2019 Colonial Distributing Benefit Guide

2019 Colonial Distributing Benefit Guide

2019 BENEFITS AT A GLANCE

CONTENTS & CONTACT INFORMATION

Refer to this list when you need to contact one of your benefit vendors. For general information contact Human Resources.

BROKER Provider Name

M.E. Wilson Company

Broker Contact

Amanda Sands

Provider Phone Number

813-229-8021 Ext. 139

Provider Email Address

[email protected]

MEDICAL

page 3

Provider Name

FloridaBlue

Provider Phone Number

800-322-2808

Provider Web Address

www.bcbsfl.com

DENTAL

page 5

Provider Name

Guardian

Provider Phone Number

1-800-541-7846

Provider Web Address

www.guardianlife.com

VISION

page 6

Provider Name

Guardian

Provider Phone Number

1-800-541-7846

Provider Web Address

www.guardianlife.com

VOLUNTARY LIFE

page 7

Provider Name

Guardian

Provider Phone Number

1-800-541-7846

Provider Web Address

www.guardianlife.com

ACCIDENT

page 8

Provider Name

Guardian

Provider Phone Number

1-800-541-7846

Provider Web Address

www.guardianlife.com

DISCLOSURE NOTICES

page 9

BENEFIT INFORMATION

Benefit

Who pays the cost?

Colonial Distributing pays the majority of the employee portion of the medical plan. You may enroll your eligible dependents for an additional cost. Colonial Distributing pays the majority of the employee portion of the (base) dental plan. You may enroll your eligible dependents for an additional cost. You may elect vision coverage for yourself and your eligible dependents on a voluntary basis and you will be responsible for the cost. Colonial Distributing offers salary continuance at a reduced rate of pay in the event of a non- occupational injury or illness that prevents you from working. Please See HR for policy information. Colonial Distributing offers voluntary life and accident coverage to enroll you and your eligible dependents for an additional cost.

Medical Insurance

YOUR BENEFITS PLAN

Colonial Distributing offers a variety of benefits allowing you 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

Salary Continuance

Life & Accident

ELIGIBILITY

All Regular full-time employees are eligible to join the Colonial Distributing Benefits Plan on the 1st of the month following 60-Days. “Regular Full-Time Employees” must be regularly scheduled and working at least 30 hours per week.

You may also enroll your dependents in the Benefits Plan when you enroll.

Eligible dependents include:

Your legal spouse

•

• Your married or unmarried natural children, step- children living with you, legally adopted children and any other children for whom you have legal guardianship, who are:

WHEN CAN YOU ENROLL?

► Under 26 years of age;

You can sign up for Benefits at any of the following times:

► A dependent who is older than 26 years of age, but less than 30 years of age may be eligible for medical benefits. To be eligible, a Dependent must:

• After completing your initial eligibility period; • During the annual open enrollment period; • Within 30 days of a qualified family-status change.

• Be unmarried and not have dependents of his or her own; AND

Be a resident of Florida or a student; AND

•

If you do not enroll at one of the above times, you may enroll during the next annual open enrollment period.

Not have coverage of their own, or covered under any other plan, including Medicare

•

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BENEFIT INFORMATION

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CHOOSING YOUR BENEFITS

You must actively choose any benefit that you pay for, or share in the cost with Colonial Distributing.

WHY DO I PAY FOR BENEFITS WITH BEFORE-TAX MONEY?

Your part of the cost is automatically taken out of your paycheck.

There is a definite advantage to paying for some benefits with before-tax money:

• BEFORE YOUR TAXES ARE CALCULATED – medical, dental, and vision

Taking the money out before your taxes are calculated lowers the amount of your pay that is taxable. Therefore, you pay less in taxes.

MAKING CHANGES

Generally, you can only change your benefit choices during the annual benefits enrollment period. However, you may be able to change your benefit choices during the plan year if you have a change in status including:

If you fail to notify Human Resources within 30 days of a family status change, you will be required to wait until the next annual enrollment period to make benefit changes unless you have another qualifying event change.

