EMPLOYEE BENEFITSGUIDE2024An overview of benefits provided by Cary Pediatric Center 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 Guide2024 Cary Pediatric CenterAs an employee of Cary Pediatric Center, 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 2024 plan year, Cary Pediatric Center 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 Cary Pediatric Center is offering an overall benefits package that can be shaped and molded by you to fit your needs.This booklet provides a high-level summary of your Cary Pediatric Center 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.INTRODUCTIONEligibility & 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 91st day of employmentBenefits End End of the month following terminationDependents Covered to age 26
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 Guide2024 Cary Pediatric CenterComparison of PlansCoverage Provided by NCMS via Blue Cross Blue Shield of NCIn-Network HDHP 5000 – 100 Plan PPO 4000 – 70 PlanBenefit Period 1/1 – 12/31 1/1 – 12/31Deductibles (Individual / Family)$5,000/$10,000($6,550 per family member)$4,000/$8,000Preventive Care Covered at 100% Covered at 100%Primary Care Visit 0% after Deductible $50 Copay*Specialist Visit 0% after Deductible $100 CopayTelehealth via Teladoc 0% after Deductible $50 CopayUrgent Care 0% after Deductible $100 CopayEmergency Room 0% after Deductible $1,000 CopayOutpatient Procedure 0% after Deductible 30% after DeductibleInpatient Visit 0% after Deductible 30% after DeductiblePharmacy / RX (30 Day Supply)Essential Formulary: Tiers 1-6Enhanced Preventive: 0%All Other: 0% after Deductible$15/$35/$45/$90/25%**min $50, max $200Lens and Frames Coverage 0% after Deductible $130 Allowance, then 90% thereafterOut-of-Pocket Max (Individual / Family)$5,000/$10,000($6,550 per family member)$8,550/$17,100MEDICALThe chart below is an overview of the In-Network benefits. Out-of-Network benefits are available; please review your North Carolina Medical Society (NCMS) plan documents for additional details.*Login to Blue Connect to select PCP. Your copay is waived for your first 3 visits to your selected PCP.
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 Guide2024 Cary Pediatric CenterHDHP 5000 – 100 PlanPricing Per Pay Period Bi-Weekly (26) Monthly (12)Employee $108.79 $235.71Employee + Spouse $428.94 $929.37Employee + Child $211.36 $457.95Employee + Children $348.12 $754.27Employee + Family $662.06 $1,434.46Your Cost PPO 4000 – 70 PlanPricing Per Pay Period Bi-Weekly (26) Monthly (12)Employee $89.34 $193.57Employee + Spouse $396.07 $858.15Employee + Child $187.62 $406.50Employee + Children $318.65 $690.40Employee + Family $619.42 $1,342.07
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 Guide2024 Cary Pediatric CenterWellness 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 Cary Pediatric Center 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 violencePREVENTIVE CARE
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 Guide2024 Cary Pediatric CenterEmployees 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.TELEHEALTHWhat 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 more
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 Guide2024 Cary Pediatric CenterThrough 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 BCBSNC 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 PROGRAMS
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 Guide2024 Cary Pediatric CenterA health savings account (HSA) is a health care account and savings account in one. HSA helps offset the cost of a HDHP while saving for your out-of-pocket eligible health care expenses. The HSA is your personal bank account and can be used for you and your dependents now and in the future.Why Is It A Good Idea To Have An HSA?HSAs benefit everyone who is eligible to have this account, including single individuals, families and soon-to-be retirees. You save money on taxes in three ways:• Tax-Free Deposits: The money you contribute to your HSA isn't taxed (up to the IRS annual limit)• Tax-Free Earnings: Your interest and any investment earnings grow tax-free• Tax-Free Withdrawals: The money used toward eligible health care expenses isn't taxed now or in the futureSetting aside pre-tax dollars into your HSA means you pay fewer taxes and increase your take-home pay by your tax savings. You save money on eligible expenses that you are