Return to flip book view

Message EMPLOYEE BENEFITSGUIDE2025 - 2026An overview of the wide array of benefits provided byCarolina Eye Associates PA 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 Guide2025 - 2026 Carolina Eye Associates PAAs an employee of Carolina Eye Associates PA , 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 2025-2026 plan year, Carolina Eye Associates PA 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 Carolina Eye Associates PA 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 Carolina Eye Associates PA 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 & EnrollmentRegular full-time employees 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 following date of hireBenefits End End of month following terminationDependents Your legal spouse and dependent children up to age 26Domestic 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 Guide2025 - 2026 Carolina Eye Associates PAComparison of PlansCoverage Provided by North Carolina Medical Society Benefits PlanIn-Network PPO 4000-70 HDHP 5000-100Benefit Period Plan Year: 8/1-7/31 Plan Year: 8/1-7/31Deductibles (Individual / Family) $4,000/$8,000$5,000/$10,000 ($6,550 family member)Out-of-Pocket Max (Individual / Family)$8,550/$17,100$5,000/$10,000 ($6,550 family member)Primary Care Visit $50 Copay* 0% after deductibleSpecialist Visit $100 Copay 0% after deductibleTelehealth via Teladoc $50 Copay 0% after deductibleUrgent Care $100 Copay 0% after deductibleEmergency Room $1,000 Copay 0% after deductibleOutpatient Procedure 30% after deductible 0% after deductibleInpatient Visit 30% after deductible 0% after deductiblePharmacy / RX(30 Day Supply)Essential Formulary$15/$35/$45/$90/25% (up to $200 max per 30 day supply of tier 5 drugs)Enhanced Preventive: 0%All Others: 0% after deductibleLens and Frames Coverage Covered up to $130 then 90% 0% after deductibleMEDICALThe 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.*Register your PCP in Blue Connect and copay is waived for 1st three visits

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 Guide2025 - 2026 Carolina Eye Associates PAWellness 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 Carolina Eye Associates PA, 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 CAREPricing Per Pay Period PPO 4000-70 HDHP 5000-100Employee $98.04 $67.41Employee + Spouse $416.35 $389.78Employee + Child $200.01 $181.00Employee + Children $335.99 $312.24Employee + Family $648.11 $613.47Your Cost

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 Guide2025 - 2026 Carolina Eye Associates PAEmployees and dependents enrolled in our medical plan 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 specialists. 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 855-549-2214Refer 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 Guide2025 - 2026 Carolina Eye Associates PAThrough 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.To register visit: https://esmmweighless.com/howitwork/enroll-choose-a-class/ and enter the employer code ASONCMSCarolinaEye . For questions, please contact Administrator@ESMMWeighLess.com.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 Guide2025 - 2026 Carolina Eye Associates PAA 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 are 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 HealthEquity HSA on a pre-tax basis through payroll deductions up to the IRS statutory maximums. The IRS has established the following maximum HSA contributions:2025 Tax Year 2026 Tax Year$4,300 Individual / $8,550 Family $4,400 Individual / $8,750 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 Guide2025 - 2026 Carolina Eye Associates PAThis Is How An FSA Works:• You set aside money for your FSA from your paycheck before taxes are taken out.• You then use your pre-tax FSA funds throughout the plan year to pay for eligible health care or dependent care expenses.• You save money on expenses you're already paying for.You will forfeit any unused funds over the $500 rollover if not incurred by the end of the plan year and submitted by the filing deadline. Health FSA Eligible Expenses• Medical expenses: copays, coinsurance and deductibles• Dental expenses: exams, cleanings, X-rays and braces• Vision expenses: exams, contact lenses, eyeglasses and laser eye surgery• Professional services: physical therapy, chiropractic and acupuncture• Prescription drugs and insulin• Over-the-counter health care items such as bandages, pregnancy tests and blood pressure monitorsDependent Care FSA Eligible Expenses• Care for your child who is under the age of 13• Before-school and after-school care• Babysitting and nanny expenses• Day care, nursery school and preschool• Summer day camp• Care for a relative who is physically or mentally incapable of self-care and lives in your homeHealth FSA 2025 Plan Limits: $3,200Dependent Care FSA 2025 Plan Limits: $5,000For more information, please refer to your Carolina Eye Associates FSA Claim Kit found on the public drive, or request from HR directly. FLEXIBLE SPENDING ACCOUNT (FSA)

