BENEFITS GUIDE 2023 Prepared by: EONE Benefits Solutions • MEDICAL & PRESCRIPTIONS • DENTAL • VISION • EMPLOYEE ASSISTANCE PROGRAM (EAP) • SHORT TERM DISABILITY (STD)/ VOLUNTARY LONG TERM DISABILITY INSURANCE (VLTD) • VOLUNTARY SUPPLEMENTAL LIFE & ACCIDENTAL DEATH & DISMEMBERMENT INSURANCE (AD&D) • VOLUNTARY ACCIDENT INSURANCE
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 2023 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 the SANS Human Resources team if you have any questions.
We hope you have a happy and healthy 2023 plan year!
YOUR BENEFITS 2 ELIGIBILITY & ENROLLMENT 3 MEDICAL BENEFITS 4 MEMBER RESOURCES 5 PRESCRIPTION RESOURCES 6 DENTAL BENEFITS 7 VISION BENEFITS 8 EMPLOYEE ASSISTANCE PROGRAM 9 SHORT TERM DISABILITY/ VOLUNTARY LONG TERM DISABILITY 10 VOLUNTARY SUPPLEMENTAL LIFE INSURANCE & ACCIDENTAL DEATH & DISMEMBERMENT INSURANCE (AD&D) 11-12 VOLUNTARY ACCIDENT INSURANCE 13 CONTACTS 14
TABLE OF CONTENTS
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ELIGIBILITY & ENROLLMENT
The SANS 2023 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, voluntary long term disability, voluntary accident insurance and voluntary life insurance benefits. New hires are eligible on the first of the month following their date of hire.
You may also elect coverage for your dependents including:
• Your legal spouse
• Your dependent children who are:
o up to 26 years old
o 26 years or older, who are incapable of self sustaining 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.
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.
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 of your eligible dependents have a Qualifying Life Event in employment or family status.
Qualifying Life Events* include:
• Marriage, divorce, or legal separation
• Adding a dependent child through birth, adoption, or court ordered custody
• Death of a spouse 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 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)
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 the Benefits Open Enrollment period will remain in effect for the entire plan year and you will have to wait until the next annual Benefits Open Enrollment period.
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January 1, 2023.
Blue Preferred PPO Plan Highlights
• Utilizes the national BlueCard PPO network
• Traditional PPO with lower deductible
• To locate an in network doctor visit www.cfablue.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 In-Network Out-of-Network
Deductible $300 Ind | $600 Fam $600 Ind | $1,200 Fam
Out-of-Pocket Maximum - Medical & Rx $1,500 Ind | $3,000 Fam $3,000 Ind | $6,000 Fam
Preventive Services
Well Child Care (Exams & Immunizations) No Charge 20% of Allowed Benefit
Adult Physical Exam (including routine GYN) No Charge Deductible then 20% of Allowed Benefit
Cancer Screenings (at set ages) & Pap Tests No Charge 0% of Allowed Benefit
Physicians Office Visit PCP or Specialist $20 Copay Deductible then 20% of Allowed Benefit Physical, Speech & Occupational Therapy $20 Copay Deductible then 20% of Allowed Benefit Chiropractic $20 Copay Deductible then 20% of Allowed Benefit Diagnostic, Lab and X ray
Deductible then No Charge 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
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 V Specialty Non Preferred Brand $45 Copay 90 Day Maintenance 2 X Retail Copay Medical Per Pay Costs (2x for monthly cost) Employee Only Employee & Spouse Employee & Child(ren) Employee & Family Employee Contribution $50.00 $80.00 $70.00 $87.50 SANS Contribution $362.96 $834.81 $671.48 $1,016.29 4 MEDICAL BENEFITS In 2023, SANS will be moving from CareFirst to CareFirst
(CFA) as our medical carrier. All medical and prescription benefits will remain the same but, all members will receive new ID cards
CFA. Please ensure you give your doctor(s) and pharmacy
ID card
Prescription
Administrators
from
the new
at your first visit after
Member
Find a Doctor
Whether you need a doctor or facility, the provider s earch online tool can help you find what you are looking for based on your specific needs It is easy for you to find the doctors you need:
• Go to www.cfablue.com.
