benefits at a glance€¦ · brand formulary is a prescription drug that is listed on the formulary...
TRANSCRIPT
Contents & Contact Information
Refer to this list when you need to contact one of your benefit vendors. For general information contact Human Resources.
NEW HIRE ENROLLMENT INFORMATION: page 5 Provider Phone Number 1-321-296-8060 Provider Web Address www.explainmybenefits.biz/baers
MEDICAL & RX: page 6-8 Provider Name Meritain – An Aetna Company Provider Phone Number 1-800-925-2272 Provider Web Address www.meritain.com
HEALTH SAVINGS ACCOUNT (HSA): page 9-12
BENEFIT RESOURCE CENTER (BRC): page 13 Provider Name Benefit Resource Center Provider Phone Number 1-855-USI-6699 Provider e-mail Address [email protected]
DENTAL: page 14 Provider Name Guardian Provider Phone Number 1-888-600-1600 Provider Web Address www.guardiananytime.com
VISION: page 15 Provider Name Guardian Provider Phone Number 1-888-600-1600 Provider Web Address www.guardiananytime.com VOLUNTARY TERM LIFE/AD&D: page 16 Provider Name Mutual of Omaha Provider Phone Number 1-800-877-5176 Provider Web Address www.mutualofomaha.com VOLUNTARY SHORT TERM AND LONG TERM DISABILITY: page 17 Provider Name Mutual of Omaha Provider Phone Number 1-800-877-5176 Provider Web Address www.mutualofomaha.com
VOLUNTARY CRITICAL ILLNESS: page 18 Provider Name Mutual of Omaha Provider Phone Number 1-800-877-5176 Provider Web Address www.mutualofomaha.com
PAYROLL DEDUCTIONS: page 19 *Please note that rates for voluntary life, voluntary STD, voluntary LTD and critical care will be available on the EMB enrollment site.
SUPPLEMENTAL BENEFITS page 20-29 Provider Name Trustmark Provider Phone Number 1-800-918-8877 Provider Web Address www.trustmarksolutions.com
Provider Name American Public Life Provider Phone Number 1-800-256-8606 Provider Web Address www.ampublic.com
DISCLOSURE NOTICES page 30-35
Your Benefits Plan
Baer's Furniture 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.
Eligible dependents include:
> Your spouse, unless you are legally separated or divorced;
> Your married or unmarried natural children, step-children living with you, legally adopted children and any other children for whom you have legal guardianship,
> Newborn to age 30.
> A dependent who is older than 26 years of age, but less than 30 years of age may be eligible for medical benefits through the end of the calendar year with no qualifications or coverage restrictions..
When Can You Enroll?
You can sign up for Benefits at any of the following times:
After completing 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.
Eligibility
All Regular full-time employees are eligible to join the. 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.
Benefit Information
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Benefit Who pays the cost?
Medical Insurance Employer & Employee
Dental Insurance Employee
Voluntary Vision Employee
Voluntary Life Employee
Short Term Disability Employee
Long Term Disability Employee
Accident Employee
Critical Illness Employee
Universal Life Events Employee
Choosing Your Benefits You must actively choose any benefit that you pay for, or share in the cost with Baer's Furniture.
Your part of the cost is automatically taken out of your paycheck.
Before your taxes are calculated – medical, dental, and vision
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 at anytime if you have a change in status including:
> 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
> 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)
If you do not notify Human Resources within 30 days of a family status change, you will have to wait until the next annual enrollment period to make benefit changes unless you have another family status change.
When Coverage Ends Coverage will stop on the last day of the month in which employment with the company ends.
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.
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. Coinsurance – The percentage of the medical or dental charge that you pay after the deductible has been met. 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 calendar year before the plan begins paying benefits. Out of Pocket Maximum – The maximum amount you will pay in coinsurance during the calendar year
Benefit Information
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Pre-Existing Conditions Limitations Notice
Effective 1/1/2014, in accordance with The Patient Protection and Affordable Care Act, there is no longer any pre-existing conditions limitations for newly covered employees or dependents or current employees or dependents covered by the medical plans.
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Frequently Asked Questions About Your Medical Plan
Q. What should I do if I have a problem getting a claim paid?
A. Start by contacting the carrier’s member services number to determine the nature of the problem. If the issue is the way the doctor or other service provider has billed the claim, then contact your doctor or Claims Advocate at USI. If the insurance company has an eligibility issue, contact Human Resources for assistance.
Q. What is the difference between brand formulary, brand non-formulary, and generic drugs?
A. Brand formulary is a prescription drug that is listed on the formulary (i.e., a list of prescription drugs covered by the plan). These drugs are protected by a patent issued to the original innovator or marketer. Brand non-formulary drugs are patent protected but are not listed. A generic equivalent drug can become available when the patent protection runs out, and is deemed equal in therapeutic power to the brand name originals.
Q. When should I go the Urgent Care vs. Emergency Room?
A. For non-life threatening injury/illness after normal doctor’s office hours.
Prescription Drug Benefits at a Reduced Cost – Did you know you can obtain prescription drugs at local retailers at a reduced cost and sometimes even free? Publix offers a variety of generic Oral Antibiotic medications to you absolutely free. Bring in your prescription for an approved medication and receive it FREE, up to a 14-day supply. Publix recently approved a medication for diabetes. CVS, Target, Walgreens & WalMart also offer over 400 generic prescriptions for $4 and a 90 day supply for approx. $10 . Remember DO NOT show your ID card to receive these benefits, or you will be charged your insurances drug rate.
