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OPEN ENROLLMENT

GUIDE

The tools for a healthy workforce.

2020


OUR

MISSION

The mission of the Arizona Diamondbacks is to provide industry-leading entertainment in a clean, safe and family-friendly environment and to make a positive impact on its fans and civic partners by focusing on team performance, fan experience, financial efficiency, workplace culture, and community contribution. In doing so, the organization will consistently compete for championships, treat its customers to quality service and entertainment, invest in its product, employees and fans, and establish and maintain a position of leadership in the community.

TEAM PLAYER

PROMISE

As members of the Arizona Diamondbacks family, our culture is built on support, respect and trust that leads to a positive and productive work environment. We value each other’s talents and dedication to create a prideful sense of unity. Our unique and versatile mindset allows us to be at the forefront and serve as pioneers and leaders in the industry. We empower each other to be the best. Our potential is endless, and we will continually strive to be innovative in every facet. Our passion is shown in our commitment to help everyone including our partners, neighbors, fans and community. We are more than just employees – We are FAMILY, we are EXCEPTIONAL, we are TEAM PLAYERS... We are the D-BACKS.

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WELCOME TO

OPEN ENROLLMENT 2020

Open Enrollment for 2020 will be held from Friday, November 1 - Monday, November 18, 2019. Open Enrollment will be completed through the Self-Service site – my.dbacks.com During Open Enrollment you will be allowed to make new elections to any of your insurance coverages. Changes to coverage will be effective January 1, 2020 (except for newly elected supplemental life and voluntary buy-up Long-Term Disability coverage which needs to be approved by the insurance company following a health questionnaire being completed by you). If you do not make any new elections during open enrollment your benefits will continue based on your current enrollment. Enrollment in a Flexible Spending Account, Health Savings Account, and/or new Accident and Critical Illness insurance will require a completed paper form. Forms must be turned in by the end of Open Enrollment (November 18, 2019).

WHAT IS NEW

THIS YEAR? NEW WELLNESS PROGRAM & PREMIUM INCENTIVE This year we are launching a new wellness program and incentive. Team players who complete the incentive requirements will receive $50 per month off medical premiums in 2020. More details can be found on pages 8-9 of the guide.

HSA DEDUCITBLE & CONTRIBUTION UPDATES HSA contributions made for you by the Arizona Diamondbacks for those electing the HDHP plan will be split into 2 funding dates – 1/15/2020 and 7/15/2020. In accordance with IRS guidelines, the HDHP plan deductible is increasing $100 for team player only coverage and $200 for team player + dependent coverage.

INTRODUCING...HEALTHJOY! All full-time Team Players will be offered a new healthcare concierge app in early 2020 - HealthJoy. This new benefit is paid 100% by the Team and has many exciting benefits. Learn more on page 12 of this guide.

ADDITIONAL DENTAL PLAN OPTION We are excited to announce an additional Dental plan option through Delta Dental. There are now 2 Dental plans – Core and Upgrade. The Upgrade plan offers an increased annual maximum of $3,000.

SHORT-TERM DISABILITY BUY-UP OPTION For 2020 you will have access to a new buy-up option on the Short-Term Disability benefit. This is an optional benefit for those looking to insure more of your income should you be unable to work due to a non-work related accident or illness.

ACCIDENT AND CRITICAL ILLNESS Two additional new voluntary benefits will also be offered in 2020 - Accident and Critical Illness insurance through The Hartford! See pages 21 and 22 for a brief overview. 3


COVERING

YOU AND YOUR FAMILY

WHO IS ELIGIBLE TEAM PLAYERS

DEPENDENTS

The Arizona Diamondbacks is proud to offer a comprehensive benefits package to eligible, fulltime team players who work at least 30 hours per week and/or meet the requirements for continuing eligibility during an approved leave of absence. Eligible team players and qualified dependents may elect to participate or waive benefits being offered to them. Plans are effective on your date of hire.

Many of the plans allow you to cover your eligible dependents, which include: •

Legally married spouse

Same sex-domestic partner with valid domestic partnership affidavit

Children up to age 26 including:

This guide provides information about the options available to you as a benefits eligible team player of the Arizona Diamondbacks Please take time to learn about these benefits so you can make an informed decision. When you make well informed decisions, you can best manage your out-ofpocket costs and also help control the rising cost of healthcare.

Biological

Adopted

Any child you support who lives with you in a parent-child relationship and for whom you are the legal guardian

Disabled children of any age who are (or become) physically or mentally incapable of selfsupport while covered by our employee benefits program

WHO PAYS BENEFITS OFFERED Medical Wellness Program Health Savings Account (HSA) Healthcare Concierge Dental Vision

Carrier / Vendor

D-Backs Pay

You Pay

Find it on Page

BlueCross BlueShield of AZ

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WellRight

HealthEquity

HealthJoy

Delta Dental

DeltaVision®

Administered by EyeMed

8 ✓

10 12

14

15

Flexible Spending Account (FSA)

HealthEquity

16

Dependent Care FSA

HealthEquity

17

Basic Life and AD&D Insurance

The Hartford

Supplemental Life and AD&D Insurance

The Hartford

Short-Term Disability

The Hartford

Long-Term Disability

The Hartford

Accident Insurance Critical Illness

18 ✓

18

19

20

The Hartford

21

The Hartford

22

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ENROLLING

IN YOUR BENEFITS

WHEN TO ENROLL NEW HIRE

OPEN ENROLLMENT

QUALIFYING EVENTS

Benefits are effective on your day of hire as a new team player.

