BENEFITS GUIDE
JANUARY 1 - DECEMBER 31, 2023
BENEFITS
TABLE
3
OF CONTENTS BENEFIT FIND IT ON PAGE HEALTH
Medical Plan 1 5 Medical Plan 2 6 Direct Value Network 7 Apta Health 8 Importance Of Preventive Care 10 Marathon Health Clinic 11 Virtual Visits 12 Where To Find Care 13 Dental 14 Vision 15 FINANCIAL BENEFITS Life and AD&D 17 Disability, Paid Parental Leave 18 Employee Assistance Program 19 NEW! Identity Theft Protection 20 401(k), Profit Sharing, Paid Time Off 21 Benefit Contacts 23 KAREN MEYER | (219) 762-3165 EXT. 352 | KAREN.MEYER@KURARAY.COM ELLEN ROSARIO | (219) 762-3165 EXT. 384 | ELLEN.ROSARIO@KURARAY.COM
BENEFITS Medical
MEDICAL PLAN 1
UMR
We use the UnitedHealthcare Choice Plus network of providers. Please see Plan Document for full details.
Plan Feature
Annual Deductible (Individual / Family)
Medical Out-of-Pocket Max (OOPM) Including Deductible (Individual / Family)
In-Network
$500 / $1,500
Out-of-Network
$1,000 / $3,000
$2,000 / $4,500 $4,000 / $9,000
Prescription Out-of-Pocket Maximum (Individual / Family) $3,000 / $6,000
Preventive Care Services 100%, not subject to deductible 50% after deductible
Physician’s Office Visits: Primary Care Physician (PCP) Specialty Care Physician (SCP) $15 copay $15 copay 70% after deductible
Telemedicine: OC24health $0 copay; 100% coverage N/A
Urgent Care Services 100% after $50 copay
Other Inpatient and Outpatient Services 90% after deductible 70% after deductible
Emergency Room Services 100% after $200 copay
Ambulance 90% after deductible
Prescription Drugs - Retail (31 day supply)
Generic Formulary Name Brands Non-Formulary Name Brands
Prescription Drugs - 90 day supply at Retail Generic Formulary Name Brands Non-Formulary Name Brands
Pre-Certification Requirements
The following services require you to pre-certify. You must call the number on your ID card in ad vance of services. A penalty of $500 will apply, if this process is not followed.
$10 $25 $50
$20 $50 $100
Services include: MRI’s, MRA’s, PET Scans, Oncology Care and Services, Dialysis, Inpatient stays, Outpatient surgeries, Colonoscopies, Home Health Care, Hospice Care, Skilled Nursing Care, Genetic Testing, Durable Medical Equipment > $1,500, Transplants
Cost per Pay
ENHANCED BENEFIT!
The infertility benefit is increasing to $15,000 per calendar year, with a $30,000 lifetime maximum. See plan document for more information.
+ Spouse
+ Child(ren)
5
Employee $18.46 Employee
$55.38 Employee
$34.62 Family $92.31
|
MEDICAL PLAN 2
UMR
We use the UnitedHealthcare Choice Plus network of providers. Please see Plan Document for full details.
Plan Feature
Annual Deductible (Individual / Family)
Medical Out-of-Pocket Max (OOPM) Including Deductible (Individual / Family)
In Network
$1,500 / $3,000
Out of Network
$3,000 / $6,000
$3,000 / $6,000 $6,000 / $12,000
Prescription Out-of-Pocket Maximum $3,000 / $6,000
Preventive Care Services 100%, not subject to deductible 50% after deductible
Physician’s Office Visits: Primary Care Physician (PCP) Specialty Care Physician (SCP) $15 copay $15 copay 70% after deductible
Telemedicine: OC24health $0 copay; 100% coverage N/A
Urgent Care Services 100% after $50 copay
Other Inpatient and Outpatient Services 90% after deductible 70% after deductible
Emergency Room Services 100% after $200 copay
Ambulance 90% after deductible
Prescription Drugs - Retail (31 day supply)
Generic Formulary Name Brands Non-Formulary Name Brands
Prescription Drugs - 90 day supply at Retail Generic
Formulary Name Brands Non-Formulary Name Brands
Pre-Certification Requirements
The following services require you to pre-certify. You must call the number on your ID card in advance of services. A penalty of $500 will apply, if this process is not followed.
