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2018 Benefits at a Glance
PLAN YEAR: January 15, 2014 – December 31, 2014
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Our Mission AMIkids is a non-profit organization dedicated to helping youth develop into responsible and productive citizens. AMIkids’ mission is to protect public safety and positively impact as many youth as possible through the efforts of a diverse and innovative staff. AMIkids works in partnership with youth agencies, local communicates and families.
CONTENTS & CONTACT INFORMATION
Refer to this list when you need to contact one of your benefit vendors. For general information contact the AMIkids Affiliated Programs Benefits Department.
AMIKIDS BENEFITS DEPARTMENT Brandie Holjes & Matt Frye
813-887-3300 [email protected] or [email protected]
M.E. WILSON COMPANY - BENEFITS PARTNER Katie Miller, Cindy Buttrill, or Jeff Lenderman
813-229-8021 [email protected]
MEDICAL & PRESCRIPTION
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Medical : Blue Cross Blue Shield (Group # 71-60757)
1-800-830-1501 www.MyHealthToolkitFL.com
Prescription : OptumRX
1-800-334-8134 www.Optumrx.com/myCatamaranrx
HEALTH SAVINGS ACCOUNT Optum Bank (Group # 71-60757)
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1-866-234-8913 www.OptumBank.com
DENTAL
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Blue Cross Blue Shield (Group # 71-60757)
1-800-222-7156 www.MyHealthToolkitFL.com
VISION
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Blue Cross Blue Shield (EyeMed network) (Group# 71-60757)
1-866-723-0513 www.MyHealthToolkitFL.com
LIFE, SHORT-TERM & LONG-TERM DISABILITY
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United Healthcare (Group # 305057)
1-888-299-2070 www.myuhc.com
403(B)
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Fidelity (Group #64688)
1-800-343-0860 www.Fidelity.com/atwork
VOLUNTARY BENEFITS
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United Healthcare (Group # 305057)
1-888-299-2070 www.myuhc.com
EMPLOYEE ASSISTANCE PROGRAM
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LifeWorks
1-888-456-1324 www.lifeworks.com User ID: amikids Password: lifeworks
HOW TO ENROLL Web Benefits Design
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1-888-639-8077 www.mybensite.com/amikids
DISCLOSURE NOTICES
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BENEFIT INFORMATION
Benefit
Who pays the cost?
AMIkids shares the cost of your medical premiums no matter what medical plan you choose! AMIkids also shares the cost of your dental premiums regardless of your dental plan choice.
Medical Insurance
YOUR BENEFITS PLAN AMIkids offers a variety of benefits allowing benefit eligible employees the opportunity to customize a benefits package that meets your personal needs. In the following pages, you’ll learn more about the benefits offered. You’ll also see how choosing the right combination of benefits can help protect you and your family’s health and finances – and your family’s future.
Dental Insurance Vision Insurance
AMIkids offers vision coverage on a voluntary basis.
Basic Term Life Insurance
AMIkids pays 100% of the cost for Basic Term Life coverage.
AMIkids offers you the option to purchase additional term life insurance for yourself, as well as life insurance for your spouse and/or child(ren). See benefits page for more on the voluntary offer of STD and eligibility specifics for the employer sponsored benefit.
Voluntary Term Life Insurance
Short Term Disability (STD) Long Term Disability (LTD)
AMIkids offers LTD coverage on a voluntary basis.
Voluntary Benefits
AMIkids offers a variety of voluntary benefits.
Eligible AMIkids employees are automatically enrolled into the AMIkids pension plan. You can also choose to open a 403(b) retirement savings account using pre-tax dollars.
Pension and Retirement Plan
ELIGIBILITY
Eligible employees are those averaging 30 hours worked per week. Newly eligible employee’s benefits will become effective on the 1 st of the month following 60 days of eligible employment status. You may also enroll your dependents in the Benefits Plan when you enroll.
Eligible dependents include: • Your legal spouse •
You or your spouse’s child who is under age 26, including natural children, step-children, legally adopted children, a child placed for adoption or any other children for whom you or your spouse are legal guardian • A child who is or becomes disabled and is dependent upon you before reaching age 26 • A child for whom health care coverage is required through a Qualified Medical Child Support Order or other court or administrative order. Please verify all dependents meet the definition of qualified dependent. Initial and periodic audits requesting proof of qualified dependent status may be conducted . You are financially responsible for any claims incurred on the plan by a dependent who does not meet eligibility requirements.
WHEN CAN YOU ENROLL? You MUST enroll within 60 days of your new hire date. Otherwise you must wait until the next annual open enrollment period, unless you experience a qualifying event. If you have a qualifying event, you MUST notify AMIkids of the event within 31 days of a qualified family-status change.
