HCL Benefits 2012. 2 Important Enrollment Information Key Items to know: You must enroll in benefits within 30 days of your date of hire or you will

HCL Benefits 2012

2

Important Enrollment Information

Key Items to know:

You must enroll in benefits within 30 days of your date of hire or you will void your

opportunity to enroll for the year unless you have a life changing event.

A life changing event is Marriage/Divorce/Birth/Death-

Spouse employed/terminated/changes jobs/leave of absence

It will take approximately 7 business days for CIGNA to receive your data. Once

received you can go to mycigna.com & print our a temporary ID Card. Your

permanent card will be mailed to your home address within 3 weeks.

FSA Flexible Spending Account must also be selected within 30 days of

employment or you will void your opportunity to enroll for the year unless you have

a life changing event.

Annual Open Enrollment: Each year you are eligible to enroll and change

plans. This occurs in November for each year

3

Premier Plan Gold Plan Standard Plan

Co-pay Office

Primary / Specialist

Annual Exams

You pay $15 / $30

Cigna pays the rest

No Co-pay Cigna pays

100%

You pay No Deductible or Co-Insurance

You Pay $15 / $30

Cigna pays the rest


100%

You pay No Deductible or Co-Insurance

You pay $20 / $40

Cigna pay the rest


100%

You pay No Deductible or

Co-Insurance

Emergency Room

Hospital Admit$100 per visit

$200 per admission

$125 per visit

$250 per admission

$150 per visit

$300 per Admission

Annual Deductible

Paid 1x per Year

$125 (3 max per family)

For Hospital & Out patient


For Hospital & Out Patient


For Hospital & Out Patient

Co-Insurance% you pay after

Deductible

You pay 0% of Bills after Deductible



Maximum % you pay after Deductible

Plan pays 100% after Deductible

When you have paid $2,000 Plan pays 100% thereafter

When you have paid $4,000 Plan pays 100% thereafter

Prescriptions

Generic

Brand

Non-Brand

Annual Ded. $100 (3 max)

$10

$20

$40


$15

$30

$50


$20

$30

$50

Mail Order (90 day) $20 / $40 / $80 $30 / $60 / $100 $40 / $60 / $100

Contributions (per Month)

E- $175

E+1- $ 350

E+ Family - $ 475

E- $ 90

E+1- $ 180

E+ Family - $ 250

E- $ 65

E+1- $ 120

E+ Family - $ 180

3 PPO Plans – Detail Explanation Cigna Open Access Network of Providers

4

What are Co-pays Deductible & Co-Insurance?

Co-paysPaid Per Visit

NO Deductibles No Co-Insurance

Additional Fees*Paid Per Visit

In Addition to Deductible

Deductible then Co-Insurance*Deductible is an Annual Payment

Co-Insurance is a % of bill you pay after Deductible

100% No Co-pay for Annual Wellness Exams

Office Primary Visit

Urgent Care Facility

Immunization

Lab and X-Ray

Ob/Gyn

Acupuncture

Allergy Treatment

Physical Therapy

Speech Therapy

Occupational Therapy

Acupuncture

Family Planning

Chiropractic to $3K Annually

Nutritional Evaluation (3 visits)

Specialist Visit 2x Primary Visit

Hospital Admission

(per admission)

Emergency Room

(Waived if admitted)

RX Annual Deductible

In-patient/Out-patient Facility and Professional Charges:

Hospital Room

Operating Room

Procedure Room

Treatment Room

Recovery Room

Physician/Surgeon

Anesthesiologist

Radiologist

Pathologist

Ambulance

Maternity Delivery and Prenatal Visits

MRI and CAT Scans

Substance Abuse

Mental and Nervous Disorder

Prosthetic Appliance

Durable Medical Equipment

Organ Transplant

Home Health Care/Hospice

Skilled Nursing Facility (120 days max)

Bereavement Counseling

Infertility Treatment Not Covered *NOTE: SPD for each plan is the final authority of plan

5

When are Deductible & Co-Insurance Applied?

Deductible & Co-insurance are paid when these services are used

Premier Plan

Gold Plan

Standard Plan

Cigna Pays 100% of Bills after you have paid the

Deductible

Cigna Pays 100% of Bills after you have paid $2,000

Cigna Pays 100% of Bills after you have paid $4,000

In-patient/Out-patient Facility and Professional Charges:

Hospital Room

Co-Insurance: You pay 20% of the next

$20,000 in bills after you have paid the deductible. The maximum you will pay

i$4,000

Operating Room Treatment Room Recovery Room

Physician/Surgeon Anesthesiologist

Radiologist Pathologist Ambulance

Maternity Delivery and Prenatal Visits MRI and CAT Scans

Co-Insurance: You pay 10 % of the

next$20,000 in bills after you have paid the deductible The maximum you will pays

is $2,000

Substance Abuse

Mental and Nervous Disorder Prosthetic Appliance

Durable Medical Equipment

Organ Transplant Home Health Care/Hospice

Skilled Nursing Facility (120 days max)

Bereavement Counseling Annual Deductible $500

Annual Deductible $125 Annual Deductible $250

6

When are Office Visits and Fees Applied?

