employee benefit programs - cpt rehab...companies like cpt to continue to self fund their medical...
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EMPLOYEE BENEFIT PROGRAMS OPEN ENROLLMENT
NOW THROUGH NOVEMBER 28TH
BENEFITS EFFECTIVE JANUARY 1, 2018
WHAT STAYS THE SAME? CPT continues to offer an ACA compliant health plan
Done
Our Preferred Provider Organization (PPO) is the UHC Choice Plus network
Our Pharmacy Benefits Manager (PBM) is Serve You For employees who choose the CDHP bronze plan, we will make an employer
contribution towards a health savings account!!!!
WHAT’S NEW? 3rd plan option Plan design changes
PPO plan that includes office visit copays, Rx copays
CDHP plan where all expenses roll into the deductible
Employee contributions Increase
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2018 COMMUNITY PHYSICAL THERAPY BENEFIT PLAN 2018 Open Enrollment
MEDICAL PLAN
UMR is the premier organization that enables middle market companies like CPT to continue to self fund their medical programs
CPT is always looking for ways to lower your employee contributions and deliver the best in class resources
UMR has exciting resources to use when you have questions
• UMR’s participant website – how to login • My Health Care Cost Estimator Tool • UMR’s mobile app
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www.umr.com
WHO, WHAT, WHY AND HOW DOES THIS CHANGE IMPACT ME?
HOW DO I CONFIRM MY DOCTOR IS IN THE NETWORK? Actual Screenshot
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UMR.com and look for the “find a provider” section
Type in “Choice Plus” network
Find provider by using the alphabetical or search box
Always confirm that your provider is in network
One-click navigation from your desktop
Use myMenu to:
• View benefits and claims • Check account balances • Order, view, print or fax
an ID card • Find a provider • Access your Optum Bank HSA/
FSA • Visit the health center for
tools and information
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It pays to shop around regardless of which plan you select
Why did my co-worker pay less for the same treatment I
received?
Your costs may depend on what doctor you see and where you go for care. Use myHealthcare Cost Estimator (myHCE) to:
1) Search for treatments or procedures from local providers
2) View estimates, including your out-of-pocket costs and what your plan will pay
3) Choose a provider and get a final estimate
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Learn more about health topics that matter to you
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Use the UMR Health Education Library to: • Access thousands of articles,
illustrations and photos
• View 120 videos on health topics
• Research medical conditions, symptoms, treatment options, surgeries and medications
• Check symptoms and drug interactions
Look for best price on your prescription medications
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An example of shopping around;
Adderall XR – 20mg 30 day supply Walgreens $75.62 CVS Pharmacy $102.12 Meijer Pharmacy $106.07 Walmart $153.04
Medical Plan 40 hours a week
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Your 2018 semi monthly contributions-40 hours +
The above represents the employee contributions for the 40 hour work week.
coverage for: Core-Silver CDHP-Bronze Low Cost CDHP Employee only $137.86 $120.51 $50.00 Employee and Spouse $336.50 $290.07 $246.32 Employee and Child(ren) $312.46 $269.35 $228.73 Family $504.75 $435.11 $369.49
Benefit Provisions 2018 Core Plan (Buy-up) 2018 CDHP Plan (Bronze) Low Cost CDHP
Deductible Network Non-Network Network Non-Network Network Non-Network Individual $2,500 $5,000 $2,700 $5,400 $4,500 $9,000 Family $7,500 $15,000 $5,400 $10,800 $9,000 $18,000 Co-Insurance 80% 60% 80% 60% 70% 50% Maximum OOP Individual $7,350 $14,700 $6,650 $13,300 $6,650 $13,300 Family $14,700 $29,400 $13,300 $26,600 $13,300 $26,600 Hospitalization
Inpatient Ded & Coins Ded & Coins Ded & Coins Ded & Coins Ded & Coins Ded & Coins Outpatient Ded & Coins Ded & Coins Ded & Coins Ded & Coins Ded & Coins Ded & Coins Preventive Care 100% Ded & Coins 100% Ded & Coins 100% Ded & Coins Emergency Room $250 copay, then 100% ded waived Ded & Coins Ded & Coins Ded & Coins Ded & Coins Office Visits (PCP/Specialist) $70/$100 Ded & Coins Ded & Coins Ded & Coins Ded & Coins Ded & Coins Prescription Drugs - Retail
