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HII's Open Enrollment Presentation for 2016.
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2016 Benefits Enrollment Guide January 1, 2016 to December 31, 2016 Medical, Dental, Vision, Basic Life, Voluntary Life, Voluntary Short & Long Term Disability, Flexible Spending Accounts, Indemnity Insurance
2016 BENEFITS ENROLLMENT GUIDE • Health Insurance Innovations offers eligible employees a variety of benefits that can provide you and your family with healthcare coverage, financial protection and more, tailored to best fit your needs. Our benefits program is a very important part of your overall compensation and we are regularly assessing the quality and cost of benefits to ensure we offer the most competitive package possible. • The benefit choices you make should be tailored to your personal needs. Take the time to review all benefits available to you and evaluate the network, costs, and covered services. After the Open Enrollment ends, you may not add, delete, or change the coverage you have selected for yourself or your dependents, until the next Open Enrollment period. Outside of Open Enrollment, changes to insurance coverage can only be made within 30 days of a Qualifying Family Status Change, which are as follows: • Marriage • Birth or adoption of a dependent child • Change in custody of a dependent child • Death of a spouse or dependent child • Your spouse has a change of employment or status affecting benefits coverage • Your change of employment status • You experience an involuntary loss of other group benefits coverage • Or within 60 days if the Qualifying Event is relative to Medicaid or CHIP Eligibility • Employees or Dependents become eligible or lose eligibility with state Medicaid or CHIP subsidies (Special Enrollment Rights Offered) TABLE OF CONTENTS Eligibility 3 Enrolling in Benefits 4 Medical Benefits 5 Pharmacy Benefits 11 Dental Benefits 12 Vision Benefits 13 Life Insurance 14 Disability Insurance 15 Colonial Life 17 Flexible Spending Account 23 Dependent Care Assistance 24 Important Disclosures 25 Contacts 28 • Our employee benefit program includes: • Medical Insurance offered through Humana. • Dental Insurance offered through Reliance Standard. • Vision Insurance offered through Superior Vision. • Basic Life Insurance offered though Reliance Standard. • Voluntary Life Insurance offered through Reliance Standard. • Short Term Disability and Long Term Disability offered through Reliance Standard. • Accident, Critical Care, and Hospital Confinement Insurance offered through Colonial Life. • PRE- TAX ADVANTAGE • A big advantage of your employee benefit program is that your premium contributions are deducted from your paycheck on a pre-tax basis. When you pay for your premiums with pre-tax dollars, you are actually reducing your taxable income. Instead of paying taxes on your total income, you now pay on your income minus pre-tax deductions. Short Term Disability, Long Term Disability and Voluntary life premium contributions are all deducted from your paycheck on a post tax basis. This booklet is intended for illustrative and information purposes only. Not all plan provisions, limitations, and exclusions are included in this publication. In the event of any conflict between the information contained in this publication and the plan provisions, the Plan Documents and insurance contracts will govern.
ENROLLING IN BENEFITS Health Insurance Innovations uses an interactive, online website for benefits administration. Before you sit down to enroll, it is important that you review all benefit information to determine which plans will best fit the needs of you and your family. You will be required to list a beneficiary and their information, as well as dependent information, if you choose to cover dependents on any benefit plan. You will need the social security number and birth date of all beneficiaries and dependents in order to enter them into the system and proceed through the enrollment process. Please make sure you gather this information before beginning the process. If you do not have it, the system will not allow you to make any elections. LOG IN TO ENROLL Once you decide what benefits you would like to elect, and have gathered all beneficiary and dependent information, log on to the enrollment website to begin at http://www.benefitsolver.com If you are a first-time user, click on ‘Register’ to set up your user name, password and security questions. Our Company Key is ‘benefits’(note: it is case sensitive). FORGOT YOUR PASSWORD? 1. Visit www.benefitsolver.com and click on the ‘Forgot your password?’ link. 2. Enter your social security number, company key and date of birth. 3. Answer your security phrase. 4. Enter and confirm your new password, then click ‘Continue’ to 5. Return to this page and login.
MEDICAL BENEFITS SOME OF THE HIGHLIGHTS OF A HUMANA HEALTHCARE PLAN Your preventive care is covered 100 percent. Preventive care services include routine wellness exams, well-child exams, physicals, mammograms, flu shots and other immunizations. Visit humana.com to access age and gender specific preventive care recommendations that will help you manage your health. A complete listing is found in this booklet. How To Find Your Doctor, Hospital, or Pharmacy: Visit www.humana.com, select “Search” in the box labeled “Find a doctor”. From there, either enter your Member ID number under “Search by Member ID Number” or choose “Insurance through your Employer” and enter your zip code. The network is called “NPOS”for all plans. Use in-network labs Humana’s in-network labs are Quest and/or LabCorp. Make sure to use one of these in-network labs whenever you have lab work done. You save money when you use their network. You can't put a price on peace of mind. Whether you are home, traveling for work or vacation, or have a child going to school in another state, a network doctor is likely nearby. • You can register at www.Humana.com to: • Check if your claim has been paid along with your estimated cost, if any • Review deductibles, coverage levels, and limits • Use Physician Finder Plus to find in-network providers near you • Use Humana’s MyChoice Tools to choose providers wisely and estimate costs • Look up coverage for drugs, estimated prices, and possible alternatives • Use the Rx Calculator to plan for out-of-pocket drug costs • Access health information specific to your conditions and life stage • Access the Year-to-Date Summary to see an at-a-glance view of your financial information • Manage access by giving other adults on your policy permission to access your health information • Update your communication preferences • Registering is easy • Have your Humana ID Card ready • Go to www.Humana.com • Select “Register” at the top of the page or in the log-in box on the left • Choose “Member all other members” • Enter some basic information and click “Next” • Create a User ID, password, and security prompt and click “next” to finish
MEDICAL BENEFITS – HIGH DEDUCTIBLE Cost to the employee per biweekly pay period: Not all plan provisions, limitations, and exclusions are included in this publication. In the event of any conflict between the information contained in this publication and the plan provisions, the Plan Documents and insurance contracts will govern.
HEALTH SAVINGS ACCOUNTS Health Insurance Innovations offers the Humana High Deductible Health Plan, which comes with a Health Savings Account (HSA) that you can use to pay for medical expenses. What is an HSA? An HSA (Health Savings Account) is a bank account tied to a High Deductible Health Plan (HDHP) that can be used to pay for qualified medical expenses. • What does an HSA do for you? • Contribute Anytime. You, and family members can contribute anytime, up to a yearly maximum. • You own your HSA. You decide how to spend – or save – your health savings account. If you change jobs or health plans, you keep the account. You can even name a beneficiary to inherit your account. • There’s no use it or lose it. Any money not used at the end of the plan year rolls over to the next year…every year. • It’s an investment. Your HSA is a savings account that earns interest. It’s a terrific way to put money away for health care costs down the road, even in retirement. After you build up to a certain amount, you will have investment options. • It’s flexible. Contributions to the fund are flexible and payroll deductions can be changed throughout the year. • Triple Tax Savings. Tax-free contributions, tax-free earnings, and tax-free spending. • Contribution Limits • Individuals can contribute up to $3,350 per year to their HSA account. • Families can contribute up to $6,750 per year to their HSA account. • Participants 55 and older, can contribute an additional $1,000 “catch up contribution” to their account. • Qualified Medical Expenses • Health Savings Accounts can only be used for qualified expenses for you and your family which include: • Medical plan deductibles and coinsurance • Dental, and vision care services • See IRS Publication 502 for complete list of qualifying expenses • You should save receipts to prove your expense is qualified in case you are ever audited. • Have you set up your HSA Banking? • If you enroll in the HSA, you will be given the option to set up an HSA bank account with HSA Bank. The account can be set up by visiting www.hsabank.com and clicking on “Open up HSA”. • You can also speak with HSA experts by calling or emailing the Client Assistance Center at 800-357-6246 or emailing firstname.lastname@example.org • Once enrolled you can also download the HSA Bank Mobile App. With the mobile app you can manage your HSA account balances, view account activity, schedule contributions, and save and store receipts. • You may change your payroll deduction any time during the year • Eligibility • To be eligible for the Health Savings Account, you must meet the following requirements: • You are covered by a high deductible health plan • You are not covered by any other health plan that is not a high deductible health plan • You are not enrolled in any part of Medicare, TRICARE or TRICARE for Life • You have not received VA benefits within the past 3 months • You are not claimed as a dependent on someone else’s tax return • You are not covered by an FSA (other than a Limited FSA)
MEDICAL BENEFITS MEDICAL INSURANCE You have a choice of enrolling in one of four medical plans through Humana. To find a doctor, visit www.humana.com and select “Search” in the box labeled “Find a doctor”. From there, either enter your Member ID number under “Search by Member ID Number” or choose “Insurance through your employer” and enter your zip code. If you search by Coverage and Network, you will also have to select your Network which is “NPOS”. The benefits are as follows: Cost to the employee per biweekly pay period: Not all plan provisions, limitations, and exclusions are included in this publication. In the event of any conflict between the information contained in this publication and the plan provisions, the Plan Documents and insurance contracts will govern.
