Life Care Partners LLC dba Family Home Health Services

Transcription

1 Prepared for: Life Care Partners LLC dba Family Home Health Services Proposed coverage: - Dental Broker: BENEFIT HELP Humana sales representative: Kelly Danforth Presented by: MARK HOLLAND Proposal date: 05/05/2017 Medical Dental Vision Disability Life Workplace Voluntary Benefits Stop-loss Retiree Benefits

2 Humana proposal for: Life Care Partners LLC dba Family Home Health Services What's inside: About Humana Dental proposal: Plan highlights and rates Terms and conditions

3 Humana proposal for: Life Care Partners LLC dba Family Home Health Services We re happy you re considering Humana for your employee benefits offering. For more than four decades, we ve helped businesses of all sizes provide their employees with quality, affordable health care benefits. We can do the same for you. Benefits* that help protect employee s health and finances: Medical: Humana offers PPO, HMO, POS, and HDHP plans with a wide range of deductibles, copayments, and prescription drug designs with access to more than 54,000 providers and almost 4,000 hospitals nationwide. Our funding options include Health Savings Accounts (HSAs), Health Reimbursement Accounts (HRAs) and Personal Care Accounts (PCAs). Dental and vision: Regular cleanings and eye exams can detect problems and other diseases throughout the body. Humana s dental and vision plans encourage prevention, early diagnosis, and treatment helping employees stay more healthy and fit. Workplace voluntary benefits: Humana s workplace voluntary benefits disability, life, accident, critical illness, cancer, and supplemental health can help your employees rest a little easier knowing they have a plan to help cover additional expenses if they can t work due to an illness or injury. Retiree benefits: With our broad-based Medicare Advantage network and consumer-driven solutions, Humana is uniquely positioned to address employers' FASB and GASB risk-mitigation strategies while providing efficient, cost-effective benefit plan solutions for your Medicare-eligible retirees. You ll find Humana makes the employee benefits experience simpler for everyone involved by providing personal guidance and resources to help you and your employees make smart choices. Here s what you can expect: A quarterly newsletter, Focus, giving you the latest benefit news and industry trends Online tools to help employees estimate costs for common procedures and prescription drugs Resources for Spanish-speaking employees Fortune Magazine named Humana one of the Top 5 Most Admired Healthcare Companies in the United States** Financially strong company ranked 73rd on the Fortune 500 Friendly, personal service Humana, in partnership with your broker, will help you find a plan that s the best fit for you and your employees. And we ll work closely with you to control costs and help your employees lead healthier, more productive lives. * Availability varies by state ** March

4 Humana proposal for: Life Care Partners LLC dba Family Home Health Services Why choose Humana Specialty Benefits? Personalize your benefits by working with your agent and our own experts. Together, we ll tailor a benefits package that works best for you and your employees Improve worker productivity: Dental problems result in the loss of 164 million work hours, 1 and vision problems result in $8 billion in lost productivity each year 2 Save on your rates when you add multiple Humana products Expect a simple and friendly experience from people who care and are ready to help you and your employees 1 CDC.gov 2 The Vision Council Rest easy, you're covered You invest in your employees and care about their future. You provide benefits that you and your employees can feel good about. When you partner with Humana, you have access to one of the industry s broadest choices of specialty benefits designed to help protect the personal health and finances of your employees and their families. Dental and vision coverage help protect employees' health Gum disease can be a risk factor for heart disease and other serious conditions. With regular cleanings, a dentist may be able to recognize early symptoms of gum disease, and provide simple treatments to prevent it from progressing keeping a patient s mouth and heart a little healthier. An annual eye health exam also is an important part of your routine preventive healthcare. Eye exams not only help vision, but an eye doctor can detect major health issues, too. Diseases such as diabetes, hypertension, multiple sclerosis, high blood pressure, osteoporosis, and rheumatoid arthritis can be diagnosed just by looking into the eyes. Disability, life, accident, critical illness, cancer, and supplemental health help protect employees finances If your employees are like most people, they probably don t plan for expenses not covered by their medical insurance such as loss of income, monthly bills, childcare services, and travel to treatment centers. By offering these benefits, you can help your employees be more financially prepared for the unexpected. Best of all, you can offer these valued benefits to your employees without increasing your benefits budget they can be 100 percent employee paid. Plus, by offering a competitive benefits package, you may even improve employee productivity and increase loyalty. 4

