Piedmont internal medicine employees benefit plans are administered by Sterling Seacrest Pritchard. Sterling Seacrest Pritchard is a full service employee benefits consulting firm. sspins.com August 1, 2023 - July 31, 2024 Enrollment Guide
2 WELCOME LETTER, ELIGIBILITY & QUALIFYING EVENTS 3 HOW TO ENROLL 4 MEDICAL INSURANCE 6 HOW TO ACCESS YOUR BENEFITS THROUGH HEALTHGRAM 7 DENTAL AND VISION INSURANCE 9 EMPLOYEE ASSISTANCE PROGRAM 10 FLEXIBLE SPENDING ACCOUNT, DISABILITY & LIFE11 UNIVERSAL LIFE INSURANCE 12 ACCIDENT & CRITICAL ILLNESS 13 FREQUENTLY ASKED QUESTIONS & INSURANCE TERMS 14 CONTACT INFO 15 LEGAL NOTICES 16 Table of Contents
Welcome!
Our employees are our greatest resource. That's why Piedmont Internal Medicine 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.
The Physicians of Piedmont Internal Medicine would like to express their gratitude to each and every one of you for your efforts, energy, and enthusiasm in support of the practice. 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.
Once you elect your benefits, the elections remain in effect for the plan year, August 1st, 2023 - July 31st, 2024. 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.
We will be using Bernie Portal again this year to make our benefit elections. You must elect or decline coverage through the Bernie Portal.
ELIGIBILITY
New hires are eligible for benefits following a 60 day waiting period. Benefits begin on the first day of the month following the 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, and Voluntary Life Insurance.
Dependent children are eligible for the group health plan until their 26th birthday regardless of whether they are a full-time student.
QUALIFYING EVENTS
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:
• Marriage
• Divorce
• Birth or adoption
• Employment changes from Part-time to Fulltime
• 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 the BerniePortal to make elections or waive coverage. To begin, visit www.bernieportal.com and use the steps below to login.
1. Click "Login" at the top right hand corner of the page.
2. Your credentials are as follows:
• Username: either your personal or work email address
• Password: 6 digits long - the last 4 digits of your SS# followed by your 2 digit birth month. (Ex: SS# 123-45-6789 & June birth month. Password is 678906)
• New Hires will be emailed a link to register for a new account.
* Be sure to print your current elections when prompted once you have logged in!
3. Confirm your personal and contact information and add a photo if you would like; then “Save and Continue”
* Please note the address listed is where your new ID cards will be sent. Please make sure this is correct so your ID cards are sent to the correct address.
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4. Dependents: Next, you will need to add your spouse/dependent information. Start by toggling the on switch for dependents that you wish to cover. Make sure to provide legal names, correct birthdates, and social security numbers. These are required to make elections with the carriers.
5. Elections: You’ll notice a benefits menu on the left, which tracks your plan election progress. Once you have made your election for that benefit type, a check mark will appear. A shopping cart on the right hand side of the page will keep track of your coverage costs.
6. Select a plan: Scroll through benefit types and explore each plan option by using the “select a plan” dropdown. If you wish to waive coverage, use the Waive option to save and continue.
7. Coverage Tiers: Cost and coverage tiers will generate based on the plan you have selected and will show based on the dependents added. If you were previously enrolled in coverage your current election will appear under each benefit type for your reference.
8. Beneficiaries: Provide the requested beneficiary information for your life insurance coverage. Adjust the percentage that each beneficiary should receive by sliding the distribution button to the desired percentage.
9. Confirm: Review your election sheet and complete any outstanding fields. Finally, move your mouse to sign the signature box and click “I Agree” to complete your enrollment.
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Medical Insurance
We will offer three new medical plans through Healthgram. Summaries of each plan are below. Additional information is available in the Bernie Portal.
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.
