SMCI Benefit Guide 2015 2016
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EMPLOYEE BENEFITS GUIDE Effective December 1, 2015 - November 30, 2016 Welcome! Southern Mutual provides a very comprehensive benefits offering to you and your family members. Most of your insurance benefits become effective on your full time date of hire; however, if you elect to purchase optional vision benefits, this coverage becomes effective on the first day of the month following your date of hire. Am I eligible? If you are a Southern Mutual full-time W2 employee, working 30 or more hours per week, you are eligible to enroll in the benefits described in this guide. Your spouse and eligible dependents may enroll for medical, dental, vision and supplemental life insurance. Premiums for all plans are paid thru pre-tax payroll deductions, resulting in 25 - 30% tax savings. What do I have to do? Medical: You must complete an enrollment form when you are first eligible, electing or waiving coverage. Please be sure to provide a beneficiary for the life benefit provided by UHC. Dental: You must complete an enrollment form when you are first eligible, electing or waiving coverage. Vision (Optional): You must complete an enrollment form to elect coverage. Long Term & Short Term Disability You are automatically enrolled in this employer paid benefit. Group Term Life Insurance: You are automatically enrolled in this employer paid benefit. You must complete an enrollment form to select a beneficiary. Supplemental Life / Dependent Life Insurance (Optional): You must complete an enrollment form to elect coverage. When can I make changes? You are able to make changes during the month of November during our Open Enrollment Period. After November, you must have a qualified change in status in order to make changes to the benefits you elect during the plan year. Qualified changes in status include: marriage, divorce, legal separation, birth, adoption of a child, change in child’s dependent status, death of spouse or child. Involuntary loss of other coverage due to a change in spouse employment or loss of Medicaid eligibility would also apply. Employees have an open enrollment period during the month of November to make changes to the medical, dental, vision and supplemental life benefits. Your UHC Benefits at a Glance for 12.01.2015 - 11.30.2016 Medical & Life Insurance United Healthcare Policy #0489680 Southern Mutual offers a Traditional Copay Plan with Office Visit and Rx Copays Included. Southern Mutual pays 100% of the employee only medical plan premium and 45% of any dependent costs. Employees are responsible for any remaining dependent cost which will be payroll deducted on a pre-tax basis resulting in approximately 30% savings. Southern Mutual offers $15,000 of Life and Accidental Death & Dismemberment Insurance to each employee. Premiums are paid by Southern Mutual. Care 24 Services offers you access to a w ide range of health and w ell -being information—seven days a week, 24 hours a day. Call 1-888-887-4114 to speak with a registered nurse and/or master’s-level counselor who can help with almost any problem ranging from medical and family matters to personal, legal, financial and emotional needs. Health Discount Program - even if you already have medical, dental and vision coveage, as an enrollment health plan member, you can save even more by using the health discount program for things such as teeth whitening, laser eye surgery, alternative medical care (i.e. chiropractics, acupuncture, etc.), infertility, etc. In addition, you can save on many wellness resources like weight management programs (i.e. Jenny Craig, NutriSystem, etc.), fitness clubs, smoking cessation programs and more. To find out more visit www.myuhc.com and select “Extra Programs and Discounts”. Children are covered to age 26 regardless of student or marital status. SMCI Pays 100% of EE Cost Employee Pays 55% of the $575.47 $287.74 $0.00 EMPLOYEE & SPOUSE $1,253.84 $440.38 $186.55 EMPLOYEE & CHILD (REN) $1,084.82 $402.35 $140.07 EMPLOYEE & FAMILY $1,767.25 $555.89 $327.74 COVERAGE LEVEL EMPLOYEE ONLY UHC & AmFirst and 45% of Dependent Cost Dependent Cost TOTAL MONTHLY Semi Monthly COST contributions SMCI pays Your Semi Monthly Deduction on your behalf Customer Service: 1-800-357-0978 Website: www.myuhc.com ***YOU MUST USE YOUR UHC & AMFIRST FOR ALL SERVICES UNTIL THE MEMBER’S MAX ANNUAL EXPOSURE IS MET!! Medical Benefits Individual Deductible: Family Deductible (Limit is 2x the Individual): Copay Plan In-Network: UHC $10,000 EE Pays - $3,000 per Individual Use Both Cards In-Network: UHC $20,000 EE Pays - $6,000 per Family Use Both Cards Calendar or Benefit Year Deductible? Calendar Year Coinsurance %: In-Network: EE 20%, AmFirst 80%, then UHC 100% Co-insurance Out of Pocket: In-Network: EE Pays $1000 Use Both Cards Co-insurance Limit Per Family: In-Network: EE Pays $2000 per Family Use Both Cards Maximum Annual Exposure *** (Deductible + Coinsurance Out of Pocket) Single (In-Network): ** UHC $10,000 EE Pays $4,000 & AmFirst Pays $6,000 (Deductible + Coinsurance Out of Pocket) Family (In-Network): ** UHC $20,000 EE Pays $8,000 & AmFirst Pays $12,000 PCP / Specialist: $25 / $50 Office Visit Copay Covers: Consultation Diagnostic Labs & X-Rays?* Yes High Tech Radiology? Deductible + Coinsurance In Office Surgery? Deductible + Coinsurance Outpatient Preferred Labs (covered @ 100%): Any In-Network Lab PCP Referral Required? No Urgent Care (Doctors Care): $75 Emergency Room: $150 Network: UHC Drug Card (generic/preferred/nonpreferred): $100 Rx Deductible $10 / $35 / $60 Specialty Medication: N/A Mail Order (up to 90 day supply): $100 Rx Deductible then $25 / $88 / $150 Preventive Care: In Network Benefits Annual Physicals: Gyn Exams & Prostate Screenings: Plan Pays 100% No Limit & No Copay Preventive Mammograms: Vision Benefit Exam covered w/copay every 24 months Maximum Annual Benefit (in/out of network): Unlimited Maximum Lifetime Benefit (in/out of network): Unlimited *Labs & X-Rays must be performed at an in-network physicians office on the same date, billed by the same physician and filed as an office visit. **Plus Copays. Customer Service: 1-800-357-0978 Website: www.myuhc.com Note: This is a brief summary, so please see your actual Insurance Policies for contractual benefits. AmFirst Gap Plan For Southern Mutual Group Supplemental Coverage Health Insurance designed exclusively for those covered under a comprehensive major medical plan. This plan picks up where your major medical plan leaves off - on Hospital and Medical Expenses that you incur when you are in the Hospital. This plan is designed to help fill the gap between what your current plan pays and what you owe on the covered expenses from: The hospital and doctor as the result of an in-patient hospital confinement. Additional benefits for outpatient expenses. Supplemental Deductible and Co-Insurance Annual Deductible - $3,000 per Individual Co-Insurance - 20% to $1,000 per Individual Out of Pocket Maximum Maximum Annual Exposure - $4,000 per Individual This plan will then pay the benefits described below for each insured, after the deductible for this plan has been satisfied, as provided in the policy until the AmFirst Plan payments under all benefits reach the Maximum Total Benefit Amount. A. Supplemental Benefits for Covered Hospital Confinement For medically necessary expenses incurred while you are confined in the hospital this plan pays: Deductible and Co-insurance Pays the amount applied to your Deductible and Co-insurance by your major medical health plan for covered charges incurred during the covered hospital confinement not paid by your major medical plan. B. Supplemental Benefits for Covered Outpatient Expenses For medically necessary expenses incurred on an outpatient basis this plan pays: Deductible and Co-insurance Pays the amount applied to your Deductible and Co-insurance by your major medical plan. Charges for the professional fees of a physician in a doctor’s office or medical clinic and outpatient prescription drugs are not covered. Maximum Total Benefit Amount Premium Saver Pays: $6,000 Single and $12,000 