New Hire Benefits Presentation - Plan Year August 1, 2020 - July 31, 2021 - Explain My Benefits
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Plan Year
August 1, 2020 –
July 31, 2021
New Hire Benefits
Presentation
Presentation
Disclaimer
Please note that this
presentation is simply a
summary of the benefits
available to both you and
your dependents. For
additional information and
details, you should refer to
the benefits guide and the
insurance carriers’
summary documents.
More importantly, the
insurance carrier
contracts will supersede
any and all information
provided in this
presentation.
Benefits are effective 30 days from date of hire.
You can enroll by utilizing the Self-Service portal at
www.explainmybenefits.com/diocese
ARTHUR J. GALLAGHER & CO. | BUSINESS WITHOUT BARRIERS™
Qualifying Events Marriage Divorce or Separation Death Birth or Adoption Loss of other Group Coverage Spouse’s Open Enrollment Medicare Entitlement Change requests must be made within 30 days of a Qualifying Event
Who is Eligible for Benefits? Employees: Benefits are effective 30 days from date of hire for all full-time employee working 30 hours or more per week Your Spouse Your Child(ren): Medical and Dental plans: up to age 26* Vision plan: up to age 30* *Coverage ends the end of the calendar year.
Benefits Highlights for 2020
Florida Blue continues as our Medical Carrier
Choice of two plans
Florida Blue Standard Plan
Florida Blue Premium Plan
First Stop Health is our NEW Carrier for Telemedicine
Delta Dental continues as our Dental Carrier
PPO Plan
VSP continues as our Vision Carrier
The Standard continues as our carrier for:
The Employer Paid Basic Life and Long Term Disability
The Voluntary Term Life and Short Term Disability
Trustmark continues as our carrier for:
Accident Plan
Universal Life with Long Term Care Plan
LifeLock continues as our carrier for:
Identity Theft Protection
Login Instructions
Medical Insurance
Option 1 Option 2
Standard Premium
Plan Plan
In-Network and In-Network and
Out-of-Network Out-of-Network
Medical Plan Options Plan Standard Plan Premium Plan Service In-Network In-Network Individual / Family Calendar Year Deductible (CYD) $400 / $1,200 $300 / $900 Coinsurance 20% 10% Plan Year Out of Pocket Max for Individual / Family $3,500 / $7,000 $2,500 / $7,500 Preventative Care No charge No charge Primary Care Office Visit $25 Copay $25 Copay Specialist Office Visit $50 Copay $50 Copay In-Patient Hospital 20% after CYD 10% after CYD Out-Patient Hospital 20% after CYD 10% after CYD Surgical Facility 20% after CYD 10% after CYD Urgent Care $25 Copay $25 Copay Emergency Room (waived if admitted) 20% after CYD + $100 PVD 10% after CYD + $50 PVD Laboratory 20% Coinsurance 10% Coinsurance X-Ray and Diagnostics $50 Copay $50 Copay Major Diagnostics: MRI, MRA, CT, PET Scans $50 Copay $50 Copay The Florida Blue plans have an out of network benefit. Please refer to FL Blue’s Benefit Summaries or Benefit Guide for out of network details.
Rx Benefits
Standard Plan Premium Plan
Generic Greater of $5 or 30% Greater of $5 or 30%
Brand Name Greater of $35 or 30% Greater of $30 or 30%
Non-Preferred Greater of $50 or 50% Greater of $45 or 50%
Specialty 20% - $375 Max per Rx 10% - $225 Max per Rx
The plans have an out of network Rx benefit. Please refer to 2020 Benefit Guide for more details.Value Adds
Take advantage of your Shingles and Flu Vaccine Program
No additional out of pocket costs. It’s FREE!
• Restriction for 17 years of age or younger: Vaccine must be
administered at a clinic or physician’s office.
Smoking Cessation Program
• Effective January 1, 2018, the Diocese of Palm Beach is pleased to announce the
introduction of a Smoking Cessation Program at your local participating retail
pharmacies. Diocese of Palm Beach member qualify for two separate 6-month
therapies per lifetime at $0 copay. You will need a prescription written for smoking
deterrent products from your physician in order to take advantage of this added
benefit to assist you in reaching your healthy initiative.
• Participating pharmacies include popular chains and independents including Costco,
CVS, Kroger, Publix, Rite Aid, Target, Walmart, and Winn Dixie.
For any questions please contact
RxEDO member Services at (888) 879-0168Ways to Save
• Use generics when available
• Request samples from doctor
• Publix offer prescriptions for free or at a reduced cost.
