Documents

EmblemHealth Benefits 2019

Description
Description:
Categories
Published
of 7
All materials on our website are shared by users. If you have any questions about copyright issues, please report us to resolve them. We are always happy to assist you.
Share
Transcript
  Page 1 of 7 2019 BENEFITS SUMMARY EmblemHealth Services Management Employees  YOUR ELIGIBILITY You are eligible to participate in the EmblemHealth Services (EmblemHealth) Health and Welfare Program if you are a management employee  who works at least 20 hours per week, unless otherwise indicated in the specific benefit plan.  YOUR ELIGIBILE DEPENDENTS Your eligible dependents include:     Legal spouse; and   Dependent children (e.g., biological, adopted, stepchildren, child for whom you are legal guardian or child for whom the court has issued a Qualified Medical Child Support Order) are eligible until the end of the month in which they turn age 26   Domestic partner and children in accordance with terms of EmblemHealth’s Domestic Partner guidelines . You are required to submit proof of your relationship to the eligible dependents that you wish to cover under your plan. We accept the following documentation to establish eligibility: marriage license for spouse, and birth certificates or guardianship papers for dependent children. BENEFITS EFFECTIVE DATE  As a newly hired employee, you will have 31 days from your date of hire to elect health and welfare benefits. Your benefits will generally be effective on the first day of the month following your date of hire and election. Please understand that the choices you make during your new-hire enrollment will remain in effect until December 31. You may only make changes during the annual enrollment period or if you have a qualifying change in status. HEALTH COVERAGE EmblemHealth offers you a choice of two health plans: HIP Access I (base plan) and EmblemHealth InBalance PPO (buy-up plan) plus the option to decline health coverage. While the two plans pay different levels of benefits and may include different network coverage areas, covered benefits, copayments, coinsurance, deductibles and prescription drug formularies, they all provide comprehensive health care coverage. Your health plan choices are: Health Benefit Highlights EmblemHealth InBalance PPO HIP Access I (HMO) In-Network Benefits: Deductible (Individual/Family) $1,000/$3,000 $0 Coinsurance 10% N/A Coinsurance Maximum (Individual/Family) $500/$1,500 N/A Office Visit copay (PCP/Specialist) No PCP referral required for Specialty Care $35 $30/40 X-ray/Laboratory Services copay $35 $0  Ambulatory Services copay Deductible & Coinsurance $200 Emergency Room copay (waived if admitted) $150 $200 Hospital Admission copay Deductible & Coinsurance $750 Prescription copays (Retail) Rx Deductible $15/$35 N/A $15/$35/$75 $100 annual deductible for tiers 2 & 3 In-Network Maximum Out of Pocket (Individual/Family) $6,850/$13,700 $6,600/$13,200  Page 2 of 7 Out-of-Network Benefits: EmblemHealth InBalance PPO HIP Access I (HMO) Deductible (Individual/Family) $2,500/$6,250 N Coinsurance 30% N Coinsurance Maximum (Individual/Family) $2,000/$5,000 N  Annual Maximum Benefit N/A N Reimbursement Level 80th %-ile of Fair Health N  HIP Access I:  Participating provider network in NY tri-state area, including Manhattan, the Bronx, Brooklyn, Queens, Staten Island, and Nassau, Suffolk, Westchester, Rockland and Orange counties, plus upstate regions that stretch north of Albany, and NJ and CT. To access the HIP Prime Network, go to “Find A Doctor” at  www.emblemhealth.com .  EmblemHealth InBalance PPO : National PPO network. To access the EmblemHealth PPO Network, go to “Find A Doctor” at  www.emblemhealth.com  The benefits described herein are only highlights of the coverage available. Please refer to applicable certificate of coverage. DENTAL COVERAGE Schedule of Benefits EmblemHealth Preferred Plus Dental Network / Fee Schedule In-Network Preferred Plus Out-of-Network Preferred Plus Deductible $50/$150 $50/$150  Annual Maximum $2,000 $2,000 Class I —  Diagnostic and Preventive Services 100% of Fee Schedule 100% of Fee Schedule Class II —  Minor Restorative 80% of Fee Schedule 80% of Fee Schedule Class III —  Major Restorative 50% of Fee Schedule 50% of Fee Schedule Class IV  –  Orthodontic Care (to age 19) 100% of Fee Schedule to a life time maximum of $2,000 100% of Fee Schedule to a life time max of $1,275 Provider Network To access the EmblemHealth Preferred Plus Dental Network, go to “Find A Doctor” at  www.emblemhealth.com .  The benefits described herein are only highlights of the coverage available. Please refer to applicable certificate of coverage. VISION COVERAGE Davis Vision Covered Service In-Network Out-of-Network Benefit Frequency One time per calendar year One time per calendar year Eye Examination $30 copay Reimbursed up to $30 Eyeglass Frames ( Davis Vision frames ) In-network retail allowance in lieu of Davis frames Covered in full Reimbursed up to $30 Up to $150, plus 20% off overage Spectacle Lenses Covered in full; buy-ups for optional lenses available Lenses reimbursed up to: $25 for single-vision, $35 for bifocals $45 for trifocals and $60 for lenticular Contact Lenses (in lieu of eyeglasses) (Formulary (4 packs) with filling and follow-up care; or Elective allowance toward non-formulary contacts lenses Covered in full Reimbursed up to $75 for elective contact lenses or up to $225 for medically necessary contact lenses with prior approval Coverage up to $150, plus 15% off overage  Access Davis Vision’s Web site at  www.davisvision.com   and utilize the “Find A Doctor     Page 3 of 7 HEALTH BENEFITS EMPLOYEE CONTRIBUTIONS  –   2019 MONTHLY AMOUNTS EmblemHealth InBalance PPO Coverage Tier “ In-Area ” Employee Contributions (a)   “ Out-of-Area ” Employee Contribution (b)  Employee $332.00 $197.00 Employee & Child(ren) $855.00 $415.00 Employee & Spouse $961.00 $454.00 Employee & Family $662.00 $553.00 a)   “In - Area”    –  refers to employees who reside in NY [except Syracuse area], NJ and CT and have access to the base plan. b)   “Out -of- Area”    –  refers to employees who reside outside of NY [except Syracuse area], NJ and CT and do not have access to the base plan.   