2015 External Employee Benefits

Transcription

1 2015 External Employee Benefits Corporate Office 9995 N. Gate Parkway Suite 100 Jacksonville, FL (904) Fax (904) Nashville Office 3000 Meridian Blvd., Bldg. A Suite 160 Franklin, TN (615) Orlando Office 151 Southhall Lane Suite 170 Maitland, FL (407) Fax (407) Tampa Office 5426 Bay Center Drive Suite 150 Tampa, FL (813) Fax (813) Atlanta Office 1230 Peachtree Street Suite 2350 Atlanta, GA (404) Fax (404) Beginning on January 1, 2015 The CSI Companies will be offering a new benefit package to eligible employees. Essential StaffCARE Indemnity Plan - Eligibility: Day 1 of assignment - Limited indemnity plan - All employees are eligible to sign up within 30 days of the beginning of an assignment - Premiums will be paid by a convenient weekly payroll deduction - Benefits will become effective the Monday following the first payroll deduction - This plan pays a set dollar amount towards covered services, such as doctor and hospital visits, immunizations, and prescriptions - You must either enroll in or decline this benefit - Click HERE to be taken to the enrollment portal - This is not major medical insurance and does not satisfy the requirements of the Individual Mandate. If you sign up for this plan you may be subject to a penalty. Essential StaffCARE MEC Wellness/Preventive Plan - Eligibility: Day 1 of assignment - Minimum Essential Coverage plan - All employees are eligible to sign up within 30 days of the beginning of an assignment - Premiums will be paid monthly directly to Essential StaffCARE via a convenient credit card payment - Benefits will become active the first day of the month following your first credit card payment - This plan covers the 63 mandated benefits to qualify as Minimum Essential Coverage under the Affordable Care Act - You must either enroll in or decline this benefit - Click HERE to be taken to the enrollment portal - This plan satisfies the requirements of the Individual Mandate, so if you sign up for this plan you will not be subject to a penalty. United Healthcare Plans - Eligibility: First of the month following a 60 day waiting period for all fulltime employees - Major medical insurance - Available to all employees who work at least 30 hours per week and who satisfy a 60 day waiting period. - Premiums will be paid by a convenient weekly payroll deduction

2 - Eligible employees will receive an with online enrollment instructions once they have completed the applicable waiting period. - These plans have both inpatient and outpatient benefits - CSI will pay $250 towards the plan of your choice - You must either enroll in or decline this benefit. - These plans satisfie the requirements of the Individual Mandate, so if you sign up for one of these plans you will not be subject to a penalty.

3 GREAT NEWS! We are now offering TWO Great Plans from Essential StaffCARE ESC Fixed Indemnity Care Plan ESC Fixed Indemnity Health Care Plans starting at $19.98 per week Medical, Rx, Dental and Vision Benefits Doctor Office Visit Benefit of $100 per day Wellness Benefit of $100 No Pre-existing Condition Limitations No Waiting Period on Medical No Deductibles on Medical No Surgical Schedule MEC Wellness/Preventive Plan MEC Wellness/Preventive Plan starting at $74.31 per month Covers the 63 Mandated Benefits to qualify as Minimum Essential Coverage Eliminates employee Individual Mandate tax for those enrolled First Health Network Monthly Direct Payment Options for Family Coverage Employee Only Employee + Child(ren) Employee + Spouse Employee + Family $19.98 $33.17 $37.96 $50.55 Employee Only Employee + Child(ren) Employee + Spouse Employee + Family $74.31 $ $ $ For additional information, or to enroll, please click HERE Essential StaffCARE Customer Service: Once enrolled, members can call this number for questions regarding plan coverage, ID card, claim status, policy booklets, and to add, change, or cancel coverage. Customer Service Call Center hours are M - F, 8:30 a.m. to 8 p.m. Eastern Standard Time. Bilingual representatives are available. Once you see a deduction for the ESC Fixed Indemnity Plan, your coverage will begin the Monday following your paycheck deduction. The MEC Wellness/Preventive Plan will be payable via direct payment. Information will be sent to you once you enroll.