5 Humana proposal for: Life Care Partners LLC dba Family Home Health Services Fully Insured Effective date: 06/01/2017 Dental plan highlights and rates Proposed plan 1: TRADITIONAL PREFERRED 100/80/50 U&C 14 Employer Sponsored n Dual Choice Plan highlights Preventive services coinsurance % 100 Endodontics Basic Basic services coinsurance % 80 Periodontics Basic Major services coinsurance % 50 Composite fillings for molars t Selected Individual Deductible $50.00 Complex surgical extractions Basic Family Deductible $ Implants Major Waive deductible on preventive Yes Orthodontia t Available Annual maximum $ Orthodontia coinsurance % 0 Extended annual max Yes Orthodontia lifetime maximum $0.00 Waive preventive on annual maximum t Selected Voluntary t Selected EE EESP EECH FAM Estimated counts Proposed rates $26.77 $53.53 $68.25 $95.01 Estimated monthly premium $2, $ $ $2, Estimated annual premium $29, $5, $6, $33, U&C: Members and their families benefit from negotiated discounts on covered services by choosing dentists in our network. If a member visits a participating network dentist, the member will not receive a bill for charges more than the negotiated fee for covered services. If a member sees an out-of-network dentist, coinsurance will apply to the usual and customary charge. Out-of-network dentists may bill you for charges above the amount covered by your dental plan. Limitations, exclusions, waiting periods, and frequency or age limitations may apply. Do not cancel current group coverage until you receive written approval from Humana. Please verify the rates and selected plan(s) before implementation to ensure a smooth transition. 5

6 SGB0166A Humana Dental Traditional Preferred 14 FLORIDA If you use an IN-NETWORK dentist If you use an OUT-OF-NETWORK dentist Calendar-year deductible (excludes orthodontia services) Calendar-year annual maximum (excludes orthodontia services) Preventive services Routine oral examinations (2 per year) Bitewing x-rays (2 films under age 10, up to 4 films ages 10 and older) Routine cleanings (2 per year) Fluoride treatment (1 per year, through age 14) Sealants (permanent molars, through age 14) Space maintainers (primary teeth, through age 14) Oral Cancer Screening (1 per year, ages 40 and older) Basic services Emergency care for pain relief Amalgam fillings (1 per tooth every 2 years, composite for anterior/front teeth) Oral surgery (tooth extractions including impacted teeth) Stainless steel crowns Harmful habit appliances for children (1 per lifetime, through age 14) Periodontics (periodontal cleanings 4 per year, scaling/root planing and surgery 1 per quadrant every 3 years) Endodontics (root canals 1 per tooth per lifetime and 1 re-treatment) do not delete Major services Crowns (1 per tooth every 5 years) Inlays/onlays (1 per tooth every 5 years) Bridges (1 per tooth every 5 years) Dentures (1 per tooth ever 5 years) Denture relines/rebases (1 every 3 years, following 6 months of denture use) Denture repair and adjustments (following 6 months of denture use) Implants (1 every 5 years for implant placement, crowns, bridges, and dentures) do not delete Orthodontia services Individual $50 Family $150 Individual $50 Family $150 Deductible applies to all services excluding preventive services. $1,000 After you reach the annual maximum amount, you will receive 30 percent coinsurance on preventive, basic, and major services for the rest of the year (excludes orthodontia.) 100% no deductible 100% no deductible 80% after deductible 80% after deductible 50% after deductible 50% after deductible Members may receive a discount on non-covered services of up to 20%. Members may contact their participating provider to determine if any discounts are available on non-covered services Humana.com Page 1 of 5

