Why are we here today? JUNE is OPEN ENROLLMENT for all benefits: HEALTH DENTAL VISION LONG TERM DISABILITY OPTIONAL LIFE OPTIONAL LONG-TERM DISABILITY This is your opportunity to change your current benefits, add additional benefits or join for the first time if you have been employed since March 1, 2013 or before. Benefits will be effective July1 st Your employer may offer some benefits (such as LTD) to you at no cost. Please see your HR representative to be sure what benefits you may or may not be eligible for.
Why are we here today?. JUNE is OPEN ENROLLMENT for all benefits: HEALTH DENTAL VISION LONG TERM DISABILITY OPTIONAL LIFE OPTIONAL LONG-TERM DISABILITY - PowerPoint PPT Presentation
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Why are we here today? JUNE is OPEN ENROLLMENT for all benefits:
HEALTH DENTAL VISION LONG TERM DISABILITY OPTIONAL LIFE OPTIONAL LONG-TERM DISABILITY
This is your opportunity to change your current benefits, add additional benefits or join for the first time if you have been employed since March 1, 2013 or before.
Benefits will be effective July1st
Your employer may offer some benefits (such as LTD) to you at no cost. Please see your HR representative to be sure what benefits you may or may not be eligible for.
What if I have benefits now and I do not want to make any changes? You do not have to do anything. You will
automatically be enrolled onto the benefits you currently have.
The only reason to act is to make changes to your current benefits. You can do this by visiting yourebl.com and clicking on “Get Application” to pull up your original application to make changes.
Benefit Administrator:
EMPLOYEE BENEFIT
LOGISTICS
Where do I fill out an app?
Your application and all health, dental, and vision information will be available on the Internet.
Simply search for yourebl.com –access your company - and you will have everything you need.
VisionWellVision Exam, Lenses, Frames, or Contacts
EVERY 12 MONTHS
MetLife DentalIn-Network Out-of-Network
Paid at R & C 90th percentile.
You may have more OOP Type A – Preventative 100% 100% Type B – Basic 80% 80% Type C – Major 50% 50%
(12 month waiting period)
Calendar Year DeductibleIndividual $50 $75Family $150 $225
Maximum benefit$1,000 / Individual
MetLife OPTIONAL Life and Long-Term Disability This benefit is above and beyond what the
employer provides for all full-time staff as a life benefit. You may also enroll your spouse and dependents in your Optional Life benefits.
To find out what you are receiving as a full-time staff member please see your HR representative.
In order to receive this benefit you must fill out BOTH the Application and Statement of Health.
MetLife Optional Life Benefits This is Life Insurance that is above and beyond what your employer provides
for you, and enables you to enroll your family in optional life benefits.
Employees are eligible for benefits in $10,000 increments up to $500,000 (not to exceed 5x your salary, whichever is less). So someone making $15/hr would be eligible for $150,000.
$15/hr x 2080 (full time hours in a year) x 5 = $156,000 This benefit is not guaranteed. Therefore, you must qualify for this benefit by
completing a Statement of Health.
Spouses are eligible for amounts that do not exceed 50% of the your Optional life amount. Spouses MUST fill out a SEPARATE Statement of Health Form to be submitted with your application.
If you apply for : $100,000Your Spouse can apply for: $50,000
Dependents are eligible for 10% of your Optional life amount, with a MAX of $10,000 per dependent.
Changes can be made on the online enrollment form at yourebl.com
Optional LTD Benefit Changes As of July 1st we will no longer have
Guardian Optional Long Term Disability.
All employee’s currently enrolled in Guardian Optional LTD will be given the same, or a matched, Optional LTD policy (with equal or less premiums) through MetLife Optional LTD.
If you wish to make any changes to your current Guardian (soon to be MetLife) LTD, now is your chance. Changes can be made on the online enrollment form at yourebl.com
MetLife OPTIONAL Long Term Disability Benefits
Who can apply? Any Full-Time employee who does NOT receive LTD benefits from your
employer.
What is the benefit coverage?Maximum LTD benefit is 60% of your pre-disability earnings, with a
maximum monthly benefit of $4,000. Premium is based on your income and age.
Why should you apply for Optional LTD Benefits?
LTD insurance replaces a portion of your income (60% of your pre-disability monthly earnings) when you can’t work, due to illness or injury, to help you
pay for your essential living expenses after a 90 day elimination period.
Social Security benefits are not available if your are expected to be out of work for LESS than one year. LTD insurance could help supplement your income if you don’t qualify for Social Security benefits.
If you or others depend on your income LTD insurance helps you to maintain a steady income when you can’t work due to illness or injury.
Pharmacy
Rx a benefit only with health coverage
Low co-pay
$10 Generic$20 Brand no generic$40 Brand with generic ava
or DAW
50% Designer Drug
0% on any med covered in the OTC program
Some medications under this program are classified as “non-preferred”. This means there are alternative medications which are therapeutically equivalent. If your physician writes for a medication that is part of our “non-preferred” list you may want to discuss alternative medications which are just as effective.
