LiveHealth Online: BCBS - RetailCatalog.uswebsites.retailcatalog.us/1360/mm/2017-benefits-overview.pdf · 2017. 1. 13. · LiveHealth Online: BCBS LiveHealth Online can treat many

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EligibilityAll associates who work 30 hours or more per pay period are eligible for coverage. Your coverage becomes effective on the first day of the month following the completion of 60 days of continuous, full-time, active employment. Benefits for associates end at midnight on the date of termination from SEI/Aaron’s, Inc. All enrollment materials must be turned in within the first seven days of employment. Please make sure you complete all necessary information on the forms as this can delay your effective date of coverage. Benefits for associates end on the date of termination from SEI/Aaron’s, Inc.

Your immediate family members are called “Dependents.” The term dependent means your spouse, to whom you are legally married and your dependent children up to age 26 regardless of marital or student status. The term children can mean your natural children, an adopted child, stepchildren, or a child for whom the associate has legal guardianship or must cover per a court decree.

Qualifying EventYour elections will be locked in until the next annual enrollment period unless you have a qualifying event. If you acquire a dependent as a result of a qualifying event, you must enroll the dependent within 30 days of the event.

Qualifying change in status include, but are not limited to:

P Marriage, divorce or legal separation, birth or adoption, death of your spouse or covered child

P Change in your spouse’s work status that affect the benefits eligibility

P Becoming eligible for Medicare or Medicaid during the year

LiveHealth Online: BCBSLiveHealth Online can treat many medical conditions via the internet, telephone, or smartphone/tablet mobile app. It will save you the time, frustration and cost of going to an Emergency Room or Urgent Care Center.

Unless you are experiencing a life or limb threatening emergency, you can save time and money by calling Live Health Online instead of going to the Emergency Room. Simply call 855-603-7985 or go online to www.livehealthonline.com. LiveHealth Online is available at NO COST to associates and their covered family members.

Claims AdvocacySEI/Aaron’s associates and dependents have access to Renee Leggitt, a claims advocacy specialist, for any benefits questions and/or claims issues. Renee is available to give you expert advice and support in dealing with claims, health care bills, payment arrangements, expert counsel of health needs, identification of physician, medical institutions, etc. Contact Renee at 404-537-4714 or [email protected].

401(k)If you are already making savings contributions, you are on your way to a more secure future and enjoying savings today. If you have not signed up to make savings contributions, there is still time to start.

□ The plan matches 50% of your savings contributions, up to 6% of your contribution.

2017 Benefits Overview

2017 Associate BenefitsSEI/Aaron’s is pleased to continue to offer a comprehensive benefits package to assist both you and your eligible dependents with insurance needs and to help offset your out-of-pocket health care expenses. SEI/Aaron’s strives to offer benefits that are cost effective for both you and the company. Benefits are reviewed annually for plan features and cost containment. It is important that you review materials closely and call if you have questions or concerns. Effective January 1, 2017, SEI/Aaron’s will continue with Blue Cross Blue Shield for the medical benefits and Cigna for disability and LAP benefits. SEI/Aaron’s will be moving dental, vision and life insurance benefits to MetLife and pharmacy benefits will be moving to Express Scripts through Rx Benefits. Critical Illness and Accident benefits will remain with Guardian.

Contact Information

Medical: Anthem Blue Cross Blue Shield 855-473-0059 | www.anthem.com

Prescription Drug Plan: Express Scripts 800-334-8134 | [email protected] | www.express-scripts.com

Dental & Vision: MetLife 800-275-4638 | www.mybenefits.metlife.com

Basic Life/AD&D; Voluntary Life: MetLife 800-275-4638 | www.mybenefits.metlife.com

Disability: Cigna 800-362-4462 |www.mycigna.com

Claims Assistance: Renee Leggitt 877-437-6854, option 1 | [email protected]

Online & Telephonic Doctor: LiveHealth Online 855-603-7985 | www.livehealthonline.com

Voluntary Benefits (Critical Illness & Accident)Guardian

Critical Illness: 800-268-2525 | Accident: 800-541-7846www.guardiananytime.com

Life Assistance Program (LAP): Cigna 800-554-6931 | www.cignabehavioral.com

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Medical Benefits: Anthem Blue Cross Blue ShieldAnthem Blue Cross Blue Shield OverviewEffective January 1, 2017, SEI/Aaron’s will continue to offer you a medical plan through Anthem Blue Cross Blue Shield (BCBS). Please refer to the chart for the plan’s major features. Download the Anthem BlueCross BlueShield app on your smartphone to find providers, order ID cards, view EOB’s and more!

