US - Jagged Peak Benefit Guide 2018

US - Jagged Peak Benefit Guide 2018

PLAN YEAR: September 1, 2018 through August 31, 2019

CONTENTS & CONTACT INFORMATION

JAGGED PEAK - FLORIDA Human Resources Phone Number Human Resources E-mail Address JAGGED PEAK - OHIO Human Resources Phone Number Human Resources E-mail Address

813-637-6900 Ext. 209

[email protected]

513-830-0107

[email protected]

BROKER Company Name Broker Contact

M.E. Wilson Company

Amanda Sands

Company Phone Number Company Email Address

813-229-8021 Ext. 139 [email protected]

MEDICAL

page 3

Company Name

UMR

Company Phone Number Company Web Address

800-826-9781 www.umr.com

Provider Network

UnitedHealthcare, Choice Plus Network

TELEMEDICINE PROGRAM

page 5

Company Name

HealthiestYou 866-703-1259

Company Phone Number Company Web Address

member.healthiestyou.com

MEDLINK SUPPLEMENTAL

page 5

Company Name

MedLink / American Public Life

Company Phone Number

800-256-8606

HEALTH SAVINGS ACCOUNT (HSA)

page 6

Company Name

OptumBank

Company Phone Number Company Web Address

866-234-8913

www.optumbank.com

DENTAL

page 7

Company Name

MetLife

Company Phone Number Company Web Address

1-800-942-0854 www.metlife.com

VISION

page 8

Company Name

MetLife

Company Phone Number Company Web Address

1-855-638-3931 www.metlife.com

CONTENTS & CONTACT INFORMATION (Cont’d)

BASIC & VOLUNTARY LIFE

page 9

Company Name

MetLife

Company Phone Number Company Web Address

1-800-523-2894 www.metlife.com

SHORT AND LONG TERM DISABILITY

page 10

Company Name

MetLife

Company Phone Number Company Web Address

1-800-858-6506 www.metlife.com

VOLUNTARY BENEFITS

page 11

Company Name

MetLife

Company Phone Number Company Web Address

1-800-438-6388 www.metlife.com

LEGAL AID & ID THEFT PROTECTION

page 14

Company Name

MetLife

Company Phone Number Company Web Address

1-800-438-6388 www.metlife.com

401K RETIREMENT PLAN

page 14

PET INSURANCE

page 15

Company Name

Nationwide

Company Phone Number Company Web Address

1-855-874-4944

www.petinsurance.com/usjaggedpeak

EMPLOYEE ASSISTANCE PROGRAM

page 16

Company Name

MetLife

Company Phone Number Company Web Address

1-888-319-7819

www.metlifeeap.lifeworks.com

ADDITIONAL BENEFITS

page 17

ONLINE ENROLLMENT SYSTEM

page 19

Company Name

Web Benefits Design

Company Phone Number Company Web Address

1-888-574-7704

www.mybensite.com/usjaggedpeak

DISCLOSURE NOTICES

page 21

BENEFIT INFORMATION

BENEFIT

WHO PAYS THE COST?

YOUR BENEFITS PLAN

Jagged Peak pays the majority of the employee premium and contributes toward the dependent cost for all eligible employees.

Medical Insurance

Jagged Peak 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 .

Jagged Peak pays the entire cost of this benefit if the employee is enrolled in the company medical plan. Employees not on the company medical plan can still elect this benefit at their own cost.

HealthiestYou

MedLink

The employee pays the entire cost.

Dental Insurance

The employee pays the entire cost.

Vision Insurance

The employee pays the entire cost.

Basic Life/AD&D Insurance

Jagged Peak pays the entire cost.

Voluntary Life Insurance

The employee pays the entire cost.

Jagged Peak pays the entire cost for all Florida employees and Ohio salary/exempt employees. Ohio hourly/non-exempt employees pay the entire cost.

Short Term Disability

Long Term Disability

Jagged Peak pays the entire cost.

Voluntary Products

The employee pays the entire cost.

MetLife Legal

The employee pays the entire cost.

ELIGIBILITY

All Regular full-time employees and eligible dependents are eligible to join the Jagged Peak Benefits Plan on the 1 st of the month following 30 days.



Eligible dependents include :

WHEN CAN YOU ENROLL?

Your legal spouse

•

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.

• 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

► 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

Be a resident of Florida or a student; AND

•

If you do not enroll at one of the above times, you must wait for the next annual open enrollment period.

• Not have coverage of their own, or covered under any other plan; AND

Not entitled to benefits under Medicare

•

1

BENEFIT INFORMATION

?

CHOOSING YOUR BENEFITS

You must actively choose any benefit that you pay for, or share in the cost with Jagged Peak. 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, vision, health savings account (HSA contributions)

• AFTER YOUR TAXES ARE CALCULATED – voluntary life, disability and voluntary products

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.