4 Option 1: ESC Fixed Indemnity Care Plan Plan 1 Medical Network First Health Network Network Provider Must Accept Plan Yes Pre-Existing Limitation None Wellness Care (once per year) $100 Inpatient Benefits First Hospital Admission (once per year) $250 Daily Room & Board Maximum $300 per day Daily Intensive Care Unit 2 $400 per day Surgery $2,000 per day Anesthesiology $400 per day Skilled Nursing 3 $100 per day Outpatient Benefits Annual Outpatient Maximum $2,000 Physician Office Visit 1 (includes lab and x-ray performed in the physician s office) $100 per day Diagnostic Lab 1 (performed outside the physician s office) $75 per day Diagnostic X-ray 1 (performed outside the physician s office) $200 per day Ambulance Services 1 $300 per day Emergency Room Benefit - Sickness 1 $200 per day Emergency Room Benefit - Accident 1 $500 per day Outpatient Surgery 1 $500 per day Anesthesiology 1 $200 per day Physical, Occupational, and Speech Therapy 1 $50 per day Prescription Drug Annual Maximum $600 Prescription Drug Benefits $20 per day Prescription Drug Network Caremark Employee Only Weekly Rates $19.98 Employee Plus Child(ren) Weekly Rates $33.17 Employee Plus Spouse Weekly Rates $37.96 Employee Plus Family Weekly Rates $ up to annual outpatient maximum 2 pays in addition to standard care benefit 3 payable for stays in a skilled nursing facility after a hospital stay Page 4

5 Dental, Vision, Term Life, STD, & AD&D Dental Benefits Annual Maximum Benefit $750 Deductible $50 Waiting Period Co-insurance Coverage A None 80% Exams, Intraoral Films and Bitewings Coverage B 3 months 60% Fillings, Oral Surgery, Repairs for Crowns, Bridges & Dentures Coverage C 12 months 50% Periodontics, Crowns, Bridges, Endodontics and Dentures Employee Only $5.23 Employee + Child(ren) $14.12 Employee + Spouse $10.46 Employee + Family $19.87 Term Life Benefits Employee Amount $10,000 (reduces to $7,500 at 65; $5,000 at age 70) Child Amount (6 months to 26 years old) $5,000 Spouse Amount $5,000 (terminates at age 70) Infant Amount (15 days to 6 months) $1,000 Employee Only $0.60 Employee + Spouse $0.90 Employee + Child(ren) $0.90 Employee + Family $1.80 Benefit Waiting Period / Maximum Benefit Period Vision Benefits In-Network Short-Term Disability 60% of Salary up to $150 per week 7 days / 26 weeks Employee Only $4.20 * Once every 12 months. ** Once every 24 months. *** Single Vision: $25, Bifocal: $40, Trifocal: $55 Discount on balance above allowed amount; Frames: 20%, Conventional Contact Lenses: 15%. Out-of-Network Eye Examination for Glasses (including dilation) Co-pay: $10, plan pays 100% Plan pays $35, you pay remaining balance Frames** Plan pays $110 allowance Plan pays $55 Standard Plastic Lenses for Glasses* Co-pay: $25, plan pays 100% Co-pay: $0, plan pays $25-$55*** Standard Contact Lens Fit* Plan pays up to $55 You pay 100% of the price Premium Contact Lens Fit* Plan pays 10% off the price You pay 100% of the price Contact Lenses or Disposable Lenses* Plan pays $110 allowance Plan pays $88 Contact Lenses Medically Necessary* Plan pays 100% Plan pays $200 Employee Only $2.35 Employee + Child(ren) $3.10 Employee + Spouse $4.18 Employee + Family $7.58 Accidental Death & Dismemberment Employee Amount $20,000 Child Amount (6 months to 26 years old) $5,000 Spouse Amount $20,000 Infant Amount (15 days to 6 months) $2,500 Accidental Death & Dismemberment is part of the Term Life Benefit Weekly Rates Weekly Rates Weekly Rates Weekly Rates Page 5

