2023 Employee Benets Guide
2 2023 Benefits In the following pages you will learn more about the benets oered by Essenal Speech & ABA Therapy. Please take the me to read through this guide and make the elecons that are right for you and your family. Inside This Guide Benet Informaon……………….……………………………………………………………………...….………..3 Changing Your Coverage…………….………………………………………………………………...…….……...4 Medical Benets……………………….………………………………………………………………...…….……….5 Dental Coverage……………………….……………………………………………………………….…………….….6 Vision Coverage……………………………………………………………………………………….………………...7 Life / AD&D….………………………………………………………………………..……………….……….……...8-9 Aac……………..…………………………….………………………………………………………………...………...10 Accident………………...…………………..………………………………………………………………...…….11-12 Hospital………………….…………………..………………………………………………………………...….…13-14 Crical Illness / Cancer……….…..………………………………………………………………...………...15-16 STD…………….……………………………….………………………………………………………………...………...17 Acve 8……………………………………….………………………………………………………………………18-19 Preventave Care......…………………..………………………………………………………………...………..20 Prescripon….………...…………………..………………………………………………………………...………..21 Paycheck Example.....…………………..………………………………………………………………...………..22 Contacts and Resources………………………………………………………………………………...………...23 This document is an outline of the coverage opons proposed by the carriers(s) based on informaon provided by your company. It does not include all of the terms, coverage, exclusions, limitaons and condions of the actual contract language. The policies and contracts must be read for those details.
3 Benefit Information Who is Eligible You are eligible to join Essenal Speech & ABA Therapy’s benet plans if you are full-me employee who works at least 30 hours per week. Eligible dependents include: • Your legal spouse • Children to age 26 regardless of student or marital status. “Children” are your natural children, stepchildren, legally adopted children, foster children and children for whom you have court appointed guardianship; • Unmarried children, up to any age, who are unable to support themselves because of a qualied physical or mental disability, provided the disability occurred prior to age 26. When Can I Enroll You can enroll in benets: • 1st of the month following 60 days of employment; • During the annual enrollment period; or • Within 30 days of a family status change If you do not enroll during these mes, you must wait for the next annual enrollment period. New Hires To enroll in benets, follow the instrucons from your HR department and make your elecons within 60 days of your hire date. The benets you choose will be eecve the rst of the month following your 60 day waing period. You will not be eligible for any other benet coverage unl the next open enrollment period, unless you have a qualied family status change. Your Medical Coverage Essenal Speech & ABA Therapy’s medical plans will be administered by United Healthcare. We encourage you to review the informaon carefully to be sure that you take full advantage of the benets of the plan you elect. If you choose to enroll in a medical plan oered, you will pay a poron of the cost. Your contribuons will be deducted from your paycheck on a pre-tax basis over the course of your pay periods. Plan Opons There are two medical plans in which to choose. There is a Navigate HMO plan and a Choice+ PPO opon. The Navigate HMO requires a PCP selecon and referrals to see specialists. The PPO plan does cover both in-network and out-of-network benets; however, by ulizing in-network providers, you will save money and prevent paying high out-of-network charges that are not always reimbursed.
