1 - moa benefit enrollment guide 2016 · 2019-03-02 · family out-of-pocket pcy $12,700 $12,700...

Plan Year 2016

Effective January 1, 2016 to December 31, 2016

EMPLOYEE

BENEFITS

ENROLLMENT

GUIDE

AMEA, Executive & Non-Represented, IBEW Technic ians , Teamsters

WHENTO ENROLL

� When you are initially eligible for coverage. You have 30 days from your hire date to make plan elections.

� Special enrollment opportunity. This is a limited enrollment period that opens if you have lost other coverage due to a reason beyond your control or you have a qualified family status change. You have 90 days from the date of the loss of coverage or a qualified family status change to make changes to your benefits.

Examples of qualified family status changes that allow you to change some of your benefits during the year include:

o Marriage or divorce

o Death of your dependent child or spouse

o Change in your or your spouse’s employment status that results in loss or gain of coverage

o Birth, adoption, or change in the custody of your child

� Annual open enrollment. This is the time of year to make benefit changes and to add or delete any eligible dependents. If you do not enroll an eligible spouse or child now, you may only add that person on the Municipality’s plan during the open enrollment period or a special enrollment opportunity.

2016 EMPLOYEE BENEFITS ENROLLMENT GUIDE 2

ELIGIBILITY REQUIREMENTS

Employees Eligibility

�To be eligible for most benefits, you must be a regular employee

working at least 20 hours per week.

�You are eligible to enroll during the first 30 days from your hire

date. Benefits become effective the 1st of the month following

your hire date. If you are hired on the 1st of the month, your

benefits are effective that day.

�Benefit elections/changes made during a qualified status change

are effective the 1st of the month following the date of the status

change.

Dependents Eligibility

�You must be covered by or enroll in a benefit plan to enroll

your eligible dependents.Your eligible dependents include your:

o Lawful spouse or same-sex domestic partner

o Children:

• Child 26 years of age or under

• Natural or legally adopted

• Minor or foster child for whom you or your spouse

has legal guardianship

• Stepchildren of lawful spouse or same-sex domestic

partner

You must enroll your eligible dependents for insurance

coverage—their enrollment is not automatic.


Documentation, such as birth

and marriage certificates are

required as proof of dependent

eligibility. If you change your

elections during the year due

to a qualified change in status,

you will be required to provide

specific information applicable

to your event.

Dependent eligibility

documentation must be

submitted within the following

time frames:

•Initial Eligibility – within 30

days of hire.

MEDICAL BENEFITS HIGHLIGHTS

Premera (In-Network) 500 Plan Co-Pay 1000 Plan 1300/2600 HDHP

Individual Annual Deductible PCY

$500 $1,000 $1,300

Family Annual Deductible PCY

$1,500 $3,000 $2,600

Individual Out-of-Pocket PCY

$2,000 $2,000Single Enrollment:

$5,000 PCY Individual

Family Enrollment: $6,850 PCY Individual$10,000 PCY Family

Family Out-of-Pocket PCY

$12,700 $12,700

Preventive Office Visit Covered in Full Covered in Full Covered in Full

Office Visit, Specialist Visit, Urgent Care

Deductible, then 20% First 6 visits $25 copay, then Deductible, 20%

Deductible, then 20%

Emergency Care Deductible, then 20% Deductible, then 20% Deductible, then 20%

Inpatient Facility Deductible, then 20% Deductible, then 20% Deductible, then 20%

Other Professional Diagnostic Imaging and Laboratory/ Pathology

Deductible, then 20% Deductible, then 20% Deductible, then 20%

Outpatient Mental Health / Chemical

DependencyDeductible, then 20% $25 copay Deductible, then 20%

Rehab Outpatient Care Deductible, then 20% $25 copay Deductible, then 20%

Acupuncture Deductible, then 20% First 6 visits $25 copay, then Deductible, 20%


Manipulations (Spinal and other)

Deductible, then 20% First 6 visits $25 copay, then Deductible, 20%


Nutritional Therapy(25 visits PCY)

Deductible, then 20% Deductible, then 20% Deductible, then 20%


PCY = Per Calendar Year. Out-of-Pocket Maximum PCY includes deductible, coinsurance; and where applicable copays and pharmacy.