• 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 physician 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. Coinsurance – The amount you pay toward medical and dental expenses each year after you have met your annual deductible. In-patient – services or care received in a hospital that require admittance or a stay of at least 24 hours. Out-patient – services or care received at a medical facility that do not require overnight admittance, or a stay less than 24 hours.

Embedded – a deductible type that means a single member of a family doesn’t have to meet the full family deductible for after-deductible benefits to apply. Instead, the individual’s after-deductible benefits will begin as soon as he/she meets the individual deductible, even if the plan is for family coverage.

2

MEDICAL INSURANCE

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.

Jagged Peak offers four medical plans through UMR and uses the UnitedHealthcare provider network. (To find participating providers go to www.umr.com and click on “Find a Provider”, then choose “UnitedHealthcare Choice Plus Network” from the network listing. Then follow the prompts to find a provider in your area.

US – Option 1

US – Option 2

US – Option 3

US – Option 4

IN-NETWORK:

Calendar Year Basis

Calendar Year

Calendar Year

Calendar Year

Calendar Year

Deductible (Individual / Family)

$4,000 / $8,000

$4,000 / $8,000

$2,000 / $4,000

$500 / $1,000

Embedded/Non-embedded

Embedded

Embedded

Embedded

Embedded

Coinsurance

80% / 20%

50% / 50%

80% / 20%

100% / 0%

Maximum Out-of-Pocket (Individual / Family)

$6,000 / $12,000

$6,500 / $13,000

$6,500 / $13,000

$6,500 / $13,000

Deductible, Coinsurance & Copays

Deductible, Coinsurance & Copays

Deductible, Coinsurance & Copays

Out-of-Pocket Max Includes

Deductible and Coinsurance

Lifetime Maximum

Unlimited

Unlimited

Unlimited

Unlimited

Routine Preventive Services

Wellness Immunizations Mammography/Colonoscopy CO-PAYS Telemedicine Program

Covered 100%

Covered 100%

Covered 100%

Covered 100%

$0 Copay – HealthiestYou – Call: 866-703-1259 or Login: member.healthiestyou.com

Referral Required

No

No

No

No

Office Visits Consultations for Illness / Injury

Deductible & Coinsurance

$40 copay

$40 copay

$25 copay

Specialist Visits

Deductible & Coinsurance

$65 copay

$55 copay

$40 copay

Inpatient Hospital

Deductible & Coinsurance

Deductible & Coinsurance

Deductible & Coinsurance

Deductible

Outpatient Surgery

Deductible & Coinsurance

Deductible & Coinsurance

Deductible & Coinsurance

Deductible

Emergency Room

Deductible & Coinsurance

$350 copay

$250 copay

$350 copay

Urgent Care

Deductible & Coinsurance

$100 copay

$100 copay

$100 copay

OUTPATIENT DIAGNOSTIC SERVICES

Lab Services (Freestanding Lab)

Deductible & Coinsurance

Covered 100%

Covered 100%

Covered 100%

X-Ray Services (Freestanding Lab)

Deductible & Coinsurance

Covered 100%

Covered 100%

Covered 100%

Complex Diagnostic

Deductible & Coinsurance

$300 copay

$300 copay

$300 copay

PRESCRIPTIONS Retail (30 day supply)

Deductible & Coinsurance

$15 / $45 / $90 / 25%

$10 / $40 / $70 / 25%

$10 / $30 / $50 / 25%

Mail Order (90 day supply)

Deductible & Coinsurance

2.5 x retail

2.5 x retail

2.5 x retail

OUT-OF-NETWORK Deductible (Individual / Family)

$12,000 / $24,000

$7,500 / $15,000

$1,500 / $3,000

Coinsurance

50% / 50%

50% / 50%

70% / 30%

Not Available In-Network Benefits Only

Maximum Out-of-Pocket (Individual / Family)

$18,000 / $36,000

$18,000 / $36,000

$19,500 / $39,000

Lifetime Maximum

Unlimited

Unlimited

Unlimited

3

MEDICAL CONTRIBUTION SCHEDULE

US – Option 1

Employee Cost Per Pay Period

Employee Only

$ 48.46 $216.92 $122.31 $258.46

Employee + Spouse Employee + Child(ren)

Family

US – Option 2

Employee Cost Per Pay Period

Employee Only

$ 57.69 $244.62 $150.00 $320.77

Employee + Spouse Employee + Child(ren)

Family

US – Option 3

Employee Cost Per Pay Period

Employee Only

$115.38 $323.08 $258.46 $408.46

Employee + Spouse Employee + Child(ren)

Family

US – Option 4

Employee Cost Per Pay Period

Employee Only

$145.38 $438.46 $346.15 $588.46

Employee + Spouse Employee + Child(ren)

Family

All employees = 26 pay periods

4

TELEMEDICINE PROGRAM

Your healthcare just got a whole lot easier!

