Employee Benefits Help Sites administered by BenefitHelp - …mybenefithelpsite.com/wp-content/uploads/2015/12/Life... · We’re happy you’re considering Humana for your employee

Prepared for:

Life Care Partners LLC dba Family HomeHealth ServicesProposed coverage:- Dental

Broker: BENEFIT HELP

Humana sales representative: Kelly Danforth

Presented by: MARK HOLLAND

Proposal date: 05/05/2017

Medical | Dental | Vision | Disability | Life | Workplace Voluntary Benefits | Stop-loss | Retiree Benefits

What's inside:

❯ About Humana. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3

Dental proposal:❯ Plan highlights and rates. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5❯ Terms and conditions. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7

Humana proposal for:Life Care Partners LLC dba Family Home Health Services

2

We’re happy you’re considering Humana for your employee benefitsoffering. For more than four decades, we’ve helped businesses of allsizes provide their employees with quality, affordable health carebenefits. We can do the same for you.

Benefits* that help protectemployee’s health and finances:

❯ Medical: Humana offers PPO, HMO, POS, andHDHP plans with a wide range of deductibles,copayments, and prescription drug designs withaccess to more than 54,000 providers and almost4,000 hospitals nationwide. Our funding optionsinclude Health Savings Accounts (HSAs), HealthReimbursement Accounts (HRAs) and PersonalCare Accounts (PCAs).

❯ Dental and vision: Regular cleanings and eyeexams can detect problems and other diseasesthroughout the body. Humana’s dental and visionplans encourage prevention, early diagnosis, andtreatment – helping employees stay more healthyand fit.

❯ Workplace voluntary benefits: Humana’sworkplace voluntary benefits – disability, life,accident, critical illness, cancer, and supplementalhealth – can help your employees rest a little easierknowing they have a plan to help cover additionalexpenses if they can’t work due to an illness orinjury.

❯ Retiree benefits: With our broad-based MedicareAdvantage network and consumer-driven solutions ,Humana is uniquely positioned to addressemployers' FASB and GASB risk-mitigationstrategies while providing efficient, cost-effectivebenefit plan solutions for your Medicare-eligibleretirees.

You’ll find Humana makes the employee benefits experience simplerfor everyone involved by providing personal guidance and resources tohelp you and your employees make smart choices.

Here’s what you can expect:

❯ A quarterly newsletter, Focus, giving you the latest benefit news andindustry trends

❯ Online tools to help employees estimate costs for common proceduresand prescription drugs

❯ Resources for Spanish-speaking employees

❯ Fortune Magazine named Humana one of the Top 5 Most AdmiredHealthcare Companies in the United States**

❯ Financially strong company ranked 73rd on the Fortune 500

❯ Friendly, personal service

Humana, in partnership with your broker, will help you find a plan that’sthe best fit for you and your employees. And we’ll work closely with youto control costs and help your employees lead healthier, moreproductive lives.

* Availability varies by state** March 2009


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Why choose HumanaSpecialty Benefits?

❯ Personalize your benefits by working with youragent and our own experts. Together, we’lltailor a benefits package that works best foryou and your employees

❯ Improve worker productivity: Dental problemsresult in the loss of 164 million work hours,1

and vision problems result in $8 billion in lostproductivity each year 2

❯ Save on your rates when you add multipleHumana products

❯ Expect a simple and friendly experience frompeople who care and are ready to help youand your employees

1 CDC.gov2 The Vision Council

Rest easy, you're covered

You invest in your employees and care about their future. You providebenefits that you and your employees can feel good about. When youpartner with Humana, you have access to one of the industry’sbroadest choices of specialty benefits designed to help protect thepersonal health and finances of your employees and their families.

Dental and vision coverage help protect employees' health

Gum disease can be a risk factor for heart disease and other seriousconditions. With regular cleanings, a dentist may be able to recognizeearly symptoms of gum disease, and provide simple treatments toprevent it from progressing – keeping a patient’s mouth and heart alittle healthier.

An annual eye health exam also is an important part of your routinepreventive healthcare. Eye exams not only help vision, but an eyedoctor can detect major health issues, too. Diseases such as diabetes,hypertension, multiple sclerosis, high blood pressure, osteoporosis,and rheumatoid arthritis can be diagnosed just by looking into the eyes.

Disability, life, accident, critical illness, cancer, andsupplemental health help protect employees’ finances

If your employees are like most people, they probably don’t plan forexpenses not covered by their medical insurance such as loss ofincome, monthly bills, childcare services, and travel to treatmentcenters. By offering these benefits, you can help your employees bemore financially prepared for the unexpected.