In addition to the network of physicians, hospitals, emergency rooms, and urgent care clinics, you also have the option of going to the convenient care clinics located within some grocery and drug stores, for minor illness such as ear aches, colds, flu and so on. By selecting one of these providers, you pay only the regular office visit copay; a significant savings over the emergency room and urgent care copayments. Please visit the various websites for locations, hours of operations and scope of services. CVS Minute Clinic: www.cvs.com Walgreen’s Take Care Clinic: www.walgreens.com
Getting more from your Health Care Dollars
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Member Resources 24-hour access to tools you can really use at www.myMERITAIN.com. Please note that Meritain is an Aetna Company. The Meritain Health member website, www.myMERITAIN.com, is designed to provide a secure, user and family-friendly, one-stop-shop for you to access the account and claims information you can use to manage your health and wellness. We’re committed to providing you with all the basics you expect, along with added features to support a healthy lifestyle, assist you with medical decisions, and give insight into the maximization of your healthcare dollars. Go to www.myMERITAIN.com to log in to our secure site. New users can create an account by following the easy instructions. You’ll need your health plan ID Card the first time. Return users, just sign in using your username and password. The first time you access the site, you will be prompted to re-register with a new username and password for enhanced security. Then take advantage of the smart, safe resources your health plan offers, right at your fingertips. Privacy Regulations. Members over 18 years of age have partially protected information according to HIPAA Privacy Regulations. Members over 18 having difficulty creating an account with their SSN, please contact Meritain Health Customer Service at: 1.800.925.2272. At myMERITAIN.com you can: Look up health and wellness topics in our online medical library.
Find the status of a claim.
Find network doctors, clinics and hospitals.
Look up prescription and over-the-counter drug information.
Order ID Cards.
Medical Insurance
Baer's Furniture offers 2 medical plans the HNOnly (Core Plan) and the HNOption (Buy Up). Both plans utilize the Aetna provider network. In order to verify a participating provider please visit www.mymeritain.com, Scroll down to the Provider Network Finder, enter provider network name: Aetna. Once you click Aetna, start your search. One can chose from provider types, hospitals and facilities, medical conditions or procedures. The chart below provides a brief comparison of the 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.
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Dual Option
HNOnly (Core Plan) HNOption H.S.A. (Buy-up) In-Network non-embedded
Plan Year / Contract Year Basis Calendar Year Calendar Year Deductible (Individual / Family) $5,500 / $11,000 $2,500 / $5,000
Maximum Out-of-Pocket (Individual / Family) $6,350 / $12,700 $4, 500 / $ 6,750
Out-of Pocket Max Includes Ded, coinsurance, copays & Rx
Ded, coinsurance, copays & Rx
Lifetime Major Medical Maximum Unlimited Unlimited Coinsurance 50% 80%
Preventive Wellness 100% 100%
Co-pays Open Access Yes Yes
Office Visits/Consultations for Illness/Injury $35 copay 20% after CYD
Specialist Visits $75 copay 20% after CYD Inpatient Hospital 50% after CYD 20% after CYD
Outpatient Surgery 50% after CYD 20% after CYD Emergency Room $300 copay 20% after CYD
Urgent Care $50 copay 20% after CYD OP Major Diagnostics
Complex Diagnostic $300 copay 20% after CYD Prescriptions RX Deductible (per calendar year) $200 Individual / $400 Family CYD
Retail (30 day supply) $15/$20/50% 30%/30%/50% CVS Caremark Mail Order (90 day supply) $30/$40/50% 30%/30%/50% Out-of-Network
Deductible (Ind/Fam)
N/C
$5,000 / $10,000
Maximum Out-of-Pocket (Ind/Fam) $10,000 / $20,000
Lifetime Major Medical Maximum Unlimited Coinsurance 60%
CYD: Calendar Year Deductible
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Health Savings Accounts (HSA)
Health Savings Accounts A health savings account (HSA) is an account funded to help you save for future medical expenses not covered by your insurance plan, including the deductible, coinsurance and even vision and dental expenses. You must be enrolled in a HSA compatible health plan to be eligible, there are certain advantages to putting money into these accounts, including favorable tax treatment and the ability to roll unused funds over from year to year.
Who Can Have an HSA? Any adult can contribute to an HSA if you:
· Have coverage under an HSA-qualified, high-deductible health plan (HDHP) · Have no other first-dollar medical coverage (other types of insurance, including specific injury or accident,
disability, dental care, vision care, or long-term care insurance are permitted) · Are not enrolled in Medicare or Tricare · Cannot be claimed as a dependent on someone else’s tax return
Contributions to your HSA would be made by you. The total contributions are limited annually. If you make a contribution, you can deduct the contributions (even if you do not itemize deductions) when completing your federal income tax return. Contributions to the account must stop once you are enrolled in Medicare. However, you can keep the money in your account and use it to pay for medical expenses tax-free.
HDHPs You must have coverage under the Baer's Furniture HDHP to open and contribute to an HSA.
HSA Contributions You can make a contribution to your HSA each year that you are eligible. Contributions from all sources can be no more than:
· Self-only coverage: $3,400 in 2017 · Family coverage: $6,750 in 2017
Individuals ages 55 and older can also make additional “catch-up” contributions. The maximum annual catch-up contribution is $1,000.
