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2012 Open Enrollment Session. Office of Human Resources & Employee Relations Kimberly Tarver, HR Manager – Benefits November 2011. Dental Insurance.

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2012 open enrollment session

2012 Open Enrollment Session

Office of Human Resources & Employee Relations

Kimberly Tarver, HR Manager – Benefits

November 2011

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Dental Insurance Definitions:BALANCE BILLING: The dollar amount charged by a provider that is in excess of the plan’s allowed amount for medical/dental care or treatment. Amounts that are balance billed by a provider are the member’s responsibility. Member costs incurred for balance billing will not apply toward the annual deductible.NETWORK RATE: The rate that has been negotiated by MetLife for dental services

MAXIMUM ALLOWED CHARGE: The lesser of the amount charged by the Dentist; OR the maximum amount which the In-Network Dentist has agreed with MetLife to accept as payment in full for the dental service. REASONABLE/CUSTOMARY CHARGE: The lowest of:

  • The Dentist’s actual charge for the services or supplies; OR
  • The usual charge by the Dentist or other provider of the services or supplies for the same or similar services or supplies; OR
  • The usual charge of other Dentists or other provider in the same geographic area equal to the 99th percentile of charges as determined by MetLife based on charge information for the same or similar services or supplies maintained in MetLife’s Reasonable and Customary Charge records.

An example of how the 99th percentile is calculated is to assume one hundred (100) charges for the same service are contained in MetLife’s Reasonable and Customary charge records. These one hundred (100) charges would be sorted from lowest to highest charged amount and numbered 1 through 100. The 99th percentile of charges is the charge that is equal to the charge numbered 99.

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Dental Insurance Waiting Periods:

BOR MetLife Plan

  • After enrollment in the plan:
      • Six (6) month waiting period for orthodontic care.
      • Two (2) year waiting period for some restorative care services, i.e. replacement of full dentures

GC MetLife Plan

  • After enrollment in the plan:
      • One (1) year waiting period for basic, restorative, and orthodontic care
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Vision Insurance: Plan Exclusions

  • Any hospital, surgical or treatment facility, or for services of an anesthesiologist or anesthetist.
  • Prescription drugs or pre-medications, whether dispensed or prescribed.
  • Medical or surgical treatment of eye, eyes, or supporting structures
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Disability Insurance

Short Term Disability – Guarantee Issue no EOI requiredLong Term Disability – EOI required and application due to HR by 5:00 p.m., November 18, 2011

SPECIAL NOTE:

PRE-EXISTING CONDITION LIMITATION: You will be considered to have a Pre-existing Condition and will be subject to the Pre-existing Conditions Limitation if:

  • (1) the disability begins in the first twelve (12) months after your effective date; and
  • (2) you have received medical Treatment, consultation, care or services, including diagnostic procedures, or took prescribed drugs or medicines for the Sickness or Injury, whether specifically diagnosed or not, causing such disability, during the three (3) months immediately prior to your effective date of insurance.
  • Weekly Income Benefits will not be paid for a disability caused by; contributed to by; or resulting from a Pre-existing Condition unless you have been Actively at Work for one (1) full day following the end of twelve (12) consecutive months from your effective date of insurance.
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Board of Regents CIGNA Life Insurance

Spouse/Child Life: $4.70 = $10,000 per covered member

Supplemental Life: 1X – 5X Salary

EOI may be required for enrollment

SPECIAL NOTE:

You must be enrolled in the supplemental life insurance at least ten (10) years prior to retirement in order to continue the benefit into retirement. The maximum benefit in retirement is $15,000.

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Board of Regents CIGNA Life Insurance

CONVERSION POLICY: If you leave the Board of Regents and would like to convert their life insurance coverage, you must do so within 30 days of termination. The conversion insurance may be a type of life insurance currently being offered for conversion by the insurance company at your age and in the amount requested. It may not be term insurance and it may not be for an amount greater than the Life Insurance Benefits in force under the Policy. Conversion life insurance will not provide accident, disability or other benefits.

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Board of Regents CIGNA Life Insurance

FREE VALUE ADDED BENEFITS

  • CIGNA Will Preparation Program: Last Will and Testament; Living Will; Health Care Power of Attorney; Financial Power of Attorney; Estate Planning Information; HIPAA Authorization Forms; Online life and disability planning kits; and Funeral Planning Services
  • CIGNA Healthy Rewards: Up to 60% discounts on health and wellness services
  • CIGNA’s Identity Theft Program: Review credit information to determine if identity theft occurred; Provide identity theft resolution kit and an affidavit for credit bureaus and creditors; Assist with cancellation and replacement of lost or stolen credit cards and documents; Help with emergency travel arrangements, translation services and message relay
  • CIGNA Living Benefits:
      • Terminal Illness Benefit – Employees who are considered to have a terminal illness can qualify to receive 50% of their life benefit up to $250,000.
      • Critical Illness-Specified Disease – 25% of the coverage in force up to a maximum benefit of $50,000.
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GC Reliance Standard Life Insurance

Child Life: $4.70 = $10,000 per covered child

Spouse Life:$10,000 to $250,000 in increments of $10,000, not to exceed 50% of the Employee’s Covered Amount (Premium is based on spouse’s age)

  • Spouses under age sixty (60): Amounts of insurance over $30,000 are subject to our approval of your spouse's proof of good health.
  • Spouse age sixty (60) and over: Amounts over $10,000 subject to EOI

Supplemental Life:

1X – 5X Salary; Guaranteed Issue - $300,000

EOI Required for Coverage Amounts over $300,000

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GC Reliance Standard Life Insurance

  • Conversion: can convert to an individual policy once no longer employed by GC
  • Portability: can continue under the plan for a period of two (2) years once no longer employed by GC

SPECIAL NOTE:

You must be enrolled in the supplemental life insurance at least ten (10) years prior to retirement in order to continue the benefit into retirement. The maximum benefit in retirement is $15,000.

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AFLAC Benefit Options

Cancer Policy:

If you or your covered dependent under the policy is diagnosed with cancer and receives treatment, AFLAC Cancer Policy pays CASH benefits directly to you, unless you choose otherwise. This means you will have additional resources to help with the financial consequences of cancer that may not be covered by major medical insurance.

This plan does not have any deductibles or copayments. The plan is fully portable and guaranteed renewable. There are no network restrictions – you choose your own medical treatment provider.

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AFLAC Benefit Options

Cancer Policy Monthly Premiums:

Pre-Tax Deductions

slide15

AFLAC Benefit Options

24-Hour Accident Only Insurance:

AFLAC pays CASHbenefits directly to you, unless you choose otherwise, if a covered member’s accidental death, dismemberment, or injury is caused by a covered accident that occurs on or off the job.

The Accident Policy has:

  • No deductibles and no copayments
  • No lifetime limit – policy won’t terminate based on number or dollar amount of claims paid.
  • No network restrictions – you choose your own medical treatment provider.
  • No coordination of benefits – AFLAC pays regardless of any other insurance.
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AFLAC Benefit Options

Accident Policy Monthly Premiums:

Individual - $23.58

Single Family - $34.98

Employee + Spouse - $30.56

Family - $45.50

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Georgia College AFLAC Representative Contact Information:

John Collins

Email: john_collins@us.aflac.com

Phone: (478) 454-7512