2021-2022
BENEFITS GUIDE December 1, 2021 – November 30, 2022
WELCOME! Our employees are our greatest resource. That's why EspriGas is continuing to provide you with health plans, wellness enhancements, and benefits that make sense for you and your family, your busy lifestyle, and your wallet. Please take the time to carefully review the information, carrier changes and all the benefits offered to you, to ensure you get the best value based on your needs. We hope the benefits offered will inspire you and your dependents to take charge of your health and continue making wellness a priority.
OPEN ENROLLMENT Open Enrollment is your opportunity to add, cancel, or make changes to your benefits. This year, open enrollment will be Wednesday, November 3rd – Thursday, November 11th. Once you elect your benefits, the elections remain in effect for the plan year, December 1st, 2021 – November 30st , 2022. You may only change coverage due to an IRS qualified “life event” and must do so within 30 days of the event. A qualifying event is a significant change in a person’s life that creates the need to add, cancel, increase, or change coverage. We encourage you to review all your benefits and make selections wisely. This year we will be using Employee Navigator to make our benefits elections. You must elect or decline coverage through Employee Navigator.
ELIGIBILITY
QUALIFYING EVENTS
New hires are eligible for benefits on the first of the month following their hire date. You may enroll yourself and eligible dependents for coverage. You must enroll yourself in benefits in order to enroll your dependents. Eligible dependents include your spouse, dependent children, legally adopted children and stepchildren. Spouses and dependent children are eligible for: Medical, Dental, Vision, Voluntary Life.
Once you have made your elections, you are NOT eligible to change or drop coverage until the next Open Enrollment period unless you have a qualifying event. If you experience a qualifying life event, contact the Human Resources Department within 30 days of your qualifying event. If you fail to do so, you will have to wait until the next open enrollment period to make any changes to your coverage. Qualifying life events include, but are not limited to:
Dependent children are eligible for the group health plan until their 26th birthday regardless of whether they are a full-time student.
•
Marriage
•
Divorce
• •
Birth or adoption Employment changes from Part-time to Full-time Change in dependent status (i.e. Dependent child reaches age 26 limit)
•
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HOW TO ENROLL All employees are required to login to Employee Navigator to make elections or waive coverage. To begin, visit www.employeenavigator.com and use the steps below to login or you can click here to watch an instructional video. 1. Click "Login" at the top right-hand corner of the page.
2. Click on Register as a new user. For the 2020-2021 Open Enrollment, all employees will need to register as a NEW USER. Prior Employee Navigator logins will not be active.
3.
Create your account by entering: • Your first and last name as they appear in payroll. • The EspriGas company identifier – ESGAS • The last 4 digits of your SSN. • Your date of birth. If you encounter a login error, please reach out to Marie Volk at Sterling Seacrest Pritchard – mvolk@sspins.com. EspriGas Benefit Guide | 3
MEDICAL Medical benefits are available through Healthgram. $1,500 PPO Plan
$3,000 HSA Plan
20%
10%
Individual
$1,500
$3,000
Family
$3,000
$6,000
Individual
$5,000
$5,000
Family
$10,000
$10,000
Preventive Care
$0
$0
TeleDoc
$0
$10
Primary Care Physician
$30
Ded + 10%
Specialist
$75
Ded + 10%
$600
Ded + 10%
$100
Ded + 10%
Inpatient Hospital & Services
Ded + 20%
Ded + 10%
Outpatient Hospital & Services
Ded + 20%
Ded + 10%
$10/$40/$75/25%
Ded + 10%
50%
50%
$6,000 / $18,000
$6,000 / $18,000
$10,500 / $31,500
$10,500 / $31,500
IN-NETWORK Coinsurance Calendar Year Deductible
Out-of-Pocket Maximum
Office Visit Copays
Emergency Room Copay (In and Out of Network) Urgent Care
Prescription Drugs Tier 1 / Tier 2 / Tier 3 / Tier 4 OUT-OF-NETWORK Coinsurance Calendar Year Deductible Individual/Family Out-of-Pocket Maximum Individual/Family
Above is a snapshot of the plan benefits. For a more comprehensive review, please refer to the Summary of Benefits produced by the insurance carrier. In the event of a conflict with the insurance carrier, the contract takes precedent.
