BENEFIT GUIDE

Transcription

1 BENEFIT GUIDE You are eligible for open enrollment NOW! THE WEEKLY COST IS DEDUCTED FROM YOUR CHECK AND YOU CAN STOP YOUR BENEFITS AT ANY TIME! Keep benefits between job assignments without having to pay! FOR LESS THAN $2.31 PER DAY, THIS BENEFIT PLAN HELPS PAY THE COST ASSOCIATED WITH: Pharmacy Benefits Wellness Benefits Doctor Office Visits Diagnostic Testing and more! All plans include $10,000 of life insurance PLUS life insurance benefits for your family! ALSO INCLUDES: Nationwide PPO Network 24 Hour Doctor Hotline 24 Hour Nurse Hotline Member Discount Card Health Advocate and more! Questions? Call us toll-free at Benefit agents are available from 8:00 am to 7:00 pm EST

2 Benefits at a Glance Benefits to Include Silver Gold Outpatient Indemnity Benefits Doctor Office Visit - 6 visits per calendar year $50 $80 Wellness Visit - 1 visit per calendar year $50 $100 Diagnostic Tests X-Ray and Lab - 4 testing days per calendar year $100 $200 In-Hospital Indemnity Benefits Daily In-Hospital Indemnity Benefit - Maximum of 30 days per confinement In-Hospital and Surgical Additional Indemnity Benefit - Maximum of 1 confinement per calendar year. Intensive Care Indemnity Benefit - Maximum of 30 days per calendar year Accident Injury Benefit $200 $0 $0 $1,000 $500 $1,000 Off-the-Job Accidental Injury Benefit - Maximum of 5 covered accidents per calendar year $100 $1,000 Surgical & Anesthesia Indemnity Benefit Surgical Benefit (see Surgical Schedule) Anesthesiology - 20% of the surgical benefit amount. Group Term Life Insurance with Accidental Death & Dismemberment (AD&D) Term life insurance available for employee, spouse and children. AD&D not available for children. Employee Life $10,000 / Spouse Life $5,000 / Children Life only $2,500 Critical Illness $1,000 Up to $200 $1,500 Up to $300 When a covered person is diagnosed for the first time with a covered critical illness, the selected amount will be paid. Payable up to 2 times for each covered person, first under the Critical Illness Indemnity Benefit and then under Subsequent Benefit. Dependent coverage 50% of amount. $0 $2,500 Prescription Benefit Prescription Drug Indemnity Benefit - Generic Only, $10 Retail Copay, $30 Mail Copay; $250 per employee/ $500 per family monthly maximum. Premium Rate Employee Employee + Spouse Employee + Child(ren) Family Silver Weekly $16.14 $25.85 $23.91 $34.11 Gold Weekly $36.55 $63.59 $56.69 $84.46 PROVIDERS CAN BE FOUND AT OR BY CALLING Dental* Maximum Available Allowance $1,000 Coinsurance Diagnostic and Preventative Services: 80% Basic Restorative Services: 50% Major Restorative Services: 50% Deductible $50 Waived for Diagnostic and Preventative Services. No Family Maximum Waiting Period Weekly Dental Rates No Waiting Period for Diagnostic and Preventative and Basic Restorative Services 12 Months for Major Restorative Services Employee Employee + Spouse Employee + Child(ren) Family $4.75 $9.24 $10.03 $15.50 PROVIDERS CAN BE FOUND AT OR BY CALLING *Employee participation in Group Hospital Indemnity Plan is required to elect this coverage.

