Contractor Benefit Plan Guide

Transcription

1 Contractor Benefit Plan Guide

2 The PDS Technical Services Benefit Plan offers options of medical care, dental care, vision care and other voluntary benefits such as life insurance and pre-paid legal. This guide is designed to help you understand the choices available to you and your family. If you have questions that are not answered in this booklet, please visit h.com/mypds_benefits.php Further questions can be directed to the Benefits Department by calling Each year during the annual open enrollment period, you have the ability to make certain benefit changes. You can add or drop dependents, change from one plan to another (i.e. move from HMO to HRA), enroll if you are not currently enrolled or you can drop all coverage. The 2009 open enrollment period will be in October or November of this year. Information will be sent out to all employees once it gets closer. The enrollment website is w ww.pdstech.essbenefits.com. The PDS Benefit Plan includes: Medical HSA HRA PPO HMO where available Dental PDO, DMO where available Life/AD& D Insurance Vision Supplemental Life Insurance Supplemental AD&D Insurance Pre-paid Legal Service Long Term Disability P re-tax and After-Tax Payment You pay for medical, dental, and vision coverage on a pre-tax basis; that is, before federal, Social Security, and most state and local taxes are withheld. Voluntary benefits are paid on an after-tax basis; that is, after federal, Social Security, and most state and local taxes are withheld. E ligible Dependents You may cover any of your eligible dependents under the PDS medical, dental and vision plans. Your eligible dependents are: Your legal spouse; Your unmarried dependent children up to age 25 (not including age 25) for all Aetna plans in the state of Texas regardless of student status. All other states age is 19 if not student and 25 if student. Coventry plan 19 if not student, 23 if student ( This plan is offered in our coverage areas for St Louis Missouri and Springfield/Bloomington, Illinois). Your unmarried dependent children age 19 or older who are not capable of supporting themselves due to a mental or physical disability, providing the disability began before age 19. C overage Categories The cost of your benefit options is partly determined by the number of dependents you choose to cover. These coverage categories are intended to help you design the most effective benefits package for you and your family. For medical, dental and vision benefits, you can choose from the following coverage categories: Medical Dental Vision Employee only Employee Only Employee Only Employee + children Employee + 1 Employee + 1 Employee + spouse Employee + 2 or more Employee + 2 or more Family Q ualified Changes in Status Once you make your benefit elections, they remain in effect for the entire calendar year. This is why it is important to consider your choices carefully. However, if one of the following changes in status occurs that causes a gain or loss in coverage, you may be able to change certain benefit elections during the year: Marriage, divorce, death or other change in your legal marital status; Birth, adoption, death or other changes in the number of eligible dependents; A change in work hours for you, your spouse or eligible dependents;

3 A dependent gaining or losing eligibility for coverage due to changes in age and/or student status; A significant change in benefit cost or coverage for you, your spouse or eligible dependents; A judgement, decree or court order that requires coverage of a spouse or eligible dependents; Eligibility for Medicare or Medicaid for you, your spouse or eligible dependents; A move in or out of a plan network area for you, your spouse or eligible dependents. You must make the change within 31 days of the event. The change must be consistent with the event. N on-duplication of Benefits If you are covered under two different employers medical and/or dental plans, the two plans coordinate payments. For example, if you are covered under a PDS medical or dental plan and as a dependent under your spouse s employer s medical or dental plan, the PDS plan is primary for you, which means it is obligated to pay first. Your spouse s plan is secondary. Where children are concerned, the primary plan is usually the plan of the spouse with the earlier birthday during the year. This is known as the birthday rule. Whenever the PDS plan is your secondary plan, benefits will be determined according to the non-duplication of benefits rule, which means that the PDS plan will pay only up to the amount the plan would normally pay if it were the primary plan, less any benefits paid by the primary plan. W hen Your Benefits Are Effective If you are a new employee, your core benefits become effective after 90 days of continuous employment (except SRC, see below), working 30 hours per week. You may enroll anytime during the 90 day period but no later than 120 days after your date of hire. Your effective date is the 91 st day of continuous employment. If you enroll after the 90 th day but b efore the 120 th day PDS will take premiums back to your effective date. If enrolling online through our benefits website, you may only log into the web after you have completed 45 days of employment. Prior to that time, you will not be able to log into the web. PDS collects your portion of insurance premiums concurrently on a weekly basis. Your deductions will begin the week your coverage becomes effective. Coverage ends on the last day of the pay period of your last day worked. Upon receipt of your insurance cards, please verify that all information is correct for yourself and your dependents. Report any discrepancies to the Benefits Department immediately. For new employees who have not yet reached their 91 st day of employment, PDS offers a limited liability medical Plan, commonly referred to as a mini-med plan without a waiting period. Following receipt of your first paycheck you are eligible to enroll in coverage in one of the two offered SRC plans. This coverage is only effective until you are eligible for coverage under the core medical options PDS offers. M edical Benefits The PDS Benefit Plan offers: Aetna SRC Mini-Medical (available for First 90 days of employment) Aetna Health Savings Account (HSA) Aetna Health Reimbursement Account (HRA) Aetna Health Maintenance Organizations (HMO) available in some areas Aetna Open Choice Preferred Provider Plan (PPO) Personal Care Preferred Provider Plan (PPO) available in Bloomington/Springfield, IL only No Coverage Aetna SRC Mini-Med The SRC Mini-Med offers limited liability as an interim coverage option until you are eligible for one of the core medical options. Coverage is provided at Aetna contracted rates, similar to the core medical offerings. The main difference between the mini-med plan and the core medical offerings is the defined annual maximum expenditures allowed by the plan. The SRC is not a replacement plan to the core medical offerings; it is a plan that offers a limited coverage during your waiting period. SRC Net Premier 5000 The Net Premier 5000 provides limited coverage for approved outpatient expenses at an annual limit of $500 per year per enrolled member and $500 per year for covered inpatient hospital services expenses. A $35 monthly pharmacy benefit to offset prescription drug co-pays is also included in the plan. Doctor s visits are covered at $15 co-pay per visit and a

