MSD of Wayne Township 2021 Benefits Guide - MSD of Wayne Township ...
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MSD of Wayne Township
2021 Benefits Guide
What’s New for 2021
New Benefit Portal – Elections Required for all 2021 Coverages
• New benefit platform at https://trustmark.benselect.com/MSDWayne. See page 4 for instructions.
• You are required to login into the new benefit platform even if you do not have any changes to your current coverages or
enroll by phone by calling the Call Center November 1 – November 15 (M-F) 8:30 am – 5:00 pm (EST) at 463-900-5392.
• If enrolled in an HSA or FSA, remember to re-enroll as contributions do not continue into 2021.
Medical – Dental – Vision
• No changes to these plan designs.
• No rate changes to Medical and Dental.
• Vision rates reduced by 5%.
Reminder – College Tuition Benefit with Davis Vision election
• The College Tuition Benefit is paired with your Davis Vision coverage.
• Visit www.guardian.collegetuitionbenefit.com or call 215-839-0119 to learn more.
Reliance Standard – New Carrier
• Short Term Disability, Long Term Disability, Accident Insurance, Hospital Indemnity and Critical Illness now
offered with Reliance Standard.
• Hospital Indemnity and Accident Insurance are independent coverages and no longer bundled, providing you
the flexibility to obtain the coverage you need.
Voluntary Universal Life
• Trustmark’s fully portable Universal Life solutions offers employees with various needs for permanent life
insurance and peace of mind for a lifetime and are available for employees, spouses and children in face
amounts from $5,000 up to $300,000.
2021 BENEFITS ENROLLMENT GUIDE
Table of Contents
Benefits Overview............................................................................................................................. 3
Enrollment Instructions ..................................................................................................................... 4
Health Benefits ................................................................................................................................. 5
Dental Benefits ................................................................................................................................. 6
Vision Benefits .................................................................................................................................. 7
Wayne Wellness & Enhanced Access ............................................................................................. 8
Rx Help Centers ............................................................................................................................... 9
Wellness Program .......................................................................................................................... 10
Life and AD&D Insurance ............................................................................................................... 11
Disability Insurance ........................................................................................................................ 12
Critical Illness, Accident & Hospital Insurance ............................................................................... 13
Critical Illness, Accident & Hospital Insurance Rates ..................................................................... 14
Employee Assistance Program ...................................................................................................... 15
Resources: Who to Contact............................................................................................................ 16
The information in this Benefits Summary is presented for illustrative purposes and is based on information provided by the employer. The text
contained in this summary was taken from various summary plan descriptions and benefit information. While every effort was taken to accurately report
your benefits, discrepancies or errors are always possible. In case of discrepancy between the Benefits Summary and the actual plan documents, the
actual plan documents will prevail. All information is confidential, pursuant to the Health Insurance Portability and Accountability Act of 1996. If you have
any questions about this summary, contact Shandy Brickler.
2 | MSD of Wayne Township | 2021 Employee Benefits Guide
BENEFITS OVERVIEW
Benefits Overview
MSD of Wayne Township offers you and your eligible family members a comprehensive and valuable benefits program. We
encourage you to take the time to educate yourself about your options and choose the best coverage for you and your family.
Who is Eligible?
If you are a full-time employee (working 30 or more hours per week), you are eligible to enroll in the benefits described in this
guide. Dependent children are allowed to be covered up to age 26 regardless of whether the child is living in your residence, is
financially dependent on you, is a full-time student, works for another employer that also offers group health coverage, or is
married. However, if your dependent child has a spouse and/or child, the spouse and/or child are NOT eligible to be covered under
the MSD of Wayne Township benefits plan.
When to Enroll
OPEN ENROLLMENT: The benefits you elect will be effective January 1, 2021.
You must enroll during MSD of Wayne Township’s annual Open Enrollment period November 1 – November 15, 2020. If you miss
these enrollment opportunities, you must wait until next year’s Open Enrollment period unless you have a qualifying life event.
Examples of qualifying events include:
• Marital Status Change: Marriage, Divorce, Legal Separation
• Dependent Status Change: Birth, Death, Adoption
• Change in Employment: Loss of coverage, Full-time to Part-Time or vice versa
Important: All plans require active elections; coverage will not roll over if no
changes are recorded for 2021. All employees must finalize open enrollment
elections by 11:59 PM (EST) on November 15, 2020.
My Checklist
• ☐ Complete your open enrollment via the portal or utilizing the call center.
