B E N E F I T G U I D E
Bailes Bates & Associates LLP is committed to a comprehensive employee benefit program that helps our employees stay healthy, feel secure and maintain a work/life balance.The benefits program was designed to provide you with a competitive level of standard coverage while allowing you the flexibility to choose benefits that reflect your needs and personal circumstances. In addition to receiving health coverage, you have the opportunity to choose additional coverage that best meets your needs.
The amount you must pay before your insurancecompany starts to pay for covered services eachyear.DEDUCTIBLEA fixed amount you pay for coveredservices such as doctor visit or diagnostic test.CO-PAYMENTSMedical services included in your insurance plan,such as doctor visits, hospital stays and diagnostictests.COVERED SERVICESA doctor or medical facility that is not contracted withyour insurance company. Using out-of- networkproviders can result in you paying a higher portion ofthe medical bills or possibly the entire bill.OUT-OF-NETWORKThe percentage of a medical expense you areresponsible for paying. This usually kicks in afteryou have met your deductible.COINSURANCEThe most you have to pay for covered services in aplan year.OUT-OF-POCKET MAXIMUMThe doctors, hospitals and other medical facilitiesand suppliers that contract with your insurancecompany to provide medical services.IN-NETWORKThe person or facility providing services to you,including doctors, hospitals and pharmacies.PROVIDERTERMS YOUSHOULD KNOW8www.elitebenefitsgroup.comTERMS YOU
E1500i70LX21BUnited HealthcareIN - NETWORKOUT - NETWORK Plan70% Participant30% CALENDAR YEAR DEDUCTIBLE Individual$1,500 Family$3,000 MAXIMUM OUT OF POCKET Individual $6,000 Family $12,000 OFFICE VISIT Primary Care Visit (non-surgical)$25 Copay Per Visit. Ded does not apply Specialist Visit (non-surgical)$75 Copay Per Visit. Ded does not apply Urgent Care Visit$50 Copay Per Visit. Ded does not apply Preventive CareNo charge HOSPITAL In-Patient Services30% Coinsurance Out-Patient Services30% Coinsurance Emergency Room30% Coinsurance RETAIL PRESCRIPTION Preferred Generic$10 / $35 / $75 / $250 EMPLOYEE CONTRIBUTION (SEMI-MONTHLY)$0.00$379.13$274.44 Employee only Employee and Spouse Employee and Child (ren) Employee and Family $656.41United Healthcare is our medical carrier. Below is a brief summary of the medical plan. Using In- Network facilities and physicians will result in significant cost savings to the member. Please refer to the United Healthcare Summary of Benefits for a more comprehensive listing of services and additional information.www.elitebenefitsgroup.comMEDICALmyuhc.com877.797.8812N/AN/AN/AN/AN/AN/AN/AN/AN/AN/AN/AN/AN/AN/A
If you use anIN-NETWORK dentistIf you use anOUT-OF-NETWORK dentistCalendar-year deductible(excludes orthodontia services)Individual$50Family$150Individual$50Family$150Deductible applies to all services excluding preventive services.Calendar-year annual maximum (excludes orthodontia services) UnlimitedPreventive services• Routine oral examinations (3 per year)• Bitewing x-rays (2 films under age 10, up to 4 filmsages 10 and older)• Routine cleanings (3 per year)• Periodontal cleanings (4 per year)• Fluoride treatment (1 per year, through age 16)• Sealants (permanent molars, through age 16)• Space maintainers (primary teeth, through age 15)• Oral Cancer Screening (1 per year, ages 40 andolder)100% no deductible 100% no deductible Basic services • Emergency care for pain relief• Amalgam fillings (1 per tooth every 2 years,composite for anterior/front teeth)• Oral surgery (tooth extractions includingimpacted teeth)• Stainless steel crowns• Harmful habit appliances for children (1 perlifetime, through age 14)80% after deductible 80% after deductible xMajor services• Crowns (1 per tooth every 5 years)• Inlays/onlays (1 per tooth every 5 years)• Bridges (1 per tooth every 5 years)• Dentures (1 per tooth ever 5 years)• Denture relines/rebases (1 every 3 years, following6 months of denture use)50% after deductible 50% after deductible • Denture repair and adjustments (following6 months of denture use)• Implant Related Services (crowns, bridges, anddentures each limited to 1 per tooth every fiveyears. Coverage limited to equivalent cost of anon-implant service. Implant placement itself is notcovered.)• Periodontics (scaling/root planing and surgery1 per quadrant every 3 years)• Endodontics (root canals 1 per tooth per lifetimeand 1 re-treatment)x xs[pspaceDENTALNetwork: Humana Dental Traditional PlusHumana.com/findadentist877-398-2980