$10 $25 $50
$20 $50 $100
Services include: MRI, MRA, PET Scan, Oncology Care and Services, Dialysis, Inpatient stays, Outpatient surgeries, Colonoscopies, Home Health Care, Hospice Care, Skilled Nursing Care, Genetic Testing, Durable Medical Equipment > $1,500, Transplants
ENHANCED BENEFIT!
The infertility benefit is increasing to $15,000 per calendar year, with a $30,000 lifetime maximum. See plan document for more information.
+ Spouse
+ Child(ren)
6
Cost per Pay Employee $6.92 Employee
$20.77 Employee
$11.54 Family $34.62
|
COVERAGE of services already
into
ENHANCED BENEFITS to maximize the quality of care
receive
PRIORITY ACCESS to top notch facilities around the country
COST SAVINGS providing $0 access to care at each stage of your health care journey
7 EXTENDED HEALTHCARE NETWORK You have access to three healthcare solutions as part of your benefit plan. This expanded network is called the Direct Value Network, or DVN. If you obtain healthcare services through the DVN, it is FREE to you. The addition of the DVN doesn’t change the fact that we are using the UHC Choice Plus network through UMR as our broad network of providers. With this expanded network, you’ll have access to top-notch care and simplified care-coordination. It connects potentially expensive yet necessary care to hands-on advocacy, ensuring you and your covered family are met with options.
you
EXPANDED
built
your plan
The Direct Value Network includes three different provider solutions to ensure better, broader and more affordable care to you and your covered dependents. These include: Everyone Health | Lab, Imaging, and Outpatient Services Regenexx | Chronic and acute orthopedic injury healing Edison Healthcare | Surgery benefit CALL APTA TO GET STARTED! 833-740-3136
HEALTHCARE JUST GOT A LOT EASIER
MEET YOUR APTA CARE COORDINATORS
Care Coordinators are an expert team of nurses, patient services representatives and benefits specialists who are ready to help you before, during and after any health event. Think of Care Coordinators as your personal healthcare team. They fight hard to help you save money and make sure you get the best possible care for you and your family. You can contact them via the website, toll-free number listed on your ID card, or through the myQHealth app.
Care Coordinators can help with:
billing and benefit questions
in-network providers
coaching to help you stay or get healthy
out-of-pocket costs
APP TO
HEALTHCARE
THE
8
• Claims,
• Finding
• Nurse
• Reducing
• Ordering ID Cards • Anything that can make the healthcare process easier for you MonoSol.myaptahealth.com Contact your care coordinators by calling: 833-740-3136 DOWNLOAD THE MYQHEALTH
HAVE
SUPPORT ON
GO.
APTA HEALTH FAQ
What is Apta Health? Apta Health is an independent, healthcare concierge model, that engages health plan members at the time they need to make a healthcare decision. Their main objective is to inform a member of their options, and then connect them to the best resources in the next steps of their health care journey. The key to the exceptional experience provided is the Apta Care Coordinator, better known as your “Healthcare Warrior.” Their Warriors have effectively served plan members for nearly two decades.
What does a Healthcare Warrior do?
The primary job of a Healthcare Warrior is to help you maximize your benefits and understand your options. Whether it’s a health plan decision, finding prescription drug savings, discussing a complex health condition with their clinical specialist, or even sorting out a bill from a medical provider, the Healthcare Warrior is there to help. Additionally, the independence of the Apta platform means that they are not tied to the insurance company, so you can trust that they are there to fight for you!
Yes! The Healthcare Warrior is there to help you navigate through the complexities of your benefits journey.
• Finding in-network providers
Can I contact my Healthcare Warrior with questions or issues
I am having with benefits other than the health plan?
• Identifying the highest quality providers or best value for services within the network
• Claims and billing questions
• Personalized nurse/clinical support for healthcare conditions
• Ordering ID cards
• Caregiver Support – advocacy and support for employees or spouses who need assistance caring for a sick plan member
• Anything that will make your healthcare journey easier
The following services will need to be pre-certified:
What services need to be pre-certified moving forward?