• ☐ Don’t forget to file your wellness claim from Voya if you are currently enrolled in the medical plan.
• ☐ Are you currently enrolled in any Voya plans? If so, the deadline for claims is 12/31/2020.
• ☐ Have you completed all your Wayne Wellness Incentives?
3 | MSD of Wayne Township | 2021 Employee Benefits GuideENROLLMENT INSTRUCTIONS
https://trustmark.benselect.com/MSDWayne
https://www.signupgenius.com/go/msdwayne
4 | MSD of Wayne Township | 2021 Employee Benefits GuideHEALTH BENEFITS
HDHP
MSD of Wayne Township offers multiple High Deductible Health Plans (HDHP) with the option for an HSA. This chart
gives you a side-by-side look at the amounts you pay by plan when you use in-network versus out-of-network
providers.
HDHP 1 PLAN HDHP 2 PLAN HDHP 3 PLAN
In-Network Out-of-Network In-Network Out-of-Network In-Network Out-of-Network
Wellness Center Yes Yes Yes
Annual
Embedded Embedded Embedded
Deductible
Single $3,500 $6,400 $3.500 $7,000 $6,750 $10,000
Family $7,000 $12,800 $7,000 $14,000 $13,500 $20,000
Coinsurance 0% 30% 20% 30% 0% 30%
Out of Pocket
Max
Single $3,500 $10,800 $5,500 $11,000 $6,750 $15,000
Family $7,000 $21,600 $11,000 $22,000 $13,500 $30,000
Preventative
100% Coverage 30% after deductible 100% Coverage 30% after deductible 100% Coverage 30% after deductible
care
Primary Care 0% after deductible
30% after deductible 20% after deductible 30% after deductible 0% after deductible 30% after deductible
Physician
Specialty Care
0% after deductible 30% after deductible 20% after deductible 30% after deductible 0% after deductible 30% after deductible
Physician
Emergency
0% after deductible 30% after deductible 20% after deductible 30% after deductible 0% after deductible 30% after deductible
Room Services
Urgent Care
0% after deductible 30% after deductible 20% after deductible 30% after deductible 0% after deductible 30% after deductible
Centers
Retail
0% after deductible 30% after deductible 20% after deductible 30% after deductible 0% after deductible 30% after deductible
Prescription
Mail Order 0% after deductible 30% after deductible 20% after deductible 30% after deductible 0% after deductible 30% after deductible
Health Savings Account (HSA) Health Savings Account (HSA)
2021 Plan Year 2021
Maximum Earned Wellness Incentive Annual IRS Limits
Employee $3,600
Employee $500
Family $7,200
Spouse $500
Catch-Up Contributions (Ages 55 and over in 2020) $1,000
5 | MSD of Wayne Township | 2021 Employee Benefits GuideDENTAL BENEFITS
Dental Enhanced Plan Basic Plan
Delta Dental Premier/Out of
PPO Network Premier/Out of Network Delta Dental PPO
Network
Annual Deductible
Single $50 $50 $50 $50
Family $150 $150 $150 $150
Annual Benefit Max
(per insured person)
$1,000 $1,000 $1,000 $1,000
Preventive Diagnostic:
Includes: Two routine exams Plan pays up to the Delta
every 12 months, includes x- Plan pays 100% Plan pays 100% Plan pays 100% Dental PPO fee, member
rays, sealants and cleanings pays the difference
Basic Services:
Fillings and Crowns, bridge and
implant repairs, root canals, Plan pays 80% after Plans pays 80% after Plan pays 80% after Plan pays 50% after
periodontics to treat gum deductible deductible deductible deductible
disease, extractions and surgery
Major Restorative:
Crowns, bridges, implants and Plan pays 50% after Plan pays 50% after Plan pays 50% after Plan pays 50% after
dentures deductible deductible deductible deductible
Orthodontia Plan pays 50% Plan pays 50% Plan pays 50% Plan pays 50%
Lifetime Orthodontia Maximum $1,000 $1,000 $1,000 $1,000
Certified/Classified Per Pay Employee Contribution (26 Pays)
Single $12.34 $3.01
Double $30.59 $12.31
Family $52.08 $20.52
2 Employee Double $22.21 $5.42
2 Employee Family $38.64 $13.79
Bus Driver/Aide PT Employee Contribution (20 Pays)
Single $16.04 $3.91
Double $39.76 $16.00
Family $67.71 $26.67
6 | MSD of Wayne Township | 2021 Employee Benefits GuideVISION BENEFITS