COST PER PAYCHECK (26) Employee Only
$89.20
$84.10
Employee Spouse
$178.40
$158.59
Employee + Child(ren)
$165.02
$148.86
Family
$254.22
$223.35 EspriGas Benefit Guide | 4
How to Access Your Benefits through Healthgram EspriGas has partnered with Healthgram to bring you valuable benefits. IMPORTANT INFORMATION TO KNOW CONTACTING HEALTHGRAM Healthgram is your medical carrier. Member support: 1-866-904-9081 8:00am-5:00PM EST Contact your Advisor:
o o o o
For answers about your plan and benefits Before any planned medical procedure Billing assistance To confirm precertification for an upcoming procedure
YOUR MEDICAL ID CARD Your ID card details the benefits offered through EspriGas. It is being mailed to your home with accompanying instructions. Provide your new ID Card to ALL of your providers after December 1st. Member support: 1-866-904-9081 8:00am-5:00PM EST
Your member portal:
o o o o
Register at members.healthgram.com Verify coverage Request a copy of your ID card Check claims status
FINDING A DOCTOR Your network access is through Cigna. To find an in-network provider, login to your Member Portal at:
members.healthgram.com
YOUR PHARMACY BENEFIT Your pharmacy provider is SmithRX. Your pharmacy information is printed on your new medical ID Card. To submit a mail in order, login to:
mysmithrx.com
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Welcome to Healthgram Connect Afamiliar situation. You need help quickly to confirm that a local doctor is in network, or maybe you’ve developed a cough or been diagnosed with a condition and are not sure where to receive care. No matter how you enter the healthcare system, there are times when questions are met with even more questions, when what you need is answers.
Help is on the way. Your employer has teamed up with Healthgram to bring you a solution. Healthgram Connect aligns you with a knowledgeable Health Advisor. Your Advisor, who is supported by a team of medical and benefits experts, is ready to answer any questions you have about your benefits or care. That means everything from network questions to appointment scheduling to billing!
A call to your Advisor can help you: Find the right doctor, hospital or facility for your specific needs Resolve insurance-related issues from claims status inquiries to billing Understand your benefits including all coverage questions and issues Estimate medical costs and in some cases, help you earn money Stay healthy with the help of alert reminders for upcoming screenings
All you need to do is call!
866.904.9081 EspriGas Benefit Guide | 5
H E A LT H S AV I N G S AC C O U N T Employees electing the $3,000 HSA plan will be automatically enroll in a Health Savings Account through Fidelity. WHAT IS AN HSA? A Health Savings Account (HSA) is like a 401(k) for healthcare. It is a tax advantaged personal savings or investment account that you can use to save and pay for qualified health expenses, now or in the future. Funds contributed to the HSA are not subject to federal income tax at the time of deposit. Withdrawals for qualified medical expenses are also taxfree. HSA funds may be used to pay for qualified medical expenses at any time without federal tax liability or penalty. HSAs are portable, which means you keep your HSA, even if you leave EspriGas or are unemployed. Funds roll over and accumulate year to year if not spent.
CONTRIBUTIONS Maximum contributions for the 2021-2022 plan year are listed below. This amount includes employer contributions. • $3,650 for Individual coverage • $7,300 for Family coverage • Additional $1,000 for “Catch-Up” age 55 and older For the 2021-2022 plan year, EspriGas will contribute the following amounts to employee’s Health Savings Account: • $500 – Employee Only • $750 – Employee + Spouse • $750 – Employee + Children • $1,000 – Family
WHAT ARE QUALIFIED MEDICAL EXPENSES? Examples of HSA eligible expenses are copays, deductibles, qualifying prescriptions, and qualifying medical equipment. A full description of qualified HSA expenditures can be found in IRS Publication 502 and is located on the web at www.irs.gov/pub/irs-pdf/p502.pdf. EspriGas Benefit Guide | 6
TELEMEDICINE
Employees and dependents enrolled in medical coverage will also be enrolled in telemedicine through Teledoc. Teladoc gives you access 24 hours, 7 days a week to a U.S. board-certified doctor through the convenience of phone, video or mobile app visits. Talk to a doctor anytime at www.teladoc.com or call 1-800-TELADOC (835-2362). SET UP YOUR ACCOUNT 1. Visit the Teladoc website and click “Set up account” or “Get Started.” 2.
