2021 OPEN ENROLLMENT - Island County
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2021 OPEN ENROLLMENT Island County
DISCLAIMER
This presentation is intended to provide a brief description of 2021 coverage
and is not a complete explanation of covered services, exclusions, limitations,
reductions or terms under which a program may be continued in force. This
presentation is not a contract. For full coverage provisions, including a
description of waiting periods, limitations and exclusions, please contact
Human Resources or refer to the applicable summary plan documents posted
to www.wcif.net.
2
ISLAND COUNTY
YOUR
Open EMPLOYER
Enrollment OFFERS THE FOLLOWING
is your annual BENEFITS
opportunity THROUGH WCIF:
as an employee to make
thoughtful benefit elections for you and your family for the upcoming
year. During this time members may change plans, add or remove
dependents to existing plans, enroll in a new line of coverage, terminate
an existing line of coverage and make FSA/HSA/HRA elections. All open
enrollment plan changes will be effective January 1, 2021.
YOUR EMPLOYER OFFERS THE FOLLOWING BENEFITS THROUGH WCIF:
Medical Dental
Voluntary Vision Employee Assistance Program (EAP)
Base Long-Term Disability (BLTD) Basic Life/Accidental Death & Dismemberment
(AD&D)
Voluntary Term Life (VTL) Voluntary Accidental Death & Dismemberment
(AD&D)
Voluntary Buy-Up Long-Term Disability Voluntary Short-Term Disability (VSTD)
(VLTD)
Flexible Spending Arrangement (FSA) Health Reimbursement Account (HRA)
Health Savings Account (HSA) Voluntary Worksite Plans 3
MID-YEAR QUALIFYING EVENTS
All open enrollment plan changes and additions will be effective January 1,
2021. Your elections are to stay in effect for all of 2021, unless you
experience a Qualifying Life Event.
Below is a table that outlines the events and time frames.
Dependent Enrollment Deadline Coverage Effective
Spouse Within 31 days of the date of marriage The first of the month following the date of marriage
The first of the month following the date of registration
Within 31 days of Washington State registration or
Domestic Partner (See or the first of the month following the date of
within 31 days of the date of completed Affidavit of
Domestic Partner Eligibility completed Affidavit of Domestic Partnership
Domestic Partnership (depending on employer’s
below) (depending on employer’s choice - see Domestic
choice - see Domestic Partner Eligibility)
Partner Eligibility)
Dependent of Spouse / If existing dependent , same rules as spouse/domestic partner (31 days – as shown above)
Domestic Partner If acquired after spouse’s/domestic partner’s effective date (60 days – as shown above)
Newborn Child Within 60 days of birth The date of birth
Adopted Child Within 60 days of placement in an employee’s home The date of adoption (or placement for adoption)
Foster child Within 60 days of placement in an employee’s home The date of foster care placement
Child Under Legal Within 60 days of legal guardianship being granted to
The date of that legal guardianship is granted
Guardianship employee
Event Enrollment Deadline Coverage Effective
Involuntary Loss of Other The first of the month following the date the application
Within 31 days of the date the other coverage ended
Coverage for coverage is received.
State Medical Assistance and
The first of the month following the date the application
Children's Health Insurance Within 60 days from the date of event (see below)
4
for coverage is received.
Program (CHIP)
DEFINITION OF TOP THREE HEALTH CARE TERMS
Deductible Coinsurance
The amount you could owe during Your share of the costs of a
a coverage period (usually one covered health care service,
year) for health care services your calculated as a percentage (for
health insurance or plan covers example, 20%) of the allowed
before your health insurance or amount for the service. You
plan begins to pay. For example, if your deductible is generally pay coinsurance plus any deductibles you
$1000, your plan won’t pay anything until you’ve met owe. For example, if the health insurance or plan’s
your $1000 deductible for covered health care services allowed amount for an office visit is $100, and you’ve
subject to the deductible. The deductible may not apply met your deductible, your coinsurance payment of 20%
to all services. would be $20. The health insurance or plan pays the
rest of the allowed amount.
Out-of-pocket Limit
The most you could pay during a coverage period (usually one year)
for your share of the costs of covered services.
After you meet this limit, the plan will usually pay 100% of the allowed
amount. This limit helps you plan for health care costs.
