0MATTERS BENEFITS GUIDE - CaroMont Health
←
→
Page content transcription
If your browser does not render page correctly, please read the page content below
2020
HEALTH
MATTERS
BENEFITS GUIDE
About This Guide
Knowledge is power, especially when it comes to getting the most from
your benefits. That’s why we created this guide to help you learn all about
the benefits and wellness resources CaroMont Health has to offer. Whether
you are enrolling in benefits for the first time, reviewing your options for
Annual Enrollment, or just seeing what’s new, this guide is designed to make
learning about your benefits fast and easy. For your convenience, this guide
is also available on CaroMont Health Intranet Portal (CHIP) on the Human
Resources page and at MyCaroMontBenefits.com. If you have questions
about any of the benefits or how to enroll, contact the CaroMont Health
Human Resources Department at 704-834-2141.
Did You Know...
The CaroMont Health Intranet Portal (CHIP) is your number one
go-to resource for just about everything you need when it comes to
your benefits. Just access CHIP and go to the Human Resources
page. To access benefits information outside of work, go to
MyCaroMontBenefits.com.
Prefer to talk? Give us a call at 704-834-2141.
We’re here and happy to help!
New Employees
Throughout this guide, information specific to new employees
appears in boxes like this one. If you’re a new employee, pay
special attention to these boxes. They provide you with important
information you’ll need to know—as a first-time participant—before
enrolling for your benefits.
This information is intended to serve as a summary of benefits offered to CaroMont Health employees.
It does not replace the plan documents. If/when there is a discrepancy between information stated, the
plan document will override.What’s Inside
Finding the information you need is quick and easy. Simply follow the color icon on the edge
of the page to get where you want to go.
Easy Online Enrollment . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .2
Getting Started . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4
Medical/Prescription Drug Benefits. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6
Wellness Matters . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13
Dental Care Benefits. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19
Vision Care Benefits . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21
Flexible Spending Accounts. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 23
Life Insurance. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 26
Retirement . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .30
Time Off . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 31
Benefit Extras . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 32
Contact Information . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .33
12020 HEALTH MATTERS BENEFITS GUIDE
Easy Online Enrollment
Online enrollment is a fast and easy way to enroll in or change your benefits. It also gives you instant
access to your personal benefits information and allows you to print a confirmation statement with your
benefit elections. Enroll in your CaroMont benefits during Annual Enrollment, from November 1 through
November 15, during your first 30 days of employment, or within 31 days of a qualifying life event.
Quick Reminders
• During the Annual Enrollment period, from November 1 through November 15, we encourage
you to log on and elect your benefits for 2020. If you need to enroll a dependent or update a
beneficiary, you’ll need to provide the person’s date of birth and Social Security number. Have
this information ready before you log on to enroll.
• Even though your current benefit elections will roll over, your Flexible Spending Account
(FSA) coverage will not. You must actively re-elect your FSA during Annual Enrollment to
participate for 2020.
• The Individual Mandate under Health Care Reform requires that all U.S. citizens must have
health insurance coverage. If you choose not to elect health insurance, you will not have
coverage through CaroMont. For more information about health insurance options available
through the Health Insurance Marketplace, visit www.healthcare.gov.
• You will receive email notifications and reminders throughout the Annual Enrollment
process. Please be sure to update your email address in ADP so you receive these
important communications.
If you need technical support or assistance logging in, please contact the Winston Benefits call
center at 1-855-228-2419. If you have questions about any of the benefits, or how to enroll, contact
the CaroMont Health Human Resources Department at 704-834-2141. Help is available
Monday through Friday between 8:30 a.m. and 5:00 p.m. ET.
2To Enroll Online:
Enrollment
Go to the online portal at MyCaroMontBenefits.com. Log in using your
Online
Employee ID Number and the last four digits of your Social Security number.
Once you have logged in, the system will know who you are, what plans you
are eligible for, and what transactions are available to you.
• Your personalized dashboard will
show important messages and
available enrollment transactions.
• On the top, you can find commonly
used navigation links to your benefits,
forms, FAQs, and helpful information.
• As you scroll down, you will find the
description of benefit programs that
are available to you.
• The lower left portion of your
dashboard will show your current
benefit selections.
• If adding a spouse or dependents,
information about required
documentation can be found under
the FORMS tab and clicking the
dependent verification link to
download the form.
If you need technical support or assistance
logging in, please contact the call center at:
1-855-228-2419.
If you have questions about any of the benefits
or how to enroll, contact the CaroMont Health
Human Resources Department at: 704-834-2141.
32020 HEALTH MATTERS BENEFITS GUIDE
Getting Started
Who’s Eligible for Benefits
You can participate in CaroMont’s benefits program if you are in a benefits-eligible payroll group.
If you are a full-time, benefits-eligible employee, you are eligible to participate in the following
CaroMont Health benefits: medical, dental, and vision; Flexible Spending Accounts (FSAs); employee
life, disability, and voluntary accidental death and dismemberment (AD&D); dependent life; and
403(b) Retirement Savings Plan.
If you are a part-time, benefits-eligible employee, you can participate in the CaroMont Health medical,
dental, and vision benefits; FSAs; and 403(b) Retirement Savings Plan.
You can also enroll your eligible dependents in any coverage for which you are eligible, including
medical, dental, and vision. Dependent coverage begins on the same day your coverage begins.
Eligible dependents include your spouse and children. You must provide a valid Social Security
number as well as marriage and/or birth certificates for your eligible dependents you are adding
to the plans. If you do not provide this information within the deadline, you will no longer receive
coverage for your eligible dependents.
Enrolling
If you are a new hire, you can enroll for benefits within 30 days after your hire date. Coverage
is effective on the first day of the pay period following 30 days of employment. You can change
or enroll in benefits during Annual Enrollment or if you have a qualifying life event. For more
information, see Changing Your Benefits below.
Changing Your Benefits
CaroMont Health understands that changes in your life can affect the benefits you need. That’s why
you can change your benefits during Annual Enrollment and whenever you have a change due to a
qualifying life event.
Annual Enrollment usually takes place each year in early November and lasts about two weeks.
During this time, eligible employees can enroll in or change their benefits. This is also the time to
re-enroll in an FSA for the upcoming year. Changes made during this time go into effect on January 1.
You can also enroll in or change your benefits due to a qualifying life event. To make a change, you
must log on to MyCaroMontBenefits.com within 31 days of the event. Any change you make must be
consistent with the qualifying life event. For example, if you get married, you can add your spouse. If
you miss the 31-day window, you will need to wait until Annual Enrollment to change your benefits.