Premier Plan Gold Plan Standard Plan Office Visit $15 / $30 Office Visit $15 / $30 Office Visit $20 / $40 100% paid by Cigna

NO Deductible or Coi-insurance

100% paid by Cigna NO Deductible

or Coi-insurance

100% paid by Cigna NO Deductible

or Coi-insurance Office & Urgent Care Visits:

NO Deductible or Co-Insurance Office Primary Visit Office Primary Visit Office Primary Visit Urgent Care Facility Urgent Care Facility Urgent Care Facility

Immunization Immunization Immunization

All proceedures are covered at 100% after Co-Pay.

Lab and X-Ray Lab and X-Ray Lab and X-Ray Ob/Gyn Ob/Gyn Ob/Gyn Acupuncture Acupuncture Acupuncture

Allergy Treatment Allergy Treatment Allergy Treatment


Physical Therapy Physical Therapy Physical Therapy Speech Therapy Speech Therapy Speech Therapy Occupational Therapy Occupational Therapy Occupational Therapy

Acupuncture Acupuncture Acupuncture

Family Planning Family Planning Family Planning




Premier Gold Standard

Fees Paid Each time You go to a Hospital or

Emergency Room No Deductible or Co-Insurance unless admitted to

Hospital

Hospital Admit $300 Hospital Admit $250 Hospital Admit $200

Emergency Room $150 Emergency Room $125

Emergency Room $100

7

Example of ‘Co-Pay’ Costs with 3 Preferred Provider Organization (PPO) Medical Plans: (In Network Comparison)


Co-pays

8 Office Visits

(0ther than exams)

4 Specialist Visits

$120 ($15 each)

$120 ($30 each)

$120 ($15 each)

$120 ($30 each)

$160 ($20 each)

$160 ($40 each)

2 Emergency Rooms

$200 ($100 each) $250 ($125 each) $300 ($150 each)

12 Generic RX $220 $100 (ded + $10 each) $280 (ded + $15 each) $340 (ded + $20 each)

Your Co-Pay Costs$660

$770

$110 more than Premier

$960


$190 more than Standard

Your Annual Contribution for Each Plan vs. Saving by Switching to a Lower Cost Plan

Ann. Cost Annual Cost Pemier to Gold Annual Cost Gold to Standard Premier to Standard

Premier Gold Annual Savings Standard Annual Savings Annual Savings

Employee $2,100 $1,080 -$1,020 $780 -$300 -$1,320

Plus 1 $4,200 $2,160 -$2,040 $1,440 -$720 -$2,760

Family $5,700 $3,000 -$2,700 $2,160 -$840 -$3,540

8

Example of ‘Deductible’ and ‘Co-insurance’ $5,000 3 PPO Plans (In Network Comparison)


1 Hospital Admit Fee(Does not count toward Max Out of

Pocket Expense) $200 $250 $300

Annual Deductible(Does not count toward Max Out of

Pocket Expense)$125 $250 $500

Co-Insurance-After Deductible None 10% of next $4.5K = $450 20% of $4.2K = $840

Your Co-Ins. Out of Pocket

Fees/Deductibles/Co-Insurance.

$325

$950


$1,640

$1,315 more than Premier

$690 more than Standard

Co-Insurance- After Deductible

(that count towards your out of pocket Maximum)

NonePlan pays 100%

After you pay $2,000 Excluding: Co-pays / Fees / Ded.

Plan pays 100%

After you pay $4,000 Excluding: Co-pays/Fees/Ded.

Your Annual Contribution for Each Plan vs. Saving by Switching to a Lower Cost Plan

Ann. Cost Annual Cost Premier to Gold Annual Cost Gold to Standard Premier to Standard

