2012 Open Enrollment Brochure
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1 FOR A HEALTHIER YOU. OPEN ENROLLMENT 2012 COVERAGE FOR YOU AND YOUR FAMILY SIMPLE ONLINE ENROLLMENT PROCESS
description
Open enrollment brochure and benefits information. Effective for the 7/1/2012 to 6/30/2012 plan year.
Transcript of 2012 Open Enrollment Brochure
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FOR A HEALTHIER YOU.
OPEN ENROLLMENT 2012 COVERAGE FOR YOU AND YOUR FAMILY
SIMPLE ONLINE ENROLLMENT PROCESS
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TABLE OF CONTENTS
THIS PRESENTATION EXPLAINS YOUR BENEFITS AND THE PROCESS FOR THIS YEAR’S OPEN ENROLLMENT.
As you navigate through this digital magazine, we hope you will find easier access to your benefits
information. All benefit summaries and carrier information are found on PAGE 14. When you mouse
over a link, it will direct you to the source of choice.
OPEN ENROLLMENT INFORMATION | page 3 PARTICIPATION COSTS | page 5 MEDICAL COVERAGE | page 6 DENTAL COVERAGE | page 9 VISION COVERAGE | page 10 LIFE & DISABILITY INSURANCE COVERAGE | page 11 EMPLOYEE ASSISTANCE PROGRAM (EAP) | page 11 FLEXIBLE SPENDING ACCOUNTS | page 12 AFLAC | page 13 CARRIER CONTACTS & BENEFIT SUMMARY LINKS | page 14 ERISA and CHIP Notices| page 49
WELCOME!
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WELCOME! This presentation will guide you through open enrollment for the 2012-2013 plan year. By clicking on the right arrow, you can read through each page as you would a magazine. Click anywhere on the page to zoom in or out. As you proceed, you will notice links to the Ceridian enrollment website as well as our carrier sites. When you are ready to enroll, follow the directions below and click on “I’m Ready to Enroll” which will direct you to the Ceridian Self-Service website. Open Enrollment gives you the opportunity to add or delete coverage for yourself or a dependent, change medical or dental plans, or enroll in benefits for the first time. The elections you make now will stay in effect until our next open enrollment period, unless you experience a change in status. You MUST contact Human Resources within 30 days of a status change, otherwise you will have to wait until the next Open Enrollment to make changes. Examples of “Status Changes” are:
DEADLINE TO
ENROLL
ON-LINE IS
JUNE 4, 2012
Below is a list of eligible dependents that you can include in your medical, dental, and vision coverage:
Spouse (Proof of marriage is required) Children Registered Domestic Partner (Proof of registration is required) Registered Domestic Partner’s children
Marriage, divorce, or legal separation Birth or adoption of a child Death of a spouse or dependent Spouse becomes employed or unemployed
Physically move outside the coverage area Receipt of a Qualified Medical Child Support Order
(QMCSO) that requires you to cover a child under your medical plan
OPEN ENROLLMENT INFORMATION
OPEN ENROLLMENT
INFORMATION
CONTINUED ON
NEXT PAGE
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HOW DO I LOG INTO CERIDIAN SELF-SERVICE? CLICK ON THIS LINK: https://sss2.ceridian.com/greendot You will be prompted to enter your USER NAME and PASSWORD on the login page. USER NAME: Full first name dot full last name (similar to your Green Dot email address (e.g., jane.doe) PASSWORD: (per your selection) If you have any login problems or forget your password please email: [email protected]
OPT OUT OF MEDICAL BENEFITS: GREEN DOT WILL PAY YOU $75/month for opting out of medical benefits as long as you provide proof of medical coverage from another company.
