beneit plans - threewill · 2020. 9. 4. · • 401k retirement plan remain balanced • employee...
TRANSCRIPT
Associate
Benefit Plans2011
Who is Eligible and When:
ThreeWill full time Associates and their eligible dependents may elect to participate in the group benefit programs. If you are a full time Associate, coverage will be effective on date of hire. If coverage is declined or
you fail to enroll before your eligibility date, the next opportunity to enroll will be during open enrollment.
Associates may add dependents or join benefit plans when the Associate experiences a qualifying life event such as marriage, the birth or adoption of a child, or a spouse’s open enrollment. The Associate has 30 days from the
life event to make any eligible additions or changes.
Stay Healthy • Medical Coverage • Dental Coverage
Feel Secure • Basic Life and AD&D Insurance • Disability Insurance • 401k Retirement Plan
Remain Balanced • Employee Assistance Program • Vacation Allowances
Our Associates are our most
valuable asset
MEDICALCoverage Level Associate Monthly Cost
7AA
$500 Deductible7AP
$2,500 DeductibleAssociate Only $0.00 $0.00
Spouse $195.00 $170.00Child/ Children $235.00 $205.00
DENTALCoverage Level Associate Monthly CostAssociate Only $0.00
Spouse $35.00
Child/ Children $70.00
Needing Assistance?
Contact Benefit Website/Email Phone
United Healthcare Medical www.myuhc.com (800) 357-0978
Principal Dental/ Life www.principal.com (800) 247-4695
Principal Employee Assistance Programwww.MagellanHealth.com/
member(800) 450-1327
Securian 401 (k) Savings Planwww..SecurianRetierment
Center.com(800) 233-2881
Benefits
Contacts
Our partners at The A.I. Group are here to help! Should
you need assistance with general benefits questions or help with any claims resolution, call our Benefits HelpDesk at (678) 808-1150 or email
DENTALCoverage Level Associate Monthly Cost
Child/ Children
ThreeWill provides medical insurance through United Healthcare. Through the plan, you are eligible to receive
comprehensive health care through a network of doctors and other health care professionals. When you enroll in
a UHC medical plan, you also have access to the prescription drug program. A web-based tool is available for plan
members to navigate through UHC’s wide range of health information and programs, as well as track personal
claims history, find in-network providers under the Choice Plus Network, and search for
preferred medications. To register visit www.myuhc.com or contact
United Healthcare’s Customer Service at (800) 357-0978.
Words to Remember:
Premium – What you pay for health
care coverage through payroll deduction.
Deductible – The amount you pay
before your medical plan begins paying
certain benefits.Coinsurance – Percentage of cost
sharing between the participant and the
plan once the deductible has been met.
Copay – A flat fee for certain services.
Out-of-Pocket – You must pay for
certain services directly. Generally,
the coinsurance you pay is considered
an “out-of-pocket” expense. There is
a maximum on out-of-pocket expenses
you must pay each year. Deductibles
and copays do not apply towards the
out-of-pocket maximum.
Network – Doctors and hospitals that
have negotiated with the medical plan
or have agreed to specific rates are “in-network”. Providers who have no
agreement with the plans are “out-of-
network” and usually result in higher
fees.
