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ProCom ConsultingEmployee BenefitsPlan Year- 5/1/2019 – 4/30/2020
Questions?
Debra RootProCom Consulting
[email protected] x124
Deborah MichaelAngus McRae Insurance
[email protected] x103
Deirdre CountsAngus McRae Insurance
[email protected] x104
EAP (Employee Assistance Program)
Online resources for every day challenges including:
• 24-hour grief counseling• Stress, addiction, depression• Parenting• Legal services• Home finances• Work-life balance
(800) 450-1327MagellanHealth.com/member
Welcome to ProCom Consulting Open Enrollment! The month of April is the time in which you can make changes to your plan including adding or dropping dependents. You can also make changes to your benefit elections. The deadline to make your elections is 4/15/19 and changes will go into effect as of 5/1/19.
We are pleased to offer the following benefit coverage to our employees:
• Aetna Medical • Principal Dental • Principal Vision• Principal Long-Term Disability• Principal Employee Assistance Program (EAP)• Ameriflex FSA- Medical and Dependent Daycare and Limited Purpose FSA• Ameriflex HSA - (eligible only to employees that elect the HSA medical option 2 only)• Principal Voluntary Life • Principal Accident • Principal Critical Illness
All summaries, electronic enrollment forms, rates and additional helpful tools are available on our Employee Benefits web page:
https://www.withbenefits.com/amibs/deborah/procomLogin: [email protected]: benefits
Important note: This is an incomplete summary. Refer to the certificate of insurance for plan details. If there is any difference between this summary and the certificate of insurance, the certificate of insurance language shall rule. Premium rates are subject to insurer approval.
Aetna Medical Plan Opt. 1
OAMC $4,000 100/70
Medical Plan Opt. 2 –HSA
OAMC $5,000 HSA- $5,000 100/70
In-Network Non-Network In-Network Non-Network
Physician office visit copay:• Primary Care / Specialist / Urgent Care• Teladoc (telemedicine)
$30 / $60 / $75$30
Deductible & Coinsurance Deductible & Coinsurance
Calendar year deductible:• Individual• Family
$4,000$8,000
$8,000$16,000
$5,000$10,000
$10,000$20,000
You pay coinsurance after deductible: 0% 30% 0% 30%
Calendar year out-of-pocket max:• Individual (includes deductible)• Family (includes deductible)
$6,850$13,700
$16,000$32,000
$6,550$13,100
$20,000$40,000
Facility Copays: $400 Emergency Room Copay Emergency Room: Deductible & Coinsurance
Prescription drug card• Tier 1 • Tier 2• Tier 3• Tier 4 / Specialty Drugs
Rx 2 - Aetna Value Plus$3 or $15
$35$65
Pref.: 20% to $250 max / Non-Pref. 20% to $500 max
EMB Rx4; Medical Deductible First; THEN$3 or $10
$30$60
Pref.: 20% to $250 max / Non-Pref. 20% to $500 max
Health Savings Account (HSA) Eligible? NoYES: Eligible for Health Savings Account (HSA)
through AmeriflexSee Web Page for Details
DocFind: www.aetna.com Managed Choice (Open Access) Managed Choice (Open Access)
Your cost per month:• Employee only• Employee & Spouse• Employee & Child(ren)• Employee & Family
$246.00$588.32$553.35$871.03
$197.39$471.56$443.53$698.16
Important note: This is an incomplete summary. Refer to the certificate of insurance for plan details. If there is any difference between this summary and the certificate of insurance, the certificate of insurance language shall rule.
Medical
AetnaMedical Plan Opt. 3
OAMC- $3,000 100/70
Medical Plan Opt. 4
OAMC - $1,500 80/60
In-Network Non-Network In-Network Non-Network
Physician office visit copay:• Primary Care / Specialist / Urgent Care• Teladoc (telemedicine)
$30 / $60 / $75$30
Deductible & Coinsurance $25 / $50 / $75 $25
Deductible & Coinsurance
Calendar year deductible:• Individual• Family
3,000$6,000
$6,000$12,000
$1,500$3,000
$5,000$10,000
You pay coinsurance after deductible: 0% 30% 20% 40%
Calendar year out-of-pocket max:• Individual (includes deductible)• Family (includes deductible)
$6,850$13,700
$15,000$30,000
$6,850$13,700
$10,000$20,000
Facility Copays: $400 Emergency Room Copay $250 + 20% Emergency Room Copay
Prescription drug card• Tier 1 • Tier 2• Tier 3• Tier 4
Rx 2- Aetna Value Plus$3 or $15
$35$65
Pref.: 20% to $250 max / Non-Pref. 20% to $500 max
Rx 2- Aetna Value Plus$3 or $15
$35$65
Pref.: 20% to $250 max / Non-Pref. 20% to $500 max
Health Savings Account (HSA) Eligible? No No
DocFind: www.aetna.com Managed Choice (Open Access) Managed Choice (Open Access)
Your cost per pay month:• Employee only• Employee & spouse• Employee & child(ren)• Employee & family
$301.36$719.95$677.16
$1,065.92
$339.68$811.49$763.25
$1,201.46
Important note: This is an incomplete summary. Refer to the certificate of insurance for plan details. If there is any difference between this summary and the certificate of insurance, the certificate of insurance language shall rule.
