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 or provider’s contract.2024 Benefits Enrollment GuideThe benefits plan year runsJanuary 1st through December 31st. Unless you have a qualified change-in-status event that impacts your eligibility and the change is allowed under the terms of the insurance contract or plan document, you cannot make changes to your benefits until the next Open Enrollment period.Benefit changes must be consistent with your qualified change-in-status event.Changes must be submitted to Human Resources within 30 days of the event; documentation supporting the change will be required.Who is eligible for benefits?All full-time employees who work a minimum of 30 hours per week are eligible for benefits. For new hires, benefits are effective on the first of the month following 60 days of employment.In addition to enrolling yourself, you may also enroll any eligible dependents. Eligible dependents are defined below:• Spouse: a person to whom you are legally married by ceremony• Child(ren): Your biological, adopted, or legal dependents up to age 26 regardless of student, financial, and marital status; coverage for a dependent child will terminate at the end of the month in which the child turns age 26Change-in-Status EventsUnless you have a qualified change-in-status event that impacts your eligibility and the change is allowed under the terms of the insurance contract or plan document, you cannot make changes to the benefits you elect until the next Open Enrollment period. Some examples of qualified change-in-status events are highlighted below:Marriage or divorceBirth, adoption, or deathChange in employment, or employment status for you, your spouse, or your dependent childChange in coverage under another employer plan, such as a change made during your spouse’s Open EnrollmentThompson + Hanson / Tiny Boxwoods takes pride in providing a comprehensive employee benefits program, and we recognize the important role employee benefits play as a critical component of your overall compensation. We strive to maintain a benefits program that is rewarding and competitive.WHAT’S INSIDEEmployee Resources Employee Contributions Medical Plan Highlights Health Savings Account (HSA) Dental Plan Highlights Vision Plan Highlights Vendor Contact Information2
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 or provider’s contract.2024 Benefits Enrollment GuideKEY TERMS TO REMEMBER & HDHP/HSA PLAN DETAILSANNUAL DEDUCTIBLEThe 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).OUT-OF-POCKET MAXIMUMThis 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.COPAYS AND COINSURANCEThese 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.MedicalPLAN TYPESPPO – A network of doctors, hospitals, and other healthcare providers. You have coverage in and out of network.HDHP – A plan that has higher deductibles in exchange for lower premiums. HDHPs are compatible with Health Savings Accounts (HSA).3
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 or provider’s contract.2024 Benefits Enrollment GuideMedical Coverage4Plan FeaturesIN-NETWORK$2,000 PPO Plan(What You Owe)$3,000 PPO Plan(What You Owe)$6,900 HDHP PPO Plan(What You Owe)Provider NetworkOpen Access Plus PPO Open Access Plus PPO Open Access Plus PPOHSA Compatible?NO NO YESDeductibles(Individual / Family)$2,000 / $6,000 $3,000 / $9,000 $6,900 / $13,800Coinsurance 20% after deductible 30% after deductible 0% after deductibleOut-of-Pocket Max(Individual / Family)$5,000 / $14,700 $7,350 / $14,700 $6,900 / $13,800Preventive Care No Charge No Charge No ChargePrimary Care Visit $30 copay $50 copay 0% after deductibleMDLive - Telehealth No Charge No Charge 0% after deductibleSpecialist Visit $60 copay $100 copay 0% after deductibleDiagnostic Test(Blood work & X-Ray)No Charge No Charge 0% after deductibleComplex Imaging(CT/MRI, PET scan)20% after deductible 30% after deductible 0% after deductibleInpatient / Outpatient Procedure20% after deductible 30% after deductible 0% after deductibleUrgent Care $75 copay $75 copay 0% after deductibleEmergency Room $500 copay per visit $500 copay per visit 0% after deductibleRetail Pharmacy RX (30-Day)• Generic• Preferred Brand• Non-Preferred Brand• Specialty $10 / $50 / $100 / $150 $10 / $50 / $100 / $1500% after deductibleMail Order Pharmacy RX*(90 Day Supply)*Excludes specialty Rx$30 / $150 / $300 $30 / $150 / $300 0% after deductibleOUT-OF-NETWORKDeductibles(Individual / Family)$4,000 / $12,000 $6,000 / $18,000 $13,800/ $27,600Out-of-Pocket Max(Individual / Family)Unlimited Unlimited $18,000 / $36,000Coinsurance 40% after deductible 50% after deductible 30% after deductibleSome services including complex imaging and prescriptions may require additional information and/or precertification/prior authorization. For more detailed coverage information regarding whatthese plans cover and what they cost, please refer to the plan’s “Summary of Benefits and Coverage (SBC)” document included in your benefits packet. You may also request a Summary Plan Description (SPD).
