Here’s to a
healthier you!
Employee Benefits Guide 2022 - 2023
TABLE OF CONTENTS Enrollment Information.................................................................3
Humana Dental Plan (Pre Tax).................................................7
Qualifying Life Event........................................................................4
Vision Plan (Pre Tax)........................................................................8
COBRA.......................................................................................................4
Value Added Benefits.....................................................................9
Medical Plans (Pre Tax)..................................................................5
Employee Rate Worksheet........................................................10
Telehealth (Post Tax).......................................................................6
Important Phone Numbers....................................................... 11
INTRODUCTION Whether you are a new employee enrolling in benefits for the first time or considering changes during open enrollment, this guide is designed to help you through the process. Sonoran Medical Centers is proud to offer you a broad range of benefit options. You can choose from a number of plans including medical, dental, vision, life, disability and voluntary supplement programs. Please take the time to read this information and ask questions so you can make the best benefits decisions for both you and your family.
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If you should have any questions: 1. Contact the carrier directly. Phone number and website information is on page 9. 2. Contact Meri Sutton, 623.298.1940, msutton@sonoranmed.com This booklet highlights important features of Sonoran Medical Centers’ benefits for its benefit eligible employees. While efforts have been made to ensure the accuracy of the information presented, in the event of any discrepancies, your actual coverage and benefits will be determined by the legal plan documents and the contracts that govern these plans.
Enrollment Information OPEN ENROLLMENT
PRE-TAX VS POST-TAX DEDUCTIONS
Open Enrollment is from May 11 through May 23, 2022. This is your one time per year to make changes.
Pre-Tax Dollars: Your insurance premiums are paid with money removed from your gross wages prior to any tax calculations. This reduces your tax liability and is a more efficient way to pay for premiums. You may elect to opt-out of this method of paying.
Please login to review your elections and submit your online enrollment by May 23.
NEW EMPLOYEES New Employees have 31 days from your hire date to complete enrollment in the group insurance program. If you have moved from a non-benefits eligible status to a benefits eligible status, you will have 31 days from the new benefits eligible status to complete your enrollment. Full-time employees are eligible to be enrolled in the plans listed in this guide on the first of the month following 60 days of employment.
Post-Tax Dollars: Some insurance premiums may be paid after taxes. Please contact HR for more information related to the specific premiums that are deducted post-tax.
Remember, if elections are not made within the 31-day initial period of eligibility, you will be required to wait until Annual Open Enrollment or until a Qualifying Life Event takes place. Late Enrollees will be required to complete an evidence of insurability form for voluntary life insurance. You may be turned down for these benefits if you do not enroll within your first 31 days as a new hire.
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Qualifying Life Event COBRA The elections you make during Open Enrollment or at your initial benefits eligibility will remain in effect for the plan year (June 1, 2022 though May 31, 2023). During that time, if your life or family status changes according to the recognized events listed below, you are permitted to revise your benefits coverage to accommodate your new status. You may make benefit changes by contacting HR and providing the proper documentation.
Through federal legislation known as the Consolidated Omnibus Budget Reconciliation Act of 1985 (COBRA), you may choose to continue coverage by paying the full monthly premium cost plus an administrative charge of 2% (if applicable).
IRS regulations govern under what circumstances you may make changes to your benefits, which benefits you can change and what kinds of changes are permitted.
Each individual who is covered by a Sonoran Medical Centers benefit plan immediately preceding the employee’s COBRA event has the right to continue his or her medical, dental or vision plan.
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All changes must be consistent with the qualifying life event. In some cases, you may change your benefit plan and modify the level of coverage (such as add or delete a dependent). This plans allows you to drop your medical plan and enroll in a Qualified Health Plan offered in the Marketplace during the Marketplace’s special or annual enrollment period.
Any changes in benefit levels must be completed within 31 days of the qualifying life event.
QUALIFYING LIFE EVENTS LIST Marital Status Changes ■ ■ ■ ■
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In most cases, if your employment ends, benefits will terminate on the last day of the month in which you worked. Benefits will end on the day of termination in cases of employee fraud.
