Health and Wellness Benefits Handbook for Eligible Family Members

Transcription

1 Health and Wellness Benefits Handbook for Eligible Family Members INFORMATION FOR 2016 AND 2017 M Rev

2 Contents 1 Introduction 2 Health Plan Information Medical Prescription Drug Dental Vision 7 Life Insurance Information 9 Flexible Spending Account Information 10 Identity Fraud Insurance Plan Information 11 Legal Insurance Plan Information 12 Employee Assistance Program 13 Rate Calculator 14 Eligibility and Enrollment Information 15 Plan Provider Directory 16 Summary Plan Descriptions Annual Benefits Enrollment What s Changing Resources

3 Introduction Travelers provides employees with the opportunity to participate in comprehensive market-competitive benefits that meet the needs of employees and their family members. This brochure provides a summary of the programs available to Travelers employees. Please note that pages 2-16 contain information regarding the 2016 plan year. Page 17 contains information regarding Annual Benefits Enrollment for the 2017 plan year. For more comprehensive information about all of the benefits Travelers offers, employees should refer to myhr. Note: The information in this overview is only a summary and is not intended to fully describe the Travelers employee benefit programs. To the extent there is any information missing from the overview or any inconsistency between the information in the overview and the official plan documents and Summary Plan Descriptions for the benefit programs, the plan documents and Summary Plan Descriptions control. To access the Summary Plan Descriptions, click here. Travelers Benefits Handbook for Eligible Family Members 2016 Plan Information 1

4 Health Plan Information Overview Travelers offers comprehensive medical, prescription drug, dental, and vision plans designed to help you and your family stay healthy and avoid the financial hardship often associated with major illnesses, routine check-ups or injuries. Medical Blue Cross Blue Shield (BCBS) Plan or UnitedHealthcare (UHC) Choice Plus Plan Open access preferred provider option (PPO) coverage. No referral required to see a specialist. In-network benefits: o $25 copay for primary care physician visits. o $37 copay for specialist physician visits. o Preventive visits: no copay. o Retail clinics: $10 copay. o Urgent care facility: $37 copay. o Emergency room: $175 copay; waived if admitted to a hospital. o Deductible and coinsurance applies to all non-preventive, non-copay based services. o The deductible is $600 per person/$1,200 per family. o After satisfying the deductible, member responsibility is 10 percent coinsurance with an out-of-pocket maximum of $3,400 per person/$6,800 per family. o For a list of in-network providers, access the Plan Provider Directory section. Out-of-network benefits: o Deductible and coinsurance applies to all non-preventive, non-copay based services. o The deductible is $1,200 per person/$2,400 per family. o After satisfying the deductible, member responsibility is 30 percent coinsurance with an out-of-pocket maximum of $6,800 per person/$13,600 per family. Premiums are: o Based on the plan and coverage level selected, the employee s annual base salary and number of hours worked, the smoking status of the employee and the spouse or domestic partner as applicable, and whether the working spouse subsidy applies. o Deducted from the employee s paycheck on a before-tax basis (deductions taken from the first two paychecks each month). o To calculate your rates, refer to the Rate Calculator section. For more detailed information, refer to the Summary of Benefits and Coverage documents for the Blue Cross Blue Shield and UnitedHealthcare plans. High Deductible Plan An indemnity plan providing access to all providers (no network requirement). o Deductible and coinsurance applies to all non-preventive, non-copay based services. o The deductible is $1,350 per person/$2,700 per family. o After satisfying the deductible, member responsibility is 20 percent coinsurance with an out-of-pocket maximum of $4,300 per person/$8,600 per family. Premiums are: o Based on the plan and coverage level selected, the employee s annual base salary and number of hours worked, the smoking status of the employee and the spouse or domestic partner as applicable, and whether the working spouse subsidy applies. o Deducted from the employee s paycheck on a pre-tax basis (deductions taken from the first two paychecks each month). To calculate your rates for 2016, refer to the Rate Calculator section. For more detailed information, refer to the Summary of Benefits and Coverage document for the High Deductible plan. Travelers Benefits Handbook for Eligible Family Members 2016 Plan Information 2

