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2019 Premier Benefits Guide - English

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2019 Premier Benefits Guide - English
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   2 Contents Welcome! ...................................................................................................................................................... 3   Eligibility ........................................................................................................................................................ 3   When to Enroll .............................................................................................................................................. 3   Making Changes ........................................................................................................................................... 3   Medical Coverage You Can Count On ......................................................................................................... 4   Medical Indemnity Plans* ......................................................................................................................... 5   How to Find an In-Network Provider ........................................................................................................ 6   Teladoc Services Save You Time and Money ......................................................................................... 6   PRESCRIPTION DRUG changes for 2019 .............................................................................................. 7   Voluntary Dental Coverage Worth Smiling About ........................................................................................ 8   Voluntary Vision Coverage for a Clear Future .............................................................................................. 8   Life and AD&D Insurance Coverage for Peace of Mind ............................................................................... 9   Basic Life and Accidental Death & Dismemberment (AD&D) Insurance ................................................. 9   Voluntary Benefits ......................................................................................................................................... 9   Voluntary Life and AD&D Insurance ........................................................................................................ 9   Voluntary Short-Term Disability (STD) ..................................................................................................... 9   Important Notices ........................................................................................................................................ 10   Questions? Your Benefit Contacts ............................................................................................................. 15     3 WELCOME! Welcome to your 2019 benefits! Use this benefits guide as a resource to compare plans and learn more about the coverages available to you. If you have questions about your benefits, SISCO is available to help and can be reached at (844) 631-6104.   ELIGIBILITY You’re eligible  for benefits on the first of the month following 59 days of employment if you are scheduled to work 30 hours or more per week. You may enroll your eligible dependents in the same plans you choose for yourself. Eligible dependents include your legal spouse and your children up to age 26. WHEN TO ENROLL You can enroll for coverage within 30 days of your eligibility date or during the annual Open Enrollment period. If you don’t  enroll for coverage within 30 days of your eligibility date, you won’t  receive health coverage during the plan year  ,   unless you have a qualified change in family status (see Making Changes for details). MAKING CHANGES The choices you make when you are first eligible are in effect for the remainder of the plan year which ends on December 31. Once you enroll, you must wait until the next Open Enrollment period to change your benefits or add or remove coverage for dependents, unless you have a qualified change in family status as defined by the IRS. The following are a few examples: ã  Marriage, divorce, legal separation, annulment or death of spouse ã  Birth, adoption or placement for adoption ã  Change in your residence or workplace (if your benefit options change) ã  Loss of other health coverage ã   Change in your dependent’s eligibility status because of age, student status or any similar circumstance   4 MEDICAL COVERAGE YOU CAN COUNT ON Take great care of your health through annual preventive care visits with your doctor. Review the medical plan options below to choose the plan that’s best for you based on your medical needs and expenses in the upcoming plan year.  This is only a brief summary of the plans. For more details, including limitations and exclusions, please contact Human Resources for a Summary Plan Description. Take great care of your health through annual preventive care visits with your doctor. Review the medical plan options below to choose the plan that’s best for you based on your medical needs and expenses in the upcoming plan year. Plan Features MVP MEC Plus In-Network Only In-Network Out-of-Network Network  Cigna Choice Fund PPO Multiplan / PHCS Deductible Individual Family   $3,000 $6,000 None None $500 $1,000 Out-of-Pocket Maximum Individual Family (Includes deductible) $6,350 $12,700 (Includes deductible) $3,000 $12,700 (Includes deductible) Unlimited Unlimited Coinsurance  60% / Not covered 100% 40% Preventive Care  Covered in full Covered in full 40% after deductible Primary Care Visit  60% after deductible $15 copay 40% after deductible Specialist Visit  60% after deductible $25 copay 40% after deductible Emergency Room  60% after deductible $400 copay ($1,500 max per visit) Diagnostic Lab & X-ray  60% after deductible $50 copay 40% after deductible  Advanced Imaging  60% after deductible $400 copay 40% after deductible Inpatient Hospital Services / Surgery  60% after deductible Not covered Prescription Drugs: Retail (up to a 30-day supply)   Generic Brand Formulary Non-Formulary   $10 after deductible $35 after deductible $70 after deductible $15 copay $25 copay $75 copay Prescription Drugs: Mail Order (up to a 90-day supply)   Generic Brand Formulary Non-Formulary   $20 after deductible $70 after deductible $150 after deductible $37.50 copay $62.50 copay $187.50 copay   MEC Basic In-Network Only   Covers only in-network  preventive care. All in-network preventive care is paid at 100%.

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Jan 12, 2019
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