Employee Benefits Guide 2023 - 2024
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.
If you should have any questions:
1. Contact the carrier directly. Phone number and website information is on page 11.
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.
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TABLE OF CONTENTS Enrollment Information................................................................ 3 Qualifying Life Event 4 COBRA ......................................................................................................4 Medical Plans (Pre Tax) 5 Telehealth (Post Tax) ...................................................................... 6 UnitedHealthcare is offering Care Cash 6 Humana Dental Plan (Pre Tax)................................................ 7 Vision Plan (Pre Tax) 8 Value Added Benefits .................................................................... 9 Employee Rate Worksheet 10 Important Phone Numbers ...................................................... 11
Enrollment Information
OPEN ENROLLMENT
Open Enrollment is from May 15 through May 19, 2023, which is your one time per year to make changes without a qualifying event.
Please login during this time to review your elections and submit your enrollment by May 19. A link will be sent to your personal email from Ease so please be sure to notify HR if you do not receive it.
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.
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.
PRE-TAX VS POST-TAX DEDUCTIONS
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.
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.
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Qualifying Life Event
The elections you make during Open Enrollment or at your initial benefits eligibility will remain in effect for the plan year (June 1, 2023 though May 31, 2024).
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.
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.
■ 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.
COBRA
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.
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).
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.
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,
■ you become entitled to Medicare; or,
■ you fail to pay the cost of coverage; or
■ your COBRA Continuation Period expires
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Marital Status Changes Covered Dependent Changes QUALIFYING LIFE EVENTS LIST
Marriage
Death of spouse ■ Divorce
Spouse gains or loses coverage from another source
Spouse employer’s Open Enrollment
Birth or adoption of a child
Death of dependent child
Dependent becomes ineligible for coverage
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Medical Plans (Pre Tax)
*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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HMO 4400 PPO 4000 PPO 1500 Navigate Network Choice Plus Network Choice Plus Network Lifetime Maximum Unlimited Unlimited Unlimited Calendar Year Unlimited Unlimited Unlimited Deductibles Individual $4,400 $4,000 $1,500 Family $8,800 $8,000 $3,000 Coinsurance 20% 30% 20% Out-of-Pocket Maximum Individual $9,100 $9,100 $8,150 Family $18,200 $18,200 $16,300 Hospital/Urgent Services 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 Office/Diagnostic Services Office Visit $45 Copay $40 Copay $30 Copay Specialist Visit $115 Copay (Referral Required) $85 or $115 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:
DNP:
Non-DNP:
Prescription Drugs Tier 1 $10 Copay $10 Copay $10 Copay Tier 2 $50 Copay $50 Copay $50 Copay Tier 3 $125 Copay $125 Copay $125 Copay Tier 4 50% Coinsurance 50% Coinsurance 50% Coinsurance Mail-Order 2.5 x Retail 2.5 x Retail 2.5 x Retail
Deductible, then 30% Non-DNP: $500, Deductible, then 50%
Deductible, then 20%
$500, Deductible, then 50%
Telehealth (Post Tax)
If you enroll in this plan, please be sure to download the HealthiestYou mobile app and set up your account. General medical consultations are free to you, your spouse and your dependent children up to age 26 if you purchase this plan.
As of June 1, 2023, general medical will be the only service provided under this plan with a $0 Copay. Mental Health and Dermatology will be available at an additional cost. Please see your HealthiestYou mobile app for additional details following June 1, 2023.
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.
UnitedHealthcare is offering Care Cash
To help employees pay for certain health care costs and encourage them to use quality care, UnitedHealthicare is offering Care Cash™. This preloaded debit card can be used for the following visits:
■ UnitedHealth Premium® Primary Care providers
■ UnitedHealth Premium® Specialist providers
■ Network Primary Care providers
■ Virtual Visits
■ Urgent Care
■ Outpatient Behavioral Health
CARE CASH IS DESIGNED TO GIVE EMPLOYEES:
■ $200 for the year for individual coverage, or
■ $500 for family coverage
HOW IT WORKS:
1. Employees receive information about Care Cash and can request the card on myuhc.com®
2. Once received and activated, the Care Cash card can be used for certain eligible health care expenses
3. Employees have access to viewing other programs and benefits through myuhc.com or can call a toll-free number for guidance
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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
Humana Dental Plan (Pre Tax)
*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.