Marriage Death of spouse Divorce Spouse gains or loses coverage from another source Spouse employer’s Open Enrollment
Covered Dependent Changes ■
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Birth or adoption of a child Death of dependent child Dependent becomes ineligible for coverage
The right to continuation of coverage ends at the earliest of the date: ■
you, your spouse or dependents become covered under another group health plan; or,
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you become entitled to Medicare; or,
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you fail to pay the cost of coverage; or
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your COBRA Continuation Period expires
Medical Plans (Pre Tax) HMO 3500
PPO 3500
PPO 1500
Navigate Network
Choice Plus Network
Choice Plus Network
Lifetime Maximum
Unlimited
Unlimited
Unlimited
Calendar Year
Unlimited
Unlimited
Unlimited
Individual
$3,500
$3,500
$1,500
Family
$7,000
$7,000
$3,000
Coinsurance
20%
30%
20%
Individual
$8,700
$8,700
$8,150
Family
$17,400
$17,400
$16,300
Inpatient Hospital
Deductible, then 20%
Deductible, then 30%
Deductible, then 20%
Outpatient Hospital
$350, Deductible, then 20%
$350, Deductible, then 30%
$350, Deductible, then 20%
Emergency Room
Deductible, then 20%
Deductible, then 30%
Deductible, then 20%
Urgent Care
$50 Copay
$50 Copay
$50 Copay
Deductibles
Out-of-Pocket Maximum
Hospital/Urgent Services
Office/Diagnostic Services Office Visit
$35 Copay
$30 Copay
$30 Copay
Specialist Visit
$100 Copay (Referral Required)
$70 or $100 Copay
$50 or $100 Copay
Preventive Care
Covered in Full
Covered in Full
Covered in Full
Lab & X-Ray*
Deductible, then 20%
Deductible, then 30%
Deductible, then 20%
Complex Imaging*
DNP: Deductible, then 20% Non-DNP: $500, Deductible, then 50%
DNP: Deductible, then 30% Non-DNP: $500, Deductible, then 50%
DNP: Deductible, then 20% Non-DNP: $500, Deductible, then 50%
Tier 1
$10 Copay
$10 Copay
$10 Copay
Tier 2
$50 Copay
$35 Copay
$35 Copay
Tier 3
$125 Copay
$110 Copay
$110 Copay
Tier 4
50% Coinsurance
50% Coinsurance
50% Coinsurance
Mail-Order
2.5 x Retail
2.5 x Retail
2.5 x Retail
Prescription Drugs
*Members must use a Designated Network Provider to prevent additional charges. See myuhc.com for more information. For purposes of deductible, medical plan year is June 1 through May 31.
Find A Doctor in the UnitedHealthcare Navigate or Choice Plus Network: myuhc.com Members register at: myuhc.com
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Telehealth (Post Tax) If you enroll in this plan, please be sure to download the HealthiestYou mobile app and set up your account. The following services and consultations are free to you, your spouse and your dependent children up to age 26 if you purchase this plan.
TALK TO A DOCTOR 24/7 UNDER $0 COPAY Speak to a licensed physician who can diagnose, treat and prescribe. HealthiestYou is 24/7/365 access to a physician, anytime, anywhere. If you have an issue, schedule a consultation with a HealthiestYou board-certified physician by phone, video or chat. HealthiestYou physicians can diagnose, treat and prescribe medications for a wide variety of common medical conditions, helping you avoid costly and time consuming trips to the doctor or urgent care center.
BEHAVIORAL HEALTH UNDER $0 COPAY Schedule an appointment with a therapist over the phone any day of the week. If something is weighing you down, talking to someone can help. HealthiestYou’s licensed therapists are available to schedule a consultation any day of the week. Choose your psychiatrist/psychologist/therapist and pick a time that is convenient for you. You can talk to a therapist from the privacy of your home. HealthiestYou therapists can treat:
Anxiety Depression We Do for Businesses ■ Stress/PTSD alth care means ensuring the right diagnosis and the right treatment. All too often, patients■are unsuredisorder Panic r care and don’t have the tools to find the answers they need. Best Doctors helps people facing any ■ Family and marriage issues DERMATOLOGY UNDER $0 COPAY edical uncertainty, ensuring they are on the optimal path of care. ■ And more Upload photos of your condition to the mobile app and ors solves the unsolvable in health care. We address the most complex, critical and costly problems by HealthiestYou has added a benefit called myStrength receive a treatment plan from a dermatologist within g expert clinical analysis with a premium member experience. We provide a trusted resource that your which can provide you with a personalized plan that two business days. s can count on to help them at their most critical points in their journeys. is designed just for you based on your responses to a series of questions. ogram ■ ■
EXPERT MEDICAL SERVICES UNDER $0 COPAY
ors works by reviewing all of the medical information in a member’s case, identifying the issues and g with a world-class for theiropinion recommendations on the case. The focus of this effort is on one Receiveexpert a second on an existing diagnosis for BACK CARE king sure the member receives the right diagnoses and the best treatment plan.
