Return to flip book view

EMPLOYEE BENEFITSGUIDE2024 - 2025An overview of the wide array of benefits provided byRaleigh Capitol Ear, Nose & Throat 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 Guide2024 - 2025 Raleigh Capitol Ear, Nose & ThroatAs an employee of Raleigh Capitol Ear, Nose & Throat, 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 – 2025 plan year, Raleigh Capitol Ear, Nose & Throat 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 Capitol Ear, Nose & Throat 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 Capitol Ear, Nose & Throat 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 1st day following 90 days of full-time employmentBenefits EndMedical, Dental & Vision end at the end of the month following terminationLife & Disability ends on your date of terminationDependentsYour legal spouse, dependent children up to age 26. For Voluntary Life, dependents are eligible up to age 19 or, if full-time student, 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 Guide2024 - 2025 Raleigh Capitol Ear, Nose & ThroatComparison of PlansCoverage Provided by NCMS Employee Benefit Plan for 7/1/2024 – 6/30/2025In-Network PPO 4000-70 HDHP 6350-100 HDHP 5000-100Deductibles (Individual / Family)$4,000/$8,000$6,350 / $12,700 (family member $6,550)$5,000 / $10,000 (family member $6,550)Preventive Care Covered in full Covered in full Covered in fullPrimary Care Visit$50Register your PCP on www.BlueConnect.com and 1st three visits copay waived 0% after deductible 0% after deductibleSpecialist Visit $100 0% after deductible 0% after deductibleTelehealth via Teladoc $50 0% after deductible 0% after deductibleUrgent Care $100 0% after deductible 0% after deductibleEmergency Room $1,000 0% after deductible 0% after deductibleOutpatient Procedure 30% after deductible 0% after deductible 0% after deductibleInpatient Visit 30% after deductible 0% after deductible 0% after deductiblePharmacy / RX Tiers 1-5(30 Day Supply)$15/$35/$45/$90/25% (min $50/max $200 for Tier 5)Enhanced Preventive: 0% no deductibleAll Others: 0% after deductibleEnhanced Preventive: 0% no deductibleAll Others: 0% after deductibleLens and Frames CoverageCovered up to $130, then 90%0% after deductible 0% after deductibleOut-of-Pocket Max (Individual / Family)$8,550/$17,100$6,350 / $12,700 (family member $6,550)$5,000 / $10,000 (family member $6,550)MEDICALThe chart below is an overview of the In-Network benefits. Out-of-Network benefits are available; please review your NCMS Employee Benefit 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 - 2025 Raleigh Capitol Ear, Nose & ThroatWellness 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 Raleigh Capitol Ear, Nose & Throat, 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 Month PPO 4000-70 HDHP 6350-100 HDHP 5000-100Employee$151.50 $112.92 $149.70Employee + Child$405.42 $354.12 $403.03Employee + Children$744.00 $675.72 $740.81Employee + Spouse$944.07 $865.76 $940.41Employee + Family$1,521.19 $1,413.95 $1,516.18Your 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 Guide2024 - 2025 Raleigh Capitol Ear, Nose & ThroatEmployees 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 www.teladochealth.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.Employee Benefits Guide2024 - 2025 Raleigh Capitol Ear, Nose & ThroatBlue Cross NC now offers 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. PRESCRIPTION DRUGSMail Order ResourceEffective November 1, 2023, coverage for anti-obesity “weight loss” drugs will be discontinued. These drugs will no longer be covered due to safety concerns, as well as the lack of data supporting long-term use of these drugs. The following products will be excluded as covered medications:Wegovy LomairaSaxenda PhendimetrazineAdipex-P ContraveBenzphetamine QsymiaDiethylpropionWeight Loss Prescription DrugsManage Your PrescriptionsPrescription drug costs vary according to factors such as the drug type, the tier or drug cost level, and the formulary or the listed of covered drugs. There are three different drug categories: brand-name, generic, and specialty.• GENERIC - Generic drugs have the same active ingredients as brand-name drugs and have received FDA approval. They can have a different shape, size, and color than the brand name drug, but they are just as safe and effective. Generics also tend to cost less than brand-name drugs. • BRAND-NAME - Brand-name drugs are the original version of a medication made by the manufacturer. For example, Tylenol® is the brand-name for acetaminophen. Brand-name drugs tend to be more expensive than their generic alternatives. Brand-name drugs may not be fully covered by insurance if there is a generic version available.• SPECIALITY - Specialty drugs treat complex, rare, or chronic conditions. Many of these drugs are injectable medications or have special administration requirements. These medicines tend to cost more than others and are only sold at specialty pharmacies. You should check your plan for your in-network specialty pharmacy options.Click here to learn more about managing your prescriptions:https://www.brainshark.com/1/player/bcbsnc?fb=0&r3f1=f3c9b7e4e8e5bdafffb5d6b4befaf5e5f3bea18fa0fff5b9&custom=manageyourrx