Are there any changes to the Prescription Plan?
MRI, MRA, & Pet Scan
Durable Medical Equipment over $1,500
Home Health Care & Services
Hospice Care
Dialysis
Genetic Testing
Inpatient Hospitalizations
Oncology Care & Services
Outpatient Surgeries
Colonoscopies
Skilled Nursing Facilities
Transplants –Organ & Bone Marrow
No. MonoSol will continue to partner with TrueScripts as our Pharmacy Benefit Manager (PBM). Plan members should receive the same great benefits and services they have experienced in the past.
9
•
•
•
•
•
•
•
•
•
•
•
IMPORTANCE OF
PREVENTIVE CARE
WHY DO YOU NEED PREVENTIVE CARE?
Your health coverage covers specific preventive care services at $0 out-of-pocket cost when completed by an in-network provider. Even when you’re feeling fine, a serious condition with no symptoms may put your health at risk.
Taking advantage of available services at the right time can help you stay healthier by:
• Identifying minor issues now before they develop into a major issue later
• Preventing certain illnesses and conditions
• Proactively detecting health problems at early stages, when treatments may be more successful
WHAT IS PREVENTIVE CARE?
Services are considered preventive when you don’t have any symptoms or diagnosed health issues connected with the preventive service. These services are often provided as part of your wellness exam.
You and your doctor will determine what services are right for you based on your: Age | Gender | Personal health history | Current health
WHAT’S YOUR SHARE OF COST?
WHAT IS NOT PREVENTIVE CARE?
If you have been diagnosed by a doctor with a health issue, the additional screenings and tests following this diagnosis are no longer considered preventive. Your health coverage still provides coverage for these services, but they are not covered under your preventive benefit.
Our health plans cover preventive care services at 100% – no additional cost to you – when you go to an in-network provider. Check your plan materials for details about your specific medical plan’s coverage and the provider directory for a list of health care professionals and facilities in your plan’s network.
10
MonoSol has contracted with Marathon Health to operate a free, near-site medical clinic!
SERVICES:
11 MARATHON HEALTH CLINIC
Use of the clinic is voluntary, and the services you receive will be 100% confidential. The clinic is available to all full-time employees, as well as their spouses and dependents age 6 and over in Valparaiso and Merrillville and age 3 and over in our Indianapolis locations.
• Primary, preventive and acute care services including annual physical • Convenient care for common conditions such as sinusitis, bronchitis, cough, pink eye, allergy symptoms, flu, etc. • Minor injury care • Routine care to monitor chronic health conditions • Provide recommendations should you need to see a specialist • Referral services with HealthPro • Wellness screenings • Labwork Marathon Health can perform most lab work ordered by Marathon Health physicians as well as those ordered by outside physicians. • Over 90 Prescriptions available • Health Coaching WHERE: Valparaiso Cumberland Crossing Shopping Center 1105 Cumberland Crossing Drive Merrillville Centier Bank corporate headquarters 600 E. 84th Street, Suite 100 WHEN: Valparaiso Monday - Friday: 8 am – 5 pm (closed daily for lunch from 12 pm – 1 pm) Merrillville Mon, Wed, Thur, Fri: 8 am – 5 pm Tuesday: 7 am - 4 pm (closed daily for lunch from 12 pm – 1 pm) INDY AREA LOCATIONS: Carmel 1111 W. Main St., Suite 120 Fishers 11787 Lantern Rd. #200 Traders Point 5630 W. 86th St. #150 Plainfield 2685 E. Main St. #101 Greenwood 1273 N. Emerson Ave., Suite H Indy East 9934 E. Washington St. Indy Downtown 155 W. Washington St. #155 HOW TO MAKE AN APPOINTMENT: (no walk-ins; please make an appointment) Online at: my.marathon-health.com/sign_in or call the specific location
are sent to pharmacy of choice if medically necessary.