This limit never includes your premium, your balance-billed charges, or health care your health insurance
or plan doesn’t cover. Some health insurance or plans don’t count all of your copayments, deductibles,
coinsurance payments, out-of-network payments or other expenses toward this limit.
5
DEFINITION OF TOP THREE HEALTH CARE TERMS
Claims Payment Example
6
MEDICAL / PREMERA BLUE CROSS
premera.com | 1.877.500.9247 (customer service) | 1.800.841.8343 (24-hour nurseline)
Heritage Network
• New Benefits: None
• Pharmacy Preferred Drug Formulary List: Preferred B3 or Open A1 (HSAs)
7
MEDICAL / PREMERA BLUE CROSS
Virtual Care Options
Virtual care gives members immediate and convenient access to care
whenever and wherever they need it. You can avoid any drive times and
wait times you might experience at an urgent care center or emergency
room. Members who are covered by this service receive care virtually
from their own doctor (if available) or from a doctor with one of
Premera’s contracted vendors for virtual care.
Major Benefit Categories Benefit “Bucket” Cost Share
Primary/Urgent Care Virtual Care Only using Premera $5 copay OR deductible &
(includes Dermatology) virtual care vendors coinsurance depending on your
plan
Primary/Urgent Care Traditional Providers (e.g. Everett Follows standard professional
(includes Dermatology) Clinic, Virginia Mason, etc.) cost shares just like in person
Mental Health Virtual Care Only – Mental Mental Health outpatient office
Health visit cost shares apply
Substance Abuse/ Virtual Care Only – Chemical Chemical Dependency
Chemical Dependency Dependency outpatient office visit cost
shares apply
8
MEDICAL / PREMERA BLUE CROSS
premera.com | 1.877.500.9247 (customer service) | 1.800.841.8343 (24-hour nurseline)
Creating an Account on Premera.com
9
NEED CARE? KNOW WHERE TO GO –
If you need care but your doctor isn’t available, you have options.
Some options are more expensive than others. The exact cost of
your visit depends on your medical plan and the care you get.
24-Hour Nurseline / FREE
Call the 24-hour nurseline listed on your medical insurance ID card—for free.
The nurse can discuss your symptoms and help you find a doctor, urgent care
clinic, or hospital near you.
Virtual Care / $
Premera members have the option of using a variety of virtual care vendors.
Urgent Care / $$
Urgent care clinics provide care for illnesses like ear infections, fever or flu
symptoms, or sprains. Clinics are often open outside of normal business hours
and are less expensive than the emergency room.
Emergency Room / $$$
Emergency room visits cost the most and should be used only for emergencies,
such as sever abdominal pain, shortness of breath, sudden numbness, loss of
consciousness, or broken bones. Most facilities are open 24 hours per day, 7
days a week (including holidays).
10REMINDERS…
1 Prescription drug formularies are subject to change with
limited notice to members.
2 Some services require prior authorization. Members
should make sure their provider requests an authorization in
advance for certain services. If the member uses an out-of-
network provider, it is the member’s responsibility to make
sure their doctor requests the prior authorization.
3 There may be times when two prior authorizations may
be needed for one condition. For example, testing to
diagnose a condition may require one prior authorization,
while the rental/purchase of durable medical equipment to
treat the diagnosed condition will require another prior
authorization.
4 Provider contracts are regularly negotiated and there is
no way to guarantee or predict continued provider
participation in any given network. Providers are subject
to change without notice to members. Please make sure to
check carrier websites for the most up-to-date information
regarding provider availability for your network.
11BALANCE BILLING PREVENTION ACT
Surprise Billing
Washington state’s Balance Billing Prevention
Act (HB 1065) took effect on January 1, 2020.
The law is intended to protect patients from getting
surprise or balance bills when they receive:
o Emergency care at an out-of-network hospital
o Treatment at an in-network facility but are seen by
certain out-of-network providers covered under the
Act
Patients are also protected from surprise bills for
emergency services provided in an out-of-network
facility in Idaho or Oregon.
Non-contracted providers covered under the new state
law can’t bill protected members above the in-network
cost sharing amount after December 31, 2019.
Contact your medical plan customer service number for specific billing questions. 12MEDICAL / WAIVER OF COVERAGE
Active employer group medical coverage can only be waived if
you have other group coverage.
