BENEFITS GUIDE 2021 Prepared by: EONE Benefits Solutions
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MEDICAL & RX DENTAL VISION VOLUNTARY LIFE & AD&D SHORT TERM DISABILITY EAP
TABLE OF CONTENTS YOUR BENEFITS
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ELIGIBILITY & ENROLLMENT
3
MEDICAL BENEFITS
4
MEDICAL RESOURCES
5
PRESCRIPTION RESOURCES
6
DENTAL BENEFITS
7
VISION BENEFITS
8
EMPLOYEE ASSISTANCE PROGRAM
9
SHORT TERM DISABILITY
10
SUPPLEMENTAL LIFE & AD&D
11-12
CONTACTS
13
SANS strives to provide its employees with a comprehensive and competitive benefit package. Please take the time to review this guide in its entirety to fully understand the array of benefits available to you and your eligible dependents. We are dedicated to the personal, professional and financial health of our employees and will continue to provide meaningful benefits at affordable rates. The 2021 benefit guide contains important information to help you make informed decisions during the benefits open enrollment period and throughout the plan year. We encourage all employees to carefully review the material contained in this guide This guide, describing the benefit plans, is only a summary of the provisions of the plan. While every effort has been made to ensure that this booklet accurately reflects the provisions of the plans, only the official plan documents govern the operation of the plans and payment of benefits. Please reach out to SANS Human Resources if you have any questions. We hope you have a happy, healthy 2021 plan year!
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ELIGIBILITY & ENROLLMENT SANS 2021 benefits plan year starts January 1st and runs through December 31st. Full-time and part-time employees who work at least 20 hours per week are eligible for medical, dental, vision, short term disability and voluntary life insurance benefits. New hires are eligible on the first of the month following their date of hire.
Open Enrollment occurs once each calendar year. At that time you may change your benefit elections. Once you have made your selection, you may not change benefit elections until the next Open Enrollment period, unless you or any eligible dependent have a Qualifying Life Event in employment or family status. Qualifying Life Events* include:
You may also elect coverage for your dependents including:
• Marriage, divorce or legal separation • Adding a dependent child through birth, adoption or court-ordered custody • Death of a spouse/domestic partner or child • Change in your work schedule affecting benefits, i.e. full-time to part-time or part-time to full-time • Your dependent loses eligibility for coverage • Your spouse involuntarily loses health coverage through his/her employer • You and/or your spouse and dependents become eligible for COBRA • You and/or your spouse and dependents gain or lose Medicaid or CHIP coverage • You receive a Qualified Medical Child Support Order (QMCSO)
• Your legal spouse • Your dependent children who are: o up to 26 years old o 26 years or older, who are incapable of selfsustaining employment by reason of mental or physical handicap and supported primarily by you (proof of ages and dependence must be submitted) When to Enroll If you are a new hire or are newly eligible for benefits, you must enroll in your benefit plans within 30 days of your hire or eligibility date. If you waive coverage upon first eligibility you will be required to wait until the next Open Enrollment period or when you experience a Qualifying Life Event.
If you experience a Qualifying Life Event, you have 30 days to notify Human Resources. If you experience a Medicaid or CHIP Qualifying Life Event, you have 60 days to notify Human Resources and make any desired benefit changes. Otherwise, elections you make during Open Enrollment period will remain in effect for the entire plan year and you will have to wait until the next annual Open Enrollment.
How to Enroll or Waive Through ADP The enrollment process must be completed through the ADP online portal. Employees will be guided through each benefit option to either enroll or waive. You will be required to submit your enrollment once you have completed or waived your elections.
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MEDICAL BENEFITS Blue Preferred PPO Plan Highlights • • • •
Utilizes the national BlueCard PPO network Traditional PPO with lower deductible eliminates the need for HRA To locate an in-network doctor visit www.member.carefirst.com For out-of-network coverage, the Allowed Benefit is what CareFirst would have paid an in-network provider in the same area for the service. Your out-of-network provider can bill you the difference between what CareFirst pays and their actual charges.