Qualifying life event changes include:
• Marriage • Death of spouse or child
• Divorce or legal separation • Significant increase or decrease in the cost
• Birth or adoption of a child of benefits coverage
• Child’s loss of eligibility due to attaining age 26 • Change in spouse’s employment that results
in a loss of coverage
• Loss of coverage for yourself or your spouse
4Coverage Levels
Getting
Started
CaroMont Health offers four coverage levels. Select one of the following levels:
• Employee Only • Employee + Spouse
• Employee + Child(ren) • Family
Paying for Benefits
The cost of some of your CaroMont Health benefits is calculated on a before-tax basis. This means
the money you pay for these particular benefits is deducted from your paycheck before taxes are
calculated and withheld. Therefore, you receive a greater savings on taxable income and benefit
costs. Before-tax benefits include:
• Medical • Dental
• Vision • Flexible Spending Accounts
• 403(b) Retirement Savings Plan Deferrals
CaroMont Health benefits that are not calculated on a before-tax basis are paid for by you with after-
tax dollars. This means the money you pay for these benefits is deducted from your paycheck after
taxes are calculated and withheld. After-tax benefits include:
• Supplemental Employee Life Insurance • Dependent Life Insurance
• Voluntary Accidental Death and • Long-Term Disability Insurance (Option 2)
Dismemberment Insurance
New Employees
If You Do Not Enroll
If you were hired after January 1, 2020, as a full-time benefits-eligible employee, the chart
below shows the default benefits coverage you will receive if you do not enroll for your benefits
within 30 days of your date of hire. After the 30-day enrollment period, you will not be able to
enroll for benefits until the next Annual Enrollment, or unless you have a qualifying life event.
Benefit Full-Time Employee Default Coverage
Medical No coverage
Dental No coverage
Vision No coverage
Employee Life Insurance 1 x salary
Employee Accidental Death and Dismemberment Insurance $20,000
Dependent Life Insurance for Spouse No coverage
Dependent Life Insurance for Children No coverage
Short-Term Disability 60% of pay; 60-day waiting period
Long-Term Disability 60% of pay; 180-day waiting period
Flexible Spending Accounts No coverage
If you do not elect health insurance, you will not have coverage through CaroMont. For more information
about health insurance options available through the Health Insurance Marketplace, visit www.healthcare.gov.
If you were hired after January 1, 2020, as a part-time benefits-eligible employee and do not
enroll within 30 days of your date of hire, you will not have any benefits for the rest of the
calendar year. You must wait until the next Annual Enrollment to enroll unless you have a
qualifying life event before then.
52020 HEALTH MATTERS BENEFITS GUIDE
Medical/Prescription
Drug Benefits
CaroMont wants you to stay healthy. Medical coverage is one of the most effective ways to protect
yourself and your family from large and unexpected medical expenses while at the same time
encouraging good health through preventive care.
For more information about the CaroMont Health medical plan, refer to the Summary of Benefits
and Coverage (SBC) on CHIP under the Human Resources page. To request a copy of the SBC,
contact Human Resources at 704-834-2141.
Take Action
To help us manage and administer our medical plan benefits, CaroMont partners with UMR.
Information about your medical plan coverage is available at www.umr.com. To find a
UnitedHealthcare network provider:
• Go to www.umr.com
• Click on Find a provider
• Click on Medical
• Scroll down the page and click on UnitedHealthcare Options PPO
Consumer Driven Health Plan
CaroMont’s medical plan is a Consumer Driven Health Plan, or CDHP for short. The CDHP gives you
greater control over your health care spending. You do not have to choose a primary care physician
and do not need to be referred to most specialists by your doctor. This plan has three components:
a Health Reimbursement Account (HRA), a calendar year deductible, and coinsurance.
Health Reimbursement Account
• The CDHP comes with a Health Reimbursement Account (HRA). At the beginning of the
year, CaroMont Health contributes money to your HRA to help you pay for medical expenses
covered by the plan. The amount CaroMont Health contributes to your HRA depends on your
coverage level.
Annual Amount CaroMont Health
Coverage Level Contributes to HRA
Employee Only $500
Employee + Spouse $1,000
Employee + Child(ren) $1,000
Family $1,500
• Your HRA pays for medical expenses covered under the plan.
• Incurred medical expenses covered under the plan will be paid from your HRA first.
6• Money remaining in your HRA at the end of the year rolls over to the next year. You must
Prescription
continue your coverage under the CDHP to have access to the monies in your HRA.
Medical /
• You can also earn additional HRA dollars by completing programs and activities throughout
the year. See Earning HRA Dollars on page 11 for more information.
• In-network preventive care (annual checkups, immunizations, etc.) is covered at 100%.
Preventive care expenses are not deducted from your HRA and do not apply toward
the deductible.
• Use your HRA wisely by choosing the most cost-effective providers. This will allow you to save
money in your HRA for future medical expenses.
Calendar Year Deductible
• You must meet the CDHP deductible before the plan begins to pay a portion of your expenses.
The medical plan deductible depends on your coverage level.
Coverage Level Plan Deductible
Employee Only $500
Employee + Spouse $1,000
Employee + Child(ren) $1,000
Family $1,500
• If you have a Health Care FSA, you can use this account to pay for eligible out-of-pocket
expenses.
Coinsurance
• Once you meet the deductible, the plan begins paying a portion of covered expenses.
• The amount you pay (otherwise known as coinsurance) depends on where you go for service
and the type of service you receive. The plan has no flat dollar copays.
• You continue to pay coinsurance until you reach the out-of-pocket maximum. Your out-of-
pocket maximum depends on your coverage level and where you go for services. See the
chart on page 8.
• Once you meet the out-of-pocket maximum, the plan pays 100% for all remaining covered
services through the end of the plan year.
Save Money: Use Tier 1 CaroMont Providers
The medical plan provides you with a significant discount when you receive care within the
CaroMont health care system. The plan’s core benefit level is designed to pay 70% (after both the
HRA is exhausted and the deductible is met) for Tier 2 UnitedHealthcare (UHC) network providers.
When you stay within CaroMont, however, the majority of services are paid at 90% after the HRA
and deductible. Review the chart on page 8 to see how Tier 1 benefit levels compare to Tier 2 (UHC)
and Tier 3 (out-of-network).
