Pilot Bank 2019 Benefits

Pilot Bank 2019 Benefits

Benefits at a Glance

Plan Year: January 1, 2019 through December 31, 2019

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CONTENTS & CONTACT INFORMATION

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

BROKER

M.E. Wilson Company Katie Reeves Miller 813-229-8021 Ext. 132 [email protected]

MEDICAL

page 3-5

Florida Blue (Policy # 69973) 800-583-9072 www.bcbsfl.com

DENTAL

page 6

MetLife (Policy # 5343653) 800-275-4638 www.metlife.com/mybenefits

VISION

page 7

MetLife (Policy # 5343653) 800-275-4638 www.metlife.com/mybenefits

BASIC & VOLUNTARY LIFE

page 8

Mutual of Omaha 800-769-7159 www.mutualofohama.com

SHORT TERM & LONG TERM DISABILITY

page 9

Mutual of Omaha 800-769-7159 www.mutualofohama.com

EAP & LIFELOCK & IDENTITY THEFT

page 10

ONLINE ENROLLMENT

page 11

DISCLOSURE NOTICES

page 13

BENEFIT INFORMATION

Benefit

Who pays the cost?

YOUR BENEFITS PLAN

Pilot Bank pays the majority of the employee portion of the medical plan. You may enroll your eligible dependents for an additional cost.

Medical

Insurance

Pilot Bank 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.

You may elect dental coverage for yourself and your eligible dependents on a voluntary basis and you will be responsible for the cost.

Dental

Insurance

You may elect vision coverage for yourself and your eligible dependents on a voluntary basis and you will be responsible for the cost.

Vision

Insurance

Basic Life

Pilot Bank pays the entire cost.

Insurance

You may elect additional life coverage for yourself and your eligible dependents on a voluntary basis and you will be responsible for the cost.

Voluntary Life Insurance

Short and Long Term Insurance

Pilot Bank pays the entire cost.

ELIGIBILITY

All Regular full-time employees are eligible to join the Pilot Bank Benefits Plan on the 1st of the month following 30 days. 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?

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.

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

1

BENEFIT INFORMATION

?

CHOOSING YOUR BENEFITS

You must actively choose any benefit that you pay for, or share in the cost with Pilot Bank. 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, dental, and vision • AFTER YOUR TAXES ARE CALCULATED – voluntary life/ accidental death & dismemberment, disability and voluntary products

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. 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.

2

MEDICAL INSURANCE

Pilot Bank offers five medical plans through Florida Blue. To find participating providers go to www.bcbsfl.com and click on “Find a Doctor”, choose the appropriate plan type (BlueOptions or BlueCare), and click continue. Then, narrow down your search based on location and provider type.

HDHP Plan Options, compatible with a Health Savings Account (H.S.A)

Pilot Bank is offering the same plans as current. Though these are the same plans you will notice a change in the plan names. The current and new plan names are shown in the chart below.

BlueCare 126/127 HMO H.S.A

BlueOptions 0314/0315 PPO H.S.A.

BlueOptions 0212/0213 PPO H.S.A.

FBA 201/202

FBA 105/106

FBA 103/104

New plan names:

IN-NETWORK

Deductible (Individual / Family)

$1,500 / $3,000

$2,500 / $5,000

$1,350 / $2,700

Maximum Out-of-Pocket (Individual / Family)

$3,000 / $6,000

$5,800 / $11,600

$5,000 / $5,000

Out-of-Pocket Includes

Deductible, Coinsurance, & Copays

Coinsurance

90% / 10%

80% / 20%

80% / 20%

Routine Preventive Services Wellness, Immunizations, & Mammography/Colonoscopy

Covered 100%

CO-PAYS

TelaDoc

$40 Copay

$40 Copay

$40 Copay

Office Visits for Illness / Injury

Deductible & Coinsurance

Deductible & Coinsurance

Deductible & Coinsurance

Specialist Visits

Deductible & Coinsurance

Deductible & Coinsurance

Deductible & Coinsurance

Inpatient Hospital

Deductible & Coinsurance

Deductible & Coinsurance

Deductible & Coinsurance

Outpatient Surgery

Deductible & Coinsurance

Deductible & Coinsurance

Deductible & Coinsurance

Emergency Room

Deductible & Coinsurance

Deductible & Coinsurance

Deductible & Coinsurance

Urgent Care

Deductible & Coinsurance

Deductible & Coinsurance

Deductible & Coinsurance

OUTPATIENT DIAGNOSTIC SERVICES Lab Services (Freestanding Lab)

Deductible & Coinsurance

Deductible & Coinsurance

Deductible & Coinsurance

X-Ray Services (Freestanding Lab)

Deductible & Coinsurance

Deductible & Coinsurance

Deductible & Coinsurance

Complex Diagnostic

Deductible & Coinsurance

Deductible & Coinsurance

Deductible & Coinsurance

PRESCRIPTIONS

(After Deductible)

(After Deductible)

(After Deductible)

Retail (30 day supply)

$10 / $50 / $80 / $125

$10 / $50 / $80 / $125

$10 / $50 / $80 / $125

Mail Order (90 day supply)

2.5 x retail

2.5 x retail

2.5 x retail

OUT-OF-NETWORK Deductible

$5,000 / $10,000

$2,500 / $5,000

Maximum Out-of-Pocket

$11,600 / $23,200

$10,000 / $10,000

Not available

Coinsurance

60% / 40%

60% / 40%

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.

