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Thermal Mechanics, Inc. Employee Benefits Review July 1, 2015
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Benefits Overview United Healthcare Medical Benefits UMB H.S.A. Banking Delta Dental Dental Benefits (4/1 Cycle) Eyemed Vision Benefits (10/1 Cycle) UNUM Employer Paid Life/AD&D Employer Paid LTD Employer Paid STD Voluntary Life/AD&D Employee Assist Program (EAP) 2
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Benefits Overview This is your Open Enrollment. Your benefit elections will remain in effect for the entire plan year. Only Qualified Status Changes allow you to make changes to your benefit elections within 31 days after any one of the following events: Marriage, Divorce, or Legal Separation Birth or Adoption of a Child Death of a Spouse or Child Loss of Benefits for you or your Covered Dependents because of a Change in Employment Eligibility Eligible dependents include your spouse and dependent children under age 26. As in years passed, we are keeping the spousal carve out. 3
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UNITED HEALTHCARE UMB DEDUCTIBLE REIMBURSEMENT Medical Benefits – as of July 1, 2015 4
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In Network Plan Design Medical plan will remain with United Healthcare and deductibles run calendar year. New Deductible – $5,000 Individual and $10,000 Family w/ Deductible Reimbursement TMI Employees will be responsible for the first $3,000 if Employee Only or first $6,000 if Employee+ Dependents Out of Pocket Maximum is the same as last year – $6,250 Individual and $12,500 Family Once Deductible has been met, the following copays will still apply: $35 Primary Physician Office Visit / $70 Specialist Physician Office Visit $100 Urgent Care $300 Emergency Room Inpatient Hospital, Outpatient Surgery and Lab, X-Ray and Diagnostics – 100% after Deductible has been met. Preventive Care Services covered at 100%.
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In Network Plan Design In-Network Employee Deductible Individual/ Max per Family $3,000/$6,000 Deductible ReimbursementLast $2,000/$4,000 Plan Deductible w/ UHC$5,000/$10,000 Coinsurance100% Employee Out of Pocket MAX$6,250/$12,500 Office Visits Deductible then $35/$70 Emergency Room/Urgent Care In-Network Deductible* then $300 / Deductible then $100 RX CopaysDeductible then $10/$35/$60
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Pharmacy Remember: Copays apply after Deductible has been met. Retail (Up to 31 day Supply) Mail Order ( Up to 90 day Supply) Tier 1$10 $ 25 Tier 2$35 $ 87.50 Tier 3$60 $ 150 Mail Service Member Select Program – This program encourages members to fill their maintenance medication through OptumRx Mail Service Pharmacy.
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myHealthcare Cost Estimator ® 8 Understand your choices in procedure, providers, even estimated prices. Find more meaningful ways to improve your health and increase your savings.
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MyUHC.com Review Claims, Deductibles and Out of Pocket Maximums Look up In Network Providers Pull Needed information for the Deductible Reimbursement Utilize the Treatment Cost Calculator Download the Health4Me App on your smartphone.
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UNITED HEALTHCARE UMB DEDUCTIBLE REIMBURSEMENT Medical Benefits – as of July 1, 2015 10
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H.S.A. – 2015 Limits Health Savings Account (UMB) 2015 Limits raised to $3,350 Individual / $6,650 Family + $1,000 additional if you are age 55 or older Remember, the account is yours. An H.S.A. has triple tax benefits: Money goes in tax-free Money grows tax-free Withdrawals for qualified medical expenses are tax-free To be Eligible to contribute to an H.S.A. you must: Be covered under a qualified High Deductible Health Plan You are not currently covered by Medicare or TRICARE You are not covered by any other health plan that is not qualified High Deductible Health Plan
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UNITED HEALTHCARE UMB DEDUCTIBLE REIMBURSEMENT Medical Benefits – as of July 1, 2015 12
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Deductible Reimbursement JW Terrill TPA will be processing all reimbursements to TMI employees. How does the plan work? 1. Claim is submitted to United Healthcare 2. United Healthcare will process the claim and send you an EOB (Explanation of Benefits). 3. The EOB will indicate if your claim was subject to a deductible. a. If no deductible applies or if services were provided by non-network providers, the Deductible Reimbursement Plan does not apply. b. If the deductible amount is applied and the services were provided by a network provider, you should:Send a copy of the United Healthcare EOB, and Provider bill along with a completed claim form (attached) to J.W. Terrill Benefit Administrators at the address listed on the claim form. J.W. Terrill Benefit Administrators will review the EOB and process the reimbursement.