4 Changing Your Coverage Making Changes During the Year For acve members, you cannot change benets elecons once you enroll, including dropping coverage, unl the next open enrollment period; this is an IRS rule. You may be able to change your coverage throughout the year if you experience a Qualied Family Status Change. • Marriage, divorce, legal separaon or annulment; • The birth, adopon or legal guardianship of a child; • The death of a spouse or eligible dependent; • A change in employment status for yourself, your spouse or a dependent; • A dependent no longer qualies due to age; • Open enrollment occurs for a spouse. Any change made in your coverage must be consistent with the Family Status Change. Requests for changes must be made within 30 days of the change event date. 60-Day Enrollment Period In addion to the qualifying Family Status Changes, you and your dependents will have a special 60-day period to elect or disconnue coverage if: • You or your dependent’s Medicaid or CHIP (Children’s Health Insurance Program) coverage terminates as a result of your loss of eligibility; • You or your dependent becomes eligible for premium assistance under Medicaid or CHIP. When Does Coverage End If your employment with Essenal Speech & ABA Therapy ends for any reason, benet coverage will cease for: • Medical, Dental and Vision: the last day of the month in which terminaon occurs
5 Medical—United Healthcare In Network CZWI HMO BCX7 PPO Network Navigate Choice+ Deducble Individual Family $3,000 $6,000 $2,000 $4,000 Coinsurance 80% 100% Out-of-Pocket Individual Family $6,000 $12,000 $3,500 $7,000 Doctor's Oce Oce Copay - PCP $10 copay (<19, $0) $30 copay Oce Copay—Specialist $60 copay $30 / $60 copay Prevenve Care 100% No Copay 100% No Copay Outpaent Services Diagnosc Tesng $40 copay No Charge Imaging $500 copay Ded. / Coins. Urgent Care $25 copay $75 copay Outpaent Surgery Ded. / Coins. Ded. / Coins. Hospital Services Emergency Room $500 copay + Ded. / Coins. (True Emergency Only) $300 copay + Ded. / Coins. (True Emergency Only) Inpaent Hospital Ded. / Coins. Ded. / Coins. Pharmacy Retail $15 / $45 / $85 / $200 $15 / $45 / $85 / $200 Mail Order 2.5 mes copay 2.5 mes copay Out of Network CZWI HMO BCX7 PPO Deducble Individual/Family N/A $5,000 / $10,000 Coinsurance N/A 70% Out-of-Pocket Individual/Family N/A Unlimited Semi-Monthly Payroll Deducon CZWI HMO BCX7 PPO Employee Only $45.54 $100.43 Employee + Spouse $227.69 $337.48 Employee + Child(ren) $227.69 $337.48 Employee + Family $409.84 $574.52
6 DENTAL—Principal Essenal Speech & ABA Therapy’s dental plans are oered through Principal. The Principal network makes it easy to protect your health—and your smile—with the right dental care at the right price. How your plan works The dental plans oered through Principal promote and encourage prevenve care. Depending on which plan you elect, coverage is provided for basic, restorave and major services. With these dental plans you are free to see any denst you choose. Although you are not required to use a network denst, addional charges may apply by doing so. If you use a non-network denst, eligible services are paid based on the in-network fee schedule or 90% of usual and customary (UCR). This means that you may be balanced billed for charges over the negoated fee schedule or UCR To locate an in-network provider log on to www.principal.com and click Find A Denst Member Service Available Visit: www.principal.com Call: 800-986-3343 Plan Name Plus Plan Value Plan Benets In-Network In-Network Deducble - Ind/Family $50 / $150 $50 / $150 Waived for Prevenve Yes Yes Annual Maximum $3,000 $1,000 Prevenve 100% 100% Basic 80% 60% Major 50% 30% Out-of-network claims basis In-network fee schedule In-network fee schedule Orthodoncs Deducble $0 $0 Children Under 19 Covered Covered Lifeme Maximum $2,500 $1,500 Semi-Monthly Payroll Deducons Plus Plan Value Plan Employee Only $14.23 $8.96 Employee + Spouse $25.57 $16.74 Employee + Child(ren) $37.95 $24.43 Employee + Family $52.13 $34.06