Medical
5
The information contained in this summary is not comprehensive. Conditions and limitations apply. Refer to the proposal, plan or policy for details. If there are any differences between the information contained
in this summary and the proposal, plan or policy to which it applies, the proposal, plan or policy language shall rule.
GETTING THE MOST FROM YOUR AETNA PLAN
Aetna Mobile App. Aetna’s mobile app is a quick and easy way to manage your healthcare
needs. Download from Google Play or the App Store.
• View medical and pharmacy claims
• Locate doctors and hospitals in your network
• Use Member Payment Estimator to compare cost esti-
mates
• View your Aetna ID card
• View your plans and coverage details
• Get help 24/7
Aetna TeleDoc. Talk to a doctor anytime for less than $40. Teladoc's U.S. board-certified doc-
tors are available 24/7/365 to resolve many of your medical issues through phone or video con-
sults. Set up your account today so when you need care now, a Teladoc doctor is just a call or click
away.
Call 1-855-835-2362 or visit Teladoc.com/aetna. Download the app at Teladoc.com/mobile.
Member Payment Estimator. Compare costs for over 650 medical tests, services and
procedures at up to 10 doctors/facilities/hospitals at once. The Member Payment Estimator tells
you where in your area — and in our network — you can find these services. Estimates are based
on your own plan details, such as your deductible and coinsurance. So they're personalized.
Principal Voluntary Dental & Vision
Principal Dental PPO – Choose High or Low VSP Vision
In-Network Non-Network www.vsp.com In-Network
Plan pays: Contracted amount Up to 90% Percentile of UCR
Plan pays:(see summary for non-network reimbursement amounts)
Contracted amount
Calendar Year Deductible:• Individual• Family
$50$150
$50$150
Exams: (1 per 12 mos.)
Contact Lens Exam:$10 Copay
Up to $60 copay for fitting/evaluation
Coinsurance (you pay):• Preventive procedures• Basic procedures• Major procedures• Orthodontia
0%20%50%
50% (high option)
0%20%50%
50% (high option)
Frames: (1 per 24 mos.)Lenses: (1 per 12 mos.)• Single vision• Bifocal• Trifocal• Lenticular
$150 allowance$25 Copay
(20-25% discount on lens enhancement)
Maximum benefit:(Calendar Year Maximum)
LOW Option: $1,000 Max; No Ortho-OR- HIGH Option: $2,500 Max;
with $2,500 Child Ortho (Lifetime Ortho Maximum)
Elective contacts: $150 allowance
Waiting periods: Late entrant or Prior Enrollees only Waiting period: Late entrant only
Provider network: www.principal.comPrincipal Plan PPO
Provider network: www.vsp.comVSP Choice Network
Your cost per month:• Employee only• Employee & spouse• Employee & child(ren)• Employee & family
Low: $44.05 ; High: $67.17Low: $85.73 ; High: $130.72Low: $91.31 ; High: $134.81Low: $138.66; High: $206.48
Your cost per month:• Employee only• Employee & spouse• Employee & child(ren)• Employee & family
$3.68$11.10$12.25$21.37
Long-Term Disability / FSA / HSA
Flexible Spending Account or *Limited Purpose Flexible Spending Account (*if used with HSA)
Long-Term Disability Insurance
Ameriflex FSAwww.myameriflex.com
Put aside pre-tax dollars to use on unreimbursed medical and dependent daycare expenses (deductibles & copays)
Elimination period: 90 days
Flexible Spending Account:
MedicalDependent Daycare
Limited Purpose FSA
*Annual Medical Maximum: $2,700Annual Dep. Daycare Maximum: $5,000
*(Limited Purpose Only FSA to be used if electing HSA (LPFSA- Dental, Vision)
Benefit percentage 60% of pre-disability earnings
Health Savings Account (HSA)www.myameriflex.com
If you elect Medical Option 2, you are eligible to enroll in an HSA through Ameriflex. HSA Account would be funded with your own dollars, on a pre-tax basis. See Additional Info. on Employee Benefit Portal
Maximum benefit: $5,000 per month
FSA, Limited Purpose FSA and HSA Plan Year: 5/1/19 – 4/30/20 Maximum benefit duration:
Up to SSNRA: Social Security Normal Retirement Age
Roll Over • Unused FSA funds up to $500 can be rolled over to the next plan year.