OPEN ENROLLMENT INFORMATION (continued)
ENROLLMENT INSTRUCTIONS
DEADLINE TO
ENROLL
ON-LINE IS
JUNE 4, 2012
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AMU MEMBERS KAISER HMO
HEALTH NET EOA
HEALTH NET PPO
DENTAL HMO
DENTAL PPO VISION
Employee Only $0 $18.32 $215.22 $0 $24.95 $0
Employee + 1 Dependent $0 $39.38 $462.74 $0 $44.60 $0
Employee + Family $0 $54.04 $634.93 $0 $82.33 $0
ADMINISTRATIVE STAFF KAISER HMO
HEALTH NET EOA
HEALTH NET PPO
DENTAL HMO
DENTAL PPO VISION
Employee Only $0 $16.79 $197.29 $0 $22.88 $0
Employee + 1 Dependent $0 $36.10 $424.18 $0 $40.89 $0
Employee + Family $0 $49.54 $582.02 $0 $75.47 $0
OTHER GREEN DOT
PAID BENEFTS
NOTE: Teachers participation costs reflect a 22-pay period cycle. Administrative Staff participation costs reflect a 24-pay period cycle. As AMU members are 11-month employees, their participation costs will be taken out of their first 22 payrolls. Participation costs will not be taken out for payrolls 23 & 24. Annual rates, therefore, are the same for all employees.
LIFE AND ACCIDENTAL DEATH AND DISMEMBERMENT INSURANCE SHORT TERM AND LONG TERM DISABILITY INSURANCE EMPLOYEE ASSISTANCE PROGRAM
YOUR PARTICIPATION COSTS PER PAY PERIOD
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KAISER HMO 100% EMPLOYER PAID
Annual deductible None
Out-of-pocket max: individual / family $1,500 / $3,000
Lifetime benefit maximum Unlimited
Office visits $10 copay
Preventive exams No charge
In-patient hospitalization Covered 100%
Out-patient surgery $10 per procedure
Chiropractic $10 copay / 30 visits
Emergency room $50 copay per visit; waived if admitted
PRESCRIPTION DRUG COVERAGE Generic (30-day supply) $10 copay
Brand formulary (30-day supply) $20 copay
Brand non-formulary Not covered
Mail order 2 copays for 100-day supply
Green Dot Public Schools has Kaiser Permanente available as an HMO medical option. This plan is 100% employer paid and is at no cost for you to participate. You must obtain authorization from your Primary Care Physician for all procedures and hospital visits.
KAISER PERMANENTE HMO MEDICAL BENEFITS MEDICAL BENEFITS
ALL MEDICAL BENEFITS REMAIN UNCHANGED FROM LAST YEAR’S PLAN.
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HEALTH NET EOA PLAN The Health Net EOA (Elect Open Access) Plan works just like an HMO. You must obtain authorization from your Primary Care Physician for all procedures and hospital visits. This plan allows you to self-refer to any provider within the Health Net PPO network for office visits, consultations, or evaluations and pay a $30 copay per visit. This feature (self-referral to a Health Net PPO provider) applies to doctor office visits only. To find an in-network EOA primary doctor, go to www.healthnet.com, select “Find a Doctor or Hospital”, and search within the EOA network. For self-refer provider searches, search within the PPO network.
HEALTH NET EOA
Annual deductible None
Out-of-pocket max: individual / family $1,500 / $4,500
Lifetime benefit maximum Unlimited
Office visits $10 copay (self-refer to PPO provider for $30 copay) Preventive exams No charge
In-patient hospitalization Covered 100% (PPO is not covered) Out-patient surgery Covered 100% (PPO is not covered) Acupuncture / chiropractic $10 copay / 30 visits
Emergency room $50 copay* (PPO is not covered) PRESCRIPTION DRUG COVERAGE Generic $10 copay
Brand formulary $20 copay
Brand non-formulary $35 copay
Mail order 2 copays for 90-day supply
*waived if admitted
ALL MEDICAL BENEFITS REMAIN UNCHANGED FROM LAST YEAR’S PLAN.
MEDICAL BENEFITS
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HEALTH NET PPO PLAN In a PPO plan, you have greater flexibility to direct your own healthcare needs. Instead of a primary care physician who oversees your medical care, you have the freedom to go in and out-of-network and direct your own referrals for specialist visits. It is important to familiarize yourself with the details of the PPO plan with regard to deductibles, coinsurance, and out-of-pocket levels for both in and out-of-network providers. You can achieve substantial savings by accessing in-network providers in the Health Net PPO provider network. To find an in-network PPO doctors, go to www.healthnet.com, select “Find a Doctor or Hospital”, and search within the PPO network.