OrthodontiaservicesChild orthodontia - Covers children through age 18. Plan pays50 percent (no deductible) of the covered orthodontia services,up to: $1,000 lifetime orthodontia maximum.Non-participating dentists can bill you for charges above the amount covered by your Humana Dental plan. To ensure you do not receive additional charges, visit a participating PPO Network dentist. Members and their families benefit from negotiated discounts on covered services by choosing dentists in our network. If a member visits a participating network dentist, the member will not receive a bill for charges more than the negotiated fee for covered services. If a member sees an out-of-network dentist, coinsurance will apply to the usual and customary charge. Out-of-network dentists may bill you for charges above the amount covered by your dental plan.DENTALNetwork: Humana Dental Traditional PlusHumana.com/findadentist877-398-2980EMPLOYEE CONTRIBUTIONS (Semi-Monthly)Employee$20.36Employer and Spouse$40.71Employee and Child(ren)$55.03Employee and Family$76.01www.elitebenefitsgroup.com
Vision care servicesIf you use anIN-NETWORK provider (Member cost)If you use anOUT-OF-NETWORK provider (Reimbursement)Exam with dilation asnecessary • Retinal imaging 1$0Up to $39Up to $30Not coveredContact lens exam options 2• Standard contact lens fit and follow-up• Premium contact lens fit and follow-up$010% off retail less $55 allowanceUp to $30Up to $30Frames 3$200 allowance20% off balance over $200$100 allowanceStandard plastic lenses 4• Single vision• Bifocal• Trifocal• Lenticular$0$0$0$0Up to $25Up to $40Up to $60Up to $100Lens options 4• UV coating• Tint (solid and gradient)• Standard scratch-resistance• Standard polycarbonate - adults• Standard polycarbonate - children <19• Standard anti-reflective coating• Premium anti-reflective coatingx– Tier 1– Tier 2– Tier 3• Standard progressive (add-on to bifocal)• Premium progressive– Tier 1– Tier 2– Tier 3– Tier 4x• Photochromatic / plastic transitions• Polarized$15$15$15$40$0$0Premium anti-reflective coatings asfollows:$22$3380% of charge less $35 allowance$0Premium progressives as follows:$45$55$70$25 copay, 80% of charge less $120allowance$7580% of chargeNot coveredNot coveredNot coveredNot coveredNot coveredUp to $25Premium anti-reflective coatings asfollows:Up to $25Up to $25Up to $25Up to $40Premium progressives as follows:Up to $40Up to $40Up to $40Up to $40Not coveredNot coveredContact lenses 5(applies to materials only)• Conventionalx• Disposable• Medically necessary$200 allowance,15% off balance over $200$200 allowance$0$160 allowance$160 allowance$210 allowanceHumana.com/find-care877-398-2980VISION
Vision care servicesIf you use anIN-NETWORK provider (Member cost)If you use anOUT-OF-NETWORK provider (Reimbursement)Frequency • Examination• Lenses or contact lenses• FrameOnce every 12 monthsOnce every 12 monthsOnce every 24 monthsOnce every 12 monthsOnce every 12 monthsOnce every 24 monthsDiabetic Eye Care: care andtesting for diabetic members• Examination- Up to (2) services per year• Retinal Imaging- Up to (2) services per year• Extended Ophthalmoscopy- Up to (2) services per year• Gonioscopy- Up to (2) services per year• Scanning Laser- Up to (2) services per year$0$0$0$0$0Up to $77Up to $50Up to $15Up to $15Up to $331 Member costs may exceed $39 with certain providers. Members may contact their participating provider to determine whatcosts or discounts are available.2 Standard contact lens exam fit and follow up costs and premium contact lens exam discounts up to 10% may vary byparticipating provider. Members may contact their participating provider to determine what costs or discountsare available.3 Discounts may be available on all frames except when prohibited by the manufacturer. 4 Lens option costs may vary by provider. Members may contact their participating provider to determine if listed costsare available. 5 Plan covers contact lenses or lenses for frames, but not both.XDONOTDELETEVISIONEMPLOYEE CONTRIBUTIONS (Semi-Monthly)Employee$6.38Employer and Spouse$12.76Employee and Child(ren)$12.87Employee and Family$19.80Humana.com/find-care877-398-2980