During the annual benefits open enrollment period.

Within 30 days of a qualifying life event.

Visit my.dbacks.com

Visit my.dbacks.com

Contact The People & Culture Department

What should you know? •

J A N UA R

Elections must be made within 30 days of hire and will remain until the next open enrollment

Y

You may elect to participate or waive benefits that are offered to you •

Enroll in benefits from November 1st - 18th

Benefits begin on January 1st

Did you have any changes in benefits or your family? •

Marriage

Birth or Adoption of child

You and/or your dependents become eligible or lose coverage with another group health plan

Spouse’s Open Enrollment

Change in work status (parttime to full-time)

HOW TO ENROLL LOG IN TO OUR TEAM PLAYER SELF SERVICE 1. Visit my.dbacks.com 2. Download forms: My Company > Electronic Forms 3. Or, check your Open Enrollment email 4. Send completed forms to The People & Culture Department by November 18, 2019 IMPORTANT NOTE ON REQUIRED PAPER ENROLLMENT FORMS Paper enrollment forms are required to enroll in or contribute to the following benefits: • Health Savings Account • Flexible Spending Accounts • Dependent Care Reimbursement Account • Voluntary Accident Insurance • Voluntary Critical Illness Insurance

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WHAT DOES THAT

WORD EVEN MEAN?

TERM

DEFINITION

Annual Deductible (Jan 1 through Dec 31)

The amount you are required to pay per calendar year before certain benefits are paid for by the plan. Once you meet the deductible amount, expenses are covered by the plan based on the coinsurance percentage. This deductible starts over every January 1st.

Annual Out-of-Pocket Maximum (Jan 1 through Dec 31)

The most you pay in a calendar year for covered services that are subject to coinsurance/ copays. The deductible is included in this amount. If you reach the annual out-of-pocket maximum, the plan pays 100% of covered in-network eligible expenses for the remainder of the plan year. Office visits and prescription copays are included in the annual out-of-pocket maximum for our medical plans. This maximum starts over every January 1st.

Balance Billing

When you are billed for the difference between the provider’s actual charge and the amount reimbursed under the medical or dental plan. This occurs when you go outside of the preferred provider network. Balance billing does not apply towards out-of-pocket maximum.

Coinsurance

The percentage you pay for covered expenses.

Copayments or Copays

The flat dollar amount you pay for certain in-network services.

Explanation of Benefits (EOB)

Provides information about how your claim was processed by the insurance company. The EOB details what portion of the claim was paid by the insurance company and what portion is your responsibility.

Guarantee Issue

The dollar amount of coverage you can be approved for without completing a health questionnaire. Guarantee issue amounts only apply during the 31 days following your initial eligibility period. If you wish to enroll in the Supplemental Life and AD&D plan or increase your coverage after your initial eligibility period, you will be required to complete the Evidence of Insurability Form, which contains questions about your health. Rates are based on your age and the amount of coverage you elect. See The People & Culture Department for additional details.

Health Savings Account (HSA)

A special, tax-advantaged, interest-bearing account to help plan and pay for qualified health care expenses (including plan deductible) while covered by a qualified high deductible health plan.

High Deductible Health Plan

A plan with a higher deductible than a traditional insurance plan. You pay more health care costs yourself before the insurance company starts to pay its share (your deductible). A high deductible plan (HDHP) can be combined with a health savings account (HSA), allowing you to pay for certain medical expenses with money free from federal taxes.

In-Network

A group of doctors, hospitals and other healthcare providers that contract with a plan vendor to provide quality healthcare services at favorable rates.

Preferred Provider Organization (PPO)

A healthcare arrangement designed to provide healthcare services at a discounted cost for members to use designated providers (the network), but which also provides coverage (at a lower level) for services received from providers that are not part of the network.

Usual, Customary, and Reasonable (UCR) Charges

Healthcare charges that are determined by your health plan vendor and are based on the range of fees charged by doctors with comparable training and experience for the same or similar service in your area. When you receive in-network care, UCR charges do not apply. You are responsible for amounts over UCR for out-of-network care.

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YOUR MEDICAL

INSURANCE OPTIONS UPGRADE PPO $250

HSA OR PPO

Provided by BCBSAZ

CORE PPO $750

HDHP W/ HSA $2,800

$250 | $500

$750 | $2,250

$2,800 | $5,600

You pay 10% once you meet your individual deductible

You pay 20% once you meet your individual deductible

You pay 0% once you meet your individual deductible

$6,350 | $12,700

$6,350 | $12,700

$2,800 | $5,600

No Charge

No Charge

No Charge

HealthJoy

$0 copay

$0 copay

$10 consultation fee

Primary Care Physician

$25 copay

$25 copay

Specialist

$35 copay

$35 copay

You pay 0% once you meet your individual deductible

Minor Labs and Blood Work (ex: X-rays, routine blood work)

Doctor’s Office: $25-35 copay Free Standing: You pay 10% once you meet your individual deductible

Doctor’s Office: $25-35 copay Free Standing: You pay 20% once you meet your individual deductible

You pay 0% once you meet your individual deductible

Major Diagnostic (ex: MRI, CT, PET scan)

You pay 10% once you meet your individual deductible

You pay 20% once you meet your individual deductible

Urgent Care

$35 copay

$35 copay

Emergency Room

$200 copay

$200 copay

HOW DOES IT WORK AT THE HOSPITAL? In-Network Deductible Individual | Family In-patient Surgery Out-patient Surgery

WHAT IS THE MOST I WILL PAY? In-Network Out-of-Pocket Maximum Individual | Family

HOW DOES IT WORK AT THE DOCTOR’S OFFICE? Preventive Care

WHAT IS MY COST FOR TESTS AND LABS?