GET THE CARE YOU NEED
can treat many medical conditions, including:
Cold and flu symptoms
Allergies
Pink eye
Ear infection
Respiratory infection
problems
be assigned a Primary Care Physician (PCP) if
have
12 FREE TELEMEDICINE THROUGH OC24HEALTH F 0317A © 2017 Teladoc, Inc. All rights reserved. Complete disclaimer at Teladoc.com/disclaimers. A pp e and the A pple ogo are trademar k s of A pple Inc reg s tered n the U S and other countr es A pp Store s a ser v ice mar k of A pple nc F 0317A © 2017 Teladoc, Inc. All rights reserved. Complete disclaimer at Teladoc.com/disclaimers. A pp e and the A pple logo are trademar k s o A pp e nc regis tered n the U S and other countr ies A pp Store is a ser v ce mar k of A pp e nc Talk to a local doctor anytime Speak with a doctor now! OC24health.com | 855.617.2116 OC24health gives you 24/7/365 access to U.S. board-certified doctors through the convenience of phone, video or mobile app visits. It’s an affordable option for quality medical care.
Our doctors
•
•
•
•
•
• Sinus
• Skin problems • And more! With your consent, we’re happy to provide information about your visit to your primary care physician. 1 2 3 4 5 6 Talk to an Indiana-based, board-certified doctor.* Receive quality care via phone, video or mobile app. Physicians are able to refer to high quality and lower cost specialist if needed. You can
you don’t already
one. Prescriptions
OC24health is less expensive than the ER or urgent care. * Does not apply during select times, and for those living outside Indiana and Ohio, virtual visits are with Teladoc® doctors This is only available to members enrolled in one of the MonoSol medical plans.
WHERE TO FIND CARE
TIP: COMPARE COSTS WITH THE COST ESTIMATOR TOOL AT WWW.UHC.COM/FIND-A-PHYSICIAN
Consider the information in the chart below when you need care. Still not sure where to go? Visit monosol.myaptahealth.com or call your healthcare concierge at 833-740-3136 to find a provider.
WHEN TO GO COST & WAIT
Usually the best choice for a long list of primary and acute care services.
The clinic can provide specialist recommendations and some prescriptions.
Ideal for times when the clinic is not open (nights and weekends). Use for non-emergency health conditions when you want to talk to a doctor from your computer or mobile device without an appointment.
TYPE OF CARE
Annual physical, Labwork, Minor Injury, Conditions such as sinusitis, cough, pink, eye, flu, etc., Routine checkups, Immunizations, Preventive services, General health management
FREE!
Requires an appointment
Very little wait time with scheduled appointments
Open Mon-Fri, 8am - 5pm (closed between 12-1p)
Allergies, Bladder Infection, Bronchitis, Cough/cold, Diarrhea, Fever, Pink eye, Rash, Seasonal Flu, Sinus problems, Sore throat, Stomach ache, UTI
Office visits can be used for preventive exams or a secondary option for a current health issue. Your doctor can also refer you to a specialist.
For when you need immediate treatment of a very serious, critical or life-threatening condition.
FREE!
Open 24/7 but services are only available in the US and may not be available in all states
Routine checkups, Immunizations, Preventive services, General health management
Heavy bleeding, Large open wounds, Sudden change in vision, Chest pain, Sudden weakness or trouble talking, Major burns, Spinal injuries, Severe head injury, Difficulty breathing, Major broken bones
Often requires a co-payment and/or co-insurance
Normally requires an appointment
Usually little wait time with scheduled appointments
Often requires high co-payment or co-insurance
In and out-of-network co-payments are the same.
In-network out-of-pocket costs are lower
24/7
13
Open
Marathon Health Clinic
Virtual Visits (OC24health)
Doctor’s Office Emergency Room
FREE FREE $$ $$$
Plan Feature Benefit Annual Deductible (Individual / Family) $50 / $150 Annual Plan Max $1,500 Diagnostic & Preventive (Routine Oral Exams, X-Rays, Children’s Fluoride Treatment) 100% Basic Extractions, Periodontics, Endodontics (root canals), Routine Fillings 80% after deductible Major (Inlays, Outlays, Crowns, Dentures, Bridgework, Implants) 50% after deductible Orthodontic Services (Dependent children under age 19) 50% Lifetime Orthodontia Plan Maximum $1,500 COST PER PAY COST PER PAY COST PER PAY COST PER PAY Employee $4.62 Employee + Spouse $13.85 Employee + Child(ren) $11.53 Family $23.07 DENTAL INSURANCE IMPORTANT NOTE: You can visit any dentist you would like because there is not a network associated with this plan.
