2014 Benefits Summary FINAL - Lindley Habilitation Services

2014 Benefit Summary
Insurance Contacts
Refer to this list when you need to contact one of your benefit vendors. For general information, contact Human
Resources.
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DENTAL
Ameritas
800.487.5553
www.ameritasgroup.com
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LIFE & WORKSITE BENFITS
Colonial Life
704.996.5969 – Kate Overton
877.865.3899 – Benefit Counselor
www.coloniallife.com
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MEDICAL
Blue Cross & Blue Shield of NC
877.258.3334
www.bcbsnc.com
VISION
Community Eye Care
888.254.4290
www.communityeyecare.net
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HEALTH ADVOCATE
Health Advocate
866.695.8622
members.healthadvocate.com
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Senn Dunn Contact
Your dedicated benefits advocates:
Senn Dunn Insurance
Employee Benefits Services
855.313.1075
[email protected]
Offices in Greensboro, High Point, Raleigh, Wilmington, Charlotte& serving the entire state of North Carolina.
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800.598.7161 | www.senndunn.com
Medical Insurance
BCBS of NC
Who is Eligible and When:
All employees regularly working 30 hours a week or more are eligible on the first
of the month following 60 days of service.
Employer Pays:
Lindley Habilitation Services pays over 50% of the employee only coverage.
Employee Pays:
Employee Only
Employee + Spouse*
Employee + Child(ren)
Family*
Semi-Monthly Payroll Deductions
$ 69.85
$ 221.03
$ 205.12
$ 404.04
Plan Feature (PPO and OOA*)
In-Network You pay:
$3,000 Individual
$6,000 Family
Deductible
Coinsurance
20% or 40% after deductible
Coinsurance Maximum
$3,350 Individual
$6,700 Family
Out-of-Pocket Maximum
$6,350 Individual
$12,700 Family
Office Visit
Primary Care
Preventive Care
Specialists
Routine Vision Exam(1 per year)**
$20 copay
0% (Covered at 100%)
Deductible, then 40%
0% (Covered at 100%)
Lab and X-Ray
In Primary Care Office
Out of Office
MRI, CAT & PET
Inpatient Services
Physician
Hospital
$20 copay
Deductible, then 40%
Deductible, then 40%
Deductible, then 20%
$250 per admission copay + Deductible, then 20%
Outpatient Services
Physician
Hospital
Deductible, then 40%
Deductible, then 40%
Other Services
Emergency Room Services
Urgent Care Copay
Chiropractic Services (20 Visits)
Deductible, then 40%
Deductible, then 40%
Deductible, then 40%
Out-of-Network
Deductible
Coinsurance
Coinsurance Maximum
Out-of-Pocket Maximum
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$6,000 Individual/$12,000 Family
50% after deductible
$6,700 Individual/$13,400 Family
$12,700 Individual/$25,400 Family
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Prescription Drug Coverage
BCBS of NC
You pay:
Retail 30-day supply
Tier 1 (Generic)
Tier 2 (Preferred Brand)
Tier 3 (Non-Preferred Brand)
Tier 4 (Specialty)
$10 copay
100% up to $100 each
100% up to $100 each 10%
100% up to $100 each
Mail-Order 90-day supply
Tier 1 (Generic)
Tier 2 (Preferred Brand)
Tier 3 (Non-Preferred Brand)
Tier 4 (Specialty)
$30 copay
100% up to $300 each
100% up to $300 each
100% up to $300 each
Don’t forget to take advantage of filling Generics Medications at many retailers for less!
$4 for 30-day or $10 for 90-day supply - Generic Drug Program
Wal-Mart, Sam’s Club, Costco, Walgreens, Target and others are running promotions where you can get generics that
are on their “approved” list for $4.00 per prescription, per month. There are also generics available for $10 per 90day supply. The lists are available on their websites, such as walmart.com, samsclub.com and target.com. And you
do not need to be a member of Costco or Sam’s Club to fill prescriptions there.
Condition'Care'
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BCBS'of'NC!
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Healthy!Outcomes!Condition!Care!can!help!you!better!manage!you!overall!health!and!your!unique!chronic!health!condition.!!By!registering!at!
www.bcbsnc.com,!and!clicking!the!“Wellness”!tab,!you!can!learn!to!recognize!and!lessen!symptoms,!understand!which!treatments!and!
medications!work!best!for!you,!and!live!healthier!and!feel!your!best,!every!day.!!Members!may!choose!to!work!on!one!or!more!of!the!
following!conditions:!!
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Asthma' '
Coronary'Artery'Disease' '
''Diabetes'
Chronic'Obstructive'Pulmonary'Disease''
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Member'Services' '
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BCBS'of'NC!