WHAT IF I NEED EMERGENCY CARE? You pay 0% once you meet your individual deductible

HOW MUCH DOES IT COST FOR PRESCRIPTIONS?* Retail (30-day supply) Mail-order (90-day supply)

$5 | $50 | $75 copay

$5 | $50 | $75 copay

$10 | $100 | $150 copay

$10 | $100 | $150 copay

You pay 0% once you meet your individual deductible

WELLNESS

NONWELLNESS

WELLNESS

NONWELLNESS

WELLNESS

NONWELLNESS

Team player

$86.06

$111.06

$43.98

$68.98

$35.59

$60.59

Team player + Spouse

$187.66

$212.66

$107.85

$132.85

$83.00

$108.00

Team player + Child(ren)

$180.23

$205.23

$90.79

$115.79

$55.03

$80.03

Team player + Family

$292.17

$317.17

$159.55

$184.55

$102.95

$127.95

YOUR COST PER PAYCHECK (24)

*RX coverage under the Team plans is customized and may differ from information available on the BCBSAZ website and your member portal. For the Team benefit plans; Tier 1: Generic Medications, Tier 2: Preferred Brand Name Medications, Tier 3: Non-Preferred Brand Name Medications.

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NEW WELLNESS

PROGRAM

Provided by WellRight* *The Team does not have access to your personal information

THE D-BACKS ARE COMMITTED TO HELPING YOU LIVE HEALTHY AND BE YOUR BEST. Our wellness program, powered by WellRight, has four main components: a health assessment, pillar initiatives and personal challenges, and incentives. You’ll also have access to certified health coaches as an additional resource. All these items are managed via WellRight’s website dbacks.wellright.com or mobile app. Health Assessment This interactive HRA includes a series of common health-related questions on subjects such as physical activity, stress levels, sleep habits and medical history. Upon completion of this assessment you will receive a calculated “health age,” as well as your identified risk factors for many common health conditions. Our HRA is NCQA certified, which requires extensive work every 2 years to maintain. The National Committee for Quality Assurance (NCQA) is an independent 501(c)(3) nonprofit organization in the United States that works to improve health care quality through the administration of evidence-based standards, measures, programs, and accreditation. The certification makes sure that our HRA is backed by credible resources, asks questions within the right topics, and is able to assess important health issues.

Annual Physical Awareness is the first step in achieving good health. Annual physicals will help you to stay on top of your health with your physician and will measure important health indicators such as cholesterol levels, blood pressure and diabetes risk, so that you can set tailored goals that fit your individual needs.

STEP 1 You will receive a registration email from WellRight on November 1st, 2019. Click on the registration link in the email to activate your account.

STEP 2 Once registered, you can request your physician form by hovering over the Annual Physical tile and clicking the “Schedule” button- this will redirect you to the online scheduler where you can find the personalized form and instructions on how to submit when completed.

STEP 3 Complete your Health Assessment by hovering over the tile and clicking on the “Start” button. You can also access the Health Assessment by hovering over the top navigation bar “Health Assessment” tab and selecting “Questions” within the drop-down menu. Note: The Health Assessment is 100% HIPAA Compliant and the Team does not have access to individual responses

MORE MONEY IN YOUR POCKET. You will receive a wellness incentive of $50/month off medical premiums Save up to $600 in 2020 when you complete your Health Assessment and wellness visit

IMPORTANT DEADLINES! Complete your Health Assessment and submit your Annual Physical form by December 15th, 2019 to earn your incentive effective January 1st, 2020. If you do not complete the Health Assessment and submit your Annual Physical form by December 15th, 2019, your wellness incentive will become effective as soon as administratively possible following the completion of your requirements.

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YOUR MEDICAL

COSTS + CONTRIBUTIONS

OVERALL PLAN COSTS FOR 2020 UPGRADE PPO $250

CORE PPO $750

HDHP W/HSA $2,800

TOTAL ANNUAL PAYCHECK DEDUCTIONS

WELLNESS

NON-WELLNESS

WELLNESS

NON-WELLNESS

WELLNESS

NON-WELLNESS

Team player

$2,065.34

$2,665.34

$1,055.58

$1,655.58

$854.14

$1,454.14

Team player + Spouse

$4,503.83

$5,103.83

$2,588.33

$3,188.33

$1,992.11

$2,592.11

Team player + Child(ren)

$4,325.60

$4,925.60

$2,178.90

$2,778.90

$1,320.74

$1,920.74

Team player + Family

$7,012.17

$7,612.17

$3,829.27

$4,429.27

$2,470.80

$3,070.80

CHANGES FROM 2019 - 2020 UPGRADE PPO $250 PER PAYCHECK DEDUCTION CHANGE

CORE PPO $750

HDHP W/HSA $2,800

WELLNESS

NON-WELLNESS

WELLNESS

NON-WELLNESS

WELLNESS

NON-WELLNESS

Team player

$11.38

$36.38

$5.46

$30.46

$3.79

$28.79

Team player + Spouse

$26.00

$51.00

$14.89

$39.89

$9.61

$34.61

Team player + Child(ren)

$25.17

$50.17

$12.75

$37.75

$6.23

$31.23

Team player + Family

$42.37

$67.37

$22.93

$47.93

$12.62

$37.62

HSA CONTRIBUTIONS 2020 SEMI-ANNUALLY

PER YEAR

Team player

$300.00

$600.00

Team player + Spouse

$450.00

$900.00

Team player + Child(ren)

$750.00

$1,500.00

Team player + Family

$900.00

$1,800.00

D-BACKS HSA CONTRIBUTIONS

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HEALTH

SAVINGS ACCOUNT

Provided by HealthEquity

A Health Savings Account (HSA) is a savings account that you can use to pay out-of-pocket health care expenses with pre-tax dollars.

