Open Enrollment November 10 November 21 - Medical Plansyourpcmbenefits.weebly.com/.../7/82279914/2016-17_pcm_open_enrollment.pdf (open enrollment information, contribution rates,

Open Enrollment

November 10 – November 21

For coverage effective December 1, 2016

Copyright 2012 Kibble & Prentice Holding Company, All rights reserved.Copyright 2015 Kibble & Prentice Holding Company, All rights reserv ed.

If you are enrolled in a medical, dental, or vision plan you

MUST enroll during this timeframe or else you will be

defaulted into a plan that might not meet your needs. This

is also a great time for you to log into Benetrac to review

your current elections, dependent demographic information,

address and beneficiary information.

Website Information:

http://yourpcmbenefits.weebly.com (open enrollment

information, contribution rates, presentations)

https://www.eenroller.net/btrac/broker.asp?ST=PCMA2555&

(Benetrac Benefits Enrollment Portal)

Do I Need to Take Action?

http://yourpcmbenefits.weebly.com/

https://www.eenroller.net/btrac/broker.asp?ST=PCMA2555&


Agenda

Benefit Plan Overview

Savings Accounts

Enrollment Process

Questions & Answers


Your opportunity to:

Enroll in benefits

Change plans

Add or drop dependent(s)

Make FSA and HSA election

Enrollment is……..


• Aetna & Kaiser (CA Only)Medical

• Delta DentalDental

• EyeMedVision

• Liberty MutualLife Insurance

• Liberty MutualVoluntary Benefits

• IGOEFlexible Spending Accounts

• PayflexHealth Savings Account

2016-2017 Benefit Plans


Medical Benefits Eligibility

• Full time employees working 30 hours per week

• First of the month following 45 days from date of hireEmployee

• Legal Spouses only. Domestic Partners where required by law.Spouse

• To age 26, regardless of student or marital statusChildren


Dental, Vision, Life, Disability and FSA

Benefits Eligibility

• Full time employees working 40 hours per week

• First of the month following 30 days from date of hireEmployee

• Legal Spouses only. Domestic Partners where required by law.Spouse

• To age 26, regardless of student or marital statusChildren


What is Changing?

Medical Insurance

PCM is moving to a consolidated benefits program across

all divisions with our new partner Aetna. There will be 5

health plans offered, allowing you to select a health plan

that best fits your healthcare and financial needs.

We will be utilizing Aetna’s Health Savings Account (HSA)

banking partner, Payflex, for those employees who enroll

in a Qualified High Deductible Health Plan

Our Kaiser Medical Plans will be renewing at the same

benefit level. (California Only)


What is Changing?

Company Paid Life and AD&D Insurance

Our company paid Life and AD&D benefit will

automatically be increasing to one times annual salary up

to a maximum of $50,000 at no cost to you.


Former En Pointe Employees

Conexis FSA Expenses: You will have until February 28, 2017 (90

days after the current FSA Plan Year) to submit your expenses for

reimbursement. No claims incurred after November 30, 2016 will be

reimbursed.

Company Paid Life Insurance Benefit: Your current company paid

basic life insurance benefit amounts will be grandfathered through

Liberty Mutual as long as you remain employed.


Medical Plans: Aetna

PCM offers you a choice of five medical plans through

Aetna. Each plan has a unique level of benefits. The level

of benefits you receive is dependent upon your choice of a

In-Network or Out-of-Network Provider. Higher benefits

will be received if you obtain care from a In-Network

Provider. For a more detail summary of coverage, please

refer to the Aetna Benefit Summaries or Contracts.


Bronze Option – Comparable to the UnitedHealthcare

Minimum Value Plan.

Silver Base Option – Comparable to the UnitedHealthcare

Qualified High Deductible Plan.

Silver Plus Option – Comparable to the Blue Shield Qualified

High Deductible Plan.

