Return to flip book view

EMPLOYEE BENEFITSGUIDE2024An overview of the wide array of benefits provided byRaleigh Medical Group, 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 Guide2024Raleigh Medical Group, PAAs an employee of Raleigh Medical Group, 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 2024 plan year, Raleigh Medical Group, 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 Raleigh Medical Group, 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 Raleigh Medical Group, 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 & 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 30 days of employmentBenefits End Last day of employmentDependents Up to age 26Domestic Partner Available for medical plan 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 Guide2024Raleigh Medical Group, PAComparison of PlansCoverage Provided by North Carolina Medical Society (NCMS)In-NetworkHSA PlanHDHP 2700-80Mid PlanPPO 4000-70High PlanPPO 2500-80Benefit Period Calendar Year: 1/1 – 12/31 Calendar Year: 1/1 – 12/31 Calendar Year: 1/1 – 12/31Deductibles (Individual / Family)$2,700 individual$5,450 Family Member$5,450 Family$4,000/$8,000 $2,500/$7,500Out-of-Pocket Max (Individual / Family)$5,000 Individual$6,550 Family Member$10,000 Family$8,550/$17,100 $7,150/$14,300 Preventive Care Covered at 100% Covered at 100% Covered at 100%Primary Care Visit 20% after deductible $50 Copay* $35 Copay*Specialist Visit 20% after deductible $100 Copay $70 CopayTelehealth via Teladoc 20% after deductible $50 Copay $35 CopayUrgent Care 20% after deductible $100 Copay $75 CopayEmergency Room 20% after deductible $1,000 Copay $500 CopayOutpatient Procedure 20% after deductible 30% after deductible 20% after deductibleInpatient Visit 20% after deductible 30% after deductible 20% after deductiblePharmacy (30 Day Supply)Essential Formulary Tiers 1-5Enhanced Preventive: 0% All Other: 20% after deductible$15/$35/$45/$90/25% to a max of $200$10/$25/$40/$80/25% to a max of $100Lens and Frames Coverage 20% after deductible$130 at 100% then 90% thereafter$130 at 100% then 90% thereafterMEDICALThe 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.*Log in to Blue Connect to select your Primary Care Provider (PCP). Your copay is waived for your first 3 visits to your selected PCP for the Mid and High Plans.

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 Guide2024Raleigh Medical Group, PAUnderstanding 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 Raleigh Medical Group, 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 CARE26 Pay Periods HSA Plan - HDHP 2700-80 Mid Plan - PPO 4000-70 High Plan - PPO 2500-80Employee$63.69 $96.71 $149.26Employee + Spouse$335.45 $528.20 $699.58Employee + Child$157.00 $200.00 $345.00Employee + Children$201.51 $271.89 $424.04Employee + Family$484.23 $903.96 $1,173.50Your Cost Per Pay Period 24 Pay Periods HSA Plan - HDHP 2700-80 Mid Plan - PPO 4000-70 High Plan - PPO 2500-80Employee$68.99 $104.76 $161.70Employee + Spouse$363.40 $572.22 $757.88Employee + Child$170.08 $216.67 $373.75Employee + Children$218.31 $294.54 $459.38Employee + Family$524.58 $979.29 $1,271.29

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 Guide2024Raleigh Medical Group, 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 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 Guide2024Raleigh Medical Group, PAThrough our partnership with NCMS, enrolled members have access to several additional programs tohelp 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 additionaltools, 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 strategiesproven to work for weight loss and maintenance. Each lesson informs, empowers and motivatesparticipants 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: ASONCMSRaleighMedGroup. For questions, please contactAdministrator@ESMMWeighLess.com.Nutrition CounselingTotal Nutrition Technology provides members with a custom-built nutrition plan and exerciseguidelines to fit each member’s lifestyle and dietary objectives. To get started on your wellnessjourney, 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 phoneconsultation and website access to articles, assessments, seminars and much more. Face to facecounseling is available.  Legal, financial and identity theft services can also be accessed. ContactVITAL 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 Guide2024Raleigh Medical Group, PAA health savings account (HSA) is a health care account and savings account in one. HSA helps offset the cost of a High Deductible Health Plan (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 Health Equity HSA on a pre-tax basis through payroll deductions up to the IRS statutory maximums. These maximums include employer contributions of $250 annually. 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 Guide2024Raleigh Medical Group, 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.Our plan through HealthEquity, offers a carry over up to $640 of unused funds to the following year. 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 enrolling for the first time in a HDHP with HSA then you must spend down your FSA balance before you can contribute or receive contributions to your HSA. Dependent 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 Guide2024Raleigh Medical Group, PASummary of CoverageCoverage provided by Blue 20/20 In-NetworkVision Exam (Once per year) $10 CopayLenses (once per year) $25 Copay Frames (Once every 2 years) $150 AllowanceElective Contact Lenses (in leu of lenses)$150 AllowanceAdditional copay applies for your contact lens exam (fitting and evaluation)Medically Necessary Contact Lenses $0 CopayVISIONOur vision coverage is provided by Blue 20/20. Please review your plan documents for additional details.Pricing Per Pay Period 26 pay periods 24 pay periodsEmployee $1.52 $1.65Employee + Spouse $4.25 $4.60Employee + Children $4.56 $4.94Employee + Family $7.41 $8.03Your 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 Guide2024Raleigh Medical Group, PACarrier ResourcesBENEFIT CARRIER GROUP # PHONE NUMBER WEBSITEMedicalNorth Carolina Medical Society877-275-9787www.BlueConnectNC.comHSA/FSA Health Equity 866-346-5800 www.healthequity.comVision Blue 20/20 # 141677581-855-400-3641www.eyemedvisioncare.com/bcbsncEAP 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.Vision Blue 20/20Will 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 Guide2024Raleigh Medical Group, PAThis page is intentionally blank

EMPLOYEE BENEFITS GUIDEPrepared By Sentinel Benefits Consulting | sentinelra.com2024Raleigh Medical Group, PA