Group coverage can be:
• Another employer plan
• Coverage through a spouse/domestic partner’s
employer plan
• Government health plan
• Tricare
• VA (with ACA letter)
• Medicaid (Washington Apple Health)
• HealthPlanFinder (State marketplace plan)
• Medicare*
*If an employee waives active group coverage through the
employer in favor of Medicare, Medicare Secondary Payer rules
prohibit the employer from providing any incentive to waive active
coverage. This includes HRA contributions and premium
reimbursement for Medicare Supplement plans.
13LIVE WELL AT WCIF
Due to today’s challenges regarding the COVID crisis,
the structure of the Live Well at WCIF program has been
adjusted to better suit the needs of employees.
Primary Program ($25 e-Gift Card): Eligible employees and
their covered spouse will have a list of activities to choose
from to earn their $25 e-Gift Card. See enrollment guide for
more detailed information.
• Health Quality Assessment (HQA) and
• One Additional Activity within SonicBoom portal
• Health Screening
• WCIF-sponsored Contest
• Academy Course
• One enhancement to the Primary Program is that the Health Quality Assessment will be
made available on SonicBoom’s mobile app sometime in September. This should make it
easier for a large portion of employees who do not have access to a desktop computer.
• Secondary Program ($50 e-Gift Card): There are no changes, however, some activities
completed to earn credit in the Primary Program will also be applied to the Secondary
Program.
The deadline has been extended to November 15, 2020. This should give you plenty of
time to earn your individual incentives as the health screening is no longer a requirement.
14HEALTH REIMBURSEMENT ACCOUNT / VIMLY
flexspending@vimly.com ǀ 1.206.859.2694 (customer service) 1.866.727.2106 (fax)
Health Reimbursement Account (HRA)
EASY TO USE
The ability to file claims directly through the SIMON portal SIMON365.com makes the
reimbursement process quick and easy. If you do not already have a SIMON account an email
invitation will be sent to you shortly after enrollment.
You must include the EOB that corresponds with your eligible services to receive
reimbursement.
SAVE MONEY
Since HRAs are entirely employer funded there will be no cost to you for utilizing your HRA funds,
and no deductions will be taken from your paychecks.
SAVE TIME
Sign up for Direct Deposit so your reimbursements are deposited directly into your bank account
instead of having to wait for a check to arrive in the mail.
Request a Direct Deposit Form from your HR department or by emailing flexspending@vimly.com.
SAVE STRESS
World class security assures that your account information will be secure because access to
accounts is always encrypted and not based on your Social Security Number.
15HEALTH REIMBURSEMENT ACCOUNT / VIMLY
flexspending@vimly.com ǀ 1.206.859.2694 (customer service) 1.866.727.2106 (fax)
Health Reimbursement Account (HRA)
A health account (HRA) is an employer-funded health care reimbursement plan that receives
favorable tax treatment under the federal Internal Revenue Code (Code). Many employers that
sponsor HRAs establish unfunded notional “bookkeeping” accounts to reimburse eligible employees
for substantiated medical expenses that are not covered by health insurance, such as deductibles,
coinsurance, and copayments.
HOW ARE DEPOSITS MADE TO MY HRA ACCOUNT?
Only employers are allowed to make HRA contributions. Island County will provide each
employee up to $4,000 towards the individual out-of-pocket costs or up to $6,000 towards the family
out-of-pocket costs. Unlike health savings accounts (HSAs) and health flexible spending accounts
(FSAs), employees cannot make contributions to their HRAs.
HOW DO I RECEIVE REIMBURSEMENT FROM MY HRA?
You can complete an online or paper claim form and submit it to Vimly Benefit Solutions by email, fax
or regular mail. You can also submit claims manually via SIMON. In order to substantiate your claims
you will need to provide documentation.
WHEN ARE EXPENSES “INCURRED”?
The IRS rules state that an expense is incurred at the time the service is rendered (not when an
appointment is made), a bill is dated, or a bill is paid.
