Upload
lamquynh
View
213
Download
0
Embed Size (px)
Citation preview
Agenda• Open Enrollment• CoreSource Connect• Medical/Rx• Dental• Vision• Payroll Deductions• Life & Disability• New!!! Hospital and Accident Insurance• Important Reminders
Open Enrollment
You can pause this presentation at anytime during viewing
Open Enrollment changes are effective July 1, 2017 Open Enrollment is the time for you to fully understand the benefits
that you are enrolled in and make changes if necessary We have continued our partnership with Benelogic for enrollment
services We are continuing our three health plans through CoreSource, using
the Cigna network CoreSource Connect is your single point of contact for all benefit
related questions We will be terminating the group AFLAC policies. We have replaced
those plans with TransAmerica alternatives. If you are currently enrolled in AFLAC and would like to keep it, you can continue that coverage on an individual basis directly billed by AFLAC.
New guidelines for spousal eligibility beginning July 1, 2017
Open EnrollmentDuring Open Enrollment you are allowed to:
• Enroll in previously declined benefits• Make changes to your current benefit selections• Add/Remove dependents
Spouse Coverage Status
Spouses of employees who are eligible for health insurance through their employer are not eligible to be covered under Mariner Finance’s health insurance plan. To determine if your spouse is eligible for
Mariner Finance’s health insurance plan, please see options below:
1) Not applicable – Please select this option if you are waiving the health insurance plan, do not have a spouse, or are choosing to not cover your spouse under the Mariner Finance health insurance plan.
2) My spouse is either not employed or employed but is not eligible for health insurance coverage through their employer – Your spouse is eligible to be covered under Mariner Finance’s health insurance plan.
3) My spouse is employed and either eligible for or enrolled through his/her employer. – Your spouse is NOT eligible to be covered under Mariner Finance’s health insurance plan.
You must select one of the above options when enrolling as an acknowledgement that you have accurately described your spouse's situation with regard to other employer sponsored health plan coverage. If your spouse's coverage situation changes during the year, you are further responsible to notify the Human Resources Department within 30 days of the qualifying life event. Any falsification, misrepresentation or inaccuracy of the information provided on this page, failure to fully cooperate with the Human Resources Department in verifying the information provided in this document, or failure to promptly notify the Human Resources Department of any change in the information provided on this page may result in the termination of your spouse's eligibility from the Mariner Finance health insurance plan
CoreSource Connect 1-855-852-6895
CoreSource-Related Questions or Issues Check claim status Verify eligibility Approve pre-certification Order ID cards Answer dental, flex, COBRA or vision
questions Connect to YourCare health and wellness
team
Other Benefit Questions or Issues Employee Assistance Program (EAP) Pharmacy Benefits Manager (PBM) Voluntary benefits 401(k) or 403 (b) Third-party wellness or disease
management Group life & health
For more complex questions or issues, you will be assigned to a Member Advocate or Registered Nurse
A CoreSource Connect Representative Answers 24/7:
Caller Assigned to Member Advocate Caller Assigned to Registered Nurse
Helps member understand medical bills & EOBs Negotiates out-of-pocket expenses with providers Provides referrals to community and
government resources Assists with claim appeals Finds in-network providers Assists with elder care issues for
children of aging parents
Member Advocate Registered Nurse Guidance and support 24/7 with acute care issues Education on diagnosis and treatments Medical support to help direct members to appropriate level of care Assistance for pre- and post-doctor
visits
For more information on CoreSource Connect, view the video under the “Resources” tab on the Benelogic employee portal.
Medical Plan Features
CoreSource administers the medical, dental and vision benefits. They are also the single point of contact benefit questions as well as a disease management and wellness team.
Three medical plans are offered through the Cigna network. Cigna offers a broad national network of providers, and no PCP elections are required. Referrals are not required. All medical plans include Teladoc.