Family AmFirst pays the same benefit regardless of whether Members go in-network or out-of-network. It is in the best interest of the Member to ALWAYS seek out in-network providers to receive discounted services, maximize their benefits and minimize their cost! Policy #14966 Customer Service: 1-888-859-3795 Claims Assistance: 1-888-888-2519 How to register on myuhc.com By registering on myuhc.com, you can find the answers to your health and benefits questions and the information you need in one easy-to-use, convenient location online. Registration is quick and simple: 1.) Go to myuhc.com 2.) Click the Register Now button 3.) Enter ID card information or your Social Security number and date of birth 4.) Enter or confirm your e-mail address or sign up for a free e-mail account 5.) Check to receive informational e-mails and confirm enrollment for electronic documents 6.) Create a username and password—then start using myuhc.com On myuhc.com you can: ~ Check past and current statements and claims status ~ Review eligibility and look up benefits ~ Find a hospital or doctor ~ Print a temporary ID card or request a replacement card ~ Estimate health care costs - compare hospitals in quality and cost at the procedure level ~ “Chat” with a nurse online in real-time ~ Take a health assessment and participate in online health coaching programs ~ Learn about health conditions, symptoms and the latest treatment options ~ Use the Personal Health Record to organize health data and receive condition-specific information to organize your overall health ~ Track your medical expenses, manage prescriptions and organize your claims Online Health Assessment on myuhc.com Take your first step towards a healthier lifestyle by taking a free, personalized health assessment at myuhc.com. You can identify your personal health needs, learn healthy habits and compare your “lifestyle score” to others of the same age and gender. Based upon your score, an interactive Health Coach may recommend up to three health improvement goals to help you achieve your personal health goals such as: ~ Weight Management ~ Nutrition ~ Stress Management ~ Diabetes Lifestyle ~ Exercise ~ Tobacco Cessation ~ Heart Health Lifestyle To access the Health Assessment, log onto myuhc.com and click on the “Health Assessment” tab on the right side of the home page. Personal Health Record on myuhc.com It’s your health history, a medical library and a customizable organizer rolled into one secure and easy-to-use tool. With the Personal Health Record you can ~ Review medical and pharmacy claims information, as well as lab results ~ Record allergies, immunizations, your family health history and personal contacts ~ Utilize Health Trackers to track progress such as blood pressure, cholesterol and weight ~ Print or download Personal Health History using historical claims data What you need to know about Health Flexible Savings Accounts What is a Flexible Spending Account? A M edical Flex ible Spending Account (FSA) is an account to which you contribute part of your pay before Social Security, Medicare and Federal Income (withholding) Tax to pay for qualified medical, dental and certain vision expenses for yourself, your spouse, and/or your dependents. What are qualified expenses? Any I R S Section 213 (D) ex penses are eligible to be reim bursed through your Medical FSA. These expenses include most medical, Rx, dental & vision related services. Why should I participate in a Medical Reiumbursement FSA? N orm ally, you w ould receive an incom e tax deduction for qualifying medical, dental and vision expenses that exceed 10% of your adjusted gross family income. (Few taxpayers ever meet that qualification or receive a tax deduction.) With the medical expenses Flexible Spending Account, every dollar contributed to your account escapes FICA, State and Federal Withholding taxes. How can I participate? First determ ine regular m edical, dental and vision ex penses you and your dependent(s) will incur during this plan year (1/1/2016 to 12/31/2016). Enter the amount you want to set aside