4 coinsurance of 80% (in-network), 60% (out-of-network) is provided after meeting a deductible of $100 (in-network), $200 (out-of-network). Please consult your enrollment materials for plan specifics. SRC Net Premier The Net Premier provides limited coverage for approved outpatient expenses at an annual limit of $1000 per year per enrolled member and $1000 per year for covered inpatient hospital services expenses. A $35 monthly pharmacy benefit to offset prescription drug co-pays is also included in the plan. Doctor s visits are covered at $15 co-pay per visit and a coinsurance of 80% (in-network), 60% (out-of-network) is provided after meeting a deductible of $100 (innetwork), $200 (out-of-network). Please consult your enrollment materials for plan specifics. Aetna HSA The HSA plan gives you more control over how you spend, or save, your health care dollars. With the HSA plan, you get the protection of a medical benefits plan plus a tax-free health savings account that you can use to help pay for qualified medical expenses. You can withdraw money from your HSA to reimburse your medical expenses (including your deductible), or you can let your HSA grow and earn interest for future or retiree health expenses. Best of all, you own your HSA so you keep it, even if you change health plans or jobs. And, at the end of the year, money left in the account rolls over to the next year. From job to job, plan to plan, your HSA goes with you. Aetna - HRA The HRA plan provides you with a fund ($500 employee only/$1000 employee + dependants) at the start of the year to help you pay for medical expenses covered by the plan. Preventive care (i.e. annual checkups, immunizations) is covered at 100% and is not counted against your fund. You can use your fund to pay for eligible health care expenses and you can stretch your fund dollars by shopping for the most cost-effective services and providers. Any money left in the fund at year end is added to your fund balance for the next year as long as you remain in the PDS plan. Your plan includes a deductible, if your fund is spent before the deductible is met; you pay for the remaining expenses until the deductible is satisfied. If you spend your entire fund and meet the deductible, remaining expenses are covered at 80% until you meet your max out of pocket expenses. Aetna HMO Plan The HMO Plan provides comprehensive medical care, preventive care and prescription drug benefits through Aetna. There is no deductible to meet. You will have the reassurance of having a personal Primary Care Physician (PCP) who is your source of routine care and for guidance when you need more than routine care. The HMO plan is only available in the cities listed below and you must live in one of those cities to be eligible for the plan. If you enroll in the HMO and do not live in one of these cities, you will be enrolled in the HRA plan. HMO Plans are available in the following cities: Atlanta, GA Austin, TX Baltimore, MD Boston, MA Cleveland, OH Connecticut Dallas/Ft. Worth, TX Houston, TX Los Angeles, CA Nashville, TN Phoenix, AZ Reston, VA San Antonio, TX Seattle, WA St. Louis, MO Tampa, FL Aetna PPO Plan The PPO Plan provides comprehensive medical, preventive care and prescription drug benefits through Aetna. The PPO plan offers two levels of benefits, depending on the provider you see. Whenever you use network providers, you will receive the Network Benefit level, which covers most expenses at 80% after you pay an annual deductible. The co-pay for an office visit to an in-network provider is $25 per visit. The Non-Network Benefit level offers you the choice of seeing a physician who is not in the network. When you see a non-network provider, the plan pays 60% of your covered expenses after you pay an annual deductible.