UNDER $0 COPAY
any condition. Whether you are questioning the accuracy of a diagnosis, trying to decide if surgery is formation is fragmented in our health care system and often causes overworked doctors Relieve to make back pain through guided videos with a the right treatment, or seeking answers to medical certified health coach. Here’s how it works: with incomplete information, lack of expertise or lack of time. Fortunately, the Best Doctors’ non-biased port helps not only our members, all parties involved in the provide members’ personcare. questions, Expertbut Medical Services will ■ Member completes a 5 minute back health alized medical advice and recommendations from xpert(s) examines a case – and answers any questions posed by the member – his/her findingsassessment and leading experts in their specialties. ndations are securely delivered to the member. A clinician reviews the Best Doctors report with the ■ Members are provided a customized back care o ensure they understand the expert’s recommendations. video program The Expert Medical Services care team will gather ■ Health coach consultations are scheduled via chat medical records and select the most-qualified experts lue or phone to conduct in-depth reviews of your case. 45% of the costs for employees and clients by: ■ Program lasts 4 to 8 weeks with access to healthy time a diagnosis is corrected or modified and 75% of ains costs for not only employees, but for clients as well, by ensuring the right care. back training sessions for one year the time, your treatment is corrected or modified. ding the best care to all employees, wherever they are in the world. Contact Expert Medical Services through your THROUGH OUR EXPERT WE HAVE FOUND: HealthiestYou mobile appREVIEWS, or at 866.904.0910.
45%
OF THE TIME WE CORRECT OR MODIFY DIAGNOSES
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75%
OF THE TIME WE CORRECT OR MODIFY TREATMENTS
Download the HealthiestYou mobile app for easy access to these services, or go to: https://member.healthiestyou.com/user/sign-in You can also contact HealthiestYou at 1.866.703.1259.
ears, we have been helping clients of sizes in all sectors across the globe, making sure their employees have access to the highest quality of care.
Humana Dental Plan (Pre Tax) PPO NETWORK In Network
Out of Network
Individual
$50
$100
Family
$150
$300
Annual Plan Maximum
Unlimited
Unlimited
Type 1 - Preventive Services
100%
80%
Type II - Basic Services
80%
50%
Type III - Major Services
50%
50%
Periodontic Coverage
50%
50%
Endodontic Coverage
50%
50%
Annual Deductibles
Benefits
Other Benefits
*Out of Network services are reimbursed based on Humana’s maximum allowable charge. Out of Network dentists may bill you above the amount covered by your dental plan. The deductible and annual maximum is based on calendar year. This plan is a voluntary benefit and paid 100% by employees.
Find a Humana dentist at humana.com
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Vision Plan (Pre Tax)
All standard lenses are covered.
Find a vision provider at humana.com
HUMANA VISION PLAN Humana Insight Network
Out of Network
Exam
$10 Copay
Reimbursed to $30
Frequency
Every 12 Months
Every 12 Months
Lenses
Covered 100%
Reimbursed $25 to $100
Single/Bifocal/Trifocal/Lenticular
After $10 copay
depending on lens
Frequency
Every 12 Months
Every 12 Months
Frames
$160 Allowance, 20% off balance
Reimbursed to $80
Frequency
Every 24 Months
Every 24 Months
Medically Necessary
Covered in Full
Reimbursed to $210
Elective Conventional
$160 Allowance + 15% off reminder*
Reimbursed to $128
Elective Disposable
$160 Allowance (no additional discount)*
Reimbursed to $128
Frequency
Every 12 Months
Every 12 Months
Contact Lenses (in lieu of frames)
*The contact lens benefit is a one-time benefit and available every 12 months from the purchase date. Members should purchase the full allowed amount of $160 (in network) to maximize their contact lens benefit. Exam, allowances and frequencies will reset based on your last service date. This plan is a voluntary benefit and paid 100% by employees.
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Value Added Benefits LONG TERM DISABILITY INSURANCE (Post Tax) Disability coverage can be one of the most important benefits you have. It provides you and your family with financial protection if you are ever unable to work due to an illness or non-work related injury. This is a voluntary benefit and paid 100% by employees.