HEALTH NET PPO IN-NETWORK OUT-OF-NETWORK
Calendar year deductible: individual / family $250 / $750 Out-of-pocket max: individual / family $2,000 / $6,000 $6,000 / $18,000
Lifetime benefit maximum Unlimited Unlimited Office visits $10 copay 70%1
Preventive exams 90%1 Not covered
In-patient hospitalization 90%1 70%1 plus $500 copay
Out-patient surgery 90%1 70%1 plus $500 copay
Acupuncture Chiropractic
Limited to 12 visits Limited to 12 visits 90%1 70%1
$10 copay 70%1 ($25 max payable amount)
Emergency room 90%1 plus $100 deductible*
70%1 plus $100 deductible*
PRESCRIPTION DRUG COVERAGE Generic $10 copay $10 + 50% AWP2 Brand formulary $20 copay $20 + 50% AWP2 Brand non-formulary $35 copay $35 + 50% AWP2
Mail order 2 copays for 90-day supply
2 copays for 90-day supply
*$100 deductible is waived if admitted.
1After calendar year deductible.
2When filling Rx at non-participating pharmacies, you are required to pay the listed dollar copay, plus 50% of the drug’s Average Wholesale Price (AWP).
MEDICAL BENEFITS
ALL MEDICAL BENEFITS REMAIN UNCHANGED FROM LAST YEAR’S PLAN.
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DELTACARE USA (HMO) BENEFIT HIGHLIGHTS 100% EMPLOYER PAID
Deductible per person (calendar year) N/A
Annual maximum benefit Unlimited Preventive care (oral exams, cleanings, X-rays, sealants) No copay
Basic care (fillings, extractions, root canals) Various copays (see schedule) Periodontal care (gums) Various copays (see schedule) Major care (crowns, bridges, dentures, inlays, onlays, veneers) Various copays (see schedule)
Orthodontic care $1,700 child $1,900 adult
DELTA DENTAL PPO BENEFIT HIGHLIGHTS PPO NETWORK NON-NETWORK* Calendar year deductible: individual / family $25 / $75 $50 / $150
Annual maximum benefit per member $1,500
Preventive care (oral exams, cleanings, X-rays, sealants) 100% deductible waived 100% deductible waived
Basic care (fillings and extractions) 80%1 80%1
Periodontal care (gums) & Endodontics (root canals) 80%1 80%1
Major care (crowns, bridges, dentures, inlays, onlays, veneers) 50%1 50%1
Orthodontic care adults and children 60% $2,500 lifetime maximum
1After deductible
Eligible employees and their dependents may choose either the DeltaCare USA dental plan or the Delta Dental PPO Plan. There is no monthly contribution for you and your family for the DeltaCare USA plan. With the DeltaCare USA plan, you select a primary dentist who directs all of your dental care.
With the Delta Dental PPO plan, you may go to any dentist of your choice at any time. You will realize the greatest savings when you use a Delta Dental PPO provider. If you elect the PPO plan, there is a monthly contribution required to participate.
To find an in-network dental provider, go to www.deltadentalins.com, select “Find a Dentist,” and search within the DeltaCare USA (for HMO) or Delta Dental PPO (for PPO) networks.
Effective July 1, 2012 dependent children will be covered to age 26. Did you know that you are able to determine your out-of-pocket dental cost before beginning any major dental treatment? The Delta Dental PPO plan covers white fillings on front and back teeth, paying 80%. You pay just 20% for services. The DeltaCare USA dental plan also covers white fillings on front and back teeth. Fillings on the front teeth are covered at 100%. Filling on back teeth require a copay.
DENTAL BENEFITS
DID YOU KNOW?
ALL DENTAL BENEFITS REMAIN UNCHANGED FROM LAST YEAR’S PLAN.
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VSP BENEFITS
IN-NETWORK
OUT-OF-NETWORK
Copay $10 Exam / $25 Materials Exam / Lenses / Frames Benefit Frequency Every 12 months Examination No charge after copay Up to $50 allowance Single Vision Lenses No charge after copay Up to $50 allowance Bifocal Lenses No charge after copay Up to $75 allowance Trifocal Lenses No charge after copay Up to $100 allowance
Frames Up to $120 allowance, 20% discount for costs over $120
Up to $70 allowance
Elective Contact Lenses Up to $120 allowance, 15% discount if over $120
Up to $105 for retail allowance
Effective July 1, 2012, dependent children will be covered to age 26. Effective July 1, 2012, COSTCO will be an in-network VSP provider. Frame allowance is $70 at COSTCO.