Tier 1 $25 copay, then 100% Ded & Coins Ded & Coins Tier 2 $45 copay, then 100% Ded & Coins Ded & Coins Tier 3 $60 copay, then 100% Ded & Coins Ded & Coins Tier 4 Specialty 25% of speciality drugs Ded & Coins Ded & Coins
Prescription Drugs - Mail Order
Tier 1 $50 copay, then 100% Ded & Coins Ded & Coins Tier 2 $90 copay, then 100% Ded & Coins Ded & Coins Tier 3 $120 copay, then 100% Ded & Coins Ded & Coins
Medical Plan 30-39 hours a week
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Your 2018 semi monthly contributions-30-39 Hrs
Benefit Provisions 2018 Core Plan (Buy-up) 2018 CDHP Plan (Bronze) Low Cost CDHP
Deductible Network Non-Network Network Non-Network Network Non-Network Individual $2,500 $5,000 $2,700 $5,400 $4,500 $9,000 Family $7,500 $15,000 $5,400 $10,800 $9,000 $18,000 Co-Insurance 80% 60% 80% 60% 70% 50% Maximum OOP Individual $7,350 $14,700 $6,650 $13,300 $6,650 $13,300 Family $14,700 $29,400 $13,300 $26,600 $13,300 $26,600 Hospitalization
Inpatient Ded & Coins Ded & Coins Ded & Coins Ded & Coins Ded & Coins Ded & Coins Outpatient Ded & Coins Ded & Coins Ded & Coins Ded & Coins Ded & Coins Ded & Coins Preventive Care 100% Ded & Coins 100% Ded & Coins 100% Ded & Coins Emergency Room $250 copay, then 100% ded waived Ded & Coins Ded & Coins Ded & Coins Ded & Coins Office Visits (PCP/Specialist) $70/$100 Ded & Coins Ded & Coins Ded & Coins Ded & Coins Ded & Coins Prescription Drugs - Retail
Tier 1 $25 copay, then 100% Ded & Coins Ded & Coins Tier 2 $45 copay, then 100% Ded & Coins Ded & Coins Tier 3 $60 copay, then 100% Ded & Coins Ded & Coins Tier 4 Specialty 25% of speciality drugs Ded & Coins Ded & Coins
Prescription Drugs - Mail Order
Tier 1 $50 copay, then 100% Ded & Coins Ded & Coins Tier 2 $90 copay, then 100% Ded & Coins Ded & Coins Tier 3 $120 copay, then 100% Ded & Coins Ded & Coins
coverage for: Core-Silver CDHP-Bronze Low Cost CDHP Employee only $178.89 $138.05 $67.41 Employee and Spouse $579.32 $518.58 $431.07 Employee and Child(ren) $523.39 $467.85 $400.28 Family $962.96 $888.44 $646.60
MEDICAL PLAN • CHOICE OF THREE MEDICAL PLANS
• The Silver Plan is the Core Plan • The Bronze Plan is the CDHP (qualified consumer driven health plan) • Introduction of new lower cost plan
• CAREFULLY CONSIDER YOUR OPTIONS • How you purchase your healthcare will help direct you to the best plan for
you and your family • Copays DO NOT apply to your deductible under the Silver Plan • Copays DO apply to your out of pocket maximum under the Silver Plan • All expenses count towards the deductible under the Bronze Plan and the low cost
CDHP • Annual preventive office visits covered at 100% for all plans
• Put more money in your pocket with the best plan for you • WHY DOES THIS MATTER? WHY SHOULD YOU CARE?
• Healthy individuals may not need the protection of office visit copays that are featured in the Silver Plan
• Individuals with high medical expenses that will most likely meet their out of pocket maximum can benefit from having all of their expenses roll into the deductible under the Bronze Plan
• Hit their out of pocket maximum faster; cheaper monthly premium
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CDHP / HSA • No other health coverage is allowed
(coordination of benefits, FSA, Medicare)
• A qualified CDHP requires that all drug charges accumulate towards the deductible
• A qualified CDHP requires that all office visit charges accumulate towards the deductible
• There is no separate Drug Copay or office visit copay
• The 2018 CDHP will allow for an embedded deductible/ OOPM so single +1 and family participants will have to satisfy their $2,700 deductible versus the full family deductible
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Preventive Care 100%
CPT Plan pays 100% after OOP
max
$6,650/ $13,300
HSA (ER
/EE funded) In-Network
Co-ins 80%
OON Co-ins 60%
Deductible
applies to all medical expenses first
(Including office visits, ER, pharmacy)
$2,700/ $5,400
In-Network Plan Design
HSA CONTRIBUTION LIMITS 2018 Individual $3,400 Family $6,750 Catch-Up Contributions (age 55 +) $1,000
CPT will make an employer contribution towards a health savings account if you select the bronze CDHP plan Single $250
Single +1 $500
Family $750
Health savings account (HSA) at-a glance
Use to pay eligible medical expenses Use money in your HSA account to pay deductibles and out-of-pocket costs for eligible medical and pharmacy expenses.
