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PIH 2022 Benefit Guide
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2022 BENEFITS OVERVIEW
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WHO IS ELIGIBLE? All full-time, non-union employees working at least 30 hours per week are eligible to participate in benefit plans on the first day of the month following 60 days of continuous active employment. HOW DO I ENROLL? Complete the 2022 Benefits Enrollment Form. Visit www.phillipsih.com/benefits to get started. WHEN CAN YOU MAKE CHANGES TO YOUR ENROLLMENT? Changes to your benefits may be made during open enrollment each year which typically occurs in the fourth quarter. Changes may be made outside of open enrollment for qualifying events including, but not limited to: marriage/divorce, birth/adoption, or change in job status. Other qualifying events may apply. When you have a qualifying event, youmust immediately notify Human Resources and submit the appropriate form(s) within 30 days after the qualifying event. In the event that you experience a change in Medicaid/ Children’s Health Insurance Program (CHIP) eligibility, appropriate form(s) must be submitted to Human Resources within 60 days after the eligibility change. QUESTIONS? If you have any questions about your PIH benefits, please contact Lee Haniford in Human Resources at [email protected] or (865) 320-4298. Medical Benefits ������������������������������������������������������������������������������������������������������������������������������������������������������������3 Medical Benefits Comparison����������������������������������������������������������������������������������������������������������������������������������� 4 Health Savings Account���������������������������������������������������������������������������������������������������������������������������������������������� 4 Dental Benefits����������������������������������������������������������������������������������������������������������������������������������������������������������������5 Vision Benefits�����������������������������������������������������������������������������������������������������������������������������������������������������������������5 Telemedicine ������������������������������������������������������������������������������������������������������������������������������������������������������������������� 6 Phillips Wellness and Healthy Pregnancies, Healthy Babies��������������������������������������������������������������������������7 Flexible Spending Accounts ������������������������������������������������������������������������������������������������������������������������������������� 8 Disability Benefits ��������������������������������������������������������������������������������������������������������������������������������������������������������� 9 Paid Maternity Leave ��������������������������������������������������������������������������������������������������������������������������������������������������� 9 Basic and Supplemental Life Insurance���������������������������������������������������������������������������������������������������������������10 Supplemental Health Insurance������������������������������������������������������������������������������������������������������������������������������� 11 Employee Assistance Program�������������������������������������������������������������������������������������������������������������������������������� 12 Student Loan Benefit Program�������������������������������������������������������������������������������������������������������������������������������� 13 401(k) Retirement Plan ����������������������������������������������������������������������������������������������������������������������������������������������14 Annual Notices��������������������������������������������������������������������������������������������������������������������������������������������������������� 15-16 Table of Contents
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Medical Benefits CIGNA - OPEN ACCESS PLUS NETWORK 1-800-244-6224 | www.mycigna.com | Group Number: 3332287
PIH offers access to medical benefits through Cigna. You may choose between two different medical plans: Health Savings Account (HSA) Plan and Preferred Provider Organization (PPO) Plan.
Option 1: HSA Plan The HSA Plan offers lower premiums and generally covers 100% of medical expenses after the annual deductible has been met. Due to the higher out-of-pocket costs associated with the HSA Plan, PIH offers employees a Health Savings Account (HSA), which we will explain in more detail on page 4.
Option 2: PPO Plan The PPO Plan offers higher premiums, but a lower deductibleandout-of-pocketmaximum. After reaching your annual deductible, medical expenses will be covered at 80%. By choosing the PPO Plan, you are eligible to set aside money in a Flexible Spending Account (FSA).
Non- Wellness Wellness
PPO Plan Weekly Premiums Employee Only EMP + Spouse EMP + Child(ren)
Non- Wellness Wellness
HSA Plan Weekly Premiums Employee Only
$62.81
$49.37
$77.34 $151.91
$64.84 $139.41
EMP + Spouse
$119.59 $106.16
EMP + Child(ren)
$104.78 $161.56
$91.34 $148.12
$132.46 $119.96 $207.02 $194.52
EMP + Family
EMP + Family
To receive the maximum benefit from your chosen plan, make sure your medical provider is a member of the network. • In-network providers will file your claims for you. • By using an out-of-network physician or facility, you will be subject to a higher deductible and responsible for a larger percentage of the charges. You may also have to pay for charges over the usual and customary rate. To find an in-network provider, download the MyCigna app or go to the online directory at www.cigna.com and click on the “Find a Doctor” button to begin your search. Please be sure to carefully review the online directory or call Cigna to confirm that your provider participates in the network.
