EMPLOYEE BENEFITS GUIDE

Transcription

1 EMPLOYEE BENEFITS GUIDE ELIGIBILITY All People 2.0 employees are eligible to enroll in The American Worker program within 30 days of your first pay check. People 2.0 offers a variety of affordable benefit plans to meet the needs of our employees. It is important that you read this enrollment guide carefully. Please take a few moments to review this information so you can make the right benefit choices for you and your family. YOUR EMPLOYEE BENEFIT CHOICES People 2.0 is pleased to announce that The American Worker will offer supplemental medical benefits to all eligible employees. The American Worker offers affordable benefit plans designed to provide coverage for routine health care services. With The American Worker you have the opportunity to enroll in the following benefit plans: Supplemental Medical - Choose from 2 benefit plans Dental and Vision Benefit Package Life and AD&D Insurance Short-term Disability Coverage ENROLLMENT INSTRUCTIONS For your convenience, The American Worker allows you to enroll by calling the enrollment center or enrolling online. If you have questions regarding the benefits being offered, contact the enrollment center and a representative will assist you. It is not required to notify the enrollment center if you are declining coverage. Enrollment Center: Call (866) Representantes que hablan español disponibles. Monday - Friday: 8:00 AM to 8:00 PM ET Enrollment must be completed within 30 days of your first paycheck. Enroll Online: Visit Online enrollment is available at all times. - Enter your Social Security number and date of birth in the box titled New User? If requested, enter Group ID Next set-up an account by establishing a user name, password, security question and confirming your personal information - After creating an account, you can elect coverage for yourself and your dependents.

2 Supplemental Medical Coverage The American Worker supplemental medical coverage provides affordable, first dollar coverage with no deductibles or coinsurance. Your acceptance in the plan is guaranteed and there are no pre-existing condition limitations or medical questions to answer. The American Worker plans are underwritten by Nationwide Life Insurance Company. The New Benefits and First Health Network programs are not insured by Nationwide, but are provided by separate vendors. These programs are included irrespective of which health plan you choose. Supplemental Medical Coverage Summary Doctor s Office Benefit Diagnostic Lab Work Diagnostic X-Rays Advanced Studies Preventive Care Emergency Room Sickness Standard Plan Pays $100 per Day, 6 Days per Person per Year Plan Pays $75 per Testing Day, Plan Pays $75 per Testing Day, Plan Pays $200 per Testing Day, Plan Pays $75 per Day, Plan Pays $100 per Day, *The Health Service Discount Program is not available to Vermont and Washington residents. Preferred Plan Pays $125 per Day, 6 Days per Person per Year Plan Pays $100 per Testing Day, Plan Pays $125 per Testing Day, Plan Pays $500 per Testing Day, Plan Pays $75 per Day, Plan Pays $100 per Day, Accidental Injury Care Plan Pays up to $1,000 per Occurrence Plan Pays up to $1,000 per Occurrence Surgical - Daily Inpatient - Inpatient Benefit Maximum - Daily Outpatient - Daily Outpatient Minor - Outpatient Benefit Maximum Plan Pays $1,000 1 Day per Person per Year Plan Pays $500 Plan Pays $100 1 Day per person per Year Plan Pays $2,000 1 Day per Person per Year Plan Pays $1,000 Plan Pays $200 1 Day per person per Year Anesthesia Plan Pays 30% of the Surgical Benefit Plan Pays 30% of the Surgical Benefit Hospital Indemnity Intensive Care Unit Substance Abuse Skilled Nursing Facility Mental Health 500 Day Lifetime Maximum Plan Pays $600 per Day, Plan Pays $150 per Day, Plan Pays $150 per Day, 60 Days per Person per Stay Plan Pays $150 per Day, Plan Pays $600 per Day, 500 Day Lifetime Maximum Plan Pays $1,200 per Day, 60 Days per Person per Stay Health Service Discount Program* Included Included Neighborhood Pharmacy Discount Included Included First Health Network Included Included + 1 $23.22 $48.95 $61.71 $36.07 $77.33 $96.91 Important Notice This program is not intended or recommended to replace any comprehensive program of insurance in which you currently participate, or intend to participate. This plan is not designed to replace or provide major medical or catastrophic coverage. This brochure is for summary purposes only. The insurance benefits for the medical indemnity plan are offered by Nationwide Life Insurance Company. A detailed Certificate of Coverage will be available upon enrollment in the Program. Plan exclusions and limitations apply. 2 Supplemental Medical Plans People 2.0

