2021 Benefits Open Enrollment - Enrollment Dates: October, 26th - November, 6th Changes Effective: January 1, 2021 - Scripps Research
←
→
Page content transcription
If your browser does not render page correctly, please read the page content below
2021 Benefits
Open Enrollment
Enrollment Dates: October, 26th – November, 6th
Changes Effective: January 1, 2021
Open Enrollment
What are my Responsibilities During Open Enrollment
• To add, change or remove dependents from your coverage
• To enroll, change or waive coverage
• To elect / increase voluntary life insurance
• To update beneficiary information (allowed any time)
• Enroll in the Flexible Spending Accounts
Enrollment will be completed in bSwift and elections must be made no later than:
November 6, 2020 at 5pm PST
All benefit changes become effective: January 1, 2021
Scripps Research 2021 Benefits Open Enrollment 2.
Who is Eligible to Enroll?
• Employees: Staff who are regularly scheduled to work at least 20 hours a week
• New Employees: Benefit eligibility begins date of hire
• Eligible Dependents:
– Spouse
– California Registered domestic Partner (1)
– Dependent children and step-children:
Medical / vision: to age 26
Dental: up to age 19; up to age 25 if full-time student
Children of any age who are incapable of self-support due to a physical or mental disability may
potentially be covered
(1) Premiums for state registered / unregistered domestic partners who do not meet the tax dependent definition of IRC section 152 for the employee, may be considered taxable
income (unregistered domestic partners will not meet the relationship test under IRC section 152). Premiums for children / registered Domestic Partners step-children under
age 26 are not taxable. Premiums for children / stepchildren over age 26 are taxable if not an IRC section 152 tax dependent.
Scripps Research 2021 Benefits Open Enrollment 3.
Can I Make Changes During the Year?
• Your healthcare elections will be effective from January 1, 2021, to December 31, 2021, and changes can only
be made mid-year if you have a Change in Status
• Some examples of a Change in Status:
– Marriage / divorce
– Birth / adoption
– Death of a dependent
– Loss or gain of benefits
– Loss or gain of dependent eligibility
– Change in residence affecting eligibility or access
• Changes must be made within 31 days of the qualifying event
• Please contact Benefits Administration immediately if you have a Change in Status. You will be required to
provide documentation of your change in status.
Scripps Research 2021 Benefits Open Enrollment 4.
Benefit Plan Review
Medical Medical Medical Medical
New
Carrier Aetna Aetna Aetna Aetna
Comprehensive HDHP Choice POS II Graduate Student
Value Network HMO
Choice POS II HSA/HRA Choice POS II
Life / AD&D / Additional
Dental Vision FSA
Disability Benefits
Delta Dental MES Vision Prudential MetLife PayFlex
Life / AD&D Critical Illness Health Care
DPPO PPO Vol. Life / AD&D Hospital Dependent Care
STD / LTD Accident
Scripps Research 2021 Benefits Open Enrollment 5.
What’s New Effective Jan 1, 2021?
• HMO Plan Change:
• The Anthem Blue Cross Select HMO plan will be replaced by the Aetna
Value Network HMO plan for California employees. Current Anthem
Blue Cross Select HMO members will automatically be placed in the
Aetna HMO, or you can choose to opt into another offered Aetna plan
during the enrollment period. If enrolling in the Aetna Value Network
HMO plan, you need to log into your bSwift account and re-elect a
primary care provider (PCP).
• Long Term Care Plan:
• UNUM will be increasing their Long Term Care Insurance premiums as
of January 1, 2021. There are plan changes available to reduce the
increase. Employees interested in discussing their premium should call
UNUM directly. If you’d like to enroll in LTC coverage, please consult
the LTC rate sheet available in bSwift for additional information.
Scripps Research 2021 Benefits Open Enrollment 6.
Open Enrollment Timeline
Action Date(s)
Tuesday, October 27th
Open Enrollment Virtual Zoom Meeting
10:00am – 11:00am PST
Monday, November 2nd
Open Enrollment Virtual Zoom Meeting
2:00pm – 3:00pm PST
Review/make changes/enroll in benefits through bSwift at:
Monday, October 26th – Friday, November 6th
http://scripps.bswift.com
Online Enrollment System closes Friday, November 6 at 5pm PST
Benefits become effective January 1, 2021
Any changes to payroll deductions will be seen in paycheck Friday, January 15, 2021
Scripps Research 2021 Benefits Open Enrollment 7.
Medical Coverage Scripps Research 2021 Benefits Open Enrollment 8.
Aetna Value Network Health Maintenance
Organization (HMO)
USING
AN HMO
In-Network
Primary Care
Physician Referral Specialist
• Each family member must select their own Primary Care Physician (PCP)
TIP • If you do not select a PCP, Aetna will select one for you
• Are you new to the HMO? Make sure your desired PCP is accepting new patients!
• With the exception of an OB/GYN, mental health, or chiropractic specialist, your PCP must
refer you to specialists
• Contact Aetna to change your PCP. PCP changes made before the 15th of the month are
effective the 15th of that month. If the member requests the change on the 15th through
the 31st, then the change is effective the 1st of the subsequent month.