THE NON-PREFERRED LIST IS AT YOUREBL.COM
Rx $0 Co-pay on OTCIf you are currently taking an anti-ulcer or allergy medication talk to your physician about using an OTC drug.
*The service must be performed by an in-network physician to be no cost to you.Any service performed by an out-of-network physician may have balance bill
fee’s that YOU will be 100% responsible for.
Durable Medical Equipment
DME benefits are covered at 50% with a benefit maximum of $1,000 per plan year.
Diabetic Testing Supplies for 1 month $100Your DME Co-pay $50The plan pays $50
Once the Plan has paid out $1,000 in DME charges for each plan year, YOU will be responsible for 100% of DME charges for the remainder of the benefit plan year.
Employee Benefit Logistics has an arrangement with a DME supplier. Please call Employee Benefit Logistics before you purchase medical supplies (even diabetic supplies) to see if we can help lower your cost.
Health Plan
As of July 1st you will have a deductible. The deductible is the amount you must pay first, before the plan pays. What is your deductible amount?
$300 per person insured
Health PlanCo-Insurance
This means the Plan will pay up to 80% of in-network approved charges and you are responsible for the remaining 20% up to a maximum out-of-pocket.
Health PlanYour Maximum out-of-pocket:
$2,500 per person$5,000 per family
Remember you still get your preventative visits for free. Preventative has $0 out-of-pocket.
The out-of-pocket includes all in-network deductible, co-insurance and co-pay.
After you have satisfied your max for out-of-pocket, the Plan will pay 100% for in-network approved charges.
COFINITY – PPO Network
Point-of service or Co-pay fee schedule:
Physician OfficeOutpatient Clinic $10 / per visitSpecialist Office
Urgent Care Center $10 / per visit
Emergency room $150 per visit waived if admitted
Ambulance ground transport $500 per transport
Example of in-network bill
You go in to your in-network hospital for a procedure.Your hospital charges $10,135
Your provider’s agreement with Cofinity allows $7,540 for this procedureYour Deductible is $300
Your Co-Insurance is $1,448The Plan pays $5,792
The total amount YOU will be responsible for $1,748
After you have met your deductible and co-insurance max for in-network approved charges the plan will pay $7,540
What if my doctor does not participate with Cofinity ?
If you go to a hospital and/or are seen by a provider who does not participate with Cofinity:
The plan will pay up to 100% of reasonable and customary fees for OUT-OF-NETWORK. This means YOU may be responsible for any remaining balance of the actual billed amount if the provider will not negotiate their fee down to a reasonable rate.
More about out-of-networkThere is NO maximum out-of-pocket for out-of-network claims.
How does this work?
You see a provider who does not participate with Cofinity for a routine office visit. The doctor charges $200 for the visit.
Reasonable and customary for this service is $50. You will pay a $10 office visit co-pay, and the plan will pay $40 (because the plan pays 100% of reasonable and customary after your co-pays are
met) and you will be responsible for $160.
This example assumes your deductible has been met first.
How will I know what was paid on my behalf and if I
owe anything? You will receive an EOB (explanation of
benefits) from Employee Benefit Logistics at your home. It will state how much the plan has paid and how much you owe the provider.
Keep all of these documents for your records.
The provider will receive the same EOB and expect payment from you for any expense you may owe.
ALERT
It is of the utmost importance that you keep your address current with Employee Benefit Logistics so that you receive your information on time
When does your new benefit year begin?
July 1, 2013
IT’S UP TO YOU! If you want benefit coverage or coverage
changes you must complete the on-line application, or update your previous on-line application. Visit:
yourebl.com
After you complete the on-line application you must go to your human resource office where the application will be printed out and you will go over all the benefits you have chosen and sign the application. Only after you have signed your application is it considered a valid submission and request for benefits.
IMPORTANT! You must enroll online at yourebl.com and
sign for all benefits with your HR representative BEFORE
June 30th
In order to begin benefits on July 1st
Any applications that are incomplete or received AFTER June 30th will NOT be accepted.
Please be sure each application is filled out completely, legibly, and signed & dated before submission.
Dis-Enrolling From Benefits
If you wish to dis-enroll from a specific benefit, please fill out a Dis-Enrollment Form in your HR office BEFORE June 30th
You will continue to pay for any benefits you are currently enrolled in, and do not specifically dis-enroll from.
Change your mind after July 1? You will not be able to make any plan
changes to your benefits until the next open enrollment period which is
June 2014 for the effective date ofJuly 1, 2014
There are a few exceptions to this rule. If you have what you think is a qualifying event such as divorce, birth or adoption of a child, marriage – please see your HR rep.
?Questions? I will not be taking questions here. Questions regarding specific coverage
or benefits should be directed to Employee Benefit Logistics.
Questions regarding specific deductions or coverage should be directed to Human Resources.
The details of the plans are on yourebl.com. Please refer to the website.
IT IS TIME TO ACT If you wish to sign up or make changes
to your benefits please visit yourebl.com today.
Your HR rep has the amount each of the benefits cost per pay.