foothill community health center / nonstop … wellness benefits snapshot...foothill community...

© 2017 Nonstop Administration and Insurance Services, Inc.

2017–2018 Benefits Snapshot

Foothill Community Health Center / Nonstop Wellness Benefits Guide

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Nonstop Wellness Benefits Guide


Medical Insurance: Nonstop Wellness + Kaiser (Kaiser DHMO 9150 as the underlying plan – See plan details in Appendix C of full benefits guide)

Plan Highlights In-Network Out-of-Network

Calendar Year Annual Deductible Covered under NSW plan Individual / Family $5,500 / $11,000 Not Covered

Calendar Year Out-of-Pocket Maximum Covered under NSW plan

Individual / Family $6,850 / $13,700 Not Covered

Lifetime Maximum

Individual / Family None None

Professional Services You Pay Cost after Deductible Paid

Primary Care Physician (PCP) Cost Covered by NSW Not Covered

Specialist Cost Covered by NSW Not Covered

Preventive Care Exam Cost Covered by NSW Not Covered Well-baby Care Cost Covered by NSW Not Covered

Maternity Services Cost Covered by NSW Not Covered

Diagnostic X-ray and Lab Cost Covered by NSW Not Covered

Complex Diagnostics (MRI / CT Scan) Cost Covered by NSW Not Covered

Therapy, including Physical, Occupational & