Embed Size (px)
Citation preview
January 1, 2018 to December 31, 2018
Employee Benefits Enrollment Guide
Welcome to
Open Enrollment
for your employee
benefits!
Republic Health Resources offers you and
your family members a comprehensive
and valuable benefits program. Our
employees are our most valuable asset
that is why we are committed to an
employee benefit program that helps our
employees stay healthy, feel secure, and
maintain a work/life balance. Every effort
is made to provide you with a thorough
plan of benefits while still keeping costs fair
and manageable for both the company
and our employees. We encourage you
to take the time to educate yourself about
your options and choose the best
coverage for you and your family.
Who is Eligible? If you are a full-time employee (working 30 or more hours per week) you are eligible to en-
roll in the benefits described in this guide.
The following family members are eligible for the benefits in this summary: spouse and/or
dependent children (up to age 26).
How to Enroll? The first step is to review your plan options in this Benefits booklet. Once you review the
benefits, you will go to the TBX website to select your benefits for the next plan year.
Once you have made your elections, you will not be able to change them until the next
open enrollment period, unless you have a qualified change in status.
When to Enroll? New Hires – If you are hired on the 25th or the month or after, you will become eligible for
benefits on the 1st of the month following your date of hire. If you are hired before the 25th
of the month, you will have benefits as of your date of hire. ALL new hire elections MUST be
made within 30 days of your hire date or you will have to wait until the next Open Enrollment
period.
How to Make Changes? You cannot make changes to the benefits you elect until the next open enrollment period
unless you have one of the following events:
- Marriage, divorce, legal separation
- Birth/Adoption of child, change in child’s dependent status
- Death of spouse, child, or other qualified dependent
- Commencement or termination of adoption proceedings
- Change in spouse’s benefits or employment status
You must notify HR within 30 days of a qualifying event in order to make changes.
Enrollment Guidelines
©2013-2016 TBX Employee Benefits, LLC. All Rights Reserved. The Benefits eXpert®, TBX® and the Benefits Enhancer Bundle® are the marketing brands of TBX Employee Benefits, LLC.
Click the link below or open your internet browser and go to
www.thebenefitsexpert.com/login/RHR
John Doe’s Social Security Number is 123-45-6789 and he was born on June 1st, 1980. His PIN is 678980
*NOTE: The home screen of your login page will look similar to the one above. This image is an example only.
Enter your Social Security Number or your employee ID
Enter the last 4 digits of your Social Security Number and the last 2 digits of your birth year
How To Login
3
Medical – H.S.A. Plan
This is a summary of the Medical H.S.A. Plan benefits. For a list of in-network
providers, claims information, and full plan details, please register at
www.bcbstx.com.
H.S.A Plan - MTBCP609 —Blue Choice Network
Plan Features In-Network Benefits
Deductible (Individual / Family)
Coinsurance
Out-of-Pocket Max (Individual / Family)
$6,000 / $12,000
0% after Deductible
$6,000 / $12,000
Preventive Care Covered 100%, No Deductible
Office Visit—Primary Care or Specialist Deductible
Outpatient Therapy Deductible (Limits Apply)
Urgent Care Deductible
Emergency Room Visit Deductible
In-Patient & Out-Patient Services Deductible
Prescription Drugs Deductible
Mail-Order Prescriptions Deductible
Lifetime Maximum Unlimited
Out-of-Network Benefits Separate Deductible Applies
Please see Plan Summary for more details
Medical Insurance
There are several advantages of choosing to participate in the high-deductible health plan (HSA): 1. You can set aside money in a Health Savings Account (HSA) before taxes to pay for eligible medical, dental and vision expenses. An HSA is similar to a flexible spending account in that you are allowed to pay for eligible expenses with pre-tax dollars. Certain items such as cosmetic procedures are not eligible. Refer to the IRS Publication 501 for a list of covered expenses.
2. Unused money in an HSA account is NOT forfeited at the end of the year and is carried forward.
There is NO “use it or lose it” policy, therefore providing incentive to save and grow your money!
3. The HSA account is yours to keep which means that you can take it with you if you change jobs or retire. If you have any money remaining in your HSA after retirement, you may withdraw the money as cash (after age 65) with no penalty. If you should choose not to participate in an HSA plan again next year, you can still use the funds in the account for qualified expenses. However, you are no longer eligible to put money in the account if you do not have a high deductible health plan that meets the IRS requirements, such as the HSA plan offered by your employer.