VSP VISION COVERAGE
NEW FOR 2013
ALL VISION BENEFITS REMAIN UNCHANGED FROM LAST YEAR’S PLAN. To find a VSP doctor, visit vsp.com and select “Find a VSP Doctor,” or call 800.877.7195.
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Green Dot provides you with Life and Accidental Death & Dismemberment coverage equal to 1 times your annual salary, up to a maximum of $200,000, at no cost to you. Be sure to designate your beneficiary when you elect your benefit coverage.
Need more than the company-paid life and accidental death & dismemberment insurance? Newly eligible employees can purchase up to $150,000 of Optional Life and Accidental Death & Dismemberment Insurance without any medical questions, or up to $500,000 (not to exceed 5x your annual covered salary) with a statement of health (subject to approval). For further information, please contact Human Resources.
Green Dot also covers 100% of the cost of disability coverage for every eligible employee. This important benefit provides valuable income protection if you are unable to work due to sickness or injury. Disability insurance covers up to 60% of your salary to a maximum of $1,500 per week for short-term coverage, and 60% of your salary to a maximum of $10,000 a month for long-term coverage. These benefits are tax-free. For further information, please contact Human Resources.
Life has its share of challenges that can affect us physically, mentally or emotionally. Sometimes you need a little help. Our Employee Assistance Program (EAP) with Empathia, Inc., provides professional, confidential counseling visits, as well as referrals and other information at no cost to you. Counselors can help you and your family members 24 hours/7 days a week with issues such as:
• Family difficulties
• Marriage or relationship conflicts
• Stress
• Financial & legal problems
• Adoption support and information
• Alcohol or drug abuse
• Child & elder care services
BASIC LIFE AND ACCIDENTAL DEATH & DISMEMBERMENT INSURANCE
DISMEMBERMENT INSURANCE OPTIONAL TERM LIFE AND ACCIDENTAL DEATH &
SHORT-TERM AND LONG-TERM DISABILITY INSURANCE
EMPLOYEE ASSISTANCE PROGRAM
THESE BENEFITS REMAIN UNCHANGED FOR THE UPCOMING PLAN YEAR.
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TYPICALLY, YOUR HEALTH CARE FSA COVERS:
A Flexible Spending Account (FSA) lets you save on everyday health and dependent care expenses using pre-tax dollars. You can use your health care spending account for anything from copays, deductibles, and prescriptions. And with a dependent care account, you can pay for day-care, pre-school, and elder-care services while you work. When you enroll in a Flexible Spending Account, money is taken out of each paycheck to pay for certain health and dependent care related expenses not covered by your benefit plans.
TYPICALLY, YOUR DEPENDENT CARE FSA COVERS:
If you are married, your spouse must be employed, a full-time student, or disabled in order to receive dependent care tax-free savings. Services need to be related to the care of: Children age 13 and younger who are listed as dependents on your tax return (if your child turns 13 during the year, contributions do not stop, so plan accordingly).
Copayments Orthodontia Vision care Eye surgery
Counseling Medical and Dental deductibles Chiropractic Treatments
FLEXIBLE SPENDING ACCOUNTS
HEALTH CARE SPENDING ACCOUNT
DEPENDENT CARE SPENDING ACCOUNT Pre-School Program Day Care and Nursery Schools Before and After-school Programs Elder Care Services
TO PARTICIPATE IN THE FSA,
PLEASE ENTER YOUR ELECTIONS
ON CERIDIAN SELF-SERVICE.
In an effort to align Green Dot’s benefit anniversary from 8/1 to 7/1 going forward, the 2012-2013 elections will be for an 11 month period (8/1/12 – 6/30/13). Next year and going forward, your election period will be for 12 months from 7/1 to 6/30 of each year.
Effective 8/1/12, due to Health care reform, you may contribute up to a maximum of $5,000 for Health Care and $5,000 for Dependent Care Spending Accounts each year. You must reconfirm your election amount each year.
Coverage cost is currently subject to pre-tax deduction savings and therefore must be applied DURING OPEN ENROLLMENT ONLY for current employees. Discount payroll rates and preferred underwriting currently apply.