Vision VSP Plan Davis Plan
VSP Choice Network Out-of-Network Davis Vision Network Out-of-Network
Routine Exam (one per 12 Months) $10 co-pay Plan pays up to $39 $10 co-pay Plan pays up to $50
Plan pays up to: Plan pays up to:
Lenses (1 pair every 12 months) $25 co-pay covers frames
$23 single
$25 co-pay covers frames
$48 single
Includes single vision, lined bifocal, $37 lined bifocal $67 lined bifocal
and lenses and lenses
lined trifocal and lenticular lenses $49 Lined trifocal $86 lined trifocal
$64 lenticular $126 Lenticular
Plan pays $130, then 20% Plan pays $130, then 20%
Frames (one every 24 months) over $130
Plan pays up to $46
over $130
Plan pays up to $48
$25 co-pay then plan
pays:
Contact Lenses (Necessary only $48 single
Plan pays 100% Plan pays up to $210 $25 co-pay
(one every 24 months) $67 bifocal
$86 trifocal
$126 lenticular
Contact Lenses (Elective) Plan pays up to $130 Plan pays $100 Not covered Not covered
Contact Lenses Not covered Not covered
Plan pays $120, then 15%
Plan pays up to $105
Elective and conventional) over $120
Certified/Classified Per Pay Employee Contribution (26 Pays)
Employee Only $4.13 $3.06
Employee + Spouse $6.95 $5.15
Employee + Child(ren) $7.08 $5.25
Employee + Family $11.21 $8.30
Bus Driver/Aide PT Employee Contribution (20 Pays)
Employee Only $5.36 $3.97
Employee + Spouse $9.03 $6.69
Employee + Child(ren) $9.20 $6.82
Employee + Family $14.57 $10.79
7 | MSD of Wayne Township | 2021 Employee Benefits GuideWAYNE WELLNESS AND ENHANCED ACCESS 8 | MSD of Wayne Township | 2021 Employee Benefits Guide
RX HELP CENTERS 9 | MSD of Wayne Township | 2021 Employee Benefits Guide
WELLNESS PROGRAM
Wayne Wellness Program
2021 Wellness Program Requirements for Earning Incentives* HSA Contribution
Employee and spouse complete annual physical exam $300
If your biometric results meet these Healthy Standards, you will earn additional HSA
contributions:
1. Body Mass Index (BMI) is less than 25 or your waist circumference is
• Less than 40’ for men $25 each (total $100)
• Less than 35’ for women
2. Blood Pressure less than or equal to 120/80
3. Hgb A1c less than or equal to 5.7
4. Triglycerides less than or equal to 150
Employee and spouse must each complete five modules of the Lifestyle Competency Program $100
(Nutrition, Physical Activity, Stress or Sleep) at www.mywaynewellness.com.
Please note: The Introduction module does not count toward the incentive.
$500 each employee and
Total HSA Dollars Available spouse
Wellness Checklist
• File wellness benefit claims with Voya until 12/31/20 at https://claimscenter.voya.com/static/claimscenter/.
o Tip: When filing a wellness benefit claim you will need to check the box for Critical Illness. Use group
#00696170 and leave policy# field blank.
• Open HSA account with BMO Harris for Wellness Incentives. Contact Shandy Brickler for the HSA application.
Reliance Standard Wellness Benefit in 2021
Additional Ways to Earn Incentive
Critical Illness – Wellness Health Screening $150
Plan A - $25
Accident Insurance – Wellness Health Screening Plan B - $75
Reasonable Alternative Standard
MSD of Wayne Township is committed to helping you achieve your best health. Rewards for participating in a wellness
program are available to all employees in the health plan. If you think you might be unable to meet a standard for a reward
under this wellness program, you may qualify for an opportunity to earn the same reward by different means. Contact
Wellnesscoach@wayne.k12.in.us and we will work with you (and if you wish, your physician) to find a wellness alternative
with the same reward that is right for you in light of your health status.
10 | MSD of Wayne Township | 2021 Employee Benefits GuideLIFE AND AD&D INSURANCE
Basic Life / AD&D
MSD of Wayne Township provides this coverage with members paying $1 per year. Update your beneficiary on the benefit portal.
Please refer to the Plan Certificate for full details.
