Return to flip book view

EMPLOYEE BENEFITSGUIDE2023 - 2024North Carolina Medical SocietyAn overview of the wide array of benefits provided byNorth Carolina Medical Society 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 Guide2023 - 2024 North Carolina Medical SocietyAs an employee of NCMS, 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 2023-2024 plan year, NCMS 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 NCMS 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 NCMS 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. (28+ hours/week eligible for Life and Disability). 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 Coverage effective on the first day of employment Benefits End End of month following terminationDependents Your legal spouse, dependent children up to age 26.Domestic 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 Guide2023 - 2024 North Carolina Medical SocietyComparison of PlansCoverage Provided by NCMSIn-Network PPO 1-2-3 4000Benefit Period Plan Year: 8/1 – 07/31Deductibles (Individual / Family)$4,000/$8,000Preventive CareCovered in fullPrimary Care Visit $35 CopaySpecialist Visit 50% after deductibleTelehealth via Teladoc $35 CopayUrgent Care 50% after deductibleEmergency Room 50% after deductibleOutpatient Procedure 50% after deductibleInpatient Visit $250 Copay, then 30% after deductiblePharmacy / RX (30 Day Supply)Tiers 1-6$10/$25/$40/$80/25% (up to $100 max) Lens and Frames Coverage Covered up to $130, then 90%Out-of-Pocket Max (Individual / Family)$8,150/$16,300MEDICALThe 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.

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 Guide2023 - 2024 North Carolina Medical SocietyWellness 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 NCMS, 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 1-2-3 4000Employee $.0.00Employee + Spouse $889.53Employee + Child $284.99Employee + Children $664.99Employee + Family $1,537.24Your 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 Guide2023 - 2024 North Carolina Medical SocietyEmployees 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 Guide2023 - 2024 North Carolina Medical SocietyThis Is How An HRA Works:• Your employer sets up an HRA account for each participant.• You don't contribute any money to your HRA account; the HRA account is funded entirely by your employer.• Each plan year, your employer contributes a specified amount to each participant's HRA. As long as there is money in your account, you can use the funds towards eligible HRA expenses.• Depending on the HRA your employer chooses, you may roll over HRA dollars that aren't used during a plan year.• Maximum Reimbursement: $1,500 per individual • Maximum Reimbursement: $3,000 per familyPlease refer to your Summary Plan Description (SPD) for specific details about your HRA.How Do I Benefit From An HRA?HRAs benefit everyone; you will appreciate your HRA because you don't pay taxes on the money in your account or your reimbursement expenses.Eligible ExpensesOnly eligible expenses can be reimbursed under your HRA. These expenses are defined by the IRS rules and by the NCMS plan. Learn more about eligible HRA expenses by reading the Summary Plan Description (SPD).Eligible expenses are those that you pay for out of your pocket for medical care that's provided to you, your spouse, and eligible dependents. Generally, IRS rules state that medical care includes items and services that are meant to diagnose, cure, mitigate, treat, or prevent illness or disease. Transportation that is primarily for medical care is also included. Here are some examples of HRA-eligible expenses:• Your health plan deductible (the amount you pay before your plan starts paying a share of your costs)• Your share of the cost for doctor's office visits and prescription drugs• Your share of the cost for eligible dental care, including exams, X-rays and cleanings• Your share of the cost for eligible vision care, including exams, eyeglasses, contact lenses, and laser eye surgeryRefer to your HRA documentation for more information.HEALTH REIMBURSEMENT ACCOUNT (HRA)

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 Guide2023 - 2024 North Carolina Medical SocietySummary of Coverage: Dental Plan ACoverage Provided by NCMS In-NetworkAnnual Deductibles(Individual / Family)N/APreventive Care Covered in fullBasic Procedures (fillings, etc.)20%Major Procedures(extractions, crowns, dentures, etc.)50%12 month waiting periodChild Orthodontics Benefits not availableContract 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.Pricing Per Pay PeriodEmployee $0.00Employee + One $31.12Employee + Two $50.05Employee + Family $80.06Your 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 Guide2023 - 2024 North Carolina Medical SocietySummary of Coverage: Dental Plan E with OrthodontiaCoverage Provided by NCMS In-NetworkAnnual Deductibles(Individual / Family)$50/$150Preventive Care Covered in fullBasic Procedures (extractions, fillings, etc.)20%Major Procedures(crowns, dentures, etc.)50%12 month waiting periodChild Orthodontics50%$1,500 Lifetime Maximum12 month waiting periodContract Year Maximum Benefit $5,000DENTALBelow 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.Pricing Per Pay PeriodEmployee $21.63Employee + One $72.43Employee + Two $117.16Employee + Family $172.67Your 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 Guide2023 - 2024 North Carolina Medical SocietySummary of CoverageCoverage provided by UnumPlan FeaturesEmployee Benefit Amount 2.5x annual earningsMaximum Benefit Amount The lesser of 2.5x annual earnings or $500,000AD&D Benefit 2.5x your earnings up to a max of $500,000Benefit Reductions begin at age 65 yearsGroup life insurance coverage is an employer-sponsored safety net in case the worst happens, with no out-of-pocket costs to you. Employees must fill out an EOI form if they exceed the guaranteed issue amount.GROUP LIFE and AD&D 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 Guide2023 - 2024 North Carolina Medical SocietySummary of CoverageCoverage provided by UnumPlan Features Short Term Long TermCoverage Paid By Employer EmployerEmployee Benefit Amount 60% of weekly earnings 60% of monthly earningsMaximum Benefit Amount $2,300 per week $10,000 per monthElimination Period (Accident) 30 days 90 daysElimination Period (Sickness) 30 days 90 daysBenefit Duration 9 weeksTo Social Security normal retirement ageDisability 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 INSURANCEPlease note, a pre-existing condition period may apply once you become covered. Please see policy for more information.

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 Guide2023 - 2024 North Carolina Medical SocietyColonial Life – Voluntary Benefits You never know when an unexpected illness or injury could leave you and your family with financial difficulties. Health insurance can help, but you can still have deductibles, co-payments, and other out-of-pocket expenses. That’s where voluntary benefits come in. Sometimes called supplemental insurance, voluntary benefits are designed to complement your health insurance and help provide extra financial protection. This year, your employer is helping you protect your way of life by giving you the opportunity to purchase the following voluntary benefits from Colonial Life: Accident insurance Cancer insurance Critical illness insurance Medical Bridge - Hospital indemnity insurance Term life insurance Whole life insurance If guaranteed-issue coverage is available, you won’t have to answer health questions. For more details, talk with your Colonial Life benefits counselor. Benefits may be subject to a pre-existing condition provision. Accident Insurance – YES … ACCIDENTS CAN HAPPEN TO ANYONE You never know when you or someone you love could get hurt in an accident. And accidents come with costs, such as emergency room fees, doctor’s bills, and lost income from missing work. Even if you have good health insurance, deductibles and co-pays can really add up. With accident insurance from Colonial Life, you can receive benefits to help with the expenses of a covered accident. This financial protection can help you focus on what really matters: healing. WITH THIS COVERAGE: • A set amount is payable based on the injury you suffer and the treatment you receive. • You do not need to answer medical questions or have a physical exam to get basic coverage. • Unlike workers’ compensation, which only covers on-the-job injuries, accident insurance covers injuries that happen on the job or off the job. • Coverage is available for you, your spouse, and eligible dependent children. Cancer Insurance - WOULD YOU BE FINANCIALLY PREPARED FOR CANCER? If you were diagnosed with cancer, you could have expenses that medical insurance doesn’t cover. In addition to your regular, ongoing bills, you could have to pay for out-of-network treatment, childcare, home health care services, and other indirect treatment and recovery costs. Hopefully, you and your family will never face cancer. If you do, cancer insurance from Colonial Life can help protect the lifestyle you’ve worked to build. WITH THIS COVERAGE: • Coverage options are available for you and your eligible dependents. • Benefits are payable regardless of any other insurance you may have with other companies. • You can use benefits to help pay for travel to and from treatment centers, lodging and meals, deductibles – or any other way you choose. • You may have the option of purchasing additional riders for even more financial protection against cancer.