7 Humana Dental Traditional Preferred 14 n-participating dentists can bill you for charges above the amount covered by your HumanaDental plan. To ensure you do not receive additional charges, visit a participating PPO Network dentist. Members and their families benefit from negotiated discounts on covered services by choosing dentists in our network. If a member visits a participating network dentist, the member will not receive a bill for charges more than the negotiated fee for covered services. If a member sees an out-of-network dentist, coinsurance will apply to the usual and customary charge. Out-of-network dentists may bill you for charges above the amount covered by your dental plan. Waiting periods Employer-sponsored funding: 10+ enrolled employees Enrollment type Preventive Initial enrollment, open enrollment and timely add-on t available Late applicant 1, 2 12 months 12 months t available 1 2 Basic Major Orthodontia Late applicants not allowed with open enrollment option. Waiting periods do not apply to endodontic or periodontic services unless a late applicant Humana.com Page 2 of 5

8 Humana Dental Traditional Preferred 14 Questions? Feel good about choosing a HumanaDental plan Use your HumanaDental benefits Make regular dental visits a priority Find a dentist Go to MyDentalIQ.com Know what your plan covers Tips to ensure a healthy mouth Use a soft-bristled toothbrush Choose toothpaste with fluoride Brush for at least two minutes twice a day Floss daily Watch for signs of periodontal disease such as red, swollen, or tender gums Visit a dentist regularly for exams and cleanings See your dentist Did you know that 74 percent of adult Americans believe an unattractive smile could hurt a person s chances for career success?* HumanaDental helps you feel good about your dental health so you can smile confidently. * American Academy of Cosmetic Dentistry After HumanaDental processes your dental claim, you will receive an explanation of benefits or claims receipt. It provides detailed information on covered dental services, amounts paid, plus any amount you may owe your dentist. You can also check the status of your claim on MyHumana at Humana.com or by calling Regular cleanings can help manage problems throughout the body such as heart disease, diabetes, and stroke.* Your HumanaDental Traditional Preferred plan focuses on prevention and early diagnosis, providing four exams and cleanings every calendar year: two regular and two periodontal. * Take a health risk assessment that immediately rates your dental health knowledge. You ll receive a personalized action plan with health tips. You can print a copy of your scorecard to discuss with your dentist at your next visit. Simply call to speak with a friendly, knowledgeable Customer Care specialist, or visit Humana.com. With HumanaDental s Traditional Preferred plan, you can see any dentist. Members and their families benefit from negotiated discounts on covered servcies by choosing dentists in the HumanaDental Traditional Preferred Network. To find a dentist in HumanaDental s Traditional Preferred Network, log on to Humana.com or call The other side of this page gives you a summary of HumanaDental benefits. Your plan certificate describes your HumanaDental benefits, including limitations and exclusions. You can find it on MyHumana, your personal page at HumanaDental.com or call Your HumanaDental identification card contains all the information your dentist needs to submit your claims. Be sure to share it with the office staff when you arrive for your appointment. If you don t have your card, you can print proof of coverage at Humana.com. Learn what your plan paid Humana group dental plans are offered by Humana Insurance Company, HumanaDental Insurance Company, Humana Insurance Company of New York, Humana Health Benefit Plan of Louisiana, The Dental Concern, Inc., Humana Medical Plan of Utah, CompBenefits Company, CompBenefits Dental, Inc., Humana Employers Health Plan of Georgia, Inc. or DentiCare, Inc. (d/b/a CompBenefits) This is not a complete disclosure of plan qualifications and limitations. Your agents will provide you with specific limitations and exclusions as contained in the Regulatory and Technical Information Guide. Please review this information before applying for coverage. The amount of benefits provided depends upon the plan selected. Premiums will vary according to the selection made. Humana.com Plan summary created on: 5/9/17 09:01 Policy Number: FL HC L 1/14, FL HC SB 1/14 Page 3 of 5

