EMPLOYEE BENEFITSGUIDE2023-2024Pneuma Behavioral HealthAn overview of the wide array of benefits provided byPneuma to help you enjoy increased well-being and financial security.
This booklet provides only a summary of your benefits. All services described within are subject to the definitions, limitations and exclusions set forth in each insurance carrier's or provider's contract.Employee Benefits GuideAs an employee of Pneuma, enjoying your work and making valuable contributions to business are equally vital. The health, satisfaction and security of you and your family are important, not only to your well-being, but ultimately, in terms of achieving the goals of our organization.For the 2023-2024 plan year,Pneuma has worked hard to offer a competitive total rewards package that includes valuable and competitive benefit plans. These programs reflect our commitment to keeping our staff healthy and secure. We understand that your situation is unique, and Pneuma is offering an overall benefits package that can be shaped and molded by you to fit your needs.This benefits booklet is a summary description of your Pneuma benefit plans. If there is a discrepancy between these summaries and the written legal plan documents, the plan documents shall prevail. This booklet and plan summaries do not constitute a contract of employment.We hope this benefits booklet, along with our additional communication and decision-making tools, will help you make the best health care choices for you and your family.2023-2024Pneuma Behavioral HealthINTRODUCTIONEligibility & EnrollmentAs a full-time employee working 30+ hours/week you are eligible for benefits. You can enroll or make changes during our annual enrollment period or within 30 days if you experience a qualifying life event during the year. A Qualifying Life Event includes changes in marital status, employment status, birth or adoption of a child, death of a dependent, entitlement to Medicaid or Medicare, loss of other coverage or eligibility of dependents.Benefits Begin Next day following 30 daysBenefits End End of month following terminationDependents Your legal spouse, dependent children up to age 26.Domestic Partner Same and opposite sex
This booklet provides only a summary of your benefits. All services described within are subject to the definitions, limitations and exclusions set forth in each insurance carrier's or provider's contract.Employee Benefits Guide2023-2024Pneuma Behavioral Health Comparison of PlansCoverage Provided by NCMS through Blue Cross of NCIn-Network PPO 2000-80 PPO 3500-80Benefit Period Plan Year: 7/1 – 6/30 Plan Year: 7/1 – 6/30Deductibles (Individual / Family) $2,000/$6,000 $3,500/$10,500Preventive Care Covered in fullCovered in fullPrimary Care Visit$35*Register your PCP on BlueConnectNC.com and 1stthree visits’ copay waived.$35*Register your PCP on BlueConnectNC.com and 1stthree visits’ copay waived.Specialist Visit $70 $70Telehealth via Teladoc $35 $35Urgent Care $75 $100Emergency Room $500 $1,000Outpatient Procedure 20% coinsurance 20% coinsuranceInpatient Visit 20% coinsurance 20% coinsurancePharmacy / RX (30 Day Supply)Tiers 1-6$10/$25/$40/$80/25% to max $100$10/$25/$40/$80/25% to max $100Lens and Frames Coverage100% to $130, then 10%100% to $130, then 10%Out-of-Pocket Max (Individual / Family)$7,150/$14,300 $8,150/$16,300MEDICALThe chart below is an overview of the In-Network benefits. Out-of-Network benefits are available; please review your NCMS plan documents for additional details.