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Frequently Asked Questions About HSA Plan Usage
How do I manage my HSA? Your Health Savings Account (HSA) is your account; the HSA dollars are your dollars. Since you are the account holder or HSA beneficiary, you manage your HSA account. You may choose when to use your HSA dollars or when not to use your HSA dollars. HSA dollars pay for any eligible expense. Most commonly, the HSA account holder will use HSA dollars to pay the out-of-pocket expenses (i.e., deductible and coinsurance) associated with their high deductible plan.
What expenses are eligible for reimbursement from my HSA? HSA dollars may be used for qualified medical expenses incurred by the account holder and his or her spouse and dependents. Qualified medical expenses are outlined within IRS Section 213(d). In summary the IRS Section 213(d) states that “the expense has to be primarily for the prevention or alleviation of a physical or mental defect or illness”. In addition to qualified medical expenses, the following insurance premiums may be reimbursed from an HSA:
· COBRA premiums · Health insurance premiums while receiving unemployment Benefits · Any health insurance premiums paid, other than for a Medicare supplemental policy, by individuals ages 65
and over
Are dental and vision care qualified medical expenses under an HSA? Yes, as long as these are deductible under the current rules. For example, cosmetic procedures, like cosmetic dentistry, would not be considered qualified medical expenses.
What expenses are NOT eligible for reimbursement from my HSA? The following expenses may not be reimbursed from an HSA:
· Premiums for Medicare supplemental policies · Expenses covered by another insurance plan · Expenses incurred prior to the date the HSA was established · Over-the-counter drugs purchased without a prescription (except insulin)
What is a coverage gap? This is the gap between total out-of-pocket expenses associated with your high-deductible health plan and your HSA dollars. For example, assume that you have a $2,000 deductible, a $4,000 maximum out-of-pocket, and either you or your employer has contributed $2,000 to your HSA account. If your medical costs incurred exceed $4,000 for the year, then you are financially obligated to pay the difference between your total maximum out-of-pocket ($4,000) and your HSA balance ($2,000) - ($4,000 - $2,000 = $2,000)
What happens when my HSA funds run out? You may be financially responsible for any eligible medical expenses that fall within the coverage gap.
Can I use my HSA dollars for non-eligible expenses? Money withdrawn from an HSA account to reimburse non-eligible medical expenses is taxable income to the account holder and subject to a 20 percent tax penalty - unless over age 65, disabled or upon death of the account holder.
When can I start using my HSA dollars? You can use your HSA dollars immediately following your HSA account activation and once contributions have been made.
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How do I pay my physician or network facility at time of service with my HSA dollars? You may request that the network provider submit your claim to your health plan. You should make sure that your provider has your most up-to-date insurance information. Once the medical claim has been processed, if applicable, out-of-pocket expenses will be billed. At this time you may choose to use your HSA Debit card to pay for any out-of-pocket expenses, or you may choose to pay with your own money and receive reimbursement at a later date. You should always ask that your medical claim be submitted to the health plan before you seek reimbursement from your HSA. This procedure will ensure that provider discounts are applied. Also, remember to keep all medical receipts and Explanation of Benefits (EOBs) for tax purposes.
What if I have HSA dollars left in my account at year-end? The money is yours to keep. It will continue to be available for you and your health care costs next year. What happens to my HSA dollars if I leave Baer's Furniture? The funds are yours to keep. You may elect one of the following options:
· Leave your funds in your current HSA account · Transfer your funds to an HSA with your new employer · Transfer your funds to another qualifying account within 60 days
Can I use the money in my account to pay for my dependents’ medical expenses? You can use the money in your account to pay for medical expenses for yourself, your spouse or your dependent children. You can pay for the unreimbursed expenses of your spouse and dependent children even if they are not covered by your HDHP.
Can couples establish a “joint” account and both make contributions to the account, including “catch-up” contributions? “Joint” HSA accounts are not permitted. Each spouse should consider establishing an account in their own name. This allows you both to make catch-up contributions when each spouse is 55 or older.
My employer offers an FSA – can I have both an FSA and an HSA? You can have both types of accounts, but only under certain circumstances. General Flexible Spending Accounts (FSAs) will probably make you ineligible for an HSA. If your employer offers a “limited purpose” (limited to dental, vision or preventive care) or “post-deductible” (pay for medical expenses after the plan deductible is met) FSA, then you can still be eligible for an HSA.
Can I shift my IRA funds to my HSA? Owners of individual retirement accounts that are enrolled in a high-deductible health plan can shift IRA funds to an HSA without facing a tax penalty. The IRS allows a one-time transfer that does not exceed your maximum HSA contribution limit.
Can I borrow against the money in my HSA? No. You may not borrow against it or pledge the funds in it. For more information on prohibited activities see Section 4975 of the Internal Revenue Code.
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Frequently Asked Questions About HSA Plan Usage - continued
HSA Banking Information
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Opening your Health Savings Account Follow the steps below to open your Health Savings Account (HSA). Step 1: Medical Plan Enrollment Enroll in the Baer’s HSA compatible HDHP Plan. Step 2: Contribution Determine how much you plan to contribute to your HSA account before taxes. Step 3: HSA Establishment Varies by bank, use their instructions. Chose a bank of your choice, open and deposit money into your HSA right away so you are prepared if you have a health event. You or anyone else can deposit money into the HSA at anytime.