With HealthiestYou you can connect with a doctor who can diagnose, treat, and prescribe over the phone 24/7/365. Using HealthiestYou can SAVE YOU TONS OF MONEY and no more time wasted in waiting rooms or trying to schedule an appointment.

Our doctors are licensed and can handle an array of common ailments including allergies, earache, sore throat, pink eye, strep throat, urinary tract infection, and many more! HealthiestYou is great for families because your spouse and dependents can use it too and there is no limit on the number of times called or the duration of each call.

Login to member.healthiestyou.com Call 1-866-703-1259 Or download the app to your smartphone!

Employee Cost Per Pay Period

Employees who are enrolled in a company medical plan

$0.00

Employees who are NOT enrolled in a company medical plan

$3.23

MEDLINK SUPPLEMENTAL

MedLink is a supplemental plan which can be used with certain Jagged Peak medical plans. It helps cover a portion or all of the deductible. MedLink is only available for employees who are enrolled in medical plan Options 2, 3 or 4.

Base Plan MedLink Plan

Enhanced Plan MedLink Plan

MedLink covers up to the lesser amount of 100% of your deductible or $2,500 for inpatient hospitalization on day 1 of your policy ($2,500 per covered person up to $7,500 max per policy period) and up to the lesser amount of 50% of your deductible or $1,250 per covered person (up to $3,750 max per policy period) for outpatient surgical or diagnostic services performed at a hospital or hospital affiliated outpatient center.

MedLink covers up to the lesser amount of 100% of your deductible or $4,000 for inpatient hospitalization on day 1 of your policy ($4,000 per covered person up to $12,000 max per policy period) and up to the lesser amount of 50% of your deductible or $2,000 per covered person (up to $6,000 max per policy period) for outpatient surgical or diagnostic services performed at a hospital or hospital affiliated outpatient center.

Employee Cost Per Pay Period

Base Plan

Enhanced Plan

Employee Only

$ 22.71 $ 52.25 $ 43.16 $ 72.68

$ 29.76 $ 68.44 $ 56.54 $ 95.22

Employee + Spouse

Employee + Child(ren)

Family

5

HEALTH SAVINGS ACCOUNT (HSA)

What is a Health Savings Account (HSA)?

It is an interest bearing account created to help you pay medical expenses. The funds in your HSA can be used to help pay your deductible, coinsurance and any qualified medical expenses not covered by your health plan (including dental and vision expenses). All of the money you contribute is tax-free when used to pay for qualified medical expenses. An HSA is your account. It goes with you if you change jobs or when you retire.

Our banking arrangement is through Optum Bank. Visit Optum Bank at www.optumbank.com to learn more about how you can save. If you have more questions, call the Customer Care Center at 866-234-8913.

IRS Annual Maximum HSA Contribution Limits (maximums include any employer contributions) 2018

2019

Employee Only

$3,450 $6,900

$3,500 $7,000

Family

Catch-up Amount for employees 55 years or older

Additional $1,000 annually

Health Savings Account – Eligible Expenses (partial list) • Acupuncture • Alcohol and drug dependency treatment • Ambulance • Artificial limbs • Breast reconstruction surgery (mastectomy-related) • Dental expenses (exams, cleanings, X-rays, root canals, bridges, etc.) • Diagnostic fees (X-rays, MRI’s, bloodwork, etc.) • Doctor fees (including Chiropractic services) • Drugs - prescription and over the counter (when ordered by physician) • Eyeglasses and exams, contact lenses & solutions, laser surgery • Fertility enhancements • Hearing aids and batteries • Hospital and Laboratory fees • Long-term care (medical expenses and premiums) • Nursing home • Physical and speech therapies • Psychiatric care • Smoking-cessation programs and products • Vasectomy • Weight-loss program (to treat a specific disease diagnosed by a physician)

6

DENTAL INSURANCE

Jagged Peak offers dental coverage through MetLife. The PPO Dental 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 chart below provides a brief overview of the plans.