HIP Access I (HMO) Coverage Tier Employee Contribution Employee $164.00 Employee & Child(ren) $305.00 Employee & Spouse $328.00 Employee & Family $501.00 SPOUSAL HEALTH PLAN SURCHARGE $100 per month surcharge for employees who enroll their spouse in the EmblemHealth employee plan where the spouse has access to health coverage from their own employer. EmblemHealth Preferred Plus Dental Coverage Tier Employee Contribution Employee $11.50 Employee & Child(ren) $22.50 Employee & Spouse $24.00 Employee & Family $38.00 LIFE AND ACCIDENTAL DEATH AND DISMEMBERMENT (AD&D) INSURANCE Life Insurance pays your designated beneficiary a death benefit if you die while covered by the policy. AD&D pays your designated beneficiary a death benefit if you die due to a covered accident while you are insured. It also pays you a benefit for certain accidental injuries, subject to the terms of the plan. A certificate of insurance will be available to explain your coverage in detail. BASIC LIFE AND AD&D INSURANCE You are provided, at no cost to you, Basic Life and AD&D Insurance in an amount equal to one time your base annual salary, to a maximum of $300,000. Guarantee issue is for the full amount. SUPPLEMENTAL LIFE INSURANCE You can purchase Supplemental Life Insurance in the amount of 1, 2, 3, 4, 5, 6 or 7 times your base annual salary to a maximum of $2.5M for Supplemental Life only, or a combined Basic and Supplemental maximum amount of $3.1M. Guarantee Issue is the lesser of 3 times base annual salary or $450,000 for new hires only. All other elections require proof of good heath acceptable to the insurer.  Page 4 of 7 You may also purchase Supplemental Life for your spouse in increments of $10,000 to a maximum of $250,000. Guarantee Issue is the full amount for new hires only. All other elections require proof of good health acceptable to the insurer. You may also purchase $10,000 of Supplemental Life Insurance coverage for each of your unmarried dependent children who are full-time students, up to age 26. SUPPLEMENTAL AD&D INSURANCE You may purchase Supplemental AD&D Insurance for yourself in increments of $25,000 to a maximum of $1,000,000. The Principal Sum requested cannot exceed the lesser of 10 times your base annual salary or the maximum amount. You may also purchase Family Supplemental AD&D Insurance for your spouse and children. The Principal Sum that applies to each person covered under your policy is determined by multiplying your Principal Sum by the following percentages: Spouse only 50 percent, Spouse and Child 40 percent, and Child only 15 percent. The Principal Sum for any one child cannot exceed the lesser of the amount calculated above or $50,000. PAID TIME OFF (PTO) The EmblemHealth PTO program provides a single bank of days that can be used for purposes of vacation, sick and personal time. You determine how you will use your PTO days. The longer you work at EmblemHealth, the more PTO time you will be provided. See chart below for details.  Years of Service Emblem Health PTO Days 0 - 4 23 days 5 + 28 days See EmblemHealth’s Paid Time O ff Program Policy on the eNet for more details. HOLIDAYS EmblemHealth Services provides 10 paid company holidays as follows: New Year’s Day  Independence Day Christmas Day Dr. Martin Luther King, Jr Day Labor Day Day after Christmas President Day Thanksgiving Memorial Day Day after Thanksgiving DISABILITY INSURANCE COVERAGE EmblemHealth provides both short and-long term disability benefits. EmblemHealth pays the full cost of your core short-term disability (STD) and core long-term disability (LTD) coverage. You have the opportunity to purchase additional coverage (buy-up) STD and LTD coverage if you have income in excess of the core plan limits, subject to the terms of the plan. Plan Core [covers first $100,000 of salary] Buy-Up [for salary in excess of core plan limits] Short Term Disability up to 26 weeks 60% of weekly earning to a weekly maximum benefit of $1,154 60% of weekly earnings to a weekly maximum benefit of $5,000 Long Term Disability up to Social Security Normal Retirement 60% of eligible monthly pay to a monthly maximum benefit of $5,000 60% of eligible monthly pay to a monthly maximum benefit of $25,000 FLEXIBLE SPENDING ACCOUNTS (FSAs) Plan Annual Contributions Examples of Covered Expenses Health Care FSA $120 up to $2,650 Copays, coinsurance, deductibles, orthodontia Dependent Care FSA $120 up to $5,000 ($2,500 if married and filing separate tax   returns)  Day care, nursery school, elder care expenses Visit www.wageworks.com for a complete list of covered expenses
We Need Your Support
Thank you for visiting our website and your interest in our free products and services. We are nonprofit website to share and download documents. To the running of this website, we need your help to support us.

Thanks to everyone for your continued support.

No, Thanks
SAVE OUR EARTH

We need your sign to support Project to invent "SMART AND CONTROLLABLE REFLECTIVE BALLOONS" to cover the Sun and Save Our Earth.

More details...

Sign Now!

We are very appreciated for your Prompt Action!

x