before taxes on the Election Form. Each pay period, SMCI will deduct this amount from your paycheck and deposit the funds directly into your Flexible Spending Account. Can I revoke my annual election amount? Generally, no. How ever, if you have a qualified change in status (marriage, divorce, birth, adoption, unpaid leave of absence, change in employment status of you or your spouse from full-time to part-time or vice-versa) you can revoke your annual elected amount and make a new election for the remainder of the plan year. Do I have a “Use It Or Lose It” rule? You m ay subm it a request for reim bursem ent for ex penses incurred through Decem ber 31, 2016. You w ill have a 60-day timeframe to submit the Reimbursement Request Form for expenses incurred during that time. SMCI allows up to $500 of unused funds to be rolled over to the next calendar year. When can I elect to participate, and how much may I contribute? Each year, during the Open Enrollment period and prior to the Plan renewal date, you must complete a new Election Form for the upcoming Plan Year. The 2015 annual contribution limit for Healthcare Reimbursement is $2,550. What expenses are not eligible? You m ust use all the funds for eligible ex penses betw een 1/ 1/ 2016 and 12/31/2016. SMCI allows up to $500 of unused funds to be rolled over to the next calendar year. What happens if my request for Medical Care Reimbursement is greater than the amount of money in my account? The annual am ount is available to you from the beginning of the 1/ 1/ 2016 plan year, and if you request more than the annual elected amount, only the elected amount will be available to you. MEDICAL FSA ELIGIBLE EXPENSES Artificial limbs or teeth Birth control pills, contraceptive devices & sterilization procedures Childbirth classes Co-pays, co-insurance, & deductibles Durable medical equipment Dental exams, cleanings & other qualified services Eye exams and vision correction surgery Eyeglasses, contact lenses and solution Hearing devices Hospital bills Insulin, diabetic supplies, and test kits Medical tests and other services Orthodontia Some over the counter items when accompanied by a prescription from a medical provider Physical exams and medical screenings X-rays, MRI’s and other screenings ...hundreds more Welcome to Delta Dental! We are pleased to offer Dental benefits for you and your family. PREVENTIVE SERVICES BASIC SERVICES MAJOR SERVICES No Waiting Period No Waiting Period No Waiting Period Zero Deductible 100% Coverage $50 Calendar Year Deductible 80% Coverage $50 Calendar Year Deductible 50% Coverage Oral Exams / Cleanings Fillings Inlays, Onlays, Crowns (1 per 6 months) Full Mouth X-rays (1 per 36 months) Oral Surgery & General Anesthesia Oral Exams / Problem Focused (Combined w/ Exam Limit) Endodontics & Periodontics (root canals) Bridges and Dentures (<14: 1 per 12 months) (19+: 1 per 12 months) Simple Extractions Repair & Maintenance of Crowns, Bridges & Dentures Fluoride Treatment Sealants & Space Maintainers (age & frequency limits apply) Implants Bitewing x-rays (<16: 1 per 12 months) Calendar Year Annual Maximum: $1,500 per member ORTHODONTICS - $1,000 Lifetime Maximum per member (dependents to age 19 only) DENTAL INSURANCE COSTS SMCI Pays 100% of the EE Cost Employee Pays Dependent Cost Only! TOTAL MONTHLY COST Semi-Monthly Contributions on Your Behalf Semi-Monthly Payroll Deductions EMPLOYEE $33.03 $16.52 $0.00 EMPLOYEE & SPOUSE $67.97 $16.52 $17.47 EMPLOYEE & CHILD(REN) $75.44 $16.52 $21.21 EMPLOYEE & FAMILY $118.00 $16.52 $42.49 COVERAGE LEVEL Customer Service: Website: www.deltadentalsc.com Welcome to EyeMed! We are pleased to offer Vision benefits for you and your family. IN NETWORK o $150 After your **. Discounts of S No claims or e sive eye exam eve y 12 months with a $10 co allowance eve y 12 months towards gl y. ses and/or contact lens* with a one-time $25 co allowance has been used, receive a 15 on surgery including A y. discount on glasses contact lens at at contact lens fitting fee of no more than $55 or 10% discount off contact lens*** most