16HEALTH SAVINGS ACCOUNT / VIMLY
flexspending@vimly.com ǀ 1.206.859.2694 (customer service) 1.866.727.2106 (fax)
A Health Savings Account (HSA) is a tax-advantaged medical savings account that is
available to taxpayers who are enrolled in an IRS-qualified High Deductible Health
Plan (HDHP). It can be used to pay for qualified medical expenses
ENROLL NOW AND SAVE
That’s right. You can pay less in taxes and essentially get a discount on
a big chunk of your medical expenses simply by signing up for an HSA.
• Be enrolled in a qualifying HDHP
• Set aside a portion of your paycheck before taxes
• Use the funds to pay for medical expenses not covered by insurance
(IRS Section 213d expenses)
• Your funds carry over and can be invested to help you plan for
future medical expenses – investment growth is tax-free
2021 CONTRIBUTION LIMITS
• $3,600 for self-only coverage (additional $1,000 catch-up contribution for
anyone over 55 years old) – Island County will contribute $2,000 of the
$3,600 maximum
• $7,200 for family coverage (additional $1,000 catch-up contribution for anyone
over 55 years old) – Island County will contribute $4,000 of the $7,200
maximum
17HEALTH SAVINGS ACCOUNT / VIMLY
When you reach age 65, your HSA eligibility will change due
to Medicare, as will the rules for withdrawing funds.
Effects of Medicare
At age 65, you become eligible for Medicare and may be
automatically enrolled. Enrolling in Medicare ends your HSA
eligibility in one of two ways:
If Medicare is your only health insurance, you are no
longer eligible to contribute to an HSA because Medicare
is not an HDHP.
If you have Medicare as secondary coverage in addition to
an employer sponsored HDHP, you will also lose HSA
eligibility because you have “other coverage.”
When you turn 65 and begin Medicare coverage, you lose
HSA eligibility on the first day of that month.
18FLEXIBLE SPENDING ARRANGEMENTS / VIMLY
flexspending@vimly.com ǀ 1.206.859.2694 (customer service) 1.866.727.2106 (fax)
Health Flexible Spending Account
• A Flexible Spending Arrangement is an easy
way to lower your taxes and increase your
spendable income.
• You set aside part of the money you earn each
year before taxes are calculated.
• Your entire election amount is available on the
first day of the plan year.
• Services must be rendered during the current
plan year.
• IRS annual FSA contribution maximum is
$2,750 (2020).
19DENTAL / DELTA DENTAL OF WASHINGTON
deltadentalwa.com | 1.800.554.1907 (customer service)
Base Plan
• New Benefits: Posterior composite fillings now covered
• Network: PPO
Benefit Period January 1, 2021 - December 31, 2021
Benefit Period Deductible $50 / $150
Benefit Period Maximum (Per Person)* $1,000
Dental Network
PPO Dentist / Premier Dentist / Non-Participating Dentist
Class 1 - Diagnostic & Preventive 80% / 80% / 80%
Class 2 - Restorative 60% / 60% / 60%
Class 3 - Major 40% / 40% / 40%
*Class 1 Services do not apply toward deductible or the benefit period maximum
20DENTAL / DELTA DENTAL OF WASHINGTON
deltadentalwa.com | 1.800.554.1907 (customer service)
Buy-up Plan
• New Benefits: Posterior composite fillings now covered
• Network: PPO
Benefit Period January 1, 2021 - December 31, 2021
Benefit Period Deductible None
Benefit Period Maximum (Per Person)* $2,000
Orthodontia - Adults & Children 50%
Lifetime Maximum (Per Person) $2,000
Dental Network
PPO Dentist / Premier Dentist / Non-Participating Dentist
Class 1 - Diagnostic & Preventive 100% / 100% / 100%
Class 2 - Restorative 90% / 80% / 80%
Class 3 - Major 50% / 50% / 50%
*Class 1 Services do not apply toward benefit period maximum
21DENTAL / WILLAMETTE DENTAL
willamettedental.com | 1.855.433.6825 (customer service)
High Plan
• New Benefits:
Starting in 2021 Willamette Dental Specialty offices will offer a
Dental Implant Benefit covering up to $1500 for implant surgical
services (limited to one implant per calendar year).
Benefit Period January 1, 2021 - December 31, 2021
Annual Maximum No Annual Maximum*
Deductible No Deductible
General or Orthodontic Office Visit $10 Copay per Visit
Speciality Office Visit $30 Copay per Visit
Comprehensive Orthodontia Treatment $1,800 Copay
Dental Implant Surgery Benefit Maximum of $1,500 per calendar year
* Benefits for TMJ, implant surgery, and orthognathic surgery have a benefit maximum, if covered.
