Choose to participate Enroll yourself and family members Waive coverage

Transcription

1 Welcme t Open Enrllment. Open Enrllment is yur pprtunity t enrll r make changes t yur benefits fr the new plan year. During Open Enrllment yu may pt t d the fllwing: Chse t participate Enrll yurself and family members Waive cverage Fr benefit details n MEC Plus and MEC Plus Advantage please refer t fllwing page. MEC Plus MEC Plus Advantage Status Semi-Mnthly Emplyee Cntributins (Twice Per Mnth) Semi-Mnthly Emplyee Cntributins (Twice Per Mnth EE Only $37.43 $62.88 EE + Child(ren) $57.59 $97.12 EE + Spuse $62.30 $ EE + Family $84.41 $ Participatin in MEC Plus Advantage Satisfies the Individual Mandate Penalty by prviding Minimum Essential Cverage (MEC). MEC Plus Advantage prvides benefits fr the fllwing: Preventive Care, Primary Care, Specialists, Urgent Care, Lab, Imaging, Sphisticated Imaging (CAT Scans and MRIs) and Prescriptin Drugs. The Penalty in 201 fr nt having a MEC Plan, r greater cverage, is $ per adult, per child up t a maximum per family f $2, r 2.5% f adjusted husehld incme, whichever is greater. 1 P age

2 Dear Emplyee, Yu will be able t take better care f yurself with access t an affrdable health care with the new Minimum Essential Cverage (MEC) plan. A plan with n cst fr preventive care services fr yu, yur spuse and children up t age 26. Minimum Essential Cverage was designed t prvide everyne with affrdable access t care. Preventive Services include Screenings Cnsultatins Immunizatins In additin, yu may have heard abut the ACA Individual Mandate Penalty f yu d nt have qualifying health care cverage hat penalty fr 201 is the greater f 2.5% f husehld incme r $695 per adult, $ per child up t a maximum f $2, By participating in the MEC plan prtects yu frm thse penalties. Sign up nw and avid penalties. Yu have the ptin f buying MEC Plus r MEC Plus Advantage. Cverage can include Primary Care, Specialists, Urgent Care, Lab, Imaging, Generic and Brand Name Drugs. We lk frward t having the pprtunity t be f service. Thank yu! ARG Staffing Cntributin Wrk Sheet Status MEC Plus Semi Mnthly Emplyee Cntributins (Twice Per Mnth) MEC Plus Advantage Semi Mnthly Emplyee Cntributins (Twice Per Mnth) EE Only $37.43 $62.88 EE + Child(ren) $57.59 $97.12 EE + Spuse $62.30 $ EE + Family $84.41 $ P age

3 Benefit Overview MEC Plus Advantage Preventive Care Benefits Nte that this list will be updated peridically and a current list is always available by visiting Benefit MEC Plus MEC Plus Advantage All 18 Preventive Services fr Adults All 26 Preventive Services fr Wmen All 27 Cvered Preventive Services fr Children 100% Cverage fr Preventive Care Services 100% Cverage fr Preventive Care Services PPO Netwrk Multiplan: Click n lg t cnduct participating prvider search fr yur Zip Cde Primary Care Physician Office Visit $0 Cpay, Max 2 visits per Calendar year $20 Cpay, Max 3 visits per Calendar year Specialist Office Visit Urgent Care Nt Cvered Nt Cvered $50 Cpay, Max 3 visits per calendar year $50 Cpay, Max 3 visits per Calendar year Diagnstic X-ray and Lab (in ffice) Cat-Scan/MRI r utpatient testing Emergency Rm Nt Cvered Nt Cvered Nt Cvered $50 Cpay, Max 5 Services per calendar year $200 Cpay, Max 1 Cat Scan, 1 MRI per calendar year Nt Cvered Benefit Tier 1 Lw Cst Generics Tier 2 - Generics Prescriptin Benefits Optum Rx: $1 Cpay 10% Cinsurance Tier 3 Preferred Brand Tier 4 Nn-Preferred Brand Tier 5 Generic and Preferred Specialty Tier 6 Nn-Preferred Specialty Pharmacy Discunt Card Up t 75% Off FDA Apprved Medicatins 20% Cinsurance 40% Cinsurance 10% Cinsurance (Plan pays 90% up t max f $150 per Rx) 20% Cinsurance (Plan pays 80% up t max f $250 per Rx) 3 P ag e