Gold Base Option – Comparable to the UnitedHealthcare

PPO Plan and Blue Cross Georgia POS Plan

Gold Plus Option – Comparable to the Blue Shield PPO Plan

Aetna Gold, Silver, and Bronze Plan

Options


Medical Plans: Aetna

*Aggregate: If more than one person is covered on the Qualified High

Deductible Medical Plan, the family deductible will need to be satisfied before

services are covered for that individual. In addition, the family out-of-pocket

maximum will also apply for services obtained by that covered individual.

Example: One person in the family with a $5,000 medical bill would have 90%

in-network coverage after the family deductible of $3,000, then pay 10% up to

the family out of pocket maximum has been met.

HOW TO FIND A PROVIDER

To find a Contracted Medical provider go to

www.aetna.com and be prepared to use the network

information noted under the plan name.

http://www.aetna.com/


Medical Plans: Aetna Bronze Option

Aetna Bronze PlanOpen Access Managed Care POS

In-Network Out-of-Network

Plan Year Deductible

Per Person $6,000 $12,000

Maximum Per Family $12,000 $24,000

Plan Year Out of Pocket Maximum

Per Person $6,350 $12,500

Maximum Per Family $12,700 $25,000


Medical Plans: Aetna Bronze Option

Percentages are member payment responsibility


In-Network Out-of-NetworkProfessional Services

PCP Office Visits 20% deductible waived 50% after deductible

Specialists Office Visits 20% deductible waived 50% after deductible

Preventive Care Visits 0% 50% after deductible

Emergency ServicesEmergency Room-Copay waived if admitted

20% after $25 copay; deductible waived

Urgent Care 0% 50% after deductible

Hospital ServicesInpatient Stay 20% after deductible 50% after deductible

Outpatient Surgery 20% after deductible 50% after deductible


Medical Plans: Aetna Silver Options

Aetna Silver Plus PlanOpen Access Managed Choice POS

Qualified High Deductible Plan

Aetna Silver Base PlanOpen Access Managed Choice POS

Qualified High Deductible Health Plan

In-Network Out-of-Network In-Network Out-of-Network


Per Person $1,500/single $3,000/single $1,500/ single $3,000/ single

Maximum Per Family $3,000/aggregate

$6,000/aggregate

$3,000/ aggregate

$6,000/aggregate


Per Person $3,000/single $6,000/single $3,200/ single $6,350/ single

Maximum Per Family $6,000/aggregate

$12,000/aggregate

$6,400/aggregate

$12,700/aggregate


Medical Plans: Aetna Silver Options


Aetna Silver Plus PlanOpen Access Managed Care POSQualified High Deductible Plan




Professional Services

PCP Office Visits10% after deductible 40% after deductible 20% after deductible 40% after deductible

Specialists Office Visits10% after deductible 40% after deductible 20% after deductible 40% after deductible

Preventive Care Visits0% 40% after deductible 0% 40% after deductible

Emergency Services

Emergency Room-Copay waived if admitted

10% after deductible 20% after deductible

Urgent Care 10% after deductible 40% after deductible 20% after deductible 40% after deductible

Hospital Services

Inpatient Stay 10% after deductible 40% after deductible 20% after deductible 40% after deductible

Outpatient Surgery 10% after deductible 40% after deductible 20% after deductible 40% after deductible


Medical Plans: Aetna Gold Options

Aetna Gold Plus PlanOpen Choice PPO

Aetna Gold Base PlanOpen Choice PPO



Per Person $750 $1,000 $1,000 $2,000

Maximum Per Family $1,500 $2,000 $2,000 $4,000


Per Person $3,500 $10,500 $5,000 $10,000

Maximum Per Family $7,000 $21,000 $10,000 $20,000


Medical Plans: Aetna Gold Options




In-Network Out-of-Network In-Network Out-of-NetworkProfessional Services

PCP Office Visits $35 copay 40% after deductible $30 copay 40% after deductible

Specialists Office Visits $35 copay 40% after deductible $50 copay 40% after deductible