3
Medical Benefits Comparison
MEDICAL BENEFITS¹
Option 1: HSA Plan
Option 2: PPO Plan
Deductible: Individual / Family
$3,000 / $6,000 (Shared) 2
$2,000 / $4,000 (Embedded) 3
Out-of-Pocket Maximum: Individual / Family
$3,000 / $6,000
$3,000 / $6,000
SERVICES RECEIVED AT A PRACTITIONER’S OFFICE Preventive Care
100%
100%
Office Visit For sick visits, please consider Teladoc first SERVICES RECEIVED AT A FACILITY Emergency Room
100% after deductible
80% after deductible
100% after deductible
80% after deductible
Most Other Services
100% after deductible
80% after deductible
PHARMACY Retail Preventive Generics Generics / Preferred Brand/Non-Preferred Brands Mail Order⁴ Preventive Generics Generics/Preferred Brand/Non-Preferred Brands
Plan pays 100% 100% after deductible
$10 / $35 / $60
Plan pays 100% 100% after deductible
3x Retail copay
Specialty Drugs
100% after deductible
N/A / $35 / $60
All benefits shown In-Network
1. See your Evidence of Coverage for Out-of-Network Benefits, prior authorization, visit limits and more. 2. Shared Family Deductible - entire family deductible must be met before the plan will pay. 3. Embedded Deductible - each individual is only responsible for the individual deductible amount before the plan will pay (maximum two deductibles).
Health Savings Account (HSA)
HSA BANK 1-855-731-5225
If you are enrolled in the HSA Plan, you are eligible to participate in a Health Savings Account (HSA) through HSA Bank. The HSA is established to pay for future qualified medical, dental and vision expenses that are incurred by you or your dependents enrolled in the plan. PIH contributes to the HSA quarterly on your behalf, so it is to your advantage to make the most of your HSA.
You may make tax-free payroll contributions to the account to pay for subsequent future qualified medical expenses. Your contributions to the HSA will be payroll deducted and the funds deposited into your HSA. You may change the amount you contribute to your HSA at any time during the plan year. When a qualified expense is incurred, you simply use your HSAdebit card or request reimbursement for the expense from the custodial account. Unused account dollars are yours to keep, even if you retire or leave the company. Also, if you are 55 years of age or older you may contribute an additional $1,000 catch-up contribution to your HSA.
Annual Maximum Contributions to your HSA
Total Amount You May Contribute
IRS Annual Maximum Contribution
PIH's Contribution
$2,750
Employee Only
$3,650 $225 Quarterly, $900 Annually
$5,700
Emp + Spouse
$7,300 $400 Quarterly. $1,600 Annually
$5,700
Emp + Child(ren)
$7,300 $400 Quarterly. $1,600 Annually
$5,300
Emp + Family
$7,300 $500 Quarterly, $2,000 Annually
4
Dental Benefits
CIGNA 1-800-244-6224 | www.mycigna.com | Group Number: 3332287
Your PIH dental benefits are administered by Cigna.
You can visit any dentist that you choose. However, if your provider is not in-network, he/she may charge more than the usual and customary rate, and you may be responsible for the additional charges. To find an in-network provider, go to the online directory at www.cigna.com. Please be sure to carefully review the online directory or call Cigna to confirm that your provider participates in the network. Dental Weekly Premiums Buy-Up Plan Employee Only $2.43 $3.71 EMP + Spouse $5.35 $8.16 EMP + Child(ren) $4.87 $7.43 EMP + Family $6.81 $10.39 Base Plan
DENTAL PLAN BENEFITS
Base Plan Buy-Up Plan $50 / $150 $25 / $75
Individual / Family Deductible Calendar Year Maximum (per enrolled person) Preventive Services (Deductible does not apply)
$1,500
$2,500
100%
100%
80% after deductible 60% after deductible
80% after deductible 70% after deductible
Basic Services
Major Restorative Services
Orthodontic Services (Deductible does not apply) Orthodontic Lifetime Maximum (Covers children up to age 19, lifetime max per child)
50%
50%
$1,500
$2,500
Vision Benefits
Your PIH vision benefits are administered by Cigna. When using in-network providers, this PPO plan covers most exams, eyeglasses, and medically necessary contacts in full. Discounts are available for upgrades on covered frames and lenses. Should you choose to see an out-of-network provider, Cigna will reimburse you up to a specified amount. The out-of-network reimbursement schedule is summarized in the Vision Plan Benefits table below. CIGNA 1-800-244-6224 | www.mycigna.com | Group Number: 3332287
Vision Weekly Premiums
Employee Only EMP + Spouse EMP + Child(ren)
$1.59 $3.20 $3.18 $5.05
EMP + Family
VISION BENEFITS
In-Network Out-of-Network
To find a n in-network provider or surgery center, review out-of- network benefits, a nd o ther p lan details, go to the online directory at cigna.vsp.com and click on the “Find a Cigna Vision Network Eye Care Professional” button to begin your search. Please be sure to carefully review the online directory or call Cigna to confirm that your provider participates in the network.