your medical benefitsare here to help you
Deductibles and Out-of-Pockets at a Glance
PPO 7AA PPO 7AP
Annual Deductible (In-Network)
Individual $500 $2,500
Family $1,500 $7,500
Annual Out-of-Pocket (In-Network)
Individual $3,000 $2,500
Family $6,000 $7,500
Covered ServicePPO 7AA PPO 7AP
In-Network Out-of-Network In-Network Out-of-Network
Medical Facility Visits
Deductible
- Individual
- Family
$500
$1,500
$1,000
$3,000
$2,500
$7,500
$5,000
$15,000
Out of Pocket Maximum
- Individual
- Family
$3,000
$6,000
$6,000
$12,000
$2,500
$7,500
$10,000
$20,000
Physician’s Office- sickness and injury $25 copay
Plan pays 60% after
deductible$30 copay
Plan pays 80% after
deductible
Physicians OfficePlan pays 100%
Plan pays 60% after
deductiblePlan pays 100%
Plan pays 80% after
deductible- preventive care, well child visits
Specialist Office $50 copay
Plan pays 60% after
deductible$60 copay
Plan pays 80% after
deductible
Maternity Visits - copay applies to initial visit, see hospital benefits for delivery and nursery
$50 copayPlan pays 60% after
deductible$60 copay
Plan pays 80% after
deductible
Urgent Care - non-urgent use of the urgent care is not covered $75 copay
Plan pays 60% after
deductible$100 copay
Plan pays 80% after
deductible
Emergency Room$200 copay $200 copay $250 copay $250 copay
Hospital - Inpatient
Plan pays 80% after
deductible
Plan pays 60% after
deductible
Plan pays 100% after
deductible
Plan pays 80% after
deductible
Hospital - Outpatient
- surgery facility/hospital charges Plan pays 80% after
deductible
Plan pays 60% after
deductible
Plan pays 100% after
deductible
Plan pays 80% after
deductible - diagnostic x-ray and lab services
- complex imaging
Therapy Services
Chiropractic Care $25 copay
Plan pays 60% after
deductible$30 copay
Plan pays 80% after
deductible
Physical, Occupational, Speech Therapy $25 copay
Plan pays 60% after
deductible$30 copay
Plan pays 80% after
deductible
Prescription Drugs
Tier 1 $10 copay $10 copay $10 copay $10 copay
Tier 2 $35 copay $35 copay $35 copay $35 copay
Tier 3 $60 copay $60 copay $60 copay $60 copay
Tier 4 $100 copay $100 copay $100 copay $100 copay
Mail-Order Maintenance Drug 2.5 X’s retail copay 2.5 X’s retail copay 2.5 X’s retail copay 2.5 X’s retail copay
plan highlights
This is meant to be a summary of benefits only. Limitations or restrictions may apply. Please refer to your benefit booklet, contact Customer Service at (800) 357-0978, or visit www.myuhc.com for a list of Network providers.
It’s
dental planyour
Going to the dentist for regular checkups & cleanings is one of the most important
factors in maintaining good oral health. Regular checkups can prevent cavities, root
canals, gum disease, oral cancer, and other dental conditions. Don’t wait until you
have a problem before you see your dentist; help prevent problems before they
happen.
• 78% of Americans have had at least 1 cavity by age 17.
• People who drink 3 or more sugary sodas daily have 62% more dental decay, fillings and tooth loss.
• Gum disease is one of the main causes of tooth loss in adults and has also been linked to heart disease and stroke.
Dental coverage is provided through Principal. With this plan you have the freedom to see any dentist, however
you will spend less out of pocket if you choose an in-network dentist. To find out if your dentist is in-network, visit www.principal.com and select Provider Directory- The Principal Plan PPO Network.
Preventive Services• Routine Oral Exams• Cleanings (once every 6 months)• Fluoride• Dental X-rays
Basic Services• Fillings
• Sealants
• Emergency Exams
Major Services• Major Restorative• Inlays, Onlays and Crowns• Bridges, Denture Repair• Surgical Periodontic Services• Surgical Tooth Extraction• Endodontics• Non-Surgical Periodontic Services
Benefits You ReceiveCalendar Year Deductible
- Individual $50
- Family $150
Annual Maximum $1,000
Preventive Services (deductible waived) 100%
Basic Services 80%
Major Services 50%
This is meant to be a summary of benefits only. Limitations or restrictions may apply. Please refer to your benefit booklet, contact Customer Service at (800) 247-4695, or visit www.principal.com for a list of Network providers.
Security for your
peace of mind
All full time Associates of ThreeWill receive $25,000 in term life insurance from Principal at no cost.
Benefits You Receive
Term Life Benefits Employee Spouse Child (ren)
Benefit Increments $25,000 $5,000
0-6 Months: $1,000
6 Months- 25 Years:
$2,000
ThreeWill provides full time Associates with Disability Insurance through Principal.
ThreeWill pays the full cost for these benefits and Associates are automatically enrolled in the plans.
Benefits You Receive- Weekly Benefit - minimum benefit - maximum benefit
60% of your base salary
$15
$500
Elimination Period 30 days
Duration of Benefits 9 weeks
Short Term Disability Long Term Disability
Benefits You Receive- Monthly Benefit - minimum benefit - maximum benefit
60% of your base salary
$50
$6,000
Elimination Period 3 Months
Duration of Benefits To age 65 or normal Social
Security retierment age
Mental & Nervous Condition Limitation 12 months
the icing on the cake
Employee Assistance ProgramProblems are just a part of everyday life. This is why Principal has teamed with Magellan Health
Services to offer you an easy and convenient way to find the help you need. Whether it is an emotional, legal or financial issue, Magellan Health Services offers a multitude of resources available to you.