6 OPTION 2 - MEC WELLNESS/PREVENTIVE PLAN BENEFITS AT A GLANCE Policy Number M-CSP Abdominal Aortic Aneurysm Alcohol Misuse Aspirin Blood Pressure Cholesterol ACA Required Wellness and Preventive Benefits Adults The MEC Plan covers 100% of the allowed amount in network; 40% out of network One time screening for men of specified ages who have ever smoked Screening and counseling Use for men and women of certain ages Screening for all adults Screening for adults of certain ages or at higher risk Colorectal Cancer Screening for adults over 50 Depression Type 2 Diabetes Diet HIV Screening for adults Screening for adults with high blood pressure Counseling for adults at higher risk for chronic disease Screening for all adults at higher risk Immunization Vaccines for adults doses, recommended ages, and recommended populations vary: Hepatitis A, Hepatitis B, Herpes Zoster, Human Papillomavirus, Influenza (Flu shot), Measles, Mumps, Rubella, Meningococcal, Pneumococcal, Tetanus, Diphtheria, Pertussis, Varicella Obesity Screening and counseling for all adults Sexually Transmitted Infection (STI) Prevention counseling for adults at higher risk Tobacco Use Screening for all adults and cessation Syphilis Screening for all adults at higher risk Women, Including Pregnant Women The MEC Plan covers 100% of the allowed amount in network; 40% out of network Anemia Screening on a routine basis for pregnant women Bacteriuria Urinary tract or other infection screening for pregnant women BRCA Counseling about genetic testing for women at higher risk Breast Cancer Mammography Screenings every 1 to 2 years for women over 40 Breast Cancer Chemoprevention Counseling for women at higher risk Breastfeeding Comprehensive support and counseling from trained providers, as well as access to breastfeeding supplies, for pregnant and nursing women Cervical Cancer Screening for sexually active women Chlamydia Infection Screening for younger women and other women at higher risk Contraception Food and Drug Administration approved contraceptive methods, sterilization procedures, and patient education and counseling, not including abortifacient drugs Domestic and Interpersonal Violence Screening and counseling for all women Folic Acid Supplements for women who may become pregnant Gestational Diabetes Screening for women 24 to 28 weeks pregnant and those at high risk of developing gestational diabetes Gonorrhea Screening for all women at higher risk Hepatitis B Screening for pregnant women at their first prenatal visit Human Immunodeficiency Virus (HIV) Screening and counseling for sexually active women Human Papillomavirus (HPV) DNA Test High risk HPV DNA testing every three years for women with normal cytology results who are 30 or older Osteoporosis Screening for women over age 60 depending on risk factors Rh Incompatibility Screening for all pregnant women and follow-up testing for women at a higher risk Tobacco Use Screening and interventions for all women, and expanded counseling for pregnant tobacco users Sexually Transmitted Infections (STI) Counseling for sexually active women Syphilis Screening for all pregnant women or other women at increased risk Well-Woman Visits To obtain recommended Preventive services for women under 65