ovi s*. e usual and fitting for to file. *Material allowance does not cover non-prescription lenses, non-prescription or cosmetic contact lenses, or non-prescription sunglasses. OUT OF NETWORK If you choose to use an out-of-network provider, you will be reimbursed the following amounts: Exam including contact lens fitting: $40 reimbursement Materials: $105 reimbursement - You will be mailed a membership card. To find an in-network provider near you, go to www.eyemed.com or call 1.866.939.3633 Please visit www.eyemed.com for participating refractive surgery providers and discounts. To make an appointment, call an in-network provider and let them know that you are an EyeMed member You are responsible for payment to the in-network provider of any amount exceeding the material allowance, any copays and any contact lens fitting fees. - This is a routine vision program. Medical and surgical treatments of the eyes are not covered benefits. - Dependent children are covered to age 26 regardless of student status. VISION INSURANCE COSTS: TYPE OF COVERAGE Employee Pays Total Cost Semi-Monthly Payroll Deductions EMPLOYEE $4.30 EMPLOYEE & SPOUSE $8.17 EMPLOYEE & CHILD(REN) $8.60 EMPLOYEE & FAMILY $12.63 EMPLOYER PAID SHORT-TERM DISABILITY Benefit is 60% of your weekly pre-disability earnings, to a maximum of $1,500 per week. Payable on the 31st day of an accident or the 31st day for an illness. 9 Week benefit duration. Your benefit will be taxable, as Southern Mutual pays 100% of your monthly premiums. EMPLOYER PAID LONG-TERM DISABILITY Benefit is 60% of your monthly pre-disability earnings, to a maximum of $7,500 per month. Payable after 90 days of a total or partial disability. Own Occupation Period is 24 months. Maximum duration of benefits is to Social Security Normal Retirement Age (SSNRA). Unlimited Return to Work Incentive. 3 months survivor benefit. Your benefit will be taxable, as Southern Mutual pays 100% of your monthly premiums. Group Number G000AY4G Customer Service: (800) 228-7104 Website: www.mutualofomaha.com EMPLOYER PAID BASIC LIFE INSURANCE $50,000 Life and Accidental Death & Dismemberment Insurance Southern Mutual pays 100% of the premium VOLUNTARY LIFE INSURANCE Employee Max Benefit - Lesser of 5x annual earnings or $100,000 in increments of $10,000, rounded to the next higher $1,000 Guarantee Issue = $100,000 Spouse Max Benefit - 50% of employee amount, up to $20,000 Guarantee Issue = $20,000. Child Max Benefit - $10,000, in increments of $2,000 Guarantee Issue = $10,000 VOLUNTARY LIFE INSURANCE RATES Sample Employee Sample Employee Employee Spouse Per-Pay-Period Per-Pay-Period Age Bracket Monthly Cost Per $10,000 Monthly Cost Per $10,000 Cost for $20,000 Cost for $100,000 0-24 $1.12 $1.12 $1.12 $5.60 25-29 $1.25 $1.25 $1.25 $6.25 30-34 $1.33 $1.33 $1.33 $6.65 35-39 $1.56 $1.56 $1.56 $7.80 40-44 $1.95 $1.95 $1.95 $9.75 45-49 $2.72 $2.72 $2.72 $13.60 50-54 $4.18 $4.18 $4.18 $20.90 55-59 $6.77 $6.77 $6.77 $33.85 60-64 $10.42 $10.42 $10.42 $52.10 65-69 $16.88 $16.88 $16.88 $84.40 70-74 $29.18 $29.18 $29.18 $145.90 75-79 $48.80 $48.80 $48.80 $244.00 Child Term Life Rate for $10,000: $1.30 Customer Service: (800) 228-7104 Group Number G000AY4G Website: www.mutualofomaha.com We at Southern Mutual Church Insurance appreciate our employees, and we hope you agree that our benefits package reflects this. CONTACT INFORMATION Assurance Benefits Group, LLC 1898 Calhoun Street #6 Columbia, SC 29201 Tammie J. King, RHU, REBC Office 803.227.8639 x102 Cell 803.738.6858 Fax 803.227.8659 Tammie@ABG-LLC.com Charlotte Hamilton Office 803.227.8639 x103 Cell 803.465.1885 Fax 803.227.8659 Charlotte@ABG-LLC.com This Guide is only intended to offer an outline of benefits. All details and contract obligations of plans are stated in the group contract/insurance documents. In the event of conflict between this guide and the group contract/insurance documents, the group contract/insurance documents will prevail. Please contact your Human Resources Department for further information.
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