2014-2015 Employee Benefits Annual Open Enrollment PresentationAnnual Enrollment

February 1, 2014 – January 31, 2015

Our insurance plans are designed to help you attain the health and dental services you need on a regular basis as well as to protect you against a catastrophic financial loss in the event of a serious health condition, disability or death. They represent a significant part of the total compensation package you have with Lindley Habilitation Services. Please review the employee benefits package carefully, and don’t hesitate to ask questions.

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IntroductionMedical Plan

• Payroll Deductions• Medical Benefits/Features• Claims Examples

Other Benefits• Dental• Vision• Health Advocate• Colonial

Things to Remember

What’s Next

Overview

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HR, Senn Dunn, & Health Advocate

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Please contact Human Resources as your primary source of contact for any benefit-related questions or concerns.

If for some reason, the Human Resources staff is not available, please contact Health Advocate. These are clinical staff, mostly nurses, that can help you with claims, benefits questions, ID cards, etc.

You may also contact Senn Dunn, our Employee Benefits Advisors. Senn Dunn has dedicated Account Managers available to assist you with you with any questions or concerns regarding your benefits.

Senn Dunn InsuranceEmployee Benefits Services855.313.1075ebservices@senndunn.com 866.695.8622

members.healthadvocate.com

Annual Open Enrollment

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• Medical Benefits start over February 1, 2014

• Annual Open Enrollment each year is your only opportunity to make changes, unless you experience a mid year qualifying event

• Everyone enrolled in Medical or Dental will receive a new BCBS and/or Ameritas ID card. Open ALL mail over the next few weeks.

• If your enrollment, or any change, requires any additional information, HR will let you know.

2014-2015 Medical Payroll Deductions

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Semi-MonthlyRates

Monthly Rates

Employee Only $ 69.85 $ 139.70

Employee + Spouse $ 221.03 $ 442.05

Employee/ Child(ren) $ 205.12 $ 410.23

Family $ 404.04 $ 808.08

Benefit Enhancements:No increase in employee premiumsLHS will help employee with their deductibleOffice copays now count towards out of pocket maxNo more Pre-existing conditionsBetter Provider Network, even on the CoastWe have no annual or lifetime maximum on our medical benefitHealth Advocate can help you keep costs down

If your Deductible related expenses exceeds $2,000, you will submit your EOB from BCBS to LHS HR and they will cut you a check to reimburse you up to the remaining $1,000 of Deductible

Examples: 1. If your deductible related expenses are $800, you will receive no HRA reimbursement

2. If your deductible related expenses are $2,700, then HR will reimburse

you $700

Healthcare Reimbursement Arrangement- HRA

Medical Plan Benefits

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Benefit Overview BCBS PlanMedical Individual Deductible Family Deductible Coinsurance Individual Coinsurance Maximum Family Coinsurance Maximum Individual total Out-of-Pocket Maximum Family total Out-of-Pocket Maximum Lifetime Maximum

$3,000 ($2,000 after Lindley reimburses the last $1,000)$6,000 ($5,000 after Lindley reimburses the last $1,000)

20% or 40%$3,350$6,700

$6,350 ($5,350 after Lindley reimburses the last $1,000 of EE Ded)$12,700 ($11,700 after Lindley reimburses the last $1000 of EE

Ded)Unlimited

Physician Services Primary Care Office Visits Specialist Office Visits

$20 CopayDeductible + 40%

Wellness & Preventive Routine Physical Exams Routine Eye Exams Pap/ Mammograms/ PSA Immunizations Colonoscopies (Preventive Only)

100% Covered100% Covered100% Covered100% Covered100% Covered

Medical Plan Benefits

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Benefit Overview BCBS PlanLab and X-Ray In Office Out of Office MRI, CAT & PET

$20 PCP, or Deductible + Coinsurance if SPC visitDed then 40% CoinsuranceDed then 40% Coinsurance

Inpatient Services Physician Hospital

$250 admission Copay then Ded + 20% CoinsDed then 20% Coinsurance

Outpatient Services Physician Hospital

Ded then 40% CoinsuranceDed then 40% Coinsurance

Other Services Emergency Room Services Urgent Care Co-pay Chiropractic Care

Ded then 40% CoinsuranceDed then 40% Coinsurance

Ded then 40% Coinsurance, up to 30 visits

Prescription Drug Benefits

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Benefit Overview BCBS PlanPrescription Drugs (30-day supply)

Tier 1 (Generic)

Tier 2 (Preferred Brand)

Tier 3 (Brand)

Tier 4 (Specialty Brand)

$10 Copay

You pay 100% up to $100

You pay 100% up to $100

You pay 100% up to $100

Mail Order (90-day supply)Tier 1 (Generic)

Tier 2 (Preferred Brand)

Tier 3 (Brand)

Tier 4 (Specialty Brand)

$30 Copay

You pay 100% up to $300

You pay 100% up to $300

You pay 100% up to $300

Don’t forget to Check Walmart, Walgreens, Target, Costco, Sam’s Club etc. for their $4 generics list

BCBS Plan

Preventive Exam Covered 100%

Spends out-of-pocket $0

Claims Example: Preventive Exam

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Employee Only Coverage

• Fairly healthy individual whose only medical care for the year was a preventive exam with a primary care physician

$300 annual preventive exam

TOTAL Cost = $300

BCBS Plan

Preventive Exam Covered 100%

Office Visits $40 (2 copays)

Prescription Costs $30 (3 copays)