YOU HAVE CONTROL • • • •

WHO IS ELIGIBLE FOR AN HSA? Anyone who is:

Unused money rolls over from year to year in an interest bearing savings account. You can use the funds on medical, dental and vision expenses for you and your family. You can even invest your funds for the future. There is no “use it or lose it” rule.

WHO IS NOT ELIGIBLE FOR AN HSA? Anyone who is:

YOU SAVE ON TAXES • • •

Enrolled in the HSA Plan which is a qualified high deductible health plan (HDHP with an HSA $2,800).

All money deposited is not taxed. Withdrawals for eligible expenses are exempt from federal income tax. You can earn interest tax free.

• •

Covered under any other medical plan that has copays. Enrolled in Medicare, Medicaid, or TriCare or have received VA benefits in the last three months. Eligible to be claimed as a dependent on someone else’s tax return, such as a person under 26 who is still on their parent’s plan.

IMPORTANT CONTRIBUTIONS 2020 Contributions cannot exceed $3,550 for individual coverage and $7,100 for employee with dependent(s) coverage annually on a pre-tax basis for the 2020 tax year. Individuals age 55 and older are eligible to make catch-up contributions of an additional $1,000 annually.

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WHAT TYPE OF

CONSUMER ARE YOU?

Have you ever wondered what type of healthcare consumer you’d be identified as based on your lifestyle? Maybe you can quickly identify yourself using the profiles below. If you’re unsure which lifestyle describes you, take the quiz by visiting: healthequity.com/me.

THE SHOPPER Susie the savvy shopper

THE SURVIVOR Breast cancer survivor story

Shoppers frequently utilize medical care and reach their health plan deductible. A single unexpected medical event or just frequent minor incidents can lead to increased medical costs.

A survivor or their dependent may be dealing with a lingering health concern. While managing a chronic condition, you or your dependent likely face frequent office visits, procedures and hospital stays.

As a single mom of 3 kids, Susie knows how important it is to shop around. That’s why when she needs medical care or a prescription, she searches for high quality, low cost providers and asks her doctors about generic medications whenever possible. Did you know that costs of services such as MRI can vary in cost from $300 to $1,200 or more! Susie does! She saves by comparing costs of different procedures, looking for low or no cost alternative medications, and paying less annually for her HSA coverage than coworkers who elect PPO coverage.

John is happy to say his wife Mary is a breast cancer survivor. However, he can also tell you of the multiple medications, doctor visits and even surgeries that it has taken to get to this point. John suffers from high blood pressure and is also no stranger to high costs for care. John and Mary have met their deductible and out-ofpocket maximum 2 of the last 3 years. This year, John did the math and is choosing the HSA plan for lower premiums and the matching HSA contribution.

THE MINIMALIST Say hello to minimalist Matt

THE SAVER Meet a family who saves

Minimalists and their dependents are most likely able to enjoy a healthy life, with little medical expenses. They look for ways to minimize their health insurance costs, while still maintaining a safety net for unexpected life events.

Savers seek opportunities to reduce their tax liability and maximize earning potential. Savers and their dependents are likely able to enjoy a healthy life, with little medical expenses. Kimberly and Greg are in their late 40’s, have 2 teenage children and are in a 28% tax bracket. They take care of themselves and rarely see the doctor. Greg has high blood pressure and takes his generic blood pressure medication daily. They save money on the HSA by having less taken from their paychecks annually for HSA premiums than they would on the PPO. Add the matching contribution to their HSA fund and they save even more. In addition, by putting the premium savings into their HSA account and using those funds to pay for qualified expenses with tax-free dollars, it’s like saving 28% on all qualified expenses!

Matthew is 28 and single. He exercises regularly and maintains a healthy diet and lifestyle. Matthew remembers to get his annual physical each year as well as his flu shot. Matthew can benefit from an HSA due to the lower costs per paycheck and ability to save his employer’s HSA contribution and let it grow tax-free for a rainy day or future expenses. He can also use a portion of his HSA funds to pay for any dental or vision expenses! He may not need much today but by saving money in his HSA he will be prepared if his family or health circumstances change in the future.

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HEALTHCARE

CONCIERGE

Provided by HealthJoy

HEALTHCARE IS COMPLICATED.

WHO IS ELIGIBLE TO ACCESS HEALTHJOY?

HealthJoy Makes it Simple.

This year we are introducing HealthJoy. You can become engaged with HealthJoy to ensure that you have the lowest possible medical costs all year and the best access to care by following these 2 easy steps:

HealthJoy is available to all benefit eligible team players. It is completely free and will provide all of these resources and Telehealth visits* right inside the app. Look out for additional details in early 2020.

TELEHEALTH VIRTUAL VISITS

Download HealthJoy to your smart phone and register as a member.

Virtual Visits are available for you and your family via HealthJoy.

Provide HealthJoy with the list of doctors, pharmacies and labs that you want to go see.

Through the HealthJoy app you can connect with a provider on-line from any location, and receive a diagnosis and personalized treatment plan, including prescriptions for common medications.

