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Creative Sign Designs Benefits at a Glance 2019-19
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2022 At A Glance GR EAT E R OKLAHOMA CITY AT A GLANCE TABLE OF CONTENTS Location & Demographics.....
2018 - 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
MEDICAL
page 3
Provider Name
Cigna
Provider Phone Number
866-494-2111
Provider Web Address
www.cigna.com
DENTAL
page 5
Provider Name
Guardian
Provider Phone Number
800-541-7846
Provider Web Address
www.guardiananytime.com
VISION
page 6
Provider Name
Guardian
Provider Phone Number
800-541-7846
Provider Web Address
www.guardiananytime.com
BASIC AND VOLUNTARY LIFE page 7 Provider Name Guardian Provider Phone Number 800-541-7846 Provider Web Address www.guardiananytime.com SHORT-TERM AND LONG-TERM DISABILITY page 8 Provider Name Guardian Provider Phone Number 800-541-7846 Provider Web Address www.guardiananytime.com EMPLOYEE ASSISTANCE PROGRAM page 9 Provider Name Guardian WorkLife Matters Provider Phone Number 800-386-7055 Provider Web Address www.ibhworklife.com
SUPPLEMENTAL BENEFITS
page 10
HOW TO ENROLL
page 12
DISCLOSURE NOTICES
page 16
BENEFIT INFORMATION
Benefit
Who pays the cost?
Creative Sign Design pays the majority of the employee portion of the medical plan. You may enroll your eligible dependents for an additional cost. You may elect dental coverage for yourself and your eligible dependents on a voluntary basis and you will be responsible for the cost. 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
Creative Sign Designs 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
Creative Sign Designs pays the entire cost.
Voluntary Life Insurance
The employee pays the entire cost.
Short Term Disability
The employee pays the entire cost.
Long Term Disability
Creative Sign Designs pays the entire cost.
ELIGIBILITY
All Regular full-time employees are eligible to join the Creative Sign Designs 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?
You can sign up for Benefits at any of the following times:
► Under 26 years of age;
► 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 (after completing initial eligibility 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
•
1
BENEFIT INFORMATION
?
CHOOSING YOUR BENEFITS
You must actively choose any benefit that you pay for, or share in the cost with Creative Sign Designs. 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:
• BEFORE YOUR TAXES ARE CALCULATED – medical and dental • AFTER YOUR TAXES ARE CALCULATED – vision, voluntary life and accidental death & dismemberment
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 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. Disability coverage will end on the day of termination.
• 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. Coinsurance – The percentage of costs of a covered health care service you pay (20%, for example) after you've paid your deductible.
2
MEDICAL INSURANCE
Creative Sign Designs offers three medical plans through Cigna. To find participating providers go to www.mycigna.com and click on “Find a Doctor”, choose the appropriate provider type. In Step 2: Plan Name, choose “LocalPlus”. Complete the remaining information and click 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 .
(Base Plan) LocalPlus 70%
(Mid Plan) LocalPlus 80%
(High Plan) LocalPlus 100%
IN-NETWORK: Plan Year or Calendar Year Basis
Calendar Year
Calendar Year
Calendar Year
Deductible (Individual / Family)
$4,500 / $9,000
$3,000 / $6,000
$1,000 / $2,000
Coinsurance
70% / 30%
80% / 20%
100%
Maximum Out-of-Pocket (Individual/Family)
$7,150 / $14,300
$6,500 / $13,000
$4,000 / $8,000
Deductible, Coinsurance & Copayments
Deductible, Coinsurance & Copayments
Deductible, Coinsurance & Copayments
Maximum Out-of-Pocket Includes
Lifetime Maximum
Unlimited
Unlimited
Unlimited
PREVENTIVE CARE:
Wellness Immunizations Mammography/Colonoscopy COPAYMENTS: Referral Required Office Visits Consultations for Illness/Injury
Covered 100%
Covered 100%
Covered 100%
No
No
No
$40 Copayment
$40 Copayment
$25 Copayment
Specialist Visits
$65 Copayment
$65 Copayment
$40 Copayment
Inpatient Hospital
Deductible & Coinsurance
Deductible & Coinsurance
$500 Deductible
Outpatient Surgery
Deductible & Coinsurance
Deductible & Coinsurance
$500 Deductible
Emergency Room Urgent Care
$350 Copayment $75 Copay
$350 Copayment $100 Copay
$250 Copayment $75 Copay
OUTPATIENT DIAGNOSTIC SERVICES: Independent/Freestanding Lab Complex Diagnostic (MRI, CT, PET, Etc.) – Freestanding Facility
Covered 100%
Covered 100%
Covered 100%
$300 Copay
$300 Copay
$250 Copay
PRESCRIPTIONS:
Tier 1: $10 copay Tier 2: $45 Copay Tier 3: $90 Copay
Tier 1: $10 copay Tier 2: $40 copay Tier 3: $70 copay
Tier 1: $10 copay Tier 2: $45 copay Tier 3: $90 copay
Retail (30 day supply)
OUT-OF-NETWORK 2 Deductible (Individual / Family)
$9,000 / $18,000
$5,000 / $10,000
$5,000 / $10,000
Maximum Out-of-Pocket (Individual/Family)
$14,300 / $28,600
$13,000 / $26,000
$10,000 / $20,000
Coinsurance
50% / 50%
50% / 50%
70% / 30%
3
MEDICAL CONTRIBUTION SCHEDULE
(Base Plan) LocalPlus 70%
Employee Pays (Bi-Weekly)
Employee Only
$ 60.48 $323.11 $227.58 $482.21
Employee + Spouse
Employee + Child(ren)
Family
(Mid Plan) LocalPlus 80%
Employee Pays (Bi-Weekly)
Employee Only
$ 73.30 $353.18 $251.20 $522.27
Employee + Spouse
Employee + Child(ren)
Family
(High Plan) LocalPlus 100%
Employee Pays (Bi-Weekly)
Employee Only
$116.61 $453.54 $330.89 $657.40
Employee + Spouse
Employee + Child(ren)
Family
4
DENTAL INSURANCE
Creative Sign Designs offers dental coverage through Guardian. 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.