Spends Out-of-pocket $70

Claims Example: Common Illness

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Employee Only Coverage

• Overall healthy individual with a couple sick care office visits and prescriptions throughout the year (e.g., sinus infection, strep throat)

$160 annually in office visits• Estimated 2 office visits (not

preventive) at contracted rate of $80 each

$300 annual preventive exam$45 annually in Rx

• Estimated 3 generic medications at $15 each

TOTAL Cost= $505

$270 towards BCBS Plan

Preventive Exams Covered 100%

Office Visits $120 (6 copays)

Prescription Costs$240 (6 generic copays and

$60 each for the 3 Brand medications)

Spends Out-of-pocket $360

Claims Example: Common Illness

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Family Coverage• Overall healthy family with a

few sick care office visits and prescriptions throughout the year (e.g., sinus infection, strep throat)

$480 annually in office visits• Estimated 6 office visits

(not preventive) at contracted rate of $80 each

$1,200: 4 Annual Preventive Exams $270 annually for Rx

• Estimated 6 generic medications at $15 each

• Estimated 3 preferred brand name medications at $60 each

TOTAL Cost = $1,950

Employee Only Coverage• Chronic condition such as high blood

pressure or diabetes that requires several office visits and medications throughout the year

$1,360 annually for office visits• Estimated 8 office visits (2 PCP average

$80 each & 6 specialist average $200 each

$300 Annual Preventive Exam$1,440 annually for Rx

• Estimated 4 monthly generics average $15 each & 1 monthly preferred brand average $60

TOTAL Cost = $3,100

Claims Example: Chronic Condition

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BCBS Plan

Preventive Exam Covered 100%

Office Visits $1,240 (2 PCP copays and $200 each for the 6 SPC visits)

Prescription Costs$1,200 (4 generic copays per

month and $60 per mo for the one brand medication

Spends out-of-pocket $2,440

Family Coverage• Chronic condition such as high blood

pressure or diabetes that requires several office visits and medications throughout the year

$2,720 annually for office visits• Estimated 16 office visits (4 PCP, average

$80 each & 12 SPC average $200 each

$1,200 4 Annual Prev Exams$1,300 ER visit$19,000 Inpatient Stay$3,840 annually for Rx

• Estimated 8 monthly generics average $15 each & 2 monthly Non-preferred brand average $100 each

TOTAL Cost = $28,060

Claims Example: Chronic Condition, ER, and IP stay

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BCBS Plan

Preventive Exams Covered 100%

Office Visits $3,280 (4 PCP copays… $3,200 towards Deductible- 16 SPC visits)

Prescription Costs$3,680 (8 generic copays per month and $100 per mo for the two brand

medications

Emergency Room Visit $1,300 towards Deductible

Inpatient Hospital Stay

$5,250: ($250 admission copay, then $1,500 remaining Deductible, then $3,500 Coinsurance --20% of

the remaining $17,500)

Lindley HRA Deductible Reimbursement - $1,000

Spends Out-of-pocket $12,510

Dental Plan Benefits: Ameritas

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Benefit OverviewBenefit Maximum Per Year $1,250 per Member

Preventive CareRoutine Exam, 2 Cleanings per Year, Flouride Treatments and Emergency Pain Relief

Covered 100% of Usual & Customary

Deductible$50 annual per member

$150 annual family maximum

Basic Services Diagnostic X-Rays, Fillings, Some Oral Surgery, and Extractions

Benefits are paid at 80% of Usual & Customary Pricing

Major Services 12 month wait Endodontics, Periodontics, Crown, Bridges, Dentures, Implants

Benefits are paid at 50% of Usual & Customary

Benefit Carryover ** New Benefit

As long as you receive at least one dental service during the year… you may be able to

carryover up to $250 of any remaining unused benefit, into the following year.

Orthodontia 12 month wait Covered at 50% up to a lifetime Maximum coverage of $1,250

Please always Keep UCR (Usual, Customary, and Reasonable) pricing in mind.If your charges will be more than $250, it is always wise to obtain a benefit estimate.

Voluntary Vision Coverage: Community EyeCare

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In Network

Copays Exam:$10 – Glasses:$25

Comprehensive Exam Covered in full, once per year

Contact Lenses Up to $130, once per year

Contact Lens Fitting $25 Copay

Lenses (single/bifocal/trifocal/lenticular)

Frames

Covered in full, once per year

Up to $130, once per year

Accident Plan• This provides a lump sum benefit based on the type of injury (or covered

incident) you sustain or the type of treatment you need. Examples of covered injuries include: broken bones, torn ligament, concussion, etc.

Short Term Disability Plan• This will pay when a disability occurs, depending on the amount of the

policy that you purchase. This can ease the burden of additional medical expenses as well as lowered income while out of work.

Critical Illness Plan• This can help fill the gaps in major medical coverage, and pays directly

to you, a lump sum benefit upon the diagnosis of a covered critical illness.

Cancer Policy• This can help fill the gaps in major medical coverage, and pays directly

to you, a lump sum benefit upon the diagnosis of cancer.

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Voluntary Worksite Benefits: Colonial

•Please turn in your election form to HR, no later than Friday January 31st. You need to turn in your form even if you are declining all voluntary benefits, or making no changes

•Colonial packets have been sent to each location, Speak to Colonial if you wish to make any changes or enroll.

•This has been a summary overview of employee benefits provided/offered by Lindley Habilitation Services – See Plan Documents for details

•The updated 2014 Benefit Summary booklet and your election form, both of which were emailed to you, and have both been posted to the LHS website.

Things to remember:

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