Voluntary Benefits 101What are voluntary benefits?Sometimes called “supplemental insurance,” voluntary benefits are policies you buy to add to the health and life insurance your employer may already provide. These benefits can help you pay for things your other insurance won’t, such as lost wages, out-of-pocket expenses and household bills.Advantages*Flexibility Use claim payments however you like – pay deductibles, co-payments and other expenses not covered by your health or life insurancePortability Take coverage with you if you leave your job or retireStability Maintain coverage whether or not you’re employedConvenience Pay premiums using your choice of payroll deduction, bank dra or direct billingTo learn more about voluntary benefits, contact us at 713-575-3722Underwritten by Colonial Life & Accident Insurance Company, Columbia, SC ©2017 Colonial Life & Accident Insurance Company. All rights reserved. Colonial Life is a registered trademark and marketing brand of Colonial Life & Accident Insurance Company.Policies Accident insurance Helps cover out-of-pocket expenses in the event of a covered accidentCancer and critical illness insurance Helps with the high cost of cancer or critical illness diagnosis and treatmentDental insurance Helps pay for dental procedures, like routine cleanings, crowns and root canalsDisability insurance Helps replace part of your regular income if you are unable to work because of a covered injury or illnessHospital confinement indemnity insurance Helps pay for covered hospital-related expenses, such as outpatient surgery and diagnostic proceduresLife insurance Protects the people who depend on you by helping cover final expenses and loss of income*Advantages may not apply to all products. See your Colonial Life benefits counselor forcomplete details.
www.elitebenefitsgroup.comUnited HealthcareVision/Dental Plan Supplemental Benefits through Colonial LifeBENEFITS & ELIGIBILITYAs an employee of Bailes Bates & Associates you have access to the following benefits for the Plan Year August 1, 2024 – July 31, 2025:Core Plan Benefits Offered:Legal Spouse. Children up to age 26, regardless of student status or marital status, including natural children, stepchildren, and legally adopted children (including children living with you before the adoption is final) who are your dependents or for whom you are required to provide health care coverage under a Qualified Medical Child Support Order. WHO IS ELIGIBILE AND WHENAll active full-time Employees, who work at least 40 hours per week. Employee benefits are effective the first of the month following 30 days of active employment.ELIGIBLE DEPENDENTSYou may enroll your eligible dependents in coverage. They include:Birth/AdoptionChange in Insurance Coverage, Address,Employment StatusDeath in the FamilyDependent Child Reaches Limiting AgeDivorce/AnnulmentFMLA-Related LeaveLegal Separation/MarriageSpouse Loss of Other CoverageEnrollment in MarketplaceCHANGING YOUR COVERAGE DURING THE YEARIf you need to change your coverage throughout theyear, you may only do so if you experience an eligiblechange in status/life event, such as:You must make changes to your benefit coverage within 30 days of an eligible change in status/life event.WHAT HAPPENS IF I DON’T ENROLL? If you do not enroll in the benefits program, you will automatically receive “default” coverage, which is:No Coverage.If later on you decide to enroll in benefits, you may be subject to benefit waiting periods, require evidence of insurability, and/or be required to wait until the next Annual Enrollment.
CONTACT INFORMATIONHEALTHDENTAL / VISIONCOLONIAL LIFEHUMAN RESOURCESELITE BENEFITS GROUP713-575-3722The information in this Enrollment Guide is intended for illustrative purposes and informational purposes only. Theinformation contained herein was taken from various summary plan descriptions, certificates of coverage and benefitinformation. Every effort was taken to accurately report your benefits however discrepancies and errors are alwayspossible. It is not intended to alter or expand rights or liabilities set forth in the official plan documents or contracts. Itis not an offer to contract nor are there any express or implied guarantees. In case of a discrepancy between thisinformation and the actual plan documents, the actual plan documents will prevail. If you have any questions aboutthis summary, please contact Human Resources or Elite Benefits Groupmyuhc.com877.797.8812United HealthcareHumanahumana.com877-398-2980www.colonialLife.com800-325-4368Cindy Breton281-565-6400