Toll-free benefit call center available to: • Answer questions regarding your health and other
benefit plans • Network: Is my doctor on the plan? • Plan Coverage: Does my plan cover this? • Billing: I received a bill from my provider, do I need
to pay? • Once you’ve tried, but need help understanding how a
carrier paid your claim • Specialist support to help you with complex claims issues • Medical appeals information and support • Life event (family status) rules – what changes can I
make? • Life Insurance Beneficiary form requirements • How do I complete an Evidence of Insurability form and
where do I send it? • What happens if I have coverage under two different
medical plans?
Benefit Resource Center Services
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Dental Insurance
Baer's Furniture offers two dental plans through Guardian. Guardian’s DHMO is an in-network only dental plan. There are no benefits for out-of-network dentists. There are no plan maximums or deductibles. The DPPO Plan allows you to use in-network or out-of-network benefits. If out-of-network dentists are used, you will be responsible to pay the difference between Guardian’s allowed amount and what the dentist may charge.
Guardian
DHMO U30 Low Plan
DPPO K7
Buy Up Plan
CDT Codes In-Network In-Network Out-of Network
Deductible
Individual No Deductible $50 $100 Family No Deductible $150 $300 Annual Maximum
Individual Unlimited $1,000
Diagnostic & Preventative Deductible Waived
Deductible Applies
Exams D0120 No Charge
100% 80% Cleanings D1110 No Charge Fluoride D1203 No Charge X-Rays D0272 No Charge Sealants D1351 No Charge Regular Restorative Services Deductible Applies Amalgam Fillings D2150 No Charge
80% 70% Extractions - Single Tooth D7140 No Charge Endodontics (Root Canal) D3320 $120 - $170 Periodontics ( Gum Disease) D4211 No Charge Major Services Deductible Applies Crowns D2791 $395.00
50% 40% Bridges D6211 $381 - $575 Dentures D5110 $381 - $575 Orthodontics Lifetime Maximum $2,500-$2,800
Not Covered Age Limitation Child to age 19
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Vision Insurance
Baer's Furniture offers a vision plan through Guardian. This vision plan provides coverage both in and out of network. The chart below provides a brief overview of the plan.
Guardian Vision
In-Network Out-of-Network
Lenses
Single $25 copay $48 allowance
Bifocal $25 copay $67 allowance
Trifocal $25 copay $86 allowance
Contact Lenses 85% of amount over $120 $105 allowance
Frames 80% of amount over $120 $48 allowance
Exams $15 copay $50 allowance
Frequency
Exam Once every 12 months
Lenses or contact lenses Once every 12 months
Frame Once every 24 months
Lens Options (Tints, coating, UV, anti-reflective lenses, polycarbonate & progressive lenses)
Members receive additional fixed copayments on lens options including anti-reflective and Scratch-resistant coatings. After copay, standard polycarbonate available at no charge for dependents less than 19 years old.
Additional Pairs Courtesy discount on a second pair of eyeglasses. This discount is available for 12 months after the covered eye exam and available through the Davis Vision Network provider who sold the initial pair of eyeglasses.
Laser Vision Correction Up to 25% off the usual charge or 5%. No discounts off promotional price.
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Voluntary Term Life Insurance/AD&D
Baer’s Furniture provides all active employees working 30 or more hours per week the option to purchase life insurance coverage through a group plan. The chart below provides an overview of the plan.
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Note: Please see your Benefits Representative for a Beneficiary Designation Form. The only time you can enroll in guaranteed issue voluntary life insurance, is at the date you first become eligible to enroll. If you do not enroll then and later decide that you would like to enroll, you will be required to complete a medical questionnaire and go through medical underwriting. The insurance carrier reserves the right to decline coverage based on medical information obtained on the medical questionnaire.
Mutual of Omaha Voluntary Term Life/AD&D
Eligible Employees All Full-Time employees working 30 hours or more
Employee Minimum Maximum
$10,000
5x annual salary, up to $300,000 Spouse
Minimum Maximum
$5,000
100% of employee’s benefit, up to $150,000 Dependent Life
Minimum Maximum
$10,000
100% of employee benefit, up to $10,000
Employee Guarantee Issue 5 times annual salary, up to $200,000
Spouse Guarantee Issue 100% of employee’s benefit, up to $30,000
Dependent Guarantee Issue 100% of employee benefit
Accelerated Death Benefit 80% death benefit, $240,000 max
Waiver of Premium Benefit Yes
Portable/Convertible Yes without having to provide Evidence of Insurability
Benefit Reduction At age 70, amounts reduce to 65% At age 75, amounts reduce to 30%
AD&D (Accident Death & Dismemberment)
For you and your spouse: The Principal Sum amount is equal to the amount of life insurance benefit.
Voluntary Disability Insurance
Baer’s Furniture provides all active employees working 30 or more hours per week the option to purchase Short Term and Long Term Disability coverage through a group plan. When you enroll in short term or long term disability you pay the full cost through payroll deductions. In the event you become disabled from a non work-related injury or sickness, disability benefits are provided as a source of income. You are not eligible to receive short-term disability benefits if you are receiving workers’ compensation benefits.
The only time you can enroll in guaranteed issue Short Term or Long Term Disability is at the date you first become eligible to enroll. If you do not enroll then and later decide that you would like to enroll, you will be required to a complete a medical questionnaire and go through medical underwriting. The insurance carrier reserves the right to decline coverage based on medical information obtained on the medical questionnaire. 17
Mutual of Omaha Voluntary Long Term Disability
Employee Definition All Full-Time, 30 hours or more
Monthly Benefit 60% of your before-tax monthly earnings, up to $5,000
Elimination Period 90 days
Duration of Benefits
If you become disabled prior to age 62, benefits are payable to age 65, your Social Security Normal Retirement Age or 3.5 years,
whichever is longest. At age 62 (and older), the benefit period will be based on a reduced duration schedule.
