Employee Benefits Program 2016
The Winter Construction Company
National Healthcare Trends
Healthcare spending will continue to increase. Spousal surcharges are increasing. Employer plans may change substantially to avoid the
“Cadillac Plan” tax in 2018 that is meant to discourage employers from offering health plans that are over generous.
Obesity and chronic disease are on the rise. 35% of adults are obese as of 2015. By 2025, the number of obese adults is expected to grow to 45%.
Chronic disease accounts for 75% of healthcare spending.
National 401(k) Trends
30% of employees ages 30-49 have not started saving for retirement.
New guidelines recommend employees save 10 to 15 percent of income for retirement.
Fewer than 20% of employees presently contribute 10 percent or more to their 401(k).
2015 Winter Benefit Highlights 100% of our employees and eligible family members
participated in Biometrics.
100% of our employees and eligible family members reached Silver Status.
Winter was awarded Atlanta’s Healthiest Employer.
Winter returned medical plan savings to employees with an increase in 401(k) match.
2016 Winter Benefit Highlights Increase in Healthcare Costs of 16% = $200,000
How did Wellness impact this increase?• Rates would have increased by 25%• Savings of approximately $75,000
What does this mean for you?
Winter is going to absorb the increase so your rates will remain unchanged.
New 401(k) Match – Effective 1/1/2016
Winter will now match 50 cents for every
dollar contributed up to 6% of base salary!
**You will need to update your salary deferral online**
Additional 401(k) changes for 2016
Automatic enrollment is set at 3% for 2016.All employees deferring less than 3%, who do not want to contribute, must re-opt out at www.netbenefits.com.
Open Enrollment
By phone: November 30th – Dec. 6th Online: November 30th- Dec. 13th
The Open Enrollment period is your chance each year to make changes to your benefits such as:
Adding/removing dependents Enrolling or cancelling coverage Changing plans
Open Enrollment for 2016 plan year:
Re-enrollment
This year’s enrollment is PASSIVE. If you do not actively call or go online and make changes to your
benefits, your coverage will remain EXACTLY the same as last year.
However, if you have an FSA and would like to continue to have one in 2016, you MUST re-enroll in it. It is
recommended that you use the call-in option if this is the case.
If you have an HSA, please check your enrollment confirmation to ensure the amounts are correct.
Changing benefits during the year There are only a few “family status” changes you can make after Open Enrollment. Qualified events include but are not limited to: Marriage or divorce Birth/adoption of a child Death of a spouse or dependent Loss of spouse’s coverage with employer
To make qualified status changes to benefits, you must contact the Enrollment Center at 866-688-9727.
They will instruct you to any forms that will need to be given to HR.
Changes must be made within 30 days of the qualifying event or you will have to wait until the next annual Open Enrollment period.
Medical Plans
Humana Medical Summary of Benefits
HMO OA Plan
In-Network
POS Plan**
In-Network Out-of-Network Deductible
Individual
Family
$500
$1,000
$1,000
$2,000
$3,000
$6,000
Total Plan Maximum Out-of-Pocket Limit
Individual
Family
$6,250
$12,500
$6,250
$12,500
$9,000
$18,000
Emergency Room (waived if admitted)
$150 copay per visit
$200 copay per visit
$200 copay per visit
Coinsurance 80% 80% 60%
Preventive Care No Charge No Charge 70% after deductible
Office Visits
PCP
Specialist
$40
$55
$40
$55
70% after deductible
70% after deductible
Inpatient Services 80% after deductible 80% after deductible 60% after deductible
Prescription Drugs (30-day supply)
***Rx Maximum Out-of-Pocket Limit
Tier 1
Tier 2
Tier 3
Tier 4
Mail Order (90 day supply) Lifetime Maximum
$3,500 Individual / $7,000 Family
You pay $15
You pay $30
You pay $50
25% coinsurance
$30/$60/$100/25%
Unlimited
$5,000 Individual / $10,000 Family
You pay $15
You pay $30
You pay $50
N/A
$30/$60/$100
Unlimited
HMO OA Plan
Hourly Salary (weekly) (bi-weekly)
POS Plan**
Hourly (weekly) Salary (bi-weekly)
Employee Only $38.87 $77.73 $38.87 $77.73
Employee + Spouse $140.40 $280.79 $140.40 $280.79
Employee + Child(ren) $102.63 $205.25 $102.63 $205.25
Family $185.32 $370.63 $185.32 $370.63
Please refer to the Summary of Benefits regarding Out-of-Network benefits. * HDHP/HSA: Winter will match your contributions into your HSA to help pay for medical expenses up to: Employee = $500 or Family = $750 ** POS: For employees with an out of state home address. ***Rx Maximum Out-of-Pocket limits apply to in-network services only.