4 What is nt cvered This list may nt be all inclusive Rehabilitative Occupatinal and Physical Therapy Skilled Nursing Mental Health unless cvered by MEC Outpatient Surgery Physician & Surgical Ambulatry Surgical Center Services Inpatient r Outpatient Hspital related serviced Rehabilitative Speech Therapy Transplants Specialty Drugs 4 P ag e

5 Overview f PPACA Cvered Preventive Care Services 100% cvered, n cpays This list was btained frm This list may be updated peridically. All Minimum Essential Cverage (MEC) plans must cmply with the required Preventive Care Services t qualify as prviding Minimum Essential Cverage under the Patient Prtectin & Affrdable Care Act. Preventive Services fr All Adults: 1. Abdminal artic aneurysm ne-time screening fr men f specified ages wh have ever smked 2. Alchl misuse screening and cunseling 3. Aspirin use t prevent cardivascular disease fr men and wmen f certain ages 4. Bld pressure screening 5. Chlesterl screening fr adults f certain ages r at higher risk 6. Clrectal cancer screening fr adults ver Depressin screening 8. Diabetes (Type 2) screening fr adults with high bld pressure 9. Diet cunseling fr adults at higher risk fr chrnic disease 10. Hepatitis B screening fr peple at high risk, including peple frm cuntries with 2% r mre Hepatitis B prevalence, and U.S.-brn peple nt vaccinated as infants and with at least ne parent brn in a regin with 8% r mre Hepatitis B prevalence. 11. Hepatitis C screening fr adults at increased risk, and ne time fr everyne brn HIV screening fr everyne ages 15 t 65, and ther ages at increased risk 13. Immunizatin vaccines fr adults dses, recmmended ages, and recmmended ppulatins vary: Diphtheria Hepatitis A Hepatitis B Herpes Zster Human Papillmavirus (HPV) Influenza (flu sht) Measles Meningcccal Mumps Pertussis Pneumcccal Rubella Tetanus Varicella (Chickenpx) 14. Lung cancer screening fr adults at high risk fr lung cancer because they re heavy smkers r have quit in the past 15 years 15. Obesity screening and cunseling 16. Sexually transmitted infectin (STI) preventin cunseling fr adults at higher risk 17. Syphilis screening fr adults at higher risk 18. Tbacc Use screening fr all adults and cessatin interventins fr tbacc users 5 P ag e

6 Preventive Services fr Wmen: 1. Anemia screening n a rutine basis 2. Breastfeeding cmprehensive supprt and cunseling frm trained prviders, and access t breastfeeding supplies, fr pregnant and nursing wmen 3. Cntraceptin: Fd and Drug Administratinapprved cntraceptive methds, sterilizatin prcedures, and patient educatin and cunseling, as prescribed by a health care prvider fr wmen with reprductive capacity (nt including abrtifacient drugs). This des nt apply t health plans spnsred by certain exempt religius emplyers. Learn mre abut cntraceptive cverage. 4. Flic acid supplements fr wmen wh may becme pregnant 5. Gestatinal diabetes screening fr wmen 24 t 28 weeks pregnant and thse at high risk f develping gestatinal diabetes 6. Gnrrhea screening fr all wmen at higher risk 7. Hepatitis B screening fr pregnant wmen at their first prenatal visit 8. Rh Incmpatibility screening fr all pregnant wmen and fllw-up testing fr wmen at higher risk 9. Syphilis screening 10. Expanded tbacc interventin and cunseling fr pregnant tbacc users 11. Urinary tract r ther infectin screening Other cvered preventive services fr wmen 1. Breast cancer genetic test cunseling (BRCA) fr wmen at higher risk 2. Breast cancer mammgraphy screenings every 1 t 2 years fr wmen ver Breast cancer chempreventin cunseling fr wmen at higher risk 4. Cervical cancer screening fr sexually active wmen 5. Chlamydia infectin screening fr yunger wmen and ther wmen at higher risk 6. Dmestic and interpersnal vilence screening and cunseling fr all wmen 7. Gnrrhea screening fr all wmen at higher risk 8. HIV screening and cunseling fr sexually active wmen 9. Human Papillmavirus (HPV) DNA test every 3 years fr wmen with nrmal cytlgy results wh are 30 r lder 10. Osteprsis screening fr wmen ver age 60 depending n risk factrs 11. Rh incmpatibility screening fllw-up testing fr wmen at higher risk 12. Sexually transmitted infectins cunseling fr sexually active wmen 13. Syphilis screening fr wmen at increased risk 14. Tbacc use screening and interventins 15. Well-wman visits t get recmmended services fr wmen under 65 6 P ag e