Preventive Care Visits0%

Up to 40% after deductible

0% 40% after deductible


20% after $100 copay $200 copay

Urgent Care $50 copay 40% after deductible $50 copay 40% after deductible

Hospital ServicesInpatient Stay 20% after deductible 40% after deductible 20% after $250

copay and deductible

40% after deductible

Outpatient Surgery 20% after deductible 40% after deductible 20% after deductible

40% after deductible


Prescription Drugs: Aetna Bronze Option



Deductible

Does Not Apply

Benefit Participating Retail Mail Order

Generic 20% 20%

Preferred Brand Name

20% 20%

Non PreferredBrand Name

20% 20%

Preferred Specialty $40 copay N/ANon Preferred

Specialty$60 copay N/A

Maximum DaySupply

30 days 90 days


Prescription Drugs: Aetna Silver Options

Aetna Silver Plus PlanOpen Access Managed Care POSQualified High Deductible Plan



DeductibleMedical Deductible Applies Medical Deductible Applies

Benefit Participating Retail

Mail Order ParticipatingRetail

Mail Order

Generic $10 copay $20 copay $10 copay $25 copay

Preferred Brand Name $25 copay $50 copay $35 copay $87.50 copay


$40 copay $80 copay $60 copay $150 copay

Preferred Specialty $40 copay N/A $40 copay N/ANon Preferred Specialty $60 copay N/A $60 copay N/A

Maximum DaySupply

30 days 90 days 30 days 90 days


Prescription Drugs: Aetna Gold Options



Deductible

Does Not Apply Does Not Apply

Benefit Participating Retail

Mail Order ParticipatingRetail

Mail Order


Preferred Brand Name $25 copay $50 copay $35 copay $87.50 copay


$40 copay $80 copay $60 copay $150 copay

Preferred Specialty $40 copay N/A $40 copay N/A

Non Preferred Specialty $60 copay N/A $60 copay N/A

Maximum DaySupply

30 days 90 days 30 days 90 days


Medical Plans: Kaiser (California Only)

KAISER PERMANENTE: HMO LOW & HIGH PLANS

With Kaiser Permanente, you have a choice between two plans, the HMO

Low Plan and the HMO High Plan. Both plans are Health Maintenance

Organization (HMO) plans which require you to use providers and facilities

within the Kaiser Permanente Network.

You must receive all covered care within the Kaiser Permanente network,

except for the following services:

1.) Emergency ambulance services;

2.) Emergency care, post-stabilization care and out-of-area urgent care;

3) Authorized referrals;

4) Hospice care.


Medical Plans: Kaiser (California Only)

Kaiser Low Option Plan(High Copay)

Group Number: 225130

Kaiser High Option Plan (Traditional Plan)

Group Number: 225130

Calendar Year DeductiblePer Person None NoneMaximum Per Family None None

Calendar Year Out-of-Pocket Maximum

Per Person $3,000 $1,500 Maximum Per Family $6,000 $3,000

Preventive CareOffice Visits 100% 100%Preventive Lab & X-Ray Services 100% 100%

ProfessionalOffice Visits $20 copay then 100% $15 copay then 100%


$150 then 100% $50 then 100%

Urgent Care $20 copay then 100% $15 copay then 100% Hospital/Facility

Inpatient Care $500 per day then 100% 100%


Prescription Drugs: Kaiser (California Only)

Low Plan High Plan

Benefit Participating Retail Mail Order Participating Retail Mail Order


Formulary $30 copay $60 copay $20 copay $40 copay

Maximum Day Supply

30 days 31 to 100 days 30 days 31 to 100 days

HOW TO FIND A PROVIDERTo find a Kaiser Permanente provider go to www.kp.orgUnder “Locate our services” click on “Find doctors and locations” Click either “Doctors” or “Locations”Select your area (California-Southern) then click “Continue”Begin Your Search


Dental Benefits: Delta Dental

PCM allows a choice between two dental plans through Delta Dental, the DHMO

Plan and PPO Plan. With the DHMO Plan, you must see a Delta Care USA

Dentist. The PPO Plan allows you to see any licensed provider. However, higher

benefits may be paid if you see a Delta Dental PPO dentist. Members under the

DHMO plan must elect a primary care dentist. This functionality is available on

Benetrac. You can search for contracted dentist at www.deltadentalins.com.