3 Vision Coverage is not affiliated with The Guardian Life Insurance Company of America a/k/a The Guardian or Guardian Life. Benefits Examination Lenses Frames Once every 12 months Once every 12 months Once every 24 months Examination Co-Pay $10 Materials Co-Pay $25 Benefits Participating Provider Non-Participating Provider* Examination 100% Up to $40 Single / Bifocal /Trifocal Lens (Standard Plastic) 100% Up to $40 / $60 / $80 Polycarbonate Lenses $0 for members age 19 and under, $30 for members over age 19 N/A Standard Progressive Lenses $50 additional co-pay N/A Standard Photochromic Lenses $60 additional co-pay N/A Frames** 100% Up to $45 Contact Lenses-Medically Necessary*** $250 allowance Up to $225 Contact Lenses-Elective**** $100 allowance Up to $100 Contact - Fitting $30 allowance N/A Laser Eye Surgery Access to discounted refractive eye surgery procedures from selected provider locations. Weekly Rates Employee Only $1.83 Employee, Spouse $3.28 Employee, Child $3.66 Family $5.16 PROVIDERS CAN BE FOUND AT OR BY CALLING

4 Customer Service Center P.O. Box Knoxville, TN IMPORTANT BENEFIT INFORMATION! Review the information in this enrollment guide today. Please complete and return the provided enrollment form or call to enroll!

5 What can you offer? First Staff Benefits First Staff Benefits was uniquely built for and specifically serves individuals in the staffing industry. We provide high quality enrollment and customer service solutions for your business. Our flexibility allows us to offer unique services including: enrollment & customer service support; claims assistance; billing administration; and marketing services. We realize the importance of investing in state-ofthe-art technology and doing so allows us to meet growth demands and maintain the most up-todate reporting capabilities. What is UNIQUE about the plans offered by? With input from the staffing industry, we build a program with the following features: NO deductibles NO co-insurance NO pre-existing condition restrictions (including maternity) NO annual benefit maximums that impeded claims payments once a certain dollar amount has been spent Unique Gap in Coverage administration A plan that truly provides first dollar benefits We understand that limited medical benefit plans are not major medical insurance. At First Staff Benefits, we work hard to make sure that your associates understand that also. Our benefits are constructed to provide the highest level of benefit possible based on weekly premiums with as few roadblocks as possible to meet the goal of paying most of the cost of getting care. We know that we can t meet every possible expectation with our benefit platform, but as we illustrated above we can certainly provide a superior program in the industry for the vast majority of your associate population. 1

6 What makes DIFFERENT? Our history in this business: First Staff Benefits is a subsidiary of Enrollment First, which is a licensed/bonded Third Party Administrator (TPA). Enrollment First has been in operation for 10 years and currently serves over 1,000 client companies in the temporary/contract staffing, transportation, retail and hospitality markets. First Staff Benefits is the only full-service insurance provider in the health insurance market that is a Corporate Sponsor of the American Staffing Association. This represents a substantial financial commitment to the staffing industry. Gap in coverage administration: We allow your associates to utilize their insurance coverage when they are between work assignments. Our gap process allows them to go up to five weeks between assignments without having to pay premium directly to First Staff Benefits. In addition, if your associate incurs a claim while on gap, we take the back premium due out of the claim and advance the balance to the medical provider. We are the only plan option that does not require the insured to pay premium due when in gap status prior to paying a medical claim. Claims payment processes: Over 98% of our claims are paid at the provider level, meaning that the medical facility does not ask your associate to pay for services in advance and file their own claim with the insurance company. Our unique web-based claim system allows providers to go to the web and file claims electronically, guaranteeing fast payment. This is another service that is only available through First Staff Benefits. On-going customer service: Our call center is located in our home office in Knoxville, TN and is open from 8:00 AM to 7:00 PM EDT Monday through Friday. Our staff can assist your associates with any question. When they call us, they will speak to a person, not a machine. Patient Advocate Program: We understand that you are offering your associates a limited benefit medical plan. There is a possibility that the charges they incur for medical services may exceed their benefit plan, therefore leaving the individual with out-of-pocket costs. in all of our plans is our Patient Advocate Program that is there to both negotiate out-of-pocket medical costs and payment plans with providers. Should this happen to one of your associates, we are there to help them in every way possible! Rate Guarantee: We guarantee our rates to January 1, In addition, we are not required to operate under a health care reform waiver issued by the Department of Health & Human Services. With First Staff Benefits you maintain both control and cost of your associate benefit program. 2