2024
BE NE F IT S GUIDE January 1, 2024 – December 31, 2024
WELCOME! Our employees are our greatest resource. That's why Spare Parts Specialist, Inc 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.
NEW HIRE ENROLLMENT After your waiting period, you are eligible for benefits through Employee Navigator. All employees must elect or decline coverage. Once you elect your benefits, the elections remain in effect for the plan year, January 1st, 2024 – December 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.
ELIGIBILITY
QUALIFYING EVENTS
New hires are eligible for benefits on the first of the month following 60 days. 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.
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.
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Marriage
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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 using Employer Naviga tor Step 1: Log In Go to www.employeenavigator.com and click Login •
Returning users: Log in with the username and password you created when you registered. If you have forgotten your password, click Reset a forgotten password.
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First time users: Click on your Registration Link in the email sent to you by your admin or Register as a new user. Create an account, and create your own username and password.
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Your company identifier is: SPSMFG
Step 2: Welcome! After you login, click Let’s Begin to complete your enrollment and additional required tasks if applicable.
Step 3: Start Enrollments After clicking Start Enrollment, you’ll need to complete some personal & dependent information before moving to your benefit elections.
TIP Have dependent details handy. To enroll a dependent in coverage you will need their date of birth and Social Security number.
Step 4: Benefit Elections To enroll dependents in a benefit, click the checkbox next to the dependent’s name under Who am I enrolling? Below your dependents you can view your available plans and the cost per pay. To elect a benefit, click Select Plan underneath the plan cost. Click Save & Continue at the bottom of each screen to save your elections. If you do not want a benefit, click Don’t want this benefit? at the bottom of the screen and select a reason from the drop-down menu.
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E M P L O Y E E N AV I G AT O R E N R O L L M E N T G U I D E Step 5: Forms If you have elected benefits that require a beneficiary designation, Primary Care Physician, or completion of an Evidence of Insurability form, you will be prompted to add in those details. Step 6: Review & Confirm Elections Review the benefits you selected on the enrollment summary page to make sure they are correct then click Sign & Agree to complete your enrollment. You can either print a summary of your elections for your records or login at any point during the year to view your summary online.
TIP If you miss a step you’ll see Enrollment Not Complete in the progress bar with the incomplete steps highlighted. Click on any incomplete steps to complete them.
Step 7: You’re Finished You are finished. You can go back to your homepage to view your elections and you can make changes until the enrollment window closes.
You can login to review your benefits 24/7! Core Clinical Partners | 4
MEDICAL Medical benefits are available through Cigna. Medical - Cigna
$5,000 100%
$2,500 80%
$500 100%
0%
20%
0%
$5,000 | $10,000
$2,500 | $5,000
$500 | $1,000
$8,550 | $17,100
$8,550 | $17,100
$2,500 | $5,000
Preventive
$0 copay
$0 copay
$0 copay
Telemedicine (MD Live)
$40 copay
$35 copay
$25 copay
PCP (Primary Care Provider)
$40 copay
$35 copay
$25 copay
Specialist
$80 copay
$70 copay
$50 copay
ER (waived if admitted)
$500 copay
$500 copay
$150 copay
Urgent Care
$100 copay
$100 copay
$75 copay
Inpatient Services
Deductible
Deductible + 20%
Deductible
Outpatient Services
Deductible
Deductible + 20%
Deductible
Prescription Copays
$20/$40/$80/50%
$15/$35/$70/25%
$10/$30/$60/25%
80%
50%
80%
$10,000 | $20,000
$5,000 | $10,000
$1,000 | $2,000
$17,100 | $34,200
$17,100 | $34,200
$5,000 | $10,000
Employee Only
$83.60
$94.41
$172.29
Employee + Spouse
$193.53
$262.42
$425.93
Employee + Child(ren)
$145.44
$212.16
$360.08
Family
$370.76
$449.38
$682.98
In-Network Coinsurance (Member pays) Deductible Employee | Family Out of Pocket Maximum (Includes deductible) Employee | Family Office Visit
Emergency Treatment
Out-of -Network Coinsurance (Member pays) Deductible Employee | Family Out of Pocket Maximum (Includes deductible) Employee | Family
Per Pay Period (26)
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How to Access Your Benefits Through Cigna! Spare Parts Specialist, Inc has partnered with Cigna to bring you valuable benefits. IMPORTANT INFORMATION TO KNOW CONTACTING CIGNA Cigna is your medical carrier. Member support: 1-800-997-1654 24 hours a day, 365 days a year Your member portal: o o o o o o
Register at mycigna.com Verify coverage Request a copy of your ID card Check claims status Access Virtual Care Connect with Cigna One Guide
FINDING A DOCTOR Your network access is through Cigna. To find an in-network provider, login to your Member Portal at:
www.myCigna.com
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Transamerica (GAP) Supplemental Medical Provides benefits to cover your deductible if you have a hospitalization or surgery. CERTIFICATE DEDUCTIBLE
$1,000 per Covered Person, 3 times per Family
INPATIENT HOSPITALBENEFITS
$4,000 per Covered Person, 3 times per Family
TransConnect pays benefits for: • Inpatient hospital stays • Inpatient procedures • Inpatient physician charges • Inpatient mental health and substance abuse treatment • Routine nursery care for dependent children You determine the calendar year maximum benefit for your employee (multiplied by three for an insured family).