Own Occupation 2 years
Pre-Existing Conditions Any condition you receive medical attention for in the 3 months prior to
your effective date of coverage that results in a disability during 12 months of coverage, would not be covered.
Mutual of Omaha Voluntary Short-Term Disability
Employee Definition All Full-Time, 30 hours or more
Weekly Benefit 60% of your before-tax weekly earnings, up to $1,000
Elimination Period On the 15th day of your disabling injury or illness
Pre-Existing Limitation Any condition you receive medical attention for in the 3 months prior to your effective date of coverage that results in a disability during 6
months of coverage, would not be covered.
Duration of Benefits Up to 11 weeks
Voluntary Critical Illness
Baer’s Furniture provides all active employees working 30 or more hours per week the option to purchase Voluntary Critical Illness Insurance through a group plan. When you enroll in Critical Illness coverage you pay the full cost through payroll deductions.
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Mutual of Omaha Voluntary Critical Illness
Benefit Category and Condition % of Critical Illness Principal Sum Heart/Circulatory
Heart Attack, Heart Transplant, Stroke Heart Valve Surgery, Coronary Artery Bypass, Aortic Surgery
100%
25%
Organ Major Organ Transplant/Placement on UNOS List, End-Stage Renal Failure Acute Respiratory Distress Syndrome (ARDS)
100%
25%
Childhood/Developmental (Benefits only available to children) Cerebral Palsy, Structural Congenital Defects, Genetic Disorders, Congenital Metabolic Disorders, Type 1 Diabetes
100%
Cancer Cancer (Invasive) Bone Marrow Transplant Carcinoma in Situ, Benign Brain Tumor
100% 50% 25%
Coverage Minimum Guarantee Issue Maximum
For You Available as a flat benefit
$10,000
$10,000
$10,000
Spouse
Available as a flat benefit
$10,000
$10,000
$10,000
Child(ren)
Benefit for each child
$3,000
$3,000
$3,000
Payroll Deductions
The Charts below show the bi-weekly payroll deduction amounts for each of the benefits offered.
Medical
Aetna HSA HN Option w/o wellness
HSA HN Option w/ wellness
HN Only w/o wellness
HN Only w/ wellness
Employee Only $70.00 $55.00 $45.00 $35.00
Employee + Spouse $310.00 $295.00 $276.00 $266.00
Employee + Child(ren) $260.00 $244.00 $227.00 $217.00
Family $502.00 $487.00 $461.00 $450.00
Dental
Guardian DHMO U30 DPPO K7
Employee Only $5.40 $15.96
Employee + Spouse $10.81 $33.40
Employee + Child(ren) $12.03 $40.02
Family $17.44 $53.44
Vision
Guardian Vision
Employee Only $2.75
Employee + Spouse $4.63
Employee + Child(ren) $4.72
Family $7.47
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*Please note that rates for voluntary life, voluntary STD, voluntary LTD, critical care, accident, and group universal life will be available on the EMB enrollment site.
Supplemental Benefits
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Note: Please see your Benefits Representative for a Beneficiary Designation Form. The only time you can enroll in guaranteed issue voluntary life insurance, is at the date you first become eligible to enroll. If you do not enroll then and later decide that you would like to enroll, you will be required to complete a medical questionnaire and go through medical underwriting. The insurance carrier reserves the right to decline coverage based on medical information obtained on the medical questionnaire.
Accident and Universal Life Customer Service: 800-918-8877 Claims: 877-201-9373
*For questions on claims or benefits contact applicable carrier above for the supplemental benefits.
Group Hospital Indemnity Insurance Customer Service & Claims: 1-800-256-8606
Trustmark Employee Employee & Spouse
Employee & Children Family
Bi-weekly Rates $9.50 $16.14 $22.92 $29.58
*Sample rates are shown for illustrative purposes only; actual payroll deduction amount may vary based on rounding calculations.
Bi-Weekly Rates Employee Employee & Spouse
Employee & Children Family
Plan 1 $9.87 $18.35 $13.27 $21.44
Plan 2 $14.99 $27.81 $20.89 $33.35
*The premium and amount of benefits vary dependent upon plan selected at time of application. Premium includes the plan selected and any applicable rider premium.
Gap Insurance
Baer’s Furniture provides Supplemental Limited Benefit Group Hospital Indemnity insurance through American Public Life. This benefits helps cover out-of-pocket expenses related to Hospital Confinement and/or medically necessary Outpatient Treatment related to an injury or sickness.
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Summary of Benefits Plan 1 Plan 2 Daily Hospital Confinement Benefit (per day) $100 $100 Benefit Riders Intensive Care/Coronary Care Unit Rider (per day)
$200
$200
Annual First Occurrence Hospital Rider (per calendar year) $1,000 $2,000 Base Policy
Daily Hospital Confinement Benefit-Pays a daily indemnity benefit when a covered person is confined as an inpatient in a Hospital for at least
24 hours for a covered injury or sickness. The maximum benefit period for any one period of confinement is 180 days unless the confinement is
due to a mental or emotional disorder. When the confinement is due to a mental or emotional disorder, the maximum benefit period for any one
period of confinement will not exceed 30 days. The Hospital confinement must be at the direction of or under the supervision of a physician for
benefits to be payable.
Exclusions
APL does not cover Hospital confinements or other losses in the policy or riders: due to hernia, adenoids, tonsils, varicose veins and appendix.
For the complete listing of exclusions please refer to your benefit booklet from American Public Life.
Termination of Policy
APL may end the coverage of a policyholder if fewer persons are insured than the policyholder’s application requires. The policyholder or APL
may terminate the policy on any premium due date after the first policy anniversary date, subject to 60 days written notice.
Premium Changes
The premium rates may be changed by APL on the first anniversary date of the policy or any premium due date thereafter.
Benefit Rider(s)
All riders are part of the policy/certificate to which it is attached and are subject to all the provisions, conditions, limitations and exclusions of the
policy/certificate that are not in conflict with the provisions of the rider.
Intensive Care/Coronary Care Unit Rider
Pays a daily indemnity benefit when a covered person is confined in a Hospital’s intensive care or coronary care unity due to a covered injury
or sickness. The maximum benefit period for any one period of confinement in an intensive care or coronary care unit is 20 days. Each period
of confinement must be separate by at least 30 days. This benefit pays in addition to the Hospital confinement benefit. A step-down unit is not
considered an intensive care unit.
Annual First Occurrence Hospital Rider
Pays an indemnity benefit the first time in a calendar year a covered person is confined as an inpatient in a Hospital. The Hospital confinement
must be due to a covered injury or sickness; begin while this rider is in force; and be at the direction of and under the supervision of a
physician. The benefit is payable once each calendar year for each covered person and the first day of confinement must be in a calendar year
the rider is in effect in order for the benefit to be payable.
Termination of Rider(s) Coverage
The rider(s) will terminate: when the insured’s coverage terminates under the policy/certificate to which the rider is attached; when any
premium for the rider is not paid by the end of the grace period; or when the insured gives APL a written request to terminate the rider.
Coverage on a dependent terminates under the rider when the dependent ceases to meet the definition of dependent as defined in the
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The Patient Protection and Affordable Care Act & The Health Care and Education Affordability Reconciliation Act of 2010, together, create the most comprehensive health insurance reform ever under taken in recent history by our Country. Many of the new law’s that required changes have already been incorporated into company health plans across the country since the effective date in September of 2010. However, there will be many more changes taking place in the months to come, as more guidance is issued by the government to employers, insurance carriers and individuals. One of the key requirements of the new law beginning in 2014, is the mandate that all U.S. citizens & legal residents either carry health insurance or pay an income tax penalty. While the tax penalty is not too severe in the first year, it becomes progressively more costly each year thereafter. Penalties for failing to buy coverage Tax penalties for failing to buy coverage are phased in according to the following schedule: In 2014, the greater of $95 or 1% of taxable income; In 2015, the greater of $325 or 2% of taxable income; In 2017, the greater of $695 or 2.5% of taxable income; and After 2017, the penalty is indexed for inflation. However, there are two ways to avoid the tax penalty: You can buy coverage for you and your family through your place of employment, if your employer offers such coverage. That coverage must meet certain standards set by the law in order for you and the employer to escape respective tax penalties. The coverage must meet certain minimum coverage standards (Generally pays at least 60% of your covered medical expenses) and must be considered “affordable” (Employer cannot charge you a premium for single or employee only coverage greater than 9.5% of your W-2 earnings for the year). The 9.5% would apply to annual salaries of up to about $45,000. Or, you can provide coverage for you and your family through a Federally run Insurance Exchange that is supposed to be up and running by 1/1/2014. Essentially, an Exchange is an interactive site where an individual can go to research, evaluate and buy health plans. The State of Florida chose not to set up a state run exchange, so the Federal government will take over that responsibility. If you obtain coverage through an Exchange: The Exchange will sell insurance policies at certain levels of coverage:
– Bronze level – a medical plan designed to pay 60% of covered medical benefits; – Silver level – a medical plan designed to pay 70% of covered medical benefits; – Gold level – a medical plan designed to pay 80% of covered medical benefits; – Platinum level – a medical plan designed to pay 90% of covered medical benefits; – Catastrophic – available to young adults up to age 30 or those exempt from the individual mandate (additional requirements
may apply) You may only obtain coverage through an Exchange if you are not participating in your employer’s plan. If you satisfy certain low income thresholds and do not have medical coverage through an employer, or have employer-provided coverage that is considered “unaffordable” or pays benefits that are below the “Bronze” plan discussed above, there are tax credits available to help you pay the premiums for coverage purchased through the Exchange. The credits also help pay for expenses like deductibles and co pays. More information on these credits will be provided to you later. If you and your family are below 133% of the Federal Poverty Level in 2014, you may qualify for Medicaid.
HealthCare Reform and You
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Required Annual Employee Disclosure Notices
The Newborns’ and Mothers’ Health Protection Act of 1996 The Newborns’ and Mothers’ Health Protection Act of 1996 prohibits group and individual health insurance policies from restricting benefits for any hospital length of stay for the mother or newborn child in connection with childbirth; (1) following a normal vaginal delivery, to less than 48 hours, and (2) following a cesarean section, to less than 96 hours. Health insurance policies may not require that a provider obtain authorization from the health insurance plan or the issuer for prescribing any such length of stay. Regardless of these standards an attending health care provider may, in consultation with the mother, discharge the mother or newborn child prior to the expiration of such minimum length of stay.