PPO NETWORK In Network Out of Network Annual Deductibles Individual $50 $100 Family $150 $300 Annual Plan Maximum Unlimited Unlimited Benefits Type 1 - Preventive Services 100% 80% Type II - Basic Services 80% 50% Type III - Major Services 50% 50% Other Benefits Periodontic Coverage 50% 50% Endodontic Coverage 50% 50%
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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
Exam $10 Copay
Frequency Every 12 Months
Lenses Covered 100%
Single/Bifocal/Trifocal/Lenticular After $10 copay
Frequency Every 12 Months
Frames $160 Allowance, 20% off balance
Frequency Every 24 Months
Contact Lenses (in lieu of frames)
Medically Necessary Covered in Full
Elective Conventional $160 Allowance + 15% off reminder*
Elective Disposable $160 Allowance (no additional discount)*
Frequency Every 12 Months
Out of Network
Reimbursed to $30
Every 12 Months
Reimbursed $25 to $100
depending on lens
Every 12 Months
Reimbursed to $80
Every 24 Months
Reimbursed to $210
Reimbursed to $128
Reimbursed to $128
Every 12 Months
*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.
SUPPLEMENTAL LIFE/AD&D (Post Tax)
During Open Enrollment, employees may purchase up to the following guarantee issue limits without evidence of insurability as long as the amount does not exceed 5 times your salary. To apply for an amount above the guarantee issue limit, you must complete evidence of insurability and be approved.
Employee: $10,000 up to $250,000 $150,000 (Guarantee Issue Limit)
Spouse: $10,000 up to $50,000; not to exceed 50% of employee amount $30,000 (Guarantee Issue Limit)
Child(ren): $10,000 (Guarantee Issue Limit)
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:
■ 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.
Waiting Period: 30 days
Benefit Amount: $1,000 per month
Benefit Period: 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.
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: $150,000
Spouse: $30,000
Child(ren): $10,000
This is a voluntary benefit and paid 100% by employees.
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.
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MEDICAL PLANS DENTAL PLAN TELEMEDICINE PLAN VISION PLAN DISABILITY PLAN HMO 4400 DENTAL PPO HEALTHIEST YOU EYEMED VOLUNTARY PPO 4000 PPO 1500 PER PAY $ 74.50 $ 350.00 $ 336.23 $ 708.15 PER PAY $ 20.06 $ 40.13 $ 51.16 $ 71.22 PER PAY $ 3.00 $ 3.00 $ 3.00 $ 3.00 PER PAY $ 3.82 $ 7.63 $ 7.25 $ 11.39 PER PAY $1.22 ($1,000 monthly benefit) EMPLOYEE ONLY EMPLOYEE & SPOUSE EMPLOYEE & CHILDREN EMPLOYEE & FAMILY EMPLOYEE ONLY EMPLOYEE & SPOUSE EMPLOYEE & CHILDREN EMPLOYEE & FAMILY EMPLOYEE ONLY EMPLOYEE & SPOUSE EMPLOYEE & CHILDREN EMPLOYEE & FAMILY PER PAY $ 141.85 $ 484.69 $ 467.55 $ 930.39 PER PAY $ 178.31 $ 557.62 $ 538.66 $ 1,050.72
Important Phone Numbers
UNITEDHEALTHCARE MEDICAL
800.782.3740 myuhc.com
HEALTHIEST YOU
866.703.1259 member.healthiestyou.com
HUMANA DENTAL
877.282.5654 humana.com
HUMANA VISION
877.398.2682 humana.com
HARTFORD LIFE & DISABILITY
800.331.7234 thehartford.com/mybenefits
AFLAC
Nancy Carlson or Karen Jones 602.229.1970
CAPITAL FINANCIAL (BROKER)
Julie Roden 480.900.6816 julie@cfplc.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