MEDICAL BENEFITS Cost to the employee per bi weekly pay period: Not all plan provisions, limitations, and exclusions are included in this publication. In the event of any conflict between the information contained in this publication and the plan provisions, the Plan Documents and insurance contracts will govern.
MEDICAL BENEFITS Cost to the employee per biweekly pay period: Not all plan provisions, limitations, and exclusions are included in this publication. In the event of any conflict between the information contained in this publication and the plan provisions, the Plan Documents and insurance contracts will govern.
PHARMACY BENEFITS LEARN MORE ABOUT YOUR PRESCRIPTION BENEFITS You will have special services to help you make decisions and help you save. • Specialty medications: If you are taking an injectable or specialty medication, you will have access to designated specialty pharmacies to fill your prescription. Specialty pharmacies will also provide educational and clinical support. • Medication pricing tools: With humana.com, you will be able to search and compare prescription medication costs and see costs based on your specific plan. It's an easy way to find lower cost options, like generic medications. Remember to ask your doctor if a lower-cost alternative medication is right for you. Humana RightSource Mail Order Pharmacy Savings: Many Humana plans provide cost savings if you fill a 90-day supply of your maintenance medicines through a preferred mail-order pharmacy, instead of a retail pharmacy. Plus, the RightSource pharmacy team works with you and your doctor to find medicines that cost less. Experienced RightSource Pharmacy Team: Pharmacists are just a phone call away. RightSource pharmacists are available at 1-855-490-2147 Monday – Friday 8 AM – 11 PM, and Saturday 8 AM – 6:30 PM EST. Safe and Accurate: Two RightSource pharmacists check your new prescriptions to make sure they’re safe to take with your other medicines. Timely Reminders: To make sure you have the medicines and supplies you need, when you need them, RightSource will remind you when its time to refill your medicines. Visit RightSourceRx.com: After you become a Humana member, you can log in with your MyHumana identification number and register to get started. You can also sign up by calling 1-855-297-7120. Specialty Drugs: You can sign up online through www.myhumana.com or you or your doctor can call 1-800-486-2668 Monday through Friday from 8 AM – 8PM and on Saturday from 8AM – 6PM EST. Pharmacy Defined What is a generic medication? Most brand medications have a generic version available. Generics contain the same active ingredients (the chemicals that make a medication work) as brand medications. Generic medications must meet the strict FDA brand medication standards for quality, strength and purity. What is a Prescription Drug List, or PDL? A Prescription Drug List, or PDL, is a list that places commonly prescribed medications for certain conditions into "tiers." The list includes brand and generic prescription medications approved by the FDA. What are tiers and what do they mean? Prescription medications are placed into tiers. Each tier is assigned a cost. Tier 1 is usually the lowest-cost tier option.
DENTAL BENEFITS DENTAL INSURANCE We will be offering dental this year through Reliance Standard. You have the choice of two plans – a base plan and a buy up plan. Both plans are dental PPOs where you have the option of seeing a dentist in the Reliance Standard network, or going to a dentist of your choice. However, if you choose a dentist who does not participate in the Reliance Standard PPO, your out-of-pocket expenses may be more, since you will be responsible to pay the difference between the dentist’s fee and your plan’s payment for the approved service. To find a dentist, go to reliancestandard.com/dental-vision/and select “Find a Dentist”. Cost to employee per biweekly pay period: Not all plan provisions, limitations, and exclusions are included in this publication. In the event of any conflict between the information contained in this publication and the plan provisions, the Plan Documents and insurance contracts will govern.
