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Philips & Jordan 2020 Benefit Guide 2019-10.29.PRINT
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2020 BENEFITS OVERVIEW
ELIGIBILITY 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. ENROLLMENT CHANGES Changes to your benefits may be made during open enrollment each year which typically occurs in the fourth quarter. Changes may bemade 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, you must 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 Once you have reviewed your benefit options, complete the appropriate form(s) and return them to Human Resources. If you have any questions about your Phillips & Jordan benefits, please contact Human Resources at [email protected] or (865) 392-3093 or (865) 392-3022. Medical Benefits - HDHP with HSA ����������������������������������������������������������������������������������������������������������������������� 2 Medical Benefits - PPO Plan ������������������������������������������������������������������������������������������������������������������������������������� 3 Medical Benefits Comparison���������������������������������������������������������������������������������������������������������������������������������� 3 Dental Benefits�������������������������������������������������������������������������������������������������������������������������������������������������������������� 4 Vision Benefits��������������������������������������������������������������������������������������������������������������������������������������������������������������� 4 Telemedicine ����������������������������������������������������������������������������������������������������������������������������������������������������������������� 5 Wellness Program��������������������������������������������������������������������������������������������������������������������������������������������������������� 6 Flexible Spending Accounts ������������������������������������������������������������������������������������������������������������������������������������ 7 Disability Benefits �������������������������������������������������������������������������������������������������������������������������������������������������������� 8 Paid Maternity Leave �������������������������������������������������������������������������������������������������������������������������������������������������� 8 Basic and Supplemental Life Insurance��������������������������������������������������������������������������������������������������������������� 9 Voluntary Aflac Products�����������������������������������������������������������������������������������������������������������������������������������������10 Employee Assistance Program������������������������������������������������������������������������������������������������������������������������������11 401(k) Retirement Plan ��������������������������������������������������������������������������������������������������������������������������������������������12 Annual Notices����������������������������������������������������������������������������������������������������������������������������������������������������� 13-16 Table of Contents
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Phillips & Jordan offers access to medical benefits through Cigna Health and Life Insurance Company. You may choose between two different medical plans: High Deductible Health Plan (HDHP) and Preferred Provider Organization (PPO) Plan. The HDHP 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 HDHP, Phillips & Jordan offers employees a Health Savings Account (HSA), which we will explain in more detail below. 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. HDHPWeekly Premiums Non-Wellness Wellness Employee Only $62.81 $49.37 EMP + Spouse $119.59 $106.16 EMP + Child(ren) $104.78 $91.34 EMP + Family $161.56 $148.12 Medical Benefits - HDHP with HSA Ci gna - Open Access P l us Ne twor k 1-800-244-6224 www.myc i gna. com Group Number : 3332287
Heal th Savings Account HSA Bank 1-855-731-5225
If you are enrolled in the HDHP, you are eligible to participate in a Health Savings Account (HSA) through HSA Bank. A 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. Phillips & Jordan contributes to the HSA quarterly on your behalf, so it is to your advantage to make the most of your HSA. Youmaymake tax-free payroll contributions to the account topay for subsequent future qualifiedmedical 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 HSA debit 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
Phillips & Jordan's Contribution $225 Quarterly, $900 Annually $400 Quarterly. $600 Annually $400 Quarterly. $600 Annually $500 Quarterly, $2,000 Annually
Employee Only
$2,650
$3,550
Emp + Spouse
$6,500
$7,100
Emp + Child(ren)
$6,500
$7,100
Emp + Family
$5,100
$7,100
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Medical Benef i ts - PPO Plan Ci gna - Open Access P l us Ne twor k 1-800-244-6224 www.myc i gna. com Group Number : 3332287 PPO PlanWeekly Premiums Employee Only
Non-Wellness Wellness
$72.20
$58.95
EMP + Spouse
$139.98 $126.73
Phillips & Jordan offers access to medical benefits through Cigna Health and Life Insurance Company. You may choose between two different medical plans: HDHP and PPO Plan. The PPO Plan offers higher premiums, but a lower deductible and out-of-pocket maximum. 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). 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. • 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. The PPO Plan is not eligible for HSA contributions due to IRS regulations. EMP + Child(ren) $122.27 $109.05 EMP + Family $190.09 $176.84
Medical Benef i ts Compar ison
MEDICAL BENEFITS 1 (All benefits shown In-Network)
HDHP with HSA
PPO Plan
Deductible: Individual / Family
$3,000 / $6,000 (Shared) 2 $2,000 / $4,000 (Embedded) 3
Out-of-Pocket Maximum: Individual / Family SERVICES RECEIVED AT A PRACTITIONER’S OFFICE Preventive Care
$3,000 / $6,000
$3,000 / $6,000
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 100% after deductible
80% after deductible 80% after deductible
MOST OTHER SERVICES
PHARMACY Retail Preventive Generics Generics / Preferred Brand / Non-Preferred Brands Mail Order 4 Preventive Generics Generics / Preferred Brand / Non-Preferred Brands
Plan pays 100% 100% after deductible
$10 / $35 / $60
Plan pays 100% 100% after deductible 100% after deductible
3x Retail copay
Specialty Drugs n/a / $35 / $60 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).