5 High Deductible + HSA Plan An indemnity plan providing access to all providers (no network requirement). o Deductible and coinsurance applies to all non-preventive, non-copay based services. o The deductible is $1,350 single coverage/$2,700 family coverage. o After satisfying the deductible, member responsibility is 20 percent coinsurance with an out-of-pocket maximum of $4,300 for employee-only coverage or, for family coverage, $6,800 per individual/$8,600 per family. o For family coverage, the $2,700 deductible must be satisfied before any cost sharing will begin except when preventive prescription drugs are filled. o Preventive prescriptions are covered as described in the Prescription Drug section listed below. Nonpreventive prescriptions are subject to the deductible ($1,350 individual/$2,700 family) and then covered at 20 percent coinsurance up to the out-of-pocket maximum. Premiums are: o Based on the plan and coverage level selected, the employee s annual base salary and number of hours worked, the smoking status of the employee and the spouse or domestic partner as applicable, and whether the working spouse subsidy applies. o Deducted from the employee s paycheck on a pre-tax basis (deductions taken from the first two paychecks each month). To calculate your rates for 2016, refer to the Rate Calculator section. This medical plan is a Health Savings Account (HSA) qualified plan. The HSA is administered by Fidelity. For more detailed information, refer to the Summary of Benefits and Coverage document for the High Deductible + HSA Plan. Prescription Drug Express Scripts Prescription Drug Plan When you enroll in any of the medical plans offered by the company, you will automatically receive prescription drug coverage through Express Scripts. Prescription drug costs vary depending on if the drug is generic or brand-name; is purchased at a retail pharmacy or delivered to your home through Express Scripts; and if the drug is included on the Express Scripts formulary. o A formulary is a list of FDA-approved prescription drugs that are preferred by Express Scripts preferred list. o For details, refer to the formulary available sorted by condition or alphabetically. Below is an overview of the plan: Prescriptions (excluding fertility drugs*) Generic - Retail to 30 days - Mail to 90 days Formulary brand - Retail to 30 days - Mail to 90 days Non-formulary brand - Retail to 30 days - Mail to 90 days Prescription out-of-pocket maximum** Preferred home delivery for maintenance prescriptions Network Pharmacy You pay $9 copay You pay $18 copay You pay 20% coinsurance: $35 minimum, $140 maximum $70 minimum, $280 maximum You pay 40% coinsurance: $35 minimum, $140 maximum $70 minimum, $280 maximum $2,500 per member, $5,000 per family per calendar year You pay an additional 10% coinsurance for maintenance prescriptions filled more than twice at a retail pharmacy, excluding prescriptions filled at Walgreens, Duane Reade or CVS pharmacies Non-network Pharmacy If you fill a prescription at a nonparticipating pharmacy but had access to a participating pharmacy, you will be reimbursed for the negotiated pharmacy cost minus the applicable in-network coinsurance. If you did not have access to a participating pharmacy, the in-network coinsurance will apply. Travelers Benefits Handbook for Eligible Family Members 2016 Plan Information 3

6 90-day supply at retail (at Walgreens, Duane Reade and CVS pharmacies only) Generics preferred program (all medication classes except Coumadin and Synthroid) Generics: you pay three retail copays (for a total of $27) Formulary brand: you pay 20% coinsurance subject to a $105 minimum and a $420 maximum Non-formulary brand: you pay 40% coinsurance subject to a $105 minimum and a $420 maximum You pay the generic copay plus the cost difference between the generic and the brand name when a generic is available but not chosen *Specialty medicine sourced by the Accredo mail order pharmacy is subject to the retail prescription plan design. **The prescription drug annual out-of-pocket maximum per person includes both retail and mail order drug expenses (excluding infertility medications, which are covered at 50 percent in all plans except the High Deductible and the High Deductible + HSA Plan) and is separate from the medical plan's annual out-of-pocket expenses. Once you pay $2,500 in prescription drug copays and coinsurance, all retail and mail order prescription drugs (excluding infertility medications) filled during the remainder of the calendar year will be covered at 100 percent of eligible expenses. Dental Aetna Dental Plan Open access plan, which means you can use any licensed dental provider. o For a list of in-network providers, access the Plan Provider Directory section. Premiums are: o Based on the coverage level selected and the number of hours the employee works. o Deducted from the employee s paycheck on a pre-tax basis (deductions taken from the first two paychecks each month). o To calculate your rates, refer to the Rate Calculator section. For more detailed information, refer to the Dental Plan Summary Plan Description. Below is an overview of the plan: Plan Features In-Network Out-of-Network Deductible (excluding orthodontia) $75 per individual, $150 per family combined network/non-network $75 per individual, $150 per family combined network/non-network Orthodontia deductible None None Annual benefit maximum Lifetime orthodontia maximum Preventive services: exam and cleanings, fluoride, sealants, routine X-rays Basic services: fillings, routine extractions, peridontia, non-routine X-rays, endodontia, oral surgery Major services: Inlays, onlays and crowns $2,000 combined network/ non-network $2,000 combined network/ non-network Covered at 100%, no deductible Covered at 90% after deductible Covered at 60% after deductible $2,000 combined network/ non-network $2,000 combined network/ non-network Covered at 100%, no deductible Covered at 80% after deductible Covered at 50% after deductible Travelers Benefits Handbook for Eligible Family Members 2016 Plan Information 4