OUTPATIENT HOSPITALBENEFITS
$4,000 per Covered Person, 3 times per Family
The policy also pays benefits (separate from the inpatient hospital benefits) for: • Radiation therapy or chemotherapy authorized by a radiologist, chemotherapist, or an oncologist for outpatient cancer treatment • Outpatient surgery performed in a hospital facility, free-standing surgery center, or physician’s office • X-rays, MRIs, C T scans, PET scans, diagnostic ultrasounds, and electrocardiogram (EKG) tests, stress tests, and cardiac catheterization • Treatment for injury due to an accident in a hospital emergency room (ER) or urgent care center • ER charges for illness if admitted to the hospital • Diagnostic testing in the ER • Treatment in the ER for an appendicitis, or kidney stones • Kidney dialysis in a hospital outpatient facility or dialysis treatment center
AMBULANCE BENEFIT
$2,000 per Covered Person, 3 times per Family
This benefit is payable when ambulance transportation (ground or air) is required to a hospital or emergency center for injuries sustained in an accident. Ambulance transportation must be within 72 hours of the accident and must be provided by a licensed professional ambulance company.
ADDITIONAL BENEFITOPTIONS Enhanced Outpatient Benefit Rider includes options for: Infusiontherapy For premium, please log in to your Employee Navigator account.
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D E N TA L Dental - Cigna Plan 1
Plan 2
$50 / $150
$50 / $150
Yearly Maximum Benefit per Person
$1,000
$2,000
Preventative Services (Oral Exams, Cleanings, X-rays)
100%
100%
Basic Services (Fillings, Simple Extractions, etc.)
80%
80%
Major Services (Crowns, Dentures, Bridges etc.)
50%
50%
Out-of-Network UCR
90th
90th
Orthodontics (Children Only)
$1,000
$1,500
Employee Only
$12.59
$15.24
Employee Spouse
$24.91
$30.18
Employee + Child(ren)
$33.97
$42.24
Family
$52.06
$63.36
Annual Deductible (Waived for Preventative) Individual / Family
COST PER PAYCHECK (26)
VISION Vision - Cigna Network Exam (1x per calendar year) Frames (once every 24 months)
Cigna Vision $10 up to $130
Lenses (once every 12 months) Single / Bifocal / Trifocal Contact Lenses (in lieu of frames; once every 12 months)
$25 up to $130
COST PER PAYCHECK (26) Employee Only
$3.09
Employee Spouse
$5.68
Employee + Child(ren)
$5.73
Family
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S p a r e Pa r t s S p e c i a l i s t , I n c O F F E R S : Basic Life Insurance and AD&D – All full-time employees are provided through New York Life, $20,000 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 $400,000 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 $200,000 (not to exceed 50% of employee’s amount). Subject to medical eligibility. At your initial enrollment, your spouse is eligible for up to a $25,000 with no medical questions ask. Increments of $1,000 up to a maximum of $10,000.
Short-Term Disability – Through New York Life, all full-time employees are provided short-term disability at NO COST. Benefit Amount: 50% of weekly salary up to a maximum of $2,000 for non-work related accidents or sicknesses. Waiting Period: Benefits begin on day 8 Benefit Period: 13 weeks
Long-Term Disability – Through Guardian all full-time employees are provided long-term disability at NO COS.T Benefit Amount: 50% of monthly earnings up to a maximum of $10,000 for a covered accidents or sicknesses. Waiting Period: Benefits begin on day 91 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 $3,050. You can carry over up to $610 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 $610 are forfeited. What are qualified healthcare expenses? Copays, deductibles, prescription drugs, dental, orthodontia, frames, contacts, over-the-counter medication and more. Clarity's FSA Store is a one-stop-destination for Flexible Spending Accounts where you can buy FSA eligible products, search for services and learn about your FSA
https://claritybenefitsolutions.com/fsa-extras
Dependent Care FSA (DC-FSA) A dependent care FSA (DC-FSA) is a pretax benefit account used to pay for dependent care services such as: • Daycare • Day-camp • Home care • Nursing aides • Nanny services Funds may be used for expenses relating to children under the age of 13 or incapable of self-care who live with the account holder more than half the year. Elder care may be eligible for reimbursement with a DC-FSA if the adult lives with the FSA holder at least 8 hours of the day and is claimed as a dependent on the FSA holder's federal tax return. The dependent care FSA maximum annual contribution limit is $5,000 per household for single taxpayers and married couples filing jointly, or $2,500 for married people filing separately. Please note, unlike the Medical FSA, the Dependent Care FSA is NOT eligible for carryover. At the end of the plan year, any unused DC-FSA dollars are forfeited.
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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 Spare Parts Specialist, Inc 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) Spare Parts Specialist, Inc, 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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