2021-2022
BENEFITS GUIDE November 1, 2021 – October 31st, 2022
Welcome! Our employees are our greatest resource. That's why Pierre Construction Group 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 Monday, October 18th – Friday, October 22nd Once you elect your benefits, the elections remain in effect for the plan year, November 1st, 2021 – October 31st , 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. Enrollment Forms are needed for all employees, even if you are waiving coverage. New hires and newly eligible employees will be given a separate employee application for completion. Friday, October 22nd is the deadline to complete your open enrollment elections. All forms are to be turned in to Katie Rambow by Friday, October 22nd.
ELIGIBILITY
QUALIFYING EVENTS
New hires are eligible for benefit first of the month following 60 days. You may enroll yourself and or 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 Accident and Critical Illness Insurance.
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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All Savers OPTION 1 – $2,500 DEDUCTIBLE PPO Medical Plan 1 – P2500i100LX21 Plan Highlights
In Network – You Pay
Out-of-Network – You Pay
Deductible
$2,500 Individual | $5,000 Family
$5,000 Individual | $10,000 Family
Coinsurance
0% after deductible
50% after deductible
$5,000 Individual | $10,000 Family
$10,000 Individual | $20,000 Family
Primary Care Physician Office Visit
$25 copay
Deductible, then 50%
Specialist Office Visit
$75 copay
Deductible, then 50%
Telemedicine
$0 copay
Not covered
Plan pays 100%
Deductible, then 50%
Complex Imaging Services (CT Scans, PET Scans & MRI’s)
Deductible
Deductible, then 50%
Hospital Inpatient Care
Deductible
Deductible, then 50%
Outpatient Surgery
Deductible
Deductible, then 50%
Emergency Room
$300 copay
Paid as In-network
Urgent Care
$50 copay
Deductible, then 50%
Annual Out-of-Pocket Maximum
Preventive Care Services
Quantity Limits: Retail = 30-day supply Mail-Order = 90-day supply
Prescription Drugs Tier 1 — Generic Drugs Tier 2 — Preferred Brand-Name Tier 3 — Non-Preferred Brand-Name Tier 4 - Specialty Drugs
Tier 1: $10 copay Mail Order: 2.5 times retail copay Tier 2: $35 copay Mail Order: 2.5 times retail copay Tier 3: $75 copay Mail Order: 2.5 times retail copay Tier 4: $250 Mail Order: 2.5 times retail copay
Tier 1: $10 copay Mail Order: 2.5 times retail copay Tier 2: $35 copay Mail Order: 2.5 times retail copay Tier 3: $75 copay Mail Order: 2.5 times retail copay Tier 4: $250 Mail Order: 2.5 times retail copay
PER CHECK DEDUCTIONS BASED ON 52 PAYROLL DEDUCTIONS Time Employed:
1-4 Years
5-10 Years
10+ Years
Employee Only
$41.31
$41.31
$41.31
Employee + Spouse
$183.88
$112.59
$84.08
Employee + Children
$157.96
$99.63
$76.30
Family
$300.53
$170.92
$119.07
!
*When you visit an ER for non-emergency medical care, services are subject to the deductible. The prescription drug coverage provided by the $2,500 deductible medical plan is expected to pay out as much as standard Medicare prescription drug coverage pays. This is important because members who enroll in a Medicare prescription drug plan after their initial eligibility period, may pay a higher premium (a penalty) if they were enrolled in a group health plan with non-creditable prescription drug coverage.
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All Savers OPTION 2 – $2,850 DEDUCTIBLE HSA PPO Medical Plan 2 – HP2850257521 Plan Highlights
In Network – You Pay
Out-of-Network – You Pay
Deductible
$2,850 Individual | $5,700 Family
$5,700 Individual | $11,400 Family
Coinsurance
0% after deductible
50% after deductible
$6,900 Individual | $13,800 Family
$11,400 Individual | $22,800 Family
Primary Care Physician Office Visit
Ded + $25 copay
Deductible, then 50%
Specialist Office Visit
Ded + $75 copay
Deductible, then 50%
$0 copay
Not covered
Plan pays 100%
Deductible, then 50%
Complex Imaging Services (CT Scans, PET Scans & MRI’s)
Deductible
Deductible, then 50%
Hospital Inpatient Care
Deductible
Deductible, then 50%
Outpatient Surgery
Deductible
Deductible, then 50%
$300 copay
Paid as In-network
Ded + $50 copay
Deductible, then 50%
Annual Out-of-Pocket Maximum
Telemedicine Preventive Care Services
Emergency Room Urgent Care
Quantity Limits: Retail = 30-day supply Mail-Order = 90-day supply
Prescription Drugs Tier 1 — Generic Drugs Tier 2 — Preferred Brand-Name Tier 3 — Non-Preferred Brand-Name Tier 4 - Specialty Drugs
Tier 1: $10 copay Mail Order: 2.5 times retail copay Tier 2: $35 copay Mail Order: 2.5 times retail copay Tier 3: $75 copay Mail Order: 2.5 times retail copay Tier 4: $150 Mail Order: 2.5 times retail copay
Tier 1: $10 copay Mail Order: 2.5 times retail copay Tier 2: $35 copay Mail Order: 2.5 times retail copay Tier 3: $75 copay Mail Order: 2.5 times retail copay Tier 4: $150 Mail Order: 2.5 times retail copay
PER CHECK DEDUCTIONS BASED ON 52 PAYROLL DEDUCTIONS Time Employed:
1-4 Years
5-10 Years
10+ Years
Employee Only
$38.83
$38.83
$38.38
Employee + Spouse
$178.66
$107.37
$78.85
Employee + Children
$153.24
$94.91
$71.58
Family
$293.07
$163.46
$111.61
!