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 or provider’s contract.2024 Benefits Enrollment Guide5Medical Summary & PremiumsPlan Features CIGNAIN-NETWORK$2,000 PPO Plan $3,000 PPO Plan $6,900 HDHP PPO Plan (You Pay)(You Pay) (You Pay)HSA Compatible? NO NO YESDeductibles(Individual / Family)$2,000 / $6,000 $3,000 / $9,000 $6,900 / $13,800Coinsurance(Member Responsibility) 20% after deductible 30% after deductible 0% after deductibleOut-of-Pocket Max (Individual / Family)$5,000 / $14,700 $7,350 / $14,700 $6,900 / $13,800Bi-Weekly (26)Your Cost Per Pay Period$2,000 PPO Plan $3,000 PPO Plan$6,900 HDHP w/ HSA PlanEmployee $96.03 $88.18 $71.49 Employee + Spouse $400.20 $367.49 $297.94 Employee + Child(ren) $380.52 $349.41 $283.28 Employee + Family $652.99 $599.63 $486.13
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 or provider’s contract.2024 Benefits Enrollment GuideFrom programs that help improve your health to tools that help manage your health spending, there’s so much you can do on myCigna.com or the myCigna® app.Find in-network doctors, hospitals and medical servicesManage and track claimsSee cost estimates for medical proceduresCompare quality of care information for doctors and hospitalsAccess a variety of health and wellness tools and resourcesThe myCigna website and app both have an easy, interactive health assessment to help you learn more about your health and what you can do to improve it.6Registering for myCigna.com
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 or provider’s contract.2024 Benefits Enrollment GuideUSER ID name@example.comPASSWORD ********* XXXXXCODE+ =Enhanced registrationWhen you register for the first time on the myCigna website or app, you’ll be required to provide a primary email address. Having an email address helps Cigna better protect the information in your myCigna account. We can send automatic alerts when you update your email or password. Your email address also can be used when you need help recovering your myCigna user ID or passwordTwo-step authenticationWith two-step authentication, you have the option of adding an extra layer of security to your myCigna account to further protect your claim, health and account information.1. First, you’ll be encouraged to add, update and verify contact information – email addresses and cell phone numbers.2. Once you enable two-step authentication and log int to your myCigna.com account, you’ll be asked to enter your user ID and password, as well as a six-digit code that will be sent to either your email address or mobile phone number. You’ll also be offered to select “Remember this Device.” If this choice is selected, you won’t be prompted for a code each time you log in to your myCigna account from that device. Questions?If you have any questions about your myCigna account or your plan benefits, call the number on the back of your Cigna ID card. Customer service representatives are ready to speak with you 24/7/365.Now compatible with iPhone® X devicesThe Apple® Face ID® feature for iPhone X devices is a new way to unlock and authenticate your myCigna app. It’s even more convenient than the Touch ID® tool and makes authenticating fast and easy. Other iPhone users can still use Touch ID to log in to the app.** Please refer to your phone’s manufacturer for your phone’s specific capabilities. The downloading and use of the myCigna app is subject to the terms and conditions of the app and the online stores from which it is downloaded. Standard mobile phone carrier and data usage charges apply.iPhone, Apple, Face ID and Touch ID are registered trademarks of Apple Inc.All Cigna products and services are provided exclusively by or through operating subsidiaries of Cigna Corporation, including Cigna Health and Life Insurance Company, Connecticut General Life Insurance Company, Cigna Behavioral Health, Inc., and HMO or service company subsidiaries of Cigna Health Corporation. The Cigna name, logo, and other Cigna marks are owned by Cigna Intellectual Property, Inc. All pictures are used for illustrative purposes only.832643 g 06/18 © 2018 Cigna. Some content provided under license.7Registering for myCigna.com