3 ADDITIONAL MEDICAL PLAN FEATURES Provider Network, Discount Prescription Drug Program and Health Service Discounts The programs listed below are not insured, but are designed to provide substantial savings on pharmaceuticals and medical services. The First Health Network and the New Benefits programs require network use. These benefits are included in the cost of the supplemental medical plan you choose Benefits Guide First Health Network The First Health Network provides members access to one of the nation s largest and most respected networks. Members that use First Health providers will receive savings on Physician and Hospital services. Visiting a First Health provider can reduce your out-ofpocket expenses and stretch your benefit dollars. The First Health Network has over 490,000 locations across the country Network providers will submit re-priced medical claims on your behalf to simplify the claim process To find a provider online, visit Members have the ability to choose any provider they wish for treatment. The plan benefits remain the same regardless of what provider you visit for service. New Benefits Pharmaceutical Discount Program The Neighborhood Pharmacy discount program assures members the lowest price on prescription drugs, saving 10% to 85% on most prescriptions. Pharmacists will calculate the discount at point-of-serivce and the member pays the discounted price. There are more than 60,000 participating pharmacies including national and regional chains as well as independent pharmacies. Visit to look up drug prices or locate a participating pharmacy. Pharmacy Discounts are Not Insurance and are Not Intended as a Substitute for Insurance. The discount is only available at participating pharmacies. New Benefits Health Service Discount Program (Not available to Vermont and Washington residents) This package of health service and discount programs can help reduce out-of-pocket expenses and provide savings on a variety of services that promote healthy living. Detailed information on all programs will be provided after enrollment. TelaDoc: 24/7 access to a network of U.S. board-certified doctors that will diagnose, treat and prescribe medication, when necessary, over the phone for medical issues including cold or flu symptoms, allergies, bronchitis and more. Medical Bill Saver TM : Can help lower out-of-pocket costs on medical or dental bills over $400 through provider negotiation. Medical Health Advisor 1 : Access to Personal Health Advocates that can assist in resolving insurance claim and billing issues. Nurseline TM and Personal Counseling Services In addition, members will receive discounts on the following services or supplies at participating providers. Lab and Imaging 2 Chiropractic Vision Hearing Diabetic Supplies Durable Medical Equipment Vitamins 1 Health Advisor does not replace health insurance, provide medical care or recommend treatment. 2 Savings may vary based on geographic location, provider selected and procedure performed. The lab network portion of this benefit is not available in MA, MD, ND, NE, NJ, NY, RI, or SD. People 2.0 Additional Medical Plan Features 3

4 Freestanding Coverage Options The American Worker also offers you the ability to purchase a variety of optional benefit plans and can be purchased on a stand-alone basis. The additional coverage options are underwritten by Nationwide Life Insurance Company. Please review the information below to decide which benefits best meet the needs of you and your family. Dental Coverage Summary Calendar Year Maximum Calendar Year Deductible $1,000 per Covered Member $50 per Covered Member Covered Services Waiting Period Coinsurance Type I Services: Preventive and Diagnostic Oral Exams, Cleanings, X-Rays, Fluoride Treatments, etc. Type II Services: Basic Treatment Fillings, Extractions, Oral Surgery, Endodontics, Sealants, Root Canal, etc. Type III Services: Major Treatment Crowns, Dentures, Inlays, Onlays, Bridges, etc. + 1 None Covered at 80% (U&C Charges) 3 Months Covered at 60% (U&C Charges) 12 Months Covered at 50% (U&C Charges) $5.45 $12.22 $17.48 Vision Coverage Summary Calendar Year Maximum Coinsurance Percentage 80% Covered Services Routine Eye Exam Lenses/Frames or Contacts + 1 $300 per Covered Member Frequency Once Every 12 Months Once Every 24 Months $1.89 $3.74 $4.92 Life Insurance and AD&D Coverage Summary Life and AD&D Insurance - $20,000 Life Insurance - Spouse - Child + 1 $10,000 $5,000 $1.54 $1.88 $1.88 Short-Term Disability Coverage Summary Weekly Maximum Benefit $125 per Maximum Benefit Period 26 Weeks Waiting Period 15 Days (Accidents and Sickness) Percent of Weekly Salary Paid 50% (Excludes Bonuses and OT) Coverage includes Disability due to pregnancy and childbirth $ Freestanding Coverage Options People 2.0