*The DHMO Dental Plan is only available to enrollees who reside within network

service areas in AL, AZ, AR, CA, CO, CT, FL, GA, HI, ID, IL, IN, IA, KS, KY, LA,

MD, MI, MS, MO, NV, NC, NJ, NM, NY, OH, OR, PA, SC, TN, TX, UT, VA, WA,

WV and WI.

http://www.deltadentalins.com/


Dental Benefits: Delta Dental

Benefits *DHMO Plan PPO Plan

Policy Year Maximum Copay Schedule $1,500

Policy Year Deductible

Individual

Benefits are paid per the DHMO Copay Schedule. The copay

schedule is available under the Resource Library in Benetrac.

$50

Family $150

Deductible waived forPreventive?

Yes

Preventive & Diagnostic Care 100%

Basic Restorative Care 80%

Major Restorative Care 50%

OrthodontiaAdults & Children Children Only Up to Age 19

BenefitsBenefits are paid per the DHMO Copay Schedule

50%

Lifetime Orthodontia Maximum

$1,000


Vision Benefits: EyeMed

In Network Benefits EyeMed Vision Care

Routine Eye Examination w/ Dilation

$10 Copay then 100% 1 every 12 months

Contact Lense Fitting(in addition to exam)

Standard: 100% up to $40Premium: 10% off Retail

Hardware (every 12 months) EyeMed Vision Care

Lenses (Single, Bifocal, Trifocal) 100% for Standard Lenses

Frames 100% up to $120, then 20% off balance

Contacts* Medically Necessary: 100%

Elective: 100% up to $135, then 15% off balance

Out-of-Network Benefits See Schedule of Benefits

* In lieu of frames


Company Paid Life Insurance:

Liberty Mutual

Liberty MutualBenefit Amount

Employee One times salary up to a maximum of $50,000

Accidental Death Benefit

In the event of an accidental death, the benefit may double. Please see your booklet for further

details.

Dismemberment

In the event of an accidental dismemberment, a benefit is provided up to a scheduled amount

corresponding to the loss. Please see your booklet for further details.

BENEFIT REDUCTIONBenefits reduce to 65% at age 65 and 45% at age 70+. Please refer to your booklet for further details


Voluntary Life/AD&D: Liberty Mutual

Liberty MutualEmployee

Benefit Amount Increments of $10,000Overall Maximum 5 x your annual salary not to exceed $850,000Guarantee Issue Amount

$200,000 - new hires only. Any new elections or additional amounts will require medical evidence of insurability.

Spouse Benefit Amount Increments of $5,000Overall Maximum Up to 100% of the Employee amount, not to exceed $250,000Guarantee Issue Amount

$50,000 - new hires only. Any new elections or additional amounts will require medical evidence of insurability.

Child(ren) From live birth to age 19 (25 if a fulltime student)Benefit Amount $2,500, $5,000 or $10,000 Overall Maximum $10,000 Guarantee Issue Amount

$10,000

AD&DBenefit Amount Matches Life Benefit


Voluntary Short Term Disability:

Liberty Mutual

Benefits Liberty Mutual

Benefits BeginsAfter a 14 day elimination (waiting) period of continuous disability from the day your disabling condition occurs

Weekly Benefit 60% of your covered pre-disability weekly earnings

Maximum Benefit $1,250 dollars per week

Maximum Benefit Duration

Up to 26 weeks

PLEASE NOTE: In the event of a disability claim, payments received under this plan would not be considered taxable

income.

If you are a former EnPointe employee or Rio Rancho employee – We are discontinuing all employer paid disability

benefits. As a result you can enroll in short term disability benefits without medical evidence of insurability.