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 or provider’s contract.2024 Benefits Enrollment Guide KNOW BEFORE YOU GOVirtual careConvenience care clinicHealth care provider’s officeUrgent care centerEmergency roomFor minor medical conditions. Connect with a board-certified doctor via video or phone when, where and how it works bestfor you. Visit myCigna.com, or call MDLIVE at 888.726.3171to talk with a doctor 24/7.*For minor medical concerns. Staffed by nurse practitioners and physician assistants.Located in retail stores and pharmacies. Often open nights and weekends.The best place to go for routine or preventive care or to keep track of medications.Many PCPs offer virtual care. Contact your PCP to schedule an in-person or virtual care visit.Find a PCP on myCigna.com.For conditions that aren’t life threatening. Staffed by nurses and doctors and usually have extended hours.For immediate treatment of critical injuries or illness. Open 24/7. If a situation seems life threatening, call 911 or go to the nearest ER.“Freestanding” ER locations are becoming more common in many areas. Because these ERs are not inside hospitals, they may look like urgent care centers. When you receive care at an ER, you’re billed at a much higher cost than at other health care facilities.•Colds and flu•Rashes•Sore throats•Headaches•Stomachaches•Fever•Allergies•Acne•Urinary tract infections (UTIs) and more•Colds and flu•Rashes or skin•conditions•Sore throats, earaches, earaches, sinus pain•Minor cuts or burns•Pregnancy testing•Vaccines•General health issues•Preventive care•Routine check-ups•Vaccines and screenings• Fever and flu symptoms•Minor cuts, sprains, burns, rashes•Headaches•Lower back pain•Joint pain•Minor respiratory symptoms•UTIs•Sudden numbness, weakness•Uncontrolled bleeding•Seizure or loss of consciousness•Shortness of breath•Chest pain•Head injury/major trauma•Blurry or loss of vision•Severe cuts or burns•Overdose•Costs the same or less than a visit with your primary care provider (PCP)• Appointments typically in•an hour or less•No need to leave home or work•Same or lower than provider’s office• No appointment needed•May charge copay/ coinsurance and/ or deductible•Usually need appointment•Short wait times•Costs lower than emergency room (ER)• No appointment needed•Wait times vary•Highest cost• No appointment needed•Wait times may be longCigna Health Information LineA telephone service staffed by clinicians who help you understand and make informed decisions about health issues you are experiencing, at no extra cost. These clinicians can help you choose the right care in the right setting at the right time, whether it’s reviewing home treatment options, following up on a PCP’s appointment or finding the nearest in-network urgent care center. Just call the number on your Cigna ID card, go to myCigna.com or use the myCigna® App.*** Open 24/7.8
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 or provider’s contract.2024 Benefits Enrollment Guide9Convenient? Yes. Costly? No.Medical virtual care for minor conditions costs less than ER or urgent care center visits, and maybe even less than an in-office primary care provider visit.Life is demanding. It’s hard to find time to take care of yourself and your family members as it is, never mind when one of you isn’t feeling well. That’s why your health plan through Cigna includes access to minor medical and behavioral/mental health virtual care.Whether it’s late at night and your doctor or therapist isn’t available or you just don’t have the time or energy to leave the house, you can:• Access care from anywhere via video or phone.• Get minor medical virtual care 24/7/365 – even on weekends and holidays.• Schedule a behavioral/mental health virtual care appointment online in minutes.• Connect with quality board-certified doctors and pediatricians as well as licensed counselors and psychiatrists.• Have a prescription sent directly to your local pharmacy, if appropriate.MDLive – Virtual 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 or provider’s contract.2024 Benefits Enrollment GuideMinor medical virtual careBoard-certified doctors and pediatricians can diagnose, treat and prescribe most medications for minor medical conditions, such as:• Acne• Allergies• Asthma• Bronchitis• Cold and flu• Constipation• Diarrhea• Earaches• Fever• Headaches• InfectionsMDLIVE providers can also conduct virtual wellness screenings.Connect with virtual care your way.