7 TMJ treatment Orthodontia services (Iimited to dependents under age 20) Covered at 50% after deductible to $750 lifetime maximum combined network/non-network Covered at 50%, no deductible to $2,000 lifetime maximum combined network/non-network Covered at 50% after deductible to $750 lifetime maximum combined network/non-network Covered at 50%, no deductible to $2,000 lifetime maximum combined network/non-network Vision EyeMed Vision Care Plan Participating vision plan providers include JCPenney Optical, LensCrafters, Pearle Vision, Sears Optical and Target Optical. o For a list of in-network providers, access the Plan Provider Directory section. Premiums are: o Based on the coverage level selected. o Deducted from the employee s paycheck on a pre-tax basis (deductions taken from the first two paychecks each month). o To calculate your rates, refer to the Rate Calculator section. For more detailed information, refer to the Vision Plan Summary Plan Description. Below is an overview of the plan: Plan Features Exam with dilation Standard contact lens fit and follow-up exam (e.g., disposable, frequent replacement, etc.) Premium contact lens fit and follow-up exam (e.g., toric, multifocal, etc.) Cost $10 copay $0 copay, paid in full up to two follow-up visits $0 copay, 10% off retail cost and a $40 allowance Frames $0 copay, 100% benefit up to $130 retail plan allowance*, 20% off retail cost over $130 Standard plastic lenses (single vision, bifocal, trifocal and lenticular) $10 copay Conventional contact lenses $10 copay, 100% benefit up to $130 retail plan allowance*, 15% off retail cost over $130 Disposable contact lenses Medically necessary contact lenses $10 copay, plus balance over $130 retail allowance $10 copay, paid in full Frequency Examination Frame Lenses OR contact lenses Once every 12 months Once every 12 months Once every 12 months Optional Lens Features** Polycarbonate lenses UV coating Standard scratch resistant lenses Standard anti-reflective coating $0 copay $15 copay $15 copay $35 copay Travelers Benefits Handbook for Eligible Family Members 2016 Plan Information 5

8 Standard progressive lenses Premium progressive lenses Contact lens replacement program U.S. laser network $50 copay 20% off retail price Available through the mail Discount of 15% or 5% off lowest advertised price for network provider for LASIK or PRK procedures *$130 allowance applies to retail price only, not sale priced frames or contacts. **In addition to standard lenses copay. Travelers Benefits Handbook for Eligible Family Members 2016 Plan Information 6