Best of all, you can offer these valued benefits to your employeeswithout increasing your benefits budget – they can be 100 percentemployee paid. Plus, by offering a competitive benefits package, youmay even improve employee productivity and increase loyalty.


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Dental plan highlights and ratesProposed plan 1: TRADITIONAL PREFERRED 100/80/50 U&C 14

Employer Sponsored Non Dual Choice

Plan highlights

Preventive services coinsurance % 100 Endodontics Basic

Basic services coinsurance % 80 Periodontics Basic

Major services coinsurance % 50 Composite fillings for molars Not Selected

Individual Deductible $50.00 Complex surgical extractions Basic

Family Deductible $150.00 Implants Major

Waive deductible on preventive Yes Orthodontia Not Available

Annual maximum $1000.00 Orthodontia coinsurance % 0

Extended annual max Yes Orthodontia lifetime maximum $0.00

Waive preventive on annual maximum Not Selected Voluntary Not Selected

EE EESP EECH FAMEstimated counts 91 8 8 29Proposed rates $26.77 $53.53 $68.25 $95.01Estimated monthly premium $2,436.07 $428.24 $546.00 $2,755.29Estimated annual premium $29,232.84 $5,138.88 $6,552.00 $33,063.48

U&C: Members and their families benefit from negotiated discounts on covered services by choosing dentists in ournetwork. If a member visits a participating network dentist, the member will not receive a bill for charges more than thenegotiated fee for covered services. If a member sees an out-of-network dentist, coinsurance will apply to the usual andcustomary charge. Out-of-network dentists may bill you for charges above the amount covered by your dental plan.

Limitations, exclusions, waiting periods, and frequency or age limitations may apply. Do not cancel current groupcoverage until you receive written approval from Humana. Please verify the rates and selected plan(s) beforeimplementation to ensure a smooth transition.


Fully InsuredEffective date: 06/01/2017

5

FLORIDA

SGB0166A

Humana Dental TraditionalPreferred 14

Page 1 of 51-800-233-4013 • Humana.com

If you use an If you use anIN-NETWORK dentist OUT-OF-NETWORK dentist

Calendar-year deductible(excludes orthodontia services)

Individual$50

Family$150

Individual$50

Family$150

Deductible applies to all services excluding preventive services.

Calendar-year annual maximum (excludes orthodontia services)

$1,000After you reach the annual maximum amount, you will receive30 percent coinsurance on preventive, basic, and majorservices for the rest of the year (excludes orthodontia.)

Preventive services•Routine oral examinations (2 per year)•Bitewing x-rays (2 films under age 10, up to 4 films

ages 10 and older)•Routine cleanings (2 per year)•Fluoride treatment (1 per year, through age 14)•Sealants (permanent molars, through age 14)•Space maintainers (primary teeth, through age 14)•Oral Cancer Screening (1 per year, ages 40 and older)

100% no deductible 100% no deductible

Basic services •Emergency care for pain relief•Amalgam fillings (1 per tooth every 2 years,

composite for anterior/front teeth)•Oral surgery (tooth extractions including impacted

teeth)•Stainless steel crowns•Harmful habit appliances for children (1 per lifetime,

through age 14)

80% after deductible 80% after deductible

•Periodontics (periodontal cleanings 4 per year,scaling/root planing and surgery 1 per quadrantevery 3 years)

•Endodontics (root canals 1 per tooth per lifetimeand 1 re-treatment)

do not delete

Major services•Crowns (1 per tooth every 5 years)•Inlays/onlays (1 per tooth every 5 years)•Bridges (1 per tooth every 5 years)•Dentures (1 per tooth ever 5 years)•Denture relines/rebases (1 every 3 years, following 6

months of denture use)


•Denture repair and adjustments (following 6months of denture use)

•Implants (1 every 5 years for implant placement,crowns, bridges, and dentures)

do not delete

Orthodontia services Members may receive a discount on non-covered services of up to 20%. Members may contact their participating provider to determine if any discounts are available on non-covered services.

Humana Dental Traditional Preferred 14

1-800-233-4013 • Humana.comPage 2 of 5

Non-participating dentists can bill you for charges above the amount covered by your HumanaDental plan. To ensure you do not receive additional charges, visit a participating PPO Network dentist. Members and their families benefit from negotiated discounts on covered services by choosing dentists in our network. If a member visits a participating network dentist, the member will not receive a bill for charges more than the negotiated fee for covered services. If a member sees an out-of-network dentist, coinsurance will apply to the usual and customary charge. Out-of-network dentists may bill you for charges above the amount covered by your dental plan.

