Creative Sign Designs Benefits at a Glance 2019-19

Creative Sign Designs Benefits at a Glance 2019-19

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

[email protected]

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

•

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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 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.

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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%

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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

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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

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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