9 Life Insurance Information Overview While we hope you'll never have to use them, Travelers offers life and accidental death and dismemberment (AD&D) insurance designed to protect the lifestyle of you and your family during times of need. The insurance carrier for the plans listed below is the Metropolitan Life Insurance Company (MetLife). For detailed information about each plan, refer to the Life and AD&D Summary Plan Description. Basic Life/AD&D Travelers provides company-paid coverage equal to an employee s annual base salary up to $100,000. Employees are automatically enrolled. Includes life and AD&D coverage, which provides additional benefits to the employee s beneficiaries if the employee dies or is seriously injured/dismembered as the result of an accident. Employees can name any individual as the beneficiary for this benefit. Optional Life/AD&D Employees may purchase up to 10 times their annual base salary for a maximum of $5 million. Includes life and AD&D coverage, which provides additional benefits to the employee s beneficiaries if the employee dies or is seriously injured/dismembered as the result of an accident. Includes will preparation and estate resolution services through Hyatt Legal Plans, a MetLife company. When you are first eligible to purchase optional life insurance, if you elect more than four times your annual base pay or $2,600,000 in coverage, you will be required to provide medical evidence of insurability to MetLife. o If your application is not approved, your coverage will be limited to the lesser of four times your annual base pay or $2,600,000. o After your initial eligibility date, you will be required to provide medical evidence of insurability if you previously waived coverage or if you are electing to increase coverage during Annual Benefits Enrollment or during a qualified status change. A non-smoker discount is available for individuals who have not used tobacco products during the previous six months and must not intend to use tobacco products in the future. The optional life/ad&d insurance beneficiary is the same as the beneficiary for the basic life/ad&d plan. Premiums are: o Based on the amount of coverage elected, as well as the employee s current age and smoker status. o Deducted from the employee s paycheck on an after-tax basis (deductions taken from the first two paychecks each month). o To calculate your rates, refer to the Rate Calculator section. Travelers Benefits Handbook for Eligible Family Members 2016 Plan Information 7

10 Spouse Life/AD&D Employees may purchase from $20,000 to $200,000 of coverage in $20,000 increments for their spouse or domestic partner. Includes life and AD&D coverage, which provides additional benefits to the spouse s or domestic partner s beneficiaries if the individual dies or is seriously injured/dismembered as the result of an accident. The employee is automatically the beneficiary for this benefit; no other beneficiary designation is required or allowed. Employees may elect more than $40,000 in coverage when their spouse or domestic partner is first eligible for spouse life insurance. o The employee s spouse or domestic partner will be required to provide medical evidence of insurability to MetLife. o If the application for the amount over $40,000 is not approved, coverage will be limited to $40,000. o After the initial eligibility date for spouse life coverage, the employee s spouse or domestic partner will be required to provide medical evidence of insurability if coverage was previously waived or if the employee is electing to increase coverage during Annual Benefits Enrollment or during a qualified status change. A non-smoker discount is available for individuals who have not used tobacco products during the previous six months and must not intend to use tobacco products in the future. The employee is automatically the beneficiary for spouse life/ad&d insurance. Premiums are: o Based on the amount of coverage elected, as well as the spouse s or domestic partner s current age and smoker status. o Deducted from the employee s paycheck on an after-tax basis (deductions taken from the first two paychecks each month). o To calculate your rates, refer to the Rate Calculator section. Child Life Employees may purchase from $5,000 to $25,000 of coverage in $5,000 increments. From birth to six months, the benefit level is limited to $1,000. Medical evidence of insurability is not required when your child is first eligible for child life insurance; after the initial eligibility date, evidence of insurability will be required if you previously waived coverage or are increasing coverage. The employee is automatically the beneficiary for child life/ad&d insurance. Premiums are: o Based on the amount of coverage elected. o Deducted from the employee s paycheck on an after-tax basis (deductions taken from the first two paychecks each month). o To calculate your rates, refer to the Rate Calculator section. Business Travel Accident The Business Travel Accident Insurance Plan provides the employee with 24-hour coverage while traveling on business away from the premises of Travelers. The plan will pay benefits if the employee dies or is injured as the result of an accident which occurs while traveling on company-approved business. If the employee s spouse or domestic partner or their children die or are injured as a result of an accident while traveling with the employee on company-approved business, the plan will also pay benefits. The Life Insurance Company of North America is the insurance carrier for this plan. Comprehensive information about this benefit plan is contained within the Business Travel Accident Insurance Summary Plan Description. Travelers Benefits Handbook for Eligible Family Members 2016 Plan Information 8