• Select Find a Doctor; Search Now
• Under search providers, click the blue box Find a Doctor under medical
• Until you have your ID card, select Browse a list of plans
• Search by Zip Code or City, State
• Select BlueCard PPO as the network.
• Search by doctor last name, specialty or facility, or choose the type of provider/facility you are looking for based on your criteria you may be prompted for additional information.
• Follow on screen instructions .
• Once you have your ID card, you can search using the 3 letter prefix of your Subscriber ID- AAL
Online Account Access
Get easy access to claims information 24/7 and order replacement ID cards, all on a secure website that is password protected and data encrypted . Registering and Creating an Account:
• Go to www cfablue com
• Select the Members option to access your client information.
• Click Register New User and enter your username, email, and type of user, and then click Submit.
• Verify your identity by providing requested information (participant ID, participant last name, participant zip/postal code, participant date of birth), and then click Next
• Establish your password, and then click Submit
Viewing your Personal Claims:
• Click on Status and choose Claims History from
• Enter the date for a specific claim you would like to review.
•
5
dropdown options
• Claims will be produced beginning with the chosen date
The Accumulators drop
claims, year to date deductibles, and out of pocket spending Your life is 24/ 7 Now your doctor is too By activating your MDLIVE account, members can consult with a board certified doctor by phone, secure video, or MDLIVE App anytime, from anywhere. Do not wait until you need care, activate your account and download the App TODAY! MDLIVE has an average wait time of less than 10 minutes for non emergency conditions and prescriptions can be sent to your local pharmacy Call MDLIVE to treat: Insect bites Allergies Ear problems Cold / Flu Pink eye Constipation Rash Cough Sore throat UTI Call 888-632-2738 or visit: https://members.mdlive.com/ Avoid the wait with MDLIVE.
down will allow you to view
Resources
PRESCRIPTION RESOURCES
Caremark.com
Register 3 different ways: Go to caremark.com, click the Register Now button and following the instructions
Download the CVS Caremark mobile application and create an account
Call the pharmacy member services number on the back of your ID card and a representative will get you started with a personalized registration email or text
• Refill prescriptions online
• Check the status of your order.
• Review coverage and track annual spending.
• Locate network pharmacies near you.
• Check medication costs and find ways to save.
• Choose from multiple payment options
GENERIC 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.
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.
6 CVS Caremark Mobile Application Easy Refill Touch ID Access ID Card Pharmacy Geo Location
•
MetLife Dental PPO MetLife Dental PPO Amounts shown are what the member will pay In Network Out of Network Plan Year Deductible $50 Individual; $150 Family Annual Plan Year $3,000 per person per year Maximum Benefit Preventive Care* No Charge Any amount above Allowed Benefit (such as cleanings, exams, X rays) Basic Services Deductible then 20% Deductible then 20% of Allowed Benefit (such as fillings, simple extractions & general anesthesia ) Major Services Deductible then 50% Deductible then 50% of Allowed Benefit (such as dentures, bridgework, crowns) DENTAL BENEFITS Dental Only Per Pay Costs (2x for monthly cost) 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 MetLife PPO Plan Highlights
Members
have access to the national MetLife PDP Plus network
can
offer
opportunity for savings
provided
provider the
• Members
go to any dentist, but In Network dentists
the biggest
• No ID card
, simply give
employee’s name and SSN
service Your out
network dentist can bill
pays and their actual charges
• 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
of
you the difference between what MetLife
locate
dentist visit
7
• To
an In Network
www.metlife.com
MetLife
VISION BENEFITS
Vision MetLife Vision PPO Amounts shown are what the member will pay In Network Out of Network Coverage Includes an Eye Exam Eye Exam Covered in full
$10 copay) Reimbursed
$45 (once every 12 months) AND either Frames and Lenses Lenses Covered in full after: Reimbursed
(one pair every 12 months) $25 copay for Single Vision
$25
$25
Frames $170 Allowance on Featured Frames Reimbursed
$70 (one pair every 12 months) $150 Allowance on All other Frames $85 Allowance at Costco, Walmart and Sam's Club OR Lens Fitting/Evaluation Exam and Contacts Medically Necessary Covered in full after $25 Copay Reimbursed up to $210 (every 12 months) Elective $150 Allowance Reimbursed up to $105 (every 12 months) Contact Fitting & Evaluation 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 $1.42 $5.36 $4.16 $8.48 SANS Contribution $2.50 $2.50 $2.50 $2.50 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 and Anti reflective or Photochromatic coatings are covered with a small copay • To locate an In Network provider visit www.metlife.com 8
(after
up to
up to:
$30 for Single Vision
copay for Bifocal $50 for Bifocal
copay for Trifocal $65 for Trifocal
up to
EMPLOYEE ASSISTANCE PROGRAM
(EAP)
An Employee Assistance Program (or EAP) is a 24/7 resource for employees and dependents that live in their household, 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
• Any and all services provided by Carebridge are 100% free and 100% confidential Speak with licensed clinicians, financial advisors, and experienced life management specialists.