7 Preventive Services fr Children: 1. Alchl and drug use assessments fr adlescents 2. Autism screening fr children at 18 and 24 mnths 3. Behaviral assessments fr children ages: 0 t 11 mnths, 1 t 4 years, 5 t 10 years, 11 t 14 years, 15 t 17 years 4. Bld pressure screening fr children ages: 0 t 11 mnths, 1 t 4 years, 5 t 10 years, 11 t 14 years, 15 t 17 years 5. Cervical dysplasia screening fr sexually active females 6. Depressin screening fr adlescents 7. Develpmental screening fr children under age 3 8. Dyslipidemia screening fr children at higher risk f lipid disrders ages: 1 t 4 years, 5 t 10 years, 11 t 14 years, 15 t 17 years 9. Fluride chempreventin supplements fr children withut fluride in their water surce 10. Gnrrhea preventive medicatin fr the eyes f all newbrns 11. Hearing screening fr all newbrns 12. Height, weight and bdy mass index (BMI) measurements fr children ages: 0 t 11 mnths, 1 t 4 years, 5 t 10 years, 11 t 14 years, 15 t 17 years 13. Hematcrit r hemglbin screening fr all children 14. Hemglbinpathies r sickle cell screening fr newbrns 15. Hepatitis B screening fr adlescents at high risk, including adlescents frm cuntries with 2% r mre Hepatitis B prevalence, and U.S.- brn adlescents nt vaccinated as infants and with at least ne parent brn in a regin with 8% r mre Hepatitis B prevalence: years. 16. HIV screening fr adlescents at higher risk 17. Hypthyridism screening fr newbrns 18. Immunizatin vaccines fr children frm birth t age 18 dses, recmmended ages, and recmmended ppulatins vary: Diphtheria, Tetanus, Pertussis (Whping Cugh) Haemphilus influenza type b Hepatitis A Hepatitis B Human Papillmavirus (PVU) Inactivated Plivirus Influenza (flu sht) Measles Meningcccal Pneumcccal Rtavirus Varicella (Chickenpx) 19. Irn supplements fr children ages 6 t 12 mnths at risk fr anemia 20. Lead screening fr children at risk f expsure 21. Medical histry fr all children thrughut develpment ages: 0 t 11 mnths, 1 t 4 years, 5 t 10 years, 11 t 14 years, 15 t 17 years 22. Obesity screening and cunseling 23. Oral health risk assessment fr yung children ages: 0 t 11 mnths, 1 t 4 years, 5 t 10 years 24. Phenylketnuria (PKU) screening fr newbrns 25. Sexually transmitted infectin (STI) preventin cunseling and screening fr adlescents at higher risk 26. Tuberculin testing fr children at higher risk f tuberculsis ages: 0 t 11 mnths, 1 t 4 years, 5 t 10 years, 11 t 14 years, 15 t 17 years 27. Visin screening fr all children 7 P ag e