5 Personal Care PPO Plan The PPO Plan provides comprehensive medical, preventive care and prescription drug benefits through Aetna. The PPO plan offers two levels of benefits, depending on the provider you see. Whenever you use network providers, you will receive the Network Benefit level, which covers most expenses at 80% after you pay an annual deductible. The co-pay for an office visit to a Primary Care Physician (PCP) is $20 per visit. No Medical Coverage If your medical coverage is already provided under another plan, you may choose to Decline coverage. However, you should carefully consider the following: Since your medical plan elections remain in effect for a full year, you will not be able to obtain medical coverage under the PDS Benefit Plan during the year unless you have a qualified change in status. Dental Benefits The PDS Benefit Plan offers: Aetna PDO Dental Plan Aetna DMO Dental Plan Dental coverage is available on a voluntary basis, which means you can elect Dental coverage without electing Medical coverage. The DMO is similar to the HMO for medical in that it typically has less out of pocket expenses and requires using a Network Provider. Some areas have a limited network of Dentists. Please check the availability of dentists before enrolling in this plan. The list of providers can be found at The PDO offers benefits for any dentist of your choice. AETNA DMO AETNA PDO Preventative 100% Preventative 100% Basic 100% Basic 80% Major 50% Major 50% Office Visit $5 co-pay Calendar Year Deductible: Orthodontia for children (Adults in California) Vision Benefits 50% Single Family $50 $150 Orthodontia for Children to age 19 50% Calendar Year Maximum $1000 The PDS Benefit Plan offers vision coverage that provides benefits for you and your family through Vision Service Plan. This coverage includes a network of providers and a schedule of co-pays for various vision needs. Vision Service Plan does not issue ID cards. Examination Lenses Frame Once every 12 months Once every 12 months Once every 24 months COPAYMENT: Examination $25.00 Materials $25.00 Services from a VSP Participating Provider * Services from a non- Participating provider Examination Paid-in Full up to $ Single Vision Lenses Paid-in-Full up to $ Bifocal Lenses Paid-in-Full up to $ Trifocal Lenses Paid-in-Full up to $ Lenticular Lenses Paid-in-Full up to $ Frame VSP fully covers a wide up to $ 46.00

6 selection of attractive frames. Contact Lenses (Instead of spectacle lenses and frame) Necessary Paid-in-full (after copay) up to $ Elective up to $ up to $ Supplemental Life & Supplemental AD&D You may purchase 1, 2, or 3 times your salary up to a maximum of $300,000 of additional life insurance and/or AD&D insurance. The guaranteed issue amount is $100,000. You will not be required to provide evidence of insurability unless you do not enroll during the initial enrollment period or enroll for an amount above the guaranteed issue amount. If you elect supplemental life insurance, you may also purchase supplemental life insurance for your spouse in increments of $10,000 up to a maximum of $50,000. The guaranteed issue amount is $30,000. You will not be required to provide evidence of insurability unless you do not enroll during the initial enrollment period or enroll for an amount above the guaranteed issue amount. If you elect supplemental life insurance, you may also purchase supplemental life insurance for your children in increments of $5,000 up to a maximum of $10,000. Pre-Paid Legal Plan Fully covered Legal Service for a wide range of personal matters Easy access to Professional Legal Services at an affordable Price Unlimited access to Plan attorneys for a wide range of legal matters including consultation-phone and in person, document preparation, and representation in many frequently needed legal matters Easy access to Plan Attorneys - Convenient locations and office hours to suit your preferences Covered Services: Wills and Estate Planning Wills and Codicils; Powers of Attorney; Living Wills; Living Trusts. Document Preparation Deeds; Mortgages; Promissory Notes. Real Estate Matters Sale or Purchase of a Home; Refinancing of a Home; Tenant Negotiations (as tenant); Eviction Defense (as tenant). Debt Collection Defense Defense of Civil Lawsuits Civil Litigation Defense; Administrative Hearings; Incompetency Defense. Family Matters Uncontested Adoption;

7 Uncontested Guardianship; Name Change There are no limits on usage for covered services. Some exclusions apply.. Long Term Disability Benefits Plan Description: plan. Monthly Benefit: Elimination Period: Please visit for more information on this 60% of monthly earnings to a maximum benefit of $6,000 per month. 90 Days Benefit Duration: To age 65/Reducing Benefit Duration (ADEA I) Coverage Exclusions and Limitations: Limitations: 24 months Mental Illness and Self-Reported Symptom Exclusions: 12/12/24 Pre-Existing Condition* Intentionally self-inflicted injuries Active participation in riot Loss of Professional License, Occupational License or Certification Commission of a crime for which the employee has been convicted War, declared or undeclared, or any act of war Incarceration *A Pre-Existing Condition means the insured employee: Received medical treatment, consultation, care or services including diagnostic measures or took prescribed drugs or medicines in the 12 months just prior to his/her effective date of coverage; and the disability begins in the first 24 months after the employee s effective date of coverage unless they have been treatment free for 12 months after his/her effective date of coverage.