7 OPTION 2 - MEC WELLNESS/PREVENTIVE PLAN BENEFITS AT A GLANCE Alcohol and Drug Use Autism ACA Required Wellness and Preventive Benefits Children The MEC Plan covers 100% of the allowed amount in network; 40% out of network Assessments for adolescents Screening for children at 18 and 24 months Policy Number M-CSP Behavioral Assessments for children of all ages: 0-11 months; 1 to 4 years; 5 to 10 years; 11 to 14 years; 15 to 17 years Blood Pressure Screenings for children: 0-11 months; 1 to 4 years; 5 to 10 years; 11 to 14 yers; 15 to 17 years Cervical Dysplasia Screening for sexually active females Congenital Hypothyroidism Screening for newborns Depression Screening for adolescents Developmental Screening for children under age 3, and surveillance throughout childhood Dyslipidemia Screening for children at higher risk of lipid disorders. Ages: 1 to 4 years; 5 to 10 years; 11 to 14 years; and 15 to 17 years Fluoride Chemoprevention Supplements for children without fluoride in their water source Gonorrhea Preventive medication for the eyes of all newborns Hearing Screening for all newborns Height, Weight, and Body Mass Index Measurements for children ages: 0-11 months; 1 to 4 years; 5 to 10 years; 11 to 14 years; 15 to 17 years Hematocrit or Hemoglobin Screening for children Hemoglobinopathies Or Sickle Cell screening for newborns HIV Screening for adolescents at higher risk Immunization Vaccines for children from birth to age 18-- doses, recommended ages, and recommended populations vary: Diphtheria, Tetanus, Pertussis, Haemophilus Influenzae Type B, Hepatitis A, Hepatitis B, Human Papillomavirus, Inactivated Poliovirus, Influenza (Flu Shot), Measles, Mumps, Rubella, Meningococcal, Pneumococcal, Rotavirus, Varicella Iron Supplements for children ages 6 to 12 months at risk for anemia Lead Screening for children at risk of exposure Medical History For all children throughout development: Ages: 0-11 months; 1 to 4 years; 5 to 10 years; 11 to 14 years; 15 to 17 years Obesity Screening and counseling Oral Health Risk assessment for young children: Ages: 0 to 11 months; 1 to 4 years; 5 to 10 years Phenylketonuria (PKU) Screening for this genetic disorder in newborns Sexually Transmitted Infection (STI) Prevention counseling and screening for adolescents at higher risk Tuberculin Testing for children at higher risk of tuberculosis: Ages 0 to 11 months; 1 to 4 years; 5 to 10 years; 11 to 14 years; and 15 to 17 years Vision Screening for all children Monthly Rates Employee Only $74.31 Employee + Child(ren) $ Employee + + Spouse $ Employee + Family + Family $213.70

