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Service Works Benefits Guide 2019
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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 Broker Contact
M.E. Wilson Company
Amanda Sands
Provider Phone Number Provider Email Address
813-229-8021 Ext. 139 [email protected]
MEDICAL
page 3
Provider Name
United Healthcare
Provider Phone Number Provider Web Address
866-633-2446
www.myuhc.com.com
DENTAL
page 5
Provider Name
Mutual of Omaha
Provider Phone Number Provider Web Address
877-999-2330
www.mutualofomaha.com
VISION
page 6
Provider Name
Mutual of Omaha
Provider Phone Number Provider Web Address
877-999-2330
www.mutualofomaha.com
BASIC AND VOLUNTARY LIFE
_____________ Mutual of Omaha
page 7
Provider Name
Provider Phone Number Provider Web Address
877-999-2330
www.mutualofomaha.com
SUPPLEMENTAL BENEFITS
___________________
page 8
Provider Name
Aflac – Jay Diaz 800-992-3522 www.aflac.com
Provider Phone Number Provider Web Address
DISCLOSURE NOTICES
page 9
BENEFIT INFORMATION
Benefit
Who pays the cost?
Service Works Commercial Roofing pays the majority of the employee portion of the medical plan. You may enroll your eligible dependents for an additional cost.
Medical Insurance
YOUR BENEFITS PLAN
You may elect dental coverage for yourself and your eligible dependents on a voluntary basis and you will be responsible for the cost.
Service Works Commercial Roofing 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
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
You may elect voluntary life coverage for yourself and your eligible dependents on a voluntary basis and you will be responsible for the cost.
Voluntary Life Insurance
Service Works Commercial Roofing pays the entire cost for employee coverage.
Basic Life
Voluntary Supplemental Benefits
The employee pays the entire cost.
ELIGIBILITY
All Regular full-time employees are eligible to join the Service Works Commercial Roofing 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;
► 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: • Be unmarried and not have dependents of his or her own; AND
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.
Be a resident of Florida or a student; AND
•
• Not have coverage of their own, or covered under any other plan, including Medicare
If you do not enroll at one of the above times, you may enroll during 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 Service Works Commercial Roofing. 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: Taking the money out before your taxes are calculated lowers the amount of your pay that is taxable. Therefore, you pay less in taxes.
• BEFORE YOUR TAXES ARE CALCULATED – medical, dental, and vision
• AFTER YOUR TAXES ARE CALCULATED – voluntary life and accidental death & dismemberment, supplemental benefits
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
• Change in your work status that affects your benefits
WHEN COVERAGE ENDS
• Change in residence or work site that affects your eligibility for coverage
Coverage will stop on the last day of the month in which employment with the company ends.
• 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
Service Works Commercial Roofing offers two medical plans through United Healthcare. To find participating providers go to www.myuhc.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 .
Option 1 Choice BJ77
Option 2 Choice AQQ4
Option 3 Choice AQOB
IN-NETWORK:
Plan Year April 1, 2019 – March 30, 2020
Plan Year April 1, 2019 – March 30, 2020
Plan Year April 1, 2019 – March 30, 2020
Plan Year or Calendar Year Basis
Deductible (Individual / Family)
$5,000 / $10,000
$2,000 / $4,000
$500 / $1,000
Coinsurance
70% / 30%
50% / 50%
90% / 10%
Maximum Out-of-Pocket (Individual/Family)
$6,350 / $12,700
$6,600 / $13,200
$3,500 / $7,000
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
Covered 100%
Covered 100%
Covered 100%
No
No
No
Office Visits Consultations for Illness/Injury
$30 Copayment
$30 Copayment
$20 Copayment
Specialist Visits
$55 Copayment
$60 Copayment
$20 Copayment
Inpatient Hospital
Deductible & Coinsurance Deductible & Coinsurance
Deductible & Coinsurance Deductible & Coinsurance
Deductible & Coinsurance Deductible & Coinsurance
Outpatient Surgery Emergency Room Urgent Care
$300 Copayment $60 Copay
$350 Copayment $100 Copay
$250 Copayment $50 Copay
OUTPATIENT DIAGNOSTIC SERVICES: Independent/Freestanding Lab Complex Diagnostic (MRI, CT, PET, Etc.) – Freestanding Facility
Deductible & Coinsurance
Covered 100%
Covered 100%
Deductible & Coinsurance
Deductible & Coinsurance
Deductible & Coinsurance
PRESCRIPTIONS:
Tier 1: $10 Copay Tier 2: $60 Copay Tier 3: $100 Copay
Tier 1: $10 copay Tier 2: $60 copay Tier 3: $100 copay
Tier 1: $10 copay Tier 2: $60 copay Tier 3: $100 copay
Retail (30 day supply)
OUT-OF-NETWORK Deductible
Unavailable
Unavailable
Unavailable
(Individual / Family)
Maximum Out-of-Pocket (Individual/Family)
Unavailable
Unavailable
Unavailable
Coinsurance
Unavailable
Unavailable
Unavailable
3
MEDICAL CONTRIBUTION SCHEDULE
Option 1 Choice BJ77
Employee Pays (Weekly)
Employee Only
$ 36.51 $ 153.69 $ 107.83 $ 216.52
Employee + Spouse Employee + Child(ren)
Family
Option 2 Choice AQQ4
Employee Pays (Weekly)
Employee Only
$ 46.07 $176.44 $125.42 $246.34
Employee + Spouse Employee + Child(ren)
Family
Option 3 Choice AQOB
Employee Pays (Weekly)
Employee Only
$ 75.99 $247.65 $180.48 $339.70
Employee + Spouse Employee + Child(ren)
Family
4
DENTAL INSURANCE
Service Works Commercial Roofing offers two dental plans through Mutual of Omaha. 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 pay the difference between Mutual of Omaha’s allowed amount and what the dentist may charge, also known as “balance billing”. The chart below provides a brief overview of the plan.