CareFirst PPO Amounts shown are what the member will pay Deductible
In-Network $300 Ind | $600 Fam
Out-of-Network $600 Ind | $1,200 Fam
Out-of-Pocket Maximum - Medical & Rx Preventive Services Well-Child Care (Exams & Immunizations Adult Physical Exam (including routine GYN) Cancer Screenings (at set ages) & Pap Tests Physicians Office Visit - PCP or Specialist Physical, Speech & Occupational Therapy Chiropractic Diagnostic, Lab and X-Ray
$1,500 Ind | $3,000 Fam
$3,000 Ind | $6,000 Fam
No Charge No Charge No Charge $20 Copay $20 Copay $20 Copay Deductible then No Charge
20% of Allowed Benefit Deductible then 20% of Allowed Benefit 0% of Allowed Benefit Deductible then 20% of Allowed Benefit Deductible then 20% of Allowed Benefit Deductible then 20% of Allowed Benefit Deductible then 20% of Allowed Benefit
Imaging: CT, PET scan, MRIs
Deductible then No Charge
Deductible then 20% of Allowed Benefit
Urgent Care Facility
$40 Copay
Deductible then 20% of Allowed Benefit
Hospital Emergency Room
Deductible then $150 Copay (copay waived if admitted)
Hospital Facility Services
Deductible then $250 Copay
Deductible then 20% of Allowed Benefit
Outpatient Facility Services
Deductible then $100 Copay
Deductible then 20% of Allowed Benefit
Prescription Coverage
Tier I – Generic
$10 Copay
Tier II - Preferred Brand
$25 Copay
Tier III - Non-Preferred Brand
$45 Copay
Tier IV -Specialty Preferred Brand
$25 Copay
Tier III - Specialty Non-Preferred Brand
$45 Copay
90-Day Maintenance
2 X Retail Copay
Medical & Dental Per Pay Costs (2x for monthly cost)
Employee Only
Employee & Spouse
Employee & Child(ren)
Employee & Family
Employee Contribution
$62.50
$95.00
$85.00
$105.00
SANS Contribution
$312.65
$767.31
$607.98
$946.19
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MEDICAL RESOURCES
BLUE REWARDS HIGHLIGHTS
VIDEO VISIT HIGHLIGHTS
Blue Rewards provides you a way to get money back
Virtual treatment for common health issues 24/7 Use Video Visit when you’re facing uncomplicated, non-emergency issues such as allergies, a sinus infection, a cold or the flu and more. Video Visit doctors will provide you a consultation, diagnosis and even prescriptions (when available and appropriate). They are all U.S. board-certified, licensed and credentialed medical professionals.
How it works: Employees and their spouse can choose which activities they want to complete. Rewards will be earned for accomplishing one, or all, of the following activities: Earn $100 Select a primary care provider (PCP) and complete a health screening
Schedule visits for additional services
Earn $50 Consent to receive wellness emails and take the RealAge® test Earn $25 Retake the RealAge® test. Employees who earned the reward for taking the test initially can earn an additional reward for retaking it after six months.
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Therapy/Psychiatry—Talk with a therapist or psychologist for help managing mental health issues including anxiety, depression and grief.
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Diet/Nutrition—Connect with a registered dietitian to get support with dietary and nutrition needs, from weight loss to food allergies and more.
Register today at carefirstvideovisit.com or download the CareFirst Video Visit app!
Register and log in to carefirst.com/sharecare to participate
Blue Rewards Flyer
CareFirst Video Visit Flyer
Click Here
Click Here
Full Link: https://www.eonebenefits.com/wpcontent/uploads/2020/11/Blue-Rew ards-Means-Money-Back-for-Employ ees.pdf
Full Link: https://www.eonebenefits.com/wp-co ntent/uploads/2020/11/carefirst-vi deo-visit.pdf
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PRESCRIPTION RESOURCES
MAIL SERVICE
WALMART
Take advantage of CVS Caremark Mail Service Pharmacy, a fast and accurate home delivery service that offers a way for you to save both time and money on your long-term (maintenance) prescriptions.