PPO HSA
PPO 80/60
PPO 100/60
Teladoc 1-800-Teladoc (835-2362)
Top 10Diagnoses
Electronic Prescription (SureScripts) by phone
• Sinus Problems• Urinary Tract Infection• Pink Eye• Bronchitis• Upper Respiratory Infection• Nasal Congestion• Allergies• Flu• Cough• Ear Infection
• Use of antibiotics limited to short durations; patient education and physician reminders for appropriate use
• No prescribing of DEA-controlled substances, medication for psychiatric illness, or lifestyle drugs (i.e. erectile dysfunction, diet, smoking-cessation).
• Generic drugs are automatically recommended
Teladoc 1-800-Teladoc (835-2362)
An employee has cold-like symptoms but doesn’t have the time to sit in an urgent care waiting
room. Instead they call Teladoc:Step 2.Request consult
Step 3.Talk with a physician
Step 4.Resolve the issue
Step 6.Settle up
They simply log on to their account or call Teladoc, 24/7/365, to request either a telephone or video consultation.
A board-certified physician licensed in their state reviews their medical history and provides a consultation over the phone or through video, just like an in-person visit.
The physician recommends the right treatment for their medical issue. If a prescription is necessary, it is electronically sent to the member’s pharmacy of choice.
Teladoc sends a claim to the health plan each night. Physicians are paid for consultations they perform. Teladoc collects the appropriate copay from the member.
Step 1.Medical historyMember is required to complete their medical history online, by phone, or by faxing a paper form prior to requesting a consultation.
Step 5.Continuity of careThe physician documents the results of the consultation in the member’s medical history. Consultation information is sent to the health plan and can be sent to the member’s primary care physician.
PPO 80/60Benefit In-Network Out-of-Network
Medical Deductible $750 Individual / $1,500 Family $1,500 Individual / $3,000 Family
Out of Pocket Maximum $2,500 Individual$5,000 Family
$7,500 Individual$15,000 Family
Office Visits $20 PCP/$30 Specialist
Deductible then 40% of Allowed Benefit
Diagnostic Services Deductible, then 20% Deductible then 40% of Allowed Benefit
X-Ray & Lab Tests $30 Copay Deductible then 40% of Allowed Benefit
Emergency Room Deductible, then 20% Paid as in network
Hospital Room and Board Deductible, then 20% Deductible then 40% of Allowed Benefit
Preventive Services No Charge Plan Pays 100% of Allowed Benefit
Prescription Drug $10/$25/$45 Retail
PPO 100/60Benefit In-Network Out-of-Network
Medical Deductible $500 Individual / $1,000 Family $1,500 Individual / $3,000 Family
Out of Pocket Maximum $2,000 Individual$4,000 Family
$4,000 Individual$8,000 Family
Office Visits $20 PCP/$30 Specialist
Deductible then 40% of Allowed Benefit
Diagnostic Services No Charge Deductible then 40% of Allowed Benefit
X-Ray & Lab Tests No Charge Deductible then 40% of Allowed Benefit
Emergency Room *Non-emergency treatment will be subject to the deductible.
$200 Copay Paid as in network
Hospital Room and Board Deductible, then $300/Admit Deductible then 40% of Allowed Benefit
Preventive Services No Charge Plan Pays 100% of Allowed Benefit
Prescription Drug $15/$35/$60 Retail
PPO HSABenefit In-Network Out-of-Network
Medical Deductible $1,300 Individual / $2,600 Family $2,500 Individual / $5,000 Family
Mariner Finance Contribution $19.24 per pay (Individual) $38.47 per pay (Family)
Out of Pocket Maximum $2,500 Individual$5,000 Family
$5,000 Individual$10,000 Family
Office Visits Deductible then 10% Deductible then 30% of Allowed Benefit
Diagnostic Services Deductible, then 10% Deductible then 30% of Allowed Benefit
X-Ray & Lab Tests Deductible, then 10% Deductible then 30% of Allowed Benefit
Emergency Room Deductible, then 10% Paid as in network
Hospital Room and Board Deductible then 10% Deductible then 30% of Allowed Benefit
Preventive Services No Charge Plan Pays 100% of Allowed Benefit
Prescription Drug Deductible, then $15/$35/$60
• Savings account for healthcare expenses• Regulated by IRS• You and your employer can make contributions
– Annual 2017 Maximum is $3,400/Individual or $6,750/Family ($1,000 catch up if over 55)
• Contributions are triple tax advantaged: contribute tax free, earn interest tax free, and spend tax free (on qualified medical expenses)
• Unused funds roll over from year to year and continue to grow• You decide when and how to spend your money• Change deduction amounts at any time• Non qualified expenses subject to 20% penalty and become taxable• Be sure to keep track of expenses and receipts, in the event of an IRS
audit
For more information on HSA vs. FSA, view the video under the “Resources” tab on the Benelogic employee portal.
HSA Basics
• Tax Advantaged way to pay for certain medical and/or dependent care expenses.
• Pay for these expenses using pre-tax dollars, lowering your taxable income which results in higher take-home pay.
• FSA Medical - annual dollar amount maximum is $2,500• Limited FSA – annual dollar amount maximum is $2,500• FSA Dependent - annual dollar amount maximum is $5,000
Without FSA’s With FSA’sCombined Gross Annual Salary $40,000 $40,000Pre-Tax Medical Expenses $800Pre-Tax Dependent Care Expenses $3,900Taxable Income $40,000 $35,300Income Taxes @ 32% $12,800 $11,296After-Tax Medical Expenses $800After-Tax Dependent Care Expenses $3,900Spendable Income $22,500 $24,004
For more information on HSA vs. FSA, view the video under the “Resources” tab on the Benelogic employee portal.
Plan Comparison Tool
Here is the link to your new Plan Selector:
https://www.planadvisor.com/EmployeePlanSelector.aspx?planselectorid=2873&token=a981ac60ce6b39899a107cc401e18e15
For additional information on how to save money on medical and Rx costs, view the helpful videos under the “Resources” tab on the Benelogic employee portal.
Dental – Cigna
Summary of Services In-Network Out-of-Network
Deductible $50 Employee/$150 Family(Applies to Basic & Major Services)
Annual Maximum $1,000
Preventive Services(Exams, X-rays, Prophylaxis, FluorideTreatment, Sealants, Palliative Treatment)
Covered at 100%, no deductible
Covered at 100% Allowed Benefit, no
deductible
Basic & Major Surgical Services (Fillings, Simple Extractions, Surgical & Non-
Surgical Periodontics, Root Canals)
Covered at 80%, after deductible
Covered at 80% Allowed Benefit after deductible
Major Services (Inlays, Onlays, Crowns, Prosthetics,Dentures, Bridges)
Covered at 50%, after deductible
Covered at 50% Allowed Benefit after deductible
Child Orthodontia ($1000 Max) 50% after Deductible 50% after Deductible
Vision Plan via VSP Network
Benefits In-Network Out of NetworkExams (every 12 months) $10 co-pay Covered up to $45Frames (every 12 months) Exclusive Tower Collection
(approx 270 Frames) no co-pay
Covered up to $45
Lenses (every 12 months)Single Covered in full Reimbursed up to $52Bifocal Covered in full Reimbursed up to $82Trifocal Covered in full Reimbursed up to $101Standard Lenticular Covered in full Reimbursed up to $181Elective Contact Lenses Covered up to $97 Reimbursed up to $97Bifocal Contact Lenses Covered up to $127 Reimbursed up to $127Contact LensesMedically Necessary
Covered in fullWith prior approval
Reimbursed up to $285 with prior approval
Life & Disability Insurance – Reliance Standard
Basic Life and AD&D Insurance (Company Paid for Full-Time Employees)
• Policy will pay up to 2 times your annual salary to a maximum of $200,000
Long Term Disability Insurance (Company Paid for Full-Time Employees)
• Policy will pay 60% (non taxable) of your basic monthly earnings up to $6,000 per month
• Benefits are payable once you are disabled and under a physician’s care for 90 consecutive days
• If your employment terminates you are still eligible for disability benefits as long as your disability occurred while you were actively employed
Voluntary Term Life is payroll deducted. Premiums are based upon your age and amount of insurance you have selected.