9 Humana proposal for: Life Care Partners LLC dba Family Home Health Services Fully Insured Effective date: 06/01/2017 Dental plan highlights and rates Proposed plan 2: TRADITIONAL PREFERRED 100/80/50 INFS 14 Employer Sponsored n Dual Choice Plan highlights Preventive services coinsurance % 100 Endodontics Basic Basic services coinsurance % 80 Periodontics Basic Major services coinsurance % 50 Composite fillings for molars t Selected Individual Deductible $50.00 Complex surgical extractions Basic Family Deductible $ Implants Major Waive deductible on preventive Yes Orthodontia t Available Annual maximum $ Orthodontia coinsurance % 0 Extended annual max Yes Orthodontia lifetime maximum $0.00 Waive preventive on annual maximum t Selected Voluntary t Selected EE EESP EECH FAM Estimated counts Proposed rates $18.65 $37.30 $47.55 $66.20 Estimated monthly premium $1, $ $ $1, Estimated annual premium $20, $3, $4, $23, INFS: Members and their families benefit from negotiated discounts on covered services by choosing dentists in our network. If a member visits a participating network dentist, the member will not receive a bill for charges more than the negotiated fee for covered services. If a member sees an out-of-network dentist, coinsurance will apply to the maximum allowable charge of one or more network providers in your geographic area. Out-of-network dentists may bill you for charges above the amount covered by your dental plan. Limitations, exclusions, waiting periods, and frequency or age limitations may apply. Do not cancel current group coverage until you receive written approval from Humana. Please verify the rates and selected plan(s) before implementation to ensure a smooth transition. 6

10 SGB0166A Humana Dental Traditional Preferred 14 Calendar-year deductible (excludes orthodontia services) FLORIDA If you use an IN-NETWORK dentist If you use an OUT-OF-NETWORK dentist Individual Family Individual Family $50 $150 $50 $150 Deductible applies to all services excluding preventive services. Calendar-year annual maximum (excludes orthodontia services) Preventive services $1,000 After you reach the annual maximum amount, you will receive 30 percent coinsurance on preventive, basic, and major services for the rest of the year (excludes orthodontia.) Routine oral examinations (2 per year) Bitewing x-rays (2 films under age 10, up to 4 films ages 10 and older) Routine cleanings (2 per year) Fluoride treatment (1 per year, through age 14) Sealants (permanent molars, through age 14) Space maintainers (primary teeth, through age 14) Oral Cancer Screening (1 per year, ages 40 and older) 100% no deductible 100% no deductible Basic services 80% after deductible 80% after deductible 50% after deductible 50% after deductible Emergency care for pain relief Amalgam fillings (1 per tooth every 2 years, composite for anterior/front teeth) Oral surgery (tooth extractions including impacted teeth) Stainless steel crowns Harmful habit appliances for children (1 per lifetime, through age 14) Periodontics (periodontal cleanings 4 per year, scaling/root planing and surgery 1 per quadrant every 3 years) Endodontics (root canals 1 per tooth per lifetime and 1 re-treatment) do not delete Major services Crowns (1 per tooth every 5 years) Inlays/onlays (1 per tooth every 5 years) Bridges (1 per tooth every 5 years) Dentures (1 per tooth ever 5 years) Denture relines/rebases (1 every 3 years, following 6 months of denture use) Denture repair and adjustments (following 6 months of denture use) Implants (1 every 5 years for implant placement, crowns, bridges, and dentures) do not delete Orthodontia services Members may receive a discount on non-covered services of up to 20%. Members may contact their participating provider to determine if any discounts are available on non-covered services Humana.com Page 1 of 5

11 Humana Dental Traditional Preferred 14 n-participating dentists can bill you for charges above the amount covered by your HumanaDental plan. To ensure you do not receive additional charges, visit a participating PPO Network dentist. Members and their families benefit from negotiated discounts on covered services by choosing dentists in our network. If a member visits a participating network dentist, the member will not receive a bill for charges more than the negotiated fee for covered services. If a member sees an out-of-network dentist, coinsurance will apply to the maximum allowable charge of one or more network providers in your geographic area. Out-of-network dentists may bill you for charges above the amount covered by your dental plan. Waiting periods Employer-sponsored funding: 10+ enrolled employees Enrollment type Preventive Initial enrollment, open enrollment and timely add-on t available Late applicant 1, 2 12 months 12 months t available 1 2 Basic Major Orthodontia Late applicants not allowed with open enrollment option. Waiting periods do not apply to endodontic or periodontic services unless a late applicant Humana.com Page 2 of 5