VISION, HEARING AND PHARMACY BENEFITSHIGHLIGHTS

Premera (In-Network) 500 Plan Co-Pay 1000 Plan 1300/2600 HDHP

Adult Vision: 1 Exam PCY; $200 PCY Hardware

Routine Vision Exam Covered in Full Covered in Full Covered in Full

Vision Hardware Covered in Full Covered in Full Covered in Full

Pediatric Vision (under age 19): 1 Exam PCY; 1 pair of glasses PCY- frames & lenses. 12 months supply of contacts PCY, in lieu of glasses-frames & lenses

Vision Exam Covered in Full Covered in Full Covered in Full

Vision Hardware Covered in Full Covered in Full Covered in Full

Hearing Exam: 1 Exam every 3 years to combined max of $800 limit every 3 consecutive years; Hardware combined $800 limit every 3 consecutive years

Routine Hearing Exam Constant 20% Constant 20% Constant 20%

Hearing Hardware Constant 20% Constant 20% Constant 20%

Pharmacy Benefits (Retail):

Generic Maintenance $2 $2


Generic $7.50 $7.50

Preferred Brand Name $15 $15

Non Preferred Brand Name

50% ($75 max copay) 50% ($75 max copay)

Mail Order Cost Share 2x Retail 2x Retail

Supply Limit per Fill

Retail: up to 90 days with 3 copays

Mail: up to 90 daysSpecialty: up to 30 days





Drug list Preferred B3 Preferred B3 Preferred B3


PCY = Per Calendar Year

DENTAL BENEFITS HIGHLIGHTS


Premera

Individual / Family Deductible PCY $25 / $75

Annual Benefit Maximum $1,500

Diagnostic/Preventive

• Cleanings (2 PCY)• Emergency Exams (1 PCY)• Routine oral exams (2 PCY)• X-Rays (once per 36 consecutive months)• Fluoride treatments (2 applications PCY)• Sealants• Space maintainers (for members under age 14)

Covered in Full

Basic

• Emergency palliative treatment• Fillings (once per tooth surface every 24 consecutive months)

• General anesthesia• Oral surgery (simple and surgical extractions)• Full mouth debridement (once every 3 calendar years)• Periodontal maintenance (4 visits PCY) • Periodontal surgery and scaling• Endodontic (root canal) treatment (limited to 2 per arch when performed in conjunction with overdentures)


Major

• Dentures, partial, and fixed bridges (replacements limited to once every 5 calendar years)

• Inlays, onlays, and crowns (replacements limited to once per tooth every 5 years)

• Recementing & repair of crowns, inlays, bridgework & dentures


According to recent findings from

the Centers for Disease Control

and Prevention (CDC), half of

Americans aged 30 or older have

periodontitis, the more advanced

form of periodontal disease.

Periodontal disease, also known

as gum disease, is caused when

bacteria in plaque builds up

between the gum and teeth.

When the bacteria begin to grow,

the gums surrounding the tooth

can become inflamed. If left

untreated, this inflammation can

cause the gums and supporting

bone structure to deteriorate.

This can lead to gum recession or

even tooth loss. In addition,

research has shown that gum

disease may be associated with

other diseases, such as diabetes

and heart disease.

Luckily, periodontal disease can

be preventable. Adding these

habits to your daily routine can

help:

� Brush your teeth

� Floss

� Swish with mouthwash

� Know your risk

� See a periodontist

ADDITIONAL BENEFITS FROM PREMERA


Teladoc ® –Virtual Care

Visit a doctor – wherever and whenever you need to. Teladoc ® virtual care gives members convenient access to

care when needed. Members can avoid long drive times and wait times that could be experienced at an urgent care

or emergency room. Teladoc ® is not meant to replace a member’s relationship with their Primary Care Provider

(PCP) or to replace all in-person, face-to-face visits. It is an expansion of your service delivery options.