New Employees
If you enroll in the Consumer Driven Health Plan (CDHP), the amount CaroMont Health
contributes to your Health Reimbursement Account (HRA) is prorated based on your
coverage effective date and coverage level.
72020 HEALTH MATTERS BENEFITS GUIDE
Medical and Prescription Benefits Chart
Consumer Driven Health Plan (CDHP) benefits vary depending on where you go for care. Tier 1
providers are CaroMont Health facility or approved providers with privileges. Tier 2 providers are
UHC network doctors and facilities. Tier 3 providers are out-of-network doctors and facilities. The plan
doesn’t have a lifetime maximum benefit. An updated Tier 1 provider/facility list is maintained on CHIP
under the Human Resources page for your reference.
Tier 1 Tier 2 Tier 3
Services at a CaroMont Services by a UHC Services by an
Health facility or by network doctor out-of-network
an approved provider or facility doctor or facility
Plan Feature with privileges
Maximum Out-of-Pocket
(includes yearly deductible)
• Employee Only $3,000 $3,500
• Employee + Spouse $3,500 $4,000 No max
• Employee + Child(ren) $3,500 $4,000
• Family $4,000 $4,500
Physician Office or Clinic Visit 90% after deductible 70% after deductible 50% after deductible
Preventive Visits (including routine
physical exams, diagnostic X-rays and lab,
100%; deductible 100%; deductible
immunizations and flu vaccines, Pap and 50% after deductible
waived waived
PSA tests, well-child visits, routine hearing
exams, mammograms, and colonoscopies)
Outpatient, Non-Emergency MRIs, 90% after deductible Not covered Not covered
CAT Scans, PET Scans
Non-Routine (non-preventive), 90% after deductible 50% after deductible Not covered
Non-Emergency Colonoscopies
Hospital Services 90% after deductible 70% after deductible 50% after deductible
(room and board, inpatient physician services)
Specialty Drug Infusions (Ocrevus, Tysabri) 90% after deductible 50% after deductible Not covered
Bariatric Surgery N/A 75% after deductible Not covered
(required to use Hickory Surgical Clinic and
Catawba Valley Medical Center)*
Non-Emergency Joint Replacement Surgeries 90% after deductible Not covered Not covered
Outpatient Surgery 90% after deductible 70% after deductible 50% after deductible
Outpatient X-Ray and Lab 90% after deductible 70% after deductible 50% after deductible
Emergency Room Visits (true emergency) 80% after deductible 80% after deductible 80% after deductible
Urgent Care Facility 90% after deductible 85% after deductible 50% after deductible
Occupational, Physical, Speech Therapy 90% after deductible 70% after deductible 50% after deductible
(for limitations refer to the Summary of
Benefits and Coverage (SBC) on CHIP
under the Human Resources page)
Durable Medical Equipment 80% after deductible 80% after deductible 50% after deductible
All Other Covered Charges 90% after deductible 70% after deductible 50% after deductible
* Required approval by PATH-WEIGH program.
Retail Pharmacy Retail Pharmacy Mail Order
Prescription Drug Tiers 30-day supply 90-day supply 90-day supply
Generic 20% to a maximum of 20% to a maximum of 20% to a maximum of
$20/prescription $60/prescription $50/prescription
Preferred Brand 30% to a maximum of 30% to a maximum of 30% to a maximum of
$75/prescription $225/prescription $190/prescription
Non-Preferred Brand 45% to a maximum of 45% to a maximum of 45% to a maximum of
$100/prescription $300/prescription $250/prescription
Specialty Drugs** $100 flat copay (limited to a 30-day supply)
Out-of-Pocket Maximum (for all Tiers) Employee Only $1,500; Employee + Child/Spouse $1,850; Family $2,350
8 ** All specialty medication will need to be filled through Express Scripts’ specialty pharmacy, Accredo.How Much Will Medical and Prescription Coverage Cost?
Prescription
Medical /
Full-Time Employee Part-Time Employee
Coverage Level Cost Per Pay Period* Cost Per Pay Period*
Employee Only $39.43 $78.86
Employee + Spouse $189.58 $379.17
Employee + Child(ren) $132.71 $265.42
Family $246.45 $492.90
* Employees hired before September 1, 2019 who do not take the CHRA by December 13, 2019 pay $15 more per pay
period in 2020.
Prescription Drug Benefits
Express Scripts—Your Pharmacy Benefit Manager
Express Scripts provides pharmacy services for participants in CaroMont’s medical plan. Express
Scripts services include a retail pharmacy network, mail order services, step therapy program, and
specialty drug monitoring and dispensing.
Express Scripts’ pharmacy network includes major retail pharmacy chains, such as CVS, Harris Teeter,
Publix, Rite-Aid, Walgreens, and Walmart, as well as numerous independent pharmacies.
Benefit levels for prescription drugs depend on whether you are buying generic, preferred brand,
non-preferred brand, or specialty drugs, and whether your prescription is filled at a network retail
pharmacy or by mail order. Refer to page 8 for benefit levels.
To find a pharmacy near you and to access the most current formulary (list of preferred brand name
drugs), go to www.express-scripts.com/caromont.
How Does the Step Therapy Program Work?
As some medications are extremely costly, it is important to try the lower-cost, clinically effective
medications first (if they are available). If your doctor writes a prescription for a medication that requires
a step therapy, the requested medication may not be covered until a more cost-effective medication
“step” is tried first. Your pharmacist will let you know if your prescription requires step therapy.
Only if your doctor contacts Express Scripts to request prior authorization approval will the next step
medication be considered.
What Are Specialty Drugs?
Specialty drugs are high-cost injectable, infused, oral, or inhaled medications that are typically
prescribed to treat chronic or long-term conditions that have few or no alternative therapies.
This includes (but is not limited to) medications for cancer, HIV/AIDS, hepatitis C, multiple sclerosis,
and more.
Specialty drugs are used when clinical monitoring and support are needed to help reduce any health
risks or potentially serious side effects.
All specialty drugs must be filled through Accredo (a subsidiary of Express Scripts) and include
drugs such as Humira, Atripla, Betaseron, Remicade, Norditropin, Copaxone, Sovaldi, Tecfidera, and
Pulmozyme. For a full list of specialty drugs, visit www.express-scripts.com/caromont.
92020 HEALTH MATTERS BENEFITS GUIDE
Save Money: Consider Mail Order
Did you know that it’s less expensive to fill your 90-day supply of medication through mail order?
Consider using mail order to keep more money in your pocket!