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Your Phillips & Jordan dental benefits are administered by Cigna Health and Life Insurance Company. The plan works like a PPO plan in that 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 Benef i ts Ci gna 1-800-244-6224 www.myc i gna. com Group Number : 3332287
Dental Weekly Premiums Employee Only EMP + Spouse EMP + Child(ren)
Base Plan Buy-Up Plan
$2.43 $5.35 $4.87 $6.81
$3.71 $8.16 $7.43
EMP + Family
$10.39
DENTAL PLAN BENEFITS
Base Plan $50 / $150
Buy-Up Plan
Individual / Family Deductible Calendar Year Maximum (per enrolled person) Preventive Services (Deductible does not apply)
$25 / $75
$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 Benef i ts Ci gna 1-800-244-6224 www.myc i gna. com Group Number : 3332287
VisionWeekly Premiums
Employee Only EMP + Spouse EMP + Child(ren)
$1.59 $3.20 $3.18 $5.05
EMP + Family
Your Phillips & Jordan vision benefits are administered by Cigna Health and Life Insurance Company. 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.
To find an in-network provider or surgery center, review out- of-network benefits, and other plan 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 BENEFITS
In-Network $10 Copay
Out-of-Network $45 Allowance
Vision Exam
Lenses (once per year) Single / Bifocal / Trifocal / Lenticular Frames (once every 2 years) Contacts in lieu of eyeglasses (once per year) Medically Necessary Elective
$10 Copay / covered in full
Up to $80 Allowance depending on type
$140 Allowance
$77 Allowance
$10 Copay
Covered in full Up to $150
$210 Allowance $120 Allowance
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Telemedicine Te l adoc
1-800-835-2362 www. te l adoc . com
No cost for you or your household to call! Phillips & Jordan is proud to offer Teladoc to all employees and dependents enrolled in themedical plan. Teladoc is a national network of board certified physicians providing telephonic consultations 24/7. Teladoc doctors are U.S. board certified in Internal Medicine, Family Practice, or Pediatrics. They average 15 years practice experience, are licensed in your state, and incorporate Teladoc into their day-to-day practice as a way to provide people with convenient access to quality medical care.
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 aTeladoc 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 term medication for a wide range of conditions when medically appropriate. Teladoc doctors do not prescribe substances controlled by the DEA, nontherapeutic and/or certain other drugs which may be harmful because of their potential abuse. 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. Setting up your account is a quick and easy process . Visit www.teladoc.com and click "Set up account." (You may also use the mobile app or call 1-800-Teladoc to set up your account.) You'll provide your medical history, add dependents, provide dependent medical history, and more. Once you're account is set up, Teladoc is quick and easy to use!
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Ci gna Mo t i va t eMe 1-800-244-6224 ww.myc i gna. com
The Phillips & JordanWellness for Life Program, administered by the Cigna MotivateMe Program, offers employees best- in-class wellness services and a discount on weekly medical benefit premiums. Through theWellness for Life Program, all your health andwellness 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 Wellness for Life Program you must earn at least 100 points by participating in wellness activities in the 2020 program year. Here’s how you earn points:
Wellness Activity
Points
Annual Physical Well Woman Exam
100 100 100 100 100 100
Colon Cancer Screening Prostate Cancer Screening Cervical Cancer Screening
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 Self-reported goals: • I made smart and delicious food choices • I took part in physical activity • I’m managing my weight Participate in Apps & Activities
25 (maximum of 50)
25 (maximum of 50)
25 (maximum of 50)
DID YOU KNOW? The preferred way to get the 100 points is to complete an annual physical .
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Flexible Spending Account Bene f i t sAss i s t 1-865-769-2800 www.mywea l thcareon l i ne. com/benef i t sass i s t
Phillips & Jordan 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 $2,700. 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 head of household 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 HDHP with HSA, 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 $2,700. 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 or Human Resources for a list of eligible medical and dependent care expenses.
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Disabi l i ty Benef i ts Gua rd i an
1-800-268-2525 Shor t -Term Di sab i l i t y 1-800-538-4583 Long-Term Di sab i l i t y www.guard i anany t ime. com 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 may be found on your enrollment form. Phillips & Jordan 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. Paid Materni ty Leave Human Resour ces 865-392-3093
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Basic Li fe Insurance Gua rd i an 1-888-600-1600 www.guard i anany t ime. com
Phillips & Jordan 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! Phillips & Jordan pays 65% of the cost, and you only pay 35% of the additional coverage amount.
Supplemental Li fe Insurance Gua rd i an 1-888-600-1600 www.guard i anany t ime. com
Employee and Spouse Rates - Monthly Cost per $1,000 of Coverage Age Rate 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
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