• Contact your in-network provider or counselor• Talk to an MDLIVE medical provider on demand on myCigna.com• Schedule an appointment with an MDLIVE provider or licensed therapist on myCigna.com• Call MDLIVE 24/7 at 888.726.3171Behavioral/Mental health virtual careLicensed counselors and psychiatrists can diagnose, treat and prescribe most medications for nonemergency behavioral/mental health conditions, such as:• Insect bites• Joint aches• Nausea• Pink eye• Rashes• Respiratory infections• Shingles• Sinus infections• Skin infections• Sore throats• Urinary tract infections• Addictions• Bipolar disorders• Child/Adolescent issues• Depression• Eating disorders• Grief/Loss• Life changes• Men’s issues• Panic disorders• Parenting issues• Postpartum depression• Relationship and marriage issues• Stress• Trauma/PTSD• Women’s issuesTo connect with an MDLIVE virtual provider, visit myCigna.com, locate the “Talk to a doctor or nurse 24/7” callout and click “Connect Now.” To locate a Cigna Behavioral Health provider, visit myCigna.com, go to “Find Care & Costs” and enter “Virtual counselor” under “Doctor by Type,” or call the number on the back of your Cigna ID card 24/7.Medical and behavioral/mental health virtual care is available from MDLIVE.*Availability may vary by location and plan type and is subject to change. See vendor sites for details.Cigna provides access to virtual care through national telehealth providers as part of your plan. Providers are solely responsible for any treatment provided to their patients. Video chat may not be available in all areas or with all providers. This service is separate from your health plan’s network and may not be available in all areas or under all plan types. A primary care provider referral is not required for this service.In general, to be covered by your plan, services must be medically necessary and used for the diagnosis or treatment of a covered condition. Not all prescription drugs are covered. Product availability may vary by location and plan type and is subject to change. All group health insurance policies and health benefit plans contain exclusions and limitations. See your plan materials for costs and details of coverage, including other telehealth/telemedicine benefits that may be available under your specific health plan.All Cigna products and services are provided exclusively by or through operating subsidiaries of Cigna Corporation, including Cigna Health and Life Insurance Company (CHLIC), Cigna Behavioral Health, Inc., and HMO or service company subsidiaries of Cigna Health Corporation, including Cigna HealthCare of Arizona, Inc., Cigna HealthCare of California, Inc., Cigna HealthCare of Colorado, Inc., Cigna HealthCare of Connecticut, Inc., Cigna HealthCare of Florida, Inc., Cigna HealthCare of Georgia, Inc., Cigna HealthCare of Illinois, Inc., Cigna HealthCare of Indiana, Inc., Cigna HealthCare of St. Louis, Inc., Cigna HealthCare of North Carolina, Inc., Cigna HealthCare of New Jersey, Inc., Cigna HealthCare of South Carolina, Inc., Cigna HealthCare of Tennessee, Inc. (CHC-TN), and Cigna HealthCare of Texas, Inc. Policy forms: OK–HP-APP-1 et al. (CHLIC); OR–HP-POL38 02-13 (CHLIC); TN–HP-POL43/HC-CER1V1 et al. (CHLIC), GSA-COVER, et al. (CHC-TN). The Cigna name, logo, and other Cigna marks are owned by Cigna Intellectual Property, Inc.937207 b 08/20 © 2020 Cigna. Some content provided under license.10MDLive – Virtual 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 or provider’s contract.2024 Benefits Enrollment Guide11Health Savings Account (HSA)Who Is Eligible?* All three criteria must be met:• Enrolled in an IRS “qualified” High Deductible Health Plan (HDHP)• Not covered by another medical plan unless the other plans is also a “qualified” HDHP• Not enrolled in Medicare coverage*It is the employee’s responsibility to notify HR if you are not eligible for HSA.How does it work? The HDHP allows employees to set aside money on a pre-tax basis into a Health Savings Account (HSA). The HSA is an account established exclusively for the purpose of paying for qualified medical expenses for you and your eligible dependents on a tax-free basis.Contributions to the HSA are funded with pre-tax deductions withheld from your paycheck. The funds are deposited into an interest-bearing account in your name. The money in the HSA can be used to reimburse eligible expenses not covered by your insurance plan, including the deductible, coinsurance, and copays. HSA funds roll over from