22VISION / VISION SERVICE PLAN
VSP.com | 1.800.877.7195 (customer service)
Voluntary Plan
• Network: Choice
• New Benefits: Starting in 2021, Walmart/Sam’s
Club will be added as a provider, working in the
same way as Costco. The frame allowance will
be $95.
Benefit Frequency Copay
WellVision Exam 12 months $15
Prescription Glasses Hardware $15
Frames / $175 allowance 24 months
Lenses 24 months
OR
Contacts / $155 allowance 24 months
Contact Lens Exam 24 months Up to $60
Remember, you get either glasses or contacts… NOT both. 23VISION / VISION SERVICE PLAN
VSP.com | 1.800.877.7195 (customer service)
Premier Program
With Premier Program locations, members will be able to choose from a wide
selection of featured frame brands which are backed by a one-year, worry-free
warranty including savings on replacement lenses. They’ll also get access to
extra member value as well as savings like rebates on lenses and contacts.
VSP’s Premier Program for VSP Network Doctors
• Great Choice in Eyewear: Wide selection of featured frame brands
available.
• Eyewear Protection: Featured frame brands are backed by a one-year
worry-free warranty if glasses are damaged or broken. Get great savings on
replacement lenses as well.
• Latest Technology: High-tech exam equipment, like retinal imaging
technology, can monitor changes inside your eyes.
• Performance Lenses for Sharp Vision: The latest High-definition lens
technology with UNITY® digital lenses available.
• Bonus Offers: Access extra savings and value only available through
Premier Providers
24FLEXIBLE SPENDING ARRANGEMENTS / VIMLY
flexspending@vimly.com ǀ 1.206.859.2694 (customer service) 1.866.727.2106 (fax)
Dependent Care Account Program (DCAP)
• A DCAP is an easy way to lower your taxes and
increase your spendable income.
• You set aside part of the money you earn each year
before taxes are calculated.
• IRS annual DCAP contribution maximum is $5,000 per
household.
• Expenses are reimbursed only as payroll deductions
are contributed to the account.
• Automatic recurring reimbursements can be set up by
the provider and participant returning one simple form.
• Services must be rendered during the current plan year.
25EAP / FIRST CHOICE HEALTH EAP
FirstChoiceEAP.com | 1.800.777.4114 (customer service)
Member Services
COUNSELING SESSIONS
WORK LIFE RESOURCES CRISIS SUPPORT
• 1-6 Sessions
• Legal Assistance • 24/7 Telephonic Support
• Individual, Couples, or Family
• Financial Resources with EAP Provider
• Parenting
• ID Theft
• Grief & Loss
• Childcare Resources
• Change & Life Transitions
• Eldercare Resources
• Depression
• Home Ownership Program
• Anxiety
• Domestic Violence
• Alcohol & Drug ASSESSMENT PROCESS
• TeleHealth
• And More • 24 Hour Number/Online
Request
CONFIDENTIALITY • Greeted by CSR
• Describe Problem
• Contacts with EAP Confidential • Preferences
WHO IS COVERED?
• Exceptions to Confidentiality: • Provider Calls within 24-48
o Intent to harm self/others Business Hours
• Employees
o Child abuse • Satisfaction Survey
• Household Members
o Elder abuse
• Children up to the age of 26
26EAP / FIRST CHOICE HEALTH EAP
FirstChoiceEAP.com | 1.800.777.4114 (customer service)
24/7 Telehealth
27EAP / FIRST CHOICE HEALTH EAP
FirstChoiceEAP.com | 1.800.777.4114 (customer service)
Website
28BASIC LIFE/ACCIDENTAL DEATH &
DISMEMBERMENT / THE STANDARD
STANDARD.com | 1.800.848.5132 (customer service)
Island County provides you with a
Basic Life/AD&D Plan that provides a
$24,000 benefit. In addition, your
employer provides dependent life
benefit of $1,000 per dependent.
This helps serve as an employee’s
financial safety net during the most
crucial income earning years.