• Employee and Spouse Benefit options are available from $10,000 to a maximum of $500,000, in increments of $10,000
• Dependent Child benefit options are available in $5,000 or $10,000 amounts• Anyone who did not enroll when first eligible is considered a late entrant and will
require a statement of insurability.• If you become totally disabled (as defined in your policy) before age 65, your life
premiums will be waived during your period of disability• Current enrollees can increase election $20,000 without statement of insurability
during the open enrollment (up to the Guarantee Issue amount)
Voluntary Accidental Death and Dismemberment
• Premiums are based upon your age and amount of insurance you have selected. • Benefit options are available from $10,000 to a maximum of $500,000, in
increments of $10,000
• Voluntary Short Term Disability is payroll deducted. Premiums are based upon your age and amount of insurance you have selected
• Three options are available:• 40% of weekly income/50% of weekly income/60% of weekly income up to a $1,250
maximum• 15th day out up to a Max of 13 Weeks are potentially covered based on the discretion of
the carrier• Late entrants require a statement of insurability (medical underwriting)• Pre-existing Conditions with diagnosis or treatment received within 3 months prior to
your effective date will not be covered for the first 12 months• Example:
• Employee Date of Hire: 05/05/2017• Benefits Effective Date: 07/01/2017• If you are treated for a pre-existing condition within the 3 months prior to July
1, 2017 (April 1- June 30), that specific condition would not be covered for the first 12 months you are enrolled. Any newly treated or diagnosed disability or injury would be covered as of July 1st, 2017.
• Some states have mandated disability. If you live in New York, New Jersey, Rhode Island, Hawaii, California or Puerto Rico – please note your state disability will offset against the group policy.
Benefit Plan Pay You Directly
Wellness $50 once for employee, once for spouse per year
Emergency Treatment $250 within 96 hours of accident. X-rays included.
X-rays Included in Emergency TreatmentAccident Follow-Up $120 one treatment per day up to 3 treatments
Initial Accident Hospitalization$900 once per period. ICU benefit ($300) is
paid even if initially admitted to hospital then transferred to ICU
Accident Hospital Confinement $100 per day up to 365 days. ICU: $300 per day up to 15 days per accident
2nd Hospitalization Opinion $120 per person, per accidentMajor Diagnostic Exams $400 once per year, per person
Physical Therapy $120 per treatment, per day up to 10 treatments per accident, per person
BiWeekly Payroll DeductionsIndividual $5.51 Employee/Spouse $8.49 Employee/Child(Ren) $7.58 Family $10.82
**Pays cash benefits dependent on severity of injuries to be used to supplement loss of FAMILY income and out of pocket medical bills.**
Benefit Plan Pay You Directly
Annual Hospitalization Confinement $500 per day up to 1 day per confinement, 1 day per year maximum
Daily In-Hospital Benefit $100 per day for Sickness or Injury. Maximum: 31 days
ICU $200 per day up to 30 daysAmbulance Transportation $100 up to 3 trips per year/6 trips per lifetime
Outpatient Surgical $250 without anesthesia. With anesthesia pays an additional 30%
Inpatient Surgical $500 per day, once per year. With anethesia pays an additional 30%
Wellness Benefit N/A
Inpatient Mental and Nervous $100 after 24 hours of confinement, up to 31 days per year, 60 days lifetime
BiWeekly Payroll Deductions
Individual $11.93Employee/Spouse $26.03Employee/Child(Ren) $19.68Family $31.12
**Can be used for Maternity or Paternity coverage!!No Pre-Existing Condition Exclusions
You must enroll through the Benelogic siteEnrollment is open May 22nd-June 2nd
Questions:CoreSource Connect 855.852.6895McQuade Consulting 410.732.7320