5 ENROLLMENT AND PLAN INFORMATION Benefits Guide Enrollment must be completed within 30 days of your first paycheck. Enrollment Instructions You can enroll by calling the enrollment center or enrolling online. If you have questions regarding the benefits being offered contact the enrollment center and a representative will assist you. It is not required to notify the enrollment center if you are declining coverage. Enrollment Center: Call (866) Representantes que hablan español disponibles. Monday - Friday: 8:00 AM to 8:00 PM ET Enroll Online: Visit Online enrollment is available at all times. - Enter your Social Security number and date of birth in the box titled New User? If requested, enter Group ID Next set-up an account by establishing a user name, password, security question and confirming your personal information - After creating an account, you can elect coverage for yourself and your dependents. Please have the following information available when enrolling: Information - Social Security Number - Date of Birth - Date of Hire - Home Address - Phone Number - Address Dependent Information - Name - Social Security Number - Date of Birth Enrollment Questions - What level of coverage do you want? - Do you want Supplemental Medical coverage? If so, which Plan? - Do you want Dental coverage? - Do you want Vision coverage? - Do you want Life and AD&D Insurance? - Do you want Short-term Disability coverage? Disability is only available for the Residents of New Hampshire are not eligible for this plan. This coverage is not considered creditable coverage under Massachusetts state regulations. This product is (a) not a substitute for minimum essential health coverage under the Affordable Care Act (ACA); and (b) does not qualify as minimum essential coverage under the ACA. People 2.0 Enrollment and Plan Information 5

6 Paying For Your Benefits Your coverage begins on the Monday following the date you receive your first paycheck with a premium deduction and will continue uninterrupted as long as premium is deducted from your paycheck. If you receive a paycheck without a premium deduction, your benefits will be suspended for the next benefit period, which starts on the following Monday, unless you make a missed premium payment. To avoid having coverage suspended you must make a missed premium payment. Missed Premium Payments You have 30 days from the date of your paycheck to pay for premiums that were not deducted from your paycheck. You can pay for missed premium deductions online, over the phone or by mail. Payment options include electronic check, credit/debit card, check or money order. If you do not pay for the missed premium deduction within 30 days, you will not be able to pay for the missed premium at a later date. If you missed a premium deduction and want to find out the balance due or have questions about making a payment contact Member Services at (800) You can also go online to to view your account balance and pay for missed premiums. Non-payment Coverage Termination If you do not have payroll deductions or make missed premium payments for 4 consecutive weeks, your coverage will be terminated for non-payment. To avoid a non-payment termination it is suggested you make a missed premium payment each time a deduction is missed. If your coverage is terminated for non-payment you will not be able to enroll again until the next open enrollment. Frequently Asked Questions 1) When can I enroll? Current employees must enroll during the annual open enrollment period or within 31 days of experiencing a Qualifying Event. New employees must enroll within 30 days of their first pay check. 2) Which insurance company pays my medical, dental and life claims? Nationwide Life Insurance Company, Columbus, OH 3) Will I receive an ID card? Yes, all enrollees will receive a packet of information that includes ID cards and Summary of Benefits. Those who enroll in a medical plan will also receive ID cards and information on the New Benefits discount pharmaceutical and health service discount program. The packets will be mailed to your home address. A certificate of coverage will be available upon request. 4) What if I need to access benefits before I receive my ID card? You can go online to and log in to print a temporary ID card. You may call member services at (800) and they will or fax you a copy of the letter. 5) Who can I contact if I have questions about my benefits? Contact a Member Services representative, tollfree, at to assist you. Member Services is available Monday through Friday from 8:00 AM to 8:00 PM ET. 6) Can I use any doctor or hospital? Yes, you can use any licensed doctor or accredited hospital you choose and you will receive the same benefits from Nationwide. However, you can maximize your savings by using a provider that participates in the First Health Network. To find a provider online, visit There is no network associated with the dental and vision benefits. 7) How do I submit a claim? At the time of service, present your Nationwide ID card to the provider and request the provider file the claim directly with Nationwide. If the provider is unwilling to file the claim on your behalf, you can submit the claim yourself and be reimbursed. 6 Frequently Asked Questions People 2.0