12 Humana Dental Traditional Preferred 14 Questions? Feel good about choosing a HumanaDental plan Use your HumanaDental benefits Make regular dental visits a priority Find a dentist Go to MyDentalIQ.com Know what your plan covers Tips to ensure a healthy mouth Use a soft-bristled toothbrush Choose toothpaste with fluoride Brush for at least two minutes twice a day Floss daily Watch for signs of periodontal disease such as red, swollen, or tender gums Visit a dentist regularly for exams and cleanings See your dentist Did you know that 74 percent of adult Americans believe an unattractive smile could hurt a person s chances for career success?* HumanaDental helps you feel good about your dental health so you can smile confidently. * American Academy of Cosmetic Dentistry After HumanaDental processes your dental claim, you will receive an explanation of benefits or claims receipt. It provides detailed information on covered dental services, amounts paid, plus any amount you may owe your dentist. You can also check the status of your claim on MyHumana at Humana.com or by calling Regular cleanings can help manage problems throughout the body such as heart disease, diabetes, and stroke.* Your HumanaDental Traditional Preferred plan focuses on prevention and early diagnosis, providing four exams and cleanings every calendar year: two regular and two periodontal. * Take a health risk assessment that immediately rates your dental health knowledge. You ll receive a personalized action plan with health tips. You can print a copy of your scorecard to discuss with your dentist at your next visit. Simply call to speak with a friendly, knowledgeable Customer Care specialist, or visit Humana.com. With HumanaDental s Traditional Preferred plan, you can see any dentist. Members and their families benefit from negotiated discounts on covered servcies by choosing dentists in the HumanaDental Traditional Preferred Network. To find a dentist in HumanaDental s Traditional Preferred Network, log on to Humana.com or call The other side of this page gives you a summary of HumanaDental benefits. Your plan certificate describes your HumanaDental benefits, including limitations and exclusions. You can find it on MyHumana, your personal page at HumanaDental.com or call Your HumanaDental identification card contains all the information your dentist needs to submit your claims. Be sure to share it with the office staff when you arrive for your appointment. If you don t have your card, you can print proof of coverage at Humana.com. Learn what your plan paid Humana group dental plans are offered by Humana Insurance Company, HumanaDental Insurance Company, Humana Insurance Company of New York, Humana Health Benefit Plan of Louisiana, The Dental Concern, Inc., Humana Medical Plan of Utah, CompBenefits Company, CompBenefits Dental, Inc., Humana Employers Health Plan of Georgia, Inc. or DentiCare, Inc. (d/b/a CompBenefits) This is not a complete disclosure of plan qualifications and limitations. Your agents will provide you with specific limitations and exclusions as contained in the Regulatory and Technical Information Guide. Please review this information before applying for coverage. The amount of benefits provided depends upon the plan selected. Premiums will vary according to the selection made. Humana.com Plan summary created on: 5/9/17 09:02 Policy Number: FL HC L 1/14, FL HC SB 1/14 Page 3 of 5

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15 Humana proposal for: Life Care Partners LLC dba Family Home Health Services Fully Insured Dental plan terms and conditions Rate Assumptions: The effective date is no later than 06/01/2017. Rates are guaranteed for one (1) year. Rates are based on SIC code 8082, situs state FL. Retirees are not included. Plan assumes an employer/employee relationship exists between all parties. These rates include a replacement commission schedule of a level 10%. Enrollment: Rates are based on 187 eligible employees. For employer-sponsored dental plans, the group must have 100% participation if the employer contributes 100% of the premium, or a minimum of 50% of all eligible employees if the employer contributes less than 100% of the premium. If enrollment changes by +/-10 percent from the quoting enrollment of 91 subscribers / 236 members, underwriting reserves the right to re-evaluate rates. On Employer Sponsored plans, no waiting periods will apply for initial or timely add-ons for PPO/TRP and DHMO plans. Rates include an annual open enrollment at renewal time. Open enrollment allows employees to enroll as timely applicants during open enrollment. Standard waiting periods apply. Plan Design: Proposal is contingent on Humana being the only dental plan(s) offered. This plan is based on our standard design and certificate language. Dependent age limitations are based on situs state requirements unless otherwise noted. Billing: With our standard billing cycle, premiums are due by the first of the month for which coverage is to be provided. Grace period is 31 days. Humana may adjust rates because of changes in plan design, legislation, or regulations that affect benefits payable, eligible, or contractual provisions. For insuring or offering entity, please see applicable sales or marketing literature. 7