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 - 2025 Raleigh Capitol Ear, Nose & ThroatThrough our partnership with NCMS, enrolled members have access to several additional programs to help support you in achieving a healthy balanced life.MEDICAL SUPPORT PROGRAMSNurse 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: ASONCMSRaleighCapitolENTFor 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/

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 - 2025 Raleigh Capitol Ear, Nose & ThroatThe NCMS sponsored EAP through VITAL WorkLife offers free, confidential assistance at no cost to you.• Unlimited phone support 24/7• Face-to-Face or Virtual Counseling sessions• Coaching Sessions• Online Resources• Articles• Website• Online Seminars• Guided Education ModulesOur EAP Provides Support For:• Grief• Anxiety/Stress• Problems with your children• Substance Abuse• Financial Counseling• Legal advice and referrals• And moreEMPLOYEE ASSISTANCE PROGRAM (EAP)Call: 800-383-1908 Or visit: www.VITALWorkLife.com Username: ncmsplan Password: ncmsplan

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 - 2025 Raleigh Capitol Ear, Nose & ThroatA 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 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$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 - 2025 Raleigh Capitol Ear, Nose & ThroatSummary of CoverageCoverage Provided by Delta Dental of NCIn-Network Base Plan Buy-Up PlanAnnual Deductibles(Individual / Family)$50 / $150 $50 / $150Preventive Care 100% 100%Basic Procedures (extractions, fillings, etc.)20% after deductible 20% after deductibleMajor Procedures(crowns, dentures, etc.)50% after deductible 50% after deductibleChild Orthodontics Not Covered50%, no deductible$1,500 lifetime max for children through age 18 and underPlan Year Maximum Benefit $1,000 per covered person $2,000 per covered personDENTALBelow 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 Month Base Plan Buy-Up PlanEmployee$43.85 $63.18Employee + Spouse$81.58 $112.90Employee + Children$94.77 $149.75Employee + Family$138.59 $209.83Your 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 Guide2024 - 2025 Raleigh Capitol Ear, Nose & ThroatSummary of CoverageCoverage provided by UNUM In-NetworkProvider Network EyeMedVision Exam (once per plan year) $10 CopayLenses (once per plan year)Single $25 CopayBifocal $25 CopayTrifocal $25 CopayFrames (once per plan year) $150 allowanceStandard Contact Lenses Fit & Follow Up Exam $40 CopayElective Contact Lenses (in lieu of glasses) $150 allowanceMedically Necessary Contact Lenses Covered in fullVISIONOur vision coverage is provided by UNUM. Please review your plan documents for additional details.Pricing Per MonthEmployee$0.00Employee + Spouse$8.50Employee + Children$10.69Employee + Family$21.43Your 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 Guide2024 - 2025 Raleigh Capitol Ear, Nose & ThroatCoverage provided by UNUMPlan FeaturesEmployee Benefit Amount $50,000Maximum Benefit Amount $50,000AD&D Benefit $50,000Benefit Reductions begin at age 65Group 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 INSURANCELife Benefit Employee Spouse Child(ren) 15 Days – Age 26Amount 5x annual earnings $5,000 increments $2,000 incrementsMinimum Amount $10,000 $5,000 $2,000Maximum Amount $500,000Up to 100% of employee’s amount$10,000Guarantee Issue (Newly Eligible Employees)$100,000 $25,000 N/ABenefit Reductions begin at age 65 65Coverage ends at age 19 or age 26 if a full-time studentAD&D coverage is equal to the Voluntary Life amount elected for you, your spouse, and child(ren). VOLUNTARY LIFE and AD&D INSURANCE For rates, please see carrier summary. Cost is age-banded and based on employee’s age.