Premier Gold Annual Savings Standard Annual Savings Annual Savings

Employee $2,100 $1,080 -$1,020 $780 -$300 -$1,320

Plus 1 $4,200 $2,160 -$2,040 $1,440 -$720 -$2,760

Family $5,700 $3,000 -$2,700 $2,160 -$840 -$3,540

Dental Plan: CIGNA Core Detailed SPD on to be up on HCLBenefits.Com shortly

In- Network

Out of Paid at 80% of Usual Customary Charges Network

Annual DeductibleEmployee

Family

Waived for Preventative Care

$25

$75

Waived for Preventative Care

$75

$225

Annual Maximum Benefit per person

$1,500 $1,500

Preventive and Diagnostic Care – Class I

100% 100%

Basic Restorative Care – Class II

90% 70%

Major Restorative Care – Class III

60% 50%

Orthodontia

Life time Max

Children Only

50%

$1,000

50%

$1,000

CIGNA Vision Plan Detailed SPD to be up on HCLBenefits.Com shortly

CIGNA/VSP Network Non Network

Exam Co-pay

Lenses & Frames Co-pay(Does not apply to contact lenses)

$10

$10Up to $45

Single Lens Co-payOne pair every year

100% Up to $32

Bi-focal

Tri-focalOne pair every year

100% Up to $55

Up to $65

Contact Lens(choice of contact lenses or frames)

One pair every year

Elective: 100% Up to $130

Therapeutic: 100%

Elective: Up to $105

Therapeutic: Up to $210

Frames (choice of contact lenses or frames)

One Pair every 2 years

100% Up to $120 Up to $66

VSP's choice network + CIGNA's networks and Retail chainsPlease visit www.mycigna.com to search for providers

Employee Assistance Plan - CIGNA 24/7 Assistance: 800-538-3543 (100% Company Paid)

Marital/Family Problems

Stress and Anxiety

Depression

Alcohol/Substance Abuse

Legal Concerns

Mental Health Concerns

Relationship Concerns

Abuse (verbal & physical)

Gambling

Maintaining Work-Life Balance

Financial Difficulties and Work-

Related concerns

For more, please log on to www.cignabehavioral.com/CGIClick on the Healthy Rewards link to access discount information:

User name: rewardsPassword: savings

Our Employee Assistance Plan offers you professional counseling with licensed doctors on a variety of matters to foster healthier living and well-being:

Group Life Insurance Plan: CIGNA Life Insurance and Voluntary coverage

Company Paid Group Life

Group Base Coverage2x Base Salary up to a Maximum $500K

for your Beneficiary upon Death(Guaranteed issue $500K)

Group Accidental Death & Dismemberment

2x Base Salary up to a Maximum $500K

for your Beneficiary upon Death

Employee Paid Voluntary Life

Employee CoverageSelect up to 1 – 5x Base Salary

(Guaranteed issue $200K)

Voluntary Spouse Coverage(50% of employee coverage)

Select up to $10k - $150K(Guaranteed issue $20K)

Voluntary Child Coverage$10k per child(Maximum $10K )

Group Short Term Disability Plan: CIGNA (100% Company Paid)

Short Term Disability

In the event of an accident or illness benefits begin from the

8th Day

(applicable if the patient is under doctor’s care and unable to work)

Maximum Weekly Benefit to replace your income up to

$2,300 weekly

(integrated with all sources of income)

% of Weekly Earnings Covered 70%

Benefit is payable for90 Days

HCL does not have a paid maternity leave benefit.

This plan provides benefits during maternity as long as you meet the criteria mentioned under the policy.

To file a claim, please call 1-800-362-4462

LTD

In the event of an accident or illness benefits begin after

90 Days

(applicable if the patient is under doctor’s care and unable to work)

Maximum Monthly Benefit to replace your income up to

$9,000 monthly

(integrated with all sources of income)

% of Monthly Earnings Covered 70%

Benefit is payable to Age 65

Group Long Term Disability Plan: CIGNA (100% Company Paid)

FSA Cafeteria Plan Pre tax Benefit

All Contributions taken out of Gross Wages CIGNA FSA

Contribution for Plans(taken out of your salary)

100% of your contribution

Health Care BenefitTo pay for expenses not covered by your plan

$5,000 Maximum Contribution Annually

Dependent Child Care Expenses $5,000 Maximum Contribution Annually

Considerations before you Enroll:Unused dollars are forfeited Health and dependent care accounts

are separate Tax implications

All elections need to be made during Open Enrollment and cannot be changed unless there is a life changing event i.e. Death, Divorce, Loss of Employment

Effective January 1, 2011, distributions from health FSAs will be allowed to reimburse the cost of over-the-counter medicines or drugs “only” if they are purchased with a prescription.

Example: FSA Expenses

Reimburses expenses not covered by your medical, dental or vision plan

Co-pays Deductibles Co-Insurance Hospital Admit Fee Emergency Room Fee Prescription drugs Co-pay Dental Deductible & Orthodontia Vision Co-pays

See a complete list at:

http://www.irs.gov/publications/p502/index.html

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Thank You!

Documents

HCL Benefits 2012. 2 Important Enrollment Information Key Items to know: You must enroll in benefits within 30 days of your date of hire or you will