*When you visit an ER for non-emergency medical care, services are subject to the deductible.
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All Savers OPTION 3 – $6,350 DEDUCTIBLE HSA PPO Medical Plan 2 – HP635021 Plan Highlights
In Network – You Pay
Out-of-Network – You Pay
Deductible
$6,350 Individual | $12,700 Family
$12,700 Individual | $25,400 Family
Coinsurance
0% after deductible
50% after deductible
$6,350 Individual | $12,700 Family
$11,400 Individual | $22,800 Family
Primary Care Physician Office Visit
Deductible
Deductible, then 50%
Specialist Office Visit
Deductible
Deductible, then 50%
Telemedicine
$0 copay
Not covered
Plan pays 100%
Deductible, then 50%
Complex Imaging Services (CT Scans, PET Scans & MRI’s)
Deductible
Deductible, then 50%
Hospital Inpatient Care
Deductible
Deductible, then 50%
Outpatient Surgery
Deductible
Deductible, then 50%
Emergency Room
Deductible
Paid as In-network
Urgent Care
Deductible
Deductible, then 50%
Annual Out-of-Pocket Maximum
Preventive Care Services
Quantity Limits: Retail = 30-day supply Mail-Order = 90-day supply
Prescription Drugs Tier 1 — Generic Drugs
Deductible
Deductible
Tier 2 — Preferred Brand-Name
Deductible
Deductible
Tier 3 — Non-Preferred Brand-Name
Deductible
Deductible
Tier 4 - Specialty Drugs
Deductible
Deductible
PER CHECK DEDUCTIONS BASED ON 52 PAYROLL DEDUCTIONS Time Employed:
1-4 Years
5-10 Years
10+ Years
Employee Only
$1.15
$1.15
$1.15
Employee + Spouse
$99.54
$28.25
$0.00
Employee + Children
$81.65
$23.32
$0.00
Family
$180.04
$50.43
$0.00
!
*When you visit an ER for non-emergency medical care, services are subject to the deductible.
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Hospital Confinement Indemnity Through Sun Life, you and your dependents are offered access to a Hospital Confinement Indemnity “Gap” insurance. GAP insurance is designed to provide benefits that supplement existing major medical plan. The additional benefits help to cover out of pocket expenses related to coinsurance, copays and deductibles for inpatient and outpatient services.
Benefit Highlights
Benefit Amount
Inpatient Hospital Hospital stay’s, inpatient surgeries, in-hospital charges, ER visit (over 24 hrs)
$1,000
To elect coverage: You must be covered under Pierre Construction Group’s Medical Plan. If you are covering dependents, on the medical, you must also cover them on the GAP plan.
Weekly Cost (Based on 52 Payroll Deductions Age
<40
40-49
50+
Employee Only
$1.69
$2.45
$3.30
Employee + Spouse
$3.05
$4.41
$5.94
Employee + Children
$3.82
$4.58
$5.43
Family
$5.18
$6.54
$8.07
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D E N TA L Dental benefits are available through UnitedHealthcare. To find dental providers visit www.uhc.com
Participating Dentist
Nonparticipating Dentist
Your Deductible
$50 individual / $150 Family
$50 individual / $150 Family
Calendar Year Maximum Applies to preventive, basic, and major services
$1,000 combined In-network and Out-of-Network
$1,000 combined In-network and Out-of-Network
Preventive & Diagnostic Services Exams, Cleanings & Bitewing X-Rays, Fluoride, Sealants
100% (Deductible waived)
100% (Deductible waived)
Basic Services Filings, Extractions, Restorations; Emergency Treatment
80% After deductible
80% After deductible
Major Services Crowns, Bridgework, Full & Partial Dentures, Oral Surgery, Implants, Endodontics (root canal), Periodontics (gum surgery)
50% Coinsurance
50% Coinsurance
$1,000 Max - Dental Plan Highlights
United Healthcare
90th Percentile
$1,000 Max - Dental Plan Based on 52 Payroll Deductions Employee Only
$8.12
Employee + Spouse
$16.24
Employee + Children
$18.08
Family
$27.53
VISION Vision benefits are available through UnitedHealthcare. To find dental providers visit myuhcvision.com.
In-Network Exam Copay
$10
Materials Copay
$25
Frames Allowance
$130
Benefit Frequency
12/12/24
Contact Lens Allowance Elective Medical Necessary
$125 Covered in full after copay
Based on 52 Payroll Deductions Employee Only
$1.55
Employee + Spouse
$2.94
Employee + Children
$3.45
Family
$4.85
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BASIC LIFE AND AD&D Basic Life Insurance and AD&D – All full-time employees are provided through The Hartford, $50,000 of Basic Life and Accidental Death & Dismemberment benefit at NO COST to you.
Benefit Highlights What is Basic Life & AD&D Insurance? Life Insurance pays your beneficiary a benefit if you die while you are covered under the policy. What is a beneficiary? Your beneficiary is the person(s) or legal entity who receives a benefit payment if you die while you are covered by the policy. Why do I need Basic Life & AD&D Insurance? This benefit provides affordable financial security for your loved ones. What amount does my beneficiary receive? Your beneficiary will receive $50,000. Can I keep my Life coverage if I leave my employer? Yes, you have the option to convert your life insurance coverage to your own individual policy.
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KEY CONTACTS & RESOURCES Questions on your benefits or need assistance with Claims, contact Sterling Seacrest Pritchard:
Your Employee Support Contact 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:
Trevor Holder 678.742.3827 tholder@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 Pierre Construction Group 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) Pierre Construction Group, in accordance with HIPAA, protects your Protected Health Information (PHI). We will only discuss your PHI with medical providers and thirdparty 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. 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.
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. 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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