealthDED & 70% 60 VISITSOutpatient Therapy$55 CO-PAY 60 VISITSDeductible$5000/$10000Included in Out of Pocket MaxYESCo-Insurance70%Maximum Out of Pocket$6250/$12500Out of Pocket IncludesDED, CO-PAY, CO-INS & RXPrescription$15/35/55/25%Lifetime MaximumUNLIMITED
9DENTAL – DMO HUMANA HS195 Deductible NONE Co-Insurance 100% Dentist COVERED 100%SpecialistCO-PAY APPLIESCleanings1 EVERY 6 MONTHSPreventive Network Non NetworkMOST PROCEDURES COVERED 100% SOME PROCEDURES HAVE CO-PAYSBasic Coverage Network Non NetworkSOME PROCEDURES COVERED 100% MOST PROCEDURES HAVE CO-PAYSMajor CoverageOrthodontic Coverage Orthodontic Maximum (Age Limits)Annual MaximumDependant Child/Student AgeUP TO AGE 26
13Semi-Monthly Payroll Deduction Vision careMETLIFE**$10 CO-PAY(EVERY 12 MONTHS)**$20 CO-PAYLenses: (EVERY 12 MONTHS)Frames: (EVERY 24 MONTHS)NETWORK DOCTORNON-NETWORKDOCTOR REIMBURSEMENTPAID IN FULLAFTER CO-PAYUP TO $45 ALLOWANCEUP TO $30 SINGLE$50 BIFOCAL$65 TRIFOCAL $100 LENTICULARUP TO $210 ALLOWANCEUP TO $150 ALLOWANCEUP TO $105 ALLOWANCEUP TO $70 ALLOWANCEPayroll deductionsSemi-Monthly Payroll DeductionEmployee Only$3.26Employee Plus Spouse$6.52Employee Plus Child(ren)$5.52Employee Plus Family$9.11
14PARTICIPATING PHARMACIES Mail Order:Right Source
15URGENCY EMERGENCY VS WHERE TO GO…AND WHEN Hospital Emergency Room Urgent CareSometimes, you may need care fast. But, your Primary Care Physician may be unavailable. You may want to try an urgent care center. They can treat many minor ailments. Chances are you won’t have to wait as long as at the ER. You may pay less, too.An Urgent Care Center can help with:• Sprains• Strains• Minor broken bones (example: finger)• Minor infections• Small cuts• Sore throats• RashesColdsFluHospital Emergency RoomYou may be tempted to go to the emergency room (ER). But, this may not be the best choice. At the ER, true emergencies are treated first. Other cases must wait—sometimes for hours. And, it may cost you more.Go to the ER for:• Heavy bleeding• Large open wounds• Sudden change in vision• Chest pain• Sudden weakness or trouble talking• Major burns• Spinal injuries• Severe head injury• Difficulty breathing• Major broken bones
16Hospitals Free Standing Facilities EDUCATIONVSHospitals Free Standing FacilitiesAdvantages of using a freestanding facility:No long wait for an appointment No wait, or only a short wait, on the day of your appointmentLower copayment or coinsurance than you'd pay at a hospital-based facilityDiagnostic imaging can be expensive. With many health plans, you could save on out-of-pocket costs by having the study done at a freestanding facility. In addition to standard X-rays, diagnostic imagingstudies include:Computed tomography (CT) scan, also called CAT scanMagnetic resonance imaging (MRI)Magnetic resonance angiography (MRA)Bone mineral density (BMD) or bone density scanUltrasound scanning, also called sonographyNuclear medicine studiesFluoroscopy studies
17Brand Name Generic Drug EDUCATIONVSBrand Name Generic DrugWhat canyou do?Ask the doctor orpharmacist if anFDA-approvedgeneric equivalentis available.Top Usage:Heart DiseaseDiabetesCholesterolDepression$4 Prescription
271 X ANNUAL INCOME EMPLOYER PAYS LIFE INSURANCE & AD&D $200,000 Max. Employer paid lifeEMPLOYER PAYS1 X ANNUAL INCOMELIFE INSURANCE & AD&D$200,000 Max.
28BENEFIT SUMMARY Voluntary life insurance GUARANTEED ISSUE Coverage is available in $25,000, $50,000, $75,000 & $100,000 increments up to 5 X’s annual salaryMinimum Coverage: $25,000Maximum Coverage: $125,000Employees age 70 and older, maximum benefit is $50,000GUARANTEED ISSUEUp to $125,000 for Employees under age 70Employees ages 70-74, reduce 40% or $50,000Age 75, reduce to 25% or $31,250 Spouse up to $10,000Note: It is recommended that the designated beneficiary be Age 18 or older
29Voluntary life Insurance RATES Semi-Monthly Deductions
30BENEFIT SUMMARY Short-term disability (std) Elimination period (When Benefits Are Payable)15TH Day of Injury15TH Day of Illness11 Week Maximum60% of Income ($1,000 Weekly Maximum)Premium is 100% paid by the employee post-tax (after-taxes) benefits are tax-free.Pre-Existing Conditions – 3/12 Look back
31BENEFIT SUMMARY Long-term disability (ltd) LTD is designed to assist the employee during a prolonged period of absence due to an illness or injury after 90 days of disabilityMaximum Monthly Benefit Amount:60% of the employee’s monthly salary up to $6,000Maximum Benefit Period:To 65 years of age or when eligible for social security retirement
32Long-term disability (ltd) BENEFIT SUMMARYElimination Period:90 DaysThe Premium is paid 100% by the EmployeePost-Tax (After Tax Deduction)Benefits are Tax-FreeBenefits are paid out MonthlyPre-Existing Conditions – 3/12 Look back
33WORLD WIDE THROUGH LINCOLN FINANCIAL Travel assistanceWORLD WIDE THROUGH LINCOLN FINANCIALTravel Assistance includes:Medical Evacuation and RepatriationLost Luggage ServiceReplacement Assistance for Lost or Stolen Travel DocumentationLegal services and Translation Services
34EMPLOYEE CONNECT Employee assistance program - eap Employee Connect is available 24 hours a day, seven days a week with support, guidance and resources.Features:Counseling Sessions24 x 7 x 365 Telephone and Web AccessConfidentialityFamilyWorkplace StressEmotional Well-BeingGrief & LossMental HealthAddiction
35WORLDWIDE TRAVEL ASSISTANCE AND IDENTY THEFT PROTECTION FOR YOU AND YOUR FAMILY
36Contact your Human Resources Representative for more information: Staci Hooper-PowellDirector of Human Resources(P)(E)