Scripps Research 2021 Benefits Open Enrollment 9.
Aetna Value Network HMO
Plan Highlights Aetna Value Network HMO
In-Network Only
Annual Calendar Year Deductible
Individual $100 per person
Family $200 per family
Maximum Calendar Year Out-of-pocket
New
Individual $2,500 per person
Carrier
Family $5,000 per family
Physician Services
Primary Care Physician (PCP) $30 Copay
Specialist $40 Copay
Routine Preventive Care & Well Child Care No charge
Diagnostic Lab No charge
Diagnostic X-ray $40 Copay
Complex Diagnostics (MRI/CT Scan) $150 Copay
Hospital Services
Inpatient 10% after deductible
Outpatient 10% after deductible
Emergency Room (copay waived if admitted) $100 Copay after deductible
Urgent Care $50 Copay
Mental Health & Substance Abuse
Inpatient 10% after deductible
Outpatient $30 Copay
Prescription Drugs Calendar Year Deductible – Applies to Preferred Brand Name Drugs and Non-Preferred Generic/Brand Name Drugs
Individual $100 per person
Family $200 per family
Retail Prescription Drugs (up to 30-day supply)
Preferred Generic $10 Copay
Preferred Brand-Name $35 Copay after Rx Deductible
Non- Preferred Generic and Brand-Name $60 Copay after Rx Deductible
Mail Order Prescription Drugs (up to 90-day supply)
Preferred Generic $20 Copay
Preferred Brand-Name $70 Copay after Rx Deductible
Non- Preferred Generic and Brand-Name $120 Copay after Rx Deductible
Scripps Research 2021 Benefits Open Enrollment 10.Aetna Preferred Provider Organization (PPO)
Comprehensive Choice POS II Plan
USING
A PPO
In-Network or Out-of-Network
or
Primary Care
Physician Specialist
TIP
• You obtain a higher level of benefit by receiving your services from participating or in-
network doctors, specialists, and facilities
• With the PPO, you have freedom of choice and referrals are not required to see a
specialist
• Before the insurance company pays certain medical expenses, you are required to pay
the deductible
• You are responsible for remaining cost up to the out-of-pocket maximum
Scripps Research 2021 Benefits Open Enrollment 11.Aetna Comprehensive Choice POS II Plan
Plan Highlights Aetna Comprehensive Choice POS II (PPO)
In-network Out-of-network
Annual Calendar Year Deductible
Individual $900 $1,800
Family $2,700 $5,400
Maximum Calendar Year Out-of-Pocket (1)
Individual $2,250 $4,500
Family $4,500 $9,000
Professional Services
Primary Care Physician (PCP) 20% after deductible 40% after deductible
Specialist 20% after deductible 40% after deductible
Preventive Care Exam No charge Cancer screenings only
Diagnostic X-ray and Lab 20% after deductible 40% after deductible
Complex Diagnostics (MRI/CT Scan) 20% after deductible 40% after deductible
Hospital Services
40% after deductible
Inpatient 20% after deductible Additional $200 Copay applies if not
pre-authorized
Outpatient Surgery 20% after deductible 40% after deductible
Emergency Room 20% after deductible 20% after deductible
Urgent Care 20% after deductible 40% after deductible
Maternity Care
Physician Office Visits No Charge 40% after deductible
40% after deductible
Hospital Services 20% after deductible Additional $200 Copay applies if not
pre-authorized
Prescription Drugs Prescription Coverage through OptumRx
$100/person
Prescription Drug Calendar Year Deductible
$200/family
$2,000/person
Prescription Calendar Year Out-of-Pocket Maximum
$4,000/family
Retail Prescription Drugs (up to 30-day supply)
Generic $10 Copay
Formulary Brand $35 Copay after Rx deductible
Non-Formulary Brand $60 Copay after Rx deductible
Scripps Research 2021 Benefits Open Enrollment (1) All percentages paid after deductible has been met 12.High Deductible Health Plan (HDHP) Health Savings Account (HSA) Scripps Research 2021 Benefits Open Enrollment 13.
What is the High Deductible Health Plan
(HDHP) + Health Savings Account (HSA)
Option?