In-Network vs. Out-of-Network ServicesAs an Anthem BlueChoice member, you have the ability to receive services either from providers in the BlueChoice PPO network or outside this network. You will pay less out of your own pocket if you elect in-network services. If you are an associate who resides in Georgia, your network of doctors and facilities is the Blue Cross Blue Shield Open Access POS Network.

BlueCard PPOIf you need medical treatment while traveling, you have access to the largest PPO network in the country – the nationwide network of Blue Shield plans. Through the BlueCard PPO program, you may obtain services from a PPO participating provider in any participating state and receive the same benefits you would at home. For a listing of participating providers in a particular area, please call 800-810-BLUE (2583) or visit www.anthem.com and select “Find a Doctor” from the drop down menu. See Certificate Booklet for complete details.

BlueChoice On CallA BCBS toll-free phone service providing 24-hour, 7 days-a-week access to a live registered nurse. Please call: 888-724-BLUE.

In-Network Out-of-NetworkLifetime Maximum Unlimited

Deductible □ Individual □ Family

$1,000$3,000

$3,000$9,000

Coinsurance □ Member pays □ Plan Pays

20%80%

40%60%

Out-of-Pocket Maximum (includes deductible & all copays)

□ Individual □ Family

$2,000$6,000

$6,000$18,000

Preventative Care 100% Not Covered

Office Visit □ Primary Care □ Specialist

Covered at 80%Covered at 80%

60% after deductible60% after deductible

Emergency Room 80% after deductible

Non-Emergency use of Emergency Room

80% after deductible


Urgent Care Covered at 80% 60% after deductible

Inpatient Hospitalization



Outpatient Services 80% after deductible


Prescription Drugs □ Retail □ Mail Order

(90-day supply)

Covered at 80%Covered at 80%

Not CoveredNot Covered

Medical: Non-Tobacco User Plan Costs

Anthem Gold Plan Non Tobacco

Total Weekly Plan costs SEI’s Weekly Contribution

Associate Weekly Contributions

Associate Only $77.50 $42.20 $35.30

Associate + Spouse $181.36 $112.19 $69.17

Associate + Child(ren) $176.71 $113.21 $63.50

Associate + Family $372.02 $268.13 $103.89

Medical: Tobacco User Plan Costs

Anthem Gold Plan Tobacco

Total Weekly Plan costs SEI’s Weekly Contribution


Associate Only $81.92 $42.21 $39.71




Only the official plan documents or insurance contracts establish and govern all rights to benefits under the plans. This guide is not a plan document or any insurance contract. If there is a discrepancy between the information provided in this guide and the applicable plan document or insurance contract, the plan document or insurance contract will control and govern.

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NEW! Pharmacy Benefits: Express Scripts

Retail: The Express Scripts website, www.express-scripts.com, allows participants to locate a participating provider as well as access the preferred drug list, which includes a list of the most commonly prescribed drugs. If your prescription is not included on this partial list, you may contact RxBenefits at: 800-334-8134 or [email protected].

Mail Order: The first time you order a drug through the mail order vendor, Express Scripts, you will need to complete an order form and mail it in along with the new prescription. You should contact Express Scripts to ensure your drug is eligible for mail order and confirm your co-payment. Please make sure your physician writes you a prescription for a 90-day supply of the drug you are ordering. After you have submitted an initial order for your prescription, you can order refills and check the status of orders on the website at: www.express-scripts.com or by calling: 800-334-8134.

REMINDER: Please ask your doctors for samples of brand prescriptions or request a generic if available.

Life Assistance Program (LAP): Cigna

Voluntary Benefits: Guardian

A Life Assistance & Work/Life Support Program is provided to all full-time and part-time associates and their family members. The LAP plan provides confidential counseling and referral services for Alcohol/Drug Abuse, Parenting Problems, Child Care and Elder Care Referrals, Financial and Legal Issues and other Personal Concerns. Associates will be provided telephonic counseling as well as referrals to local therapists. If needed, associates are provided with up to three face-to-face counseling sessions per problem at no charge to the associate.

The LAP is a free service to all associates.

Operators are available 24/7 at 800-554-6931 or visit www.cignabehavioral.com.

Voluntary benefits, such as Critical Illness & Accident plans, will continue to be offered through Guardian.

The accident policy offers cash benefits for treatments or procedures due to an accident. Accident coverage will cover injuries suffered while off the job. Examples include hospitalization, emergency room visits, x-rays, etc. The critical illness policy provides cash benefits for critical illnesses such as cancer, heart attack and stroke. There are different benefits based on the plan selected. Rates are based on age.