11 Flexible Spending Account Information Overview Helping you stretch your hard-earned dollars further, Travelers offers Dependent Care and Health Care Spending Accounts as part of the company's employee benefits package. Both spending accounts provide you with the opportunity to fund dependent care and health care expenses through pretax payroll. Since pre-tax deductions are not considered taxable income, these accounts can save you money by reducing your taxable income. Any reimbursement that you receive from the accounts is tax-free. Dependent Care Spending Account (DCSA) Minimum contribution = $200; maximum contribution = $5,000. The DCSA is a use it or lose it account, which means the IRS requires that money accrued in your account for a calendar year cannot be refunded to you, carried over beyond March 15 of the next calendar year or transferred to another account. o If your claim for reimbursement does not meet the eligibility requirements or fall within the assigned timeframe, the money in your account will be forfeited. An eligible dependent is either a qualifying child up to age 13 or a mentally or physically disabled individual regardless of age (a disabled individual is your spouse, a qualifying child or a qualifying relative). For specific information about eligibility and other plan details, refer to the Flexible Spending Account Summary Plan Description. Eligible and ineligible dependent care expenses are determined by the IRS. Participants in the DCSA must submit claim forms to WageWorks for reimbursement. Health Care Spending Account (HCSA) Minimum contribution = $200; maximum contribution = $2,550. Only covered expenses incurred between January 1 of the calendar year for which you have made your election and March 15 of the following plan year will be considered eligible for reimbursement, provided these expenses are submitted by April 15 of that following plan year. Eligible and ineligible health care expenses are determined by the IRS. Participants in the HCSA can elect to be reimbursed via automatic claim submission, by using a Benefit Card or by filing manually. o Additional information is available regarding the Benefit Card. For plan details, refer to the Flexible Spending Account Summary Plan Description. Travelers Benefits Handbook for Eligible Family Members 2016 Plan Information 9

12 Identity Fraud Insurance Plan Information Overview The Travelers company-paid identity fraud coverage is provided to protect employees and their eligible family members should they fall victim to identity fraud. Plan Details The Travelers policy provides expense reimbursement up to $2,500 per covered person for named expenses incurred as a result of remedying an identity fraud event. To assist in recovering from identity fraud and in restoring financial health and credit history, the benefit provides a custom Identity Fraud Risk Management website and dedicated fraud specialists who will assist employees in the event they are a victim of identity fraud. For plan details, refer to the Identity Fraud Insurance Plan Summary Plan Description. Travelers Benefits Handbook for Eligible Family Members 2016 Plan Information 10

13 Legal Insurance Plan Information Overview The legal insurance plan provides employees and eligible family members with access to a variety of legal services through ARAG. Plan Details Most attorneys' fees are 100 percent paid-in-full, without copays or deductibles, when you use a network attorney. Covered services include wills, property protection and transfers, powers of attorney, guardianship, dissolution of marriage, IRS audit protection and more. Telephone legal services and online legal resources are also provided. The cost for this benefit is deducted from the employee s paycheck on an after-tax basis (deductions taken from the first two paychecks each month). o To calculate your rates, refer to the Rate Calculator section. For plan details, refer to the Legal Insurance Plan Summary Plan Description. Travelers Benefits Handbook for Eligible Family Members 2016 Plan Information 11

14 Employee Assistance Program Overview Travelers has contracted with Harris Rothenberg, International to offer employees and their family members access to the Family Connection program. Through this employee assistance program, you can access professional counseling services and work-life seminars, resources and referrals. The program is confidential and free, and representatives are available 24 hours a day, seven days a week. Information is available about the following topics: Addiction Adoption Career development Child and elder care Depression Financial and legal issues Finding and paying for school Grief and loss Health and wellness Parenting/discipline Relationship issues Retirement planning Separation/divorce Stress and anxiety Contact Information Call (TTY: ) to speak with a trained specialist who can provide guidance and/or referrals to local service providers. You can also access the Employee Assistance Program website (user name: travelers, password: eap) for links to additional information and resources. Travelers Benefits Handbook for Eligible Family Members 2016 Plan Information 12

15 Rate Calculator Overview The rate calculator provides an estimate of the cost per paycheck for the following benefits: Medical Dental Vision Optional life insurance Legal insurance plan Using the Rate Calculator To access the rate calculator, click here. You will need to enter the employee work status and annual base salary, as well as tobacco use information for you and the employee. Travelers Benefits Handbook for Eligible Family Members 2016 Plan Information 13

16 Eligibility and Enrollment Information Eligibility Employee Eligibility Employees are generally eligible to participate in the Travelers benefit plans if they are a regular status, salaried employee who is scheduled to work at least 20 hours a week. Definition of Eligible Family Members An employee s spouse, children, sponsored dependents, domestic partner and children of a spouse or domestic partner are eligible for coverage if they meet the specific eligibility requirements and if coverage is elected under the plan. For specific information, refer to the Summary Plan Descriptions. Enrollment New Employees New employees can enroll in benefits within 31 days of their date of hire. Benefits are effective retroactive to date of hire. Current Employees Current employees may change their benefit elections: o During the Annual Benefits Enrollment period, typically held in October or o Within 31 days of a qualified status change event if the change in benefit coverage is consistent with the qualified status change (a qualified status change includes events such as the birth of a child, marriage or divorce). For specific information about qualified status changes, refer to the Summary Plan Descriptions. Travelers Benefits Handbook for Eligible Family Members 2016 Plan Information 14