USING What to Know About Your Health Savings Account
AN HDHP
In-Network or Out-of-Network
or
You own Your money You choose Paired with a You receive
Primary Care your HSA rolls over year how much to contribute high-deductible a triple tax
HSA Funds Specialist
Physician after year (max. amounts apply) health plan advantage
• You are financially responsible for all eligible expenses, such as doctor’s visits, non-preventive prescription
TIP drugs and lab charges, until the deductible has been met
• If you are enrolled under Employee + 1 or more Dependents, the Family Deductible must be met before the
coinsurance applies
• Similar to traditional PPO plan, you may use the provider of your choice, but the plan will pay more if you
utilize in-network physicians or facilities
• This medical plan can be paired with a Health Savings Account (HSA) to help pay for qualified health care
expenses
• Contribute towards your HSA through convenient payroll deductions by enrolling in an HSA through PayFlex
Scripps Research 2021 Benefits Open Enrollment 14.Aetna HDHP Choice POS II Plan
HDHP Aetna Choice POS II
Plan Highlights
(HSA/HRA)
In-network Out-of-network
Annual Calendar Year Deductible Family Deductible applies to all members
Employee Only $2,000 $2,000
Employee & Dependent(s) $6,000 $6,000
Maximum Calendar Year Out-of-Pocket (1) Family OOP applies to all members
Employee Only $4,500 $6,750
Employee & Dependent(s) $6,750 $10,125
Professional Services
Primary Care Physician (PCP) 20% after deductible 40% after deductible
Specialist 20% after deductible 40% after deductible
Routine cancer screenings only
Routine Preventive Care No charge
40% after deductible
Routine Well-Child Exams No charge Not Covered
Diagnostic X-ray and Lab 20% after deductible 40% after deductible
Complex Diagnostics (MRI/CT Scan) 20% after deductible 40% after deductible
Hospital Services
40% after deductible
Inpatient 20% after deductible Additional $200 Copay applies if not
pre-authorized
Outpatient Surgery 20% after deductible 40% after deductible
Emergency Room 20% after deductible 20% after deductible
Urgent Care 20% after deductible 40% after deductible
Prescription Drugs Prescription Coverage through OptumRx
Retail Prescription Drugs (up to 30-day supply)
$10 Copay
Generic
Subject to Medical Plan Deductible (except for Preventive Medications)
Formulary Brand $35 Copay after deductible
Scripps Research 2021 Benefits Open Enrollment 15.
Non-Formulary Brand $60 Copay after deductibleHDHP vs. Traditional PPO Plan
Similarities Differences
• Plans use the same network of doctors, • The deductible amount for the HDHP will be
specialists and hospitals significantly higher than a traditional PPO
• Once the plan deductible has been met, you • Monthly premiums are usually higher on a
will receive a higher level of benefit by Traditional PPO
receiving services from in-network providers
• Only the HDHP allows you to use HSA funds to pay
for current and future qualified health care
expenses
• The deductible for a HDHP applies to all services
except Preventive Services and Preventive Generic
Rx
• The family deductible for a HDHP is cumulative,
meaning if you cover a spouse or child(ren), you
must meet the family deductible before your plan
benefits kick in
Scripps Research 2021 Benefits Open Enrollment 16.How do they Compare? HSA vs. HRA
Health Savings Health Reimbursement
Feature
Account (HSA) Account (HRA)
Account Ownership Employee Owned Employer
Contributions Employer and/or Employee Employer Only
Account Funding May be funded by Employer and/or Notional arrangement; Fund reimburses
Employee contributions employees for approved medical care expenses
as they are incurred
Useable for Non-Qualified Yes, but taxable and 20% penalty applies No
Expenses
Account accrual of Interest or Yes, accrues interest and investment No, the account does not accrue interest or have
Investment Earnings earnings, which are not federally taxable, investment earnings
but are taxable for State purposes in some
states
Useable for Non-Medical Yes, as long as qualified and comply with No, only Medical expenses are paid or
expenses (Dental & Vision) Section 213 reimbursed by the HRA
Balances for Terminated Remains with the Employee Remains with the Employer
Employees
Scripps Research 2021 Benefits Open Enrollment 17.Alight Services
Alight is a patient advocacy firm providing personal concierge available
to Aetna HDHP plan members at no cost. Services include:
• Unlimited access to a health care expert
• Researching generic or clinical alternative prescription options
• Unbiased doctor recommendations based on quality and cost
• Coordinating transfer of medical records
• Reviewing bills and charges
• Resolving billing issues with Aetna, hospitals, and provider billing offices
• Explanation of insurance processes and Scripps Research benefit plans
• Comparing service costs, cost estimates
You can get in touch with Scripps Research’s Health Pro
TIP via:
• Phone: 800.513.1667
• Email: answers@alight.com
• Website: https://member.compassphs.com
Scripps Research 2021 Benefits Open Enrollment 18.HSA Eligibility Rules
For you, the employee, to be eligible to contribute to an HSA, you must:
• Be enrolled in a qualified high deductible health plan (HDHP)
• NOT be enrolled in a non-HDHP including a spouse’s plan, Medicare, Tricare or prescription
drug only plan
• NOT be claimed as a dependent on another individual’s tax return, other than your spouse’s
• NOT have received any hospital care or medical services from the Veterans Administration,
in the last three months (unless these services were related to a service-connected
disability)
• NOT be enrolled in a Health Care Flexible Spending Account (FSA) or a Health
Reimbursement Account
In order to have deductions from your paycheck, you must be earning a taxable paycheck from
Scripps Research
Scripps Research 2021 Benefits Open Enrollment 19.HSA Contribution Limits
Eligible Individuals and the Employer can make Financial Contributions to an HSA.
Calendar Year Maximum
2021
Contribution
Employee Only $3,600
Employee + dependents $7,200
Additional “catch-up” if 55 or older $1,000
• Maximum contribution is reduced pro-rata for partial year enrollment (i.e. 1/12 for each month of HDHP
Coverage)
• The plan / calendar deductible is not pro-rated from the enrollment date like the fund is
• Scripps Research contributes towards your HSA account with an annual amount of $1,000 for Employee
Only and $3,000 for Employee & Dependent(s). Employer contributions will be made on a quarterly basis.