Enter your name, date of birth, and zip code. Then click “Continue.”
3.
Follow the directions online to complete account setup and to provide your medical history.
REQUEST A CONSULT Once your account is set up, a doctor is always just a call or click away. 1.
Visit the Teladoc website and click “Request a consult”.
2.
Select the type of consult you want.
3.
Talk to a doctor within an hour.
R E S O U RC E S Employees enrolled in medical will also have access to the following benefits.
• Vitality Wellness Program – earn rewards by maintaining or improving well-being through nutrition, healthy activates and preventive education.
• KisX Card – assist in scheduling planned surgeries and diagnostics at prenegotiated prices with top providers.
• GlobalFit – discounted gym memberships nationwide. Use eligibility ID, IDP12608, when registering. • SmartMatch – offers Medicare-eligible employees alternative coverage options. • TeleDoc – gives you mobile access to a doctor, therapist, or medical expert anywhere you are by phone or video
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WELLNESS Employees and dependents enrolled in medical coverage will be automatically enrolled in the Vitality wellness program.
Powering Up With Vitality The Vitality program has all kinds of healthy activities to inspire you to be the healthiest you can be for yourself, your friends and your family. Along the way, celebrate your accomplishments by earning Vitality Points® for the rewards you deserve. 1. Register at PowerofVitality.com 2. Download the Vitality Today mobile app from your app store. 3. Take the Vitality Health Review. Vitality Points translate into Vitality Bucks that can be spent in the Vitality Mall, redeemable for gift cards and other great rewards like fitness devices and movie tickets. Vitality Bucks = Vitality Currency!
Get Rewarded by EspriGas Employees reaching Gold status will receive a $800 wellness incentive bonus. Bonuses will be paid quarterly to employees who have earned Gold following quarter end. Employees who have achieved Silver or Gold in the 2020-2021 plan year will qualify for the first quarter bonus in 2022.
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D E N TA L Dental benefits are available through Guardian. To find dental providers visit www.guardiananytime.com Your Network is
DentalGuard Preferred
Annual Deductible (Waived for Preventative) Individual / Family Yearly Maximum Benefit per Person Preventative Services (Oral Exams, Cleanings, X-rays)
$50 / $100 $1,500 100%
Basic Services (Fillings, Simple Extractions, etc.)
80%
Major Services (Crowns, Endodontics, Periodontics, etc.)
50%
Orthodontia Services (to age 19)
50%
Orthodontia Maximum
$1,500
Out-of-Network UCR
90th
COST PER PAYCHECK (26) Employee Only
$7.77
Employee Spouse
$15.78
Employee + Child(ren)
$20.13
Family
$30.03
Oral Health Rewards Program: Regular visits to the dentist can help prevent and detect the early signs of serious disease. Guardian’s Maximum Rollover Oral Health Rewards Program encourages and rewards members who visit the dentist, by rolling over part of your unused annual maximum into a Maximum Rollover Account (MRA). This can be used in future years if your plan’s annual maximum is reached.