Low Dental PPO Plan (Option 1)
High Dental PPO Plan (Option 2)
Out-of Network 1
In-Network
In-Network
Out-of Network 1
Calendar Year Deductible Individual
$50
$100 $300
$50
$50
Family
$150
$150
$150
Annual Maximum
$1,000
$1,500 $1,000
Diagnostic & Preventive Exams Cleanings Fluoride X-Rays Sealants Regular Restorative Services Fillings Extractions - Single Tooth Periodontics (Gum Disease) Endodontics (Root Canal) Major Services Crowns
Covered in full
Covered in full
Covered in full
Covered in full
Covered 80% after deductible
Covered 50% after deductible
Covered 80% after deductible
Covered 50% after deductible
Covered 50% after deductible
Covered 25% after deductible
Covered 50% after deductible
Covered 25% after deductible
Bridges Dentures Orthodontia Child Only
Not Available
Not Available
Not Available
Not Available
1 Subject to balance billing. Please refer to your plan document for specific details.
Low PPO Dental Plan (Option 1)
High PPO Dental Plan (Option 2)
Employee Contributions (Weekly)
Employee Only
$ 3.92 $ 9.00 $ 9.92 $14.54
$ 6.23 $14.31 $15.69 $23.08
Employee + Spouse Employee + Child(ren)
Family
5
VISION INSURANCE
Service Works Commercial Roofing offers vision coverage through Mutual of Omaha. The Vision Plan allows you to use in-network (EyeMed Providers) or out-of-network benefits. If out-of-network vision providers are used, you will be responsible for pay the difference between Mutual of Omaha’s allowed amount and what the provider may charge, also known as “balance billing”.
Vision
Routine Eye Exams
$10 Copay
Lenses* Single
$25 Copay $25 Copay $25 Copay $25 Copay
Bifocal Trifocal Lenticular
Frames
$100 allowance, less applicable copay
Contact Lenses
$100 allowance, less applicable copay
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.
Employee Contributions (Weekly)
Vision
Employee Only
$1.51 $2.54 $2.59 $4.10
Employee + Spouse Employee + Child(ren)
Family
6
BASIC LIFE AND AD&D & VOLUNTARY LIFE INSURANCE
BASIC LIFE INSURANCE Service Works Commercial Roofing 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
$15,000
35% at age 65 60% at age 70 75% at age 75
Age Reduction Schedule
Included Equal to basic life
Accidental Death & Dismemberment (AD&D)
VOLUNTARY LIFE INSURANCE
Service Works Commercial Roofing 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 $25,000 up to $200,000
Employee Guarantee Issue
$100,000 for timely entrants
Spouse Life
Increments of $5,000 up to 100% of employee's amount or $100,000
Spouse Guarantee Issue
$25,000 for timely entrants
10% of employee’s amount not to exceed $10,000 (Coverage limits based on child age.)
Dependent Life
VOLUNTARY LIFE - Weekly
$50,000 Policy (Employee) Election Amount
$75,000 Policy (Employee) Election Amount
$100,000 Policy (Employee) Election Amount
$25,000 Policy (Employee) Election Amount
Age
Employee
Spouse
Child
Employee
Spouse
Child
Employee
Spouse
Child
Employee
Spouse
Child