paying for out of your pocket. The amount you save depends on your tax bracket. For example, if you are in the 30% tax bracket, you can save $30 on every $100 spent on eligible health care expenses.HSA funds roll over from year to year and accumulate in your account. There is no "use-it-or-lose-it" rule with HSAs, and you decide how and when to use your HSA funds, which can be used for eligible expenses you have now, in the future, or during retirement. Also, when you have a certain balance in your HSA, investment opportunities are available.Who is Eligible?You are eligible to contribute to an HSA if:• You are enrolled in a qualified HDHP• You are not enrolled in a copay plan such as a spouse’s non-HDHP, Medicare, Medicaid or Tri-Care• You or your spouse is not enrolled in a full purpose Health Care Flexible Spending AccountRefer to your HSA documentation for more information.HSA Contribution LimitsYou can contribute to your Optum Bank HSA on a pre-tax basis through payroll deductions up to the IRS statutory maximums. These maximums include employer contributions. The IRS has established the following maximum HSA contributions:2024 Tax Year$4,150 Individual / $8,300 FamilyIf you are age 55 and over, you may contribute an extra $1,000 catch-up contribution. HEALTH SAVINGS ACCOUNT (HSA)
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 Guide2024 Cary Pediatric CenterSummary of CoverageCoverage Provided by Principal In-NetworkCalendar Year Deductible(Individual / Family)$50/$150Preventive Care Covered at 100%Basic Procedures (extractions, fillings, etc.)20% after DeductibleMajor Procedures(crowns, dentures, etc.)50% after DeductibleCalendar Year Maximum Benefit $1,000 per covered member*Waiting Periods 12 months for Basic & Major ServicesDENTALBelow 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 Pay Period Bi-Weekly (26) Monthly (12)Employee $6.87 $14.89Employee + Spouse $28.29 $61.29Employee + Child(ren) $29.32 $63.53Employee + Family $53.21 $115.29Your Cost*Maximum accumulation benefit applies – some of your unused annual benefit maximum can be carried over to next year – for more details, please review carrier benefit summary or certificate of coverage
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 Guide2024 Cary Pediatric CenterPlan FeaturesEmployee Benefit Amount 1 x Annual SalaryMaximum Benefit Amount $100,000AD&D Benefit1 x Annual SalaryBenefit Reductions Begin At age 65Group 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. Evidence of insurability may apply – see benefit summary or certificate of coverage for more details. Benefits are provided by Principal.GROUP LIFE and AD&D INSURANCELife Benefit Employee Spouse DependentAmount Increments of $25,000 Increments of $5,000 $5,000 or $10,000Minimum Amount $25,000 $5,000 $5,000Maximum Amount $150,000 $75,000 $10,000Guarantee Issue $100,000 $25,000 $5,000 or $10,000Benefit Reductions Begin At age 65 At age 65 Benefit ends at age 26VOLUNTARY 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.During Open Enrollment, Principal offers employees the opportunity to enroll or increase their voluntary life insurance one increment ($25k) without needing to answer health statements. This also applies to an employee’s spouse, who can enroll or increase their voluntary life insurance one increment ($5k).
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 Guide2024 Cary Pediatric CenterSummary of CoveragePlan Features Short Term DisabilityCoverage Paid By EmployeeTaxation Benefit is not taxedEmployee Benefit Amount 60% of Weekly EarningsMaximum Benefit Amount $1,000 per WeekElimination Period (Accident) 14 Days, Benefits begin on 15th DayElimination Period (Sickness) 14 Days, Benefits begin on 15th DayBenefit Duration Up to 26 Weeks (including elimination period)Evidence of Insurability You must enroll within 31 days of being eligible. If you don’t, you’ll need to provide health information for Principal to review for approval.Disability 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. Coverage is provided by Principal.DISABILITY INSURANCEPlease note, a pre-existing condition period may apply once you become covered. Please see policy for more information.
EMPLOYEE BENEFITS GUIDEPrepared By Sentinel Benefits Consulting | sentinelra.com2024Cary Pediatric Center
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 Guide2024 Cary Pediatric CenterOptional pages follow