Contact Renee Leggitt at Ironwood at 877-437-6854, option 1, for more information.

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The vision benefit is available to associates that elect the Dental Plan through MetLife. In-Network doctors can be found at www.mybenefits.metlife.com. Once enrolled in the Vision Plan, each participating associate will receive a Vision Card.

In-Network Out-of-NetworkLenses

□ Single □ Bifocal □ Trifocal □ Lenticular

Covered in FullCovered in FullCovered in FullCovered in Full

Reimbursements:$30 $50 $65 $100

Contact Lenses □ Medically Necessary □ Elective

Covered in FullCovered up to

$130

Retail Allowance:Up to $210 Up to $105

Frames $20 Copay (Covered up to

$130)

$70

Vision Exam $20 Copay $45

Materials $20 Copay N/A

Network VSP

Frequency 12 / 12 / 24

Dependent Child Eligibility

Age 26

The MetLife dental plan is a PPO plan, which includes a network of preferred providers. Unlike a medical plan, dental PPO plans have the same benefit coverage in-network and out-of-network. You can maximize your benefits by using an in-network dentist since these providers charge a discounted rate for services and do not charge you for amounts in excess of the usual and customary rate. In addition, the in-network providers will file claims on behalf of members. You will have the choice of using a PPO or non-PPO dentist. You can locate participating providers at: www.mybenefits.metlife.com.

Network PDP PlusCalendar Year Deductible

□ Individual □ Family

$50 $150

Annual Benefit Maximum $2,000

Preventive ServicesExams, cleanings, x-rays, sealants (under age 16)

100%

Basic ServicesSimple extractions, Periodontics & End-odontics, fillings


Major ServicesCrowns, inlays, onlays, bridges, den-tures, complex oral surgery


Orthodontia Services (children up to age 19 and adults)

50%No deductible

Orthodontia Lifetime Maximum $1,500

Dental Benefits: MetLife

Vision Benefits: MetLife

Dental & Vision Plan Costs

MetLife Dental and Vision Plans Total Weekly Plan Costs

SEI’s Weekly Contribution


Associate Only $6.18 $3.73 $2.45




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Life and Disability

Life and Accidental Death & Dismemberment (AD&D) Insurance: MetLifeSEI/Aaron’s provides all of its full-time associates an employer paid Basic Life and AD&D benefit worth one times your annual salary up to a maximum of $100,000. This Basic Life and AD&D policy is for all full-time associates. This benefit is provided by MetLife and is 100% paid for by SEI/Aaron’s, Inc.

Voluntary Life and AD&D Insurance: MetLifeSEI/Aaron’s offers associates the option to purchase additional Term Life Insurance for themselves, their spouses and unmarried children at group rates through payroll deduction. Please review the information provided to determine what coverage amounts will best meet your family’s needs.

Voluntary Life and AD&D Associate Benefit Incremements of $10,000

up to the lesser of $500,000 or 5X salary

Associate AD&D 100% of elected life amount up to $500,000

Associate Guarantee Issue (GI)

$200,000

Spouse Benefit Increments of $5,000 up to the lesser of 100% of associate

amount or $200,000

Spouse Guarantee Issue (GI) $50,000

Child(ren) Benefit $1,000, $2,000, $4,000, $5,000 or $10,000 not to exceed spouse’s benefit

amount

Short-Term Disability (STD): CignaShort-Term Disability (STD) is a benefit 100% paid by SEI/Aaron’s, Inc. on your behalf. This benefit is provided above and beyond any state-mandated benefit. You will receive benefit payments every two weeks for accidents and/or illness caused by a non-work related incident.

Short-Term Disability

Weekly Benefit Amount 66 2/3% of weekly salary

Maximum Weekly Benefit $500

Elimination Period □ Accident □ Illness

7 Days7 Days

Benefit Duration 12 Weeks

How to report a short-term disability (STD) claim and/or family medical leave (FML) under SEI/Aaron’s group disability plan:Simply do one of the following:

1. Call toll-free 888-84-Cigna (24462) or 866-562-8421 (Español). A representative will walk you through the process or

2. Create a new leave request online at myCigna.com □ Select the ‘Review my Coverage’ tab from the header □ Then select the ‘Disability/Leave of Absence’ from the dropdown

□ Click on ‘submit a request for a disability or leave of absence’

When do I call?Call Cigna as soon as you know you’ll be absent for any of these reasons: 1. STD - If you plan to be absent from work for more than 7 calendar days for accident or sickness due to your own disability. 2. FML – If you have a serious health condition that means you can’t do your job and you plan to be absent from work for:

□ More than three days in a row □ Hours or days not necessarily in a row (intermittent) □ A hospitalization for any amount of time

Long-Term Disability Long-Term Disability (LTD) is also a benefit 100% paid by SEI/Aaron’s, Inc. on your behalf. It is designed to protect your income if you are totally or partially disabled and not able to work for SEI/Aaron’s, Inc. for an extended period of time. LTD pays a cash benefit to replace a portion of the earnings you lose as a result of your disability.

