Palmer Trinity School_OE Presentation

2024-2025 OPEN ENROLLMENT

©2019 ARTHUR J. GALLAGHER & CO. | AJG.COM

WELCOME TO YOUR 2024-202515OPEN , 2024 ENROLLMENT th



Annual Open Enrollment: August 12th – August 15th 2024



If you have not already, please schedule an appointment with a benefit counselor to enroll/change elections



UHC Medical plan names are changing with 2 minor plan design changes (same rich plans)

- CareCash program ending 

Changes to Employee Contributions:

- Medical, Dental and Vision 

Basic Life Insurance and Short Term Disability plan enhancements



New Voluntary Benefits administered by Trustmark (replacing Colonial)

BG\GBS\03

- Accident, Critical Illness, Hospital Indemnity, Perm Life w/ Long Term Care 2

WHO IS ELIGIBLE FOR BENEFITS

BG\GBS\03

Full-time employees working 40 or more hours per week who have met the new hire waiting period, 1st of the month following 60 days 

Your legal spouse including same sex spouses or domestic partner is eligible



Your dependent children to age 26, unmarried dependent children between ages 27-30 (if special criteria met), disabled children of any age

3

QUALIFYING LIFE EVENTS 

Marriage, Divorce and Legal Separation



Birth, adoption, legal custody, guardianship of child



Change in student status of dependent child



Change in scheduled work hours



Beginning or returning from leave of absence



Death of a spouse or child



Change in spouse’s employment and/or benefit status



Enrolling in Medicare



Eligibility or termination of Medicaid or CHIP (60 days)



Involuntary loss of other group coverage

BG\GBS\03

Changes in benefit elections are only allowed within 30 days of the life event – documentation is required 4

BG\GBS\03

MEDICAL PLANS 

Primary Care Physician selection Required (HMO & POS)



No Referral required to see Specialist (HMO & POS)

MEDICAL PLAN: DU3A-M HMO In-Network Only

Out-of-Network

$0

N/A

Out of Pocket Maximum

$2,500 Individual / $7,500 Family

N/A

Coinsurance

10%

N/A

Physician and Specialist visits

$15 Copay / $35 Copay

N/A

Emergency Room

$100 Copay

N/A

Urgent Care

$35 Copay

N/A

$0

N/A

Calendar Year Deductible

Diagnostic Test (Xray / bloodwork) Imaging (CT / PET scans , MRIs) Prescriptions

BG\GBS\03

Inpatient Hospital Outpatient Hospital

Designated Network: $100 Copay Regular Network: $200 Copay Retail (30 days) - $10 / $50 / $85 Mail Order (90 days) - $25 / $125 / $212.50 $200 Copay per day to max $1,000 per admission $150 Copay

N/A

N/A

N/A N/A

6

MEDICAL PLAN: DU2H-M POS In-Network

Out-of-Network

Calendar Year Deductible

$0

$500 Individual / $1,500 Family

Out of Pocket Maximum

$2,500 Individual / $5,000 Family

$5,000 Individual / $10,000 Family

Coinsurance

20%

50%

Physician and Specialist visits

$20 Copay / $40 Copay

50% after Deductible

Emergency Room

$100 Copay

50% after Deductible

Urgent Care

$45 Copay

50% after Deductible

$0

50% after Deductible

Diagnostic Test (Xray / bloodwork) Imaging (CT / PET scans , MRIs)

Regular Network: $250 Copay

50% after Deductible

Retail (30 days) - $10 / $50 / $85 Mail Order (90 days) - $25 / $125 / $212.50

Not Covered

Inpatient Hospital

$600 Copay per admission

50% after Deductible

Outpatient Hospital

$200 Copay

50% after Deductible

Prescriptions

BG\GBS\03

Designated Network: $150 Copay

7

SEMI-MONTHLY PAYROLL DEDUCTIONS Palmer Trinity Private School continues to pay 100% of the cost of your healthcare coverage for employee only on the HMO plan.