Grow your nest egg Any money remaining at the end of the year rolls over to the next year. Money in the account is yours, even if you retire or leave for a job with another employer.
Save money Your contributions, payments and any interest earned on the account are all tax-free.*
Tax advantages: Never pay FICA or federal income taxes if money is spent on qualified health care expenses (state income tax laws may vary).
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HSA: Qualified health care expenses
DO Use your HSA dollars for: • Qualified CDHP deductibles and
coinsurance
• Prescription medications
• Dental or vision care
• Health coverage while receiving unemployment benefits
• COBRA continuation coverage
• Qualified long-term care
• Medicare premiums and out-of-pocket expenses
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HSA: Qualified health care expenses
DON’T Use HSA funds for non-qualified expenses: If you do, the amount is:
• Taxable as income
• Subject to a 20% tax penalty
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You may participate in an HSA account if:
HSA eligibility requirements
Status as a dependent
• You are NOT claimed as a dependent on someone else’s tax return
Medicare enrollment
• You are NOT enrolled in Medicare
QCDHP Coverage
• You are enrolled in a QCDHP plan • You are not covered by any other plan
• Your FSA is considered coverage under another plan; must spend the FSA before receiving any employer funded HSA contributions
• Your coverage is active on the first day that you open your HSA account
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Flexible spending account (FSA) at-a-glance Silver PPO plan only
Save money Contributions to your FSA are deducted pre-tax, reducing your tax-able income and saving you money.
Use to pay medical and child care expenses Use money in your FSA account to pay for eligible medical and day care expenses.
“Use it” or “Lose it!” Any money remaining at the end of the year WILL NOT rollover to the next year*.
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Using your FSA debit card, you can: • Current participants will be receiving a
new card
• Access the money available in your account
• Simply swipe your card to pay for qualified eligible expenses
• Have the amount of your qualified purchases automatically deducted from your account
FSA debit card ‘Benny’
Every transaction on an FSA debit card must be substantiated, either through electronic validation (auto-substantiation) or paper receipts submitted by the card user (similar to paper claims).
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Need to know your FSA/ HSA balance in 2018 Go to account balances on umr.com
Log in now to:
• File a claim online • Upload receipts and
track expenses • View up-to-the-minute
account balances • View your account activity,
claims history and payment history
• Download plan information, forms and notifications
• Add or update a direct deposit account
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DENTAL Year Six With The Guardian
HIGHLIGHTS: About Guardian
Go to www.guardianlife.com to find a provider PPO Dental network: DentalGuard Preferred network DHMO Dental network: First Commonwealth Exciting new College Tuition Benefit Reward Program
Benefit Levels Cleanings covered 2X in a calendar year No waiting periods on services for new participants In and out of network coverage Porcelain crowns are available on all teeth (PPO) Composite (white) fillings are available on all teeth (PPO)
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DENTAL PLAN PPO Plan Summary
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Maximum Rollover $ Threshold Explanation Threshold $700 If a member has $700 or more of the annual maximum remaining at the
end of the year Rollover In-Network $500 $500 can be rolled over (if only in-network providers were used) Rollover Amount $350 $350 can be rolled over (if in- and oon-network providers were used) Account Limit $1,250 Rollover dollars accumulate year-over-year up to $1,250
• Maximum Rollover Provision allows a portion of unused maximum to rollover to next plan year (applies to each individual member of the plan as long as at least one dental service occurs during the calendar year)
Dental Network Non-Network Single Deductible $50 Family Deductible $150 Individual Annual Maximum $1,500 No Ortho coverage $0 Preventive (deductible waived) 100% 100% Basic 90% 80% Major 60% 50%
www.guardiananytime.com
• Overall plan design stays the same with added provisions and a rollover provision
DENTAL PLAN DHMO Plan Summary – Only for Illinois based employees/ limited network
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Services Your Cost Office Visit Copay $10 Due at each visit Oral Exams $0 Cleanings $0 X-Rays $0 Full Mouth Fillings $28 One Surface Amalgam