In addition, a Travel Assistance
Benefit through Assist America, Inc. is
provided as well as a Life Services
Toolkit through Morneau Shepell.
29VOLUNTARY LIFE / THE STANDARD
STANDARD.com | 1.800.848.5132 (customer service)
Select the amount of Voluntary Life and Dependents
Voluntary Life insurance for which you are interested in
applying.
Minimum Maximum Guarantee
May elect
Benefit Benefit Issue
$500,000 or 6x Annual
Earnings, whichever is
Employee Multiples of $10,000 $10,000 $150,000*
less, when combined
with Basic Life Amount
Spouse/ Domestic
Multiples of $10,000 $10,000 $250,000 $30,000*
Partner
Child(ren) Multiples of $2,000 $2,000 $10,000 $10,000
*The Guarantee Issue amount only applies during the initial 31-day eligibility period
Amounts of coverage elected above the Guarantee Issue amount or after the initial
eligibility period are subject to medical underwriting approval.
Please see the Voluntary Life Benefit Booklet for benefit details and rates 30BENEFICIARY DESIGNATION REMINDER
STANDARD.com | 1.800.848.5132 (customer service)
Setting up beneficiaries isn’t a one-time thing. Be sure to review your
beneficiary designations regularly, especially after life events such as
marriage, divorce, birth, and death. Circumstances might have changed
for you or your beneficiaries, and you may need to alter your
designations to reflect that.
This is a great time of year to review and make any necessary changes.
31VOLUNTARY AD&D / THE STANDARD
STANDARD.com | 1.800.848.5132 (customer service)
If you elect coverage for yourself, you may also
elect coverage for your spouse/domestic partner
and dependent children.
May elect Minimum Benefit Maximum Benefit
Multiples of $500,000 or 10X Annual
Employee $25,000
$25,000 Earnings whichever is less
Spouse/ Domestic Multiples of 50% or 100% of
$25,000
Partner $25,000 employee amount
10% of employee amount
Child(ren) N/A N/A
not to exceed $30,000
Please see the Voluntary AD&D Benefit Booklet for benefit details and rates.
32LONG TERM DISABILITY / THE STANDARD
STANDARD.com | 1.800.848.5132 (customer service)
Have you ever thought about how you would protect
yourself, your lifestyle, and those who count on you from
an unexpected loss of income?
Island County provides eligible employees with Base LTD
coverage to help protect a certain level of income, if you
are enrolled in the medical plan.
Guarantee issue coverage only applies during the initial 31-day eligibility period.
Benefit Maximum
LTD Monthly Benefit*
Waiting Period Benefit
40% of first $10,000 of monthly
Base LTD 180 Days $4,000
pre-disability earnings
60% of first $10,000 of monthly
Buy-Up LTD 90 Days $6,000
pre-disability earnings
*Disability reduced by deductible income.
Please see the Buy-Up LTD Benefit Booklet for benefit details & rates.
33VOLUNTARY STD / THE STANDARD
STANDARD.com | 1.800.848.5132 (customer service)
Short Term Disability is voluntary – Employee Paid
The LTD plan you have determines the best VSTD plan for you:
• Base LTD plan: VSTD plan has 180-day maximum benefit period.
• Buy-Up LTD plan: VSTD plan has 90-day maximum benefit period.
• No LTD plan: Employee elects 180- or 90-day maximum benefit period.
Guarantee issue coverage only applies during the initial eligibility period.
Benefit Maximum
STD Waiting Period Weekly Benefit* Benefit*
60% of first $1,667 of weekly
STD 30 Days $1,000
pre-disability earnings
*Disability reduced by deductible income.
Please be advised, plan benefits are impacted by the new Washington State Paid Family and
Medical Leave Program. More information available on website:
https://www.paidleave.wa.gov/workers
Please see the STD Benefit Booklet for benefit details and rates.
