EMPLOYEE BENEFITSGUIDE2024An overview of the medical benefits provided byCharlotte Gastroenterology & Hepatologyto 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 Charlotte Gastroenterology & HepatologyAs an employee of Charlotte Gastroenterology & Hepatology, 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, Charlotte Gastroenterology & Hepatology 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 Charlotte Gastroenterology & Hepatology 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 Charlotte Gastroenterology & Hepatology medical 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 First of the month following 60 daysBenefits End Last day of employmentDependents 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 Guide2024 Charlotte Gastroenterology & HepatologyComparison of PPO Plan OptionsCoverage Provided by North Carolina Medical Society (NCMS)In-Network PPO 5000-70 PPO 7900-100Benefit Period Plan Year: 1/1 - 12/31 Plan Year: 1/1 - 12/31Deductibles (Ind/ Family) $5,000 / $10,000 $7,900/$15,800Out-of-Pocket Max (Ind/Family) $8,550 / $17,100 $7,900/$15,800Preventive Care No Charge No ChargePrimary Care Visit $40 Copay* 0% after deductibleSpecialist Visit $120 Copay 0% after deductibleTelemedicine Visit $40 Copay 0% after deductibleUrgent Care $120 Copay 0% after deductibleEmergency Room $1,000 Copay 0% after deductibleOutpatient Care 30% after deductible 0% after deductibleInpatient Care 30% after deductible 0% after deductiblePharmacy / RX (30-Day Supply)Essential Formulary$15/$35/$45/$90/25% up to $200 max$20/$35/$45/$90/25% up to $200 maxLens and Frames Coverage Covered up to $130, then 90% Covered up to $130, then 90%MEDICALThe chart below is an overview of the two PPO plan options 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 Guide2024 Charlotte Gastroenterology & HepatologyComparison of High Deductible Health Plan OptionsCoverage Provided by North Carolina Medical Society (NCMS)In-Network HDHP 2700-100 HDHP 8050-100Benefit Period Plan Year: 1/1 - 12/31 Plan Year: 1/1 - 12/31Deductibles (Ind/ Family)$2,700/$5,450($5,450 family member)$8,050/$16,100($8,050 family member)Out-of-Pocket Max (Ind/Family)$2,700/$5,450($5,450 family member)$8,050/$16,100($8,050 family member)Preventive Care No Charge No ChargePrimary Care Visit 0% after deductible 0% after deductibleSpecialist Visit 0% after deductible 0% after deductibleTelemedicine Visit 0% after deductible 0% after deductibleUrgent Care 0% after deductible 0% after deductibleEmergency Room 0% after deductible 0% after deductibleOutpatient Care 0% after deductible 0% after deductibleInpatient Care 0% after deductible 0% after deductiblePharmacy / RX (30-Day Supply)Essential FormularyEnhanced Preventive: 0%All Other: 0% after deductibleEnhanced Preventive: 0%All Other: 0% after deductibleLens and Frames Coverage 0% after deductible 0% after deductibleMEDICALThe chart below is an overview of the two HDHP options 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 Guide2024 Charlotte Gastroenterology & HepatologyAnnual Deductible - The amount you must pay each year before the plan starts paying a portion of medical expenses. All family members’ expenses that count toward a health plan deductible accumulate together in the aggregate; however, each person also has a limit on their own individual accumulated expenses (the amount varies by plan).Copays and Coinsurance - These expenses are your share of cost paid for covered health care services. Copays are a fixed dollar amount and are usually due at the time you receive care. Coinsurance is your share of the allowed amount charged for a service and is generally billed to you after the health insurance company reconciles the bill with the provider.Out-of-Pocket Maximum - This is the total amount you can pay out of pocket each calendar year before the plan pays 100 percent of covered expenses for the rest of the calendar year. Most expenses that meet provider network requirements count toward the annual out-of-pocket maximum, including expenses paid to the annual deductible, copays and coinsurance. MEDICAL PLAN INFORMATIONWellness 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 Charlotte Gastroenterology & Hepatology, 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 Charlotte Gastroenterology & HepatologyEmployees 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 Charlotte Gastroenterology & HepatologyThrough 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 available from Human Resources. 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 Guide2024 Charlotte Gastroenterology & HepatologyA 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 Health Equity HSA on a pre-tax basis through payroll deductions up to the IRS statutory maximums. The IRS has established the following maximum HSA contributions:2023 Tax Year 2024 Tax Year$3,850 Individual / $7,750 Family $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 Charlotte Gastroenterology & HepatologyThis 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.If you don’t use it, you lose it. You have 2.5-month grace period to incurred expenses after the plan year or you will forfeit any unused funds. Refer to your FSA documentation for more details.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 monitorsIf enrolled in a HDHP with HSA then you can enroll in a limited purpose FSA. Limited Purpose Health FSA Eligible Expenses• Dental expenses: exams, cleanings, X-rays and braces• Vision expenses: exams, contact lenses, eyeglasses and laser eye surgeryDependent 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 homeRefer to your FSA documentation for more information. 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 Guide2024 Charlotte Gastroenterology & HepatologyFull Time Employees PPO 5000-70 PPO 7900-100 HDHP 2700-100 HDHP 8050-100Employee $111.00 $66.25 $232.00 $13.50Employee + Spouse $501.03 $409.24 $755.16 $342.81Employee + Child $235.96 $176.14 $399.62 $119.01Employee + Children $402.58 $322.66 $623.11 $259.68Employee + Family $785.03 $658.99 $1,136.10 $582.59¾ Time Employees PPO 5000-70 PPO 7900-100 HDHP 2700-100 HDHP 8050-100Employee $177.92 $132.94 $300.98 $90.05Employee + Spouse $567.94 $475.92 $824.14 $419.36Employee + Child $302.88 $242.83 $468.60 $195.56Employee + Children $469.49 $389.35 $692.09 $336.23Employee + Family $851.95 $725.67 $1,205.08 $659.14Your Cost Per Pay Period Carrier ResourcesBENEFIT CARRIER GROUP # PHONE NUMBER WEBSITEMedicalNorth Carolina Medical Society#141675511001 877-275-9787www.BlueConnectNC.comHSA Health Equity 866-346-5800 www.healthequity.comFSA Flores & Associates800-532-3327www.flores247.comEAP Vital WorklifeUsername & Password: ncmsplan800-383-1908www.VITALWorkLife.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.Employee Benefits Guide2024 Charlotte Gastroenterology & HepatologyThis page is intentionally blank
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