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

WHEN COVERAGE ENDS

• Change in your work status that affects your benefits

Coverage will stop on the last day of the month in which employment with the company ends.

• Change in residence or work site that affects your eligibility for coverage

• Change in your child’s eligibility for benefits

• Receiving Qualified Medical Child Support Order (QMCSO)

KEY BENEFIT TERMS

Copayment – A flat fee that you pay for medical services, regardless of the actual amount charged by your doctor or another provider. This generally applies to physicians’ office visits and prescription drugs. Deductible – The amount you pay toward medical and dental expenses each year before the plan begins paying benefits. Out of Pocket Maximum – The maximum amount you will pay in deductibles, coinsurance and copayments during the year.

2

MEDICAL INSURANCE

Colonial Distributing offers three medical plans through FloridaBlue. To find participating providers go to www.bcbsfl,com and click on “Find a Doctor”, then follow the prompts to complete the search. The chart below provides a brief overview of the medical plans. 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 your exact description of services and supplies that are covered, those which are excluded or limited, and other terms and conditions of coverage .

BlueOptions 05302 BRONZE PLAN

BlueCare 68 PREMIUM PLAN

BlueOptions 05770 DELUXE PLAN

IN-NETWORK: Plan Year or Calendar Year Basis

Calendar Year

Calendar Year

Calendar Year

Deductible (Individual / Family)

$5,000 / $10,000

$1,000 / $3,000

$1,000 / $3,000

Coinsurance

70% / 30%

80% / 20%

80% / 20%

Maximum Out-of-Pocket (Individual/Family) Maximum Out-of-Pocket Includes

$6,350 / $12,700

$4,500 / $9,000

$3,500 / $7,000

Deductible, Coinsurance & Copayments

Deductible, Coinsurance & Copayments

Deductible, Coinsurance & Copayments

Lifetime Maximum

Unlimited

Unlimited

Unlimited

PREVENTIVE CARE:

Wellness Immunizations Mammography/Colonoscopy COPAYMENTS: Referral Required

Covered 100%

Covered 100%

Covered 100%

No

No

No

Office Visits Consultations for

$30 Copayment

$35 Copayment

$25 Copayment

Illness/Injury

Specialist Visits

$55 Copayment

$60 Copayment

$45 Copayment

$500 Copay per Day $1,500 Max

Inpatient Hospital

Deductible & Coinsurance

Deductible & Coinsurance

Outpatient Surgery

Deductible & Coinsurance

$600 Copay

Deductible & Coinsurance

Emergency Room Urgent Care

$300 Copayment $60 Copay

$500 Copay $80 Copay

$200 Copayment $50 Copay

OUTPATIENT DIAGNOSTIC SERVICES: Independent/Freestanding Lab Complex Diagnostic (MRI, CT, PET, Etc.) – Freestanding Facility

100%

100%

100%

Deductible & Coinsurance

$500 Copay

$200 Copay

PRESCRIPTIONS:

Tier 1: $10 copay Tier 2: 20% Coinsurance Tier 3: Not Covered

Tier 1: $10 copay Tier 2: $50 copay Tier 3: $80 copay

Tier 1: $10 copay Tier 2: $50 copay Tier 3: $80 copay

Retail (30 day supply)

OUT-OF-NETWORK 2 Deductible (Individual / Family)

$10,000 / $30,000

Not Covered

$3,000 / $6,000

Maximum Out-of-Pocket (Individual/Family)

$20,000 / $40,000

Not Covered

$7,000 / $14,000

Coinsurance

50 / 50%

Not Covered

50 / 50%

3

MEDICAL CONTRIBUTION SCHEDULE

Employee Pays (Bi-Weekly)

BRONZE PLAN

Employee Only

$ 36.71 $239.34 $160.05 $347.99

Employee + Spouse

Employee + Child(ren)