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Level 1 Level 2 Level 3 IN-NETWORK Coinsurance 80% 100% 80% Calendar Year Deductible $5,000 / $10,000 $3,000 / $7,500 $1,500 / $3,000 Out-of-Pocket Maximum Individual Family $8,500 $17,000 $8,000 $16,000 $5,000 $15,000 Preventive Care Covered in Full Covered in Full Covered in Full Office Visit Copays Primary Care Physician Specialist $25 $75 $25 $75 $25 $75 Emergency Room Copay $1,500 $1,500 $1,500 Urgent Care $50 $50 $50 Inpatient Hospital & Services Covered at 80% after Ded Covered at 100% after Ded Covered at 80% after Ded Outpatient Surgery Covered at 80% after Ded Covered at 100% after Ded Covered at 80% after Ded Prescription Drugs Ded (Individual | Family) Tier 1 - Ded waived Tier 2 Tier 3 Tier 4 $150 | $300 $15 $45 $85 25% $150 | $300 $15 $45 $85 25% No Ded $15 $35 $60 25% OUT-OF-NETWORK Coinsurance 50% 50% 50% Deductible Single Family $15,000 $30,000 $7,500 $22,500 $3,000 $9,000 Out-of-Pocket Maximum Single Family $23,700 $47,400 $23,700 $47,400 $12,000 $36,000 Office Visit Primary Care Physician Specialist Covered at 50% after Ded Covered at 50% after Ded Covered at 50% after Ded Covered at 50% after Ded Covered at 50% after Ded Covered at 50% after Ded Urgent Care Covered at 50% after
Covered at 50%
Covered at 50% after Ded
Ded
after Ded
COST PER PAYCHECK Employee Only $50.00 $111.67 $151.00 Employee + Spouse $625.62 $755.10 $837.70 Employee + Child(ren) $547.12 $667.36 $744.06 Family $1,122.75 $1,122.75 $1,430.77
How to Access Your Benefits through Healthgram
Healthgram, in partnership with Piedmont Internal Medicine, strives to offer the best network options to its employees. To do so, we allow Piedmont Internal Medicine employees to access the Cigna medical network.
This means that the medical network is through Cigna and the benefits are administered by Healthgram
It's important for Members and Providers to note the following instructions for how to access care, eligibility and benefits coverage information.
MEMBERS
• To find an in network provider, login to your Member Portal at www.members.healthgram.com
• Always take your Health Insurance ID Card with you to appointments and show it to the provider's office upon arrival.
• You may also share this document with your provider to give them guidance on who to contact if they have questions regarding your eligibility or benefits coverage.
• To view a digital copy of your ID card, log into your Member Portal at ww.members.healthgram.com and click on the "ID Card" link on your dashboard.
• If you need to manually submit a claim to Healthgram for reimbursement, login into your Member Portal at www.members.healthgram.com and download the Claim Form within the "Documents" section.
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Click
866.904.9081 or members.healthgram.com
Your concierge health advisor can assist in finding network doctors, hospitals and facilities, verify benefits and answer questions related to your benefits, and estimate treatment cost. You can receive up to a $200 incentive.
Through this program you pay $0* for the most common surgical & imaging procedures such as Orthopedic, General Surgery, Colonoscopies, MRl, CT and PET Scans.
For upcoming surgery and imaging procedures, call, or text 877-GET-KISX and speak with a nurse.
Your virtual KISx card – KISx Card
*HSA Plans require first dollar coverage from patient before procedure up to IRS Minimum, before program incentives are received.
Vitality is our interactive wellness program to encourage a healthy lifestyle.
Points are earned by engaging in activities such as dental checkups, health screenings, participating in a sporting league or athletic event, and even daily workouts.
To register your account and start earning points, visit PowerofVitality.com
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 1-800TELADOC(835-2362).
Your account must be registered before accessing care. To register an account, visit teleadoc.com and click setup.
Husk, formerly GlobalFit, allows you access to discounted gym memberships nationwide.
To register, visit https://marketplace.huskwellness.com/ Your eligibility ID is P4694.
H e a l t h g r a m C o n n e c t
Enrolling in medical coverage allows you access to the following programs at no additional cost.
here to learn more.
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Dental Insurance
Dental benefits are available through MetLife. To find dental providers visit www.metlife.com/mybenefits.