Long-Term Disability

Monthly Benefit Amount 60% of monthly salary

Maximum Montly Benefit $5,000

Elimination Period 90 days

Benefit Duration SSNRA

Own Occupation 2 years

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2017 Benefits Enrollment Form

Please complete the information below to enroll in benefits with SEI/Aaron’s, Inc. This form must be signed and dated in order for your enrollment to be complete. Benefits will be effective the first of the month following 60 days from date of hire. Please remember this form must be returned within 7 days from your date of hire to the Store Support Center.

EMPLOYEE INFORMATION

Last Name: _______________________________ First Name: _____________________________ Social Security No: _____ - ____ - _______

Home Address: ____________________________________________________________ County: ___________________________________

City: _________________________________________________ State: _____________________ Zip Code: ___________________________

Date of Birth: ____ / ____ / _______ Date of Hire: ____ / ____ / _______ Phone #: ____________________ Job Title: ________________

All associates receive Basic Life/AD&D, Short Term Disability, Long Term Disability and an EAP Program paid for by SEI/Aaron's, Inc.

p I would like to make benefit elections. I understand that I will not be able to make any coverage changes until the next open enrollment period unless I have a qualifying event (e.g., marriage, birth/adoptionn of a child, etc.).

Please select 2017 benefits below:

MEDICAL PLANBCBSGA PPO - Weekly Costs

Medical & Pharmacy Gold Plan Non-Tobacco Tobaccop Associate Only $35.30 $39.71p Associate + Spouse $69.17 $77.81p Associate + Child(ren) $63.50 $71.43p Associate + Family $103.89 $116.87

DENTAL & VISION PLANMetLife - Weekly Costsp Associate Only - $2.45

p Associate + Spouse - $4.87

p Associate + Child(ren) - $4.48

p Associate + Family - $6.91

VOLUNTARY LIFE/AD&D

p Employee Voluntary Life/AD&D

p Spouse Voluntary Life/AD&D

p Child(ren) Voluntary Life/AD&D

*PLEASE NOTE: IF ELECTING VOLUNTARY LIFE YOU MUST COMPLETE THE METLIFE VOLUNTARY LIFE ELECTION FORM.

DECLINING COVERAGEIf you are declining coverage, please indicate in the appropriate box.

p Decline Medical I understand that I will not receive coverage under this plan and will not be able to obtain coverage until the next open enrollment period, if applicable, or until a qualified status change. In addition, I may be subject to evidence of insurability requirements.

I also understand that there are waiting periods that may apply before I am eligible for benefits.

p Decline Dental & Vision

p Decline Voluntary life

If you are interested in enrolling in Critical Illness and/or Accident Coverage, please call the Store Support Center.

(OVER)

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Ironwood Insurance Services, LLC3715 Northside Parkway NW | Suite 1-500 | Atlanta, GA 30327 | 404.503.9100 | ironwoodins.com

MEMBER INFORMATION Complete the following information for each dependent and indicate plan elections.

Social Security # Last Name First Name Middle Initial

Date of Birth

Male/Female Enrolling in:

Associate p Male

p Female

p Medical p Dental p Vision

Spouse p Male

p Female


Dependent Child p Male

p Female



p Female



p Female



p Female


BENEFICIARY INFORMATION

Name: ____________________________________________________________ Relationship: _____________________________________

ASSOCIATE SIGNATURE

I have read the plan materials and understand my enrollment rights. I agree to notify the Plan Administrator or Plan Services Provider if any covered dependents or I become covered by another group health plan or entitled to Medicare of have a change of address. My participant in the plan is subject to all the plan terms and conditions as set forth in the plan documents and SPDs.

________________________________________________________________________________________ ____ / ____ / _______

Associate Signature Date

________________________________________________________________________________________

Print Name

2017 Benefits Enrollment Form

Documents

LiveHealth Online: BCBS - RetailCatalog.uswebsites.retailcatalog.us/1360/mm/2017-benefits-overview.pdf · 2017. 1. 13. · LiveHealth Online: BCBS LiveHealth Online can treat many