Return to flip book view

MEDICAL BENEFITS GUIDE2024 - 2025An overview of the medical benefits provided byCarolina Eye Associates 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.Medical Benefits Guide2024 - 2025 Carolina Eye AssociatesAs an employee of Carolina Eye Associates, 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.This benefits booklet is a summary description of your medical plan offerings. 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 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 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.Medical Benefits Guide2024 - 2025 Carolina Eye AssociatesComparison 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)Essentials 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.Medical Benefits Guide2024 - 2025 Carolina Eye AssociatesUnderstanding 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, 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$98.03 $67.41Employee + Spouse$416.35 $389.78Employee + Child$200.01 $181.00Employee + Children$335.99 $312.24Employee + Family$648.11 $613.47Your Cost Amazon PharmacyThrough your medical coverage you have access to Amazon Pharmacy for your mail order needs. This includes Meds Your Way, a discount card that provides additional savings through Amazon Pharmacy. At check out you’ll see the lowest cost available for your prescription. Sign up and learn more at www.amazon.com/bluecrossnc.

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.Medical Benefits Guide2024 - 2025 Carolina Eye AssociatesEmployees 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 1-855-549-2214Refer 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.Medical Benefits Guide2024 - 2025 Carolina Eye AssociatesThrough 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.Medical Benefits Guide2024 - 2025 Carolina Eye AssociatesA 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 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:2024 Tax Year 2025 Tax Year$4,150 Individual / $8,300 Family $4,300 Individual / $8,550 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.Medical Benefits Guide2024 - 2025 Carolina Eye AssociatesSummary of CoverageCoverage provided by USAblePlan FeaturesEmployee Benefit Amount $15,000AD&D Benefit $15,000Benefit Reductions begin at age 65Carolina Eye Associates also provides group life insurance coverage through NCMS. This is an employer-sponsored safety net in case the worst happens, with no out-of-pocket costs to you. GROUP LIFE and AD&D INSURANCECarrier ResourcesBENEFIT CARRIER GROUP # PHONE NUMBER WEBSITEMedical NCMSCEA: 141709931001GO: 141709931002877-275-9787 www.BlueConnectNC.comEAP Vital WorklifeUsername & Password: ncmsplan800-383-1908 www.VITALWorkLife.comBasic Life & ADD NCMS/USAble CEA: 50044936GO:50044974800-370-5856 www.usablelife.comHow to access ID CardsBENEFIT CARRIER HOW TO ACCESSMedical NCMS/BCBSNCWill receive an ID Card in the mail. Can also access through the portal: www.blueconnectnc.com Or Mobile App.

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.Medical Benefits Guide2024 - 2025 Carolina Eye AssociatesThis page was intentionally left blank

MEDICAL BENEFITS GUIDEPrepared By Sentinel Benefits Consulting | sentinelra.com2024 - 2025Carolina Eye Associates