HealthJoy can reach out to each of your providers and make sure that your next appointment is easy and at the lowest possible cost.

Example of minor medical needs: Rash | Sinus Problems | Stomach Ache | Fever *A $10 consultation fee applies for Team Players enrolled in the HDHP w/HSA $2,800 plan.

BENEFITS WALLET

ONLINE DOCTOR

MEDICAL BILL REVIEW

APPOINTMENT BOOKING

HEALTHCARE CONCIERGE

PROVIDER RECCOMENDATIONS

RX SAVINGS REVIEW

HSA / FSA SUPPORT

Start the conversation today by logging into the HealthJoy app or call 855-947-6900. 12


HELP CONTROL HEALTHCARE COSTS

TIPS ON

HEALTHCARE COSTS

Visit the Emergency Room only in the case of a true emergency. Check your area for an Urgent Care location or Convenience Care Clinic.

Use Generic prescriptions, if available. Ask your doctor for a Generic or request the Generic equivalent when having your prescription filled. Connect with your pharmacy to find where you can purchase your prescriptions at the lowest cost and even find coupons.

Save time and money by taking advantage of the mail order prescription drug program. Check out azblue.com for more details.

Utilize In-Network Providers. Your medical costs increase greatly when you visit a provider who is not in the network. Always confirm your provider is in the correct BCBSAZ network based on your plan selection, especially when being referred to another provider or facility for services.

Be sure you and your dependents receive routine annual physical exams and immunizations. Adults and children should have preventive health screenings recommended for their age for early detection of health conditions. All of these preventive services are covered at 100% on each of our plans. 13


YOUR DENTAL

INSURANCE OPTIONS Provided by Delta Dental DELTA DENTAL CORE PLAN In-Network

Out-of-Network

DELTA DENTAL UPGRADE PLAN In-Network

Out-of-Network

BENEFITS In-Network Calendar Year Deductible Individual | Family

$25 | $75

$25 | $75

$1,500

$3,000

These services are covered at 100%

These services are covered at 100%

You pay 10% of the charges

You pay 10% of the charges

You pay 30% of the charges

You pay 30% of the charges

Endodontics

You pay 10% of the charges (Covered as Basic)

You pay 10% of the charges (Covered as Basic)

Periodontics

You pay 10% of the charges (Covered as Basic)

You pay 10% of the charges (Covered as Basic)

Maximum Benefit (Per Person)

HOW DOES THE PLAN WORK? Preventive Services Cleaning and X-rays Basic Services

Fillings and Extractions Major Services

Crowns and Bridgework Root Canals Gum Disease

ORTHODONTICS Lifetime Maximum

50% up to $1,500

50% up to $1,500

Children and Adults

Children and Adults

Maximum Allowable Charge (MAC)

Maximum Allowable Charge (MAC)

PPO Plus Premier

PPO Plus Premier

Team player

$5.50

$7.56

Team player + Spouse

$8.25

$12.47

Team player + Child(ren)

$9.50

$14.65

Team player + Family

$12.25

$18.15

Age Limit

COVERAGE CONSIDERATIONS Out-of-Network Reimbursement Network

YOUR DENTAL COST PER PAYCHECK (24)

WHAT DOES A BALANCE BILL AMOUNT LOOK LIKE? Dr. Jones charges $750 for a crown. Delta Dental’s Plan

Since Dr. Jones isn’t in the network, he has the right to bill you for the $150 difference - plus the 30% coinsurance you still have to pay.

The Delta Dental Plan will only cover $600.

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On the other hand, if you visit an in-network dentist, he or she has already agreed to charge the $600 that the plan covers for crowns, so you would only owe 30% of that.


DELTA VISION PLAN

YOUR VISION

INSURANCE OPTION DeltaVision administered by EyeMed DELTAVISION PLAN In-Network

Out-of-Network

Eye Exam (once every 12 months)

$10 copay

Reimbursed up to $30

Eyeglass Lenses (once every 12 months) Single | Bifocal | Trifocal

$10 copay

Reimbursed up to $25 | $40 | $55

Frames (once every 12 months)

$150 allowance + 20% off balance

Reimbursed up to $75

Elective Contacts

$150 allowance + 15% off balance

Reimbursed up to $120

Covered in full

Reimbursed up to $200

BENEFITS

Medically Necessary Contacts Network

EyeMed Insight

YOUR VISION COST PER PAYCHECK (24) Team player

$1.17

Team player + Spouse

$5.85

Team player + Child(ren)

$5.85

Team player + Family

$5.85

Just for being a member, you are eligible for extra discounts and savings! You can find out more by visiting eyemed.com.

ADDITIONAL MATERIALS •

40% off additional pairs of glasses and 15% off conventional lenses once funded benefit is used

20% off any item not covered by the plan, including non-prescription sunglasses

LASER VISION •

Average 15% off the regular price or 5% off the promotional price for laser surgery

HEARING CARE •

Receive 40% off hearing exams and low price guarantee on discounted hearing aids

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FLEXIBLE

SPENDING ACCOUNT

Provided by HealthEquity

Flexible Spending Accounts (FSAs) enable you to set aside money on a pre-tax basis to pay for your out-of-pocket health and daycare costs. There are two types of accounts: the Healthcare FSA and the Dependent Care FSA. Team Players who have waived Medical coverage or who elect the Core PPO $750 or Upgrade PPO $250 plan can participate in one, both or neither FSA plan. Team Players electing the HDHP w/HSA $2,800 plan may only participate in the Dependent Care FSA plan; you can elect to participate in the HSA if you elect the HDHP, but both HSA and FSA is not allowed. Enrollment will be handled with a paper form.