17 Plan Provider Directory Refer to the providers listed below for plan-related questions and provider directories. If you have general questions regarding your benefits, contact the Travelers Employee Services Unit (ESU) at Provider Name Phone Number Group Number Website/Provider Directory Dental Aetna Dental Provider Directory Note: Select Dental PPO/PDN with PPO II network. Employee Assistance Program (EAP) Employee Assistance Program Employee Assistance Program Website (user name: travelers, password: eap) Flexible Spending Accounts WageWorks WageWorks website Identity Fraud Insurance Identity Fraud Insurance Legal Insurance Plan ARAG ARAG Legal Center Click on Member Login and enter the personal user name and password you created after enrolling in the plan. Life/AD&D MetLife Medical Blue Cross Blue Shield (BCBS) Plan UnitedHealthcare (UHC) Choice Plus, High Deductible, High Deductible + HSA and Out-of-Area Plans EP632 Blue Cross Blue Shield Plan Website To view the BCBS Provider Directory, click the link above and then select Find a doctor myuhc Website Provider Directory Greater Minnesota and western Wisconsin area participants are part of the Minnesota Passport Network and should use the Medica provider directory. Click on the Member Through WorK link and then select Medica Choice with United Healthcare Choice Plus. United Behavioral Health Mental Health Provider Directory Prescription Drug Express Scripts SSTV Current Enrollee: Express Scripts Website Prospective Enrollee: Express Preview Website Vision EyeMed Vision Current Enrollee: EyeMed Vision Care Website Choose the Select network. Prospective Enrollee: EyeMed Provider Locator Travelers Benefits Handbook for Eligible Family Members 2016 Plan Information 15

18 Summary Plan Descriptions Within the following Summary Plan Description documents, you will find a table of contents that will assist you with navigation. Simply click on a subject from the table of contents and you will be linked to the page on which that topic appears. Introduction Business Travel Accident Insurance Dental Flexible Spending Accounts Identity Fraud Insurance Legal Insurance Plan Life and AD&D Medical Qualified Status Changes Vision Travelers Benefits Handbook for Eligible Family Members 2016 Plan Information 16

19 2017 Annual Benefits Enrollment Overview The 2017 Annual Benefits Enrollment period begins Wednesday, Oct. 19, and ends at 8 p.m. ET/7 p.m. CT on Friday, Nov. 4, During the enrollment period, employees are able to enroll in the following benefits: Dental Dependent Care Spending Account Excess Liability Insurance Health Care Spending Account Legal Services Plan Life Insurance Child, Optional and Spouse Long-Term Disability Medical Prescription Drug Purchased Paid Time Off (PTO) Vision For comprehensive information about all of these benefits and to complete their 2017 benefit elections, employees should refer to myhr. For your reference as an eligible family member, below is information about what s changing for 2017 and some additional resources you can use as your family member makes his or her 2017 benefit elections. What s Changing Click here to access an overview of what s changing for Resources 2017 Rate Calculator: Provides an estimate of the cost per paycheck for the medical, dental, vision, optional life insurance and legal services plans Summary of Benefits and Coverage documents: o Blue Cross Blue Shield medical plan o High Deductible + HSA medical plan o High Deductible medical plan o UnitedHealthcare medical plan How to Choose a Medical Plan: Compares the medical plan options available to help you choose what might be right for you and your family. 17 travelers.com The information in this overview is only a summary and is not intended to fully describe the Travelers employee benefit programs. To the extent there is any information missing from the overview or any inconsistency between the information in the overview and the official plan documents and Summary Plan Descriptions for the benefit programs, the plan documents and Summary Plan Descriptions control The Travelers Indemnity Company. All rights reserved. Travelers and the Travelers Umbrella logo are registered trademarks of The Travelers Indemnity Company in the U.S. and other countries. Rev