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BENEFIT INFORMATION
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CHOOSING YOUR BENEFITS
WHY DO I PAY FOR BENEFITS WITH BEFORE-TAX MONEY? There is a definite advantage to paying for some benefits with before-tax money: Taking the money out before your taxes are calculated lowers the amount of your pay that is taxable. Therefore, you pay less in taxes.
Your portion of the cost of benefits is automatically taken out of your paycheck. There are two ways that the money can be taken out:
• BEFORE YOUR TAXES ARE CALCULATED – Medical, Dental, Vision, H.S.A and 403(b) contributions
• AFTER YOUR TAXES ARE CALCULATED – Life, Disability and Voluntary Benefits
MAKING CHANGES
Generally, you can only change your benefit choices during the annual benefits enrollment period. However, under certain circumstances you may be allowed to make changes to your benefit elections if you or your eligible dependents experience a qualifying life event. An eligible event is determined by the Internal Revenue Service (IRS) Code, Section 125. Examples of Qualifying Events:
• Your marriage • Your divorce or legal separation • Birth or adoption of an eligible child • Death of your spouse or covered child
• Change in your spouse’s work status that affects his or her benefits • Change in your work status that affects your benefits • Change in your child’s eligibility for benefits • Receiving Qualified Medical Child Support Order (QMCSO)
You must enter a life event via www.mybensite.com/amikids and notify AMIkids Benefits Department, in writing, within 30 days of the qualifying event. At this time you will also be required to provide appropriate documentation.
WHEN COVERAGE ENDS Medical, Dental and/or Vision coverage will end on the last day of the month in which employment with the company ends, you or a covered dependent no longer meet the eligibility requirements, the plan ends, and/or failure to make required contributions outside payroll deductions (ex: on leave of absences).
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MEDICAL & PRESCRIPTION INSURANCE
AMIkids offers medical coverage through Blue Cross Blue Shield for the 2018 plan year. The plan year runs from May 1 st , 2018 – April 30 th , 2019. AMIkids contributes about 77% of the cost for employee coverage on the Base H.S.A. Plan. You are responsible for the additional cost associated with buying up to another plan and / or adding dependent(s) on the plan. The chart below provides an overview of the medical plan offered. This chart is intended only to highlight the benefits available and should not be relied upon to fully determine your coverage. If the below illustration of benefits conflicts in any way with the Summary Plan Description (SPD), the SPD shall prevail. It is recommended that you review the exact description of services and supplies that are covered, those which are excluded or limited, and other terms and conditions of coverage .
Base HDHP H.S.A. Plan
Copay H.R.A. Plan
Copay Premium Plan
IN-NETWORK
PREVENTIVE CARE Wellness, Immunizations, Mammography, Colonoscopy, Annual bloodwork, etc. OFFICE VISITS Referral Required? Teledoc Virtual Visits Office Visits (Illness/Injury) Specialist Visits
Covered 100%, no cost to you.
No Meet deductible, then $25 Copay
No $25 Copay $50 Copay $75 Copay
No $25 Copay $35 Copay $60 Copay
Meet deductible, then 20% Meet deductible, then 20%
HOSPITAL SERVICES Inpatient Hospital Outpatient Surgery
Meet deductible, then 20% Meet deductible, then 20% Meet deductible, then 20% Meet deductible, then 20%
Meet deductible, then 30% Meet deductible, then 30%
Meet deductible, then 20% Meet deductible, then 20%
Emergency Room Urgent Care Clinic
$500 Copay $100 Copay
$350 Copay $100 Copay
DIAGNOSTIC TESTING Lab, X-Ray, Advanced Imaging (MRI, CAT, PET, etc.)
Meet deductible, then 20%
Meet deductible, then 30%
Meet deductible, then 20%
PRESCRIPTIONS Retail (30 day supply) Tier 1 / 2 / 3
Meet deductible, then $10 / $35 / $60 Copay
$20 / $50 / $80 Copay
$10 / $35 / $60 Copay
Medicare (Part D) Creditable
NO
YES
YES
DEDUCTIBLE (your first dollar cost for covered in-network claims) Deductible (Individual / Family) $3,000 / $6,000
$4,500 / $9,000
$1,500 / $3,000
COINSURANCE (your responsibility on claims costs once you’ve met the deductible) 20% 30% OUT OF POCKET MAXIMUM (once met all in-network covered services are covered by the plan) Maximum Out-of-Pocket (Individual / Family) $6,000 / $12,000 $6,000 / $12,000
20%
$5,000 / $10,000
Max Out-of-Pocket includes
Deductible , Coinsurance, Prescription Costs, and Copays paid by you during the course of the plan year OUT-OF-NETWORK (charges are subject to balance billing)
Deductible Coinsurance Out of Pocket Maximum
$7,500 / $15,000 50% $15,000 / $30,000
$10,000 / $20,000 50% $15,000 / $30,000
$7,500 / $15,000 50% $15,000 / $30,000
1 Charges are subject to balance billing
WHAT ARE TELADOC VIRTUAL VISITS? They allow you to see and talk to a doctor from your cell phone, tablet or computer regarding non-emergency medical conditions like the flu, pink eye, rashes and fever. These visits are subject to your deductible (or a copay depending upon your plan selection) but are typically at a lesser cost than an office visit. A great way to SAVE TIME AND MONEY! To access Teladoc, visit www.teladoc.com or call 1-800-Teladoc (835-2362)
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HOW TO FIND IN-NETWORK PROVIDERS
To utilize your benefits you want to seek services from in-network doctors and facilities. You can search and locate in-network providers by visiting www.MyHealthToolkitFL.com and following the below instructions.