3

MEDICAL INSURANCE

Pilot Bank offers five medical plans through Florida Blue. To find participating providers go to www.bcbsfl.com and click on “Find a Doctor”, choose the appropriate plan type (BlueOptions or BlueCare), and click continue. Then, narrow down your search based on location and provider type.

Copay Plan Options

Pilot Bank is offering the same plans as current. Though these are the same plans you will notice a change in the plan names. The current and new plan names are shown in the chart below.

BlueCare 0402 HMO

BlueOptions 0307 PPO

New plan names:

FBA 305

FBA 004

IN-NETWORK Deductible (Individual / Family)

$3,500 / $5,000

$750 / $2,250

Maximum Out-of-Pocket (Individual / Family)

$6,350 / $12,700

$3,250 / $6,750

Out-of-Pocket Includes

Deductible, Coinsurance, Copays, & Prescriptions

Coinsurance

70% / 30%

80% / 20%

Routine Preventive Services Wellness, Immunizations, & Mammography/Colonoscopy

Covered 100%

CO-PAYS

TelaDoc

$0 Copay

$0 Copay

Office Visits for Illness / Injury

$40 Copay

$30 copay

Specialist Visits

$65 Copay

$60 Copay

Inpatient Hospital

Deductible & Coinsurance

Deductible & Coinsurance

Outpatient Surgery

Deductible & Coinsurance

Deductible & Coinsurance

Emergency Room

$300 Copay

$300 Copay

Urgent Care

$85 Copay

$65 Copay

OUTPATIENT DIAGNOSTIC SERVICES

Lab Services (Freestanding Lab)

100% Covered

100% Covered

X-Ray Services (Freestanding Lab)

$65 Copay

$50 Copay

Complex Diagnostic

$200 Copay

Deductible & Coinsurance

PRESCRIPTIONS

Retail (30 day supply)

$10 / $40 / $80 / $125

$10 / $40 / $80 / $125

Mail Order (90 day supply)

2.5 x retail

2.5 x retail

OUT-OF-NETWORK Deductible

$1,750 / $5,250

Maximum Out-of-Pocket

Not Available

$6,000 / $12,000

Coinsurance

50% / 50%

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.

4

MEDICAL CONTRIBUTION SCHEDULE

HDHP Plan Options, compatible with a Health Savings Account (H.S.A)

BlueCare 126/127 FBA 201/202 HMO H.S.A

Employee Pays Semi-Monthly

Employee Only

$46.47

Employee + Spouse

$216.57

Employee + Child(ren)

$160.80 $335.08

Family

BlueOptions 0314/0315 FBA 105/160 PPO H.S.A.

Employee Pays Semi-Monthly

Employee Only

$49.94

Employee + Spouse

$149.56 $104.62 $245.07

Employee + Child(ren)

Family

BlueOptions 0212/0213 FBA 103/104 PPO H.S.A.

Employee Pays Semi-Monthly

Employee Only

$57.60

Employee + Spouse

$226.10 $197.40 $412.09

Employee + Child(ren)

Family

Employer Health Savings Account (H.S.A) Contribution

Employee Only

$750.00

Employee & Dependent(s)

$1,500.00

Copay Plan Options

BlueOptions 0307 FBA 004 PPO

Employee Pays Semi-Monthly

Employee Only

$71.20

Employee + Spouse

$331.80 $246.36 $513.36

Employee + Child(ren)

Family

BlueCare 0402 FBA 305 HMO

Employee Pays Semi-Monthly

Employee Only

$46.47

Employee + Spouse

$216.55 $160.78 $335.04

Employee + Child(ren)

Family

5

DENTAL INSURANCE

Pilot Bank offers dental coverage through MetLife. 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 MetLife’s allowed amount and what the dentist may charge, also known as “balance billing”. The charts below provides a brief overview of the plans.

Met 1000

Met 1500

Met 3000

Out-of- Network*

Out-of- Network*

Out-of- Network*

Network

In- Network

In- Network

In- Network

Calendar Year Deductible Individual

$50

$50

$50

$150

$150

$150

Family

Annual Maximum

$1,000

$1,500

$3,000

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

100%

80%

100%

80%

100%

100%

80%

60%

80%

60%

80%

80%

50%

40%

50%

40%

50%

50%

Bridges Dentures Orthodontia Services Adult & Child Lifetime Maximum

50% $1,500

50% $1,500

Not Covered

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

Met 1000 Employee Cost Semi-Monthly

Met 1500 Employee Cost Semi-Monthly

Met 3000 Employee Cost Semi-Monthly

Employee Only

$14.46 $29.46 $31.97 $50.69

$19.98 $40.70 $44.15 $70.02

$24.78 $50.42 $58.78 $90.42

Employee + Spouse

Employee + Child(ren)