BG\GBS\03

MEDICAL

HMO DU3A-M

POS DU2H-M

Employee Only

$0

$27

Employee + Spouse

$230

$292

Employee + (Child)ren

$90

$141

Family

$317

$401

8

UHC REWARDS PROGRAM  Enrolled Employee & Spouse can earn up to $300 each!  Earn dollars by completing various activities: - Tracking steps - Tracking sleep - Connect a tracker - and much more!  Visit UHC Rewards for the full list of rewardable activities  Redeem rewards in form of a gift card  Questions? Call 1-866-230-2505

BG\GBS\03

How do you get started?

9

VIRTUAL CARE / MOBILE APP Access Virtual Visits!

Mobile App

Included in your health plan

Puts your plan at your fingertips



See and talk to a doctor via mobile device or computer – 24/7



$0 cost share

 

Get care in 20 minutes or less To get started with a Virtual Visit, visit: myuhc.com/virtualvisits



Use a Virtual Visit for minor medical issues such as:

BG\GBS\03

        

    

Find nearby care options in your network Estimate costs Video chat with a doctor 24/7 View and share your medical/dental/vision plan ID card See your claim details and view progress toward your deductible

Bladder infection (UTI) Bronchitis Cold/flu Fever Pinkeye Rash Sinus problems Sore throat Stomachache 10

BG\GBS\03

DENTAL PLANS

DENTAL HMO / PPO HMO Network

In-Network Only

In-Network

Calendar Year Deductible

No Deductible

$50 per person ; $150 family limit

Calendar Year Benefit Maximum

N/A

$1,000

Preventive Dental Services (cleanings, exams, x-rays)

Various copay applies – please see schedule of benefits

Covered

Basic Services (fillings, extractions)

Various copay applies – please see schedule of benefits

20% after deductible

Major Services (crowns, dentures, bridges)

Various copay applies – please see schedule of benefits

50% after deductible

Orthodontia Services

BG\GBS\03

PPO

Estimated cost: $2,250 Child to age 19 Estimated cost: $2,350 Adult Semi-Monthly Payroll Deductions:

Not Covered

Employee Only

$0

$16

Employee + Spouse

$6

$36

Employee + (Child)ren

$10

$43

12

BG\GBS\03

VISION PLAN

VISION In Network Vision Exam

$10

Materials

$15

Vision Exam

12 months

Lenses or Contact Lenses

12 months

Frames

12 months

Single Vision, Bifocal and Trifocal Lenses

Covered 100% after applicable materials copay ($15) $150 allowance; additional 30% off balance

Frames

Formulary (disposable): up to 6 boxes Non-Formulary: $150 allowance

Contact Lenses Medically Necessary

Covered in full

BG\GBS\03

Semi-Monthly Payroll Deductions: Employee Only

$0

Employee + Spouse

$3

Employee + (Child)ren

$5

Family

14

FLEXIBLE SPENDING ACCOUNT A Flexible Spending Account (FSA) offers you a convenient, pre-tax way to pay for eligible health and dependent care expenses. There are two types of Flexible Spending Accounts: Health Care FSA

Eligible health care expenses includes health plan deductibles, coinsurances, copays, and other related expenses not covered by your health plan.

Examples of eligible expenses are:  Medical, dental, or vision deductibles, coinsurances and copays  Prescription drugs  Over-the-counter medical supplies  Eyeglasses, contact lenses, contact solution vision exams To see a full list of eligible and ineligible expenses, please visit: www.irs.gov, search for forms and publications (502 for healthcare plans and 503 for dependent care plans).

BG\GBS\03

    

Dependent Care FSA

To be eligible for the dependent care FSA, your child must be 13 years or under and you must be at work during the time your eligible dependent receives care. In certain circumstances, adult dependent care expenses may also be eligible.

Dependent Care Expenses may be reimbursed for services provided:  In or outside your home by anyone other than your spouse, a person you list as your dependent for income tax purposes, or one of your children under the age of 13.  By a dependent care center or childcare center (including preschool). If the center cares for more than 6 children, it must comply with all applicable state and local regulations.  By a housekeeper, whose services partially include caring for a qualifying individual.