DHMO
PPO
Calendar Year Deductible
In-Network
Out-of-Network
Individual
$0
$50
$75
Family
$0
$150
$225
Annual Maximum
Unlimited
$1,500
Diagnostic & Preventative
Exams & X-rays
Fee Schedule
100%
80%
Cleanings
Fee Schedule
Regular Restorative Services
Amalgam Fillings
Fee Schedule
Extractions – Single Tooth
Fee Schedule
80% after deductible
80% after deductible
Endodontics (Root Canal)
Fee Schedule
Peridontics (Gum Disease)
Fee Schedule
Major Services Crowns
Fee Schedule
Bridges
Fee Schedule
50% after deductible
50% after deductible
Dentures
Fee Schedule
Orthodontia
Child
$1,895
50%
Adult
$2,195
Not Covered
Lifetime Max
N/A
$1,000
Age Limit
N/A
18
1 Subject to balance billing. Please refer to your plan document for specific details.
Employee Contributions (Bi-Weekly)
DHMO
PPO
Employee Only
$ 5.30
$10.75
Employee + Spouse
$ 9.77
$22.17
Employee + Child(ren)
$11.92
$30.88
Family
$18.30
$42.29
5
VISION INSURANCE
Creative Sign Designs 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 Davis/Full Feature – Designer B
In-Network
Out-of-Network
Routine Eye Exams
No Charge
Up to $50 reimbursement
Standard Lenses: $48 - $126 reimbursement, depending on lens type
Standard Lenses: No Charge
Lenses *
Additional costs apply for specialty materials and/or lens coating*
Additional costs apply for specialty materials and/or lens coating*
Up to $150 allowance, plus 20% off balance over $150, plus an additional $50 allowance if purchased at Vision Works
Frames
Up to $48 reimbursement
Contact Lenses Fitting & Follow-up Exam
Included, when contacts are purchased
Not Included
Conventional Lenses: Up to $150 allowance, plus 15% off balance over $150 (copay waived)
Elective
Up to $105 reimbursement (Copay waived)
Medically Necessary:
No Charge (Copay waived)
Up to $210 reimbursement (Copay waived)
Frequency Exam
• Lenses, Frames & Contacts are limited to either one pair of contacts or frames/lenses per calendar year.
Once every 12 months
Lenses or contact lenses
Once every 12 months
Frame
Once every 24 months
* Please refer to your plan document for specific details.
Employee Contributions (Bi-Weekly)
Vision
Employee Only
$ 2.88 $ 5.54 $ 5.08 $ 8.31
Employee + Spouse
Employee + Child(ren)
Family
6
BASIC LIFE AND AD&D & VOLUNTARY LIFE INSURANCE
BASIC LIFE INSURANCE
Creative Sign Designs provides life insurance to all active full time employees at no cost to the employee. The chart below provides an overview of the plan.
Basic Life Insurance
Employee Benefit Amount
$20,000
Age Reduction Schedule
35% at age 65; 50% at age 70; 75% at age 75
Accidental Death & Dismemberment (AD&D)
Included - Equal to basic life
VOLUNTARY LIFE INSURANCE
Creative Sign Designs 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. Please note that anyone enrolling outside of their initial open enrollment period is considered a late entrant and will be subject to medical underwriting.
Voluntary Life Insurance
Employee Life
Increments of $10,000 up to $500,000
Employee Guarantee Issue
$100,000 (for timely entrants under age 65 only)
Spouse Life
Increments of $5,000 up to $250,000 (not to exceed 50% of Employee’s amount)
Spouse Guarantee Issue
$25,000 (for timely entrants under age 65 only)
Dependent Life
Increments of $1,000 up to $10,000 (not to exceed 50% of Employee’s amount)
Accidental Death & Dismemberment (AD&D)
Included - Equal to Voluntary Life amount
Age Reduction Schedule
35% at age 65; 50% at age 70
Age
Employee
Spouse
Child
VOLUNTARY LIFE Life Rates per $1,000 of benefit Includes AD&D Cost