Family

6

VISION INSURANCE

Pilot Bank offers vision coverage through MetLife. The MetLife 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 VSP Network

In-Network

Out-of-Network

Routine Eye Exams

$10 Copayment

Reimbursed up to $35

$15 Copayment $30-$100 allowance $15 copay Up to $55 allowance $15 copay Up to $120 allowance

Lenses*

$15 Copayment

$15 copay Up to $120 allowance

Frames

$15 copay Up to $120 allowance (elective) 100% after copay (necessary)

Contact Lenses

Frequency Exam

Once every 12 months

Lenses or contact lenses

Once every 12 months

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 Semi-Monthly

Employee Only

$3.46 $6.92 $7.12 $9.86

Employee + Spouse

Employee + Child(ren)

Family

7

BASIC AND VOLUNTARY LIFE INSURANCE

BASIC LIFE

Pilot Bank provides all full-time employees working 30 or more hours per week are automatically enrolled in Basic Life and AD&D with a benefit of 1x your annual salary, to a maximum of $500,000. Officers of the bank receive 2x annual salary.

**The Basic Life insurance is paid 100% by Pilot Bank.**

VOLUNTARY LIFE

Pilot Bank provides all full-time employees working 30 or more hours per week the option to purchase voluntary life insurance coverage. If you elect additional life insurance for yourself you may also elect coverage for your spouse and/or child(ren). The chart below provides an overview of the plan.

Employee

Benefit is available in increments of:

$25,000

Maximum Benefit:

Up to a maximum of 7x salary or $500,000, whichever is less.

Spouse

Benefit is available in increments of:

$25,000

Maximum Benefit:

Up to a maximum of 50% of employee amount or $250,000, whichever is less

Child(ren)

Benefit:

$10,000

Refer to Mutual of Omaha summary for voluntary life insurance pricing.

Benefit Reduction Schedule

Age

Benefits reduced by:

Late entrants, benefit elections and increases during open enrollment will require evidence of insurability (EOI).

65

35%

70

Additional 35%

8

SHORT TERM DISABILITY

Pilot Bank provides all full-time employees working 30 or more hours per week Short Term Disability coverage. This insurance can help protect your income in the event of a disability by providing you a benefit for injuries and sickness that are not work related.

**This coverage is 100% paid for by Pilot Bank. **

31 st Day

Benefits Begin

Benefits Payable

Maximum of 9 weeks

Percentage of Income Replaced

60% of Basic Earnings

Maximum Benefit

$1,615 per week

LONG TERM DISABILITY

Pilot Bank provides all full-time employees working 30 or more hours per week Long Term Disability coverage. This insurance can help protect your income in the event of a disability by providing you a benefit for injuries and sickness that are not work related.

**This coverage is 100% paid for by Pilot Bank.**

91 st Day

Benefits Begin

Benefits Payable

Until Social Security Retirement Age

Percentage of Income Replaced

60% of Basic Earnings

Maximum Benefit

$10,000 per month

9

EMPLOYEE ASSISTANCE PROGRAMS

The Employee Assistance Program is offered to all full-time benefit eligible employees and immediate family members of Pilot Bank through MehraVista Health. It is a completely confidential counseling program that covers issues such as marital and family concerns, depression, substance abuse, grief and loss, financial entanglements, and other personal stressors.

You can contact MehraVista Health toll free at 866-684-2007, or you can visit their website at www.mehravista.com

LIFELOCK & INDENTITY THEFT

LifeLock Benefit Elite ™ Identity Theft Protection LifeLock Benefit Elite identity theft protection helps proactively safeguard your credit, your finances and your good name with vigilant services that alert you of potential threats before the damage is done. If identity thieves steal your personal information, they could take out a mortgage, commit tax fraud, open new credit accounts and a whole lot more. LifeLock Benefit Elite Includes:

• Identity Theft Detection and Alerts • Lost Wallet Protection • Address Change Verification • Black Market Website Surveillance • Reduced Pre-Approved Credit Card Offers • Credit, Checking & Savings Account Activity Alerts • Court Records Scanning

LifeLock Ultimate Plus ™ Identity Theft Protection The leading identity theft protection from the industry leader.

You’ve worked hard. You’ve sacrificed and you’ve saved. Now you want to do everything you can to protect your finances, your family and your future.

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• Checking and Savings Account Application Alerts • Bank Account Takeover Alerts • Investment Account Activity Alerts • Credit Inquiry Activity • Monthly Credit Score Tracking • File Sharing Network Search • Lost Wallet Protection • >Page 1 Page 2 Page 3 Page 4 Page 5 Page 6 Page 7 Page 8 Page 9 Page 10 Page 11 Page 12 Page 13 Page 14 Page 15 Page 16 Page 17 Page 18 Page 19 Page 20 Page 21 Page 22 Page 23 Page 24

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