• Your and your Scripps Research’s contributions count toward the annual contribution maximum
Any statements concerning actuarial, tax, accounting, investment or legal matters are based solely on our experience as insurance brokers and are not to be relied upon
as actuarial, accounting, tax, investment or legal advice, for which you should consult your own professional advisors.
Scripps Research 2021 Benefits Open Enrollment 20.Using HSA Funds
Your HSA Funds can be used for Qualified Healthcare Expenses
• Examples:
– Unreimbursed qualified medical, dental and vision expenses
– LASIK
– Orthodontia
– Prescriptions
– Medical premiums for COBRA, or health coverage while receiving unemployment compensation,
– Medicare Parts B & D
– Certain Long Term Care premiums
– Medical Supplies
• The HSA must be established and an initial deposit must be made before you can be reimbursed for eligible
expenses or use funds
• Because you own the HSA, funds can be used towards eligible expenses even after you are no longer
covered by an HSA-qualified plan
• If you use an HSA for non-IRS approved medical expenses, you will be subject to pay earned income taxes
on the misused funds as well as a 20% excise tax
Scripps Research 2021 Benefits Open Enrollment 21.Where are my HSA Funds?
Scripps Research has selected PayFlex as the preferred bank to
handle Health Savings Accounts. Money is deposited at PayFlex into
an interest-bearing account.
• Like a Medical IRA
• Owned by Employee; Portable
• Tax-advantaged personal savings account
• Employee contributions are tax-free and reduce taxable income*
• Use today or save for future and retirement health expenses
• Unused money rolls over year to year
• PayFlex will administer your HSA account through convenient payroll
deductions
• If you leave Scripps Research or change medical plans, the HSA
account still belongs to you
* Taxable for California income tax
Scripps Research 2021 Benefits Open Enrollment 22.Advantages of an HSA
You Own the Build
Cost Invest Tax Savings
HSA Savings
In most instances, When you leave the Because you and [Vendor / bank] Contributions are tax
an HSA plan company or retire, your employer can offers a wide array deductible at the
premium is a less you can take the contribute to your of investment federal level and
costly option for you money with you HSA, you have the options for you to earnings grow tax
and your family ability to grow a invest and grow your free (1)
sizeable account savings tax-free (1)
over time
(1) Contributions and earnings to an HSA are taxable income in CA, AL & NJ and earnings are only taxable in NH & TN
Scripps Research 2021 Benefits Open Enrollment 23.Healthcare Cost Comparison Scripps Research 2021 Benefits Open Enrollment 24.
Health Reimbursement Account (HRA) Scripps Research 2021 Benefits Open Enrollment 25.
What is a Health Reimbursement
Account (HRA)?
How to Use Your Health Reimbursement Account
Your employer Visit In-Network Use HRA debit HRA funds will be
makes tax-free provider card or turn in used for payment
contributions to receipts for eligible or reimbursement
your HRA expenses
Employee who are ineligible for Health Savings Account (HSA) contributions enroll in the Aetna HDHP
TIP Choice POS II Health Fund (HRA) plan and will be set up with a Health Reimbursement Arrangement
(HRA) through PayFlex.
Scripps Research 2021 Benefits Open Enrollment 26.HRA Contributions
Scripps Research makes Financial Contributions to your HRA
Annual Contribution
Individual (Employee Only) $1,000
Family (Employee + Dependents(s)) $3,000
• If you were hired in the middle of the plan year, contributions will be pro-rated
based on the number of quarters you are enrolled in the HRA Plan
• Employer HRA Fund contributions are tax free
Any statements concerning actuarial, tax, accounting, investment or legal matters are based solely on our experience as insurance brokers and
are not to be relied upon as actuarial, accounting, tax, investment or legal advice, for which you should consult your own professional advisors.
Scripps Research 2021 Benefits Open Enrollment 27.How Will I Receive HRA Funds?
Scripps Research has selected PayFlex as the preferred
administrator to handle Health Reimbursement Arrangements.
• If you leave Scripps Research or you have a change in your
eligibility, any remaining HRA funds will stay with the company
unless you elect COBRA
• Claims are paid from the HRA for you and your covered dependents
only once the incurred expense is approved
• Unused funds rollover each year
• Register at www.PayFlex.com to monitor your fund
Scripps Research 2021 Benefits Open Enrollment 28.Prescription Drug Plans
Aetna AVN HMO Plan Comprehensive PPO Plan - Optum Rx
Prescription Drugs Calendar Year Deductible Prescription Drugs Calendar Year Deductible
(Preferred Brand Name and Non-Preferred Generic/Brand Name Drugs) (Formulary and Non-Formulary Brand Name Drugs)
Individual $100 per person $100/person
Family $200 per family Prescription Drug Calendar Year Deductible
$200/family
Retail Prescription Drugs (up to 30-day supply)
$2,000/person
Preferred Generic $10 Copay Prescription Calendar Year Out-of-Pocket Max
$4,000/family
Preferred Brand-Name $35 Copay after Rx Deductible Retail Prescription Drugs (up to 30-day supply)
Generic $10 Copay
Non- Preferred Generic and Brand-Name $60 Copay after Rx Deductible
Formulary Brand $35 Copay after Rx deductible
Mail Order Prescription Drugs (up to 90-day supply) Non-Formulary Brand $60 Copay after Rx deductible
Preferred Generic $20 Copay Mail Order Prescription Drugs (up to 90-day supply)
Preferred Brand-Name $70 Copay after Rx Deductible Generic $20 Copay
Formulary Brand $70 Copay after Rx deductible
Non- Preferred Generic and Brand-Name $120 Copay after Rx Deductible Non-Formulary Brand $120 Copay after Rx deductible
High Deductible Health Plan - Optum Rx
Calendar Year Deductible (Does Not Apply to Preventive Medications as Defined by Aetna)
$2,000/person
Medical/Rx Deductible
$6,000/family
Retail Prescription Drugs (up to 30-day supply)
Generic $10 Copay after deductible
Formulary Brand $35 Copay after deductible
Non-Formulary Brand $60 Copay after deductible
Mail Order Prescription Drugs (up to 90-day supply)
Generic $20 Copay after deductible
Formulary Brand $70 Copay after deductible
Scripps Research 2021 Benefits Open Enrollment Non-Formulary Brand $120 Copay after deductible
29.Health Care Reform Not all Employees are Entitled to a Premium Tax Subsidy in the Health Marketplace: If an employer offers its full-time employees Minimum Value and Affordable coverage, those employees may not be entitled to a premium tax credit in the Health Marketplace/Exchange. Proof of Coverage: You will receive proof of coverage from your insurance company and employer describing the coverage made available to you. These forms are called the 1095-B (from the insurance company) and 1095-C (from your employer). Expect to receive this in time to file your taxes. (Non-Applicable Large Employers (Non-ALEs) who have less than 50 FT/FTE employees are not required to provide Form 1095-C to full-time employees) Scripps Research 2021 Benefits Open Enrollment 30.
Forms Forms Forms
You will receive the following forms next year to use when you file your taxes.
1095 B: Provided by your insurance carrier
• Provides proof that you and your dependents have at least Minimum Essential Coverage
1095 C: Provided by your employer
• Describes what kind of coverage was
made available to you
You will get both around the same
time as your W2 and need to use
them when filing your taxes. For
more information, contact your CPA.
Scripps Research 2021 Benefits Open Enrollment 31.Tools, Resources, and Discount Programs Scripps Research 2021 Benefits Open Enrollment 32.
iBenefits: Mobile Benefits App
With iBenefits, you can take your Employee
Benefits information on the go!
• View company benefit plans, 24/7
• Access group numbers and review detailed plan
information when you need it most
• Quickly contact an insurance company using the
“tap to call” feature
• Keep up with important benefit plan
announcements via “push notifications” such as
Open Enrollment dates, deadlines and more
• Store ID card images
Company Code: scripps2021
Scripps Research 2021 Benefits Open Enrollment 33.Aetna: Online or On-the-go! • Secure 24/7 Access • Look up a claim status • Check account balances • Find costs of test and doctor visits • View tools and educational materials • Download a temporary ID Card Plus, Discounts Available! Scripps Research 2021 Benefits Open Enrollment 34.
Aetna’s Discount Programs & Resources
Discounts Available to You!
Aetna provides you and your family discounts on a range of health
and wellness-related services and products, such as:
• Acupuncture, Chiropractic, & • Vision, Hearing & Dental Care
Massage Therapy
• Vitamins & Supplements
• Books & DVDs with Tips on
Health Living • Weight-loss programs such as
Jenny Craig, NutriSystem &
• Fitness Club Memberships eDiets
• Online Provider Consultations
Scripps Research 2021 Benefits Open Enrollment 35.Telehealth
TelaDoc allows employees and their eligible dependents enrolled in an
Aetna medical plan to access medical care through a board certified
physician conveniently via internet connection or by phone.
Treatable illnesses include:
• Allergies / asthma • Bronchitis / cough • Pink eye
• Colds and flu • Rash / sunburn • Strep throat
• Diarrhea / • Sprains / strains • Urinary Tract
constipation • Sports injuries Infections
Cost:
• Medical:
• Aetna Select EPO: Same Copay/Coinsurance as a Specialist visit
• Aetna Comprehensive Choice POS II Plan: Same Copay/Coinsurance as a Primary
Care Physician (PCP) visit
• Behavioral Health: Same Copay/Coinsurance as a Specialist Physician visit
To get started:
• Download the app from the Apple App Store or Google Play
• Call 1-855-TELADOC (835-2362)
• Visit www.TelaDoc.com/Aetna
Scripps Research 2021 Benefits Open Enrollment 36.OptumRx
With the OptumRx app, you can easily:
• Refill or renew a home delivery prescription
• Transfer a retail prescription to home delivery
• Find drug prices and lower-cost options
• View your prescription claim history or order status
• Locate a pharmacy
• Set up refill reminders
• Track your order
• Download the OptumRx App now from the Apple App
Store or Google Play.
Scripps Research 2021 Benefits Open Enrollment 37.PayFlex
With the free PayFlex mobile app, it’s easier than ever to:
• Access to your account information and important dates
• Make payments
• You can use the app on iPhone and iPad mobile digital devices, as well as
Android smartphones.
• To download, search for “PayFlex Mobile” in your app store.
• Once you create your username and password on the PayFlex member
website, you can log in to the app.
Scripps Research 2021 Benefits Open Enrollment 38.DENTAL COVERAGE Dental Scripps Research 2021 Benefits Open Enrollment 39.
Delta Dental PPO Plan
Overview:
• Freedom to see a wider network of dentists
• You don’t need to select a Primary Care Dentist and a referral is not
necessary to receive specialty services
• You will pay a higher amount for services from an out-of-network dentist
NOTE: If you’re planning to have extensive dental work, a Predetermination of Benefits is suggested so you
can fully understand your out-of-pocket cost before receiving services.
Scripps Research 2021 Benefits Open Enrollment 40.Delta Dental PPO Plan
PLAN HIGHLIGHTS DELTA DENTAL PPO
PPO Dentist Delta Premier All Other Providers
Provider
Calendar Year Deductible
Individual
----------------------$50 / person*----------------------
Family
Annual Maximum
Individual ---------------$2,000 / Calendar Year---------------
Dental Services
Preventive 100% 80% 80%
Deductible waived
Basic Services 90% 80% 80%
Major Services 60% 50% 50%
Orthodontia Services
Child up to age 19 50% 50% 50%
Adult 50% 50% 50%
Lifetime Maximum ---------------$1,500 / Person / Lifetime---------------
*Deductible does not apply to Orthodontia services.
Scripps Research 2021 Benefits Open Enrollment 41.Vision Scripps Research 2021 Benefits Open Enrollment 42.
MES Vision PPO
PLAN HIGHLIGHTS MES VISION PPO
In-Network Out-of-Network
Copay $10 Copay / Person $10 Copay / Person
Exam – Every 12 months Plan pays 100% Up to $40 allowance
Lenses – Every 12 months
Single Plan pays 100% Up to $30
Bifocal Plan pays 100% Up to $50
Trifocal Plan pays 100% Up to $65
Plan pays 100% up to a $150
Frames – Every 24 months Up to $75
frame allowance
Contacts – Every 12 months, in lieu of lenses & frames
Medically Necessary Plan pays 100% Up to $250
Plan pays 100% up to $150, Up to $150 allowance, plus up
Cosmetic plus up to $40 for a contact lens to $40 for a contact lens fitting
fitting fee fee
Scripps Research 2021 Benefits Open Enrollment 43.2021 Monthly Medical/Vision Premiums
Scripps
Employee Total Monthly
Coverage Level Research
Contribution Premium
Contribution
Comprehensive Choice POS II Plan
Employee Only $82.50 $676.50 $759
Employee and Spouse / DP $286 $1,232 $1,518
Employee and Child(ren) $220 $1,048 $1,268
Employee and Family $429 $1,598 $2,027
Aetna Value Network HMO Plan
Employee Only $50 $384 $434
Employee and Spouse / DP $250 $703 $953
Employee and Child(ren) $180 $600 $780
Employee and Family $390 $953 $1,343
HDHP Aetna Choice POS II Plan
Employee Only $0 $624 $624
Employee and Spouse / DP $0 $1,326 $1,326
Employee and Child(ren) $0 $1,149 $1,149
Employee and Family $20 $1,665 $1,685
Scripps Research 2021 Benefits Open Enrollment 44.2021 Monthly Dental Premiums
Scripps
Employee Total Monthly
Coverage Level Research
Contribution Premium
Contribution
Delta Dental PPO Plan
Employee Only $0 $48 $48
Employee and Spouse / DP $20 $75 $95
Employee and Child(ren) $15 $64 $79
Employee and Family $35 $92 $127
Scripps Research 2021 Benefits Open Enrollment 45.Scripps Research 2021 Benefits Open Enrollment
Life Insurance and AD&D
46.Basic Term Life and AD&D*
underwritten by
Scripps Research offers choice of:
• $50,000 flat benefit amount, OR
• 2x your annual salary up to $1,500,000, OR
• 3x your annual salary (on age-rated basis) up to $1,500,000
You may elect 3x annual salary during this open enrollment
Proof of good health is required if your total basic life coverage
exceeds $1,000,000
Required! Update your beneficiary information in bSwift.
TIP
Scripps Research encourages you to enter your beneficiary information in the bSwift system
for ease of tracking.
* Postdoctoral Fellows/Associates eligible for $50,000 Basic Life benefit.
Trainees and Graduate Students are not eligible for the basic life plan.
Scripps Research 2021 Benefits Open Enrollment 47.Voluntary Term Life
100% Employee Paid
Coverage Description
Level
underwritten by • Increments of $10,000 up to $500,000
• Premium based on Employee Age
• All enrollment (except new hires) require
Employee
Evidence of Insurability (EOI)
• Guarantee Issue up to $100,000 coverage for 1st
time eligible
• Increments of $10,000 up to $500,000
• Guarantee Issue up to $50,000 coverage for 1st
Spouse time eligible
• Spouse may be enrolled regardless if you enroll
yourself
Child • Increments of $2,500 up to $10,000
Enroll , make changes, or update your beneficiary information in bSwift.
TIP
Scripps Research encourages you to enter your beneficiary information in the bSwift system for
ease of tracking.
Scripps Research 2021 Benefits Open Enrollment 48.Voluntary AD&D Insurance
100% Employee Paid
Coverage Description
Level
underwritten by Employee • Increments of $50,000 up to $500,000
• Coverage amount equal to 50% of employee
Spouse
amount
• Coverage amount equal to 15% of employee
Child(ren)
amount
• Coverage amount for your spouse equal to 40%
Family of employee amount. Coverage amount for
child(ren) equal to 10% of employee amount
Enroll, make changes, or update your beneficiary information in bSwift.
TIP
Scripps Research encourages you to enter your beneficiary information in the bSwift system for
ease of tracking.
Scripps Research 2021 Benefits Open Enrollment 49.Voluntary Long Term Care
• Available to Staff, spouses, children (age 18+), parents and
grandparents
• Guarantee Issue Coverage equals:
• Up to $4,000 Nursing Facility Benefit Amount
• And a Facility Benefit Duration of 3 or 6 years
• To elect higher levels of coverage or longer benefit durations, or
to enroll in the plan after your initial eligibility period, you must
provide Evidence of Insurability
• To enroll, you must complete the Benefit Election Form available
through bSwift or by contacting Benefits Administration at
858.784.8487 or benefits@scripps.edu. Forms are also available
through the Benefits website.
* Postdoctoral Fellows/Associates. Trainees and Graduate Students are not eligible
Scripps Research 2021 Benefits Open Enrollment 50.Flexible Spending Account (FSA) Scripps Research 2021 Benefits Open Enrollment 51.
What is a Flexible Spending Account (FSA)?
An FSA is a pre-tax benefit allowed under IRS Code Section 125, which allows you to set aside a
specific pretax dollar amount for unreimbursed medical, dental, vision and dependent care expenses.
• Pre-tax benefits
• FSA Plan Year: January 1, 2021 through December 31, 2021
• It is not required that you be enrolled in your company’s health plans
• Depending on the type of FSA you have (Health Care FSA or
Dependent Care FSA), you can contribute up to an annual maximum
level per plan year
• You are not permitted to enroll in the Health Care FSA if you enroll in a
HSA eligible plan
Any statements concerning actuarial, tax, accounting, investment or legal matters are based solely on our experience as
insurance brokers and are not to be relied upon as actuarial, accounting, tax, investment or legal advice, for which you
should consult your own professional advisors.
Contribution Limits
$2,750 $5,000
Health Care Dependent Care
Scripps Research 2021 Benefits Open Enrollment 52.What is a Flexible Spending Account (FSA)?
[continued]
Health Care Spending Accounts*
• $2,750 Annual Maximum Contribution (minimum is $120)
• Out of pocket expenses for you, your spouse, and your
dependents
• Does not include domestic partner
Dependent Care Spending Account**
• $5,000 maximum per calendar year
• $2,500 if married, filing separately
• $5,000 maximum if married, filing jointly
*Research Associates. Trainees and Graduate Students are not eligible for Health Care Spending Account
** Research Associates, Trainees, & Graduate Students may be eligible for Dependent Care Spending
Account based on status. Please see Human Resources for eligibility
Scripps Research 2021 Benefits Open Enrollment 53.Using the Flexible Spending Account (FSA) Scripps Research 2021 Benefits Open Enrollment 54.
FSA Eligible Expenses
Health Care FSA • Physician prescription not required (continued)
– Sunscreen, SPF 30+
• Applicable for you and any eligible dependent – Contact lens supplies
– Denture adhesives
• Medical – First aid supplies
– Copays – Diabetic supplies
– Deductibles – Diagnostic tests & monitors
– Prescriptions – Reading glasses
– Hospital costs – Wheelchair, walker, cane
– Smoking cessation – Other durable medical equipment
– Fertility / family planning
– Acupuncture
– Chiropractic Dependent Care FSA
– OTC medications with physician prescription
• Daycare centers
• Dental
– Deductible • In-home day care / Nanny / Au Pair
– Copays • Before or after school programs for children under age
– Orthodontia 13
• Vision • Summer day camp
– Prescription glasses and sunglasses (frames and
lenses) • Nursery school and Pre-school programs
– Contact lenses and products
• Elder care or dependents not capable of self-care
– LASIK, PRK, etc.
• Physician prescription not required
– Band Aids
– Bandages and wraps
– Braces and supports
Scripps Research 2021 Benefits Open Enrollment 55.Claim Reimbursement
• Claims for expenses to PayFlex
• Online (www.payflex.com)
• Mail
• Debit Card
• Request for reimbursement includes:
• Request form
• Proper documentation
• PPO Services – Explanation of Benefits (EOB)
• Other Services – itemized bill or receipt showing name of
provider, name of patient, date of service, details of the service
or product, cost of service or product.
• OTC items – cash register receipt and prescription
• Orthodontia contract
Scripps Research 2021 Benefits Open Enrollment 56.Disability Coverage Scripps Research 2021 Benefits Open Enrollment 57.
Long Term Disability (LTD)
underwritten by
100% Employer Paid
60% of monthly earnings
up to $20,000 per month
Eligible after 90 days
Note: Employees have the option to pay for this coverage and receive tax free benefits
Scripps Research 2021 Benefits Open Enrollment 58.Employee Assistance Program (EAP) Scripps Research 2021 Benefits Open Enrollment 59.
Employee Assistance Program (EAP)
Scripps Research understands that you and your family members might experience a
variety of personal or work-related challenges. Through the EAP with onsite Counseling
and Psychological Services Department, you have access to resources, information, and
counseling that are fully confidential and no cost to you.
– 10 Face to face consultations per member per issue per year
Childcare
Topics May Include
Eldercare By email: caps@scripps.edu
Legal services
Marital, relationship or family problems
Bereavement or grief counseling
By Phone: 858.784.7297
Substance abuse and recovery
Educational materials
Scripps Research 2021 Benefits Open Enrollment 60.Voluntary Coverage & Products Scripps Research 2021 Benefits Open Enrollment 61.
METLIFE VOLUNTARY COVERAGE
Coverages Offered:
• Accident Coverage
• Critical Illness Coverage
• Hospital Protection
Contact MetLife at 800.GET.MET8 with any questions.
Scripps Research 2021 Benefits Open Enrollment 62.Voluntary Group Critical Illness Coverage
100% Employee Paid
When you or your family is faced with a life-threatening disease or
debilitating illness or injury, Critical Illness Coverage offered by
MetLife will pay you cash to help with the associated expenses.
Critical illness coverage pays a one-time, lump sum payment,
dependent on the illness.
Some of the medical conditions may include:
• Cancer
• Heart attack
• Stroke
• End stage kidney failure
• Major organ transplant
Scripps Research 2021 Benefits Open Enrollment 63.Voluntary Group Accident Coverage
100% Employee Paid
Accidents happen when you least expect them including motor
vehicle accidents, sports injuries, and slips and falls! MetLife’s
policy will pay cash to help families offset the expenses associated
with accidents or injuries.
Benefits may be paid for:
• Emergency room treatment
• Intensive care unit
• Hospital admissions and confinement
• Ambulance transportation
• Travel expenses to distant treatment centers
Scripps Research 2021 Benefits Open Enrollment 64.Voluntary Group Hospital Protection
100% Employee Paid
Having hospital protection through MetLife may help by paying
cash to you or your family to offset both medical and non-medical
bills when you’re sick, injured or on maternity leave.
The cash benefit can be used towards services or expenses other
medical plans might not cover, such as:
• Copayments & Deductibles
• Transportation expenses
• Child care
• Prescriptions
• Lost income
Scripps Research 2021 Benefits Open Enrollment 65.Next Steps Scripps Research 2021 Benefits Open Enrollment 66.
Take Action! Time to Enroll!
All employees will need to log in to bSwift to:
• Complete benefit elections or waive for the 2021 plan year,
• New elections must be made to continue Flexible Spending Accounts and
Health Savings Accounts
• Enter beneficiary information for life insurance coverage
To enroll, follow these simple steps:
• Go to http://scripps.bswift.com
• Username: first initial and last name (e.g. John Doe would be jdoe)
• Enter established password (last 4 digits of Social Security Number for first-
time users)
• Click on “Start Your Enrollment” to begin making elections
• Click on “Complete Enrollment” once finished. You can print or email your
final confirmation statement once finished.
You will be prompted to verify your personal and family information before selecting your benefits. A
helpful tool to walk you through the process is “Ask Emma.” Emma will guide you through your enrollment
and help you decide which plans to enroll in if you are unsure. NOTE: An enrollment guide and
instructions will be posted on the Benefits Administration webpages.
bSwift will open on October 26th and will close on November 6th at 5pm PST and all changes will take effect
starting January 1, 2021 through December 31, 2021.
Scripps Research 2021 Benefits Open Enrollment 67.Questions? Scripps Research 2021 Benefits Open Enrollment 68.
Client Logo All rights reserved. No part of this document may be reproduced or transmitted in any form or by any means, electronic, mechanical, photocopying, recording, or otherwise, without prior written permission of Marsh & McLennan Insurance Agency LLC company. This document is not intended to be taken as advice regarding any individual situation and should not be relied upon as such. Marsh & McLennan Insurance Agency LLC shall have no obligation to update this publication and shall have no liability to you or any other party arising out of this publication or any matter contained herein. Any statements concerning actuarial, tax, accounting or legal matters are based solely on our experience as consultants and are not to be relied upon as actuarial, accounting, tax or legal advice, for which you should consult your own professional advisors. Any modeling analytics or projections are subject to inherent uncertainty and the analysis could be materially affective if any underlying assumptions, conditions, information or factors are inaccurate or incomplete or should change. CA Insurance Lic: 0H18131
You can also read