Waiting periods

Employer-sponsored funding: 10+ enrolled employees

Enrollment type Preventive Basic Major Orthodontia Initial enrollment, open enrollment No No No Not availableand timely add-on

Late applicant 1, 2 No 12 months 12 months Not available

1 Late applicants not allowed with open enrollment option.2 Waiting periods do not apply to endodontic or periodontic services unless a late applicant.

Questions? Simply call 1-800-233-4013 to speak witha friendly, knowledgeable Customer Carespecialist, or visit Humana.com.

Humana.com

Plan summary created on: 5/9/17 09:01

Feel good about choosinga HumanaDental plan Make regular dental visits a priorityRegular cleanings can help manage problemsthroughout the body such as heart disease, diabetes,and stroke.* Your HumanaDental Traditional Preferredplan focuses on prevention and early diagnosis,providing four exams and cleanings every calendar year:two regular and two periodontal.* www.perio.org

Go to MyDentalIQ.comTake a health risk assessment that immediately ratesyour dental health knowledge. You’ll receive apersonalized action plan with health tips. You can print acopy of your scorecard to discuss with your dentist atyour next visit.

Tips to ensure a healthy mouth• Use a soft-bristled toothbrush• Choose toothpaste with fluoride• Brush for at least two minutes twice a day• Floss daily• Watch for signs of periodontal disease such as red,

swollen, or tender gums• Visit a dentist regularly for exams and cleanings

Did you know that 74 percent of adult Americans believe anunattractive smile could hurt a person’s chances for careersuccess?* HumanaDental helps you feel good about your dentalhealth so you can smile confidently.* American Academy of Cosmetic Dentistry

Use your HumanaDentalbenefitsFind a dentistWith HumanaDental’s Traditional Preferred plan, you cansee any dentist. Members and their families benefit fromnegotiated discounts on covered servcies by choosingdentists in the HumanaDental Traditional PreferredNetwork. To find a dentist in HumanaDental’s TraditionalPreferred Network, log on to Humana.com or call1-800-233-4013.

Know what your plan coversThe other side of this page gives you a summary ofHumanaDental benefits. Your plan certificate describesyour HumanaDental benefits, including limitations andexclusions. You can find it on MyHumana, your personalpage at HumanaDental.com or call 1-800-233-4013.

See your dentistYour HumanaDental identification card contains all theinformation your dentist needs to submit your claims. Besure to share it with the office staff when you arrive foryour appointment. If you don’t have your card, you canprint proof of coverage at Humana.com .

Learn what your plan paidAfter HumanaDental processes your dental claim, you willreceive an explanation of benefits or claims receipt. Itprovides detailed information on covered dental services,amounts paid, plus any amount you may owe yourdentist. You can also check the status of your claim onMyHumana at Humana.com or by calling1-800-233-4013.

Policy Number: FL-70090-HC L 1/14, FL-70090-HC SB 1/14

Humana group dental plans are offered by Humana Insurance Company, HumanaDental Insurance Company, Humana InsuranceCompany of New York, Humana Health Benefit Plan of Louisiana, The Dental Concern, Inc., Humana Medical Plan of Utah,CompBenefits Company, CompBenefits Dental, Inc., Humana Employers Health Plan of Georgia, Inc. or DentiCare, Inc. (d/b/aCompBenefits)

This is not a complete disclosure of plan qualifications and limitations. Your agents will provide you with specific limitations andexclusions as contained in the Regulatory and Technical Information Guide. Please review this information before applying forcoverage. The amount of benefits provided depends upon the plan selected. Premiums will vary according to the selection made.


Page 3 of 5

Dental plan highlights and ratesProposed plan 2: TRADITIONAL PREFERRED 100/80/50 INFS 14

Employer Sponsored Non Dual Choice

Plan highlights

Preventive services coinsurance % 100 Endodontics Basic

Basic services coinsurance % 80 Periodontics Basic

Major services coinsurance % 50 Composite fillings for molars Not Selected

Individual Deductible $50.00 Complex surgical extractions Basic

Family Deductible $150.00 Implants Major

Waive deductible on preventive Yes Orthodontia Not Available

Annual maximum $1000.00 Orthodontia coinsurance % 0

Extended annual max Yes Orthodontia lifetime maximum $0.00

Waive preventive on annual maximum Not Selected Voluntary Not Selected

EE EESP EECH FAMEstimated counts 91 8 8 29Proposed rates $18.65 $37.30 $47.55 $66.20Estimated monthly premium $1,697.15 $298.40 $380.40 $1,919.80Estimated annual premium $20,365.80 $3,580.80 $4,564.80 $23,037.60

