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2019 Colonial Distributing Benefit Guide
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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
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
•
1
BENEFIT INFORMATION
?
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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