VISION BENEFITS VISION INSURANCE Vision insurance will now be offered through Superior Vision. Please visit www.superiorvision.com to find a provider in your area. Superior Vision’s national network is comprised of both independent and national retail optical locations, including Visionworks, For Eyes, Sam’s Club, Costco, Target, Walmart, Pearle Vision, Sears Optical, EyeGlass World, Lenscrafters, ShopKo, Eyemart Express, and America’s Best. Benefits are as follows: Cost to the employee per biweekly pay period: Not all plan provisions, limitations, and exclusions are included in this publication. In the event of any conflict between the information contained in this publication and the plan provisions, the Plan Documents and insurance contracts will govern.
LIFE INSURANCE BASIC LIFE AND ACCIDENTAL DEATH & DISMEMBERMENT As a benefit to all eligible employees, Health Insurance Innovations provides, at no cost to you, Basic Life and Accidental Death & Dismemberment Insurance through Reliance Standard. It is provided to all full time employees in the amount of $15,000. In the event of your death, this benefit is paid to your designated beneficiary. VOLUNTARY LIFE INSURANCE In addition to your company paid life insurance, you have the opportunity to purchase additional life insurance for you and your dependents through Reliance Standard at group rates. Employees can choose amounts in increments of $10,000 up to 5 times your annual salary, not to exceed $300,000. The guaranteed issue is 100,000. For amounts over the guaranteed issue amount, an Evidence of Insurability will be required. Benefit amounts reduce to 65% at age 65 ,40% at age 70 and 20% at age 75. Spouses can choose amounts in increments of $10,000 up to a maximum amount of $150,000, not to exceed 100% of employee’s benefit amount. The guaranteed issue amount is $30,000. Benefit amounts reduce to 65% at age 65 ,40% at age 70 and 20% at age 75. The child benefit option can be purchased in the amount of $10,000 for children age 14 days to age 20 (26 if a full-time student). From birth to 14 days the benefit is $500. • EVIDENCE OF INSURABILITY • Evidence of Insurability (EOI) will be required for either you, your spouse, or child under the following circumstances: • For any amount elected over the guaranteed issue amount. • For questions regarding Evidence of Insurability, please contact Human Resources. The Evidence of Insurability form can be found on the benefits website or by contacting Human Resources. Cost for spouse Voluntary Life is based on the spouse’s age as follows: Cost for employee Voluntary Life is based on the employee’s age as follows: Example: For a 44 - year-old employee who wants to buy $50,000 of voluntary life, the cost would be $10.00 per month or $4.62 per biweekly paycheck. ($0.20 x $50,000/$1,000 = $10.00, $ 10.00*12/26= $4.62) Not all plan provisions, limitations, and exclusions are included in this publication. In the event of any conflict between the information contained in this publication and the plan provisions, the Plan Documents and insurance contracts will govern.
DISABILITY INSURANCE SHORT TERM DISABILITY The short term disability benefit is offered through Reliance Standard. The benefits are as follows: Benefit Percentage: 60% of pre-disability earnings Weekly Max Benefit: $1,500 Weekly Minimum Benefit: $25 Benefits Begin: 15th day for accident or illness Benefits Duration: 24 weeks Pre-Existing Condition: Disabilities that occur during the first 6 months of coverage due to a pre-existing condition during the 3 months prior to coverage are excluded. The Short Term Disability rate is $0.61 per $10 of weekly benefit. Not all plan provisions, limitations, and exclusions are included in this publication. In the event of any conflict between the information contained in this publication and the plan provisions, the Plan Documents and insurance contracts will govern.
DISABILITY INSURANCE LONG TERM DISABILITY The long term disability benefit is offered through Reliance Standard. The benefits are as follows: Benefit Percentage: 60% of pre-disability earnings Monthly Max Benefit: $5,000 Monthly Minimum Benefit: $50 Elimination Period 180 days Benefits Duration: Social Security Normal Retirement Age (SSNRA) or Duration of Benefits Pre-Existing Condition: Disabilities that occur during the first 12 months of coverage due to a pre-existing condition during the three months prior to coverage are excluded. Not all plan provisions, limitations, and exclusions are included in this publication. In the event of any conflict between the information contained in this publication and the plan provisions, the Plan Documents and insurance contracts will govern.