If you are sending a mail order prescription for the first time, you will need to send it to Express
Scripts Home Delivery Services.
To get started, you will need to enroll with the Home Delivery program. It’s easy:
• Have your doctor write your prescription for the maximum supply allowed (a 90-day supply).
Your doctor will need to include your name, date of birth, and identification number on the
back of each original prescription.
• You will need to complete an Express Scripts order form.
• Mail or fax the form, original prescriptions, and payment information to:
Express Scripts
Home Delivery Service
P.O. Box 66566
St. Louis, MO 63166-6565
Please allow 10 to 14 days for delivery of your prescriptions. If you have any questions, please call
Member Services at 1-866-834-0478. Representatives are available 24 hours a day, 7 days a week for
your prescription needs.
Consumer Assistance
The CaroMont Consumer Driven Health Plan offers the following consumer assistance services to
ensure you and your family receive timely and appropriate health care services: UMR Nurseline and
UMR Consumer Concierge.
UMR NurseLine
A simple call to the NurseLine puts you in touch with a highly trained registered nurse who can
answer your medical questions and provide you with advice without an appointment. NurseLine is a
24-hour-a-day, 7-days-a-week nurse telephone line. This service is free and completely confidential.
You can reach the NurseLine by calling 1-866-494-4502 (this number is also on the back of your
medical insurance card).
UMR Consumer Concierge
Acting as your advocate, the UMR Consumer ConciergeSM provides service and assistance, beginning
at pre-enrollment and continuing throughout the life of your plan. Your concierge also serves as the
liaison between you, your medical plan, and product and care management experts. Your UMR
Consumer Concierge is just a phone call away to answer any of your medical plan questions. Call
1-800-758-4910 and learn more about how they can help.
• Search for in-network physicians and hospitals that best meet your needs.
• Estimate treatment costs, including drug alternatives.
• Understand your Flexible Spending Account and Health Reimbursement Account balances,
contributions, and other basics.
• Explore online benefits information, decision-making tools, and health education resources
available at www.umr.com.
10Earning HRA Dollars
Prescription
Medical /
In addition to the contribution CaroMont makes into your Consumer Driven Health Plan’s (CDHP)
Health Reimbursement Account (HRA), you can earn HRA dollars just by taking care of yourself.
Complete any of these health and wellness programs to earn HRA dollars.
Completing these programs provides another way to offset your out-of-pocket medical expenses.
By making these programs available, CaroMont rewards its covered employees for improving their
health status or maintaining a healthy lifestyle.
Eligibility for HRA incentive dollars is limited to covered employees who elect the CDHP as their
medical plan for the current plan year, complete an eligible program, and receive documentation of
satisfactory completion. Deposits to your HRA are made on a quarterly basis.
Evidence or HRA Dollars
Program/ Documentation Deposited
Activity Eligibility Criteria Required to Your Account
Fitness Earn 8 fitness points each month for participating in Complete the following $25 per month
Incentive one or more of the following activities: steps for successful (deposited into HRA
• Join the CaroMont Health and Fitness Center or any submission: quarterly)
other fitness center. 1. Print and fill out the
Each fitness facility visit = 1 fitness point. activity log found on
CHIP. To complete
• Track physical activity using a CaroMont approved form, you must have
physical activity tracker app or device. Approved a signature from
devices/apps include: Apple, Garmin, Samsung the fitness facility
watches; FitBit, Google Fit; Strava, Apple Health, representative.
Garmin Connect.
2. Attach a copy of
Walking at least 7,000 steps per day = 1 fitness point proof of activity.
Completing 30 min of physical activity = 1 fitness point Proof of Activity:
Unsure if your device or app meets the criteria? – Printed facility
Call the Health Promotions Coordinator at Ext. 3081 visits report from
fitness facility
– Printed activity
history from app
or device that
indicates the
date and amount
of steps; OR
physical activity
completed for the
indicated day.
3. Send the PRINTED
activity log and
proof of activity to
Human Resources
via interoffice mail.
Metabolic Earn HRA dollars by maintaining a healthy BMI, Documentation from $25 dollar earned per
Support improving BMI category or maintaining a healthy waist provider or other quarter if healthy BMI
Program circumference. qualified person. or Waist Circumference
(BMI) CaroMont’s Standards are as follows: Members of the wellness is maintained
team or Fitness Center OR
Accepted BMI range: 18.5–27.5 staff can certify during
Underweight: less than 18.5 the last two weeks of $25 dollars earned
Overweight: 27.6–29.9 January, April, July, for improving BMI
and October. Insurance categories (Extreme risk
High Risk: 30–34.9
member ID number is Æ High Risk) towards a
Very High Risk: 35–40 healthy BMI
Extreme Risk: greater than 40 required.
OR
Accepted Female Waist Circumference: )35
$50 dollars earned from
Accepted Male Waist Circumference: )40 moving to the accepted
healthy BMI range.
112020 HEALTH MATTERS BENEFITS GUIDE
Evidence or HRA Dollars
Program/ Documentation Deposited
Activity Eligibility Criteria Required to Your Account
Tobacco Complete a formal Tobacco Cessation Program Documentation or $25 maximum; one
Cessation: (e.g., Quit Smart). certificate from tobacco per covered employee
Level I cessation instructor.
Insurance member ID
number required.
Tobacco Remain tobacco-free following completion of Tobacco Affidavit certifying $50 maximum; one
Cessation: Cessation Program. compliance six months per covered employee
Level II after completing the
program. Complete
form on CHIP>HR page.
Tobacco You and your covered dependents have been Affidavit certifying $50 maximum; one
Cessation: tobacco-free for 12 months. compliance. per covered employee
Level III Complete form on
CHIP>HR page.
Positively • Begin prenatal care and enroll in the Positively Pregnant Certificate of $100
Pregnant Program by the end of the 16th week of pregnancy. Completion from your
Program • Remain free of tobacco, alcohol, and other harmful health care provider
drugs during pregnancy. must be turned in to
HR.
• Attend all scheduled appointments with your prenatal
health care provider.
• Follow all recommendations made by your prenatal
health care provider.
Wellness Meet with a Wellness Coach one time during the Documentation from $50 max.; one per
Coaching calendar year to discuss current health status, health Wellness Coach. covered employee per
goals, and behavior changes to reach your goals. calendar year
Your medical plan is committed to helping you achieve your best health. Rewards for participating
in a wellness program are available to all employees. If you think you might be unable to meet a
standard for a reward under these wellness programs, you might qualify for an opportunity to earn
the same reward by different means. Contact the Health Promotions Coordinator (704-834-3081)
to work with you (and, if you wish, with your doctor) to find a wellness program with the same
reward that is right for you in light of your health status.