Vision Insurance
Vision benefits are available through Metlife. To find vision providers visit
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Base Plan Buy Up Plan Annual Deductible (Waived for Preventive) Individual Family $50 $150 $50 $150 Yearly Maximum Benefit per Person $1,000 $3,000 Preventative Services (Oral Exams, Cleanings, X-rays) 100% 100% Basic Services (Fillings, Simple Extractions, etc.) 80% 80% Major Services (Crowns, Endodontics, Periodontics, etc.) 0% 50% Orthodontia Services (to age 19) 0% 50% Orthodontia Maximum per Person - $1,000 IN NETWORK OUT OF NETWORK Exam (1x per calendar year) $10 copay up to $45 allowance Frames (once every 24 months) $150 allowance after $20 copay up to $70 allowance Lenses (1x per calendar year) Single Bifocal Trifocal $20 copay $20 copay $20 copay $30 allowance $50 allowance $65 allowance Contact Lenses (in lieu of frames) $150 allowance $105 allowance
www.metlife.com/mybenefits. COST PER PAYCHECK Employee Only $7.42 $17.72 Employee + Spouse $14.13 $33.67 Employee + Child(ren) $18.43 $38.08 Family $27.19 $57.82
PER PAYCHECK Employee Only $3.27 Employee + Spouse $6.53 Employee + Child(ren) $6.60 Family $10.53
COST
Employee Assistance Program
Piedmont Internal Medicine offers our employees an Employee Assistance Program through MetLife.
• Call 1-888-319-7819 to speak with a counselor or schedule an appointment, 24/7/365. The program includes up to 5 phone or video consultations with licensed counselors for you and your eligible household members, per issue, per calendar year
• Use the Website: metlifeeap.lifeworks.com User name: metlifeeap Password: eap
• Using the mobile app makes it easy for you to access and personalize educational content important to you! Search "LifeWorks" on iTunes App Store or Google Play. Log in with the user name: metlifeeap and password: eap
• Family: Going through a divorce, caring for an elderly family member, returning to work after having a baby
• Work: Job relocation, building relationships with co-workers and managers, navigating through reorganization
• Money: Budgeting, financial guidance, retirement planning, buying or selling a home, tax issues
• Legal Services: Issues relating to civil, personal and family law, financial matters, real estate and estate planning
• Identity Theft Recovery: ID theft prevention tips and help from a financial counselor if you are victimized
• Health: Coping with anxiety or depressions, getting the proper amount of sleep, how to kick a bad habit like smoking
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Flexible Spending Accounts
Piedmont Internal Medicine offers two Flexible Spending Accounts (FSA) through Benefit Alternatives. These accounts allow you to set aside money on a pre-tax basis to pay for eligible dependent care and qualified medical/dental/vision/pharmacy expenses not covered by your insurance.
Contributing to an FSA gives you the opportunity to save money because your contributions are deducted from your pay before federal / state income taxes, Social Security, and Medicare taxes are withheld. The maximum you can contribute to the Healthcare FSA is $3,050 per year. You can roll over up to $610 of unused funds to the next plan year. The maximum you can contribute to the Dependent Care FSA is $5,000.
Disability & Life Insurance
For more information on any of these plans, see details in the Bernie Portal.
SHORT & LONG TERM DISABILITY
Piedmont Internal Medicine pays 100% of the Short Term Disability and Long Term Disability coverage for full time employees that have satisfied their waiting period. Coverage is provided through MetLife.
Short Term Disability covers 60% of your weekly earnings to a maximum of $2,500 a week. The maximum benefit period is 12 weeks.
Long Term Disability provides 50% of your monthly income to a max of $6,000.
Employees have the option to purchase additional coverage for LTD. Contact Erica LaBarreare at Sterling Seacrest Pritchard for more information.
BASIC LIFE, AD&D & VOLUNTARY LIFE
Piedmont Internal Medicine pays 100% of the Basic Life and Accident Death and Dismemberment Insurance coverage for full time employees that have satisfied their waiting period. Coverage is provided through MetLife. The benefit amount is 1.5x your annual salary.
AD&D insurance provides additional financial protection for covered injuries that are the result of a covered serious accident, whether that accident happens at work, on a business trip or vacation, or as you go about your daily activities. It also covers the accidental loss of life.
