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Confidential
Employee Benefits Open Enrollment Effective: January 1, 2012
Confidential2
Filice Insurance:
Broker Overview - EBI Partnership
Dedicated Account Management Team Melanie Beranek: Client Services Manager
Charlie Weckel: Broker
Dawn Alvarez: Compliance/Wellness Director
Patrick Arnold: CEO - Lafayette, CA Division
New Enrollments/Benefits Orientation
Assistance with Claims, Eligibility, Carrier Issues…
Customized Benefits Website: www.filice.com/benefits/EBI
Confidential3
EBI Employee Benefits 2012:
Insurance Carrier Selection: – Kaiser Permanente and MetLife
Employee Premium Contributions:– Full-Time Eligible Employees: $40 per Month– Part-Time Eligible Employees: $75 per Month
Plan Availability - Effective January 1, 2012:– Medical: Kaiser – Deductible HMO (Base Plan) & HMO 15 – Dental: Met Life PPO– Vision: Discount Program (MetLife dental participants only) – Flexible Spending Accounts (FSA): Optum Health Financial– 401K: John Hancock
Confidential4
Kaiser 2012 Plan Options:
aega Kaiser Permanente HMO for EAST BAY INNOVATIONS, INC. Purchaser ID: 72129 HMO Deductible HMO
Annual Deductible: Individual / Family per calendar year(s) None / None $1000 / $2,000
Maximum Out-Of-Pocket $1,500 per member, $3,000 per family
$3,000 per member, $6,000 per family
Maximum Lifetime Benefit None / None None / None
* Benefit applies to deductible
Hospital Inpatient (all services rendered while hospitalized) $100 per day 20% per admit *
Outpatient (specialty, routine, eye/hearing exams, and urgent care) $15 per visit $20 per visit Well-child preventive care visits (23 months or younger) No charge No charge Scheduled prenatal care and first postpartum visit No charge No charge Outpatient surgery $100 per procedure 20% per procedure * Allergy Injections / Immunizations $3 per visit No charge X-rays and Lab tests No charge $10 per encounter Ambulance services $75 per trip $150 per trip Emergency department visits $100 per visit 20% per visit *
Outpatient Prescription Drugs (pharmacy and mail order) $10 gen / $25 brand, $20 gen / $50 brand MOI $10 gen / $30 brand, $20 gen / $60 brand MOI
Days supply 30 days, 100 days MOI 30 days, 100 days MOI
Mental Health Services Inpatient psychiatric care / days per calendar year $100 per day 20% per admit * Outpatient individual therapy visits $15 per visit $20 per visit Outpatient group therapy visits $7 per visit $10 per visit
Chemical Dependency Services Inpatient detoxification $100 per day 20% per admit * Outpatient individual therapy visits $15 per visit $20 per visit Outpatient group therapy visits $5 per visit $5 per visit Transitional Residential Recovery Services $100 per admit $100 per admit
Infertility Services Covered services related to the diagnosis and treatment of infertility 50% per visit 50% per visit
Additional Benefits Supplemental Durable Medical Equipment 20% per item 20% per item Skilled Nursing, Home and Hospice Care No charge 20% per admit Optical eyewear (frames, lenses, contact lenses) $150 per 24 months Not covered Hearing aids Not covered Not covered Chiropractic Not covered Not covered Dental Not covered Not covered
The information presented in this chart is a summary only. For a complete understanding of benefits, please read this chart in conjunction with the Evidence of Coverage (EOC). The EOC contains a detailed explanation of benefits, exclusions, and limitations. We reserve the right to modify the rates and benefits if we receive further clarification of Federal Health Reform requirements, or to incorporate other applicable Federal Health Reform requirements. In addition, Kaiser Permanente reserves the right to make any change in these rates and benefits due to changes in State or Federal legislation or regulatory action.
Confidential5
Medical Plan Alternative:
Alameda Alliance for Health (Public Authority)
– Medical, Dental and Vision Benefits for In Home Supportive Services (IHSS) workers in Alameda County
– Eligibility: 160 hours of paid employment (issued checks) for two consecutive months.
– Benefits: Alameda Alliance Group Care HMO based medical services administered by contracted medical providers with
Alameda County (Medical groups and Hospitals). Two Dental Options: HMO and PPO plan designs Vision: Exam and Eyewear coverage.
– Monthly Premiums: $20: Medical and Dental (HMO) $45: Medical and Dental (PPO)
– Enrollment Process: Contact #: 510-777-4201 (Additional Info/Enrollment Packet Request)
Confidential6
Dental:
MetLife Dental PPO
Deductible:
In Network: $50/Individual - $150/Family (Waived for Preventive) Out of Network: $50/Individual - $150/Family (Waived for Preventive)
Annual Maximum: $1,500 per Person
Co-Insurance : In Network Out of Network (90th % UCR) Preventive 100% 100% Basic 80% 80% Major 50% 50% Ortho 50% 50%
Orthodontics Maximum: $2,000 Lifetime (Child Only)
Confidential7
Flexible Spending Accounts (FSA)
Administered by Optum Health Financial
Medical and Dependent Care Reimbursement
Pre-tax payroll deductions to pay for un-reimbursed medical and dependent care expenses.
Annual Maximums Medical Reimbursement Account - $2,500
Dependent Care Reimbursement Account - $5,000 (IRS limit)
To enroll, complete the required election forms: Cannot change enrollment election during plan year
Funds leftover at the end of the year will be lost. Plan carefully!
For questions and eligible expenses: www.optumhealthfinancial.com