12Wellness Matters
Wellness
Matters
CaroMont Disease Management (DM) Program
Living with diabetes or hypertension is enough of a challenge without having to worry about health
care costs. That’s why CaroMont Health offers participants who enroll in the Diabetes DM Program
or Hypertension DM Program the opportunity to get 100% coverage for certain condition-related
services and prescriptions. Here’s how it works:
• To enroll in the CaroMont DM Program, call your Clinical Health Coach (CHC) at 704-671-7855
and schedule an onsite coaching appointment. You must enroll each year to participate in this
voluntary program.
• You and the CHC will review your health status and goals and develop a plan of engagement
for the rest of the year.
• Maintain your agreed-upon coaching plan throughout the year and you’ll receive the following
selected in-network services/prescriptions at 100% coverage, leaving you more money for
other covered expenses:
Diabetes DM Program Hypertension DM Program
• Two primary care visits/diabetes specialist preventive • Two primary care visits/hypertension specialist care
care visits per year visits per year
• Quarterly A1C test • Annual lipid panel
• Annual lipid panel • Approved meds: lisinopril, furosemide, amlodipine
• Annual urine microalbumin besylate and losartan potassium (formulation
• Foot exam determined by CaroMont Health)
• Annual dilated eye exam
• Approved glucose monitoring devices (brand
determined by CaroMont Health)
• Approved meds: metformin, glyburide, glipizide
and glimiperide (formulation determined by
CaroMont Health)
Note: If you’re enrolled in disease management for both diabetes and hypertension, 100% coverage for primary
care visits is limited to two per year and annual lipid panel is limited to one per year.
Even if you do not have diabetes or hypertension, the (CHC) is there for all CaroMont Health’s
medical plan participants. The CHC is a trusted, experienced nurse who is dedicated to helping
members confidentially improve their health and obtain the medically necessary services and
treatment that they need. The CHC can help you understand your health conditions and your
physician’s treatment plan. There is no cost for working with the CHC and sometimes you can
actually save money. Call your CHC at 704-671-7855.
132020 HEALTH MATTERS BENEFITS GUIDE
CaroMont’s Wellness Programs
The best-kept secret at CaroMont Health just may be all the wellness programs and activities
offered throughout the year. Take a look at the programs below and make a commitment to
participate. For more information about these programs, contact The Wellness Team at
704-834-3081 or visit Your Health Connection on the CHIP home page.
Step Up to Shape Up Employee Wellness Committee Stress Less
This is a team walking Let your voice be heard This program teaches
program for employees at and have a say in the next employees new ways
CaroMont Health. The goal Employee Wellness Event to identify, reduce,
of this program is to get and/or program! The goal of and control stress by
moving and to have fun. the Wellness Committee is to embracing a new outlook
deliver effective programs to on stressors and reshaping
ALL employees by including our mindsets.
ALL perspectives.
Wellness Challenges Wellness Coaching
Employees can challenge themselves Meet with the Wellness Coach who can provide
and others with a new wellness you with the education, coaching, and support
challenge each month. Explore new you need to begin making lasting healthy
areas of wellness with a fun focus each lifestyle changes. The Wellness Coach is available
challenge. No lectures, no meetings! to provide you one-on-one coaching for weight
Every employee can participate no loss, stress reduction, time management, tobacco
matter what department, shift, or cessation, establishing healthy nutrition habits,
location they’re in. starting and sticking to a fitness plan, and
making overall healthier choices.
Personal Training Jump Start Reimbursement
Personal training is an The Jump Start weight management program is a
excellent way to get started 12-week weight loss program that uses weekly lifestyle
and/or stay consistent with lessons, group exercise, and group discussion to help
your exercise program. set and achieve realistic weight loss goals. This program
Whether it’s general meets at the CaroMont Health and Fitness Center twice
overall fitness you seek or a week. Participants are expected to attend lessons, log
a specific health concern their weight, and complete weekly homework.
such as weight loss, disease The program fee is $115 (subject to change), and
prevention/management, CaroMont employees are eligible for reimbursement of
and/or an improved quality 50% of the fees if they complete the pre- and post-screen
of life, our Certified Personal and attend 80% of the sessions (19 classes out of 24).
Trainers are here for you. For more information, contact the CaroMont Health and
Affordable individual sessions Fitness Center at 704-671-7930.
and packages are available.
14PATH-WEIGH
Wellness
Matters
Maintaining a healthy weight is work that requires a lifetime. CaroMont’s medical plan is
offering a new, holistic program and resources to support those who desire a healthy weight
loss journey. Participation in this program will be mandatory prior to approval for Bariatric
Surgery beginning in 2020. Milestones along the way include:
• First Stop: Schedule and meet with your Clinical Health Coach (CHC) at 704-671-7855.
This visit is free! At this stop, you and the CHC will discuss your weight loss goals and
devise your personalized weight loss itinerary.
• Second Stop: A Wellness Dietitian will develop a personalized approach to address your
nutrition needs. At CaroMont, you’ll have the option of working on weight loss in a group
or 1:1 with a Wellness Dietitian.
• Third Stop: Together, you and your Wellness Dietitian will evaluate your progress and
determine what the next steps are for a successful weight loss journey. Next steps may
include a referral to Dr. Dorothy Kodzwa, a CaroMont Provider.
1 2 3
Clinical Health Coach — Wellness Dietitian — Evaluate success
Discuss weight loss Create a personalized and plan for
goals and design a nutrition plan and support continued success!
personalized itinerary. options (group versus 1:1).
Visits with the Clinical Health Coach (CHC) and Wellness Dietitian are provided at no charge. Visits
with medical providers are subject to usual coinsurance and deductibles.
CaroMont Health and Fitness Center
It’s estimated that 60% of Americans are at risk for health problems related to lack of physical
activity. Regular physical activity helps to prevent heart disease, colon cancer, obesity, diabetes,
and high blood pressure. To increase your physical activity, you can take advantage of the
CaroMont Health and Fitness Center.
The CaroMont Health and Fitness Center is available to all employees at no charge. Eligible family
members are also welcome to use the center for just $10 a month. The center is located inside the
Summit Building off of Court Drive. The address is 660 Summit Crossing Place, Suite 302. If you’re
new to the fitness center, consider scheduling an equipment orientation or weight demo to learn
about the fitness equipment. For hours of operation and group class schedules, go to CHIP, click
Department and Services and then CaroMont Health and Fitness Center or call 704-671-7930.