8 BENEFITS Medical PROVIDER Choice Plus 0F5 M / Rx 02V In Network Benefits Unlimited Maximum Policy Benefit Coinsurance: 70% / 30% Calendar Year Deductible: $2,500 Individual / $5,000 Family Physician Office Visit: $30 Copay Specialist Office Visit: $60 Copay Preventive Care Services: 100% / $0 Annual Deductible Inpatient Hospital: Deductible + 30% Coinsurance Outpatient Surgery: Deductible + 30% Coinsurance Emergency Room: $400 Copay Urgent Care: $75 Copay Max Out of Pocket: Individual $6,350 / Family $12,700 (Includes Deductible, Coinsurance, and Copayments) RX Copays: Tier 1 $10 / Tier 2 $35 / Tier 3 $60 Choice Plus 0MI M / Rx 00I In Network Benefits Unlimited Maximum Policy Benefit Coinsurance: 50% / 50% Calendar Year Deductible: $5,000 Individual / $10,000 Family Physician Office Visit: $40 Copay Specialist Office Visit: $80 Copay Preventive Care Services: 100% / $0 Annual Deductible Inpatient Hospital: 50% After $500 Per Occurrence Deductible + Annual Deductible Outpatient Surgery: 50% After $250 Per Occurrence Deductible + Annual Deductible Emergency Room: $300 Copay Urgent Care: $100 Copay United Healthcare Plans January 1st, 2015 December 31, 2015 Benefit Eligibility: First of the month following 60 days of employment for full time employees who work 30+ hours per week BENEFIT DESCRIPTION Please See Certificate of Coverage for Out of Network Max Out of Pocket: Individual $6,350 / Family $12,700 (Includes Deductible, Coinsurance, Copays & Per Occurrence Deductibles) RX Copays: Tier 1 $10 / Tier 2 $35 / Tier 3 $70 Please See Certificate of Coverage for Out of Network Choice 0KR M / Rx 02V In Network Benefits Unlimited Maximum Policy Benefit Coinsurance: 100% / 0% Calendar Year Deductible: $2,000 Individual / $6,000 Family Physician Office Visit: $25 Copay Specialist Office Visit: $50 Copay Preventive Care Services: 100% / $0 Annual Deductible Inpatient Hospital: Deductible Outpatient Surgery: Deductible Emergency Room: $200 Copay Urgent Care: $75 Copay Max Out of Pocket: Individual $4,000 / Family $12,000 (Includes Deductible, Coinsurance, and Copayments) RX Copays: Tier 1 $10 / Tier 2 $35 / Tier 3 $60 No Out of Network Coverage Choice Plus 0L8 M / Rx 02V (For Employees in the following states AL, AR, AZ, HI, KS, LA, MN, MS, MT, NC, NM, OK) In Network Benefits Unlimited Maximum Policy Benefit Coinsurance: 100% / 0% Calendar Year Deductible: $2,000 Individual / $6,000 Family Physician Office Visit: $25 Copay Specialist Office Visit: $50 Copay Preventive Care Services: 100% / $0 Annual Deductible Inpatient Hospital: Deductible Outpatient Surgery: Deductible Emergency Room: $200 Copay Urgent Care: $75 Copay Max Out of Pocket: Individual $4,000 / Family $12,000 (Includes Deductible, Coinsurance, and Copayments) RX Copays: Tier 1 $10 / Tier 2 $35 / Tier 3 $60 Please See Certificate of Coverage for Out of Network Employer Monthly Premium Employer Monthly Premium Emp/Spouse $2, $ Emp/Spouse $ Emp/Child(ren) $2, $ Emp/Child(ren) $ Family $3, $ Family $ Employer Monthly Premium Employer Contribution Per Month Employee Weekly Deductions Employee $1, $ Employee $ Emp/Spouse $3, $ Emp/Spouse $ Emp/Child(ren) $2, $ Emp/Child(ren) $ Family $4, $ Family $ Employer Monthly Premium PREMIUMS Employer Contribution Per Month Employee $1, $ Employee $ Emp/Spouse $2, $ Emp/Spouse $ Emp/Child(ren) $2, $ Emp/Child(ren) $ Family $4, $ Family $ Employer Contribution Per Month Employer Contribution Per Month Employee Weekly Deductions Employee $1, $ Employee $ Employee Weekly Deductions Employee Weekly Deductions Employee $1, $ Employee $ Emp/Spouse $3, $ Emp/Spouse $ Emp/Child(ren) $2, $ Emp/Child(ren) $ Family $4, $ Family $1, This chart is intended to highlight some of the principal provisions of the plans offered by your employer. In case of a conflict between the Group Master Contract, Certificate of Coverage, and this chart, the Group Master Contract and Certificate of Coverage will govern.

9 Benefit Summary for The CSI Companies, Inc. January 1, 2015 December 31, 2015 Employee Contact Information The CSI Companies, Inc. Address: 9995 Gate Parkway North Suite 150 Jacksonville, FL Website: Contact: Julie Moore, Benefits Coordinator Phone: (904) Ext. 252 Fax: (866) Insurance Carrier Contact Information United Healthcare Policy #: Member Service: (800) Website: Broker Contact Information If the insurance carrier did not answer your question(s) to your satisfaction, please contact: Address: 236 Ponte Vedra Park Drive, Suite 101 Contact: Ponte Vedra Beach, FL Account Manager Phone: (800) Phone: (904) Local: (904) Fax: (904) Web Site: Margo Arrington, Ext. 480 Client Services Manager Jason Griggs, Ext. 413 Phone: (904) Benefits Advisor / Broker JasonG@MontoyaBenefits.com Julia Liningham Ext: MArrington@MontoyaBenefits.com