2020 Mezrah Benefits at a Glance

2020 Mezrah Benefits at a Glance

BENE F I TS AT A GLANCE January 1, 2020 - December 31, 2020 I L January 1, 2020 - Dece ber 31, 2020

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 Broker Contact

M.E. Wilson Company

Amanda Sands

Provider Phone Number Provider Email Address

813-229-8021 Ext. 139 [email protected]

MEDICAL

page 6

Provider Name

FloridaBlue

Provider Phone Number Provider Web Address

800-352-2583

www.floridablue.com

HEALTH SAVINGS ACCOUNT (HSA)

page 8

Provider Name

Health Equity (866) 346-5800

Provider Phone Number Provider Web Address

www.healthequity.com

DENTAL

page 9

Provider Name

Lincoln

Provider Phone Number Provider Web Address

800-423-2765 www.lfg.com

VISION

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Provider Name

Lincoln

Provider Phone Number Provider Web Address

800-423-2765 www.lfg.com

BASIC & VOLUNTARY LIFE AND DISABILITY

page 11

Provider Name

Reliance Standard

Provider Phone Number Provider Web Address

800-351-7500

www.reliancestandard.com

DISCLOSURE NOTICES

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BENEFIT INFORMATION

Benefit

Who pays the cost?

Mezrah Consulting pays the majority of the employee portion of the medical plan. You may enroll your eligible dependents for an additional cost. Mezrah Consulting pays the entire cost of the employee only dental coverage. You may elect dental coverage for yourself and your eligible dependents and you will be responsible for the cost above what Mezrah Consulting contributes. You may elect vision coverage for yourself and your eligible dependents on a voluntary basis and you will be responsible for the cost.

Medical Insurance

YOUR BENEFITS PLAN

Mezrah Consulting 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

Basic Life Insurance

Mezrah Consulting pays the entire cost.

Voluntary Life Insurance

The employee pays the entire cost.

The employer pays the entire cost for Short Term and the employee pays the entire cost for Long Term.

Voluntary Short and Long Term Insurance

ELIGIBILITY

All Regular full-time employees are eligible to join the Mezrah Consulting Benefits Plan following 90 days of employment. 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:

► Under 26 years of age;

WHEN CAN YOU ENROLL?

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

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

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

Be a resident of Florida or a student; AND

•

• Not have coverage of their own, or covered under any other plan; AND

If you do not enroll at one of the above times, you must wait for the next annual open enrollment period.

Not entitled to benefits under 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 Mezrah Consulting. Your part of the cost is automatically taken out of your paycheck. There are two ways that the money can be taken out:

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.

• BEFORE YOUR TAXES ARE CALCULATED – medical, dental, vision, health savings account (HSA)

• AFTER YOUR TAXES ARE CALCULATED – voluntary life/ accidental death & dismemberment and disability

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 family status 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. Life insurance ends the last day of employment.

• 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

COBRA – A Federal law that allows workers and dependents who lose their medical, dental, or vision coverage to continue any of these coverages for a specified length of time by electing and paying for continuation benefits. 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, copayments and coinsurance during the year.

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MEDICAL INSURANCE

Mezrah Consulting offers two medical plans through FloridaBlue. To find participating providers go to www.floridablue.com and click on “Find a Doctor”, choose the appropriate provider type. The Low and the High plan use the BlueCare (HMO) Network.

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.

LOW BlueCare 15572 Essential (HSA)

HIGH BlueCare 14256 All Copay

IN-NETWORK: Plan or Calendar Year Basis

Calendar Year

Calendar Year

Deductible (Individual/Family)

$2,700 / $7,000

$1,000 / $3,000

Coinsurance

80% / 20%

80% / 20%

Maximum Out-of-Pocket (Individual/Family)

$5,000, $10,000

$4,000 / $8,000

Maximum Out-of-Pocket Includes

Deductible, Coinsurance & Copayments

Deductible, Coinsurance & Copayments

Lifetime Medical Maximum

Unlimited

Unlimited

PREVENTIVE CARE:

Wellness Immunizations Mammography/Colonoscopy COPAYMENTS: Primary Physician Office Visits – No Referral Required

Covered 100%

Covered 100%

Deductible & Coinsurance

$25 Copayment

Specialist Visits

Deductible & Coinsurance

$45 Copayment

Inpatient Hospital

Deductible & Coinsurance

$300/day to a Max of $1,500

Outpatient Surgery

Deductible & Coinsurance

$350 Copayment

Emergency Room

Deductible & Coinsurance

$300 Copayment

Urgent Care

Deductible & Coinsurance

$50 Copayment

OUTPATIENT DIAGNOSTIC SERVICES:

Lab Services

Deductible & Coinsurance

$100 Copayment

X-Ray Services

Deductible & Coinsurance

$60 Copayment

Complex Diagnostic

Deductible & Coinsurance

$250 Copayment

PRESCRIPTIONS: Retail (30 day supply)

$10 / $30 / $50 copays after Deductible

$15 / $60 / $100

Mail Order (90 day supply)

2 X retail

2 X retail

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

$5,600 / $11,200

In-Network Only

Maximum Out-of-Pocket (Individual/Family)

$11,600 / $23,200

In-Network Only

Lifetime Medical Maximum

Unlimited

In-Network Only

Coinsurance

50% / 50%

In-Network Only

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MEDICAL CONTRIBUTION SCHEDULE

LOW BlueCare 15572 (HSA)

HIGH BlueCare 14256 (All Copay)

Employee Cost Per Pay Period (24)

Employee Only

$ 48.43

$110.02

Employee + Spouse

$242.13

$365.31

Employee + Child(ren)

$213.07

$327.01

Family

$406.77

$582.30

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HEALTH SAVINGS ACCOUNT (HSA)

What is a Health Savings Account (HSA)?