Further, a health insurer or health maintenance organization may not:
1. Deny to the mother or newborn child eligibility, or continued eligibility, to enroll or to renew coverage under the terms of the plan, solely to avoid providing such length of stay coverage;
2. Provide monetary payments or rebates to mothers to encourage such mothers to accept less than the minimum coverage;
3. Provide monetary incentives to an attending medical provider to induce such provider to provide care inconsistent with such length of stay coverage;
4. Require a mother to give birth in a hospital; or
5. Restrict benefits for any portion of a period within a hospital length of stay described in this notice.
These benefits are subject to the plan’s regular deductible and co-pay. For further details, refer to your Summary Plan Description. Keep this notice for your records and call Human Resources for more information.
Women’s Health and Cancer Rights Act of 1998 The Women’s Health and Cancer Rights Act of 1998 requires Baer’s Furniture to notify you, as a participant or beneficiary of the Baer’s Furniture Health and Welfare Plan, of your rights related to benefits provided through the plan in connection with a mastectomy. You, as a participant or beneficiary, have rights to coverage to be provided in a manner determined in consultation with your attending physician for:
1. All stages of reconstruction of the breast on which the mastectomy was performed;
2. Surgery and reconstruction of the other breast to produce a symmetrical appearance; and
3. Prostheses and treatment of physical compilations of the mastectomy, including lymphedema.
These benefits are subject to the plan’s regular deductible and co-pay. For further details, refer to your Summary Plan Description. Keep this notice for your records and call Human Resources for more information.
Section 111 Effective January 1, 2009 group health plans are required by Federal government to comply with Section 111 of the Medicare, Medicaid, and SCHIP Extensions of 2007’s new Medicare Secondary Payer regulations. The mandate is designed to assist in establishing financial liability of claims assignments. In other words, it will help establish who pays first. The mandate requires group health plans to collect additional information, more specifically Social Security numbers for all enrollees, including dependents 6 months of age or older. Please be prepared to provide this information on your benefits enrollment form when enrolling into benefits.
Michelle’s Law The law allows for continued coverage for dependent children who are covered under your group health plan as a student if they lose their student status because of a medically necessary leave of absence from school. This law applies to medically necessary leaves of absence that begin on or after January 1, 2010
If your child is no longer a student, as defined in your Certificate of Coverage, because he or she is on a medically necessary leave of absence, your child may continue to be covered under the plan for up to one year from the beginning of the leave of absence. This continued coverage applies if your child was (1) covered under the plan and (2) enrolled as at student at a post-secondary educational institution (includes colleges, universities, some trade schools and certain other post-secondary institutions).
Your employer will require a written certification from the child’s physician that states that the child is suffering from a serious illness or injury and that the leave of absence is medically necessary.
Required Annual Employee Disclosure Notices
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Required Annual Employee Disclosure Notices continued
I. No access to protected health information (PHI) except for summary health information for limited purpose and enrollment / dis-enrollment information.
Neither the group health plan nor the plan sponsor (or any member of the plan sponsor’s workforce) shall create or receive protected health information (PHI) as defined in 45 C.F.R. §160.103 except for (1) summary health information for purpose of (a) obtaining premium bids or (b) modifying, amending, or terminating the group health plan, and (2) enrollment and dis-enrollment information.
II. Insurer for group health plan will provide privacy notice
The insurer for the group health plan will provide the group health plan’s notice of privacy practices and will satisfy the other requirements under HIPAA related to the group health plan’s PHI. The notice of privacy practices will notify participants of the potential disclosure of summary health information and enrollment / dis-enrollment information to the group health plan and the plan sponsor.
III. No intimidating or retaliatory acts
The group health plan shall not intimidate, threaten, coerce, discriminate against, or take other retaliatory action against individuals for exercising their rights , filing a complaint, participating in an investigation, or opposing any improper practice under HIPAAA.
IV. No Waiver
The group health plan shall not require an individual to waive his or her privacy rights under HIPAA as a condition of treatment, payment, enrollment or eligibility. If such an action should occur by one of the plan sponsor’s employees, the action shall not be attributed to the group health plan.
HIPAA Privacy Policy for Fully-Insured Plans with no Access to PHI
The group health plan is a fully-insured group health plan sponsored
by the “Plan Sponsor”. The group health plan and the plan sponsor intend to comply with the requirements of 45 C.F.R. §164.530 (k) so that the group health plan is not subject to most of HIPAA’s privacy requirements.
Patient Protection: If the Group Health Plan generally requires the designation of a primary care provider who participates in the network and who is available to accept you or your family members. For children, your may designate a pediatrician as the primary care provider.
You do not need prior authorization from the carrier or from any other person (including a primary care provider) in order to obtain access to obstetrical or gynecological care from a health care professional in the network who specializes in obstetrics or gynecology. The health care professionals, however, may be required to comply with certain procedures, including obtaining prior authorization for certain services, following a pre-approved treatment plan or procedures for making referrals.
For a list of participating health care professionals who specialize in obstetrics or gynecology, or for information on how to select a primary care provider, and for a list of the participating primary care providers, contact the Plan Administrator or refer to the carrier website.
It is your responsibility to ensure that the information provided on your application is accurate and complete. Any omissions or incorrect statements made by you on your application may invalidate your coverage. The carrier has the right to rescind coverage on the basis of fraud or misrepresentation.