Voluntary Life / AD&D
Who Can Enroll Benefit Amounts Maximum Amount Guaranteed Issue (GI) Amount
$150,000
Employee $10,000 minimum $300,000 (amounts over GI subject to medical
underwriting)
$30,000
Spouse $5,000 minimum $150,000 (amounts over GI subject to medical
underwriting)
Children Birth through age 26 $10,000 N/A
Refer to the benefits portal for the rates and available coverages.
Universal Life
Plan Features – Universal LifeEvents
An innovative concept in life insurance, Universal LifeEvents is uniquely designed to match the needs of insureds
throughout their lifetime.
• LifeEvents pays a higher death benefit during the working years when expenses are high, and families need
maximum protection.
• At age 70, when financial needs are typically lower, the death benefit reduces to one third.
• However, higher Living Benefits do not reduce – they continue through retirement to match the greater need for
Long Term Care (LTC).
Please refer to the Plan Certificate for full details.
Eligibility
Each Active Full‐Time Employee working 30 hours or more per week. Rates are based on smoking status, age and benefit amount.
Refer to the benefits portal for rates and available coverages.
11 | MSD of Wayne Township | 2021 Employee Benefits GuideDISABILITY INSURANCE
Voluntary Disability Insurance (Income Protection)
Think you will never need disability insurance? Statistics say that one in four 20-year-olds will be disabled before they reach
retirement, and 95 percent of accidents are not work- related. Pregnancy, back and neck pain, cancer, heart disease, mental
illness are the most common disabilities. Why not insure your paycheck the way you do your car, your house and your health?
Voluntary Short Term Disability (STD) and Voluntary Long Term Insurance
MSD of Wayne Township offers Voluntary Short Term Disability and Voluntary Long Term coverage for purchase through Reliance
Standard. If purchased, STD and LTD benefits are provided as a source of income in the event you become disabled from a non-
work-related injury or sickness. You are not eligible to receive STD or LTD benefits if you are receiving Workers’ Compensation
benefits. Please refer to the Plan Certificate for full details.
Disability Insurance STD LTD
Greater of 15th day or day after
Benefits Begin (sickness and accident) 181st day
accumulated sick days
Benefits Payable 26 weeks 24 months
60% 60%
Percentage of Income Replaced
of your weekly income of your monthly income
Maximum Benefit $750 per week $5,000 per month
Refer to the benefits portal for your per pay Refer to the benefits portal for your per pay
Rates
cost cost
12 | MSD of Wayne Township | 2021 Employee Benefits GuideCRITICAL IILLNESS, ACCIDENT & HOSPITAL VOLUNTARY BENEFITS
Accident Plan A Plan B
Cash payments for a range of injuries or
Benefit Description treatments resulting from an accident, on or
off the job
Voluntary Yes
Emergency Treatment $75 $225
Hospital Confinement $100 per day $300 per day
Physical Therapy $25 per session $35 per session
Physician Office visit $50 initial $75 initial
Rehabilitation Facility confinement $50 per day $100 per day
Xray’s $25 $50
Acc Dismemberment % of Death Benefit % of Death Benefit
Accidental Death Employee: $5,000 Employee: $50,000
Critical Illness Hospital Indemnity
Lump-sum cash payment for a diagnosis of a Cash payment for hospital admission,
Benefit Description wide range of covered conditions Benefit Description room and board and/or intensive care
unit stays
Employer Paid Benefit $5,000 for all members
Voluntary on the medical plan Voluntary Yes
Additional Benefit: Employee Paid Room and Board $100 per day
Carcinoma in Situ 25% Critical Care Unit $100 per day
Coma 100% One Daily Benefit $500 per coverage year
Coronary Disease 25% Guaranteed Issue Enrollment Period Only
Heart Attack 100% Waiting Period None
Life Threatening Cancer 100% Pre-Existing None
Major Organ Failure 100%
Paralysis 100%
Skin Cancer 10%
Stroke 100%
Critical Illness insurance covered at 100% for all employees enrolled in a medical plan. Employees not enrolled in a
medical plan may elect to buy coverages for themselves and their family.
13 | MSD of Wayne Township | 2021 Employee Benefits GuideCRITICAL ILLNESS, ACCIDENT & HOSPITAL INSURANCE RATES
Accident Insurance Contribution Requirements
Coverage is 100% employee paid.