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Deductible Reimbursement Remember, three items are need to submit for reimbursement: 1. A copy of the United Healthcare EOB (explanation of benefits) 2. Provider bill 3. Completed claim Please note: Make sure to include the provider’s name, address and phone number on the claim form to avoid delays in processing the reimbursement. If you have already paid the provider of service the deductible amount, you will need to provide J.W. Terrill Benefit Administrators proof that payment was made.
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Contributions National Contribution Average Employee Only 18% Family 30% TMI Employee Cost Per Month Employee Only0% Employee + Sp0% Employee + Child0% Family0% Mid-West Contribution Average Employee Only 25% Family 58%
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UNUM Short Term Disability, Long Term Disability, and Life insurance 16
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Short Term Disability Coverage Details All full-time employees working 30+ hours a week 100% employer-funded Benefit equal to 60% of basic weekly earnings Maximum benefit up to $1,385 per week. Maximum Benefit Period: 11 weeks Elimination Period: 14 Days for disability due to injury 14 Days for disability due to sickness Your benefit amount *Please refer to your policy certificate for the full list of offsets
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Long Term Disability Coverage Details All full-time employees working 30+ hours a week 100% employer funded Definition of Disability Regular occupation Elimination Period = 90 days Benefit equal to 60% your basic monthly earnings ● Benefit maximum of $6,000 a month 18 Your benefit amount *Please refer to your policy certificate for the full list of offsets
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Basic Life Insurance Coverage Details All full-time employees working 30+ hours a week 100% employer funded Flat benefit amount = $20,000 Accidental Death & Dismemberment benefit = $20,000 19 Your benefit amount *Please refer to your policy certificate for the full list of offsets
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Voluntary Term Life and AD&D Coverage Employee ● Elect up to 5x your annual salary ● From $10,000 up to $500,000 Spouse ● Elect up to 100% of employee’s amount Children ● $10,000 benefit ● Covers all children *An unmarried handicapped dependent child who becomes handicapped prior to the child's attainment of age 26 may be eligible for benefits. Please see your plan administrator for details on eligibility
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Remember, changes above the guarantee issue elections will require medical data. Employees can change election in any increment as long as request is below the following: $100,000 guaranteed issue for employees $25,000 guaranteed issue for spouses $10,000 guaranteed issue coverage for children. If you would like to change your previous election, please complete the Evidence of Insurability form. Spouse benefits cannot be more than the employee elected benefit. Employees must elect coverage to insure a spouse or dependent. Voluntary Term Life and AD&D Coverage
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Work-life balance employee assistance program Confidential, professional assistance for a wide range of personal and work-related issues for you and your family — by telephone or online. There’s no additional charge and you don’t have to file a disability claim to use it. Limited number of face-to-face counseling Find childcare or learn about adoption options Get help with legal or financial issues Help with finding elder care services Call 1-800-854-1446 Go online at www.lifebalance.netwww.lifebalance.net user ID and password: lifebalance More services for you and your loved ones Work-life balance employee assistance program services are provided by Ceridian Corporation. These services are available with selected Unum insurance offerings. Exclusions, limitations and prior notice requirements may apply, and service features, terms and eligibility criteria are subject to change. The services are not valid after termination of coverage and may be withdrawn at any time. Please contact your Unum representative for full details.
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Questions?
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DELTA DENTAL Voluntary Dental Insurance – Reminder 24
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In Network Plan Design Renews Annually in April PPO Deductible - $25 Individual and $75 Family Premier Deductible - $50 Individual and $150 Family Non-Participating - $50 Individual and $150 Family Annual Maximum - $1,000 PPO Network Benefit Coverage vs. Premier & Non-Participating 100% Preventative 90% Basic & Restorative 60% Major Orthodontic Lifetime Maximum $1,500 Lifetime 100% Preventative 90% Basic & Restorative 60% Major 80% Preventative 80% Basic & Restorative 50% Major
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EYEMED Voluntary Vision - Reminder 26
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In Network Plan Design Renews Annually in October Exam With Dilation as Necessary $10 Copay Frames $0 Copay; $100 allowance; 20% off retail price over $100 Contact Lenses Conventional $0 Copay; $100 allowance; 15% off retail price over $100 Disposable $0 Copay; $100 allowance; plus balance over $100 Medically Necessary $0 copay, Paid in Full Dependents Covered Until Age 26 12 / 12 / 24 Schedule
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Next Steps Passive enrollment: No changes? No forms! Reminder - Spousal Opt Out Watch mail for new UHC ID Cards Remember: UHC and JWT TPA do not feed information, we have to keep the TPA informed.
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