7 FAQ s Continued 8) How do I access the pharmaceutical discount program? Present your New Benefits Discount Rx ID card to the pharmacy when dropping off your prescription. The pharmacy will process the discount at the point-of-sale. There are no claim forms for the drug program. Note: You must use a network pharmacy to access benefits. To locate a pharmacy in your area visit 9) How are benefits paid? Benefit maximums are paid according to the calendar year, not on a plan year basis. 10) What is the dependent child age limit? Children up to age 26 are eligible for coverage regardless of student, marital or dependent tax status. 11) When does coverage become effective? For employees on a weekly or bi-weekly payroll cycle, coverage begins on the Monday following the first pay check with a deduction. For employees on a semi-monthly payroll cycle, coverage begins on the day following the first pay check with a deduction. DISCLAIMERS Disclaimers - The American Worker Plans insured by Nationwide Life Insurance Company This program is not intended nor recommended to replace any comprehensive program of insurance in which you currently participate, or intend to participate. This plan is not designed to replace or provide major medical or catastrophic coverage. This brochure is for summary purposes only. The insurance benefits of the limited medical indemnity plan are offered by Nationwide Life Insurance Company. A Summary of Benefits will be provided upon enrollment in the program. Plan exclusions and limitations apply. New Hampshire residents are not eligible for any of the benefit programs offered by The American Worker. Massachusetts residents are eligible for the supplemental benefit medical plan, but this plan does NOT meet Minimum Creditable Coverage standards and will NOT satisfy the individual mandate that you have health insurance. The medical coverage offered by Nationwide Life Insurance Company does NOT meet the minimum standards required by the Affordable Care Act. Disclaimers - New Benefits Pharmaceutical Discount Card Pharmacy Discounts are Not Insurance and are Not Intended as a Substitute for Insurance. The discount is only available at participating pharmacies. Teladoc is not available to Idaho residents Teladoc, Inc. All rights reserved. Teladoc and the Teladoc logo are registered trademarks of Teladoc, Inc. and may not be used without written permission. Teladoc does not replace the primary care physician. Teladoc does not guarantee that a prescription will be written. Teladoc operates subject to state regulation and may not be available in certain states. Teladoc does not prescribe DEA controlled substances, non-therapeutic drugs and certain other drugs which may be harmful because of their potential for abuse. Teladoc physicians reserve the right to deny care for potential misuse of services. Teladoc phone consultations are available 24 hours, 7 days a week while video consultations are available during the hours of 7am to 9pm, 7 days a week. The Discount Health Savings Program is NOT insurance. This plan provides discounts at certain healthcare providers for medical services. This plan does not make payments directly to the providers of medical services. Pharmacy discounts range from 10% to 85% on most medications. The plan member is obligated to pay for all healthcare services but will receive a discount from those healthcare providers who have contracted with the discount plan organization. The plan is not insurance coverage and does not meet the minimum creditable coverage requirements under the Affordable Care Act or Massachusetts M.G.L. c. 111M and 956 CMR This discount card program contains a 30 day cancellation period. The range of discounts for medical or ancillary services provided under the plan will vary depending on the type of provider and medical or ancillary service received. The discount medical card program makes available, before purchase and upon request, a list of program providers, including the name, city, state, and specialty of each program provider located in the cardholder s service area. Member shall receive a full refund of membership fees, excluding registration fee, if membership is cancelled within the first 30 days after the effective date. AR and TN residents: A refund of all fees will be issued if membership is cancelled within the first 30 days. MD Residents: The membership fee and one-time registration fee (minus $5.00) will be refunded if cancelled within the first 30 days and upon return of the discount card. Discount Medical Plan Organization: New Benefits, Ltd., Attn: Compliance Department, PO Box Dallas, TX , Website to obtain participating providers: MyMemberPortal.com. People 2.0 FAQ s Continued and Disclaimers 7