Here’s what the center has to offer:
Equipment Group Classes Staff
• Treadmills • Bands • Body Toning • Personal trainers who can help you
• Elliptical machines • Strength Rack • Zumba develop an exercise plan
• Rowers • Strength Training • Cycle • Exercise specialists
• Recumbent bicycles Machines • Yoga • Nurses trained in cardiopulmonary
• Steppers • Indoor Walking Track • Flexibility and strength conditioning
• Dumbbells and more! • Registered dietitian available to assist
with healthier diet and weight loss
152020 HEALTH MATTERS BENEFITS GUIDE
WW Reimbursement Program
WW (formerly known as Weight Watchers) is an integrated approach that combines smarter eating,
healthy habits, exercise, and a supportive environment. Reimbursement periods are offered every
12 weeks. All CaroMont Health employees are welcome to participate and the joining fee is waived
for employees registering through the CaroMont WW portal. Registration instructions are available
by clicking Your Health Connection, found on the left side of the CHIP home page in the rotating
banner, and scrolling down to the WW section. Participants must register using the CaroMont
WW portal when they begin seeking reimbursement and must sign up on the SurveyMonkey
reimbursement survey tool each quarter they are seeking reimbursement. If you have any
questions, call 704-834-3787. For help with registration, please call WW customer service at
1-866-204-2885.
Three Ways to Lose Weight and Save Money
When you sign up through CHIP, you receive special pricing for the following programs. In addition
you have an opportunity to earn reimbursement for some or all of the program costs.
Option Type of Reimbursement Program Participation Requirement Reimbursement*
1 “At Work” meetings: Must buy 3-month Attend 10 out of 12 onsite 50% of $120 total cost
plan; program may be repeated meetings (Community “make-up”
meetings will count)
• Biggest Loser reward: 1 per quarter; Attend 10 out of 12 meetings Increased to 100% of
eligibility for this reward may be repeated and lose the most weight in $120 total cost
in future quarters the CaroMont Health “At Work”
meetings
• Lifetime Goal Achievement reward: 1 per Attend 10 out of 12 meetings and Increased to 100% of
person; once earned, eligibility for this reach your lifetime weight goal $120 total cost
reward may not be repeated
2 Community meetings: Must buy 3-month Attend 10 out of 12 meetings 50% of $120 total cost
plan; program may be repeated
3 Digital program (meeting attendance Log weight online for at least 50% of $54 total cost
not required; online participation only): 10 weeks in 12-week period
Must buy 3-month plan; program may be
repeated
* Maximum reimbursement for the “At Work” meetings option, including Biggest Loser and Lifetime Goal Achievement
rewards: 100% of total cost. You must show successful weight loss from week 1 of the reimbursement period. Prices
subject to change at WW discretion.
Reporting Your Participation for Reimbursement:
To report your participation in the WW program of your choice, complete the SurveyMonkey
reimbursement survey, which is located on Your Health Connection on CHIP. Instructions for registration
and frequently asked questions can also be found on Your Health Connection.
16Employee Assistance Program
Wellness
Matters
Living a healthy lifestyle includes taking care of yourself physically, mentally, and emotionally.
To help you cope with the challenges of everyday life, CaroMont Health offers the Employee
Assistance Program (EAP). The EAP provides employees with professional guidance and
counseling through McLaughlin Young Services that are confidential; three visits per calendar
year are free, and many other services are available at no cost to all employees and members of
their households.
We encourage you to take advantage of this valuable benefit, whether you have a simple question,
a sudden emergency, or an ongoing problem. The EAP staff at McLaughlin Young Employee
Services is available 24 hours a day, 7 days a week, and is ready to assist you.
Reasons to Seek Assistance Legal Services Financial Services
• Stress, depression, and • Attorney referrals in all • Toll-free information line
anxiety 50 states • Financial counseling
• Balancing work and family • Free telephone advice • Debt management plan
• Help with elder care • Free 30-minute session • Bankruptcy prevention unit
• Grief and loss with an attorney
• Credit report review
• Marital difficulties • 25% attorney fee reduction
• Educational materials
• Parenting and family • Quality attorney network
• Discounted session with a
problems • Educational materials Certified Financial Planner
• Crisis events (living wills, power of
• Comprehensive financial
attorney, legal library, etc.)
• Alcohol and drug use/abuse fitness
• Identity theft assistance
• Work-related issues
and protection
To speak with an EAP Counselor, call 1-800-633-3353 or 704-529-1428. Call anytime, 24 hours
a day, 365 days a year. You can also access valuable work-life information and services, including
elearning and online seminars, on the McLaughlin Young website.
• Go to www.mygroup.com
• Click on the My Portal Login
• Click on Work-Life box
• Username: caromont
• Password: guest
172020 HEALTH MATTERS BENEFITS GUIDE
Family Education Classes at The Birthplace
CaroMont Health employees, their spouses, pregnant dependents covered under the CaroMont-
sponsored medical plan, and preschool/school-age children can attend any of the Family Education
Classes that we offer at The Birthplace at no charge. Class dates and times can be found by going to
www.caromonthealth.org, selecting the For Community tab, and selecting Classes & Events.
Employees should not register online, as this does not allow for the discount. Call the Baby Line at
704-834-2229 to register. Be sure to mention that you are a CaroMont Health employee. These
classes are first-come first-serve, and some do fill up quickly—so please be sure to register several
weeks in advance.
Employee
Class Description Fee
During this two-hour class, parents will learn about newborn hospital procedures,
Baby Beginnings Free
normal newborn appearance and behavior, plus basic baby care techniques and tips.
Getting started, latching on, and positioning are among the skills taught in this two-
Breast Feeding
hour session to promote a smooth transition into breast feeding. The Birthplace Free
Class
Team believes breast feeding is the very best way to feed your infant.
These classes will help to prepare mom and her support person for labor and
Birth and Beyond birth. Couples learn about the labor process, practice labor positions, massage,
Free
Childbirth Series relaxation, and other coping measures. Medical pain relief measures, induction, and
Cesarean birth are covered. A tour of The Birthplace is also given.
The Birthplace This is a group tour of The Birthplace for mom and her family.