Walmart has over 300 generic prescriptions available for $4/month or $10 for a 90-day supply. If you are on a generic, maintenance medication, visit Walmart.com or contact your local Walmart to see if it is on their list.
As a CareFirst member, once you register for Mail Service Pharmacy, you’ll be able to:
When you utilize this resource it does not go through your CareFirst insurance. You simply bring your prescription to Walmart to be filled and pay either the $4 or $10 copay, depending on the amount of medication you are filling.
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Refill prescriptions online, by phone or email
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Schedule automatic refills
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Choose your delivery location
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Consult a pharmacist by phone 24/7
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Receive email notification of order status
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Choose from multiple payment options
It’s easy to register for mail service Register at www.carefirst.com/myaccount or call the toll-free number on the back of your ID card.
Mail Service Pharmacy Flyer Click Here Full Link: https://www.eonebenefits.com/wp -content/uploads/2020/11/Mail-S ervice-Pharmacy.pdf
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DENTAL BENEFITS MetLife PPO Plan Highlights • • • • •
Members have access to the national MetLife PDP Plus network Members can see any dentist, but In-Network dentists offer the biggest opportunity for savings No ID card provided, simply give provider the employee’s SSN and name If seeing an out-of-network dentist, the allowed benefit is what MetLife would have paid an in-network dentist in the same area for the service. Your out-of-network dentist can bill you the difference between what MetLife pays and their actual charges To locate an In-Network dentist visit www.metlife.com
MetLife PPO In-Network
Out-of-Network $50 Individual;
Plan Year Deductible
$150 Family
Annual Plan Year Maximum Benefit
$3,000 per person per year Amounts shown are what the member will pay
Preventive Care* (such as cleanings, exams, X-rays) Basic Services (such as fillings, simple extractions & general anesthesia ) Major Services (such as dentures, bridgework, crowns)
No Charge
100% of Allowed Benefit
Deductible then 20%
Deductible then 20% of Allowed Benefit
Deductible then 50%
Deductible then 50% of Allowed Benefit
Dental Only Per Pay Costs (2x for monthly cost)- If you elect medical, dental contributions are already included in your premium
Employee Only
Employee & Spouse
Employee & Child(ren)
Employee & Family
Employee Contribution
$12.50
$15.00
$15.00
$17.50
SANS Contribution
$5.40
$17.21
$20.48
$36.39
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VISION BENEFITS Comprehensive vision plan through MetLife • • •
This plan covers routine eye care, including eye exams and eyeglasses (lenses and frames) or contacts Lens Enhancements like Ultraviolet coating, Polycarbonate, Progressives, Anti-reflective and Photochromatic coatings are covered with a small copay To locate an In-Network provider visit www.metlife.com
MetLife Vision MetLife Vision PPO Amounts shown are what the member will pay In-Network
Out-of-Network
Coverage Includes an Eye Exam… Eye Exam (once every 12 months)
Covered in full (after $10 copay)
Reimbursed up to $45
AND either Frames and Lenses… Covered in full after: $25 copay for Single Vision $25 copay for Bifocal $25 copay for Trifocal $170 Allowance on Featured Frames $150 Allowance on All other Frames
Lenses (one pair every 12 months)
Frames (one pair every 12 months)
$85 Allowance at Costco, Walmart Sam's Club
Reimbursed up to: $30 for Single Vision $50 for Bifocal $65 for Trifocal Reimbursed up to $70
and
OR Lens Fitting/Evaluation Exam and Contacts Medically Necessary (every 12 months) Elective (every 12 months) Contact Fitting & Evaluation
Covered in full after $25 Copay