Vision Exam
$10 Copay
$45 Allowance Up to $80 Allowance depending on type
Lenses (once per year) Single / Bifocal / Trifocal / Lenticular
$10 Copay / covered in full
Frames (once every 2 years)
$140 Allowance $77 Allowance
Contacts in lieu of eyeglasses (once per year) Medically Necessary Elective
$10 Copay
Covered in full Up to $150
$210 Allowance $120 Allowance
5
Telemedicine TELADOC 1-800-835-2362 | www.teladoc.com No cost for you or your household to call!
PIH is proud to offer Teladoc to all employees and dependents enrolled in the medical plan. Teladoc is a national network of board-certified physicians providing telephonic consultations 24/7. Teladoc does not replace your primary care physician. Teladoc should be used when you need immediate care for non-emergency medical issues. It is an affordable, convenient alternative to Urgent Care and ER visits. You can talk with a Teladoc doctor via a phone consult, video consult within the secure member portal, or video consult within the Teladoc mobile app. To request a consult, visit the Teladoc website, log into your account and click “Request a Consult”. You can also call Teladoc to request a consult by phone, or request a consult through the Teladoc mobile app. Teladoc doctors can prescribe short termmedication for awide range of conditions when medically appropriate. When you go to your pharmacy of choice to pick up the prescription, you may use your health/prescription insurance card to help pay for the medication. You will be responsible for the co-pay based on the type of medication and your plan benefits.
6
Phillips Wellness CIGNA 1-800-244-6224 | www.mycigna.com, Login and click on Wellness
The Phillips Wellness Program, administered by Cigna, offers employees best-in-class wellness services and a discount on weekly medical benefit premiums. You can save $50 per month! Through the Phillips Wellness Program, all your health and wellness benefits will be integrated into one place and provide you with easy access to your plans, programs, and wellness resources. Most wellness activities will automatically be tracked for you. When you elect to participate in the program, the weekly medical benefit premium discount is automatically applied to your paycheck. To stay in the program, you must earn at least 100 points by participating in wellness activities each year. Here’s how you earn points:
Wellness Activity
Points
Annual Physical
100 100 100 100
Well Woman Exam
Cancer Screening (various)
Mammogram
Complete the Cigna on-line Health assessment
50 25
Receive a flu shot
Complete an online coaching program • Nutrition • Exercise • Positive Mood • Weight • Stress • Tobacco one and six month programs
25 (maximum of 50)
Participate in Apps & Activities
25 (maximum of 50)
Self-reported goals: • I made smart and delicious food choices • I took part in physical activity • I’m managing my weight
25 (maximum of 50)
DID YOU KNOW? The preferred way to get the 100 points is to complete an annual physical.
CIGNA 1-800-615-2906 | www.mycigna.com, Click on Wellness Healthy Pregnancies, Healthy Babies®
If you're pregnant or become pregnant, be sure to sign up for the Cigna Healthy Pregnancies, Healthy Babies® program, designed to help you and your baby stay healthy during your pregnancy and in the days and weeks after your baby’s birth. When you enroll in Cigna Healthy Pregnancies, Healthy Babies and complete the program, including your postpartum check-in, you’ll be eligible to receive up to $225 in gift cards.
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Flexible Spending Account BENEF I TSASS I ST 1-865-769-2800 | www.mywealthcareonline.com/benefitsassist /
PIH offers employees the option to defer money on a pre-tax basis for use on approved medical and dependant care expenses. This is NOT insurance. This is simply a way for you to save on your healthcare or daycare expenses by setting money aside from your gross income, pre-tax for expenses that you anticipate for the plan year. Healthcare FSA With the healthcare FSA, the total dollar amount set aside for the plan year is eligible for withdrawal from the account on day one of your first payroll deduction towards the account. The maximum healthcare FSA annual contribution amount is $2,750. If you are a new hire and enroll in the plan midyear, your contributions will be prorated for the annual amount you select. Dependent Care Account (DCA) You may elect to set money aside to use for your approved childcare services, provided at a daycare facility, in your home, or in someone else’s residence through a DCA. Certain requirements must be satisfied for the services to be approved for reimbursement. The maximum DCA annual contribution amount is $5,000 per family (if you are single or married and file a joint tax return) or $2,500 (if you are married and file a separate tax return). Limited FSA If you enroll in the HSA Plan, you are only eligible for the Limited FSA. This account may be used on qualified dental and vision expense only, not medical expenses (you will use your HSA for medical expenses). The maximum annual contribution is $2,750. By setting aside money pre-tax into either a FSA or DCA, you save on taxes and take home more spendable income! Please contact BenefitsAssist for a list of eligible medical and dependent care expenses.
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Disability Benefits GUARDIAN 1-800-268-2525 (STD) | 1-800-538-4583 (LTD) | www.guardiananytime.com | Group Number: 00534925
Disability insurance can help support you and your family should you become disabled for a short period of time or for an extended period of time.
Short-Term Disability (STD) STD provides you financial support in the event that you become temporarily disabled. STD coverage provides 60% of your weekly earnings up to a maximum of $1,000 per week. Benefit payments begin after an eight day waiting period if the disability is illness-related, or the first day if the disability is injury-related, and ends after 26 weeks of continuous disability. Long-Term Disability (LTD) LTD insurance protects your income in the event of a long-term illness or injury. LTD coverage provides 60% of your monthly earnings up to a maximum of $5,000 per month for hourly employees and a maximum of $10,000 per month for salaried employees. Benefit payments begin after you have been deemed to be disabled for 180 days, and ends when you are no longer disabled or reach Social Security Normal Retirement Age. Premium information for both benefits may be found on your enrollment form.
Paid Maternity Leave LEE HANIFORD - HUMAN RESOURCES 865-320-4298 | Email: [email protected]
PIH is proud to offer up to 8 weeks of paid maternity leave to its employees following the birth of a child. This benefit is eligible to employees that meet the following criteria: • Be a full-time, regular employee • Have been employed with the company for at least 12 months or • Have worked at least 1,250 hours during the 12 consecutive months immediately preceding the date the leave would begin.
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Basic Life Insurance
GUARDIAN 1-800-600-1600 | www.guardiananytime.com | Group Number: 00534925
PIH provides you with Basic Life and Accidental Death & Dismemberment (AD&D) insurance at no cost through Guardian. All full-time hourly and salaried employees receive: • $50,000 of coverage for yourself, • $10,000 of coverage for your spouse, and • $2,000 of coverage for child(ren) ages 6 months to 26 years, or $1,000 of coverage for child(ren) live birth to 6 months. You will need a beneficiary for this policy. Contact Human Resources to update your beneficiaries anytime during the year. Salaried Employees Buy-Up Option Salaried employees may increase their Basic Life and AD&D coverage up to three times their annual salary (up to $300,000). Additional coverage premiums are based on your annual salary and only costs between $2.00 and $5.15 per week! PIH pays 65% of the cost, and you only pay 35% of the additional coverage amount.
Supplemental Life Insurance GUARDIAN 1-800-600-1600 | www.guardiananytime.com | Group Number: 00534925
In addition to the Basic Life insurance provided by PIH, you have the option to purchase Supplemental Life/AD&D insurance through Guardian. You may purchase: • Employee coverage in increments of $20,000 up to a maximum of $500,000. Newly hired employees may purchase the first $200,000 without Evidence of Insurability. • Spousal coverage may be purchased in increments of $1,000 up to $100,000, but must not exceed 50% of the employee purchase amount. Newly hired employees may purchase the first $50,000 without Evidence of Insurability. • Child(ren) coverage: • $500 of coverage on child(ren) age birth to 6 months. • $10,000 of coverage on child(ren) age 6 months to 26 years (if a full-time student). • The full amount is available without Evidence of Insurability.
Employee and Spouse Rates - Monthly Cost per $1,000 of Coverage Age Rate