How to access the EAPToll-Free Counselor: 1-800-450-1327
Online: www.MagellanHealth.com/member
Self-Screening: 1-866-272-4084
HolidaysNew Year’s Day
Good Friday
Memorial Day
Independence Day
Labor Day
Thanksgiving
Friday following Thanksgiving
Christmas Eve
Christmas
Paid Time Off (PTO)First Year 10 PTO
1 Year 15 PTO
4 Years 20 PTO
8 Years 25 PTO
12 years 30 PTO
Assistance is available for:
• Family, relationship and parenting issues
• Child and elder care needs• Emotional and stress related issues• Conflicts at home or work• Alcohol and drug dependencies• Health and wellness issues• Emotional and stress related issues
Holidays & Paid Time Off
401 kThreeWill provides a comprehensive 401 (k) Investment Savings Plan through Securian. The plan offers
Associates an outstanding combination of savings. You may contribute up to $16,500 for 2011. Enrollment
information provided under separate cover.
ThreeWill contributes a 3% safe harbor automatic contribution
The Fine
Print...IMPORTANT EMPLOYEE NOTICES
HIPAA NOTICE OF SPECIAL ENROLLMENT
If you are declining enrollment for yourself or your dependents (including your spouse) because of other health insurance or group health plan coverage, you may be able to enroll
yourself and your dependents in this plan if you or your dependents lose eligibility for that other coverage (or if the employer stops contributing towards your or your dependents’
other coverage). However, you must request enrollment within 31 days after you or your dependents’ other coverage ends (or after the employer stops contributing toward the other
coverage).
In addition, if you have a new dependent as a result of marriage, birth, adoption, or placement for adoption, you may be able to enroll yourself and your dependents. However, you
must request enrollment within 31 days after the marriage, birth, adoption, or placement for adoption.
The following events also qualify as special enrollment events and request for enrollment must be made within 31 days:
• If you reach a plan’s lifetime limit on benefits, you may “special enroll” in another health plan.• If you no longer reside or work in an HMO’s service area and there is no other access to any other benefit option, you may “special enroll” on another health plan.• If you enroll in an option (e.g., HMO) and subsequently obtain a new dependent, you may enroll yourself and the dependent in a different option under the plan (e.g., PPO).• If you enroll in the group health plan but your dependent declines coverage due to other coverage and then loses that coverage, your dependent has the right to “special enroll” in the plan.
The following events also qualify as special enrollment events and request for enrollment must be made within 60 days:
• If you decline coverage because you and/or your dependents are covered under Medicaid or a State Children’s Health Insurance Program (SCHIP) and the coverage terminates, you may “special enroll” in the plan with 60 days of the termination.
• If you enroll in an option but you and/or your dependent becomes eligible for a State Children’s Health Insurance Program (SCHIP) premium assistance subsidy during the plan year, you and/or your dependent has the right to “special enroll” in the plan within 60 days of the termination of Medicaid or SCHIP coverage or becoming eligible for the premium
subsidy.
To request special enrollment or obtain more information, contact our partners at The A.I. Group, Inc., Outsourcing Department, 678-726-1000.
GENERAL NOTICE OF PRE-EXISTING CONDITION EXCLUSION
This plan imposes pre-existing condition exclusion. This means that if you have a medical condition before coming to our plan, you might have to wait a certain period of time before
the plan will provide coverage for that condition. This exclusion applies only to conditions for which medical advice, diagnosis, care, or treatment was recommended or received within
a six-month period. Generally, this six-month period ends the day before your coverage becomes effective. However, if you were in a waiting period for coverage, the six-month
period ends on the day before the waiting period begins. The pre-existing condition exclusion does not apply to pregnancy nor to a child who is enrolled in the plan within 31 days
after birth, adoption, or placement for adoption.
This exclusion may last up to 12 months (18 months if you are a late enrollee) from your first day of coverage, or, if you were in a waiting period, from the first day of your waiting period. However, you can reduce the length of this exclusion period by the number of days of your prior ‘‘creditable coverage’’. Most prior health coverage is creditable coverage and
can be used to reduce the pre-existing condition exclusion if you have not experienced a break in coverage of at least 63 days. To reduce the 12-month (or 18-month) exclusion period
by your creditable coverage, you should give us a copy of any certificates of creditable coverage you have. If you do not have a certificate, but you do have prior health coverage, we will help you obtain one from your prior plan or issuer. There are also other ways that you can show you have creditable coverage. Please contact us if you need help demonstrating
creditable coverage.