HOW AN FSA WORKS

HEALTHCARE FSA

1. Each year during the Open Enrollment period (or when you are first hired), you decide how much to set aside for health care and/or dependent care expenses.

The Healthcare FSA allows you to set aside pre-tax dollars to pay for eligible health-related expenses that may not be covered by insurance. You can contribute a maximum of $2,700 annually.

2. Your contributions are deducted from your paycheck on a pre-tax basis in equal installments throughout the plan year.

ELIGIBLE EXPENSES A few examples of Dependent Care include:

3. When you have expenses to be reimbursed, you have the following options: •

Use your FSA Debit Card provided by HealthEquity. Keep your receipts just in case you need to substantiate any claims. Complete a claim form indicating that the expense has been incurred during the plan year, along with supporting documents as proof the eligible expense, such as a bill or itemized receipt from the provider. If these items are not available, you may have the care provider acknowledge receipt of payment by signing directly on a claim form.

Medical and dental deductibles, copayments and coinsurance

Prescription drugs copayments

Eye examinations, glasses, contacts, Lasik

Hearing examinations

Transportation to and from medical provider

Orthodontic expenses

Fertility treatments

Smoking cessation programs

Over-the-counter medicines are not considered eligible unless you have a doctor’s prescription.

THE USE IT OR LOSE IT RULE Due to IRS regulations, any unused funds remaining in an FSA at the end of the plan year are forfeited, however you may roll-over up to $500. This is handled automatically for you. This is known as the “Use It or Lose It” rule. You must incur expenses by the end of the plan year.

PLAN

SPEND

COLLECT

Determine how much to contribute based on the contribution limits.

Use your funds on eligible expenses by using your debit card or paying up front and submitting for reimbursement.

Submit IRS-Required documentation to substantiate your claims and collect your reimbursement.

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DEPENDENT CARE FLEXIBLE

SPENDING ACCOUNT

Provided by HealthEquity

The Dependent Care FSA allows you to pay for dependent daycare while you are at work or school. If you have dependent children under the age of 13 or dependents of any age who are unable to care for themselves, you can enroll in this plan and choose the amount you want to put aside for daycare. The maximum amount you can set aside each year is $5,000 (or $2,500 if married and filing separately). Enrollment will be handled with a paper form.

ELIGIBLE EXPENSES

An eligible care provider can be any provider you choose, except a dependent child who is claimed as a dependent and is under the age of 19. The care provider must meet the requirements of your state. The services may be as informal as care provided by your neighbor, as long as the provider claims the money as income when determining their taxes at the end of the year.

A few exmaples of Dependent Care include:

Daycare facility fees (excluding transportation, lunches and educational services)

Before-school and after-school care

Local day camp

In-home babysitting fees (income must be claimed by your care provider)

Nursery school and preschool (preschool expenses are eligible if the amount you pay for schooling cannot be separated from the cost of care).

IMPORTANT Healthcare FSA money can be used right away, even if you haven’t contributed your full amount through payroll deductions. Dependent Care FSA is the opposite. You must have the money in your account before you are allowed to claim reimbursement. Remember, “Money in before money out.”

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LIFE AND

AD&D INSURANCE

Provided by The Hartford

EMPLOYER-PAID LIFE AND AD&D It’s important that our team players have some level of financial protection. That’s why we provide eligible team players with Basic Life and AD&D coverage through The Hartford at no cost to you. All eligible team players receive guaranteed coverage in the amount of two times your annual earnings to a maximum of $500,000. Benefits are reduced to 65% once you reach age 70 and to 50% at age 75.

SUPPLEMENTAL LIFE AND AD&D We provide all eligible team players the option of purchasing additional Life and AD&D insurance through The Hartford. These benefits provide valuable peace of mind and give you the option of covering your dependents. If you elect coverage for yourself, you are eligible to elect coverage for your spouse or dependent children as well. You cannot elect Supplemental Life for your spouse and dependent children unless you elect coverage for yourself. SUPPLEMENTAL LIFE AND AD&D BENEFITS Team player Benefit

$25,000 increments up to a maximum of $750,000 Guarantee Issue: $300,000

Spouse Benefit

$5,000 | $15,000 | $25,000 | $50,000 | $75,000 | or $100,000 Not to exceed 100% of team player’s election Guarantee Issue: $50,000

Dependent Child(ren) <age 26

The original amount of your benefit will be reduced to 65% once you reach age 70 and to 50% at the age of 75.

Age Reduction

TEAM PLAYER AGE BAND

$2,000 | $5,000 | or $10,000 Guarantee Issue: $10,000

PER $1,000

SPOUSE

PER $1,000

NonSmoker

Smoker

<25

$0.044

<30

$0.060

$0.090

26-29

$0.048

CALCULATING THE COST OF VOLUNTARY LIFE

30-34

$0.070

$0.100

30-34

$0.062

35-39

$0.090

$0.150

35-39

$0.094

To calculate your cost, complete the following by selecting your coverage amount and rate (based on your age).