Reimbursed up to $210
$150 Allowance
Reimbursed up to $105
Copay not to exceed $60
Applied to contact lens allowance
Vision Per Pay Costs (2x for monthly cost)
Employee Only
Employee & Spouse
Employee & Child(ren)
Employee & Family
Employee Contribution
$1.43
$5.37
$4.16
$8.49
SANS Contribution
$2.50
$2.50
$2.50
$2.50
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EMPLOYEE ASSISTANCE PROGRAM
Effective January 1, 2021 An Employee Assistance Program or EAP is a 24/7 resource for employees, at no cost, that provides confidential guidance on a variety of topics that affect most people including: • • • • • • •
Stress, Depression and Work/Life Balance Confidential Mental Health Assistance Life Management Solutions Relationship Conflicts Personal Money Management Education Planning Virtual Resources and Support
Speak with licensed clinicians, financial advisors and experience life management specialists. 24 Hours a Day, 7 Days a Week 800.437.0911 clientservice@carebridge.com www.myliferesource.com
Carebridge Flyer
Click Here
Full Link: https://www.eonebenefits.com/wp-content/upload s/2020/11/SANS-Institute_One-Page-Flyer_Jan202 0_11092020.pdf
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SHORT TERM DISABILITY Short Term Disability SANS provides all employees working 20 or more hours per week Short Term Disability insurance at no cost You become eligible on the first day of the month following your date of hire Disability insurance is a plan designed to provide partial income replacement coverage to eligible employees who become disabled and are unable to work due to an illness or injury
Benefit
Details
ShortTerm Disability
• The maximum benefit amount is 60% of your gross weekly earnings, up to a maximum of $2,300 • The maximum benefit period is 13 weeks • Benefits begin after the end of the elimination period. The elimination period begins on the day you become disabled and is the length of time you must wait, while disabled, before you are eligible to receive a benefit. The elimination period is 0 days for an accident and 7 days for sickness
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SUPPLEMENTAL LIFE & AD&D Supplemental Life Life insurance is a plan that pays out a cash sum to a designated beneficiary (beneficiaries) in the event of the covered person’s death This plan’s purpose is to provide economic security for one’s family should the covered person pass away For 2021 only: if you did not previously enroll in Supplemental Life and AD&D you (and your spouse) can enroll up to the guaranteed issued amount with no medical underwriting (i.e. Statement of Health)
Benefit
Details
Supplemental Life Insurance and AD&D
• Buy in $10,000 increments • To a maximum of 5 times your pay or $500,000 • Guaranteed Issue Amount- $100,000
Spouse Supplemental Life Insurance
• Buy in $5,000 increments • To a maximum of $100,000 or 50% of the employee's election • Guaranteed Issue Amount- $25,000
Dependent Supplemental Life Insurance
Other Benefits
Buy $10,000 on all children Children 15 Days to 6 months get $1,000 of coverage Children 6 months or older get $10,000 of coverage Child age limit: 19 or 23 if a full-time student (must have documentation in ADP showing student status) • Guaranteed Issue Amount- $10,000 • • • •
• Conversion & Portability • Accelerated Benefit Option- if you have 12 months or less to live you can request up to 80% of your insured coverage while living • Will Preparation, Estate Resolution Services & Travel Assistance
When is a Statement of Health (SOH) needed? If you want to purchase more than $100,000 of coverage for yourself or $25,000 for your spouse, a Statement of Health is required. You can find the Statement of Health form on ADP or you can click here. The completed Statement of Health must be submitted as per the instructions on the form. You must be approved for any amounts over the Medical Evidence Level, if you do not submit the Statement of Health or are declined you will get $100,000 of coverage on yourself or $25,000 on your spouse.