year to year and accumulate in your account. There is no “use-it-or-lose-it” rule with HSAs; you decide how and when to use your HSA funds. In the event you leave the company, you own the account and the money therein. For a complete list of “qualified medical expenses,” please refer to Publication 502 at www.irs.gov. How much can I contribute? *The Company will match employee contributions dollar for dollar up to a max of $19.23 per pay period. Employees can contribute any amount per pay period to their HSA. To receive the maximum employer contribution for the 2024 plan year ($500), the employee must contribute a minimum of $19.23 per pay period to the Health Savings Account. IRS ANNUAL LIMITS**2024 Max Contribution (Employer + Employee)Annual Employer ContributionHow much YOU can contribute in 2024Employee Only$4,150 $500 $3,650Employee + Dependents$8,300 $500 $7,800Catch-Up Contribution Employees Age 55+ may be eligible to contribute an additional $1,000
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 or provider’s contract.2024 Benefits Enrollment GuideDental Coverage12Plan Features CignaProvider Network Total Cigna Choice DPPOIN-NETWORK Base DPPOCalendar Year Maximum (Progressive Plan)Members progress to the next level by utilizing Class I services in the prior year.Year 1: $1,000Year 2: $1,100 Year 3: $1,200 Year 4: $1,300 Annual Deductible (Individual / Family) $50 / $150What You Owe: Class I: Preventive & Diagnostic CareNo Charge•Routine Exam (2 per calendar year)•Routine Cleanings (2 per calendar year)•Bitewing X-rays (2 per calendar year)Class II: Basic Restorative Care20% after deductibleSimple extractions•Fillings•Periodontics & EndodonticsClass III: Major Restorative Care 50% after deductible•Crowns/Inlays/Onlays•Bridges •Dentures Class IV: Orthodontia (Children to age 19) 50% after deductibleOrthodontia Lifetime Maximum$1,500 OUT-OF-NETWORK DPPOOut-of-Network Claim Payment Basis 90th PercentileYour Cost Per Pay Period Bi-Weekly (26)Employee$13.21 Employee + Spouse$28.77 Employee + Child(ren)$32.58 Employee + Family$50.47
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 or provider’s contract.2024 Benefits Enrollment GuideVision Coverage13*Benefit includes coverage for glasses frames or contact lenses, not both.**Covered in Full for members who have specific conditionsPlan FeaturesIn-NetworkFrequency(begins January 1)Out-of-Network ReimbursementNetworkEyeMed Vision Exam$10 copay 12 Months Up to $45Prescription Lenses12 Months•Single Vision $25 copay Up to $32•Lined Bifocal $25 copay Up to $55•Lined Trifocal $25 copay Up to $65•Lenticular $25 copay Up to $80Frames*$0 copay; $130 allowance;12 Months Up to $7120% off balance over allowanceContact Lenses*12 MonthsElective Contacts Elective: $130 allowance Up to $105Medically Necessary**Medically Necessary: Paid in full Up to $210Additional DiscountsSavings on laser vision correction and additional pairs of prescription glasses and non-prescription sunglasses.Your Cost Per Pay Period Bi-Weekly (26)Employee$2.73 Employee + Spouse$5.43 Employee + Child(ren)$4.96 Employee + Family$7.66
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 or provider’s contract.2024 Benefits Enrollment GuideVendor Contact Information14Carrier Name Group # Website Phone NumberMedical/RXCigna 00652736www.myCigna.com (best to register)1.Select ‘find a doctor, dentist, or facility’2.Log-in, or search ‘Plans through employer’3.Enter address, city, or zip code4.Select doctor by type, name, or facility5.Select a Plan/Network:
Open Access Plus PPO (all plans)1-(800) 244-6224DentalCigna0652736www.myCigna.com (best to register)1.Select ‘find doctor, dentist, or facility’2.Log-in, or search ‘Plans through employer’3.Enter address, city, or zip code4.Select doctor by type - Dentist5.Enter your zip code or address to find a providernear you6.Select a Plan/Network:
Total Cigna Choice DPPO1-(800) 244-6224VisionCigna0652736www.myCigna.com (best to register)1.Log into myCigna.com, under “Coverage”, selectVision.2.Click on ‘Visit Cigna Vision.’3.Select “Find a Cigna Vision Network Eye CareProfessional” to search the Cigna Vision – serviced by EyeMed directory.4.Enter search criteria1-(888) 353-2653Health Savings AccountHSABankwww.myaccounts.hsabank.com 1-(800) 357-6246General HR & PayrollQuestionsEmail: hrteam@thompsonhanson.com
Email: hrteam@tinyboxwoods.com(713) 661-9500