40-44

$0.120

$0.240

40-44

$0.14

45-49

$0.190

$0.380

45-49

$0.214

50-54

$0.320

$0.670

50-54

$0.292

55-59

$0.550

$0.870

55-59

$0.404

60-64

$0.780

$1.120

60-64

$0.596

65-69

$1.270

$2.220

65-69

$0.98

70-74

$1.960

$3.02

70-74

$2.36

>75

$5.200

$6.520

>75

$2.36

Coverage Amount

Rate

Team player $________ x $________

Per Pay Cost ÷ 1,000

= $________ ÷ 2 = $________

Spouse

$________ x $________

÷ 1,000

= $________ ÷ 2 = $________

Children

$________ x $________

÷ 1,000

= $________ ÷ 2 = $________ Total Cost Per Pay

Child Life Rate (all ages up to 26) Per $1,000 = $0.26

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$________


SHORT-TERM

DISABILITY

Provided by The Hartford

In the event you become disabled from a non-work related injury or sickness, disability income benefits provide a source of income while you are unable to work. NEW FOR 2020 Arizona Diamondbacks is now a “core/ buy-up” plan. Core benefits offer a basic level of income protection, and are paid for by the D-Backs.

CORE PLAN

The first $58,471 of your annual salary is protected in the event of a short-term disability through the “core” benefit provided by the Team. If your earnings are higher, you are now able to insure the amount between $58,471 and $155,922 of your income by enrolling in the new voluntary STD buy-up option. Please take time to calculate your costs and determine whether electing the buy-up option makes sense for you and your individual circumstances.

BUY-UP PLAN

Benefit Amount

66.7% Weekly Earnings 66.7% Weekly Earnings

When are Benefits Payable?

Benefits are payable following a 14-day waiting period

Benefits are payable following a 14-day waiting period

Maximum Benefit

$750 per Week

$2,000 per Week

Maximum Benefit Duration

24 Weeks

24 Weeks

Contributions

100% Employer Paid

100% Team player Paid

BUY-UP CALCULATION EXAMPLE SALARY

CORE BENEFIT

$80,000 ÷ 52

WEEKLY BENEFIT

x .667

EXCESS BENEFIT

BUY-UP OPTION

= $275.69

÷ 10

= $1,025.69

CORE

EXCESS BENEFIT

- $750

= $275.69

RATE

MONTHLY COST

PER PAY COST

x $0.33

= $9.10 ÷ 2

= $4.55

*Excess Benefit:

CALCULATE YOUR BUY-UP COST SALARY

CORE BENEFIT

$________ ÷ 52

WEEKLY BENEFIT

x .667

EXCESS BENEFIT*

BUY-UP OPTION

= $_______

÷ 10

If the excess benefit amount from the core benefit calculation is between $10 and $1,250 enter that amount in the excess benefit section of the buy-up calculation

If the excess benefit amount from the core benefit calculation is over $1,250, enter $1,250 in the excess benefit section of the buy-up calculation

EXCESS BENEFIT*

= $_______

- $750

= $_______

RATE

MONTHLY COST

PER PAY COST

x $0.33

= $____ ÷ 2

= $_______

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LONG-TERM

DISABILITY

Provided by The Hartford

In the event you become disabled from a non-work related injury or sickness, disability income benefits provide a source of income while you are unable to work.

The LTD plan offers a monthly benefit to help replace lost income if you experience a disability lasting longer than 26 weeks.

CORE PLAN

Arizona Diamondbacks is a “core/ buy-up” plan. You have the option to purchase a buy-up plan that would cover a higher percentage of your monthly earnings.

Option 1: Up to 60% of Monthly Earnings

Benefit Amount

Up to 50% Monthly Earnings

When are Benefits Payable?

Benefits are payable following a 180-day elimination period

Benefits are payable following a 180-day elimination period

Maximum Benefit

$12,000 per Month

$12,000 per Month

Maximum Benefit Duration

Social Security Normal Social Security Normal Retirement Age* Retirement Age* (SSNRA) (SSNRA)

INJURY

+

BUY-UP PLAN

Contributions

100% Employer Paid

Option 2: Up to 66.67% Monthly Earnings

Option 1: $0.26/$100 of Covered Payroll Option 2: $0.45/$100 of Covered Payroll

*If disabled before the age of 63, the benefit would be paid on the greater of your SSNRA or 4 years.

DISABILITY INSURANCE

BUY-UP CALCULATION EXAMPLE

=

SALARY

RATE

PER PAY COST

BUY-UP OPTION 1

$50,000 ÷ 12

÷ 100 x $0.26 = $____ ÷ 2

= $_______

BUY-UP OPTION 2

$50,000 ÷ 12

÷ 100 x $0.45 = $____ ÷ 2

= $_______

FINANCIAL PROTECTION

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ADDITIONAL

COVERAGE

Provided by The Hartford

ACCIDENT INSURANCE Group Accident insurance is designed to help you meet the out-of-pocket expenses and extra bills that can follow an accidental injury, whether minor or catastrophic. Lump sum benefits are paid directly to you based on the amount of coverage listed in the schedule of benefits. The accident base plan is guaranteed issue, so no health questions are required. Enrollment will be handled with a paper form. EXAMPLES OF YOUR BENEFITS INCLUDE:

Team player Accidental Death

$30,000

Joint Replacement

$2,000

Loss of speech and hearing

$30,000

Dislocations: Elbow, shoulder, wrist

$1,000

Fractures: Lower jaw, kneecap, hand bones

$1,000

YOUR ACCIDENT COST PER PAYCHECK

PER MONTH

PER PAYCHECK

Team player

$8.46

$4.23

Team player + Spouse

$13.35

$6.68

Team player + Child(ren)