DHMO

Low PPO

High PPO

FLORIDA EMPLOYEES ONLY

In-Network Only

In-Network

Out-of Network*

In-Network

Out-of Network*

Calendar Year Deductible

N/A

$50 / $150

$100 / $300

$25 / $75

$25 / $75

Individual / Family Annual Maximum

Unlimited

$1,250

$2,250

Diagnostic & Preventive

Covered in full after deductible

Exams, Cleanings, Fluoride, X-Rays, Sealants Regular Restorative Services

See Fee Schedule

Covered in full

Covered in full

Covered in full

Amalgam Fillings, Extractions – Single Tooth, Endodontics (Root Canal), Periodontics (Gum Disease)

Covered 80% after deductible

Covered 50% after deductible

Covered 90% after deductible

Covered 80% after deductible

See Fee Schedule

Major Services

Covered 50% after deductible

Covered 25% after deductible

Covered 60% after deductible

Covered 50% after deductible

See Fee Schedule

Crowns, Bridges, Dentures Orthodontia Services

50% $500 Lifetime Maximum

50% $2,000 Lifetime Maximum

See Fee Schedule

Children only under the age of 19

DHMO

Low PPO

High PPO

Employee Cost Per Pay Period

Employee Only

$ 5.53 $ 9.72 $ 11.58 $ 16.31

$ 10.73 $ 21.77 $ 28.41 $ 42.17

$ 6.54 $ 13.25 $ 17.41 $ 26.34

Employee + Spouse Employee + Child(ren)

Family

• Subject to balance billing. Please refer to your plan document for specific details .

Low PPO

High PPO

OHIO EMPLOYEES ONLY

In-Network

Out-of Network*

In-Network

Out-of Network*

Calendar Year Deductible

$50 / $150

$100 / $300

$25 / $75

$25 / $75

Individual / Family Annual Maximum

$1,250

$2,250

Diagnostic & Preventive

Covered in full after deductible

Covered in full

Covered in full

Covered in full

Exams, Cleanings, Fluoride, X-Rays, Sealants Regular Restorative Services

Covered 80% after deductible

Covered 50% after deductible

Covered 90% after deductible

Covered 80% after deductible

Amalgam Fillings, Extractions – Single Tooth, Endodontics (Root Canal), Periodontics (Gum Disease) Major Services

Covered 50% after deductible

Covered 25% after deductible

Covered 60% after deductible

Covered 50% after deductible

Crowns, Bridges, Dentures

Orthodontia Services

50% $500 Lifetime Maximum

50% $2,000 Lifetime Maximum

Children only under the age of 19

Employee Cost Per Pay Period

Low PPO

High PPO

Employee Only

$ 6.54 $ 13.25 $ 17.41 $ 26.34

$ 10.73 $ 21.77 $ 28.41 $ 42.17

Employee + Spouse

Employee + Child(ren)

Family

• Subject to balance billing. Please refer to your plan document for specific details .

7

VISION INSURANCE

Jagged Peak offers vision coverage through MetLife. The MetLife vision network consists of optometrists, ophthalmologists, 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

In-Network

Out-of-Network

Routine Eye Exams

$10 copayment

Reimbursed up to $45

Lenses: Single

Copay applies

Reimbursed from $30 to $65 depending on type of lenses

Bifocal

Copay applies

Trifocal

Copay applies

Frames

$150 allowance + 20% discount

Reimbursed up to $70

Contact Lenses (elective)

$150 allowance

Reimbursed up to $105

Frequency Exam

Once every 12 months

Lenses or contact lenses

Once every 12 months

Frames

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 year.

Employee Cost Per Pay Period

Employee Only

$3.35

Employee + Spouse

$5.65

Employee + Child(ren)

$5.76

Family

$9.11

8

BASIC & VOLUNTARY LIFE INSURANCE

Jagged Peak provides Basic Life insurance to all full-time employees working 30 or more hours per week. Eligible employees also have the option to purchase voluntary life insurance coverage through the group plan. The chart below provides an overview of the plan.

What is Life Insurance? Having adequate Life Insurance can help your family manage expenses and make a difficult transition less stressful by providing them with financial support after your death. AD&D (Accidental Death & Dismemberment) provides a benefit if you suffer a covered accidental death or injury.

BASIC LIFE AND AD&D

$20,000 for all employees **Basic Life and AD&D coverage is paid 100% by Jagged Peak**

Employee Only

Age Reductions

35% at age 65, 60% at age 70, 75% at age 75, 85% at age 80

VOLUNTARY LIFE

Employee

Increments of $10,000 up to a maximum of $500,000 or 5x annual salary, whichever is less.

Employees Under Age 65

No evidence of insurability up to max of $150,000 (newly eligible employees only).

Increments of $5,000 up to a maximum of $100,000 or 100% of Employee amount, whichever is less.

Spouse

Spouses Under Age 65

No evidence of insurability up to max of $50,000 (newly eligible dependents only).

Children

Option of $1,000, $2,000, $4,000, $5,000 or $10,000 – 6 months to 26 years

VOLUNTARY LIFE Monthly rates per $1,000 of benefit

Age

Employee/Spouse

Child