Plan A Per Pay Plan B Per Pay
Rates Employee Contribution – 26 weeks Employee Contribution – 26 weeks
Employee Only $2.59 $8.39
Employee + Spouse $4.18 $12.89
Employee + Child(ren) $4.64 $14.07
Employee + Family $6.23 $18.97
Plan A Per Pay Plan B Per Pay
Rates Employee Contribution – 20 weeks Employee Contribution – 20 weeks
Employee Only $3.37 $10.90
Employee + Spouse $5.44 $16.76
Employee + Child(ren) $6.03 $18.29
Employee + Family $8.09 $24.67
Contribution Requirements – Voluntary Critical Illness Insurance
If enrolled in a medical plan, Paid Benefit of $5,000 is 100% employer paid.
Additional coverage is 100% employee paid. Tier Rates for $5K in benefit for EE, SP, and Children.
Per Pay Per Pay
Rates Employee Contribution – 26 weeks Employee Contribution – 20 weeks
Employee Only $1.62 $2.10
Employee + Spouse $3.23 $4.20
Employee + Child(ren) $1.73 $2.25
Employee + Family $3.35 $4.35
Contribution Requirements – Hospital Indemnity Insurance
Coverage is 100% employee paid.
Per Pay Per Pay
Rates Employee Contribution – 26 weeks Employee Contribution – 20 weeks
Employee Only $6.07 $7.90
Employee + Spouse $12.82 $16.66
Employee + Child(ren) $9.11 $11.84
Employee + Family $15.85 $20.61
14 | MSD of Wayne Township | 2021 Employee Benefits GuideEMPLOYEE ASSISTANCE PROGRAM Employee Assistance Program (EAP) and Work-Life Services 100% of the costs are fully covered by MSD of Wayne Township. The IU Health EAP provides professional services to help employees address a variety of personal, family, life and work-related issues. From everyday stress to relationship issues at work or home, the EAP provides completely confidential support, education, solutions and recommendations for your level of stress Who is Eligible and When? All Employees and your eligible household members, including spouse, significant others, domestic partners and children up to age 26. The employee does not need to participate in the EAP services with a family member. Program Access • 6 free EAP sessions for Wayne employees and immediate household members • 24-hour crisis access by phone The IU Health EAP helps cope with: • Stress and anxiety • Grief and loss related to death, divorce, life change and job transitions • Workplace or home relationship conflict • Family, marital and couples’ problems • Substance abuse of alcohol and drugs • Depression Learn More or Get Started: • Call 317-962-8001 or 800-745-4838, ext. 2 • Visit Iuhealth.org/employee-assistance 15 | MSD of Wayne Township | 2021 Employee Benefits Guide
RESOURCES: WHO TO CONTACT
We’re here to help!
Medical & Pharmacy Short Term Disability
IU Health Medical Reliance
1-866-895-5975 https://www.iuhealthplans.org 1-800-351-7500 www.rsli.com
TrueRX Customer Service Long Term Disability
1-866-921-4047 Reliance
1-800-351-7500 www.rsli.com
Prescription Drug Advocacy
RX Help Center Accident Insurance
1-866-478-9593 rxhelpcenters.com Reliance
1-800-351-7500 www.rsli.com
Dental
Delta Dental Critical Illness Insurance
1-800-524-0149 www.deltadentalin.com Reliance
1-800-351-7500 www.rsli.com
Vision
Guardian Hospital Indemnity Insurance
1-800-541-7846 www.guardiananytime.com Reliance
1-800-351-7500 www.rsli.com
Flexible Savings Accounts (FSA)
Nyhart
Employee Assistance Program
1-800-428-7106 or 317-845-3500
IU Health EAP
1-317-962-8001 or 1-800-745-4838, ext. 2
Health Savings Account (HSA)
BMO Harris Bank VOYA – Until 12/31/2020
1-866-472-4632 Accident/Critical Illness/Cancer/Wellness claims
1-877-236-7564
Telemedicine
IU Health Benefit Questions
https://iuhealth.org/find-medical-services/virtual-visits Benefits@wayne.k12.un.us
Clinic Benefits
MSD of Wayne Township
Wayne Health Care Center
Shandy Brickler 1-317-988-8656
1-317-536-2200
Shandy.brickler@wayne.k12.in.us
https://district.wayne.k12.in/us/staff/wellness-center
Wellness Program
Federal Notices
wellnesscoach@wayne.k12.in.us
https://trustmark.benselect.com/MSDWayne
Life and AD&D
Reliance
1-800-351-7500 www.rsli.com
Universal Life
Trustmark
1-800-918-8877
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