HOSPITAL CONFINEMENT INSURANCE COLONIAL INSURANCE PLANS Health Insurance Innovations will offer group indemnity insurance through Colonial. There are three separate products to choose from: Hospital Confinement, Accident, and Critical Care. HOSPITAL CONFINEMENT Even if you have coverage that helps with most of the expenses, you may still have to deal with deductibles, copayments, and coinsurance. Colonial’s Hospital Confinement Insurance offers added financial protection for those out-of-pocket costs related to a covered accident or sickness. A$3,000 Hospital Confinement benefit can help pay for the costs associated with a hospital stay. (Maximum of 1 benefit per calendar year per covered person). A $25 Doctor Office Visit Benefit can offer additional coverage if you have to go to the doctor. Maximum of 3 visits per calendar year for employee coverage. A $150 Emergency Room Visit Benefit can help pay for charges related to an emergency room visit. Maximum of 1 visit per calendar year per covered person. A $250 Diagnostic Procedure Benefit can help pay for the costs associated with the following common diagnostic procedures: (Maximum of 1 diagnostic procedure per calendar year per covered person).
HOSPITAL CONFINEMENT INSURANCE HOSPITAL CONFINEMENT CONT. An Outpatient Surgical Procedure Benefit can help cover costs associated with a covered surgical procedure. Maximum of $2,500 per covered person per calendar year for Tiers 1 & 2 combined. Tier 1 Outpatient Surgical Procedure Benefit $750 Tier 2 Outpatient Surgical Procedure Benefit $1,500 Tier 1 Tier 2 The surgeries listed above are only a sampling of the surgeries that may be covered. Surgeries must be performed by a doctor in a hospital or ambulatory surgical center. For complete details and definitions, please refer to your certificate. There are some limitations and exclusions. Please see the Colonial Insurance handouts for specific details.
ACCIDENT INSURANCE • ACCIDENT INSURANCE • Colonial’s Accident Insurance helps you fill some of the gaps caused by increasing deductibles, copayments, and out-of-pocket costs related to an accidental injury. It also provides $50 when you receive your annual wellness screening. Benefits listed are for each covered person per covered accident unless otherwise specified. • Initial Care • Accident Emergency Treatment: $125 • Ambulance: $200 • Air Ambulance: $1,500 • X-Ray Benefit: $30 • Your Colonial Life certificate also provides benefits for the following injuries received as a result of a covered accident. • Burn (based on size and degree): $1,000 to $12,000 • Burn - Skin Graft for 2nd or 3rd degree burns : 50% of Burn benefit • Coma: $10,000 • Concussion: $150 • Emergency Dental Work: $100 Extraction, $300 Crown, Implant, or Denture • Lacerations (based on size): $25 to $600
ACCIDENT INSURANCE ACCIDENT INSURANCE CONT. Your Colonial Life certificate also provides benefits for the following injuries received as a result of a covered accident. • Requires Surgery • Eye Injury: $300 • Ruptured Disc: $500 • Tendon/Ligament/Rotator Cuff: $500 – 1, $750 – 2 or more • Torn Knee Cartilage: $500 • Surgical Care • Blood/Plasma/Platelets: $300 • Surgery (arthroscopic or exploratory): $150 • Surgery (cranial, open abdominal or thoracic): $1,500 • Surgery (hernia): $200 • Transportation/Lodging Assistance • If injured, the covered person must travel more than 50 miles from residence to receive special treatment and confinement in a hospital. • Lodging (family member or companion): $150 per night up to 30 days for a hotel/motel lodging costs • Transportation: $500 per round trip up to 3 round trips • Accident Hospital Care • Hospital Admission: $1,000 per accident • Hospital ICU admission: $1,500 per accident • Colonial will not pay the hospital admission benefit and ICU admission benefit for the same covered accident simultaneously • Hospital Confinement: $200/day up to 365 days per accident • Hospital ICU Confinement: $400/day up to 15 days per accident • Colonial will not pay the hospital confinement benefit and ICU confinement benefit simultaneously. • Accident Follow-Up Care • Accident Follow-Up Doctor Visit: $50 (up to 3 visits per accident) • Appliances: $100 (such as wheelchair, crutches) • Medical Imaging Study: $150 per accident (limit 1 per covered accident and 1 per calendar year) • Occupational or Physical Therapy: $25 per day up to 10 days • Pain Management (Epidural Anesthesia): $100 (limit 1 per covered accident) • Prosthetic Devices/ Artificial Limb: $500 – one, $1,000 – two or more • Rehabilitation Unit Confinement: $100/day up to 15 days per covered accident, and 30 days per calendar year • Colonial will not pay the hospital confinement benefit & rehabilitation unit confinement benefit simultaneously. • Accidental Dismemberment • Loss of Finger/Toe: $750 – one/ $1,500 – two or more • Loss or Loss of Use of Hand/Foot/Sight of Eye: $7,500 – one, $15,000 – two or more Catastrophic Accident For severe injuries that result in the total and irrecoverable: Loss of one hand and one foot, loss of both hands or both feet, loss or loss of use of one arm and one leg, loss or loss of use of both arms or both legs, loss of sight of both eyes, loss of the hearing of both ears, loss of the ability to speak Named Insured: $50,000 Spouse: $50,000 Children: $25,000 (365 day elimination period. Payable once per lifetime for each covered person). Accidental Death
CRITICAL CARE INSURANCE CRITICAL CARE INSURANCE Colonial’s Critical Care Insurance combines both cancer insurance and critical illness insurance into a single policy. The plan pays a lump sum of $20,000 to assist with medical and/or non-medical costs associated with the diagnosis of a covered critical illness. The covered critical illness conditions are as follows: If you are diagnosed with cancer, you will receive a lump sum benefit to assist with medical and/or non-medical costs associated with the diagnosis of cancer (internal or invasive). The cancer treatment and care benefits pays $500 per calendar month for 12 months. This benefit assists with ongoing medical and/or non-medical costs associated with a diagnosis of cancer (internal or invasive) or carcinoma in situ. The benefit is payable when you or a covered family member incurs charges for and receives one more of the covered treatments or services in a calendar month for your treatment or care of cancer (internal or invasive) or carcinoma in the situ: Hospice Care, Confinement, Chemotherapy, Radiation, Surgery. Colonial will also pay a Cancer Vaccine Benefit of $50 if you or a covered family member incurs a charge for and receives any cancer vaccine that is FDA approved for the prevention of cancer, while your certificate is in force. This plan also includes coverage for subsequent diagnosis of a different or the same critical illness. If you receive a benefit for a critical illness and later are diagnosed with a different critical illness, Colonial will pay the original percentage of the face amount for that particular critical illness. If you are diagnosed with the same critical illness, they will pay 25% of the original face amount.
HOSPITAL CONFINEMENT, ACCIDENT & CRITICAL CARE INSURANCE HOSPITAL CONFINEMENT The rates for the Colonial Hospital Confinement Insurance are age banded based on the employee’s age. The rate per biweekly pay period is as follows: ACCIDENT The rates for the Colonial Accident Insurance per biweekly pay period are as follows: CRITICAL CARE INSURANCE There is also a $50 wellness benefit provided for completing your annual wellness screening. $20,000 CRITICAL CARE The rates for the $20,000 critical care benefit are age banded based on the employee’s age. The rates per biweekly pay period are as follows: *Colonial claim forms are located on the benefits website or by calling Colonial directly at 1-800-325-4368 Some exclusions and limitations apply to the Colonial Insurance plans. Please reference the Colonial documents directly for a listing.