Voluntary Life Insurance is available for full time employees and their dependents. Rates will vary based on age and the benefit amount you select. An employee can elect up to 5x their annual salary. Pricing and plan information can be found in the Bernie Portal.
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Universal Life Insurance & LTC
TransElite® is universal life insurance, underwritten by Transamerica Life Insurance Company that helps provide financial protection at a competitive cost.
HELP PROTECT THE PEOPLE WHO DEPEND ON YOU
An employee chose universal life insurance because she didn't want to worry what would happen to her five year old in the event of her death. It helped her feel better about his well-being to know her life insurance death benefit would help him if the worst happened. Universal life insurance can help safeguard your family members' futures, with benefits that can assist with your final expenses and their dependent care, living expenses, or college tuition.
HELP GIVE YOURSELF PEACE OF MIND
The universal life insurance policy builds cash value so you can borrow against it in the future and protect your savings if an unexpected expense arises. In later years, the built-up cash value will continue to pay the cost of insurance, maintaining the policy even after retirement.
HOW IT WORKS
• No physical or blood work
• Accumulates cash value
• Guaranteed 3% interest rate
ELIGIBILITY
• Loan and withdrawal options
• Convenient payroll deduction
You can insure your eligible spouse, children, and grandchildren with their own policies or purchase protection for your children through a child level term life insurance rider. The chart below gives the ages at which you and family members may apply, bu all universal life policies can be maintained up to age 100. Visit transamericabenefits.com or call 888.763.7474 for more information.
Self Ages 16 - 80
Spouse or Equivalent by Law Ages 16 - 65
Children / Grandchildren Ages 0 - 25 years
$10,000 - $500,000 benefit, not to exceed 5x base salary
$10,000 - $100,000 benefit
$25,000 benefit
Children under Optional Child Term Rider Ages 15 days - 25 years $10,000 or $20,000 benefit
The Chronic Condition Rider (LBR) - this is the Long Term Care portion - pays if you cannot perform at least two activities of daily living such as dressing, bathing, eating, toileting, continence or moving from one activity to another OR if you are diagnosed with a permanent cognitive impairment.
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Accident & Critical Illness
Life is full of tough choices, but this isn't one of them. Aflac makes selecting the right coverage easier and less stressful. With your trusted Aflac agent, you can tailor Aflac plans to meet your specific needs and enhance your existing coverage. Choose the options you want and ignore the rest.
HOSPITAL CONFINEMENT INDEMNITY INSURANCE - OPTION 1
Aflac Choice offers hospital-related benefits to help with the expenses not covered by major medical. This can help prevent high deductibles and out-of-pocket expenses from derailing your life plans.
ACCIDENT-ONLY INSURANCE - OPTION 2
Accidents can happen at any time. You could suffer an accidental injury while you are working around the house or walking into work. Or your child may get injured at basketball practice. The financial impact of an accident is often surprising. Most people have expenses after an accident they never thought of before. From out-of-pocket medical costs to a temporary loss of income, your finances may be strained. Accident insurance can help.
CANCER PROTECTION ASSURANCE - OPTION 2
Cancer treatment is changing. Thanks to advances in science and treatment, more and more Americans today are living with cancer. Aflac Cancer Protection Assurance helps cover these innovative treatments with benefits that really care for you as a whole person. Prom prevention to recovery, Aflac is with your every step of the way. Benefits are built to see you all the way through cancer reatement and they'll stay with you for life after cancer.
• This coverage including benefits for early detection and preventative care life mammograms, PSA blood tests, and other screenings.
• If you're diagnosed with cancer, we offer benefits that you can count on - thanks to One Day Pay℠, your claim can be processed in just one day.
• You and your doctor decide on a treament plan together - we help provide you the financial support for every month that you're undergoing that treatment. Want a second opinion? We provide a benefit for that, too.