Medical PlansHumana Medical Summary of Benefits
HDHP 2500 Plan*
In-Network Out-of-Network HDHP 4000 Plan*
In-Network Out-of-Network
Non-embedded: Family deductible must be satisfied before individual co-insurance benefits are available to everyone on the plan.
Deductible
$2,500
$7,500
$4,000
$12,000 Individual
Family $5,000 $15,000 $8,000 $24,000
Total Plan Maximum
$3,000
$9,000
$5,000
$15,000
Out-of-Pocket Limit
Individual
Family $6,000 $18,000 $10,000 $30,000
Emergency Room (waived if admitted)
$150 copay per visit after deductible is met
$150 copay per visit after deductible is met
90% after deductible
90% after deductible
Coinsurance 100% 70% 80% 60%
Preventive Care No Charge 70% after deductible No Charge 70% after deductible
Office Visits $30 after deductible is met
70% after deductible
90% after deductible
60% after deductible PCP
Specialist $45 after deductible is met
70% after deductible 90% after deductible 60% after deductible
Inpatient Services 100% after deductible 70% after deductible 90% after deductible 60% after deductible
Prescription Drugs (30-day supply)
N/A
N/A ***Rx Maximum Out-of-Pocket Limit
Tier 1 You pay $10 Subject to deductible and coinsurance
Tier 2 You pay $30 Subject to deductible and coinsurance
Tier 3 You pay $50 Subject to deductible and coinsurance
Tier 4 25% coinsurance
Subject to deductible and coinsurance
Mail Order (90 day supply) $25/$75/$125/25% Subject to deductible and coinsurance
Lifetime Maximum Unlimited Unlimited
HDHP 2500 Plan*
Hourly (weekly) Salary (bi-weekly)
HDHP 4000 Plan
Hourly (weekly) Salary (bi-weekly)
Employee Only $27.54 $55.07 $17.54 $35.07
Employee + Spouse $107.79 $215.57 $83.18 $166.35
Employee + Child(ren) $79.66 $159.32 $59.68 $119.35
Family $137.49 $274.97 $104.63 $209.26
Please refer to the Summary of Benefits regarding Out-of-Network benefits. * HDHP/HSA: Winter will match your contributions into your HSA to help pay for medical expenses up to: Employee = $500 or Family = $750 ** POS: For employees with an out of state home address. ***Rx Maximum Out-of-Pocket limits apply to in-network services only.
Pharmacies At www.myhumana.com tools are available to assist you with
determining the price you pay for covered prescriptions.
The 2016 pharmacy formularies can be found online on the WinterWire and Winter Intranet.
You can access the Mail Order Pharmacy at www.myhumana.com and have prescriptions delivered to you.
The OneRx mobile app helps you determine the lowest-priced prescriptions at pharmacies in your area and also provides you with coupons for valuable savings.
Health Savings Account (HSA)Humana/UMB* Winter will match employee contributions dollar for dollar up to $500 for employee only ($750 for all other plans) annually Contributions matched by Winter in January and July
What is a Health Savings Account (HSA)? It is a tax-free account that helps you budget for health care expenses
both for the current year and for the future You can use this fund to cover your qualified healthcare costs
Are you eligible for an HSA? In order to contribute to an HSA, you must have only HDHP medical
coverage Your spouse may not have a Flexible Spending Account if on your plan You may not be receiving Medicare benefits You may not be claimed as a dependent on another person’s tax return
(doesn’t include your spouse’s)*Employees who are currently enrolled in HealthyEquity HSA are eligible to stay in HealthEquity HSA or may roll
their accounts during Open Enrollment into Humana HSA.
HSA 2016 Contribution Limits IRS Contribution Limit
(employer + employee)Individual Family
$3,350 $6,750
HSA catch up contribution: For ages 55-65 an additional $1,000 contribution is allowed.
Employee Coverage Type
Annual Winter Contribution
Employee Only Match up to $500
Employee and Spouse
Match up to $750
Employee and Child(ren)
Match up to $750
Family Match up to $750
Winter’s Annual Contribution
Flexible Spending Account (FSA) An FSA allows you to set aside funds on a pre-tax basis for predictable out-of-pocket
expenses not covered under a medical plan.