7 VISION—Principal Essenal Speech & ABA Therapy’s vison coverage is oered through Principal. Vision benets are just as important as medical and dental coverage—a regular eye exam is important for keeping your eyes healthy. Eye exams can idenfy both vision and major medical condions such as diabetes and hypertension. Early detecon for eye disease like glaucoma, cataracts and macular degeneraon is also important, as these condions can aect the way you see. How your plan works With the Principal vision plan, you and your covered family members have access to quality vision care. Your plan provides coverage for roune eye exams, glasses and contact lenses. The network for your vision plan is VSP. You will save the most money if you choose an in-network provider. If you choose a provider who is not in the network, you will have to pay the total amount due at your appointment and le a claim for reimbursement. To locate an in-network provider log on to www.vsp.com and click Find A Provider. You will need to choose the “Choice” doctor network to view the VSP doctors for your coverage. VSP Benets In-Network Out of Network Reimbursement Exam (once every 12 months) $10 Up to $45 Lenses (once every 12 months) Single $25 Up to $30 Bifocal $25 Up to $50 Trifocal $25 Up to $65 Standard Progressive $0 Not Covered Frames (Once every 12 months) Retail $130 allowance 20% o over $130 Up to $70 Contact Lenses (in lieu of glasses) Exam Standard Fit & Follow Up $25 Not covered Contact Lenses Convenonal/Disposable $130 Allowance Up to $105 Semi-monthly Payroll Deducon Employee Only $3.74 Employee + Spouse $6.49 Employee + Child(ren) $6.52 Employee + Family $9.81 Member Service Available Visit: www.vsp.org
8 LIFE / AD&D—Principal Basic Life / Accident Death & Dismemberment (AD&D) Life and Accidental Death & Dismemberment helps protect you and your family from nancial diculty. Your beneciaries will receive a lump sum payment if you pass away while employed by Essenal Speech & ABA Therapy. Essenal Speech & ABA Therapy pays the enre cost of the Basic Life and AD&D insurance through Principal. Member Basic Life Insurance Your basic life coverage is $25,000. The proceeds will be paid to your beneciary(ies) in the event you were to pass way. Member Basic AD&D Insurance Accidental Death & Dismemberment (AD&D) Insurance pays a benet equal to the basic life insurance benet. If you die as the result of an accident, your beneciary(ies) will receive your AD&D insurance in addion to your Basic Life Insurance. If you experience a serious injury resulng in dismemberment, you will receive all or a poron of this benet depending on the nature of your injury and according to the published schedule in the policy itself. Please be sure the HR Department has the most up-to-date beneciary on le for your Life and AD&D insurance. All benets will be paid to the designated beneciary on le. Supplemental Life and AD&D Insurance In addion to Basic Life and AD&D Insurance, you can purchase supplemental Life and AD&D for yourself. If you purchase Supplemental Life and AD&D for yourself, you are also eligible to purchase coverage for your eligible dependents. Any coverage applied for over the Guarantee Issue amount requires an Evidence of Insurability (EOI) form be complete and approved before the addional coverage is provided. Employee Coverage Benet Increments of $10,000 Maximum Benet $300,000 Guarantee Issue Amount Under 70 $150,000 / 70+ $10,000 Age Reducons To 65% at age 65, to 50% at age 70 Spouse Coverage Benet Increments of $5,000 Maximum Benet $100,000 not to exceed 100% of EE amount Guarantee Issue Amount Under 70 $30,000 / 70+ $10,000 Age Reducons To 65% at age 65, to 50% at age 70 Child Coverage Benet Maximum Benet $10,000 Child Eligibility 14 days to age 26 Addional AD&D Benets Air Bag, Seatbelt, Common Carrier
9 Supplemental Life / AD&D Rates Calculang your Cost $ ÷ 1,000 = $ x Age Based Rate = $ Benet Elected Monthly Premium $ x 12 = $ x 26 = $ Monthly Premium Annual Premium Bi-Weekly Premium Supplemental Life/AD&D Rates - Monthly Rate Per $1,000 Member Age Employee Spouse 29 and under $0.119 $0.119 30 - 34 $0.136 $0.136 35 - 39 $0.204 $0.204 40 - 44 $0.296 $0.296 45 - 49 $0.435 $0.435 50 - 54 $0.699 $0.699 55 - 59 $1.103 $1.103 60 - 64 $1.662 $1.662 65 - 69 $2.807 $2.807 70 and over $5.037 $5.037 Child Rate - $10,000 $2.00 $2.00
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23 Contact Information and Resources If you have specic quesons about a benet plan, please contact the administrator listed below or your Essenal Speech & ABA Therapy Human Resources department. Benet Carrier/Contact Group # Phone Number Website / E-mail Medical United Healthcare 800-521-2227 www.uhc.com Dental Principal 800-986-3343 www.principal.com Vision Principal 800-986-3343 www.principal.com Life/AD&D Principal 800-986-3343 www.principal.com Disability Principal 800-986-3343 www.principal.com Online Enrollment Securance - Mindy Shelander 713-977-6606 ext. 517 Human Resources Worksite Aac - Vinson Drewry 281-813-2830 vinson_drewry@us.aac.com
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