Go to www.MyHealthToolkitFL.com and click on the highlighted field
Enter the name of the provider you wish to search and/or the desired location and/or the specialty. Choose “Show me only doctors and hospitals in my Plan” and enter the alpha prefix EQO in the field that pops up.
DOES ANYONE UNDERSTAND THIS STUFF?
YOU WILL IN A SECOND….
STARTING WITH THE BASICS (KEY TERMS)
Deductible is the amount you have to pay out of pocket for services not covered by a copay before co-insurance starts. Once you’re enrolled in medical, you're a Blue Cross Blue Shield member. Because you’re a member you get the discounted rate with all in-network providers and facilities! This discount is typically 50%-70% off the amount charged to someone without insurance. Coinsurance is cost-sharing. The cost-sharing “kicks in” AFTER you meet the deductible. Even though you’ve met your deductible, you still get the discounted rates! On the medical summary chart you can see coinsurance is 20% or 30% depending upon which plan you choose. When you have coinsurance, you pay 20% or 30% of that discounted rate and the plan pays the rest! Copayment (aka Copay) is a flat fee that you pay for medical services and/or prescriptions. On the Base H.S.A. Plan you do not have copays with the exception of prescriptions and virtual visits, though you must meet your medical deductible prior to having copays for prescriptions and virtual visits. Out of Pocket Maximum is the maximum total amount you will pay in deductible costs, coinsurance and copays during the policy year. Once you meet the Out of Pocket Maximum, the plan pays 100% of your costs.
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YES PLEASE, MORE INFORMATION
To understand how plans work, you can break it down into three phases….
Base HDHP H.S.A. Plan
Phase 1
You’re responsible to pay the first dollar costs for medical services and prescriptions (Rx) until you meet your deductible.
Phase 2
Once you’ve met the deductible, coinsurance kicks in for all medical services and now copays apply to Rx. That’s right, you’ll pay 20% of the cost for medical services and the plan pays the rest! You’ll pay the copay for Rx and the plan pays the rest!
Phase 3
You’ve got a maximum out-of-pocket. This amount is an accumulation of the deductible, Rx, coinsurance, and copays. Once all these costs add up to the total max out-of-pocket the plan will pay 100% of all in-network, covered medical services and Rx for the rest of the policy year.
You pay the copay amount for day to day services, as stated on page 3. Your deductible applies to the additional services not covered by a copay. Once you meet your deductible your coinsurance will “kick in”, on the Copay H.R.A. Plan, you pay 30% of the cost and AMIkids pays 70% of the cost of the claim, on the Copay Premium Plan, you pay 20% of the cost and AMIkids pays 80% of the cost of the claim. The amounts you pay towards your deductible, coinsurance, copay amounts, and prescription copays apply to your out-of-pocket maximum. Copay H.R.A . Plan & Copay Premium Plan
Want to earn some Wellness Incentives?
Register for one of AMIkids Wellness Programs!
Rally Wellness Program
Employees enrolled in one of the three AMIkids medical plans, have access to the Rally Wellness Program through BlueCross BlueShield at no cost to you! Rally can help you get healthier one step at a time. It will show you how to make simple changes to your daily routine, set smart goals for yourself and stay on target. You’ll get personalized recommendations to get you moving more, eating better, feeling happier and you’ll have FUN doing it!
To get started, login to www.MyHealthToolKitFL.com . Once you register, select Wellness, then Rally. Once you earn 2,000 coins, contact the Benefits Department to receive a new FitBit Charge2 (while supplies last). Real Appeal Weight Loss Program
AMIkids offers a FREE online weight loss program to ALL employees with a BMI of 20 or higher. You do not have to be enrolled in any of the AMIkids benefits to participate. Spouses and dependents over the age of 18 can also participate in Real Appeal as long as they’re enrolled in one of the three AMIkids medical plans. Real Appeal is a free, 52 week online weight loss program that is customized to what works for you! You will learn simple steps to help you transform and earn incentives along the way. You’ll have access to a transformation coach, digital tools, weekly online support group classes and a success kit full of healthy weight management tools.