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Log!in!to!the!Member!Services!section!of!www.BCBSNC.com!!to!take!advantage!of!these!tools!and!features.!
My'Account!
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Request!ID!card,!update!information!
My'Benefits'and'Claims! !
View!Claims,!check!benefits!
Doctors,'Rx'&'Hospitals! !
Find!a!doctor,!look!up!medications!&!drug!information,!compare!hospitals!
Health'Programs!
Health!&!Wellness!Programs,!Personal!Health!Assessment!Survey,!assistance!with!tobacco!cessation,!
diabetes,!and!more!
Rewards'&'Discounts!
Receive!discounts!on!health!services!&!products,!track!&!redeem!rewards!for!physical!fitness!&!wellness!
activities,!get!discounts!on!vitamins!and!weight!management!programs!
Health Reimbursement Arrangement (HRA)
Linley Habilitation Services will provide the employee with deductible assistance through a Health Reimbursement
Arrangement (HRA). Once the employee has met the first $2,000of the deductible for an individual, LHS will
reimburse the employee for the next $1,000 of that employees deductible expenses. The deductible
reimbursement is not to exceed that $1,000 for the employee only. An employee will send an EOB (explanation of
benefits) to Human Resources for reimbursement, this will not provide confidential claims information to HR but will
indicate how much of the deductible has been met. Please note that this is for employees, not for dependents.
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Dental Insurance
Ameritas
Who is Eligible and When:
All employees regularly working 30 hours a week or more are eligible on the first
of the month following 60 days of service.
Employer Pays:
This is a voluntary, employee paid benefit. Premiums do come out pre-tax.
Employee Pays:
Employee Only
Employee + Spouse
Employee + Child(ren)
Family
Monthly Payroll Deductions
$29.76
$58.08
$66.92
$104.16
Type of Service
Benefit
$50 Individual
$150 Family
Deductible
Policy Year Maximum
$1,250 per covered member
Diagnostic & Preventive Services
Exams, Cleanings, Fluoride Treatment, Space
Maintainers, Diagnostic X-Rays, Sealants, etc.
Covered at 100% of usual and customary
Deductible does not apply
Basic Services
Emergency Pain Treatment, Stainless Fillings,
Simple Extractions, Some Oral Surgery, etc.
Covered at 80% of usual and customary
Major Services
Crowns, Inlays, Onlays, Bridges, Dentures,
Dentures, Repairs and Adjustments,
Endodontics (Root Canal), Periodontics (Gum
Disease), Periodontics (Surgical)
Covered at 50% of usual and customary
12 month new enrollee waiting period
Orthodontic Services for children up to age 19
Appliances and Related Services
Lifetime Maximum
Waiting Period
Benefit Carryover
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Semi-Monthly Payroll Deductions
$14.88
$29.04
$33.46
$52.08
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Covered at 50% of UCR/Deductible applies
$1,250
12 month new enrollee waiting period
As long as you receive at least one dental service during
the year (i.e a cleaning), if you have unused benefit left
over, you may be able to carry up to $250 of it into the
next year, giving you more benefit that next year.
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Vision Insurance
Community Eyecare
Who is Eligible and When:
All employees regularly working 30 hours a week or more are eligible on the first
of the month following 60 days of service.
Employee Pays:
This is a voluntary, employee paid benefit. Premiums do come out pre-tax.
Employee Only
Employee + 1
Employee + 2 or more
Monthly Payroll Deductions
$ 7.91
$15.38
$24.59
Benefits
Semi-Monthly Payroll Deductions
$ 3.96
$ 7.69
$12.30
In Network
Exam
$15 copay
Standard Frames
$15 copay / $130 allowance
Standard Lenses
$15 copay
Contact Lenses (Conventional)
$15 copay / $130 allowance
Frequency of Services
Exams
Frames
Lenses OR Contacts
LASIK
12 months
12 months
12 months
Discount from participating providers
Please refer to CEC for full In Network and Out of Network benefits.
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Individual Worksite Products
Lindley Habilitation Services offers you the opportunity to purchase the following voluntary benefits through
the convenience of semi-monthly payroll deduction (24 pay periods) for yourself and your dependents. Your
coverage is portable at the same rate on a direct pay basis after termination of employment. You pay the full
cost for these benefits. Rates are based on age.
Short-Term Disability- You are provided with benefit amount options (how much benefit you want to
purchase), a choice of benefit periods (how long the plan pays for an off-the-job accident and sickness), and
with a choice of elimination periods (how long before the benefit pays before an off-the-job accident or
sickness) - to ensure that you are receiving a pay-check should you not be able to work because of a
disabling off-job accidental injury or sickness. Post Tax Deduction. Please see Colonial packet for rates
and more details.