SPECIFIED HEALTH EVENT INSURANCE - OPTION 2
Aflac's Critical Care Protection policy helps provide financial peace of mind if you experience a serious health event, such as a heart attack or stroke. You will receive a lump sum benefit upon diagnosis of a covered event with additional benefits to be paid for things such as hospital confinement, intensive care unit confinement, ambulance, transporation, lodging, and therapy. Benefits are paid directly to you and can be used for any out-of-pocket expenses you have such as car payments, mortgage or rent payments, or utility bills.
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Insurance FAQs
MEDICAL
No matter which Healthgram medical option you elect, all preventive care is covered at 100% in-network and you will have no lifetime maximums or pre-existing limitations.
COVERAGE LEVELS
You also have the choice of whom, in addition to yourself, you want to cover under medical benefits. You will have the choice of covering just yourself, you and a spouse, you and your children, or your entire family.
HEALTHCARE TERMS
• Coinsurance: The percentage of allowed charges for covered services that you are required to pay. For example, your benefits plan may cover 90% of the charges for a covered hospitalization, leaving you responsible for the other 10%. This 10% is known as the coinsurance.
• Copayment (Copay): A flat dollar amount you must pay for a covered service. For example, you may have to pay a copay for each covered visit to a primacy care doctor. Copays will now accumulate towards your out-of-pocket maximum.
• Deductible: The amount you pay each year before your benefits plan shares in the cost of certain services. The deductible may not apply to all services. For example, preventive is always covered innetwork and no deductible will be required before your preventive services are paid.
• Out-of-Pocket Limit: The most you will pay during the plan year (excluding payroll deductions). Once you pay this amount of your pocket during the year, your benefits plan usually pays 100% of the covered services.
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Contact Information
If you have any questions about your benefits, please contact our team of service representatives from Sterling Seacrest Pritchard:
Marie Volk 770.635.0451 mvolk@sspins.com
If you have a claims issue, please contact our dedicated claims specialist at Sterling Seacrest Pritchard:
Darlene Moorman 770.635.0439 dmoorman@sspins.com
Kristie Mercer 770.635.2293 kmercer@sspins.com
MEDICAL
Healthgram
www.healthgram.com
DENTAL & VISION
MetLife
www.metlife.com/mybenefits
Group #: 5396612
LIFE & DISABILITY
MetLife
www.metlife.com/mybenefits
Group #: 5396612
EMPLOYEE ASSISTANCE PROGRAM
MetLife
1-888-319-7819
www.metlifeeap.com
FLEXIBLE SPENDING ACCOUNT
Benefit Alternatives
770.993.8683
UNIVERSAL LIFE & LTC
Transamerica
888.763.7474
www.transamericabenefits.com
ACCIDENT & CRITICAL ILLNESS
Aflac www.aflac.com
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Legal Notices
THIS GUIDE
This brochure summarizes the health care and income protection benefits that are available to Piedmont Internal Medicine employees 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.
SPECIAL ENROLLMENT NOTICES
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 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.
HEALTH INSURANCE PORTABILITY AND ACCOUNTABILITY ACT (HIPAA)
Piedmont Internal Medicine, 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.
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 mastectomyrelated 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
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Legal Notices
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)
If you are eligible for health coverage from your employer, but are unable to afford the premiums, some states have premium assistance programs that can help pay for coverage. These states use funds from their Medicaid of CHIP programs to help people who are eligible for employer-sponsored health coverage, but need assistance in paying their health premiums. If you or your dependents are NOT currently enrolled in Medicaid or CHIP, and think you or any of your dependents might be eligible for either of these programs, you can contact your State Medicaid or CHIP office or dial 1-877-KIDS NOW or visit www.insurekidsnow.gov to find out how to apply. If you qualify, you can ask the state if it has a program that might help you pay the premiums for an employer-sponsored plan.
Once it is determined that you or your dependents are eligible for premium assistance under Medicaid or CHIP, your employer's health plan is required to permit you and your dependents to enroll in the health plan - as long as you and your dependents are eligible, but not already enrolled in the employer's plan. This is called a "special enrollment" opportunity and you must request coverage within 60 days of being determined eligible for premium assistance. The full CHIP Notice is available upon request from your Human Resources department.
NEWBORNS' & MOTHERS' HEALTH PROTECTION ACT
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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