To get started, login to www.amikids.realappeal.com . Once you complete ten group session, you will receive a FitBit Charge 2 (All incentives will be available year round while supplies last).
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ENOUGH INFO, WHAT’S IT GOING TO COST ME?
SALARY RANGE: BELOW $35,000
Cost for Coverage Amounts shown are per pay check ( 24 payments/year )
Base HDHP H.S.A Plan
Copay H.R.A. Plan
Copay Premium Plan
Employee Only
EE ES EC
$ 56.23 $ 153.51 $ 128.21 $ 194.00
$ 91.73 $ 225.84 $ 192.31 $ 294.16
$ 144.09 $ 339.49 $ 293.80 $ 453.36
Employee + Spouse Employee + Child(ren) Employee + Family
FAM
SALARY RANGE: $35,000 TO BELOW $50,000
Cost for Coverage Amounts shown are per pay check ( 24 payments/year )
Base HDHP H.S.A Plan
Copay H.R.A. Plan
Copay Premium Plan
Employee Only
EE ES EC
$ 64.67 $ 171.22 $ 144.23 $ 219.30
$ 101.22 $ 245.77 $ 210.34 $ 322.62
$ 154.63 $ 361.63 $ 313.84 $ 484.99
Employee + Spouse Employee + Child(ren) Employee + Family
FAM
SALARY RANGE: $50,000 AND OVER
Cost for Coverage Amounts shown are per pay check ( 24 payments/year )
Base HDHP H.S.A Plan
Copay H.R.A. Plan
Copay Premium Plan
Employee Only
EE ES EC
$ 73.10 $ 188.94 $ 160.26 $ 244.60
$ 110.70 $ 265.69 $ 228.37 $ 351.09
$ 165.18 $ 383.77 $ 333.87 $ 516.62
Employee + Spouse Employee + Child(ren) Employee + Family
FAM
REMINDER : If you sign up for the Base HDHP H.S.A Plan AMIkids WILL GIVE YOU $500, pro-rated, into your open and active Health Savings Account Of course you have to open the account and keep it open to get the money! If you sign up for the Copay H.R.A. Plan AMIkids WILL GIVE YOU up to the first $500 of any deductible related expenses as they are incurred.
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2018 Annual Enrollment Elections
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As a current employee , the 2018 Annual Open Enrollment period begins on March 26 th , 2018 and runs through 11:59:59pm on April 9 th , 2018. All benefits eligible employees are strongly encouraged to participate in Annual Open Enrollment by visiting the on line benefits administration site at www.mybensite.com/amikids or by calling 1-888-639-8077 and making their benefits selections. Employees that have current medical coverage in any of the 2017 medical plans that do NOT participate in Annual Open Enrollment will automatically be rolled over into the Base HDHP H.S.A. Plan. All other current coverages (dental, vision, life, disability, etc.) will be rolled over into the new plan year as is. As a recently hired employee , you have a New Employee Enrollment Period to elect your benefits. The enrollment period starts as soon as you are loaded into the BenAdmin system (usually the week after your first paycheck) and ends on your 60 th day following your date of hire. If you do not make your elections during this window, you cannot enroll in the AMIkids benefit plan until the next annual enrollment unless you experience a qualified change in status (see page 2).
Is participation in the 2018 Annual Open Enrollment Mandatory this year? • No, but if you’re currently enrolled in one of the medical plans and do not participate, you will automatically default to the Base HDHP H.S.A. Plan regardless of the plan in which you are currently enrolled. • All other coverages will be rolled over “as is.” • Participation in your health care decisions is STRONGLY encouraged.
HOW DO I DETERMINE WHICH PLAN IS BEST FOR ME AND MY FAMILY?
“Nobody knew health care could be so complicated!”
We have always known that deciding which of the employee benefits are right for your situation can be a difficult and stressful proposition. Because of the IRS 125 rules, the decisions that you make during annual open enrollment or upon your initial eligibility in the plan year are with you until the beginning of the next plan year; so you want to get it right, right?
In the next 2 pages are a couple of scenarios that will hopefully assist you in determining which plan makes the most sense for you – if you want assistance with creating your own scenario, please contact your Benefits Department and we’ll be happy to walk through the process with you!
CHOOSE WISELY! The benefit elections you make will remain in effect until April 30, 2019.
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HOW DO I DETERMINE WHICH PLAN IS BEST FOR ME AND MY FAMILY?
SCENARIO 1: EMPLOYEE AND CHILD(REN) EARNING LESS THAN $35,000
Karl with EE + Ch