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VISION Guardian offers easy access to thousands of conveniently located vision care providers including optometrists, ophthalmologists, opticians, Visionworks, and most Pearle Vision® locations through the VSP network To locate a participating network eye care doctor or location, log in at www.guardiananytime.com. Network
VSP
Exam (1x per calendar year)
$10
Frames (once every 12 months)
$130 retail max + 20% off balance
Lenses (once every 12 months) Single
$15
Bifocal
$15
Trifocal
$15
Contact Lenses (in lieu of frames; once every 12 months)
$130 max
COST PER PAYCHECK (26) Employee Only
$1.57
Employee Spouse
$3.12
Employee + Child(ren)
$3.32
Family
$5.26
I D E N T I T Y P ROT E C T I O N
EspriGas employees have the option to purchase Identity Protection through Allstate. Coverage includes identity monitoring, credit monitoring, full remediation and up to $1 million expense coverage and stolen funds reimbursement. COST PER PAYCHECK (26) Employee Only
$4.61
Family
$8.28
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ESPRIGAS OFFERS: Basic Life Insurance and AD&D – All full-time employees are provided through Guardian, $50,000 of Basic Life and Accidental Death & Dismemberment benefit at NO COST to employees.
Voluntary Life Insurance and AD&D – Employees are offered the option to purchase additional life insurance through Guardian. Rates will vary based on age and the benefit you select. All rates can be found in your Employee Navigator portal. Plan Highlights Employee: Spouse: Child(ren):
Increments of $10,000 up to a maximum of $500,000 subject to medical eligibility. At your initial enrollment, you are eligible for up to a $100,000 with no medical questions asked. Increments of $5,000 up to a maximum of $150,000 (not to exceed 50% of employee’s amount). Subject to medical eligibility. At your initial enrollment, your spouse is eligible for up to a $20,000 with no medical questions ask. Increments of $5,000 up to a maximum of $10,000. Coverage begins at 15 days.
Short-Term Disability – Through Guardian all full-time employees are provided short-term disability at NO COST. Benefit Amount: 60% of weekly salary up to a maximum of $1,500 for non-work related accidents or sicknesses. Waiting Period: Benefits begin on day 15 Benefit Period: up to 24 weeks
Voluntary Long-Term Disability – Through Guardian all full-time employees are offered long-term disability. Rates will vary based on age and the benefit you select. All rates can be found in your Employee Navigator portal. Benefit Amount: 60% of monthly earnings up to a maximum of $6,000 for a covered accidents or sicknesses. Waiting Period: 180 days Benefit Period: up to Social Security Normal Retirement Age (SSNRA)
401K – Through Guardian all full-time employees are offered long-term disability. Rates will vary based on age and the benefit you select. All rates can be found in your Employee Navigator portal. Benefit Amount: 60% of monthly earnings up to a maximum of $6,000 for a covered accidents or sicknesses. Waiting Period: 180 days Benefit Period: up to Social Security Normal Retirement Age (SSNRA)
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F L E X I B L E S P E N D I N G AC C O U N T Health Flexible Spending Account (FSA) A health FSA is a benefit that allows you to choose how much of your paycheck you’d like to set aside, before taxes are taken out, for qualified healthcare expenses. The annual maximum allowed for medical is $2,750. You can carry over up to $550 of your unused health FSA elected funds to help pay for qualified expenses that occur in this plan year. At the end of the plan year, any unused FSA dollars over $550 are forfeited. What are qualified healthcare expenses? Copays, deductibles, prescription drugs, dental, orthodontia, frames, contacts, over-the-counter medication and more.
For a searchable list of FSA eligible expenses please visit: https://www.wexinc.com/insights/benefits-toolkit/eligible-expenses/ Employees enrolling in the health savings account cannot enroll in the health FSA.
Dependent Care Flexible Spending Account (FSA) A dependent care FSA allows you to put aside a portion of your paycheck before taxes for eligible dependent care expenses each year. The annual maximum allowed for dependent care is $5,000 per family.
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KEY CONTACTS & RESOURCES Questions on your benefits or need assistance with Claims, contact Sterling Seacrest Pritchard:
Your Employee Support Contacts Claims Questions?
Benefit Questions?