Accident Coverage(preferred)– Accidental Injuries are unexpected and costly, and they happen more
often than you think. Colonial’s family-friendly Accident Plan provides lump-sum daily benefits for covered on
and off-the job injuries (including ER treatment, follow-up visits, PT, ambulance. appliances, hospital
confinement, x-rays/Imaging, lodging/transportation, surgery, catastrophic coverage, AD&D, and Health
Screening…and more) - offsetting your out-of-pockets expenses. Pre Tax Deduction Please see Colonial
packet for rates and more details.
Cancer Coverage– Medical advances have resulted in an increased chance of surviving this dread disease.
But with these advances come increased health care costs. Lengthy, expensive recovery periods can mean
the loss of personal wages and a person’s ability to pay for care and treatment. Even with the most
generous employer-provided medical and disability plans, you may need additional resources to manage
your financial needs. The Colonial Cancer 1000 Plan pays lump-sum benefits that can help you pay for
both medical and non-medical expenses resulting from cancer treatment. The plan also pays a wellness
benefit to encourage you to have regular screenings – improving your chances of early detection and
survival. Pre Tax Deduction Please see Colonial packet for rates and more details.
Critical Illness Coverage– Your Colonial Critical Illness Plan helps you pay for the direct
(deductibles/coinsurance) and indirect costs (loss of wages, home healthcare, rehabilitation, and basic living
expenses) associated with a Critical Illness. Your plan provides a lump sum payment (from $5,000 to
$75,000) upon the DIAGNOSIS of a covered critical illness. Covered illnesses are: Heart Attack, Stroke,
Major Organ Failure, End-Stage Kidney Failure, Permanent Paralysis due to an accident, Coma, Blindness,
Occupational Infections HIV or Hepatitis (B, C, D), and Coronary Artery Bypass Graft Surgery. The plan also
pays a $50 annual wellness benefit to encourage you to have regular screenings – improving your chances
of early detection and survival (Note: Spouse coverage limit is 50% of employee to $40,000 max, and
Dependent coverage is 25% of named insured. Maximum payout is 3x the face amount for all covered
persons combined. Diagnoses must be separated by 180 days). Post Tax Deduction Please see Colonial
packet for rates and more details.
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Health Advocate
Paid for 100% by Senn Dunn Insurance
Health Advocate is a service that provides you with personalized assistance to help you and your eligible family
members resolve healthcare issues, saving time and money. During your first call, you will be assigned a Personal
Health Advocate who will begin helping you right away by cutting through the red tape, talking to your doctors and
insurance company, and getting to the heart of your issue fast.
Your Personal Health Advocate will help you:
Download'the'
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Find the right doctors, specialists, and hospitals
FREE'Health'
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Untangle medical bills and solve complex healthcare issues
Advocate'app!'
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Locate eldercare and support services
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…and much more!
Use your unlimited calls to save time, money and worry for yourself, your spouse, your kids, your parents, and your
in-laws—all at no cost to you.
Summary of Benefits (SBC)
A Summary of Benefits and Coverage (SBC) for the medical plan offered to full-time employees of Lindley Habilitation Services
has been prepared by our insurance carrier, BlueCross BlueShield of NC, in accordance with the requirements of the Patient
Protection and Affordable Care Act and the Health Care and Education Reconciliation Act (collectively referred to as”PPACA”). The
SBC will be available in your account online at www.mybcbsnc.com. If you have not registered with BCBS in the past, you will
want to register and view this notice prior to electing coverage. A paper copy is also available, free of charge, by calling the tollfree number on the back of your ID card. Also, a paper or electronic copy is available from HR if you don’t have online access or
if you are not yet enrolled. *Note, the examples are generic examples, they do not take into account our Plan.
Pre-Tax Advantage: Section 125 Plan
Your share of medical, dental, and vision payroll deductions are taken on a pre-tax basis through an IRS Section 125
Plan. This saves you approximately 30% in taxes. However, due to Section 125 Plan rules, you may only make
changes in your payroll deductions at the annual Open Enrollment or at the time of a Qualifying Event
such as marriage, divorce, birth of a child, loss of insurance, or court order. Any Qualifying Events must be reported
to Human Resources within 30 days of the event. If there has not been a Qualifying Event, you may not make any
changes to your payroll deductions until Open Enrollment for 2014. These are Internal Revenue Service rules
and there can be no exceptions.Contact Human Resources for more information.
The information in this Benefits Summary is presented for illustrative purposes and is based on information provided by the employer. The text
contained 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.
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