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 - 2025 Raleigh Capitol Ear, Nose & ThroatSummary of CoverageCoverage provided by UNUMPlan FeaturesCoverage Paid By Raleigh Capitol Ear, Nose & ThroatEmployee Monthly Benefit Amount60% of your total monthly earnings up to the plan maximumElimination Period 90 daysBenefit Duration Social Security Normal Retirement AgeWaiver of PremiumIf you’re disabled and receiving benefit payments, Unum waives your cost until you return to work.Disability 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. Long-Term coverage is available for extended disabilities. LONG-TERM 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 Guide2024 - 2025 Raleigh Capitol Ear, Nose & ThroatVoluntary Benefits are offered through Colonial Life to assist your personal insurance needs. These programs are designed to fill the gaps in coverage such as your deductibles and co-insurance under your major medical.Worksite BenefitsMedical Bridge (GAP)The benefits of the GAP plan are:• Hospital Confinement benefit: $1,500• Outpatient Surgical procedures: $750 and $1,500 options• Wellness/ Health screening benefit: $100• Additional riders availableAccidentAccident insurance helps offset the unexpected medical expenses, such as emergency room fees, deductibles and copayments that can result from a fracture, dislocation or other covered accidental injuries that may occur on or off the job. It pays a lump sum benefit if you or a covered family member experience an accident. Coverage for you, your spouse and dependent child(ren) may be purchased. Features include the same benefits for you, your spouse and dependent child(ren), worldwide coverage, and portability. CancerThe Cancer Assist plan pays lump-sum benefits that can help you protect yourself and your loved ones through the diagnosis, treatment, and recovery journey. The plan also pays a $100 Health Screening benefit (per covered person per calendar year) to encourage annual screenings – improving your chances of early detection and survival.Critical IllnessThe Critical Illness plan provides a lump sum payment of $5,000 to $100,000 upon the diagnosis of a covered critical illness to help pay for medical and non-medical recovery expenses.

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 - 2025 Raleigh Capitol Ear, Nose & ThroatVoluntary Benefits are offered through Colonial Life to assist your personal insurance needs. These programs are designed to fill the gaps in coverage such as your deductibles and co-insurance under your major medical.Worksite BenefitsShort-Term Disability (STD)Colonial Life STD fills in the elimination gap in the Group LTD plan.• Covers up to 60% of gross monthly earnings to a max of $400 - $6,500• Elimination (waiting) period for Accident/Illness:• 0-day Accident & 7-day Sickness• 0-day Accident & 14-day Sickness• 7-day Accident & 7-day Sickness• 14-day Accident & 14-day Sickness• Benefit periods: 3 months or 6 months• Covers accident, sickness, & maternityTerm Life InsuranceTerm Life provides protection for a specified period of time, typically offering the greatest amount of coverage for the lowest initial premium. Coverage term periods are:• 10-Year Term• 15-Year Term• 20-Year Term• 30-Year TermWhole LifeWhole Life provides features –cash value accumulation, premium rates and a death benefit –that help ensure those benefits will be there to help protect your family’s way of life. Coverage is available for you, your spouse, and your child(ren).• Death benefit levels from to $5,000 to $500,000• Plan options: paid up at age 70 or paid up at age 100• Optional riders are available

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 - 2025 Raleigh Capitol Ear, Nose & ThroatCarrier ResourcesBENEFIT CARRIER GROUP # PHONE NUMBER WEBSITEMedical NCMS/BCBSNC 14170829 888-206-4697 www.bluecrossnc.comDentalDelta Dental of NC10297 800-662-8856 www.deltadentalnc.com Vision UNUM/EyeMed 803078 866-679-3054 www.eyemedvisioncare.com/unum Group Life&DisabilityUNUM 803076 866-679-3054 www.unum.com Voluntary LifeUNUM 803077 866-679-3054 www.unum.com EAP Vital WorkLifeUsername & password: ncmsplan800-383-1908 www.VITALWorkLife.com Worksite BenefitsColonial Life N/AKjell Terrell919-815-1065Kjell.Terrell@coloniallifesales.com How 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 here: https://member.bcbsnc.com/blueconnect/web/registrationDental Delta Dental of NCNo ID card is issued. Once enrolled, you can generate a card from the Delta Dental portal:www.memberportal.com Vision UNUM/EyeMedElectronic copies can be accessed here: www.eyemedvisioncare.com/unum

EMPLOYEE BENEFITS GUIDEPrepared By Sentinel Benefits Consulting | sentinelra.com2024 - 2025