This booklet provides only a summary of your benefits. All services described within are subject to the definitions, limitations and exclusions set forth in each insurance carrier's or provider's contract.Employee Benefits Guide2023-2024Pricing Per Month PPO 2000-80 PPO 3500-80Employee $194.72 $173.32Employee + Spouse $996.93 $887.39Employee + Child $451.73 $402.10Employee + Children $794.43 $707.14Employee + Family $1,581.07 $1,407.35Your Cost Please see Employee Navigator for cost on a per pay period basisPneuma Behavioral HealthPricing Bi-Weekly PPO 2000-80 PPO 3500-80Employee $97.36 $86.66Employee + Spouse $498.47 $443.70Employee + Child $225.87 $201.05Employee + Children $397.22 $353.57Employee + Family $790.54 $703.68
This booklet provides only a summary of your benefits. All services described within are subject to the definitions, limitations and exclusions set forth in each insurance carrier's or provider's contract.Employee Benefits Guide2023-2024Pneuma Behavioral HealthPREVENTIVE CAREWellness and Health ManagementUnderstanding the full value of covered benefits allows you to take responsibility for maintaining good health and incorporating healthy habits into your lifestyle. Some examples include getting regular physical examinations, mammograms and immunizations. Through the plans offered by NCMS, all covered individuals and family members are eligible to receive routine wellness services like these, at no cost; all copays, coinsurance, and deductibles are waived.Which Preventive Care Services Are Covered?The US Preventive Services Task Force maintains a regular list of recommended services that all Affordable Care Act (i.e., Health Care Reform) compliant insurance plans should cover at 100% for in-network providers. Below is a list of common services that are included in the plans offered this year:• Routine physical exam• Well baby and childcare• Well women visits• Immunizations• Routine bone density test• Routine breast exam• Routine gynecological exam• Screening for Gestational diabetes• Obesity screening and counseling• Routine digital rectal exam• Routine colonoscopy• Routine colorectal cancer screening• Routine prostate test• Routine lab procedures• Routine mammograms• Routine pap smear• Smoking cessation• Health education/counseling services• Health counseling for STDs and HIV • Testing for HPV and HIV• Screening/counseling for domestic violence
This booklet provides only a summary of your benefits. All services described within are subject to the definitions, limitations and exclusions set forth in each insurance carrier's or provider's contract.Employee Benefits GuideEmployees and dependents enrolled in our medical have access to telemedicine through Teladoc. telehealth provides acute and behavioral care 24 hours a day via phone or video by board-certified doctors and behavioral health specialist. Telehealth is a good option for minor health problems when you can’t see your regular doctor. It is also a convenient choice when you want to speak to a counselor or therapist. Some providers will also offer telehealth appointments. Check with your provider on the availability and cost.How Does Telehealth Work?Your virtual visit will take place via phone, video call on a laptop, tablet or cellphone; or through an app. The provider will ask you the same questions you'd be asked at an in-person visit and may recommend treatment based on their findings.What Can’t Telehealth Be Used For?• Life-threatening or emergency situations • Situations in which diagnostic care (e.g., blood work, imaging or lab tests) are required• Situations of severe illness or complex conditionsHow Do I Access Telehealth?There are 3 ways to access Teladoc:• Download the Teladoc mobile app• Go to Teladoc.com and click “Log in/Register”• Call 1-800-835-2362Refer to your plan documentation for more information.TELEHEALTH2023-2024What Can Telemedicine Be Used For?General, non-life-threatening doctor's visits or consultations for acute care, such as:• Allergies• Cough, cold and flu• Diarrhea, nausea and vomiting• Ear problems• Insect bites• Sinus problems• Urinary problems• And moreBehavioral health issues such as:• Addictions• Anxiety• Depression• Grief and loss• Relationship issues• And morePneuma Behavioral Health
This booklet provides only a summary of your benefits. All services described within are subject to the definitions, limitations and exclusions set forth in each insurance carrier's or provider's contract.Employee Benefits Guide2023-2024Through our partnership with NCMS, enrolled members have access to several additional programs to help support you in achieving a healthy balanced life.Nurse Support Program Condition CareManaging a chronic condition can be complicated. This NCMS program connects you to additional tools, resources and care if you have a condition such as:• Asthma• Chronic Obstructive Pulmonary Disease• Congestive Heart Failure• Coronary Artery Disease• Diabetes• HypertensionA Nurse Advocate may call you to provide one-on-one support. If you have not already been contacted by the Nurse Advocate, you can call 1-888-229-8510, Monday through Friday, between 9:00 a.m. and 7:00 p.m.Eat Smart, Move More, Weigh