FLEXIBLE SPENDING ACCOUNTS (FSAs) Flexible Spending Accounts (FSAs) Flexible Spending Accounts are offered to Health Insurance Innovations employees through Medcom. What is an FSA? An FSA is a tax advantaged benefit plan whose funds are exempt from taxes. The account is setup and administered under a cafeteria plan for employees to elect to participate. Your out-of-pocket health care expenses are eligible for reimbursement if the expenses are for medically necessary care or treatment incurred during the Plan Year. If you have dependents, your out-of-pocket costs for their expenses are eligible too! Your Tax Advantage Federal, State and FICA taxes are not taken on the amount you contribute to your Health FSA and/or Dependent Day Care Account. This could represent a 25% - 40% savings on your "out-of-pocket" costs for medical expenses and dependent day care expenses! Eligible expenses include: any health-related medical treatment, medication, medical procedure, including flu shots, chiropractic care, acupuncture, lasik eye surgery, eye exams, prescription sunglasses, orthodontia*, physical therapy, durable medical equipment, OTC “drugs” and “medicines” with a prescription, etc. *Please consult with Medcom for limitations on orthodontia expenses. Ineligible expenses* include: any cosmetic medical or dental care and treatments. Procedures for “general well being” such as massage therapy and weight loss programs. Other ineligible expenses include vitamins, nutritional supplements and food, minerals, herbs, insurance premiums, eligible services paid for but not yet received, and OTC “drugs” and “medicines” except insulin without a prescription, etc. *Exceptions may be made for certain ineligible expenses to be covered by your FSA Plan if they are medically necessary to treat a specific medical condition. A letter of medical necessity from a licensed medical practitioner is required before any of these expenses are reimbursable. Please consult Medcom Customer Service for details and specifics of what is required. These types of services may not be used with your debit card; manual claim is required. • How does my FSA work? • Once enrolled, you receive a Mastercard directly linked to your FSA account to pay for your healthcare and or dependent daycare expenses • Purchases should always be processed as “credit” transactions. Always know your balance – transactions that exceed your available balance will be declined • Reimbursements will not be made for any amount exceeding the election amount. Your FSA annual election is available the first day of your plan. • You are required to substantiate certain debit card transactions to verify the expense or services being paid for are eligible under your plan. Please submit receipts as requested. • If you need a replacement debit card, please contact Medcom. A replacement card fee may apply. This fee will automatically be deducted from your FSA account. • You may contribute up to these amounts for the Plan Year: • $2,550 for your Health Care FSA • $5,000 for your Dependent Day Care Account ($2,500 if married filing separately)
DEPENDENT CARE ASSISTANCE Dependent Care Assistance Dependent Care Assistance is offered to Health Insurance Innovations employees through Medcom. • Reimbursement of Your Day Care Expenses • You can use your debit card if the day care provider accepts MasterCard®. If not, you must pay the day care provider and submit a paper claim to Medcom. • Paper claims are given priority and paid within 3 days of receipt • Day Care expenses can be reimbursed by you to any individual over 19 years old. They must have a Social Security Number and file taxes (for example, a nanny, relative or neighbor, no one whom you claim on your taxes is an eligible provider) • Dependent Day Care claim payments are limited to the available balance accumulated due to payroll deductions. • You can not be reimbursed for Day Care expenses that exceed the available balance that has been payroll deducted. • What is a Dependent Care Assistance Program? • Dependent Care Assistance Programs are funds deducted from your paycheck specifically designated to cover dependent care expenses. Your out-of- pocket, Dependent Day Care expenses are eligible for reimbursement if they are for custodial care of dependents claimed on your federal income tax return. • You may contribute a maximum of: • $5,000 if you are single; and • $2,500 if you are married filing separately. • Examples of Eligible Dependent Care Expenses: • Before and After School custodial care • Day Camps • Licensed Day Care Centers • Examples of Ineligible Dependent Day Care Expenses: • Medical Care • Tuition • Food • Overnight camps • Day Care or Babysitting incurred after your work hours • Day Care expenses that have not been actually incurred • Day Care expenses for children 13 and older • Late fees assessed by the provider for making late payments • General Information • Your debit card cannot be used at ATM machines. • You may not use your debit card when you are on Leave of Absence or if you terminate employment. • If you do not repay ineligible FSA expenses, your debit card will be deactivated. • The funds available are not interchangeable between dependent care and medical FSAs. • Always contact Medcom to confirm what is eligible if you are not certain. • Your FSA and DCAP elections may not be changed unless you have a qualified Family Status change. • If you do not use the funds in your FSA (incur an eligible expense) during the Plan Year and throughout the grace period, you will lose them. You must submit these claims to Medcom by the end of the run-out period. • Contact Medcom to obtain a Recurring Transaction Expense Form (for medical expenses only). Contact Medcom: P.O. Box 10269 Jacksonville, FL 32247 Office 904.596.4500 Toll Free 800.523.7542 Fax: 904.421.3696 Toll Free Fax: 866.598.7800 www.emedcom.net