Free
Tour
This class provides demonstration and hands-on practice of the ABCs of infant
Infant CPR and
resuscitation. Household safety-proofing tips and accident prevention are also Free
Safety Class
reviewed.
This one-hour class teaches children ways they can be “helpers” with the baby
Preschool to promote positive feelings. Children will also be shown a short video about
Free
Sibling becoming a big brother or sister and visit a Birthplace room. Recommended for
children ages 2 to 5 years.
This one-hour class allows boys and girls expecting a new sister or brother to visit
School-Age
The Birthplace and learn some basic baby care. Children are shown a short video Free
Sibling
about becoming a big brother or sister. Recommended for children ages 6 to 10.
This one-hour class is designed for any expectant mom who may want to use
Epidural Class Free
epidural anesthesia during labor. Benefits, risks, and what to expect are covered.
Employee Health Services
Employee Health Services provides health screenings, immunizations, flu vaccines, and follow-up care
for job-related illnesses, injuries, and exposures. They also conduct pre-employment health screenings
to ensure employees are physically able to perform their jobs. These services are available to all
employees. For more information, contact Employee Health at 704-834-2179 or on CHIP on the
Employee Health page.
18Dental Care Benefits
Dental Care
Benefits
CaroMont Health offers a dental plan through Delta Dental. This plan provides you and your family
with the comprehensive coverage you need at an affordable price.
Where to Go
Delta Dental has two networks—PPO and Premier. You get your full benefits and the largest discount
if you go to a PPO dentist. If you go to a Premier dentist, you get your full benefits, but the discount
is slightly less. If you go to a non-network dentist, you will not get a discount—this means your
out-of-pocket costs will be higher.
The annual deductible is $50 per person, up to a maximum of $150 per family per year. The
deductible does not apply to Class I (preventive) and Class IV (orthodontia) benefits.
What the Plan Pays
The plan pays the entire (100%) cost for diagnostic and preventive care services listed under Class I in
the chart below. For all other services, the plan pays a percentage of the cost after the deductible has
been satisfied. The maximum the plan pays is $1,200 per person each year for Class I, II, and III services
combined. For orthodontia (i.e., braces), the lifetime maximum the plan pays is $1,500 per person.
Percentage Covered
Class I: Diagnostic and Preventive Care Services by the Plan*
Diagnostic and Preventive Services – includes exams, cleanings, fluoride, and space maintainers 100%
Emergency Palliative Treatment – to temporarily relieve pain 100%
Brush Biopsy – to detect oral cancer 100%
Radiographs – X-rays 100%
Sealants – to prevent decay of permanent molars 100%
Class II: Basic Services
Minor Restorative Services – includes fillings and crown repair 80%
Non-Surgical Periodontic Services – to treat gum disease 80%
(including periodontal maintenance cleanings)
Relines and Repairs – to bridges and dentures 80%
Simple Extractions – non-surgical removal of teeth 80%
Other Basic Services – miscellaneous services 80%
Class III: Major Services
Major Restorative Services – includes crowns 50%
Prosthodontic Services – includes bridges, implants, and dentures 50%
Surgical Periodontic Services – surgical services to treat gum disease 50%
Endodontic Services – includes root canals 50%
Other Oral Surgery Services – extractions and dental surgery 50%
Class IV: Orthodontic Services
Orthodontic Services – includes braces 50%
Orthodontic Age Limit No age limit
* If you go to a non-network dentist, you do not get a participating network dentist discount. The percentages in this column indicate
the portion of Delta Dental's non-network maximum allowed amount that will be paid for those services. This non-network maximum
allowed amount may be less than your dentist's fee, which means that you will be responsible for the difference.
192020 HEALTH MATTERS BENEFITS GUIDE
How Much Will It Cost?
Full-Time Employee Part-Time Employee
Coverage Level Cost Per Pay Period Cost Per Pay Period
Employee Only $5.87 $9.10
Employee + Spouse $19.48 $22.40
Employee + Child(ren) $20.99 $24.14
Family $34.47 $41.36
Preventive Care. No Cost, No Excuse.
Preventive care is important to protect your oral health. Since CaroMont Health pays the entire
cost for these services, there’s really no reason why you should put it off. Preventive care
services include oral exams, cleanings, X-rays, fluoride treatments, and more. These services are
listed under Class I: Diagnostic and Preventive Care Services in the chart on page 19.
Take Action
Make the most of your dental benefits by going to a PPO or Premier dentist. Finding a PPO or
Premier dentist provider is quick and easy.
• Go to www.deltadentalnc.com; or
• Call 1-800-524-0149.
20Vision Care Benefits
Vision Care
Benefits
CaroMont Health offers two vision plan options through Community Eye Care (CEC) (based in
Charlotte). This group plan is designed to reduce the amount you and your family spend on routine
eye care. Both plan options include an eye exam and a standard contact lens fitting (as needed)
every 12 months each—for a low copay.
What’s the difference in plans? The Vision 150 Plan has a $150 annual eyewear allowance.
The Vision 350 Plan comes with a $350 annual eyewear allowance. The annual allowance can be
applied to frames, spectacle lenses, contact lenses, special lens options, or any combination.
Vision 150 Plan Vision 350 Plan
• Eye exam once a year ($10 copay) • Eye exam once a year ($10 copay)
• $150 annual eyewear allowance ($20 copay) • $350 annual eyewear allowance ($20 copay)
• Standard contact lens fitting for new fits, or re-fits • Standard contact lens fitting for new fits, or re-fits
as needed ($20 copay) as needed ($20 copay)
Note: Periodic contact lens evaluations are not covered under either plan.
Where to Go
Both vision plan options give you the freedom to visit any eye care provider you choose. You receive
full plan benefits, and there is no penalty if you see an out-of-network provider. However, network
providers do offer CEC participants some perks.
Network Provider Out-of-Network Provider
If you go to a network provider, you will not need to If you go to an out-of-network provider, you pay the
file any paperwork. All you pay is your copay(s) and full amount for services and eyewear at the time of
any amount over the eyewear allowance. If you exceed your visit. You then submit an out-of-network claim
your eyewear allowance, most CEC network providers form to CEC within 180 days of the purchase date. You
offer discounts on the coverage amount. Most network will be reimbursed for the full cost of your exam (minus
providers offer a 20% discount on glasses and a 10% the copay) and for the full amount of your eyewear
discount on contact lenses. allowance (minus the copay). Claim forms are available
on CHIP on the Human Resources page or by calling
CEC at 1-888-254-4290.