VSP Plan In Network
Out of Network
$50
15
Exam (Once a year) $10 copay Up to $45 after $10 copay Lenses (Once a year) Single Bifocal Trifocal $25 copay After $25 copay: Up to $30 Up to
Up to $65 Contact Lenses (in lieu of frame and lens benefits; once a year) $60 copay for fitting & evaluation Lenses covered up to $130 Up to $105 Frames (Once every 24 months) $25 copay then up to $130 Up to $70 after $25 copay COST PER PAY COST PER PAY COST PER PAY COST PER PAY Employee $4.01 Employee + Spouse $6.76 Employee + Child(ren) $6.90 Employee Family $11.12 VISION INSURANCE MonoSol is offering the VSP Plan for its employees’ vision benefits. Take a look at the charts below to see what you will be paying and what the plan includes. Please see www.vsp.com or the Plan Document for full details.
BENEFITS Financial
LIFE AND AD&D INSURANCE
Basic Life and AD&D
MonoSol provides Basic Life and Accidental Death and Dismemberment (AD&D) insurance in the amount of 1½ times your basic annual earnings, up to a maximum of $500,000 at no cost to its employees. This benefit will terminate when your employment terminates or upon retirement, and benefits will reduce according to age. If you wish to select
coverage…
Voluntary Life and AD&D
This
provided by MonoSol.
PLAN FEATURE
EMPLOYEE
coverage beyond
SPOUSE
CHILD(REN)
Benefit Amount
Increments of $10,000
Increments of $5,000
Birth to 13 days: no ben efit. 14 days to 6 months: $250 6 months to age 26: Increments of $1,000 with a minimum of $2,000
Guarantee Issue Amount
Overall Max $250,000, not to exceed 5x salary $50,000, not to exceed 50% of employee amount $10,000
Reduce
COST FOR
AND
Benefits reduce to 65% at employee’s age 65. Ben efits terminate at employ ee’s age 70 or Retirement, whichever occurs first.
FOR LIFE AND AD&D INSURANCE COVERAGE
Rate
Rate
Dependent
monthly premium is $0.10 per $1,000. Please see
Document for full
17
more
is a voluntary plan that provides you the option to purchase
the Basic Term Life Insurance
$200,000 $35,000 $10,000
Benefits
to Age 65 Age 70 Age 75 Age 80 Age 85 Age 90 65% 45% 30% 20% 15% 10%
N/A MONTHLY
EMPLOYEE
SPOUSE
Age <30 30-34 35-39 40-44 45-49 50-54 55-59 60-64 65-69 70-74 75+ Employee
per $10,000 $.94 $1.06 $1.30 $2.01 $3.43 $5.69 $8.88 $13.85 $24.86 $44.51 $73.40 Spouse
per $5,000 $.67 $.76 $.93 $1.43 $2.44 $4.05 $6.32 $9.86 $17.70 $17.70 $17.70
Life
Plan
details.
DISABILITY INSURANCE
To assist our employees during illness or injury, MonoSol offers short term and long term disability benefits at no cost to you.
ENHANCED BENEFIT!
Both STD and LTD max monthly benefits were increased!
SHORT TERM DISABILITY (STD)
This benefit is paid for entirely by MonoSol
• Begins: 8th day of disability
• Max Weekly Benefit: 60% of weekly earnings up to a max of $2,000 per week
• Max Benefit Duration: 13 weeks
LONG TERM DISABILITY (LTD)
This benefit is paid for entirely by MonoSol
• Begins: After 90 days of disability
• Max Monthly Benefit: 60% of monthly earnings up to $10,000 per month
• Max Benefit Duration: Later of age 65 or Social Security Normal Retirement Age
Please see Plan Document for full details.
PAID PARENTAL LEAVE
MonoSol’s paid parental leave benefit is available to all full-time, non-union employees, with eligibility being first of the month after hire.
All new parents (birth mothers, fathers and adoptive parents) are eligible to receive four weeks of paid parental leave. For birth mothers, MonoSol will supplement any related, approved short-term disability benefits up to 100% of salary. The four-week benefit is available to use any time during the first year, as long as leave is continuous, not intermittent.