It is an interest-bearing account created to help you pay medical expenses. The funds in your HSA can be used to help pay your deductible, coinsurance and any qualified medical expenses not covered by your health plan (including dental and vision expenses). All of the money you contribute is tax-deductible when used to pay for qualified medical expenses. An HSA is your account. It goes with you if you change jobs or when you retire.

IRS Annual Maximum HSA Contribution Limits (maximums include employer contributions)

2020

Employee Only

$3,550

Family

$7,100

Catch-up Amount for employees 55 years or older

Additional $1,000 annually

Mezrah’s Tax-Free HSA Contribution

SINGLE COVERAGE

FAMILY COVERAGE

$500

$500

Annual amount*

* Employer contributions: amount and frequency deposited to your Health Savings Account will be determined by Mezrah Consulting and will not exceed the plan year contribution amount.

Health Savings Account – Eligible Expenses (partial list) • Acupuncture • Alcohol and drug dependency treatment • Ambulance • Artificial limbs • Breast reconstruction surgery (mastectomy-related) • Dental expenses (exams, cleanings, X-rays, root canals bridges, etc.) • Diagnostic fees • Doctor fees (including Chiropractic services) • Drugs - prescription and over the counter (when ordered by physician) • Eyeglasses and exams, contact lenses & solutions, laser surgery • Fertility enhancements • Hearing aids and batteries • Hospital and Laboratory fees • Long-term care (medical expenses and premiums) • Nursing home • Physical and speech therapies • Psychiatric care • Smoking-cessation programs and products • Vasectomy • Weight-loss program (to treat a specific disease diagnosed by a physician)

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DENTAL INSURANCE

Mezrah Consulting offers dental coverage through Lincoln Financial . The Dental PPO Plans allow 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 Aetna’s allowed amount and what the dentist may charge, also known as “balance billing”. The charts below provides a brief overview of the plans.

LOW Dental PPO Plan

In-Network

Out-of Network*

Calendar Year Deductible Individual

$25 $75

$75

$225

Family

Annual Maximum

$1,750

Diagnostic & Preventive Exams Cleanings Fluoride X-Rays Sealants Regular Restorative Services Amalgam Fillings Extractions - Single Tooth Endodontics (Root Canal) Periodontics (Gum Disease) Major Services Crowns

Covered in full

Covered 80% after deductible

Covered 80% after deductible Covered 70% after deductible

Covered 50% after deductible Covered 40% after deductible

Bridges Dentures Orthodontia Services

Not covered

Children only under the age of 19

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

Dental PPO Plan Employee Cost Per Pay Period

Employee Only

$ 0.00

Employee + Spouse

$13.76

Employee + Child(ren)

$14.84

Family

$31.36

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VISION INSURANCE

Mezrah Consulting offers vision coverage through Lincoln Financial. The vision network consists of optometrists, ophthalmologist opticians and optical retailers. You have the option of visiting any provider, however by choosing a participating provider, you receive the highest level of benefits.

Vision

In-Network

Out-of-Network

Routine Eye Exams

$10 Copayment

Reimbursed up to 40

Reimbursed from $40 to $80 Depending on type of lenses

Lenses *

$25 Copayment

Frames

$130 allowance

Reimbursed up to $45

Contact Lenses

$130 allowance

Reimbursed up to $125

Frequency Exam

Once every 12 months Once every 12 months

Lenses or contact lenses

Frame

Once every 24 months

• Covered lenses include single vision, bifocal, trifocal and lenticular.

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

Employee Cost Per Pay Period

Employee Only

$ 3.38 $ 6.41 $ 7.52 $10.57

Employee + Spouse Employee + Child(ren)

Family

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BASIC AND VOLUNTARY LIFE AND AD&D INSURANCE

Mezrah Consulting provides all full-time employees working 30 or more hours per week the option to purchase voluntary life insurance coverage through a group plan. The chart below provides an overview of the plan.

Basic Life Insurance

Reliance Standard

$15,000 **The Basic Life insurance is paid 100% by Mezrah Consulting.**

Employee Only

Voluntary Life and AD&D Insurance

Reliance Standard

Increments of $10,000 up to a maximum of 5x salary or $500,000, whichever is less. Minimum Election: $10,000

Employee Only

Employees Under Age 65 No evidence of insurability up to max of $100,000 (newly eligible employees only).

Increments of $5,000 up to a maximum of 50% of employee amount or $250,000, whichever is less. Minimum Election: $5,000

Spouse

Spouses Under Age 65

No evidence of insurability up to max of $30,000 (newly eligible dependents only).

At age 65, benefits reduce by 35% of original amount, at age 70, benefits reduce by 35% of in force amount.

Benefit Reduction Schedule

Children

$10,000

Accidental Death & Dismemberment

Matches elected life amount

VOLUNTARY LIFE Life Rates per $10,000 of benefit (Spouse rate is based on employee’s age )

EMPLOYEE ELECTION:

Age Employee/ Spouse Child Life

_____________________ Benefit Amount / 10,000 x___________________ Monthly Rate = ___________________ x12 /24 =____________________ Per Pay Contribution _____________________ Benefit Amount / 10,000 x____________________ Monthly Rate = ___________________ ) = ____________________ x12 /24 =____________________ Per Pay Contribution SPOUSE ELECTION: