New Hire 2015 Benefits Enrollment. educational service center. Council of Governments COG

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1 New Hire 2015 Benefits Enrollment COG educational service center Council of Governments

2 Information Page Welcome to the Ohio Healthcare Plan. The benefits program is an important part of the total compensation package. The 2015 Benefits Enrollment provides a comprehensive outline of all offerings through the ESC of Central Ohio. Below you will find a list of customer service numbers for each benefit administrator: Employee Benefit Management Corp (medical) P.O. Box 9057 Dublin, OH Delta Dental (dental) Ameritas (vision) Lincoln (life, disability insurance) Chard Snyder (flexible spending account) HelpNet user name: esc password: employee W.E.L.L , ext 2 2 Benefits Enrollment

3 Core and Voluntary Benefits Below, ESC employees will find a list of the providers and benefits: Core Benefits Employee Benefit Management Corp (EBMC) Medical and Prescription Drug Dental Voluntary Benefits Vision - Ameritas FSA (Flexible Spending Account, Health Care and Dependent Care) - Chard Snyder, effective Jan. 1, 2015 Lincoln Group Term Life Insurance, Accidental Death Insurance Disability Insurance (short-term, long-term) Core Benefits HelpNet Wellness Collective Benefits Enrollment

4 Frequently Asked Questions Q: Can an employee change benefits coverage at any time? A: No. There are only two occasions when an employee can change (add or drop) their benefits coverage: During open enrollment Within 30 days of a qualifying event Q: What is a qualifying event? A: A qualifying event is a change in a person s life that creates the need to add, drop, increase or change coverage. Examples of qualifying events include: Marriage or divorce Birth or adoption Spouse losing coverage Check with the benefits department to determine if that employee s situation is a qualifying event. Q: How much time do employees have to submit a request to change coverage after a qualifying event? A: Employees must submit their request for change to the benefits department within 30 days of the qualifying event. Otherwise, the employee will have to wait until the next open enrollment period to change coverage. Q: How long is an employee s child eligible to stay on their insurance? A: An employee s child may remain on their medical, dental and vision insurance up to age 26. Q: When will employees receive their identification cards? A: Generally within two weeks after the date coverage takes effect, employees will receive their medical and dental ID cards in the mail. Check the card(s) right away to make sure the coverage is correct. 4 Benefits Enrollment

5 Core Benefits Medical Insurance Amounts shown are what you pay for in- network benefits. Preventative Care Annual Deductible PPO- Mid PPO- High HDHP/Bronze Plan Preventative services covered 100% for all plans $750/person 2,000/family $500/person $1,500/family $1,500/person $3,000/family This is the dollar amount you must pay first in a year before the plans begin paying specified benefits. Maximum Out- of Pocket Includes deductibles and copays. This is the most you will pay toward your in- network expenses. You do not have to meet the deductible before copays apply. $3,000/person $6,000/family You do not have to meet the deductible before copays apply $3,500/person 7,000/family You must meet the deductible before the prescription copays apply. $2,500/person $5,000/family Doctor Office Visit Primary care includes family practice, internist, pediatrician, OB/GYN, mental health and chiropractor. $25 for primary care $50 for specialist $30 for primary care $50 for specialist $0 after deductible Urgent Care $50 copay $50 copay $0 after deductible Emergency Room $250 copay $250 copay $0 after deductible (waived if admitted) (waived if admitted) Inpatient Hospital and Outpatient 20% after deductible 20% after deductible $0 after deductible Surgery Prescription Drugs Deductible does not apply Deductible does not apply After the deductible is reached Retail- 30 day supply Mail Order- 90 day supply $10 generic $35 formulary brand $60 non- formulary $25 generic $87.50 formulary brand $150 non- formulary brand $15 generic $30 formulary brand $60 non- formulary $25 generic $87.50 formulary brand $150 non- formulary $15 generic $30 formulary brand $60 non- formulary $25 generic $87.50 formulary brand $150 non- formulary Employee Benefit Management Corp (EBMC)

6 Core Benefits Medical Insurance Rates* Employee Insurance Rates PPO- High Single: Full Time (80/20) Part Time (50/50) Board pays $ $ Employee pays $ $ Total $ $ Family Full Time (80/20) Part Time (50/50) Board pays $1, $ Employee pays $ $ Total $1, $1, PPO- Mid Single Full Time (80/20) Part Time (50/50) Board pays $ $ Employee pays $ $ Total $ $ Family Full Time (80/20) Part Time (50/50) Board pays $1, $ Employee pays $ $ Total $1, $1, HDHP/Bronze Single Full Time (80/20) Part Time (50/50) Board pays $ $ Employee pays $ $ Total $ $ Family Full Time (80/20) Part Time (50/50) Board pays $1, $ Employee pays $ $ Total $1, $1, *Insurance rates are calculated on a monthly basis. 6 Employee Benefit Management Corp (EBMC)

7 Rates for Dental Benefits (full-time and part-time employees) Core Benefits Single or Family 2015 Board pays $72.10 Employee pays $18.02 Total $90.12 Dental Rates for Vision Benefits Insurance (full-time and part-time Rates* employees) Rates for Dental Benefits (full-time and part-time employees) Vision Benefits 2015 Single Employee or Family 2015 $8.16 Board Employee pays +1 $72.10 $12.32 Employee Employee +2 pays or $18.02 $21.87 Total more dependents $90.12 *Insurance Rates for Vision rates Benefits are are calculated (full-time on and on a monthly part-time a monthly basis. employees) basis. Additional Vision Benefits Benefits 2015 Employee $8.16 Employee employee. +1 $12.32 Employee +2 or $21.87 more dependents The ESC Governing Board provides the following benefits at a cost of more than $1,000 per 1. Term Life Insurance of $50, Employee Assistance Program 3. Dental Insurance Plan (100% of premiums for employees hired before 1/1/09) Optional Insurance Benefits rates are calculated on a monthly basis. The Board also makes a Section 125 unreimbursed medical savings account program available, which allows for employee savings via tax-free contributions. Additional Benefits The Other ESC optional Governing coverage: Board provides the following benefits at a cost of more than $1,000 per employee. Vision 1. Term Life Insurance of $50,000 Term life and Accidental Death and Dismemberment 2. Employee Assistance Program 3. Disability Dental Insurance Plan (100% of premiums for employees hired before 1/1/09) Optional Questions Benefits The If you Board have also any makes questions a Section about the 125 insurance unreimbursed plan or medical to add, savings change account or drop coverage, program available, request forms which from allows Kim for Kelso employee at savings via or tax-free contributions. Other optional coverage: Vision Term life and Accidental Death and Dismemberment Disability Questions If you have any questions about the insurance plan or to add, change or drop coverage, request forms from Kim Kelso at or Delta Dental

8 Core Benefits Dental Insurance Plan For verification of eligibility please refer to the telephone number on the employee s identification card. Call this number to verify eligibility for plan benefits before the charge is incurred. Please read the section Alternate Treatment in the Dental Plan. Employees will need to follow this section or reimbursement from the plan may be reduced. DENTAL CARE BENEFIT SCHEDULE DENTAL CARE BENEFIT SCHEDULE DENTAL CARE BENEFIT DENTAL CARE BENEFIT MAXIMUM BENEFIT AMOUNT BENEFIT MAXIMUM BENEFIT AMOUNT BENEFIT For Class A Preventive, Class B Basic, and For Class A Preventive, Class B Basic, and $1500 per Benefit year Class C Major $1500 per Benefit year Class C Major For Class D Orthodontia $1,000 per Lifetime (For Class Depedendent D Orthodontia Children under age 25 Only) $1,000 per Lifetime COVERED (For Depedendent CHARGES Children under age 25 Only) Classes COVERED of Benefits CHARGES Percentage Payable Class Classes A Services of Benefits - Preventive Percentage 100% Payable Class B A Services - Basic Preventive 100% 80% Class C B Services - Major Basic 70% 80% Class D C Services - Major Orthodontia 50% 70% Class D Services - Orthodontia 50% Dental expenses under the dental benefits section of this plan do not apply to the benefit year deductible or to the out-of-pocket maximum under the medical portion of this plan. 8 Delta Dental

9 Voluntary Benefits Rates for Dental Benefits (full-time and part-time employees) Single or Family 2015 Board pays $72.10 Employee pays $18.02 Total $90.12 Vision Insurance Rates,* Plan Rates for Vision Benefits (full-time and part-time employees) Vision Benefits 2015 Employee $8.16 Employee +1 $12.32 Employee +2 or $21.87 more dependents *Insurance rates are are calculated on on a a monthly basis. basis. Additional Benefits Copayments Frequency Based on Date of Service Choice Plan $15 Exam / $15 Materials Exam/Lens/Frame 12/12/12 VSP Participating Provider Annual Eye Exam Lenses (per pair) Single Vision Covered in full Optional Bifocal Benefits Covered in full Trifocal The Board also makes a Section 125 Covered unreimbursed in full medical savings account program Lenticular Covered in full Progressives Contacts The ESC Governing Board provides the following benefits at a cost of more than $1,000 per employee. 1. Term Life Insurance of $50, Employee Assistance Program Covered in full 3. Dental Insurance Plan (100% of premiums for employees hired before 1/1/09) available, which allows for employee savings via tax-free contributions. Other optional coverage: See lens options Fit & Follow Up Exams $15 Discount from doctor s U&C Vision Elective Contact Lenses Up to $130 Allowance applied to fit, follow up Disability and contact lenses. Necessary Covered in full Frames $130 Questions Non-Participating Provider Examination Up to $45 Single Vision Lenses Up to $30 Lined Bifocal Lenses Up to $50 Lined Trifocal Lenses Up to $65 Lenticular Up to $100 Progressives Up to $50 Frame Up to $70 Elective Contact Lens* Up to $105 Lens Options (Member Cost) Progressive Lenses Custom Progress - $150 - $175 Premium Progressive - $95 - $105 Standard Progressive - $55 Std. Polycarbonate $31 - $35 Solid Plastic Dye $15 - $17 Photochromic Lenses (Glass & Plastic) $70 - $82 Scratch Resistant Coating 20% off doctor s usual and customary fee Anti-Reflective Coating $41 Ultraviolet Coating $16 Lasik or PRK Term life and Accidental Death and Dismemberment If you have any questions about the insurance plan or to add, change or drop coverage, request forms from Kim Kelso at or Fully-Insured Rates Average discount of 15% off retail Three-Tier $8.16 / $12.32 / $21.87 Ameritas

10 Voluntary Benefits Flexible Spending Account (FSA) A Flexible Spending Account, or FSA, allows an employee to set aside a portion of their income, before taxes, for approved healthcare and dependent care expenses. Benefits of an FSA include: Helping budget and pay for approved expenses over the course of the plan year. Increasing take-home pay because the FSA contribution reduces tax liabilities. Creating financial flexibility because the total medical FSA pledge amount is available at any time during the plan year. Getting Started During open enrollment, an employee may choose the amount of money to be deducted from their paycheck for contribution toward a FSA. The maximum amount of money an employee can contribute is $2,500 for medical savings and $5,000 for dependent care. Debit Card The ESC offers a debit card that can be used virtually everywhere that Visa and MasterCard are accepted. This allows payments to be deducted directly from the FSA account, eliminating paperwork and reimbursement wait time. FSA or child care: Which is better for a tax return? The same dependent care expenses that qualify for the FSA are eligible for a federal income tax credit. Employees cannot use both tax advantages for the same expenses, though they may be able to take a tax credit for expenses they do not pay though the FSA. Other tax credits, such as the Earned Income Credit (EIC) can be affected by using the FSA. Depending on an employee s income level, the EIC may either increase or decrease if they incur a salary reduction to contribute to the FSA plan. Employees should consult a tax advisor to confirm which would be best. 10 Chard Snyder

11 Voluntary Benefits Flexible Spending Account (FSA) Qualified Medical Expenses* Any medical/dental/optical expense incurred during the plan year for the employee, their spouse or dependents may be paid through the employee s medical FSA, such as: Acupuncture Lab fees Alcohol/drug treatment Lasik eye surgery Ambulance Learning disability tuition Blood pressure monitoring devices Obesity program fee Body scans Office visit co-pays Chiropractors Orthodontia Christian Science practitioners Ostomy products Contact lenses and solution OTC drugs with prescription Deductibles and co-pays OTC medical supplies Dentures Oxygen Diabetic supplies and insulin Prescription drugs and co-pays Emergency room co-pay Prescription sunglasses Eye exams and eyeglasses Psychological counseling Fertility treatment/drugs Smoking cessation program Guide dog Vaccines Hearing exams/aids Vasectomy *This list is not comprehensive. Internal Revenue Code 213(d) defines expenses eligible for reimbursement. Qualified Dependent/Child Care Expenses Expenses for the care of a dependent that enable the employee and/or their spouse to work qualify. The maximum amount that they can contribute to a Dependent Care FSA is $5,000 in a calendar year or $2,500 if they are married and filing a separate tax return. Day care or babysitting for an employee s child under age 13. Services that can be provided in the home or in another location (such as a day care center). Service must be for the physical care of the child, not for education. Qualified expenses include costs for adult day care (such as spouse or dependent parent). The adult dependent must reside with the employee and regularly spend at least eight hours per day in their home. The election cannot be greater than their spouse s income or one half their joint income, whichever is smaller. An employee must supply the care provider s name, address and employer identification number or social security number with the reimbursement claim. An employee will be reimbursed up to the current balance in their account when submitting a claim. Chard Snyder

12 Voluntary Benefits Life Insurance Disability Insurance Group Term Life and Accidental Death Insurance* Basic group term life insurance in the amount of $50,000 is provided to all full-time employees at no cost. In addition to the group term life provided by the ESC of Central Ohio, employees have the opportunity to purchase additional term life protection up to five times their annual salary not to exceed $500,000, whichever is less. No medical questions are asked for amounts up to $150,000 if the employee enrolls when they are first eligible. Employees also have the option to cover a spouse up to $50,000 and children up to $10,000. This coverage includes accidental death and dismemberment (AD&D) insurance equal to the amount of life insurance elected. This coverage will double the amount of benefit the employee s beneficiaries receive if they die due to an accident. Premium payment is handled through payroll deduction and is portable so they may be eligible to apply for continuation of coverage should their employment end. Disability Insurance (short-term, long-term)* Voluntary short- and long-term disability insurance from Lincoln provides employees with the security of knowing a paycheck will not stop if they have an extended disability due to illness or accident. This program provides 60 percent of the monthly salary up to a maximum of $5,000 with two options for both short- and long-term coverage with benefit duration periods from nine weeks up through social security full retirement age. Disability insurance does have a pre-existing condition period of 3/12. This means that if an employee was treated for a medical condition three months prior to the effective date, it will be considered a pre-existing condition and will not be covered unless they are treatment free for 12 months after the effective date of coverage. *This information is not intended to be a complete description of the insurance coverage available. The policy has exclusions and limitations, which may affect any benefits payable. The benefits counselor can give complete details of the coverage and availability. 12 Lincoln Financial Group

13 Voluntary Benefits HelpNet Work-Life Programs - Click on Work-Life Programs in upper right corner Username: esc Password: employee Free online access to a wide range of resources on topics of interest to the employee and members of their household - all available on one website. Articles on balance, parenting, wellness, grief, relationships, career skill-builders, and more. Spanish language available. Seminars with featured monthly themes, such as Getting Organized, Handling Bullies at Any Age, Improving Sleep, Strengthening Work Teams, Parenting and Communication. Savings center with free registration using the company code Advantage for percent discounts off regular retail prices. Relocation assistance provides community information on demographics, home sales, school districts, school reports, places of worship, up-to-date maps and more. Personal Counseling Solution-focused brief therapy (1 to 6 sessions) at no cost for the employee or members of their household. Counseling provided for marital and family issues, addictions, emotional problems, career issues, relationships, aging parents, stress/anxiety, depression, and life enrichment techniques. Available 24 hours a day, 7 days a week, 365 days a year. All services are strictly confidential. Call anytime. Legal, Financial and ID Recovery The employee and members of their household can receive telephonic consultation when a legal issue, financial matter or an instance of identity fraud disrupts life. Through professional consultation, these programs can save time, while providing valuable information, support and peace of mind. Legal Assist provides access to qualified legal advice and council, either by phone or inperson, as determined by the need. Coverage is available nationwide. Consultations are free, half-hour sessions with an attorney qualified to handle the issue. Receive a 25 percent discount on hourly attorney fees if representation is required. Valuable legal resources are available online as part of the work-life website. HelpNet

14 Voluntary Benefits W.E.L.L. Health Matters Health Matters, the monthly e-newsletter, is sent to everyone on the last Wednesday of every month. Past issues are also posted on OurESC under the Health Central tab. On-Site Group Fitness Employees have access to group exercise classes three days a week, and they are open to all employees, as well as all spouses and dependents covered on the ESC or CDMU insurance plans. These are completely free of charge. During the official school year, the ESC will be offering classes on Mondays, Wednesdays and Thursdays. All classes run from 4:45 p.m. - 5:30 p.m. and all fitness levels are encouraged to attend. Please see our calendar of events for specific locations, dates and formats. Wellness Wednesdays Wellness Wednesday s are an occasional collection of news and reminders about the ESC W.E.L.L. program. ESC staff also can find up-to-date information and archives of presentations and materials on OurESC under the Health Central tab. Wellness Consulting Employees have the added benefit of telephonic and electronic access to a dedicated and professional wellness specialist. A knowledgeable and friendly team will address and answer any questions or concerns employees have in a safe and confidential environment. One of these team members can be contacted via at or by telephone at ext. 2. Employees can expect to receive a response within 24 hours during business hours. All of your information is maintained in a confidential manner to fully comply with HIPPA regulations. Programming is offered in partnership with Wellness Collective. For more information, please or call Sarah Towning at ext. 2, with any questions about the W.E.L.L. program. 14 Wellness Collective , ext 2

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