Endodontic (Root Canal) $260 Anterior $400 Molar
Periodontal (Scaling & Root Planing) $50 Per Quadrant Simple Extractions $35 Per Tooth
Complex Extractions $145 Soft Tissue Impacted $215 Full Bony Impacted
Bridges & Dentures $580 Complete Denture $620 Partial Denture
Single Crowns $430 Porcelain with Metal $430 Cast Metal
Orthodontia $1500 Comprehensive Ortho for Dep Child to Age 19 $2800 Comprehensive Ortho for Other Members
Bleaching $165 Per Arch
DENTAL PLAN COSTS PPO and DHMO
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DHMO Plan Enrollment Tier
Full Monthly Premium
Your Semi-Monthly Payroll Deduction
Single $12.21 $2.32
Employee + 1 $41.52 $7.86 Family $41.52 $7.86
• The semi-monthly payroll deduction is shown below • CPT pays the remainder of the full monthly premium • Dental HMO network is limited. Check to make sure of a provider near you if you elect this coverage
PPO Plan Enrollment Tier
Full Monthly Premium
Your Semi-Monthly Payroll Deduction
Single $36.46 $6.89 Employee + 1 $106.60 $20.20 Family $106.60 $20.20
Go to www.guardianlife.com to find a provider
PPO Dental network: DentalGuard Preferred network
DHMO Dental network: First Commonwealth
www.GuardianAnytime.com
PRINT FORMS & PLAN MATERIALS Forms Certificate booklets Customized provider directories…and more
BENEFITS INFORMATION Check claim status Review benefit provisions Look up coverage amounts View deductible & coinsurance amounts
AS A GUARDIAN MEMBER, YOU CAN ACCESS HELPFUL, SECURE INFORMATION
ABOUT YOUR BENEFITS INSTANTLY
Employee Benefits Hotline1.888.600.1600 25
VOLUNTARY VISION
HIGHLIGHTS: VSP continues as the carrier No change in rates; same plan design
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Benefit Description Frequency Exam $10 copay One exam every 12 months Frames $25 copay; Allowance up to $130 Once every 24 months Lenses $25 copay; Allowance up to $130 Once every 12 months Contacts Allowance up to $130 Once every 12 months
Vision Plan Enrollment Tier
Full Monthly Premium
Your semi-monthly Payroll Deduction
Single $7.31 $3.65 Employee + Spouse $11.69 $5.85 Employee + Child(ren) $11.94 $5.97 Family $19.24 $9.62
LIFE / DISABILITY
HIGHLIGHTS: CPT continues offers employer paid Life & STD
Flat $20,000 for basic life
66 2/3% of weekly earnings up to $650/ week for STD for 13 weeks
CPT offers the option to purchase optional Life Insurance and voluntary Long Term Disability (90 day elimination period)
Think about what would happen if you become disabled and unable to work beyond 90 days; who would pay your mortgage?, car payment?
Open enrollment for the voluntary LTD subject to underwriting
Why wouldn’t you sign up for optional life & VLTD
Convenient pay roll deduction
Benefit is tax free/ Guarantee issue up to certain levels
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VOLUNTARY LIFE INSURANCE Annual Enrollment For CPT Employees
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Life/AD&D Benefits Employee $10,000 increments up to $250,000
Dependent Spouse $5,000 increments up to $125,000 (not to exceed 50% of EEs election)
Dependent Child Options include: $1,000, $5,000 or $10,000 for
each eligible child who is 6 months but under 19 (to 26 if full time student)
Guarantee Issue No medical questions up to:
Employee $100,000
Dependent Spouse $50,000 Dependent Child $10,000
ACTION REQUIRED • MEDICAL – IF CHANGING YOUR ELECTION
• Complete the Benefits Election Form to enroll in the plan of you choice • Complete the Benefits Election Form to enroll/waive/change your election • No action necessary if you want the same coverage in 2018
• DENTAL – IF ADDING DENTAL OR CHANGING CURRENT ELECTION • Complete the Benefits Election Form to enroll or change dependent election
• VOLUNTARY VISION – IF ADDING VISION OR CHANGING CURRENT ELECTION • Complete the Benefits Election Form to enroll or change dependent election
• FSA – OR NO FSA WILL BE ELECTED FOR 2018 • Complete the Enrollment Form
• VOLUNTARY LIFE AND/OR VOLUNTARY LONG TERM DISABILITY • If you want to add coverage or increase your current coverage within limits,
complete the appropriate form • Reliance Standard for voluntary life • Reliance Standard for voluntary long term disability
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Forms Due in Business Office November 28th, 2017
IF YOU TAKE NO ACTION DURING THIS OPEN ENROLLMENT PERIOD:
Your Coverage Will Continue In 2018 under the current plan and coverage tier
• You need to make sure your provider is in the UMR Network • You are required to enroll in the FSA Annually • Enrollment forms are due back on Wednesday, November
28th • Do not forget to consider the voluntary LTD
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CALL TO ACTION!