$14.43

$7.22

Team player + Family

$22.61

$11.31

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ADDITIONAL

COVERAGE

CRITICAL ILLNESS INSURANCE Critical Illness insurance is designed to help you offset the financial effects of a catastrophic illness with a flat lump sum benefit if an insured is diagnosed with a covered critical illness. The Critical Illness benefit is based on the amount of coverage in effect on the date of diagnosis of a critical illness or the date treatment is received according to the terms and provisions of the policy. Refer to your policy for more details. Enrollment will be handled with a paper form. BENEFIT AMOUNTS

Team player

Up to $20,000

Spouse

Up to 50% of team player’s coverage amount

Child

Up to $5,000

EXAMPLES OF COVERED BENEFITS

Invasive Cancer

100%

Heart Attack

100%

Stroke

100%

Renal Failure

100%

Loss of Vision

100%

Benign Brain Tumor

100%

AGE BAND

$10,000 BENEFIT AMOUNT TEAM PLAYER

TEAM PLAYER + SPOUSE

TEAM PLAYER + CHILDREN

TEAM PLAYER + FAMILY

18-24

$3.90

$6.34

$6.41

$9.26

25-29

$4.74

$7.59

$7.25

30-34

$5.28

$8.42

35-39

$6.64

40-44

AGE BAND

$20,000 BENEFIT AMOUNT TEAM PLAYER

TEAM PLAYER + SPOUSE

TEAM PLAYER + CHILDREN

TEAM PLAYER + FAMILY

18-24

$6.79

$10.67

$9.30

$13.59

$10.52

25-29

$8.38

$13.04

$10.89

$15.96

$7.79

$11.35

30-34

$9.43

$14.62

$11.94

$17.55

$10.45

$9.15

$13.38

35-39

$12.12

$18.65

$14.63

$21.57

$9.16

$14.34

$11.67

$17.26

40-44

$17.09

$26.26

$19.60

$29.18

45-49

$13.99

$21.84

$16.50

$24.77

45-49

$26.69

$41.10

$29.20

$44.03

50-54

$19.29

$30.06

$21.80

$32.98

50-54

$37.27

$57.51

$39.78

$60.44

55-59

$26.16

$40.74

$28.67

$43.67

55-59

$51.00

$78.87

$53.51

$81.80

60-64

$36.66

$57.03

$39.17

$59.95

60-64

$72.01

$111.43

$74.52

$114.36

65-69

$49.96

$77.29

$52.47

$80.22

65-69

$98.61

$151.97

$101.11

$154.89

70-74

$33.70

$52.32

$35.41

$54.32

70-74

$66.08

$102.02

$67.79

$104.02

>75

$43.67

$67.47

$45.38

$69.46

>75

$86.02

$132.31

$87.74

$134.31

CALCULATING THE COST OF CRITICAL ILLNESS

FOLLOW THESE STEPS TO FIND YOUR COST

To calculate your cost, complete the following by selecting your coverage amount and rate (based on your age).

1. Select $10,000 or $20,000 benefit rate table 2. Find the age range that you will fall into on January 1, 2020

Rate

Per Pay Cost

3. Select your coverage tier = monthly cost

$________ ÷ 2

= $________

4. Divide by 2 to get your per paycheck cost 22


IMPORTANT

BENEFIT CONTACTS

BENEFIT

PROVIDER

PHONE

Medical + Pharmacy

BlueCross BlueShield of AZ

AZ: 602-864-4400 Non-AZ: 800-232-2345

Health Savings Account + Flexible Spending Account

HealthEquity

866-346-5800

healthequity.com

Healthcare Concierge

HealthJoy

855-947-6900

Download the app

Dental

Delta Dental

800-352-6132

deltadentalaz.com

866-800-5457

eyemed.com

Vision

DeltaVision®

Administered by EyeMed

WEBSITE azblue.com

Life and AD&D

The Hartford

800-523-2233

thehartford.com

Short-Term and Long-Term Disability

The Hartford

800-523-2233

thehartford.com

Accident + Critical Illness

The Hartford

866-547-4205

thehartford.com/benefits/myclaim

Employee Assistance Program

The Hartford’s Ability Assist

800-964-3577

guidanceresources.com

EAP Coordinator

Ray Karesky

480-221-4881

ray@karesky.com

Benefit Questions

MJ Insurance

602-772-3327

clientadvocate@mjinsurance.com

Director, People and Culture Jackie Dickerson

Arizona Diamondbacks

602-462-6644

jdickerson@dbacks.com

IN-NETWORK MEDICAL

PROVIDERS

DENTAL

VISION

BCBS OF ARIZONA

DELTA DENTAL

DELTAVISION

azblue.com

deltadentalaz.com

eyemed.com

1. Select Find a Doctor/Rx

1. Under Provider Search, select Find a Network Dentist

1. Select Find a Provider

2. Enter your address or zip code

3. Select Insight from the Choose Network dropdown

2. Select Find a Doctor 3. Select I am a BCBSAZ Member... who has a health plan through my employer 4. Select PPO from the Search a Network dropdown

3. Select Search 4. If you’d like to enter additional search criteria, do so and then select Update

5. Select Search 6. Enter your zip code 7. Enter any other search criteria 8. Select the search icon

23

2. Enter your zip code

4. Select Get Results


The tools for a healthy workforce.

The information in this Enrollment Guide is presented for illustrative purposes and is based on information provided by the employer. The text contained in this Guide 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 Guide 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.

Profile for MJ Insurance

Arizona Diamondbacks Open Enrollment Guide 2020  

Arizona Diamondbacks Open Enrollment Guide 2020