�Common conditions handled by virtual care providers: cold and flu symptoms, nasal congestion, sinus problems,

bronchitis, respiratory infections, allergies and ear infections.

�Get care via phone call, online, video or other online media as easily as walking into an office and getting care face-

to-face.

�Phone consultations available 24/7; video consultations available 7 a.m. – 9 p.m., 7 days a week

�For more information, visit the Teladoc ® website at www.teladoc.com/premeraAK

Medical Travel Support

Premera’s Medical Travel Support benefit reimburses you for approved travel expenses when you travel for qualified

medical procedures at pre-approved medical facilities in and outside of Alaska. Approved travel expenses are partly

covered for both you and a travel companion.

Because the price of medical care may be lower outside Alaska, your share of the medical costs may also be lower.

To take advantage of Medical Travel Support

�Call Premera (800-508-4722) to see if the procedure you need is covered under Medical Travel Support.

�Talk to your doctor to make sure traveling is safe for you. If it is safe, call Premera to help you understand what is

covered by this benefit and how to take full advantage of its services.

24-Hour Nurse Line

Registered Nurses are trained to offer advice, guidance and support to members and their families. RNs are trained

to ask the right questions to make a recommendation about when or where a member should seek treatment for

an injury or illness. RNs also have access to high-quality health resources and will listen to members’ concerns,

answer questions, and offer advice about many health-related topics.

�Free and confidential service available 24 hours a day, 7 days a week by phone, 800-841-8343 or at

www.premera.com, go to Find a Doctor, then choose 24-Hour NurseLine.

LIFE/ACCIDENTAL DEATH & DISMEMBERMENT (AD&D) BENEFITS HIGHLIGHTS

Life insurance, while it’s not a popular topic, is a

valuable benefit that can provide financial protection

for your family. The basic premise is that if you

should die, your survivors will receive money to help

fill the financial gap you leave. The life insurance

benefit can replace your income, or cover basic

needs such as clothing, food, child care, and

education. While it is not pleasant to think about,

defining your life insurance needs is important and

can provide peace of mind for you and your loved

ones.


A Life Insurance MUST:

Naming a Beneficiary

Your beneficiary is the person (or people) you

choose to receive the death benefit when you die.

It’s very important to name a beneficiary.

�If your wishes are not known when you die, your

money may not go where you intend it to go.

�If you do not have a beneficiary on file with your

employer or life insurance provider, the money

may not be paid to your loved ones—even if

you’ve paid premiums. Read your policy for details.

�Without clear direction on file, your family could

end up fighting for your death benefit in court. This

can take time and money, and it’s the last thing you

want your loved ones to encounter after your

death.

Unum

Basic

Life/AD&D

Benefit

Amount

$50,000

Included

Benefits

Seatbelt/AirbagEducationRepatriationLoss of use/ParalysisLoss of speech and/or hearingConversion privilege

Accelerated

Death

Benefit

If you are terminally ill, you may be able to receive a portion of your life coverage benefit as a lump sum

Reduction

Schedule35% at age 75

Cost of

Coverage

MOA pays the full cost for the Basic Life/AD&D Benefit. Supplemental Insurance is available for purchase.

Make sure your beneficiary information is up-to-date.

DISABILITY BENEFITS HIGHLIGHTS

Short Term Disability (SDI) insurance provides

income protection in the case of a short-term

illness or injury. The benefit amount received is

based on your earnings before your disability

and the benefit option in which you enroll.

Long Term Disability (LTD) provides income

protection in case of a long-term illness or injury.

Once you meet the eligibility waiting period, you

will be automatically enrolled in the Municipality

provided basic LTD coverage. Benefits will be

payable after the elimination period; during this

period, you can use your Paid-Time Off (PTO) or

sick leave and STD benefits (if applicable).