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 Guide2025 - 2026 Carolina Eye Associates PASummary of CoverageCoverage Provided by Delta Dental In-NetworkAnnual Deductibles(Individual / Family)$50 / $150Preventive Care No cost; covered at 100%Basic Procedures (extractions, fillings, etc.)20% after deductibleMajor Procedures(crowns, dentures, etc.)50% after deductibleChild Orthodontics 50% up to $1,000 lifetime maxPlan Year Maximum Benefit $1,000DENTALBelow 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. Benefits shown below capture member responsibility.Your CostPricing Per Pay PeriodEmployee $14.66Employee + Spouse $30.81Employee + Child(ren) $35.64Employee + Family $51.42Late entrant penalties may apply; please see carrier certificate for 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 Guide2025 - 2026 Carolina Eye Associates PASummary of CoverageCoverage provided by Pacific LifePlan FeaturesEmployee Benefit Amount $25,000Maximum Benefit Amount $25,000AD&D Benefit $25,000Benefit Reductions begin at age 65Voluntary Dependent Life Spouse $5,000, Child $2,500Group 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.GROUP LIFE and AD&D INSURANCESummary of CoverageLife Benefit Employee Spouse DependentAmount $10,000 Increments $5,000 Increments $10,000Minimum Amount $10,000 $5,000 $10,000Maximum AmountLesser than 5x Annual Earnings or $500,000$150,000 $10,000Guarantee Issue (Newly Eligible Employees)$200,000 $50,000 $10,000Benefits Will Reduce By 35% at 65, 50% at 70Benefit available up to age 26VOLUNTARY LIFE and AD&D INSURANCEFor summary of rate sheet, please see carrier summary or Employee Navigator.

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 Guide2025 - 2026 Carolina Eye Associates PASummary of CoverageCoverage provided by Pacific LifePlan Features Short Term Long TermCoverage Paid By Carolina Eye Associates EmployeeTaxation Benefit is Taxed Benefit is Not TaxedEmployee Benefit Amount 66.67% of Covered Earnings 60% of Covered EarningsMaximum Benefit Amount $800/Weekly $10,000/MonthlyElimination Period Day 14 180 DaysPre-Ex NA 3/12Benefit Duration 26 Weeks SSNRAEvidence of Insurability NARequired if enrolling after first eligibleDisability 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. DISABILITY INSURANCE

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 Guide2025 - 2026 Carolina Eye Associates PACarrier ResourcesBENEFIT CARRIER GROUP # PHONE NUMBER WEBSITEMedical NCMS 141709931001 877-275-9787 www.BlueConnectNC.comDental Delta Dental 194465 800-662-885 www.memberportal.comLife and AD&D Pacific Life TLMP1696421461 855-810-3301www.benefits.pacificlife.comShort Term DisabilityPacific Life STDMP1725791014 855-810-3301www.benefits.pacificlife.comLong Term DisabilityPacific Life LTDMP1725790534 855-810-3301www.benefits.pacificlife.comHSA HealthEquity 866-735-8195 https://www.healthequity.comEAP Vital WorklifeUsername & Password: ncmsplan800-383-1908 www.VITALWorkLife.comFSACarolina Eye AssociatesContact Human ResourcesHow to access ID CardsBENEFIT CARRIER HOW TO ACCESSMedical NCMS/BCBSNCHard copy ID cards are issued and mailed to your home address; electronic copies can be accessed via www.bluecrossnc.com Dental Delta DentalElectronically through the Delta Dental mobile app or member portal www.memberportal.com

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 Guide2025 - 2026 Carolina Eye Associates PAENROLL IN YOUR BENEFITS: One step at atimeStep 1: Log InGo to www.employeenavigator.com and click Login• Returning users: Log in with the username and password you selected. Click Reset a forgotten password.• First time users: Click on your Registration Link in the email sent to you by your admin or Register as a new user. Create an account and create your own username and password.Step 2: Welcome!After you login click Let’s Begin to complete your required tasks.Step 3: Onboarding (For first time users, if applicable) Complete any assigned onboarding tasks before enrolling in your benefits. Once you’ve completed your tasks click Start Enrollment to begin your enrollments.T I Pif you hit “Dismiss, complete later” you’ll be taken to your Home Page. You’ll still be able to start enrollments again by clicking “Start Enrollments”Step 4: Start EnrollmentsAfter clicking Start Enrollment, you’ll need to complete some personal& dependent information before moving to your benefit elections.T I PHave dependent details handy. To enroll a dependent in coverage you willneed their date of birth and Social Securitynumber.

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 Guide2025 - 2026 Carolina Eye Associates PAStep 8: HR Tasks (if applicable)To complete any required HR tasks, click Start Tasks. If your HR department has not assigned any tasks, you’re finished!You can login to review your benefits 24/7Step 7: Review & Confirm ElectionsReview the benefits you selected on the enrollment summarypageto make sure they are correct then click Sign & Agree to complete your enrollment. You can either print a summary of your elections for your records or login at any point during the year to view your summary online.T I PIf you miss a step, you’ll see Enrollment Not Complete inthe progress bar with the incomplete steps highlighted. Click on any incomplete steps to complete them.Click Save & Continue at the bottom of each screen to save yourelections.If you do not want a benefit, click Don’t want this benefit? at the bottom of the screen and select a reason from the drop-down menu.Step 6: FormsIf you have elected benefits that require a beneficiary designation, Primary Care Physician, or completion of an Evidence of Insurability form, you will be prompted to add in thosedetails.Step 5: Benefit ElectionsTo enroll dependents in a benefit, click the checkbox next to the dependent’sname under Who am I enrolling?Below your dependents you can view your available plans and the cost per pay. To elect a benefit, click Select Plan underneath the plan cost.

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 Guide2025 - 2026 Carolina Eye Associates PA

EMPLOYEE BENEFITS GUIDEPrepared By Sentinel Benefits Consulting | sentinelra.com2025 - 2026Carolina Eye Associates PA