Required Annual Employee Disclosure Notices - Continued
Children’s Health Insurance Program Reauthorization Act (CHIPRA) of 2009 Effective April 1, 2009, a special enrollment period provision is added to comply with the requirements of the Children’s Health Insurance Program Reauthorization Act (CHIPRA) of 2009. If you or a dependent is covered under a Medicaid or CHIP plan and coverage is terminated as a result of the loss of eligibility for Medicaid or CHIP coverage, you may be able to enroll yourself and/or your dependent(s). However, you must enroll within 60 days after the date eligibility is lost. If you or a dependent becomes eligible for premium assistance under an applicable State Medicaid or CHIP plan to purchase coverage under the group health plan, you may be able to enroll yourself and/or your dependent(s). However, you must enroll within 60 days after you or your dependent is determined to be eligible for State premium assistance. Please note that premium assistance is not available in all states.
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Required Annual Employee Disclosure Notices - Continued
Medicare Part D This notice applies to employees and covered dependents who are eligible for Medicare Part D.
Please read this notice carefully and keep it where you can find it. This notice has information about your current prescription drug coverage with Aetna and about your options under Medicare’s prescription drug Plan. If you are considering joining, you should compare your current coverage including which drugs are covered at what cost, with the coverage and costs of the plans offering Medicare prescription drug coverage in your area. Information about where you can get help to make decisions about your prescription drug coverage is at the end of this notice.
1. Medicare prescription drug coverage became available in 2006 to everyone with Medicare through Medicare prescription drug plans and Medicare Advantage Plan (like an HMO or PPO) that offer prescription drug coverage. All Medicare prescription drug plans provide at least a standard level of coverage set by Medicare. Some plans may also offer more coverage for a higher monthly premium.
2. Aetna has determined that the prescription drug overage offered by the Welfare Plan for Employees of Baer’s Furniture under the Aetna option are, on average for all plan participants, expected to pay out as much as the standard Medicare prescription drug coverage pays and is therefore considered Creditable Coverage. Because your existing coverage is Creditable Coverage, you can keep this coverage and not pay a higher premium (a penalty) if you later decide to join a Medicare drug plan.
You should also know that if you drop or lose your coverage with Aetna and don’t enroll in Medicare prescription drug coverage after your current coverage ends, you may pay more (a penalty) to enroll in Medicare prescription drug coverage later. ___________________________________________________________
When can you join a Medicare Drug Plan?
You can join a Medicare drug plan when you first become eligible for Medicare and each year from October 15th to December 7th.
However, if you lose your current creditable prescription drug coverage, through no fault of your own, you will also be eligible for a two (2) month Special Enrollment Period (SEP) to join a Medicare drug plan.
What happens to your current coverage if you decide to join a Medicare Drug Plan?
If you decide to join a Medicare drug plan, your current Aetna coverage will not be affected. You can keep this coverage if you elect part D and this plan will coordinate with Part D coverage.
If you decide to join a Medicare drug plan and drop your current Aetna coverage, be aware that you and your dependents will be able to get this coverage back.
When will you pay a higher premium (penalty) to join a Medicare drug Plan?
You should also know that if you drop or lose your current coverage with Aetna and don’t join a Medicare drug plan within 63 continuous days after your current coverage ends, you may pay a higher premium (a penalty) to join a Medicare drug plan later.
If you go 63 continuous days or longer without creditable prescription drug coverage, your monthly premium may go up at least 1% of the Medicare base beneficiary premium per month for every month that you did not have that coverage. For example, if you go nineteen months without creditable coverage, your premium may consistently be at least 19% higher than the Medicare base beneficiary premium. You may have to pay this higher premium (a penalty) as long as you have Medicare prescription drug coverage. In addition, you may have to wait until the following October to join.
For more information about this notice or your current prescription drug coverage…
Contact our office for further information (see contact information below). NOTE: You’ll get this notice each year. You will also get it before the next period you can join a Medicare drug plan, and if this coverage through Aetna changes. You also may request a copy of this notice at any time.
For more information about your options under Medicare prescription drug coverage…
More detailed information about Medicare plans that offer prescription drug coverage is in the “Medicare & You” handbook. You’ll get a copy of the handbook in the mail every year from Medicare. You may also be contacted directly by Medicare drug plans. For more information about Medicare prescription drug coverage:
> Visit www.medicare.gov
> Call your State Health Insurance Assistance Program (see your copy of the Medicare & You handbook for their telephone number) for personalized help,
> Call 1-800-MEDICARE (1-800-633-4227). TTY users should call 1-877-486-2048.
If you have limited income and resources, extra help paying for Medicare prescription drug coverage is available. For information about this extra help, visit Social Security on the web at www.socialsecurity.gov, or call them at 1-800-772-1213 (TTY 1-800-325-0778).
Remember: Keep this notice. If you enroll in one of the new plans approved by Medicare which offer prescription drug coverage, you may be required to provide a copy of this notice when you join to show that you are not required to pay a higher premium amount. Name of Entity/Sender: Baer's Furniture Contact--Position/Office: Susan Scovin Address: 1589 NW 12th Ave. Pompano Beach, FL 33069 Phone Number: 954-946-8007 ext. 215
Required Annual Employee Disclosure Notices - Continued
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Notes
The information in this Benefits Summary is presented for illustrative purposes and is based on information provided by the employer. The text contained in this Summary was taken from various summary plan descriptions and benefit information. While every effort was taken to accurately report your benefits, discrepancies or errors are always possible. In case of discrepancy between the Benefits Summary and the actual plan documents, the actual plan documents will prevail. All information is confidential, pursuant to the Health Insurance Portability and Accountability Act of 1996. If you have any questions about this summary, contact Human Resources.
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