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Protect your own personal finances and standard of living in the event of a covered illness, pregnancy, or injury with the best supplemental plans available. All plans pay CASH benefits directly to the employee.
ENROLLMENT OPTIONS FOR YOU AND YOUR FAMILY INCLUDE:
• Short Term Disability Supplement
• Personal Accident Indemnity & Wellness Benefits
• Hospital Indemnity Plan & Wellness Benefits
• Personal Cancer Plan & Wellness Benefits & Annual Building Benefit
• Specified Health Event (Critical Illness/Injury and Intensive Care) & Wellness Benefits & Annual Building Benefit
Underwriting questions and waiting periods may apply for some pre-existing conditions INCLUDING CURRENT PREGNANCY. Coverage is PORTABLE AND GUARANTEED RENEWABLE FOR LIFETIME at same rates after 30 days of policy payroll deduction at employment separation. Current policyholders may now choose to file for CASH WELLNESS BENEFITS and other claims online at www.aflac.com.
For Plan details and options or to apply for coverage, email: [email protected] or call (661) 904-6542
AFLAC
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CARRIER WEBSITES Health Net—Medical EOA or PPO (800) 676-6976 www.healthnet.com
Kaiser Permanente—Medical HMO (800) 464-4000 www.kaiserpermanente.org
Delta Dental—(DeltaCare USA) Dental HMO (800) 422-4234 www.deltadentalins.com
Delta Dental—Dental PPO (888) 335-8227 www.deltadentalins.com
VSP—Vision (800) 877-7195 www.vsp.com
Prudential—Life/AD&D and Disability (800) 346-3778 www.prudential.com
Empathia—Employee Assistance Program (EAP) (800) 367-7474 www.mylifematters.com
IGOE Flexible Spending Accounts (800) 633-8818 www.goigoe.com
AFLAC—Voluntary Benefits (661) 904-6542 Dawn Christensen [email protected]
GREEN DOT HUMAN RESOURCES CONTACT: Lidia Larrazabal: (323) 565-1658 [email protected]
CARRIER CONTACT INFORMATION
CLICK TO GET TO
WEBSITES, BENEFIT
SUMMARIES, AND
BENEFIT FORMS
KAISER HMO—Medical PRUDENTIAL—Life/AD&D and Disability
HEALTH NET EOA—Medical EMPATHIA—Employee Assistance Program (EAP) HEALTH NET PPO—Medical AFLAC—Voluntary Benefits DELTA CARE USA—Dental DELTA DENTAL PPO—Dental VSP–Vision Plan IGOE – Flexible Spending Account Forms IGOE—FSA Reimbursement Form FAQs
IGOE—FSA Web Access Information
IGOE—FSA Plan Highlights
BENEFIT SUMMARIES & FORMS
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BENEFIT SUMMARIES & FORMS, AND PLAN INFORMATION
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KAISER PERMANENTE
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KAISER PERMANENTE
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HEALTHNET EOA
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HEALTHNET EOA
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HEALTHNET PPO
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HEALTHNET PPO
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HEALTHNET PPO
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DENTAL HMO
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DENTAL HMO
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DENTAL HMO
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DENTAL HMO
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DENTAL HMO
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DENTAL HMO
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DENTAL HMO
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DENTAL HMO
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DENTAL HMO
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DENTAL HMO
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DENTAL HMO
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DENTAL HMO
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DENTAL HMO
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DENTAL PPO
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DENTAL PPO
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EMPLOYEE ASSISTANCE PROGRAM
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EMPLOYEE ASSISTANCE PROGRAM
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Life/Disability
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Life/Disability
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Life/Disability
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Life/Disability
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Flexible Spending Account ACCESS INFORMATION
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Flexible Spending Account PLAN HIGHLIGHTS
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Flexible Spending Account FAQs (Page 1)
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Flexible Spending Account FAQs (Page 2)
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Flexible Spending Account Enrollment Guide
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Vision Coverage
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ERISA Notice
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ERISA Notice
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ERISA Notice
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ERISA Notice
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ERISA Notice
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ERISA Notice
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ERISA Notice
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CHIP Notice
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CHIP Notice
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CHIP Notice
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CHIP Notice
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CHIP Notice
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CHIP Notice