If you are a PCM or TigerDirect employee – All new short term disability elections WILL be subject to medical evidence of

insurability. Coverage will not begin until Liberty Mutual approves your application for benefits.


Voluntary Long Term Disability:

Liberty Mutual

PLEASE NOTE: In the event of a disability claim, payments received under this plan would not be considered

taxable income.

If you are a former EnPointe employee or Rio Rancho employee – We are discontinuing all employer paid

disability benefits. As a result you can enroll in long term disability benefits without medical evidence of

insurability.

If you are a PCM or TigerDirect employee – All new long term disability elections WILL be subject to medical

evidence of insurability. Coverage will not begin until Liberty Mutual approves your application for benefits.

Benefits Liberty Mutual

Benefits BeginAfter a 180 day elimination (waiting) period of continuous disability from the day your disabling condition occurs

Monthly Benefit 60% of your covered pre-disability monthly earnings

Maximum Benefit $10,000 per month


Health Savings Account: Payflex

If you enroll in a Qualified High Deductible Health Plan through Aetna , you

can set up a Health Savings Account (HSA) through Payflex. Please refer to

the Payflex communication materials for more information on how to sign-up.

To be eligible to open and contribute to an HSA:-You must be covered by a qualified single or family high deductible health plan

(HDHP). (The Silver Plan Options under the PCM group health plan are qualified

HDHP.)

-You must not be covered by another non-HDHP health plan, such as a spouse’s

plan, that provides any benefits covered by your health plan. (Please note there

are exceptions to this rule. Please see Human Resources for a full explanation.)

-You are not enrolled in Medicare.

-You are not in the TRICARE or TRICARE for Life military benefits program.

-You are not claimed as a dependent on another person’s tax return.

-You are not covered by a health care flexible spending account (FSA) for the tax

year in which you will claim your HSA deposits as tax deductions.


Health Savings Account: Payflex

2017 Health Savings Account Contribution Maximums

You may contribute up to the following in your HSA:

$3,400 Individual*

$6,750 Family*

* Will be adjusted in Benetrac after January 1, 2017

If you are age 55 and over, you may contribute an extra $1,000 for catch up

contributions.


Flexible Spending Accounts (FSA):

IGOE

Flexible Spending Accounts are a great way for you to

SAVE MONEY on pre-planned health and day care

expenses!

• Participation is 100% Voluntary

• Savings are TAX FREE, not Tax Deferred

• Supported by Section 125 & 129 of the IRS Code

Account Options

• Health Care Spending Account

• Dependent or “Day Care” Spending Account


HealthCare FSA: (Not Available if you Enroll in a

Qualified High Deductible Health Plan)

• Annual pledge is available

immediately! No waiting for the

dollars to be withheld each check.

• The whole family** can use the fund!

Even if they have other healthcare

coverage!

• Set aside up to $2,550 this year!

The Health Care Spending Account allows you to

reimburse yourself for out-of-pocket healthcare expenses

not covered by our Medical and Dental plans.


Dependent Care FSA

• To participate you must be the

Custodial Parent

• You and your spouse must be

working full time, be actively looking

for work or be a full-time student

• Funds are available as they are

withheld

• Set aside up to $5,000 per household

per calendar year

The Day Care Flexible Spending Account is an alternative to the Child Care Tax Credit and an opportunity to save TAX FREE dollars on pre-planned Day Care expenses.