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9 ARG Staffing Benefits Enrllment Frm Emplyee Infrmatin Emplyee Name (First, MI, Last) Date f Birth: Date f Hire: Gender: Scial Security Number: Mailing Address: City State: Zip Cde: Address: Hme Phne: Cell Phne: 1) Reasn fr Applicatin Open Enrllment New Hire Qualifying Event Terminatin 2) Change f Status/Cverage Change f Address Divrce Marriage Drp Dependent Birth f Child Terminatin Date: 3) MEC Electin: MEC Plus: MEC Plus Advantage: Waive: Marital Status: Single: Married: Divrced: Elect cverage fr: Emplyee Only: Emplyee/Child(ren): Emplyee/Spuse: Emplyee/Family: Spuse s Name: (First, MI, Last) Date f Birth: Gender: M / F Scial Security Number: Waive: Child 1: (First, MI, Last) Date f Birth: Gender: M / F Scial Security Number: Child 2: (First, MI, Last) Date f Birth: Gender: M / F Scial Security Number: Child 3: (First, MI, Last) Date f Birth: Gender: M / F Scial Security Number: Child 4: (First, MI, Last) Date f Birth: Gender: M/ F Scial Security Number: MEC Plus and MEC Plus Advantage are administered by Benefits Management Grup, Inc., 1520 Kinsingtn Rad, Suite 200, Oakbrk, IL Custmer Service: Phne: / custserv@bmgiweb.cm: Please Sign here fr enrlling r waiving cverage fr yurself r dependents. I acknwledge I have been given the right t apply fr this cverage; hwever, I and/r my dependent(s), am/are electing t enrll r waive cverage. I acknwledge that I, and/r my dependent(s), may have t wait until the plans next anniversary date t be enrlled fr medical cverage if waiving cverage. Signature f Emplyee: Date: 9 P age

10 Discunt Plan Package Optins BENEFITS Package 1 Mnthly Cst $6.00* Dental Visin Pharmacy & Vitamins BENEFITS Package 2 Mnthly Net Cst $9.95 Dental Visin Pharmacy and Vitamins Health Advcate Lab Services MRI/CT Hearing Aids BENEFITS Package 3 Mnthly Net Cst $12.00 Dental Visin Pharmacy and Vitamins Health Advcate Lab Services MRI/CT Durable Medical Equipment Hearing Aids Diabetic Supplies Pet Care 10 P ag e

11 BENEFITS Package 4 Three reasns t use Teladc: Teladc gives yu anytime access t U.S. bard-certified dctrs thrugh the cnvenience f phne r vide. It s a lw-cst way fr treating cld and flu symptms, brnchitis, respiratry infectin, allergies and mre! COLD & FLU mst careful persn can get sick. Frtunately, yu have Teladc. Request a visit anytime yu feel under the weather. With yur cnsent, Teladc is happy t t yur primary care physician. ALLERGIES and keep yu frm having a gd treat yur allergy symptms thrugh phne r vide. PEDIATRIC CARE Any parent knws their children dn t get sick n a pediatric netwrk prvides even if yu need a dctr in the middle f the night. $7.50 Per Mnth Visit MyMemberPrtal.cm Phne: Disclsures: This plan is NOT insurance. The plan is nt insurance cverage and des nt meet the minimum creditable cverage requirements under the Affrdable Care Act r Massachusetts M.G.L. c. 111M and 956 CMR This discunt card prgram cntains a 30 day cancellatin perid. Member shall receive a reimbursement f all peridic membership fees if membership is canceled within the first 30 days after the effective date. Discunt Medical Plan Organizatin: New Benefits, Ltd., Attn: Cmpliance Department, PO Bx , Dallas, TX , Nt available t FL, KS, UT, VT r WA residents Teladc, Inc. All rights reserved. Teladc and the Teladc lg are registered trademarks f Teladc, Inc. and may nt be used withut written permissin. Teladc des nt replace the primary care physician. Teladc des nt guarantee that a prescriptin will be written. Teladc perates subject t state regulatin and may nt be available in certain states. Teladc des nt prescribe DEA cntrlled substances, nn-therapeutic drugs and certain ther drugs which may be harmful because f their ptential fr abuse. Teladc physicians reserve the right t deny care fr ptential misuse f services.

12 Discunt Benefit Descriptins 12 P ag e

13 Discunt Benefit Descriptins Cntinued 13 P ag e