How to Use Your Vision Benefits
1. Go to www.communityeyecare.net or call Community Eye Care at 1-888-254-4290
to find a network provider.
2. Call and make an appointment. Tell the provider you have Community Eye Care coverage.
3. See the eye care provider and select your eyewear.
4. Pay your copays and any amount that exceeds the eyewear allowance.
212020 HEALTH MATTERS BENEFITS GUIDE
How Much Will It Cost?
The cost for vision coverage is the same for full-time and part-time employees.
Vision 150 Plan Vision 350 Plan
Coverage Level Cost Per Pay Period Cost Per Pay Period
Employee Only $3.22 $9.85
Employee + Spouse $6.76 $20.70
Employee + Child(ren) $6.12 $18.75
Family $9.97 $30.00
Four Ways to Save on Eyewear
1. Get a written prescription. If you get an eye exam at a retail store, you will be
encouraged (but are not required) to purchase eyewear at the same place. If you wish to
shop around for the best price on eyewear, simply ask for your prescription in writing.
2. Save online. Online retailers can save you a lot of money on eyewear. All you need to
do is give them a prescription. Ask around and get recommendations from friends and
family who are already getting their eyewear online.
3. Reuse your old frames. You don’t need to get new frames when you get a new
prescription. Just have your new lenses inserted into your old frames. This can save you
hundreds of dollars.
4. Use your FSA. Plan ahead and sign up at Annual Enrollment to use your Health Care
Flexible Spending Account (FSA) to pay for your eye care expenses with tax-free dollars.
Take Action
Make the most of your vision plan by going to a network provider. Locating a network provider is
quick and easy.
• Go to www.communityeyecare.net.
• Click on Find a Provider.
• You can search by county, state, doctor’s last name, practice name, or zip code.
22Flexible Spending Accounts
Spending
Accounts
Flexible
CaroMont Health offers Flexible Spending Accounts (FSAs) to save you money on health care
and dependent care expenses. You set aside before-tax dollars to pay for eligible health care
expenses not covered by your health care insurance (e.g., deductibles and copayments) and day
care expenses for children up to age 13 and elderly relatives. When the money comes out of the
accounts, it remains tax-free.
How It Works
There are two types of FSAs: Health Care FSA and Day Care FSA. Here’s how they work:
• Estimate the amount you expect to spend on eligible health care and/or day care expenses
during the coming year.
• Decide how much, based on that estimate, you want to deposit into each account. You may
deposit up to $2,700 a year in the Health Care FSA and $5,000 in the Day Care FSA.
• The contributions to your Health Care and Day Care FSAs are deducted from your paycheck
each pay period on a before-tax basis.
• With the Health Care FSA, you can either file a claim for reimbursement or use your Flex Card
to pay at the time you incur an eligible health care expense (see Using Your Flex Card on
page 24 for details).
• With the Day Care FSA, you must file a claim to be reimbursed. Payments for claims are
issued as your account receives your pretax contributions throughout the year.
• Claims for expenses incurred by you or eligible dependents during the current plan year must
be filed by March 31 of the following plan year in order to be reimbursed.
• According to Internal Revenue Service (IRS) regulations, money left in your account(s) at
the end of the year must be forfeited and cannot be returned to you. So, be conservative in
estimating your expenses for the coming year.
By law, your Health Care FSA and Day Care FSA must remain separate. You cannot use money
deposited in your Health Care FSA for day care expenses or vice versa.
Health Care FSA
You can contribute up to $2,700 a year to the Health Care FSA on a before-tax basis. You can use
this money to reimburse yourself for eligible health care expenses. Eligible expenses under the
Health Care FSA are governed by IRS regulations and are, therefore, subject to change. To obtain a
list of eligible and ineligible expenses, visit the IRS website at www.irs.gov/publications, and then
select publication 502. You may also contact UMR at 1-800-758-4910 regarding eligible and
ineligible expenses.
232020 HEALTH MATTERS BENEFITS GUIDE
Stretch Your FSA Dollars
You can use the Health Care FSA to reimburse yourself for deductible-related expenses after you
have used all the money in your Health Reimbursement Account (HRA). Make the most of your
Health Care FSA by using it to:
• Pay your prescription drug coinsurance.
• Pay out-of-pocket expenses after your HRA dollars are used up.
• Buy prescription sunglasses or an extra pair of eyeglasses.
Using Your Flex Card
Using your Health Care FSA is fast and easy with the Flex Card. Use your Flex Card to pay for health
care expenses at any merchant that accepts MasterCard® and is an allowable provider. Your Health
Care FSA is electronically debited whenever you use the card, and you don’t have to wait for
reimbursement. For more information about the Flex Card, go to www.umr.com.
Keep Your Receipts
Always keep your receipts for your out-of-pocket health care expenses. Periodically, you may
be required to submit a receipt to UMR to prove purchase of eligible expenses (known as a
substantiation request). Receipts are required when reimbursing expenses incurred under a
health care plan other than CaroMont’s medical plan.
If your health care Flex Card becomes frozen because you have not responded to a UMR
substantiation request, then you will not be able to use the card again until those requests are
cleared up. Your only option will be to file manual reimbursements until your card is released.
Day Care FSA
You can contribute up to $5,000 a year to the Day Care FSA. This account allows you to use before-
tax dollars to pay for day care expenses for an eligible child or adult. The day care must be necessary
in order for you to work. The Day Care FSA can be used as an alternative to the child care tax credit.
You will not receive a Flex Card for the Day Care FSA. Reimbursement instructions are available at
www.umr.com (see page 25 of this guide for access instructions).
Eligible expenses under the Day Care FSA are governed by regulations and are, therefore,
subject to change. To obtain a list of eligible and ineligible expenses, visit the IRS website at
www.irs.gov/publications, and then select publication 503. You may also contact UMR at
1-800-758-4910 regarding eligible and ineligible expenses.
Please note: In 2019, highly compensated employees were limited to an annual maximum
contribution of $1,300 to the Day Care FSA. If you are determined to be a highly compensated
employee in 2020, you may be subject to a similar contribution maximum. If you anticipate your
annual earnings to be $125,000 or more for 2020, we recommend that you elect an annual
amount of no greater than $1,300.
New Employees
The Day Care FSA maximum annual contribution of $5,000 applies across all employers.
For example, if you’ve already contributed $2,000 to a Day Care FSA at a previous
employer in 2020, you may only contribute $3,000 under the CaroMont plan for the
remainder of the 2020 plan year.
24You can also read