24 Hours a Day, 7 Days a Week 800.437.0911 clientservice@carebridge.com www.myliferesource.com
Full Link: https://www.eonebenefits.com/wp content/uploads/2020/11/SANS Institute_One Page Flyer_Jan2020_11092020.pdf
Carebridge Flyer Click Here
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SHORT TERM DISABILITY
Benefit Details
• 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
Short Term Disability -Employer Paid
• 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
VOLUNTARY LONG TERM DISABILITY
Long Term Disability (LTD) most people have enough savings to remain solvent for a short period of time after becoming disabled but if you do not have a means of income until Social Security kicked in would you be able to continue your lifestyle?
• SANS provides all employees working 20 or more hours per week the option to purchase long term disability insurance
• 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 for a long period of time
• If you did not elect the benefit when it was originally offered in 2022, you can still elect during Open Enrollment but a Statement of Health (SOH) will be required
Benefit Details
• The maximum benefit amount is 60% of your gross monthly earnings, up to $8,000 per month
• The maximum duration is until your SSNRA (Social Security Normal Retirement Age)
Voluntary Long Term Disability
• Benefits begin after a 90 day 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
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VOLUNTARY SUPPLEMENTAL LIFE INSURANCE AND ACCIDENTAL DEATH & DISMEMBERMENT INSURANCE (AD&D)
Voluntary Supplemental Life Insurance
• 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
Benefit Details
• Buy in $10,000 increments
Voluntary Supplemental Life Insurance and Accidental Death & Dismemberment Insurance (AD&D)
Voluntary Spouse Supplemental Life Insurance
Voluntary Dependent Supplemental Life Insurance
Other Benefits
• To a maximum of 5 times your pay or $500,000
• Guaranteed Issue Amount $100,000
• Buy in $5,000 increments
• To a maximum of $100,000 or 50% of the employee's election
• Guaranteed Issue Amount $25,000
• 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. If you are not newly eligible for this benefit a Statement of Health is required for any coverage election amount. You can find the Statement of Health form on ADP for you to submit online. The completed Statement of Health must be submitted as per the instructions on the form. If you are newly eligible for this benefit, you must be approved for any amounts over the guaranteed issue amount, 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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$4.78 $23.88 $47.75 $119.38 $238.75 70+ $0.891 $8.91 $44.53 $89.05 $222.63 $445.25
Voluntary Supplemental Life Insurance • 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 Life & AD&D Rates Per $1,000 $10,000 $50,000 $100,000 $250,000 $500,000 Less than 30 $0.032 $0.32
30 34 $0.034
35 39
40 44
45 49
50 54
55
60
65
Spouse Life & AD&D Rates Per $1,000 $5,000 $10,000 $25,000 $50,000 $100,000
35 39 $0.042 $0.21 $0.42
40 44 $0.056 $0.28 $0.56
45 49 $0.082 $0.41 $0.82
50 54 $0.124 $0.62 $1.24
55 59 $0.189 $0.95 $1.89
60 64 $0.286 $1.43 $2.86
65 69 $0.478 $2.39 $4.78
70+ $0.891 $4.46 $8.91
Child Life AD&D Rate per $1,000 $10,000 Per Unit $0.293 $1.47 *Child(ren) rates are per child unit, a unit may consist of more than one child 12 VOLUNTARY SUPPLEMENTAL LIFE INSURANCE AND ACCIDENTAL DEATH & DISMEMBERMENT INSURANCE (AD&D)
$1.58 $3.15 $7.88 $15.75
$0.34 $1.68 $3.35 $8.38 $16.75
$0.041 $0.41 $2.05 $4.10 $10.25 $20.50
$0.055 $0.55 $2.75 $5.50 $13.75 $27.50
$0.082 $0.82 $4.08 $8.15 $20.38 $40.75