INFS: Members and their families benefit from negotiated discounts on covered services by choosing dentists in ournetwork. If a member visits a participating network dentist, the member will not receive a bill for charges more than thenegotiated fee for covered services. If a member sees an out-of-network dentist, coinsurance will apply to the maximumallowable charge of one or more network providers in your geographic area. Out-of-network dentists may bill you forcharges above the amount covered by your dental plan.

Limitations, exclusions, waiting periods, and frequency or age limitations may apply. Do not cancel current groupcoverage until you receive written approval from Humana. Please verify the rates and selected plan(s) beforeimplementation to ensure a smooth transition.


Fully InsuredEffective date: 06/01/2017

6

FLORIDA

SGB0166A


Page 1 of 51-800-233-4013 • Humana.com

If you use anIN-NETWORK dentist

If you use anOUT-OF-NETWORK dentist

Calendar-year deductible(excludes orthodontia services)

Individual$50

Family$150

Individual$50

Family$150

Deductible applies to all services excluding preventive services.

Calendar-year annual maximum (excludes orthodontia services)

$1,000After you reach the annual maximum amount, you will receive30 percent coinsurance on preventive, basic, and majorservices for the rest of the year (excludes orthodontia.)

Preventive services•Routine oral examinations (2 per year)•Bitewing x-rays (2 films under age 10, up to 4 films

ages 10 and older)•Routine cleanings (2 per year)•Fluoride treatment (1 per year, through age 14)•Sealants (permanent molars, through age 14)•Space maintainers (primary teeth, through age 14)•Oral Cancer Screening (1 per year, ages 40 and older)

100% no deductible 100% no deductible

Basic services •Emergency care for pain relief •Amalgam fillings (1 per tooth every 2 years,

composite for anterior/front teeth) •Oral surgery (tooth extractions including impacted

teeth)•Stainless steel crowns•Harmful habit appliances for children (1 per lifetime,

through age 14)


•Periodontics (periodontal cleanings 4 per year,scaling/root planing and surgery 1 per quadrantevery 3 years)

•Endodontics (root canals 1 per tooth per lifetimeand 1 re-treatment)

do not delete

Major services•Crowns (1 per tooth every 5 years)•Inlays/onlays (1 per tooth every 5 years)•Bridges (1 per tooth every 5 years)•Dentures (1 per tooth ever 5 years)•Denture relines/rebases (1 every 3 years, following 6

months of denture use)


•Denture repair and adjustments (following 6months of denture use)

•Implants (1 every 5 years for implant placement, crowns, bridges, and dentures)

do not delete

Orthodontia services Members may receive a discount on non-covered services of up to 20%. Members may contact their participating provider to determine if any discounts are available on non-covered services.

Humana Dental Traditional Preferred 14

1-800-233-4013 • Humana.comPage 2 of 5

Non-participating dentists can bill you for charges above the amount covered by your HumanaDental plan. To ensure you do not receive additional charges, visit a participating PPO Network dentist. Members and their families benefit from negotiated discounts on covered services by choosing dentists in our network. If a member visits a participating network dentist, the member will not receive a bill for charges more than the negotiated fee for covered services. If a member sees an out-of-network dentist, coinsurance will apply to the maximum allowable charge of one or more network providers in your geographic area. Out-of-network dentists may bill you for charges above the amount covered by your dental plan.

Waiting periods

Employer-sponsored funding: 10+ enrolled employees

Enrollment type Preventive Basic Major Orthodontia Initial enrollment, open enrollment No No No Not availableand timely add-on

Late applicant 1, 2 No 12 months 12 months Not available

1 Late applicants not allowed with open enrollment option.2 Waiting periods do not apply to endodontic or periodontic services unless a late applicant.

Questions? Simply call 1-800-233-4013 to speak witha friendly, knowledgeable Customer Carespecialist, or visit Humana.com.

Humana.com

Plan summary created on: 5/9/17 09:02

Feel good about choosinga HumanaDental plan Make regular dental visits a priorityRegular cleanings can help manage problemsthroughout the body such as heart disease, diabetes,and stroke.* Your HumanaDental Traditional Preferredplan focuses on prevention and early diagnosis,providing four exams and cleanings every calendar year:two regular and two periodontal.* www.perio.org

Go to MyDentalIQ.comTake a health risk assessment that immediately ratesyour dental health knowledge. You’ll receive apersonalized action plan with health tips. You can print acopy of your scorecard to discuss with your dentist atyour next visit.

