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Pilot Bank 2019 Benefits
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2 T A B L E O F CON T E N T S Attribution ..........................................................
Benefits at a Glance
Plan Year: January 1, 2019 through December 31, 2019
Custom Image
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
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• 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
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