Employee Benefits Open Enrollment
OVERVIEW Trutina Financial – Resource for employees Open Enrollment Medical – Kaiser – Access PPO VisitsPlus Silver $2,500 Dental – Willamette Dental Vision – Vision Service Plan (VSP) Life & AD/D – Unum Short Term Disability (STD) – Unum Health Reimbursement Account (HRA) – Sound Benefits Administration
TRUTINA FINANCIAL Trutina Financial is a resource for you: General benefits questions Claim issues / resolutions Contacts: Morgan Patterson, Account Manager 425.401.1211 Client Services Team 800.401.4534 clientservices@trutinafinancial.com
OPEN ENROLLMENT Opportunity to add or delete coverage for self and dependent for an effective date of December 1, 2018 Coverage will remain in place until November 30, 2019 unless you have a qualifying event ALL EMPLOYEES MUST COMPLETE ENROLLMENT ON EE NAVIGATOR BY NOVEMBER 12TH
ENROLL THROUGH EE NAVIGATOR http://nhm-benefits.com/
MEDICAL PLAN OVERVIEW kp.org/wa/provider-directory Plan Name Kaiser Permanente Access PPO VisitsPlus Silver Benefits Preferred Provider Network Out-of-Network Deductible In Network: $2,500 Individual and $5,000 Family Out-of-Network: $5,000 Individual and $10,000 Family Annual Out-of-Pocket In Network: $7,350 Individual and $14,700 Family Out-of-Network: $22,050 Individual and $44,100 Family Cost Share In-Network: Copay or Deductible, then 30% Coinsurance Out-of-Network: Deductible, then 50% Coinsurance Office Visits Primary Care Specialist $35 Copay ($25 Copay – Enhanced Benefit) $55 Copay ($45 Copay – Enhanced Benefit) Deductible, then 50% Coinsurance Preventative Care Covered 100% Emergency Services Deductible, then 30% Coinsurance Urgent Care $35 Copay ($25 Copay – Enhanced Benefit)-Primary $55 Copay ($45 Copay – Enhanced Benefit)-Specialty Pharmacy Up to 30 day supplies at Preferred & Up to 90 day supplies at Group Health Pharmacy Generic: $25 Copay Preferred Brand : $55 Copay ($50 Copay Enhanced Benefit) Specialty Drugs: 50% Coinsurance Not Covered kp.org/wa/provider-directory https://www.fchn.com/ProviderSearch
Utilize Enhanced Benefit Care Clinics care-clinic.org
Health Reimbursement account New Horizons Medical Plan: $2,500 Deductible $7,350 Out-Of-Pocket Max 1: Member receives a medical bill $4,000. 2: Member has to pay $2,500 Deductible first. 3: HRA FUNDING = Member pays first $1,250, New Horizons pays next $1,250 through HRA (Health Reimbursement Account) HRA Health Reimbursement account 4: After the deductible has been paid; Insurance pays 70%, the member pays 30%. $2,500 (deductible)+(30% of $1,000 =$300)=$2,800 *Remember - $1,250 of the $2,500 Deductible was paid by New Horizons through the HRA so member pays $1,250 (deductible) + $300 (coinsurance) = $1,550. 5: The member pays 30% of medical expenses until they reach their Out-Of-Pocket Maximum (OOPM). 6: The Out-Of-Pocket Maximum ($7,350) is the most you pay out of pocket in a calendar year. Once the Out-Of-Pocket is met, medical expenses are covered 100% with in-network providers.
DENTAL PLAN OVERVIEW Willamette Dental Plan Name Provider Network Provider Network Willamette Dental Group Benefit Period January 1, 2019 – December 31, 2019 Deductible Copay Per Person: $0 / Per Family: $0 $25 Per Visit Benefit Period Maximum No annual Maximum Diagnostic & Preventive Exams, Cleanings, X-rays, Fluoride & Sealants Covered with Office Copay $25 Restorative Fillings & Crowns Fillings Covered with Office Copay $25 Crowns Covered with $400 Copay Endodontics & Periodontics Refer to schedule Oral Surgery Routine Extraction (Single Tooth) Surgical Extraction $190 Copay Orthodontia Pre-Ortho Services Comprehensive Ortho $150 Copay $2,850 Copay
Vision Service Pan (VSP) VISION PLAN OVERVIEW Plan Name Vision Service Pan (VSP) Provider Network VSP Signature Well Vision Exam $10 Copay Every 12 months Prescription Glasses $25 Copay Lenses - every 12 months Frame – every 24 months $150 allowance + 20% discount on any amount over allowance. Contact Lenses (If chosen instead of glasses) Up to $60 copay for contact lens exam $150 allowance for contacts
Life & AD/D OVERVIEW Unum Plan Name Additional Benefits: Employee Life Insurance $10,000 Employee AD&D Insurance Additional Benefits: Will Preparation Preparing a will doesn’t have to be complicated — or expensive. Your employee assistance program includes simple tools that can help you create a basic will in no time. Work Life Balance (EAP) Balance can be a call or click away: 1-800-854-1446, English 1-877-858-2147, Spanish 1-800-999-3004, TTY/TDD www.lifebalance.net When you have questions, concerns or emotional issues surrounding your personal or work life, you can count on us to offer help. Unum’s EAP offers unlimited access to master’s level consultants by telephone, resources and tools online, and up to three face-to-face visits with a consultant for help with a short-term problem.
Short Term Disability (STD) Plan Name Unum Employee Weekly Benefit Amount 60% of weekly earnings up to a maximum of $1,500 per week. Elimination Period 14 days for both covered injury & covered sickness Benefit Duration Benefits extend for 11 weeks as long as you meet the definition of disability Definition of Disability You are disabled when Unum determines that, due to sickness or injury: • You are limited from performing the material and substantial duties of your regular occupation;* and • You have a 20% or more loss in weekly earnings due to the same sickness or injury.
REMINDERS Do preventive checkups/cleanings No cost for preventive medical procedures provided you go in network and the procedure is coded as preventive ALL EMPLOYEES MUST COMPLETE BENEFIT ELECTION THROUGH EE NAVIGATOR BY NOVEMBER 12TH Be sure you have the right beneficiary Reach out to us or the carrier with individual medical questions
New Horizons Ministries Benefits Plan Contacts: 12/1/18 - 11/30/19 Medical: Kaiser Permanente Group # 8431200 888.901.4636 https://wa.kaiserpermanente.org Health Reimbursement Account (HRA): Sound Benefit Administration 360.779.7047 www.soundadmin.com Dental: Willamette Dental Group # WA477 855.433.6825 www.willamettedental.com Life/AD&D & STD: Unum 800.421.0344 www.unum.com Vision: VSP Group # 30030553 800.877.7195 www.vsp.com Employee Assistance Program (EAP): Unum 800.854.1446 www.lifebalance.net If you have any questions that your health insurance companies cannot answer, please feel free to contact us at ClientServices@TrutinaFinancial.com 800.401.4534 425.401.1211