4. You can use the HSA funds for any immediate family member, even if they are not covered on your
medical plan. However, if you have a spouse or dependents covered on a plan with copays they can NOT be enrolled as a dependent on the HSA plan.
5. Per IRS regulations, you are NOT eligible to contribute to an HSA pre-tax if you are currently enrolled in a traditional Flexible Spending Account (FSA) or if you are eligible for or enrolled in Medicare. Further, if an individual’s spouse is enrolled in a general purpose health FSA (with spouse’s employer), then the individual is not eligible to receive or make contributions to an HSA.
HSA Limits for 2018 The following Health Savings Account (HSA) limits apply:
2018
HSA Maximum Contribution Amount
Individual $3,450
Family $6,900
Catch-Up Contributions (age 55 and older) $1,000
Health Savings Account
Medical – Base Plan
This is a summary of the Medical Base Plan benefits. For a list of in-network
providers, claims information, and full plan details, please register at
www.bcbstx.com.
PPO MTBC813—Blue Choice Network
Plan Features In-Network Benefits
Deductible (Individual / Family)
Coinsurance
Out-of-Pocket Maximum (Individual / Family)
$5,000 / $14,700
30% after Deductible
$5,600 / $14,700
Preventive Care Covered 100%, No Copay
Office Visit / Specialist Visit $45 Copay / $90 Copay
Outpatient Therapies Deductible then 30% (Visit Limits Apply)
Urgent Care $75 Copay
Emergency Room $500 Copay + Deductible then 30%
Out-Patient Facilities/Surgeries Deductible then 30%
In-Patient Facilities/Surgeries Deductible then 30%
Prescription Drugs
Copays listed are for “non-preferred” pharma-
cies. You can receive lower copays at
“preferred” pharmacies.
Preferred Drug / Non-Preferred Drug
Generic—$10 Copay / $20 Copay
Brand—$70 Copay / $120 Copay
Specialty—$150 Copay / $250 Copay
Mail-Order Prescriptions 3X Copay (90 Day Supply)
Lifetime Maximum Unlimited
Out-of-Network Benefits Separate Deductible Applies
Please see Plan Summary for more details
Medical Insurance
Medical – Buy Up Plan
This is a summary of the Medical Buy Up Plan benefits. For a list of in-network
providers, claims information, and full plan details, please register at
www.bcbstx.com.
PPO MTBC808—Blue Choice Network
Plan Features In-Network Benefits
Deductible (Individual / Family)
Coinsurance
Out-of-Pocket Maximum (Individual / Family)
$2,500 / $7,500
20% after Deductible
$5,500 / $14,700
Preventive Care Covered 100%, No Copay
Office Visit / Specialist Visit $30 Copay / $60 Copay
Outpatient Therapies Deductible then 20% (Visit Limits Apply)
Urgent Care $75 Copay
Emergency Room $500 Copay + Deductible then 30%
Out-Patient Facilities/Surgeries Deductible then 30%
In-Patient Facilities/Surgeries Deductible then 30%
Prescription Drugs
Copays listed are for “non-preferred” pharma-
cies. You can receive lower copays at
“preferred” pharmacies.
Preferred Drug / Non-Preferred Drug
Generic—$10 Copay / $20 Copay
Brand—$70 Copay / $120 Copay
Specialty—$150 Copay / $250 Copay
Mail-Order Prescriptions 3X Copay (90 Day Supply)
Lifetime Maximum Unlimited
Out-of-Network Benefits Separate Deductible Applies
Please see Plan Summary for more details
Medical Insurance
Virtual Visits
Getting sick is never convenient, and finding time to get to the doctor can be hard. Blue Cross and Blue
Shield of Texas (BCBSTX) provides you and your covered dependents access to care for non-emergency
medical issues and behavioral health needs through MDLIVE.
Whether you’re at home or traveling, access to a board certified doctor is available 24 hours a day, seven
days a week. You can speak to a Doctor immediately or schedule an appointment based on your
availability. Virtual visits can also be a better alternative than going to the emergency room or urgent care
center.
MDLIVE doctors or therapists can help treat the following conditions and more:
General Health Pediatric Care Behavioral Health
Allergies
Asthma
Nausea
Sinus Infection
Cold/Flu
Ear Problems
Pinkeye
Anxiety/Depression
Child behavior/learning issues
Marriage problems
Get connected today!
To register, you’ll need to provide your
first and last name, date of birth, and
BCBSTX member ID number
Benefits Resources
www.goodrx.com
Use GoodRx’s drug price search to
compare prices (just like you do for
travel or electronics on other sites)
for your prescription at pharmacies
near you. GoodRx does not sell the
medications, they tell you where you
can get the best deal on them.
GoodRx will show you prices,
coupons, discounts, and savings tips
for your prescription at pharmacies
near you.
Download GoodRx’s iPhone or
Android app to get drug prices and
coupons on the go.
Please note if you use Good RX
Coupon you will not be able to use
your medical insurance to receive
deductible/out of pocket credit.
Join the Fair Price Revolution
Find out what you should expect to pay for
healthcare services in your area with
Healthcare Bluebook’s free search tool.
Did you know that the cost for the same in-
network procedure can vary by over 400%?
Healthcare Bluebook levels the playing field
with cost and quality transparency that
makes shopping for healthcare services
simple and straight forward.
From Fair Price Comparison to industry
leading quality rankings, Healthcare
Bluebook gives you everything you need to
quickly find and connect with Value
Certified Providers.
It is our responsibility to be the best
consumers we can be. This is a quick and
easy tool to help us make the right medical
decisions for ourselves and our families.
www.healthcarebluebook.com
This is a summary of your vision plan benefits. Please see benefit summary for more detail,
or visit www.humana.com.
Vision Benefits VSP Network
Exams $10 Copay—Covered once every 12 months
Glass Lenses $15 Copay (for Basic lenses) - Covered once every 12 months
Frames $130 Allowance + 20% off remaining balance—Covered once every
24 months
Contact Lenses $130 Allowance + 15% of remaining balance—Covered once every
12 months
Lens Limit Benefits include glass lenses or contact. NOT both in the same year.
Dental Benefits Traditional Plan—PPO Network
Annual Plan Maximum Unlimited
Deductible $50 employee/ $150 family
Preventive 100% (i.e. cleanings)
Basic Services 80% after Ded (i.e. fillings, endo, perio)
Major Services 50% after Ded (i.e. crowns, dentures)
Orthodontia 50%
Ortho LIFETIME Maximum $2,000
Dental & Vision Insurance
This is a summary of your dental plan benefits. Please see benefit summary for more detail,
or visit www.humana.com
Basic Life Insurance
Republic Health Resource provides all full-time active employees with Group Life and
Accidental Death (AD&D) policies through Humana. The Life policy will provide $25,000 in
Life and AD&D benefits. The AD&D policy will pay your beneficiary double the benefit, if
you were to pass away as a result of an accident. Republic Health Resources pays the full cost of these benefits.
Please use the TBX enrollment system if you need to update your beneficiary at any time.
Life and AD&D
Important Notices
This booklet is a summary of plan highlights only. Please consult the carrier’s contract for full
information on covered charges, limitations, and exclusions. This is not a binding contract. In the
event of a discrepancy, the carrier’s contract will prevail.
If you have further questions, please contact your Human Resources representative or Gus Bates
Insurance & Investments.
The following notices applies to all benefits eligible employees:
Notice Regarding Availability of Health Insurance Marketplace Coverage Options
(Employer Exchange Notice)
Summary of Benefits and Coverage (SBC) and Uniform Glossary
Notice of Special Enrollment Rights
Women’s Health and Cancer Rights Act (WHCRA) Notices
Employer CHIP Notice
HIPAA Notice of Privacy Practices for Protected Health Information
General Notice of COBRA Rights
Plan Document
Summary Plan Description (SPD)
Blue Cross Blue Shield of Texas:
Medical Benefits
(800) 521-2227
www.bcbstx.com
Humana:
Dental Benefits
(800) 233-4013
www.humana.com
Vision Benefits
(866) 995-9316
www.humana.com
Group Life Benefits
(800) 233-4013
www.humana.com
Refer to this list when you need to contact one of your benefit vendors. For general
information contact Human Resources or Gus Bates Insurance & Investments.
Gus Bates Insurance & Investments
3221 Collinsworth Street
Fort Worth, TX 76107
Phone: (817) 335-9547
Fax: (817) 529-5341
Justin Phipps
Sales
(817) 529-5311
Olivia Cummings
Account Manager
(817) 529-5319
Megan Lewis
Account Manager
(817) 529-5327
Contact Information