LessEat Smart, Move More, Weigh Less is an online weight management program that uses strategies proven to work for weight loss and maintenance. Each lesson informs, empowers and motivates participants to live mindfully as they make choices about eating and physical activity.Nutrition Counseling Total Nutrition Technology provides members with a custom built nutrition plan and exercise guidelines to fit each member’s lifestyle and dietary objectives. To get started on your wellness journey, complete and submit this form: https://www.totalnutritiontechnologycharlotte.com/curi-member-form/. Employee Assistance ProgramVITAL WorkLife is available to assist you and your family with life issues which are confronting you., such as grief, anxiety, problems with your children, substance abuse and more. Unlimited phone consultation and website access to articles, assessments, seminars and much more. Face to face counseling is available. Legal, financial and identity theft services can also be accessed. Contact VITAL WorkLife at 800-383-1908 or visit www.vitalworklife.com username: ncmsplan; password: ncmsplan. MEDICAL SUPPORT PROGRAMSPneuma Behavioral Health
This booklet provides only a summary of your benefits. All services described within are subject to the definitions, limitations and exclusions set forth in each insurance carrier's or provider's contract.Employee Benefits Guide2023-2024Summary of CoverageCoverage Provided by Principal In-NetworkAnnual Deductibles(Individual / Family)$0/$0Preventive Care Covered in fullBasic Procedures (extractions, fillings, etc.)80% coinsuranceMajor Procedures(crowns, dentures, etc.)50% coinsuranceCalendar Year Maximum Benefit $1,500DENTALBelow is a high-level summary of our dental benefits. While Out-of-Network coverage is available, using an In-Network provider will result in less out of pocket expenses. In-Network dentist cannot balance bill you for the amount over the allowable charges. Please review your plan documents for additional details.Pricing Per MonthEmployee $42.11Employee + Spouse $80.04Employee + Children $89.19Employee + Family $132.77Your CostPneuma Behavioral Health Please see Employee Navigator for cost on a per pay period basis
This booklet provides only a summary of your benefits. All services described within are subject to the definitions, limitations and exclusions set forth in each insurance carrier's or provider's contract.Employee Benefits Guide2023-2024Summary of CoverageCoverage provided by Principal In-NetworkVision Exam (Once per plan year) $10 copayLenses (once per plan year) $25 copayFrames (Once every 2 years) $130 allowance, 20% off amount over allowanceStandard Contact Lenses Fit & Follow Up Exam$130 + up to $60 for contact lenses (fitting and evaluation)Elective Contact Lenses $130 allowanceMedically Necessary Contact Lenses $25 copayVISIONOur vision coverage is provided by Principal. Please review your plan documents for additional details.Pricing Per MonthEmployee $8.92Employee + Spouse $16.28Employee + Children $17.35Employee + Family $26.39Your CostPneuma Behavioral Health Please see Employee Navigator for cost on a per pay period basis
This booklet provides only a summary of your benefits. All services described within are subject to the definitions, limitations and exclusions set forth in each insurance carrier's or provider's contract.Employee Benefits Guide2023-2024Summary of CoverageCoverage provided by PrincipalPlan FeaturesEmployee Benefit Amount $25,000AD&D Benefit $25,000 covered for employees on and off the jobBenefit Reductions begin at age 35% age reduction at age 65 and an additional 15% reduction at age 70; Age reductions apply to the benefit amount after proof of good health.Group life insurance coverage is an employer-sponsored safety net in case the worst happens, with no out-of-pocket costs to you. If you believe you need additional coverage, you may wish to enroll in voluntary life insurance as well. Employees must fill out an EOI form if they exceed the guaranteed issue amount.BASIC LIFE and AD&D INSURANCESummary of CoverageLife Benefit Employee Spouse DependentAmount $10,000 increments $5,000 increments $2,500, $5,000, or $10,000Minimum Amount $10,000 $5,000 $2,500Maximum Amount $100,000Lesser of 100% of employee or $25,000 Lesser of 100% of employee or $10,000Guarantee Issue (Newly Eligible Employees)$100,000 up to age 70$10,000 age 70+$25,000 up to age 70$10,000 age 70+$10,000Benefits Reductions Begin at age 65 Begin at age 65 N/AVOLUNTARY LIFE and AD&D INSURANCEFor summary of rate sheet, please see carrier summary or Employee Navigator.Cost is age-banded and based on employee’s age.Pneuma Behavioral Health