18
19 Life is full of challenges and sometimes balancing it is difficult. MonoSol is proud to provide a confidential program dedicated to supporting the emotional health and well-being of our employees and their families. The Employee Assistance Program (EAP) is provided at no cost to you for five sessions through Franciscan Alliance. You and your eligible dependents have access to short-term counseling with a licensed mental health professional and referrals to supportive resources. View some of the resources a counselor can address on the right side. ASSISTANCE PROGRAM EMPLOYEE Provided by Franciscan Alliance AN EAP CAN ADDRESS THE FOLLOWING ISSUES: WORK & CAREER SUBSTANCE ABUSE & ADDICTION FINANCIAL WELLNESS FAMILY & RELATIONSHIPS LEGAL ASSISTANCE EMOTIONAL WELL-BEING CONTACT YOUR EAP AT (219) 662-3730 OR (800) 747-7262 Convenient locations include Chesterton, Crown Point, Dyer, Hammond, Lafayette, Mishawaka, Munster, Michigan City, and Rensselaer, Indiana as well as Olympia Fields, Illinois
IDENTITY THEFT PROTECTION
PLAN FEATURES
Allstate Identity Protection’s comprehensive monitoring helps you protect yourself and your family against the impact of identity theft and the stress of trying to remediate fraud that may occur. See your personal data, manage it with rapid alerts, and help protect your identity.
• Identity and credit monitoring
• High-risk transaction monitoring
• Dark web monitoring
• Data breach notifications
• Social media account takeover monitoring
• Protect yourself and your family (“under your roof and wallet” and seniors 65+)
• Remediation of pre-existing conditions at no additional cost
• Full service, U.S.-based remediation support
• Up to $1 million identity theft expense reimbursement
BASIC PLAN BUY-UP PLAN
Free to Monosol employees
$13.95/month Voluntary for spouses/ dependents
To learn more, click here or visit https://bit.ly/AIPflyer
THREE EASY STEPS to get the most out of your Allstate Identity Protection benefit:
Set up your account at myaip.com/signin
Activate credit monitoring by verifying your identity Add family members, if applicable
20
1 | 2 | 3 |
401(K) AND PROFIT SHARING
In order to help you plan for your future, MonoSol offers a 401(k) plan, with a matching benefit.
401(k) Match Profit Sharing
Employees may make deferrals, in 1% increments. MonoSol will match dollar for dollar up to 6%.
In addition to the 6% company match, MonoSol’s plan provides for a Profit Sharing contribution. While these contributions are discretionary, in recent years they have been consistent and very generous, at amounts up to 9%.
PAID TIME OFF
Vesting
Employer matching and discretionary contributions are vested on a 5 year schedule, with 20% earned for each year of service.
21
Full-Time Work Schedule 30 hours - < 40 Hours 40 Hours Up to 5 years of service 11 PTO days 15 PTO days Between 5 and 9 years of service 15 PTO days 20 PTO days Between 10 and 19 years of service 19 PTO days 25 PTO days 20 or more years of service 23 PTO days 30 PTO days The following schedule is based on 8-hour days.
NOTES
BENEFIT CONTACTS Medical Prescription Dental
Near Site Health Clinic
Virtual Visits
833-740-3136
And download the MyQHealth app: monosol.myaptahealth.com
Valparaiso 219-440-4835 valparaiso@ourhealth.org Merrillville 219-801-3921 centier@ourhealth.org Indy Area 317-559-2185 https://my.marathon-health.com/sign_in
Download the app or visit OC24health.com 855-617-2116
Vision www.vsp.com 800-877-7195
Life/ AD&D Voluntary Life Short Term Disability Long Term Disability
www.lfg.com 800-423-2765
EAP: 888-628-4824
Employee Assistance Program 219-662-3730 or 800-747-7262
Identity Theft Protection www.myaip.com 800-789-2720
401(k)
www.netbenefits.com - 800-294-4015
Retirement Plan Financial Advisor: James Percifield and Brad Harber, Wells Fargo Advisors, LLC - 219-928-7004 brad.harber@wellsfargoadvisors.com
23
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.