IMPORTANT DISCLOSURES AVAILABILITY OF SUMMARY HEALTH INFORMATION – HEALTH CARE REFORM As an employee, the health benefits available to you represent a significant component of your compensation package. They also provide important protection for you and your family in the case of illness or injury. Your plan offers a series of health coverage options. Choosing a health coverage is an important decision. To help you make an informed choice, your plan makes available a Summary of Benefits and Coverage (SBC), which summarizes important information about any health coverage option in a standard format, to help you compare across options. NOTICE OF HEALTH INSURANCE EXCHANGES The Health Insurance Marketplace is designed to help you find health insurance that meets your needs and fits your budget. The Marketplace helps you to find and compare private health insurance options. You may qualify to save money and lower your monthly premium, but only if your employer does not offer coverage, or offers coverage that doesn't meet certain standards. The savings on your premium that you're eligible for depends on your household income. If you have an offer of health coverage from your employer that meets certain standards, you will not be eligible for a tax credit through the Marketplace and may wish to enroll in your employer's health plan. However, you may be eligible for a tax credit that lowers your monthly premium, or a reduction in certain cost-sharing if your employer does not offer coverage to you at all or does not offer coverage that meets certain standards. If the cost of a plan from your employer that would cover you (and not any other members of your family) is more than 9.5% of your household income for the year, or if the coverage your employer provides does not meet the "minimum value" standard set by the Affordable Care Act, you may be eligible for a tax credit. Note: If you purchase a health plan through the Marketplace instead of accepting health coverage offered by your employer, then you may lose the employer contribution (if any) to the employer offered coverage. Also, this employer contribution as well as your employee contribution to employer offered coverage is often excluded from income for Federal and State income tax purposes. Your payments for coverage through the Marketplace are made on an after-tax basis. Please visit HealthCare.gov for more information, including an online application for health insurance coverage and contact information for a Health Insurance Marketplace in your area.
IMPORTANT DISCLOSURES HEALTH SAVINGS ACCOUNT HEALTH SAVINGS ACCOUNT IMPORTANT - U. S. DEPARTMENT OF LABOR NOTICE Medicaid and the Children’s Health Insurance Program (CHIP) Offer Free or Low-Cost Health Coverage to Children and Families If you are eligible for health coverage from your employer, but are unable to afford the premiums, some States have premium assistance programs that can help pay for coverage. These States use funds from their Medicaid or CHIP programs to help people who are eligible for employer-sponsored health coverage, but need assistance in paying their health premiums. If you or your dependents are already enrolled in Medicaid or CHIP and you live in a State listed below, you can contact your State Medicaid or CHIP office to find out if premium assistance is available. If you or your dependents are NOT currently enrolled in Medicaid or CHIP, and you think you or any of your dependents might be eligible for either of these programs, you can contact your State Medicaid or CHIP office or dial 1-877-KIDS NOW or www.insurekidsnow.gov to find out how to apply. If you qualify, you can ask the State if it has a program that might help you pay the premiums for an employer-sponsored plan. Once it is determined that you or your dependents are eligible for premium assistance under Medicaid or CHIP, your employer’s health plan is required to permit you and your dependents to enroll in the plan – as long as you and your dependents are eligible, but not already enrolled in the employer’s plan. This is called a “special enrollment” opportunity, and you must request coverage within 60 days of being determined eligible for premium assistance. If you or your dependents live in one of the states on the attached list, you may be eligible for assistance paying your employer health plan premiums. The list of states is current as of January 31, 2011.You should contact your state for further information on eligibility – To see if any more States have added a premium assistance program since January 31, 2011, or for more information on special enrollment rights, you can contact either: U.S. Department of Labor U.S. Department of Health and Human Services Employee Benefits Security Administration Centers for Medicare & Medicaid Services www.dol.gov/ebsawww.cms.hhs.gov 1-866-444-EBSA (3272) 1-877-267-2323, Ext. 61565 OMB Control Number 1210-0137 (expires 09/30/2013)
CONTACTS Questions about benefits? Your Health Insurance Innovations Benefits Team: John Parker, Human Resources Manager (ph) 813-397-1190 email@example.com Your Stahl & Associates Insurance Benefits Team: Not all plan provisions, limitations, and exclusions are included in this publication. In the event of any conflict between the information contained in this publication and the plan provisions, the Plan Documents and insurance contracts will govern.