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SUPPLEMENTAL LIFE & AD&D Supplemental Life
Below are the Life & AD&D rates per $1,000 of coverage by your age Rates for your age will only change each year on January 1st if you “age up” into a new age band We have also provided several example calculations should you choose one of the below coverage levels
Employee Less than 30 30-34 35-39 40-44 45-49 50-54 55-59 60-64 65-69 70+
Spouse Less than 30 30-34 35-39 40-44 45-49 50-54 55-59 60-64 65-69 70+
Life & AD&D Rates Per $1,000 $0.063 $0.067 $0.082 $0.110 $0.163 $0.247 $0.377 $0.571 $0.955 $1.781 Life & AD&D Rates Per $1,000 $0.064 $0.068 $0.083 $0.111 $0.164 $0.248 $0.378 $0.572 $0.956 $1.782
$10,000
$50,000
$100,000
$250,000
$500,000
$0.63 $0.67 $0.82 $1.10 $1.63 $2.47 $3.77 $5.71 $9.55 $17.81
$3.15 $3.35 $4.10 $5.50 $8.15 $12.35 $18.85 $28.55 $47.75 $89.05
$6.30 $6.70 $8.20 $11.00 $16.30 $24.70 $37.70 $57.10 $95.50 $178.10
$15.75 $16.75 $20.50 $27.50 $40.75 $61.75 $94.25 $142.75 $238.75 $445.25
$31.50 $33.50 $41.00 $55.00 $81.50 $123.50 $188.50 $285.50 $477.50 $890.50
$5,000
$10,000
$25,000
$50,000
$100,000
$0.32 $0.34 $0.42 $0.56 $0.82 $1.24 $1.89 $2.86 $4.78 $8.91
$0.64 $0.68 $0.83 $1.11 $1.64 $2.48 $3.78 $5.72 $9.56 $17.82
$1.60 $1.70 $2.08 $2.78 $4.10 $6.20 $9.45 $14.30 $23.90 $44.55
$3.20 $3.40 $4.15 $5.55 $8.20 $12.40 $18.90 $28.60 $47.80 $89.10
$6.40 $6.80 $8.30 $11.10 $16.40 $24.80 $37.80 $57.20 $95.60 $178.20
Life AD&D Rate per $10,000 $1,000 Per Unit $0.293 $2.93 *Child(ren) rates are per child unit, a unit may consist of more than one child Child
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CONTACTS Benefit
Carrier / Group #
Contact
Website
CareFirst/ YC40
800-537-5963
www.carefirst.com
Dental
MetLife/ 005956493
800-942-0854
www.metlife.com
Vision
MetLife/ 005956493
800-942-0854
www.metlife.com
Employee Assistance Program
Carebridge- Access 800-437-0911 Code 54N6A clientservice@carebridge.com
Life & Disability
MetLife/ 005956493
Medical and Prescriptions
800-942-0854
SANS Human Resources
Myliferesource.com www.metlife.com
hr@sans.org
You Have Questions. We’re Here To Help! The EONE Benefit Advocate Team (BAT) provides answers to employee’s day-to-day questions about all the benefits offered in this guide. Employee of SANS have direct access to our team by emailing mybenefits@eonebenefits.com or calling 1-877-719-EMP1(3671) and we take it from there. BAT has direct access to the systems and insurance carrier contacts needed to resolve issues that can range from minor to complex.
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Explaining Benefits Coverage: helping you understand the details of you medical, dental, vision and life and disability plans to maximize your benefits.
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Explanation Of Benefits (EOB): navigating the information on the EOB can be overwhelming. Our team has the knowledge to review these with you.
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Resolving Claims & Provider Billing Issues: we will research to ensure the claim has been accurately processed and the provider bill is accurate to eliminate overpayments to the provider.
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Locating Participating Providers: employees have access to the carrier sites, but we are happy to review providers to ensure in-network participation with your current plan.
This is a summary of your benefits only. Certain restrictions and exclusions apply. For exact terms and conditions, please refer to your summary plan description (SPD) or Certificate of Coverage. If information in this Employee Benefits Guide differs from the legal contract, the legal contract is the ruling document. SPD’s or Certificates of Coverage are available from your Human Resources Department. Plan Sponsor is not bound by any typographical errors and/or omissions contained herein. 13