WOMEN’S HEALTH & CANCER RIGHTS ACT
Beginning on January 1, 1999, Federal law requires group health plans to provide coverage for the following services to an individual receiving benefits in connection with a mastec-
tomy:
• Reconstruction of the breast on which the mastectomy has been performed;• Surgery and reconstruction of the other breast to produce a symmetrical appearance; and• Prostheses and physical complications for all stages of a mastectomy, including lymphedemas (swelling associated with the removal of lymph nodes).• Coverage will be in a manner that is determined in consultation with the attending physician and patient.This notice is being sent to you to comply with the Federal legislation requiring notification to all employees during the open enrollments on or after October 28, 1998.
The coverage for breast reconstruction and related services will be subject to the same conditions and provisions as any other covered service. Benefits will be paid consistent with all other medical benefits that apply under this plan.
CONSUMER CHOICE OPTION
This notice concerns Georgia Senate Bill 210, which requires the insurance carrier to offer the new “Consumer Choice Option” to Georgia residents enrolled in certain insured man-
aged care medical and/or dental plans as those plans are issued or renewed on or after January 1, 2000.
Under this new benefit option, and with certain restrictions required by law, members of certain plans may nominate an out-of-network provider or hospital to provide covered services, for themselves and their covered family members, for an additional monthly premium cost. Benefits and co-payments will be the same as for in-network providers. The out-of-network provider must agree to:
• accept the insurance carrier compensation, • to not balance bill a member,• to adhere to the plan’s quality assurance requirements,• to meet all other reasonable criteria required by the plan of its in-network providers and hospitals. It is possible your nominated provider will not agree to participate.
Please note that, in selecting any such non-participating provider, you will not have the benefit of the credentialing that the health insurance carrier usually performs when determin-
ing whether to admit a provider to their network. The carrier will not credential or otherwise perform any review of the qualifications of the non-participating provider you select, beyond verifying that the provider holds a current, valid Georgia license.
This Consumer Choice Option is available from the date your plan is issued or renews on or after January 1, 2000. It will be available for an increased premium, in addition to the
premium you would otherwise pay, and will be effective from the date of your signed election form.
Exact pricing and additional information, including an election form and package, can be obtained by calling The A.I. Group at 678-726-1000. Please have your member identification (ID) card available when you call.
You will have 31 days from the time of receiving your Consumer Choice Option election package to return the election form to us. If you do not return your election form within this
time period, you will not be eligible to enroll in this option until the next open enrollment period. Existing members should note that failure to re-enroll could result in termination of
the Consumer Choice Option coverage. This action, however, does not affect the basic health care coverage provided by your employer.
If you have questions regarding this notice, the provisions, or benefits you may contact our partners at The A.I. Group at (678) 726-1000 or contact the Human Resources Department
More Fine Print...
2011 Benefit Election Form
FO
LD
TH
EN
TEAR O
N D
OTTED
LIN
E
To Elect Benefits: (Medical and Dental)
Check if Electing Group Medical (Choose One) Cost/Month Election Cost
PPO 7AA PPO 7AP
$500 Ded $2,500 Ded
_______ Associate $0 $0 ____________
_______ Spouse $195 $170 ____________
_______ Child/Children $235 $205 ____________
Check if Electing Group Dental Cost/Month Election Cost
_______ Associate $0 ____________
_______ Spouse $35 ____________
_______ Child/Children $70 ____________
Total Deduction / Month ____________
(Total all costs)
Signature____________________________________ Date_____________________
Name_______________________________________
Printed
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
I decline Medical and/or Dental Benefits offered by ThreeWill, LLC . I understand that the next opportunity I have to elect benefits will be at open election time (annual renewal / company benefit change), if I have a life event change, or if my current benefits are terminated.
_____I have other coverage
_____Other reasons__________________________________
Signature________________________________ Date___________________
Name___________________________________
Printed
The information in this Benefits Summary is presented for illustrative purposes and is based on information provided by ThreeWill. The text con-
tained in this Summary was taken from various summary plan descriptions and benefit information. While every effort was taken to accurately report your benefits, discrepancies, or errors are always possible. In case of discrepancy between the Benefits Summary and the actual plan documents the actual plan documents will prevail. All information is confidential, pursuant to the Health Insurance Portability and Accountability Act of 1996. If you have any questions about this summary, contact Human Resources.