Your FSA elections run from September 1 – August 31 Claims reimbursement must be submitted by December 31 You may roll over an IRS maximum of $640 (healthcare FSA only), anything additional will be forfeited You MUST re-enroll from year to year, this benefit does NOT automatically continue New card is sent to those who are enrolling for the first time or who’s card is expiring soon (Health Care only, no card for Dependent Care) 15

BG\GBS\03

LIFE AND DISABILITY PLANS

BASIC, VOLUNTARY LIFE AND AD&D BASIC LIFE AND AD&D 

This benefit is 100% paid by Palmer Trinity School



2x Annual earnings to a max $500,000 (previously $400,000)



The guarantee issue is $325,000



Your Accidental Death and Dismemberment benefit will match your Basic Life benefit



Make sure to assign a beneficiary during Open Enrollment on Employee Navigator

VOLUNTARY LIFE AND AD&D 

This benefit is 100% paid by the employee



Please note you must elect Employee Life Insurance before electing Spouse and/or Child coverage



Rates for Voluntary Life are specific to the amount elected and age



Employee Voluntary Life Insurance Guarantee Issue is $150,000 (Employee coverage cannot exceed

 

$500,000 / 5x annual earnings - increments of $10,000) Spouse Voluntary Life Insurance Guarantee Issue is $20,000 (Spouse coverage cannot exceed $250,000 nor 50% of employee coverage – increments of $5,000)



Child(ren) Voluntary Life Insurance (14 days and over) Guarantee Issue is $10,000 (not to exceed 50% of employee coverage –

BG\GBS\03

increments of $2,000)

17  Anyone who has previously declined coverage will need to submit and Evidence of Insurability form. If you are currently

EMPLOYER PAID DISABILITY  SHORT TERM DISABILITY 

Automatically enrolled at no cost to you



Provides 66.67% of your Basic Weekly Earnings (previously 60%)



Benefit Maximum: $2,000 per week



7 day elimination period for disabling illness / 0 days for disabling injury



Benefit payable for up to 13 weeks

LONG TERM DISABILITY 

Automatically enrolled at no cost to you



Provides 60% of your Basic Monthly Earnings



Benefit Maximum: $10,000 per month



The benefit will begin after you have been disabled for 90 days



Pre-existing condition limitation 3/12 (must not have a claim for a preexisting disabling condition during first 12 months of coverage. If a claim is filed, look back is 3 months from effective date)

BG\GBS\03



Benefits could be payable up to age 65 or Social Security Normal Retirement Age

18

BG\GBS\03

EMPLOYEE ASSISTANCE PROGRAM (EAP) 

3 free counseling sessions per incident per year



Confidential and private; not shared with employer



Helps you and your family with managing stress, anxiety, legal, financial concerns and more



For enrolled medical members only

19

BG\GBS\03

VOLUNTARY BENEFIT PLANS

VOLUNTARY BENEFITS POLICY FEATURES Health Insurance Designed to cover treatment of any illness, accident or hospital stay* Pays providers directly (doctors, hospitals, pharmacies)

*Subject to plan designs, limitations, and exclusion

Voluntary Benefits Covers specific illnesses, accidents and hospital confinements only Benefits are paid direct to you and designed to assist with out of pocket expenses

BG\GBS\03

Voluntary Benefits are a supplement, not a replacement to health insurance

21

CRITICAL ILLNESS INSURANCE Policy Design Lump sum benefit payable upon diagnosis of a covered critical illness $10,000, $20,000, or $30,000 Spouse at 50% | Child(ren) at 25% (up to age 26) Invasive Cancer Heart Attack Stroke Major Organ Transplant End Stage Renal Failure Skin Cancer 10% Different / Same Illness: 0 month Diagnosis Separation Wellness Benefit: Annual Benefit:

$50 (once per covered person per calendar year) Restores yearly Underwriting Offer GUARANTEE ISSUE!