$0.124 $1.24 $6.18 $12.35 $30.88 $61.75
59 $0.189 $1.89 $9.43 $18.85 $47.13 $94.25
64 $0.286 $2.86 $14.28 $28.55 $71.38 $142.75
69 $0.478
Less than 30 $0.032 $0.16 $0.32 $0.80 $1.60 $3.20 30 34 $0.034 $0.17 $0.34 $0.85 $1.70 $3.40
$1.04 $2.08 $4.15
$1.39 $2.78 $5.55
$2.05 $4.10 $8.20
$3.10 $6.20 $12.40
$4.73 $9.45 $18.90
$7.15 $14.30 $28.60
$11.95 $23.90 $47.80
$22.28 $44.55 $89.10
Accidents can happen anytime, anywhere at home or at work, on the playground, or on the road. Some of the most common injuries include:
Pay Rates Employee Only
Here are some examples of how the plan works (Low plan / High plan):
• Ground Ambulance $300 / $400
• Emergency Room $150 / $200
• Broken Nose (closed fracture) $1,000 / $2,000
• Urgent Care visit $75 / $100
• Testing (MRI, CT scan) $150 / $200
• Outpatient Surgery $300/ $400
• Death of Employee $25,000 / $30,000
Employee + Spouse Employee
• Concussion $250 / $500 These are just a few examples of how the Voluntary Accident Insurance pays out. There are additional covered services that you are eligible for with this benefit. Please contact SANS HR to get additional details. The policy has exclusions and limitations. Costs of treatment and benefit amounts may vary. *Please see MetLife summary of benefits for benefit details, limitations, and exclusions. Information provided in carrier document supersedes any provided within benefits guide. Child(ren) Family
Broken bones
Burns
Lacerations
Back or knee injuries
Accidental injuries
Concussions MetLife’s Voluntary Accident Insurance helps you fill some of the gaps caused by increasing deductibles, co payments, and out of pocket costs related to an accidental injury. With this coverage you may not need to use your savings or secure a loan to help pay those unexpected out of pocket expenses associated with a covered accident. For any funds received after an accident, you can use the money however you would like. Whether this be for your deductible and copays, or for food delivery services while you recuperate…the money is yours! Per
&
High Plan $5.93 $11.66 $14.00 $16.52 Low Plan $4.35 $8.59 $10.36 $12.21
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VOLUNTARY ACCIDENT INSURANCE
CONTACTS
Benefit
Medical and Prescriptions
Prescriptions
Carrier / Group # Contact Website
CFA / AAL 877 889 2478 www.cfablue.com
CVS Caremark / AAL 800 386 7951 www.cfablue.com
Dental MetLife/ 005956493 800 942 0854 www.metlife.com
Vision MetLife/ 005956493 800 942 0854 www.metlife.com
Employee Assistance Program
Carebridge Access Code 54N6A 800 437 0911 clientservice@carebridge.com Myliferesource.com
Voluntary Life & Disability MetLife/ 005956493 800 942 0854 www.metlife.com
Voluntary Accident Insurance MetLife/ 005956493 800 942 0854 www.metlife.com SANS Human Resources hr@sans.org
If you have questions, we are 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 Employees of SANS have direct access to our team by emailing mybenefits@eonebenefits.com or calling 1 877 719 EMP1(3671) and we will help you with your benefit questions.
Our BAT has direct access to the systems and insurance carrier contacts needed to resolve issues that can range from minor to complex.
• Explaining Benefits Coverage: helping you understand the details of your medical, dental, vision and life and disability plans to maximize your benefits
• Explanation Of Benefits (EOB): navigating the information on the EOB can be overwhelming. Our team has the knowledge to review these with you.
• 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.
• 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 plans
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.
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