Unum - SDI

Elimination Period

0 days for disability due to an injury

14 days for disability due to a sickness

Benefits begin after the elimination period is completed

Weekly Benefit

60% of weekly earnings

Maximum Weekly Benefit Available

Option 1: $300; Option 2: $500; Option 3: 60% of weekly earnings up to $1,500

Maximum Payment Period

39 weeks

Unum - LTD

Elimination Period

273 days or the date your insured Short

Term Disability payments end, if applicable

Benefits begin the day after the elimination period is completed

Monthly Benefit

60% of monthly earnings

Maximum Benefit Available

$6,250 per month

Maximum Payment Period

Social Security Normal Retirement Age

HEALTH SAVINGSACCOUNTS (HSA)

A Health Savings Account (HSA) is an account where you can save money tax-free and use it to pay for current

and future IRS-approved healthcare expenses, including deductible, copays, and coinsurance. It’s your money and

you decide when and how to spend it. The HSA belongs to you even if you decide to change employers, health

plans, or retire. And there is no “use it or lost it” rule with the HSA.

�The Municipality’s HSA is administered by Premera.

� If elected, you can access your HSA account 24/7 through your Premera account on premera.com.

� HSA plan participants will not pay any transaction fees while participating in the Municipality sponsored HSA.

Things to know about the Municipality’s Health Savings Account

�You must elect the Municipality’s High Deductible Health Plan to participate in the HSA.

� Eligibility for HSA is defined by the IRS. You must be able to answer “no” to all of these questions:

� Are you claimed as a tax dependent on another person’s taxes?

� Are your enrolled in Medicare?

� Have you received any Veterans Affairs or Indian Health Services health benefits in the last three

months?

� Are you covered by your own or your spouse’s flexible spending account (FSA), health reimbursement

arrangement (HRA) or a non-HSA health plan?

�You may transfer your existing funds in another HSA to Premera.

�You’ll have the option of investing in a variety of mutual funds once you reach a balance over $1,000.


2016 CONTRIBUTION LIMITS

Individual $3,350

Family $6,750

55+ catch up payment $1,000

You can find more information about the Municipality

sponsored HSA accounts on the Employee Benefits page

on Muniverse.

Save a copy of your receipts, invoices, explanation of benefits (EOB), and bills for your records so that you have a copy if audited.

FLEXIBLE SPENDINGACCOUNTS (FSA)

A Flexible Spending Account (FSA) is a tax-advantaged account that allows you to use pre-tax dollars

to pay for out-of-pocket qualified medical or dependent care expenses. You choose how much money

you want to contribute to an FSA at the beginning of each plan year and can access these funds

throughout the year. Plan wisely as the Health FSA funds are “use it or lose it” after a roll over of

$500 per plan year.

Things to know about the Municipality’s Health & Dependent Care Flexible Spending Accounts

�The Municipality’s FSA is administered by Premera.

� If elected, you can access your FSA account 24/7 through your Premera account on premera.com.

� Premera offers direct deposit for quick and easy claim reimbursement. This feature can be set up through your Premera account on premera.com.

� The Municipality’s FSA offers the benefit of a healthcare payment card that can be used for qualified purchases at approved merchants or providers.

� Health FSA funds are available immediately but plan wisely as amounts over $500 at the end of the year are forfeited.

� Dependent Care FSA funds are available as they are deposited in the account. Any unused amount remaining at the end of the plan year will be forfeited.


2016 CONTRIBUTION LIMITS

Health FSA $2,550 (not including any MOA contribution)

Dependent Care FSA $5,000

$2,500 (married filing separately)

Health FSA Rollover $500 (does not count toward your annual contribution limit)

*Save a copy of your receipts, invoices, explanation of benefits (EOB), and bills for your records so that you have a copy tosubmit in the event there is a request for supporting documentation or if audited.

*This material is not intended to be tax or legal advice. The reader should consult with his or her own tax advisor to

determine the tax implications of participating in the products discussed herein.