Darlene Moorman 770.635.0439 dmoorman@sspins.com
Marie Volk 770.635.0451 mvolk@sspins.com
BE SURE TO HAVE THE FOLLOWING INFORMATION WHEN CALLING:
Laura Delavan 770.635.4016 laurad@sspins.com
Subscriber ID # Date of Service Name of Patient Name of Doctor, Facility or Hospital Copy of Bill or Explanation of Benefits (EOB)
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LEGAL NOTICES THIS GUIDE - This brochure summarizes the health care and income protection benefits that are available to EspriGas and their eligible dependents. Official plan documents, policies, and certificates of insurance contain the details, conditions, maximum benefit levels and restrictions on benefits. These documents govern your benefits program. If there is any conflict, the official documents prevail. These documents are available upon request through your Human Resources department. Information provided in this brochure is not a guarantee of benefits. HEALTH INSURANCE PORTABILITY AND ACCOUNTABILITY ACT (HIPAA) EspriGas, in accordance with HIPAA, protects your Protected Health Information (PHI). We will only discuss your PHI with medical providers and third-party administrators when necessary to administer the plan that provides you your medical, dental and vision benefits or as mandated by law. A copy of the Notice of Privacy is available upon request through your Human Resources department.
CONTINUATION REQUIRED BY FEDERAL LAW FOR YOU & YOUR DEPENDENTS (COBRA) The continuation required by Federal Law does not apply to any benefits for loss of life, dismemberment or loss of income. Federal law enables you or your dependent to continue health insurance if coverage would cease due to a reduction of your work hours or your termination of employment (other than gross misconduct). Federal law also enables your dependents to continue health insurance if their coverage ceases due to your health, divorce, or legal separation, or with respect to a dependent child, failure to continue to qualify as a dependent. Continuation must be elected in accordance with the rules of your Employer's group health plan(s) and is subject to federal law, regulations and interpretations.
WOMEN'S HEALTH ACT If you have had or are going to have a mastectomy, you may be entitled to certain benefits under the Women's Health and Cancer Rights Act of 1998 (WHCRA). For individuals receiving mastectomy-related benefits, coverage will be provided in a manner determined in consultation with the attending physician and the patient for: • All stages of reconstruction of the breast on which the mastectomy was performed; • Surgery and reconstruction of the other breast to produce a symmetrical appearance; • Prostheses; and • Treatment of physical complications of the mastectomy, including lymphedema. These benefits will be provided subject to the same deductibles and coinsurance applicable to other medical and surgical benefits provided under this plan. If you have any questions about your coverage, please contact your Human Resources department.
MEDICAID AND THE CHILDREN'S HEALTH INSURANCE PROGRAM (CHIP) The continuation required by Federal Law does not apply to any benefits for loss of life, dismemberment or loss of income. Federal law enables you or your dependent to continue health insurance if coverage would cease due to a reduction of your work hours or your termination of employment (other than gross misconduct). Federal law also enables your dependents to continue health insurance if their coverage ceases due to your health, divorce, or legal separation, or with respect to a dependent child, failure to continue to qualify as a dependent. Continuation must be elected in accordance with the rules of your Employer's group health plan(s) and is subject to federal law, regulations and interpretations.
SPECIAL ENROLLMENT NOTICES
NEWBORNS' & MOTHERS' HEALTH PROTECTION ACT
If you decline enrollment in your employer's health plan for you or your dependents (including your spouse) because of other health insurance or group health plan coverage, you or your dependents may be able to enroll in your employer's plan without waiting for the next open enrollment period if you: • Lose other health insurance or group health plan coverage. You must request enrollment within 30 days after the loss of other coverage. • Gain a new dependent as a result of marriage, birth, adoption or placement for adoption. You must request (medical plan OR health plan) enrollment within 30 days after the marriage, birth, adoption or placement for adoption. • Lose Medicaid, or Children's Health Insurance Program (CHIP) coverage because you are no longer eligible. You must request medical plan enrollment within 60 days after the loss of such coverage.
Federal law prohibits the plan from limiting a mother's or newborn's length of hospital stay to less than 48 hours for a normal delivery or 96 hours for a Cesarean delivery or from requiring the provider to obtain pre-authorization for a stay of 48 or 96 hours, as appropriate. However, federal law generally does not prohibit the attending provider, after consultation with the mother, from discharging the mother or her newborn earlier than 48 hours for normal delivery or 96 hours for Cesarean delivery.
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