Bi-Weekly Contribution Rates

MEDICAL Aetna Bronze Plan

Employee $26.54

Employee & Spouse $92.31

Employee & Child(ren) $92.31

Employee & Family $138.46

Spousal Surcharge (if Spouse Eligible for another plan)

$100.00

MEDICAL Aetna Silver Base Plan Aetna Silver Plus Plan

Employee $73.85 $92.81

Employee & Spouse $176.54 $212.01

Employee & Child(ren) $163.85 $190.45

Employee & Family $268.15 $314.78

Spousal Surcharge (if Spouse Eligible for another plan)

$100.00 $100.00



MEDICAL Aetna Gold Base Plan Aetna Gold Plus PlanEmployee $124.62 $145.57Employee & Spouse $270.46 $316.37Employee & Child(ren) $240.00 $278.15Employee & Family $415.38 $482.25Spousal Surcharge (if Spouse Eligible for another plan)

$100.00 $100.00

MEDICALKaiser

Low HMOKaiser

High HMOEmployee $68.05 $99.55Employee & Spouse $174.97 $241.12Employee & Child(ren) $155.53 $215.53Employee & Family $281.90 $382.70Spousal Surcharge (if Spouse Eligible for another plan)

$100.00 $100.00



SPOUSAL SURCHARGE

If your spouse is eligible for comparable medical coverage elsewhere and is covered under the PCM Medical

plan, a surcharge of $100 per pay period will be added to your medical premium. To avoid this surcharge, you

must complete and return the Spousal Affidavit Form located in the BeneTrac Library to Human Resources

within 30 days of enrollment. You will be charged the spousal surcharge until you turn your affidavit into

Human Resources. Human Resources will stop the surcharge once your form is turned in and you have

indicated your spouse does not have creditable coverage elsewhere.

DENTAL DHMO PLAN PPO PLAN

Employee $10.11 $17.22

Employee & Spouse $17.35 $36.50

Employee & Child(ren) $17.47 $32.72

Employee & Family $25.37 $55.08

VISION PPO PLAN

Employee $2.58Employee & Spouse $4.90Employee & Child(ren) $7.19Employee & Family $7.19


4 Easy Steps:1) Enter the following address into your browser:

https://www.eenroller.net/login.asp?ST=PCMA2555

User Name = Your first initial + last name

(no spaces/no hyphens, up to 10 characters)

Password = Last four digits of your social security number (if first time user); if you don’t remember your password, following the link to reset it

2) Review/update your personal information on the My Family page

3) Enroll in your benefits or change existing benefits

4) Finalize your changes

Online Enrollment With Benetrac

https://www.eenroller.net/login.asp?ST=PCMA2555


Kibble & Prentice’s

Benefit Resource Center (BRC)

• Do you have a claim that is not paying?

• Are you just not sure what is covered?

• Assistance in Spanish!

Contact the BRC for help!

1-866-4ourBRC

[email protected]

8:00am – 6:00pm PT


Kibble & Prentice/USI: (866) 468-7272

[email protected]

Kimberly Reyes@

310.226.4026

[email protected]

[email protected]

Questions?


Disclosure Statement - Confidentiality

These materials are produced by Kibble & Prentice for the sole use of its clients, prospective clients, and their

representatives. Certain information contained in these materials are considered proprietary information created

by Kibble & Prentice and/or their licensed and appointed insurance carriers. Such information and any insurance

designs furnished by Kibble & Prentice are considered “Confidential Material.” Such information shall not be used

in any way, directly or indirectly, detrimental to Kibble & Prentice and clients and/or potential clients and any of

their representatives will keep that information confidential.

Neither Kibble & Prentice nor any of its respective representatives or advisors has made or makes any

representation or warranty, expressed or implied, as to the accuracy or completeness of the Confidential Material.

Neither Kibble & Prentice nor their respective representatives or advisors shall have any liability resulting from the

use of the Confidential Material or any errors or omission therein. These materials contain confidential

information and provide general information for the use of our clients, potential clients, or that of our clients’ legal

and tax advisors. Only a qualified attorney may prepare any document needed to implement any strategy

explained in these materials, and the agent/broker or advisor is not in the business of practicing law, legally

representing clients, or drafting legal documents.

Documents

Open Enrollment November 10 November 21 - Medical Plansyourpcmbenefits.weebly.com/.../7/82279914/2016-17_pcm_open_enrollment.pdf (open enrollment information, contribution rates,