Family

Employee Pays (Bi-Weekly)

PREMIUM PLAN

Employee Only

$ 77.01 $335.27 $234.21 $473.76

Employee + Spouse

Employee + Child(ren)

Family

Employee Pays (Bi-Weekly)

DELUXE PLAN

Employee Only

$133.80 $470.42 $338.70 $650.91

Employee + Spouse

Employee + Child(ren)

Family

4

DENTAL INSURANCE

Colonial Distributing offers dental coverage through Guardian. The Dental DHMO Plan is an in-network plan only, whereas the Dental PPO Plan allows you to use in-network or out-of-network benefits. If out-of-network dentists are used, you will be responsible for paying the difference between Guardian’s allowed amount and what the dentist may charge, also known as “balance billing”. The chart below provides a brief overview of the plan.

Dental

BASE DMO Plan

PREMIUM PPO Plan

In-Network

In-Network

Out-of Network*

Calendar Year Deductible Individual

Not Applicable

$50

$50

Family

Not Applicable

$150

$150

Annual Maximum

$1,000

Not Applicable

$1,000

Diagnostic & Preventive Exams

Cleanings Fluoride X-Rays Sealants Regular Restorative Services Amalgam Fillings

Fee Schedule

Covered in full

Covered in full

Covered 90% after deductible

Fee Schedule

Covered 80% after deductible

Extractions - Single Tooth Major Services Crowns

Bridges Dentures

Fee Schedule

Covered 60% after deductible Covered 50% after deductible

Endodontics (Root Canal) Periodontics (Gum Disease)

* Subject to balance billing. Please refer to your plan document for specific details.

BASE DHMO Dental Plan

PREMIUM PPO Dental Plan

Employee Contributions (Bi-Weekly)

Employee Only

$ 1.15 $ 5.08 $ 8.82 $12.54

$ 7.70 $21.66 $29.40 $42.73

Employee/Spouse

Employee/Child(ren)

Family

5

VISION INSURANCE

Colonial Distributing offers vision coverage through Guardian. The Vision PPO Plan allows you to use in-network or out-of-network benefits. If out-of-network vision providers are used, you will be responsible for paying the difference between Guardian’s allowed amount and what the provider may charge, also known as “balance billing”.

Vision

Routine Eye Exams

$10 Copay

Lenses*

Single Bifocal Trifocal Lenticular

$25 Copay $25 Copay $25 Copay $25 Copay

Frames

$130 allowance

Elective: $130 allowance Medically Necessary: Covered in Full, after Copay

Contact Lenses

Frequency Exam

Once every 12 months

Lenses or contact lenses

Once every 12 months

Frame

Once every 24 months

• Lenses, Frames & Contacts are limited to either one pair of contacts or frames/lenses per calendar year.

Vision (Bi-Weekly Deductions)

Employee Contributions

Employee Only

$ 0.60 $ 3.27 $ 4.25 $ 6.96

Employee + Spouse

Employee + Child(ren)

Family

6

VOLUNTARY LIFE INSURANCE

VOLUNTARY LIFE INSURANCE

Colonial Distributing. provides all active employees working 30 or more hours per week the option to purchase life insurance coverage through a group plan, at the employee’s cost. The chart below provides an overview of the plan.

Voluntary Life Insurance

Employee Life

Increments of $10,000 up to $500,000

Employee Guarantee Issue

$100,000 for timely entrants

Spouse Life

Increments of $5,000 up to lesser of 100% of employee's amount or $250,000

Spouse Guarantee Issue

$25,000 for timely entrants

Dependent Life

Increments of $5,000 up to lesser of 100% of employee’s amount or $10,000

Accidental Death & Dismemberment (AD&D)

Equal to voluntary life amount

VOLUNTARY LIFE/AD&D Life Rates per $1,000 of benefit Cost of AD&D included. *Spouse premium is based on employee age.

Age

Employee

Spouse*

Child

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