34ACCIDENT INSURANCE / METLIFE
Plan Highlights
You have a choice of two plans: Low Plan and High Plan
Covered Conditions Low Plan High Plan
MetLife Accident Insurance Pays You MetLife Accident Insurance Pays You
Injuries – Ranging from Ranging from
12 covered injury types $25 – $5,000 per injury $50 – $10,000 per injury
Medical Services & Treatment –
Ranging from $15 – $1,000 Ranging from $25 – $2,000 per
15 covered medical
per medical service/treatment medical service/treatment
services & treatments
Hospital Coverage1 Admission – $500 per accident Admission – $1,000 per accident
(due to an Accident) ICU Supplemental Admission – $500 per accident ICU Supplemental Admission – $1,000 per accident
Confinement – $100 a day, up to 31 days Confinement – $200 a day, up to 31 days
ICU Supplemental Confinement – $100 a day, up to ICU Supplemental Confinement – $200 a day, up to
31 days 31 days
• 1Hospital does not include certain facilities such as nursing homes, convalescent care or extended care facilities.
See MetLife’s Disclosure Statement or Outline of Coverage/Disclosure Document for full details.
35ACCIDENT INSURANCE / METLIFE
Plan Highlights
You have a choice of two plans: Low Plan and High Plan
Covered Conditions Low Plan High Plan
MetLife Accident Insurance Pays You MetLife Accident Insurance Pays You
$25,000 $50,000
Accidental Death
$75,000 if passenger on common carrier2 $150,000 if passenger on common carrier2
Dismemberment,
$250 – $10,000 per injury $500 – $50,000 per injury
Loss & Paralysis
Additional Benefits –
Lodging1 $100 per night, up to 31 nights $200 per night, up to 31 nights
1The lodging benefit is not available in all states. It provides a benefit for a companion accompanying a covered insured while hospitalized, provided that lodging is at least 50
miles from the insured’s primary residence.
2Common Carrier refers to airplanes, trains, buses, trolleys, subways and boats. Certain conditions apply. See your Disclosure Statement or Outline of Coverage/Disclosure
Document for specific details. Be sure to review other information contained in this booklet for more details about plan benefits, monthly rates and other terms and conditions.
36HOSPITAL INDEMNITY INSURANCE / METLIFE
Plan Highlights
You have a choice of two plans: Low Plan and High Plan
Covered Conditions1 Low Plan High Plan
MetLife Hospital Indemnity Pays You MetLife Hospital Indemnity Pays You
Hospital Coverage (Accident and Sickness)
Admission – $500 1 time per calendar year Admission – $1,000 1 time per calendar year
Admission
ICU Supplemental Admission – $500 1 time per ICU Supplemental Admission – $1,000 1 time per
calendar year calendar year
Confinement – $100 a day, up to 15 days2 Confinement – $200 a day, up to 15 days2
Confinement
ICU Supplemental Confinement – $100 a day, up to ICU Supplemental Confinement – $200 a day, up to
15 days 15 days
Inpatient Rehab $100 per day, $200 per day,
up to 15 days per calendar year up to 15 days per calendar year
1Covered services/treatments must be the result of an accident or sickness as defined in the group policy/certificate.
See the Disclosure Statement or Outline of Coverage/Disclosure Document for more details..
37
2 When plan includes an Admission benefit, Confinement begins on Day 2.CRITICAL ILLNESS INSURANCE/ METLIFE
Plan Highlights
Key Features
• Perpetual Guaranteed Issue of $15,000 or $30,000: No Evidence of
Insurability (EOI) or Statement of Health (SOH) needed ever!
• Lump sum benefit paid upon diagnosis verification
• Maximum benefit (Total Benefit) is 3x the amount of your Initial Benefit
• Recurrence benefit1 of 50%
• No waiting periods or age restrictions
• No limitations on filing claims for covered conditions
• Pre-existing condition exclusion 3/6 (does not include heart attack or stroke)
• Portable (continuation of coverage)3
MetLife Critical Illness Insurance Pays Benefits Directly to Employee
. There is a Benefit Suspension Period between Recurrences. We will not pay a Recurrence Benefit for a Covered Condition that Recurs during a Benefit Suspension Period. We will not pay a Recurrence Benefit
for either a Full Benefit Cancer or a Partial Benefit Cancer unless the Covered Person has not had symptoms of or been treated for the Full Benefit Cancer or Partial Benefit Cancer for which we paid an Initial
Benefit during the Benefit Suspension Period.
2. Coverage is guaranteed provided: (1) the employee is actively at work. Additional restrictions apply to dependents serving in the armed forces or overseas.