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 Guide2023 - 2024 North Carolina Medical SocietyCritical Illness - YOU CAN’T PREDICT AN ILLNESS, BUT YOU CAN BE PREPARED No matter where you are in life, you never know when you or a loved one could experience a critical illness, such as a heart attack or stroke. Medical advancements and early detection are helping many people survive critical illnesses. However, preventive tests and treatment can lead to increased medical expenses, and your health insurance may not cover these costs. Critical illness insurance from Colonial Life helps supplement your major medical coverage by providing a lump-sum benefit you can use to pay the direct and indirect costs related to a covered critical illness. WITH THIS COVERAGE: • Benefits are payable directly to you unless you specify otherwise. • You may receive additional benefits if you’re diagnosed with more than one critical illness. • Coverage options are available for you, your spouse, and eligible dependent children. Medical Bridge (Hospital Indemnity Insurance) - GET HELP WITH RISING HEALTH CARE COSTS If you’re admitted to the hospital because of a covered accident or sickness, it’s important to focus on your recovery – not your finances. That’s easier said than done if you have costly co-payments, deductibles and other expenses coming your way. Hospital indemnity insurance from Colonial Life can help you pay for medical expenses that your health insurance may not cover for Accidents, Illnesses, and Maternity. WITH THIS COVERAGE: • Benefits are payable directly to you (unless you specify otherwise) and can be used as you see fit. • Coverage is available for you, your spouse, and eligible dependent children. • Benefits are payable regardless of any other insurance you may have with other companies. Whole Life insurance - LIFE INSURANCE THAT COMES WITH GUARANTEES — BECAUSE LIFE DOESN’T You can’t predict the future, but you can rest easier knowing you have life insurance with lifelong guarantees. Whole life insurance provides features – cash value accumulation, premium rates and a death benefit (minus any loans and loan interest) – that help ensure those benefits will be there to help protect your family’s way of life. WITH THIS COVERAGE: • Life insurance benefits for the beneficiary are typically free from income tax. • You have three opportunities to purchase additional coverage with no proof of good health required if you are 55 or younger when you initially purchase coverage. • The policy’s accelerated death benefit can pay a percentage of the death benefit if the covered individual is diagnosed with a terminal illness. Accelerated benefit payments will reduce the amount the policy pays upon the recipient’s death. • A $3,000 immediate claim payment can be paid to the designated beneficiary as an advance of the death benefit.

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 Guide2023 - 2024 North Carolina Medical SocietyTerm Life insurance - LIFE INSURANCE PROTECTION WHEN YOU NEED IT MOST Life insurance needs change as life circumstances change. You may need different coverage if you’re getting married, buying a home, or having a child. Term life insurance from Colonial Life provides protection for a specified period of time, typically offering the greatest amount of coverage for the lowest initial premium. This fact makes term life insurance a good choice for supplementing cash value coverage during life stages when obligations are higher, such as while children are younger. It’s also a good option for families on a tight budget – especially since you can convert it to a whole life insurance plan later. WITH THIS COVERAGE: • A beneficiary can receive a benefit that is typically free from income tax. • The policy’s accelerated death benefit can pay a percentage of the death benefit if the covered person is diagnosed with a terminal illness. Accelerated benefit payments will reduce the amount the policy pays upon the recipient’s death. • You can convert it to a Colonial Life cash value insurance plan, with no proof of good health, to age 75.

EMPLOYEE BENEFITS GUIDEPrepared By Sentinel Benefits Consulting | sentinelra.com2023 - 2024North Carolina Medical Society