Waiting Period: Benefit Amount: Benefit Period:
30 days $1,000 per month 24 months
If you do not elect within 31 days as a new hire, you may be turned down as you will be required to complete an evidence of insurability form.
SUPPLEMENTAL LIFE/AD&D (Post Tax) To purchase Supplemental Life/AD&D during Open Enrollment, employees are required to complete evidence of insurability and be approved. Employees may be underwritten for the following amounts. Employee: Spouse: Child(ren):
$10,000 up to $250,000; not to exceed 3 times salary $10,000 up to $50,000; not to exceed 50% of employee amount $10,000
New Hires may purchase up to the following guarantee issue limits without evidence of insurability when you elect within 31 days of your hire date. If you do not elect within 31 days as a new hire, you may be turned down as you will be required to complete an evidence of insurability form. Employee: Spouse: Child(ren):
$150,000 $30,000 $10,000
This is a voluntary benefit and paid 100% by employees.
AFLAC SUPPLEMENTAL PLANS (Pre Tax and Post Tax) American Family Life Assurance Company (Aflac) is pleased to offer Sonoran Medical Centers employees the opportunity to elect a variety of Aflac policies. A few things to remember about these policies: ■
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An Aflac policy is separate from other policies listed in this guide and does not replace your medical insurance coverage. Aflac pays you directly, no matter what other insurance you may have. You can enroll in one or all of the policies.
To enroll in these policies, you must meet with an Aflac representative. A representative will be on site during Open Enrollment to provide enrollment assistance and answer any questions. If you are a new hire, please speak with HR to arrange an on-site meeting.
Short Term Disability Plan: This plan pays a percentage of your weekly income while you are not working. Accident Advantage Plan: This plan pays cash benefits in the event of an accidental injury that needs emergency treatment. Hospital Choice Plan: This plan pays cash benefits in the event of a hospitalization. Cancer Care Plan: This plan pays cash benefits for an individual diagnosed with internal cancer. Term Life Plan: This plans pays a cash benefit if you are no longer living.
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Employee Rate Worksheet Use this worksheet to provide a general estimate of your benefits costs for the upcoming plan year. This is a great place to start planning for you and your family’s health and wellness for next year.
MEDICAL PLANS
EMPLOYEE ONLY EMPLOYEE & SPOUSE EMPLOYEE & CHILDREN EMPLOYEE & FAMILY
EMPLOYEE ONLY EMPLOYEE & SPOUSE EMPLOYEE & CHILDREN EMPLOYEE & FAMILY
EMPLOYEE ONLY EMPLOYEE & SPOUSE EMPLOYEE & CHILDREN EMPLOYEE & FAMILY
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HMO 3500
PPO 3500
PPO 1500
PER PAY $ 68.31 $322.12 $309.43 $652.07
PER PAY $ 130.03 $ 445.57 $ 429.79 $ 855.76
PER PAY $ 168.91 $ 523.33 $ 505.61 $ 984.06
DENTAL PLAN
VISION PLAN
DENTAL PPO
EYEMED
PER PAY $ 18.49 $ 36.99 $ 47.16 $ 65.65
PER PAY $ 3.60 $ 7.19 $ 6.83 $ 10.73
TELEMEDICINE PLAN
DISABILITY PLAN
HEALTHIEST YOU
VOLUNTARY
PER PAY $ 5.00 $ 5.00 $ 5.00 $ 5.00
PER PAY $ 1.22
Important Phone Numbers UNITEDHEALTHCARE MEDICAL
HARTFORD LIFE & DISABILITY
800.782.3740 myuhc.com
800.331.7234 thehartford.com/mybenefits
HEALTHIEST YOU
AFLAC
866.703.1259 member.healthiestyou.com
Nancy Carlson or Karen Jones 602.229.1970
HUMANA DENTAL
CAPITAL FINANCIAL (BROKER)
877.282.5654 humana.com
Julie Roden 480.900.6816 julie@cfplc.com
HUMANA VISION 877.398.2682 humana.com
SONORAN MEDICAL CENTERS HR Meri Sutton 623.298.1940
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ABOUT THIS BOOKLET This booklet highlights important features of Sonoran Medical Centers’ benefits for its benefit eligible employees. While efforts have been made to ensure the accuracy of the information presented, in the event of any discrepancies your actual coverage and benefits will be determined by the legal plan documents and the contracts that govern these plans.
Capital Financial 14614 N. Kierland Blvd., Suite N230, Scottsdale, AZ 85254 Office / 480.347.0926 Fax / 480.360.6417