2016 PREMIUMS COSTS

PlanTotal Monthly

PremiumMOA Benefit Contribution

Employee Cost Share Per Month

Payroll Deduction

500 Plan $1,965.45 $1,859.81 $105.64 $52.82

Co-Pay 1000 Plan $1,923.65 $1,859.81 $63.84 $31.92

1300/2600 with HSA* $1,675.64 $1,859.81 $0.00 $0.00

1300/2600 with FSA* $1,675.64 $1,859.81 $0.00 $0.00

Opt-Out $0.00 $350.00 $0.00 $0.00


Health Premiums (AMEA members refer to the separate rate sheet included at the end of the guide)

Benefit Amount Monthly Cost

$25,000 $6.14

$50,000 $12.26

$75,000 $18.38

$100,000 $24.50

$125,000 $30.64

$150,000 $36.76

$175,000 $42.88

$200,000 $49.00

*The MOA benefit contribution exceeds the total premium for the 1300/2600 Plan resulting in an excess of $184.17 monthly. This amount will be deposited into a Health Savings Account (HSA) or Health Flexible Spending Account (FSA) of the employee’s choosing.

Plan Monthly Cost

$300 Weekly Benefit $24.60

$500 Weekly Benefit $41.00

60% of weekly warnings to a

maximum of $1,500

$1.35 per $100 of covered payroll

Voluntary Supplemental Life and AD&D Insurance Voluntary Short Term Disability Insurance


In-Network vs. Out-of-Network Providers:The difference you pay can be a lot

Use an in-network provider for the highest level of benefits from your health plan and lower out-of-pocketcosts. In-network providers agree to a lower negotiated fee for each service they provide; out-of-networkproviders don’t. If you use an out-of-network provider, the portion of the bill you pay may be much higher.

Maximize your benefits

To make the most of your benefits, check to see if your provider is part of your plan’s network. You’ll find alist of in-network providers by logging in to premera.com and using the “Find a Doctor” tool.

Log in as a member to get a wealth of information

Step 1 Register and log in to premera.comStep 2 Click on “Find a Doctor”

As a registered member, you now have access to the following:• List of in-network providers• Provider comparison• Out-of-pocket estimates• List of providers who are board certified, accepting new patients and offer extended office hours• Search by specialty, treatment, hospital affiliation, language spoken, and gender

Registered members can also get information about a hospital’s medical specialties and quality scores for:• Medical services• Surgical care• Re-admissions• Provider affiliations• Patient experiences

To save money, make sure all of your medical services, pharmacies, hospitals, lab services, and home medical

equipment providers are in-network. Find them by using the “Find a Doctor” tool on premera.com.

Avoid Costly Facility Fees

Some medical clinics charge a separate facility fee for provider visits – even if their providers are in our network.

So, when making an appointment, always ask if your provider’s office charges a facility fee. You can get the most

value from your medical benefits if you choose an in-network provider who practices at a medical center that

does not charge a facility fee.

CONTACT INFORMATION


Medical, Rx, Vision, Dental

STD/ LTD/Life/AD&DFlexible

Spending/Health Savings Accounts

Premera Blue Cross Blue Shield of Alaska

1-800-508-4722

www.premera.com

M-F: 7 a.m. – 5 p.m. (AKST)

Unum

1-800-679-3054

www.unum.com

M-F: 8 a.m. – 8 p.m. (ET)

ConnectYourCare on behalf of Premera

Blue Cross Blue Shield of Alaska

1-800-941-6121

www.premera.com

Available 24/7

Health Savings Account 24-Hour NurseLineTeladoc ® (Virtual

Care)

ConnectYourCare on behalf of Premera

Blue Cross Blue Shield of Alaska

1-800-941-6121

www.premera.com

Available 24/7


1-800-841-8343

www.premera.com

Available 24/7


1-855-332-4059

www.Teladoc.com/premeraAK

Phone Consultations - Available 24/7Video consultations available 7 a.m. -

9 p.m., 7 days a week

MOA Benefits Staff

Benefits Hotline

(907) 343-4422

[email protected]

Available M-F: 8 a.m. – 5 p.m. (AKST)

1 - moa benefit enrollment guide 2016 · 2019-03-02 · family out-of-pocket pcy $12,700 $12,700...

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