38
3. Eligibility for portability through the Continuation of Insurance with Premium Payment provision may be subject to certain eligibility requirements and limitations. For more information, contact your MetLife
representativeCRITICAL ILLNESS INSURANCE/ METLIFE
Covered Conditions
Conditions
• Full Benefit Cancer1 • Coronary Artery Bypass Graft (CABG)
• Partial Benefit Cancer1 • Alzheimer’s Disease3
• Heart Attack • Major Organ Transplant
• Stroke2 • 22 Listed Conditions4
• Kidney Failure
• 1Please review the Disclosure Statement or Outline of Coverage/Disclosure Document for specific information about cancer benefits. Not all types of cancer are covered. Some cancers are covered
at less than the Initial Benefit Amount. For NH-sitused cases and NH residents, there is an initial benefit of $100 for All Other Cancer.
• 2In certain states, the Covered Condition is Severe Stroke.
• 3Please review the Outline of Coverage for specific information about Alzheimer’s disease.
• 4MetLife Critical Illness Insurance will pay 25% of the Initial Benefit Amount when a covered person is diagnosed with one of the 22 Listed Conditions.
A Covered Person may only receive one benefit payment of a Listed Condition in his/her lifetime. The Listed Conditions are: Addison’s disease (adrenal hypofunction); amyotrophic lateral sclerosis
(Lou Gehrig’s disease); cerebrospinal meningitis (bacterial); cerebral palsy; cystic fibrosis; diphtheria; encephalitis; Huntington’s disease (Huntington’s chorea); Legionnaire’s disease; malaria; multiple
39
sclerosis (definitive diagnosis); muscular dystrophy; myasthenia gravis; necrotizing fasciitis; osteomyelitis; poliomyelitis; rabies; sickle cell anemia (excluding sickle cell trait); systemic lupus
erythematosus (SLE); systemic sclerosis (scleroderma); tetanus; and tuberculosis.CRITICAL ILLNESS INSURANCE/ METLIFE
Health Screening Benefit
MetLife provides an annual Health Health Screening Benefit
Screening Benefit for taking one of the
$50
eligible screening/prevention measures.
This coverage would be in addition to the
Total Benefit Amount payable for previously
mentioned Covered Conditions.
45+ ways to get the annual Health
Screening Benefit,1 including:
• Lipid panel
• Annual physical exam
• Mammogram
• Blood test to determine total cholesterol
• Pap smears or thin prep pap test
• Colonoscopy
• Prostate-specific antigen (PSA) test
• Electrocardiogram (EKG)
• Serum cholesterol test to determine LDL
• Fasting blood glucose test
and HDL levels
Plus, spouses and children can use the Health Screening Benefit, too
1. The Health Screening Benefit is not available in all states. There is a separate mammogram benefit for MT residents and for cases sitused in CA and MT. Some 40
states may limit the number of health screening tests.BENEFITHUB DISCOUNT CENTER
All employees have access to
BenefitHub! To register, go to the
WCIF website and look at the
dropdown menu under Employees.
Click on Discounts & Rewards, then
look for the link. Be sure to use the
Referral Code on the flyer!
41NEXT STEPS…….
SIMON ESS Portal
This is a CHANGE ONLY open enrollment. If you
wish to change plans, add or remove a dependent,
or drop a voluntary plan please access your
SIMON portal and process your 2021 open
enrollment changes online. The website address
is: https://wcif.simon365.com.
IMPORTANT: If you cancel or decline the
electronic signing process, any changes you have
made will not be saved. If you do not wish to
electronically sign your enrollment form, you will
not be able to process your open enrollment
changes through SIMON.
42CARRIER CUSTOMER SERVICE
Carrier Customer Service Website
Premera 1.877.500.9247 Premera.com
Delta Dental 1.800.554.1907 Deltadentalwa.com
Willamette Dental 1.855.433.6825 Willamettedental.com
VSP 1.800.877.7195 Vsp.com
First Choice EAP 1.800.777.4114 Firstchoiceeap.com
Vimly CDHP 1.206.859.2694 Email:
flexspending@vimly.com
The Standard 1.800.848.5132 Standard.com
MetLife 1.800.438.6388 Metlife.com
Planning to Retire? Please visit the Retiree Page on our WCIF website
43THANK YOU
If you think of any questions later that you need help with,
please reach out to Human Resources.
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