• Unused HSA Funds roll over from Year to Year.
Own occupation definition:
Two Years
Eligible/Ineligible ExpensesA list of eligible and ineligible expenses can be found on the employee portal
Pre-existing conditions:
3 months prior /12 months insured
Debit Card You will receive a convenient debit card to use on qualified medical expenses
Cost: Employer Paid-Automatic Enrollment
7
GETTING THE MOST FROM YOUR PRINCIPAL PLANS
Principal.com Mobile App. Use your smart phone to access all of your group benefit infor-
mation from Principal Life. Register at principal.com and then download the app.
• Locate providers in your network
• Access your benefits summary
• Submit a claim
• View or email your Principal ID card
• Get claims information
• Stay connected
Principal’s Employee Assistance Plan (EAP). Principal’s EAP plan provides resources
for everyday challenges. Contact the EAP team at 1-800-450-1327 or magellanhealth.com/member.
• 24-hour grief counseling
• Stress, addiction and depression
• Parenting
• Legal services
• Home finances
• Work-life balance
Discounts and Services. The discounts and services are not a part of and Principal Life insurance
contract and may be changed or discontinued at any time. Principal Life and its affiliates are not responsible
for any loss, injury, claim liability, or damages related to the use of the discounts and services. The third par-
ty providers are not members of the Principal Financial Group. Discounts and services include:
• Beneficiary support
• Identity theft kit
• Will and legal document center
• Hearing aide discount program
• Travel assistance
• Laser vision correction discount
The information contained in this summary is not comprehensive. Conditions and limitations apply. Refer to the proposal, plan or policy for details. If there are any differences between the information contained
in this summary and the proposal, plan or policy to which it applies, the proposal, plan or policy language shall rule.
Principal Voluntary Life, Accident and Critical Illness
• ProCom offers Voluntary Life, Accident and Critical illness to you and your family. Please find the summary of benefits and rate sheets on the benefit web page.
• Employee Benefits web page: Please access the benefits web page for enrollment and change forms, full summaries, rates and helpful information to make the most of your benefits:
o https://www.withbenefits.com/amibs/deborah/procomo Login: [email protected] Password: benefits
• You can reach out to our benefits consultant, Deborah Michael at (770) 300-0001 or [email protected] with any benefit questions.
Employee Open Enrollment Action Items
Please access the Employee Benefits web page for enrollment and change forms, full summaries, rates and helpful information to make the most of your benefit elections:
• Election/Waiver form - Complete only if making changes to current elections. If you are not making any changes, you do not have to submit a form.
• Aetna Enrollment/Change Form: Medical – complete if enrolling for the first time –OR- making changes in Medical coverage
• Principal Enrollment Form: complete if enrolling for the first time in Dental, Vision, LTD, Voluntary Life, Critical Illness, Accident
• Principal Change Form: complete if you are making any changes to coverages you are enrolled in or adding new coverage
(i.e adding dependents, dropping dependents, or adding or dropping a new line of coverage at this Open Enrollment. You may
also switch from High to Low Dental or Low to High during Open Enrollment).
• Ameriflex FSA Form– New election forms required for all employees participating in the FSA for the new plan year. Your previous plan year elections will not roll over to the new year. Anyone interested in participating in the FSA must complete a new election form for the new 5/1/19-4/30/20 plan year.
• Ameriflex HSA Form- If you are eligible for and participating in the HSA (Option 2) Health Savings Account; you do not need to complete a new Ameriflex HSA form unless you are signing up for the first time.
Employee Benefits Web Page: https://www.withbenefits.com/amibs/deborah/procom
Login: [email protected]
Password: benefits
Return Forms To Insurance Questions
Debra RootProCom Consulting
Phone: 678-393-8610 ext. [email protected]
Deadline to submit forms is 4/15/2019
Deborah MichaelAngus McRae Insurance
Phone: 770-300-0001 ext. [email protected]