This booklet provides only a summary of your benefits. All services described within are subject to the definitions, limitations and exclusions set forth in each insurance carrier's or provider's contract.Employee Benefits Guide2023-2024Summary of CoverageCoverage provided by PrincipalPlan Features Short Term Long TermCoverage Paid By Employer EmployeeTaxation TaxableEmployees pay the taxes on the premium so the benefit is not taxableEmployee Benefit Amount 60% of weekly earnings 60% of monthly earningsMaximum Benefit Amount $1,000 per week $5,000 per monthElimination Period (Accident) 14 days 90 daysElimination Period (Sickness) 14 days 90 daysBenefit Duration 11 weeksTo Social Security normal retirement ageEvidence of Insurability n/a n/aDisability insurance is coverage that provides you with income protection should you be unable to work due to an injury or illness. With disability coverage, you are compensated for a portion of your lost income. Short-Term disability provides coverage in the near term, while Long-Term coverage is available for extended disabilities. DisabilityPlease note, a pre-existing condition period may apply once you become covered. Please see policy for more information.Pneuma Behavioral Health
This booklet provides only a summary of your benefits. All services described within are subject to the definitions, limitations and exclusions set forth in each insurance carrier's or provider's contract.Employee Benefits Guide2023-2024Pneuma Behavioral HealthColonial Life – Voluntary Benefits You never know when an unexpected illness or injury could leave you and your family with financial difficulties. Health insurance can help, but you can still have deductibles, co-payments, and other out-of-pocket expenses.That’s where voluntary benefits come in. Sometimes called supplemental insurance, voluntary benefits are designed to complement your health insurance and help provide extra financial protection. This year, your employer is helping you protect your way of life by giving you the opportunity to purchase the following voluntary benefits from Colonial Life:1. Group Accident insurance2. Group Critical illness insurance3. Whole life insuranceIf guaranteed-issue coverage is available, you won’t have to answer health questions. For more details, talk with your Colonial Life benefits counselor. Benefits may be subject to a pre-existing condition provision.Group Accident Insurance – YES … ACCIDENTS CAN HAPPEN TO ANYONEYou never know when you or someone you love could get hurt in an accident. And accidents come with costs, such as emergency room fees, doctor’s bills, and lost income from missing work. Even if you have good health insurance, deductibles and co-pays can really add up.With accident insurance from Colonial Life, you can receive benefits to help with the expenses of a covered accident. This financial protection can help you focus on what really matters: healing. WITH THIS COVERAGE:• A set amount is payable based on the injury you suffer and the treatment you receive.• You do not need to answer medical questions or have a physical exam to get basic coverage.• Unlike workers’ compensation, which only covers on-the-job injuries, accident insurance covers injuries that happen on the job or off the job.• Coverage is available for you, your spouse, and eligible dependent children. Group Critical Illness insurance - YOU CAN’T PREDICT AN ILLNESS, BUT YOU CAN BE PREPAREDNo matter where you are in life, you never know when you or a loved one could experience a critical illness, such as a heart attack, stroke, or cancer diagnosis. Medical advancements and early detection are helping many people survive critical illnesses. However, preventive tests and treatment can lead to increased medical expenses, and your health insurance may not cover these costs. Group Critical illness insurance from Colonial Life helps supplement your major medical coverage by providing a lump-sum benefit you can use to pay the direct and indirect costs related to a covered critical illness.WITH THIS COVERAGE:• Benefits are payable directly to you unless you specify otherwise.• You may receive additional benefits if you’re diagnosed with more than one critical illness.• Coverage options are available for you, your spouse, and eligible dependent children.
This booklet provides only a summary of your benefits. All services described within are subject to the definitions, limitations and exclusions set forth in each insurance carrier's or provider's contract.Employee Benefits Guide2023-2024Pneuma Behavioral Health Whole Life insurance - LIFE INSURANCE THAT COMES WITH GUARANTEES — BECAUSE LIFE DOESN’TYou can’t predict the future, but you can rest easier knowing you have life insurance with lifelong guarantees.Whole life insurance provides features – cash value accumulation, premium rates, and a death benefit (minus any loans and loan interest) – that help ensure those benefits will be there to help protect your family’s way of life. WITH THIS COVERAGE:• Life insurance benefits for the beneficiary are typically free from income tax.• You have three opportunities to purchase additional coverage with no proof of good health required if you are 55 or younger when you initially purchase coverage.• The policy’s accelerated death benefit can pay a percentage of the death benefit if the covered individual is diagnosed with a terminal illness. Accelerated benefit payments will reduce the amount the policy pays upon the recipient’s death.• A $3,000 immediate claim payment can be paid to the designated beneficiary as an advance of the death benefit.
EMPLOYEE BENEFITS GUIDEPrepared By Sentinel Benefits Consulting | sentinelra.com2023-2024Pneuma Behavioral Health