NO PRE-EXISTING CONDITION WAITING PERIOD! A covered critical illness must occur on or after the effective date

BG\GBS\03

Rates based on Non-Tobacco and Tobacco status, spouse rate based on employee age (See Guide or Employee Navigator for rates)

22

See brochure / policy for all benefit features, limitations, and

ACCIDENT INSURANCE Policy Design Benefits are paid direct to you based on treatment received and injuries sustained as a result of a covered accident.

Common activities that are covered: Football, baseball, basketball, soccer, tennis, paintball, mountain biking, cheerleading, boxing, skateboarding, skiing, car accidents, motorcycle accidents, hunting, fishing, hiking, etc.

Excluded activities: Aeronautical events, motorized vehicular racing or track days, illegal activities, etc.

Benefit Highlights Coverage Type:

24 Hours

Over 20 named benefits listed in the brochure Urgent Care:

$100

X-Ray:

$200

Follow Up:

$100 (6)

Fractures:

Up to $10,000

Hospital Admission and Daily Benefit: Wellness Benefit

$2,000 (24HR) Initial / $400 (365) Day $50 (once per covered person per calendar year)

A covered accident must occur on or after the effective date

BG\GBS\03

(See Guide or Employee Navigator for rates)

23

See brochure / policy for all benefit features, limitations, and

HOSPITAL INDEMNITY INSURANCE Policy Design Expenses associated with a hospital stay can be financially difficult if money is tight and you are not prepared. But having the right coverage in the right place before you experience a sickness or injury can help eliminate your financial concerns and provide support at a time when it is needed most.

Benefit Highlights Initial Hospital Confinement (20HR)

$1,500 (1 time per year)

Daily Hospital Confinement (daily)

$100 (up to 10 days)

ICU Hospital Confinement (daily)

$100 (up to 10 days)

Provisions Guarantee Issue?

YES!

Pre-Existing Condition Waiting Period?

NO!

Pre-Existing Pregnancy Covered?

YES!

A covered hospital stay must occur on or after the effective date

BG\GBS\03

(See Guide or Employee Navigator for rates)

24

See brochure / policy for all benefit features, limitations, and

PERMANENT LIFE INSURANCE w/ LONG TERM CARE Policy Design Permanent Life insurance can provide you and your family with long term financial security.

Permanent Life insurance provides coverage that will last a lifetime. This permanent life insurance plan also includes living benefits by providing financial protection in the event of a long-term care stay.

Benefit Highlights Life and Care Rider 90 Day Waiting Period 2 of 6 ADLS Professional Care: 4% per month, for licensed care, up to the life insurance volume Family Caregiving: 2% per month, up to the life insurance volume Benefit Restoration (protects life insurance) Terminal Illness Benefit Provisions GUARANTEE ISSUE up to $100,000 / $20,000 for Spouse No Death Benefit Reduction at any age

BG\GBS\03

Rates based on Non-Tobacco and Tobacco status, spouse rate based on employee age (See Guide or Employee Navigator for rates)

25

See brochure / policy for all benefit features, limitations, and

LEGAL PROTECTION + IDENTITY THEFT Legal Protection + Identity Theft Protection now called: Experian IdentityWorks Our voluntary prepaid legal program, offered through Preferred Legal, gives you and your family access to advice from experienced attorneys over the telephone, through their online legal system, or through in-office consultations about a wide range of personal legal matters, such as:      

Free simple of wills for member and spouse/domestic partner Free notary services Free review of legal documents Free face-to-face consultations with attorneys Free unlimited legal advice via phone consultation Free credit report analysis and repair + settling accounts in collection

BG\GBS\03

Victims of identity theft spend countless hours trying to sort out the damage. Identity protection could help you catch fraud in its early stages through 24/7 monitoring of your personal and financial information. It can also help you act quickly to limit the damage if your personal or financial information is stolen.

26

ADVOCATE TEAM

BG\GBS\03

COMING SOON:

27

©2019 ARTHUR J. GALLAGHER & CO. | AJG.COM | Page 28