You can elect an FSA without electing a medical plan.
REMEMBER – You may roll over up to $500 of unused funds remaining at the end of the 2015 plan year.
Contribution Maximum: $2,500 per year
Contribution amount must be chosen at Open Enrollment Eligible expenses include:
Co-pays $ deductibles
Vision care
Prescriptions & some over-the-counter drugs (Rx needed)
Chiropractic treatments
Infertility treatments
A full list can be found at http://www.irs.gov/pub/irs-pdf/p502.pdf
The cut-off to use funds from your 2015 FSA contributions is March 15, 2016.
Humana Vitality
At the beginning of the year, your Vitality status will return to Blue. You will retain 10% of your existing points, and will keep all of your Vitality Bucks.*Anyone who will be 18 or older during the 2016 plan year must
participate*
Humana Vitality App
Register on the app and customize your profile
Earn Vitality Points faster for achieving short-term milestones
Connect compatible fitness devices
Join a challenge and submit activity verification
Silver Status Savings
There is no guaranteed rate for our 2017 healthcare insurance coverage. However, if you do not reach Silver Status by 8/31/2016, then you will not qualify for the wellness rate in 2017. Depending on your type of coverage, this could cost you significant $$$$!
If exercise is an issue that you feel will hinder your ability to reach Silver Status, contact Humana to determine the best course of action for you to take.
Healthiest You 24x7 Access to Doctors
Unrestricted access to the nation’s largest network of doctors, available via phone or video
Provider Discovery Location-aware provider directory with reviews and ratings
Prescription Pricing
Insurance Connectivity Up-to-date coverage information, deductible tracking, and benefit
summaries
Price Transparency Cash vs. insurance pricing
Intelligent Alerts
GAP Insurance – Accident Coverage
Accident Insurance coverage provides expense reimbursement for charges up to $1,000.
Accidental injuries, hospital care and accidental death are covered even when they occur outside of the workplace.
Coverage is available to the insured employee as well as their spouse and dependents
Benefit AmountGround AmbulanceHospital Indemnity
Up to $1,000/accident$150$150
GAP Insurance – Critical Illness and Cancer
Voluntary Critical Illness and Cancer is a group policy that provides coverage for heart complications, strokes, cancer and critical illnesses.
Health Screening Benefit: pays annually for covered health screenings $150 per insured person
Benefit Amount EESpouseChild
$5,000$2,500$2,500
GAP Insurance – Supplemental Health
Supplemental Health coverage provides indemnity benefits for hospitalization and the intensive care unit (ICU).
Benefits are paid directly to you, and you can use the cash however you want. It’s that simple.
The maternity waiting period is 300 days
The average hospital stay is 4.8 days
Hospital Indemnity Benefit AmountFirst Hospital Occurrence (per year)
$200/day first 15 days$500/day up to 4 days
Dental
Important Dental Notes
Be sure to request a pre-treatment authorization and/or estimate before any major dental work. This way you will be aware of your out-of-pocket costs. Your provider’s office can assist you with this.
Payments toward preventive, basic and major dental services apply toward your annual calendar year maximum.
The calendar year maximum is the total amount paid each year by your insurance company for each family member enrolled in the dental plan.
Vision
Basic Term Life and AD&D Insurance Employer Paid
Life Insurance Benefit Amount:1X Annual Salary up to $250,000 maximum benefit
AD&D Benefit Amount: The Principal Sum amount is equal to the amount of life insurance benefit
Living Care/Accelerated Benefit: 50% of the amount of the life insurance benefit
Waiver of Premium
Additional AD&D Benefits: Seatbelt and Airbag
Travel Assistance
Conversion
Voluntary Term Life and AD&D Insurance
Voluntary Term Life/AD&D coverage is available without answering medical questions or physical exams up to the guaranteed issue amount for new hires only. Any other employee will be required to provide evidence of insurability.
Note: In order to purchase life coverage for your dependents, you must buy coverage for yourself.(Children include those 14 days old, up to age 21 (26 if a full-time student)). In order to enroll in AD&D insurance, you must also enroll in Voluntary Life insurance.