Tips to ensure a healthy mouth• Use a soft-bristled toothbrush• Choose toothpaste with fluoride• Brush for at least two minutes twice a day• Floss daily• Watch for signs of periodontal disease such as red,

swollen, or tender gums• Visit a dentist regularly for exams and cleanings

Did you know that 74 percent of adult Americans believe anunattractive smile could hurt a person’s chances for careersuccess?* HumanaDental helps you feel good about your dentalhealth so you can smile confidently.* American Academy of Cosmetic Dentistry

Use your HumanaDentalbenefitsFind a dentistWith HumanaDental’s Traditional Preferred plan, you cansee any dentist. Members and their families benefit fromnegotiated discounts on covered servcies by choosingdentists in the HumanaDental Traditional PreferredNetwork. To find a dentist in HumanaDental’s TraditionalPreferred Network, log on to Humana.com or call1-800-233-4013.

Know what your plan coversThe other side of this page gives you a summary ofHumanaDental benefits. Your plan certificate describesyour HumanaDental benefits, including limitations andexclusions. You can find it on MyHumana, your personalpage at HumanaDental.com or call 1-800-233-4013.

See your dentistYour HumanaDental identification card contains all theinformation your dentist needs to submit your claims. Besure to share it with the office staff when you arrive foryour appointment. If you don’t have your card, you canprint proof of coverage at Humana.com .

Learn what your plan paidAfter HumanaDental processes your dental claim, you willreceive an explanation of benefits or claims receipt. Itprovides detailed information on covered dental services,amounts paid, plus any amount you may owe yourdentist. You can also check the status of your claim onMyHumana at Humana.com or by calling1-800-233-4013.

Policy Number: FL-70090-HC L 1/14, FL-70090-HC SB 1/14

Humana group dental plans are offered by Humana Insurance Company, HumanaDental Insurance Company, Humana InsuranceCompany of New York, Humana Health Benefit Plan of Louisiana, The Dental Concern, Inc., Humana Medical Plan of Utah,CompBenefits Company, CompBenefits Dental, Inc., Humana Employers Health Plan of Georgia, Inc. or DentiCare, Inc. (d/b/aCompBenefits)

This is not a complete disclosure of plan qualifications and limitations. Your agents will provide you with specific limitations andexclusions as contained in the Regulatory and Technical Information Guide. Please review this information before applying forcoverage. The amount of benefits provided depends upon the plan selected. Premiums will vary according to the selection made.


Page 3 of 5

Dental plan terms and conditionsRate Assumptions:

❯ The effective date is no later than 06/01/2017.

❯ Rates are guaranteed for one (1) year.

❯ Rates are based on SIC code 8082, situs state FL.

❯ Retirees are not included.

❯ Plan assumes an employer/employee relationship exists between all parties.

❯ These rates include a replacement commission schedule of a level 10%.

Enrollment:

❯ Rates are based on 187 eligible employees.

❯ For employer-sponsored dental plans, the group must have 100% participation if the employer contributes100% of the premium, or a minimum of 50% of all eligible employees if the employer contributes less than100% of the premium.

❯ If enrollment changes by +/-10 percent from the quoting enrollment of 91 subscribers / 236 members,underwriting reserves the right to re-evaluate rates.

❯ On Employer Sponsored plans, no waiting periods will apply for initial or timely add-ons for PPO/TRP andDHMO plans.

❯ Rates include an annual open enrollment at renewal time. Open enrollment allows employees to enroll astimely applicants during open enrollment. Standard waiting periods apply.

Plan Design:

❯ Proposal is contingent on Humana being the only dental plan(s) offered.

❯ This plan is based on our standard design and certificate language.

❯ Dependent age limitations are based on situs state requirements unless otherwise noted.

Billing:

❯ With our standard billing cycle, premiums are due by the first of the month for which coverage is to beprovided. Grace period is 31 days.

❯ Humana may adjust rates because of changes in plan design, legislation, or regulations that affect benefitspayable, eligible, or contractual provisions.

For insuring or offering entity, please see applicable sales or marketing literature.


Fully Insured

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Employee Benefits Help Sites administered by BenefitHelp - …mybenefithelpsite.com/wp-content/uploads/2015/12/Life... · We’re happy you’re considering Humana for your employee

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