Amlodipine – High BP
Amoxicillin Lisinopril – High BP
Ampicillin Metformin - Diabetes
Sulfamethoxazone/Trimethoprim Montelukast – Allergies and Asthma
Ciprofloxacin
Penicillin VK
• Walmart offers many generics at $4More Ways to Save
Convenience Care can treat common conditions
including: cough, cold, flu, ear infections, strep
throat, bronchitis, sinus infections, and more…
Minute Clinic (CVS)
The Little Clinic (Publix)
Take Care Clinic (Walgreens)
Nurse Practitioners
Urgent Care can treat more serious conditions
including: sore throats, flu, ear aches, respiratory
infections, small cuts and minor lacerations
requiring stitches, sprains, minor broken bones,
minor burns and injuries, and more…
Physicians
Labs and Xrays
May even Dispense Prescriptions
To find an in-network provider, go to
www.floridablue.comTelemedicine
For Members and their covered dependents
who elect the Diocese of Palm Beach Medical
Coverage
CONSULT WITH A DOCTOR 24/7/365
WHAT IS TELEMEDICINE?
Telemed is a national network of board-certified physicians who
provide quality healthcare through the convenience of phone or
online video consultations for members of any age.
Talk to a doctor within MINUTES
Teladmed physicians can diagnose, treat, and write prescriptions, by
when necessary for routine medical conditions, including:
1-888-691-7867
• Cold & flu symptoms
• Allergies Using the Mobile App
• Bronchitis
• Urinary tract infection
Or log into fshealth.com
• Respiratory Infection
• Sinus problems HOW MUCH does it cost?
• And more! Nothing! $0 – no fees or copaysDental Plans
Primary Flex PPO Plan
Network Name Primary Flex PPO
In-Network Out-of-Network*
Individual Deductible / Family Deductible $100 per Individual
Waived for Preventive Care Yes Yes
Calendar Year Benefit Max (per covered person) $1,500
Your Cost
Preventive: Oral Exams, Cleanings Covered at 100% Covered at 100%*
Basic: Fillings, Extractions, Oral Surgery, Covered at 80% after Covered at 80% after
Endodontics (Root Canal), Periodontics Deductible Deductible*
Major: Inlays, Onlays, Crowns, Bridgework, Covered at 50% after Covered at 50% after
Dentures Deductible Deductible*
* Out-of-Network Benefits subject to balance billing for charges over the Delta Dental reimbursement schedule.
Go to www.deltadentalins.com to locate a network PPO provider.Vision Insurance
Vision Insurance
Network Name: WellVision
In-Network Out-of-Network
Plan
Service Your Cost Reimbursement
Eye Exam $10 Copay Up to $45
Frequency Every 12 months
Lenses
Single Vision $25 Copay Up to $30
Bifocals $25 Copay Up to $50
Trifocals $25 Copay Up to $65
$55 to $175 Copay then 20-25%
Progressive Up to $50
discounts
Frequency Every 12 months
$150 Allowance / $170 Allowance for
Frames - Selected Up to $70
featured frames then 20% off balance
Frequency Every 24 months
Contact Allowance (Elective) $150 Allowance then 15% off balance Up to $105
Frequency Every 12 months
Go to www.vsp.com to locate a network provider.Basic Life Insurance & AD&D
Basic Life Insurance
– $25,000
Accidental Death &
Dismemberment (AD&D)
– $25,000
Please make sure
your beneficiary
information is up to dateSupplemental Life Insurance & AD&D
You: Available in $10,000 increments up
to a maximum of $100,000
*Guaranteed Issue Amount: $50,000
Spouse: Available in $10,000 increments up to a
maximum of $50,000
*Guaranteed Issue Amount: $20,000
Up to 100% of employee benefit amount
Child(ren): Available in $2,000 increments up to a
maximum of $10,000
Not to exceed 50% of the employee benefit amount
Includes AD&D Coverage
* Initial Enrollment OnlyDisability Insurance Short Term Disability • Voluntary STD begins on 15th day of illness or injury • Up to 11 weeks of benefit • Benefit of 60% of weekly pre-disability salary up to $1,500 per week Long Term Disability • Employer Paid LTD begins on 91st day of illness or injury • Benefit of 60% of monthly pre-disability earnings up to $3,000 per month • Benefits provided to SSNRA Age Pre-existing conditions will not be covered.
Additional Voluntary Benefits - TRUSTMARK
Trustmark - 24 Hour Accident Plan
Pays $50 two times Per Year, Per Covered Person for Wellness
Pays Cash Benefits for Accidental Injuries: up to $15,000 for
fractures
Pays Cash Benefit of $3,200 per Hospital Admission due to an
Accident
Trustmark - Universal Life Events with Long Term
Care
Permanent Life Insurance
Long Term Care benefit equal to Life Insurance Benefit
Accumulates Cash Value
ARTHUR J. GALLAGHER & CO. | BUSINESS WITHOUT BARRIERS™Identity Theft Protection
LifeLock offers Proactive Protection in both of the plans offered:
ARTHUR J. GALLAGHER & CO. | BUSINESS WITHOUT BARRIERS™Reminders: Thank you • For applicable coverage costs, please refer to the Benefits Guide available at www.explainmybenefits.com/diocese. • You can enroll by utilizing the Self-Service portal at www.explainmybenefits.com/diocese. • Be sure to have all social security numbers and dates of birth for any dependents you with to enroll.
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