Coverage Guidelines
Employee Spouse Child(ren)
Minimum $10,000 $5,000 $2,000
Maximum 5X Annual salary, up to $500,000
100% of employee’s
benefit, up to $100,000
$10,000
Guarantee Issue Amount
5X Annual salary, up to $140,000
50% of employee’s benefit, up to
$25,000
$10,000
Voluntary Short-Term Disability Insurance 100% Voluntary and Employee Paid
Elimination Period: Benefits begin on the 15th day of your disabling injury or illness
Weekly Benefit: 60% of your pre-tax weekly earnings, not to exceed the plan’s maximum benefit amount ($1,500)
Maximum Benefit Period: Short-Term Disability benefits are available for up to 11 weeks
Features: Partial Disability Benefit, Vocational Rehabilitation Benefit, Survivor Benefit, Waiver of Premium, Portability
Pre-existing Conditions: Disabilities that occur during the first 6 months of coverage due to a pre-existing condition during the 3 months prior to coverage are excluded
Voluntary Long-Term Disability Insurance 100% Voluntary and Employee Paid
Elimination Period: Benefits begin 90 days after the onset of your disability
Weekly Benefit: 60% of your pre-tax weekly earnings, not to exceed the plan’s maximum benefit amount ($6,000), less other income sources
Maximum Benefit Period: If you are disabled prior to 62, benefits are payable until age 65 (or your Social Security Normal Retirement Age). At 62+ the benefit period will be based on a reduced duration schedule
Definition of Disability: Own Occupation is 24 months
Features: Partial Disability, Vocational Rehabilitation, Survivor, Waiver of Premium, Alcohol & Drug Abuse, Mental Disorders
Pre-existing Conditions: Disabilities that occur during the first 12 months of coverage due to a pre-existing condition during the 3 months prior to coverage are excluded
Employee Assistance Program
• 24/7 live answer by Master’s level clinician
• Online tools and resources• Preserves the employee’s behavioral
health benefit by using EAP first• Follow-up calls at 7 and 45 days to ensure
employee needs are met
Winter offers a variety of tools that are designed to help you and your family members successfully manage life’s challenges by identifying options and making informed choices.These programs are confidential and voluntary and offered at .
• Chaplains on call 24/7/365
• Regular work site visits along with hospital, home or neutral site visits when appropriate
• Employee and immediate family may contact chaplains regarding anything they need help with, whether it is work-related or personal
1-800-316-2796
1-866-440-6556
(678)634-9236
Legal Shield & Identity Theft Shield LegalShield
Unlimited advice
Letters written and calls placed on your behalf
Documents reviewed
Representation for traffic infractions
Uncontested separation, divorce, adoption
Child custody support
Mortgage documents prepared for personal residence
Online resources
Trial defense & IRS audit assistance
Wills and trusts prepared
Identity Theft Shield• Credit monitoring with activity alerts
• Credit report with score & analysis
• Credit report consultation
• Identity restoration services
• Fraud alerts
• Safeguard for minors
The new fees are for new enrollees only, if you are already enrolled, your prices will not change.
LegalShield
Identity Theft Shield
Individual (weekly)
$1.95 $2.99
Individual(bi-weekly)
$3.91 $5.98
Family (weekly)
$2.19 $3.92
Family(bi-weekly)
$4.38 $7.83
Wellness TimelinesActivity Recommended Deadline
Change 401(k) contribution amounts 1/1/2016
Go online to establish HealthiestYou accounts for you and your family
1/1/2016
Download the MyHumana App 1/8/2016
Log on to Humana.com 1/8/2016
Create a user ID and password 1/8/2016
Take your Health Assessment 1/8/2016
Set your goals 1/8/2016
Complete your Biometric Screening 1/22/2016
Earn Vitality points via activities 1/1/2016-8/31/2016
Achieve Silver Vitality Status 8/31/2016
Summary This year’s Open Enrollment is passive – you need to actively enroll if you
want to enroll for the first time, change plans, change coverage levels or renew your FSA for 2015
Cards for your medical plan and HSA will be distributed in January for new members. No new cards will be issued for existing members
Use Humana.com and Health Advocate to help you find in-network providers. Avoid paying more for out-of-network services
You will be able to register online at Humana.com starting 1/1/16 in order to start earning Vitality points and access your plan information/letters of coverage
The HealthiestYou telemedicine benefit can help reduce your medical expenditures
HSA contributions matched January and July
Vitality – Keep our employees healthy!
401(k) – Don’t leave money on the table. Take advantage of your Winter Company Match by increasing your 401(k) contribution to 6%.
Questions? Comments?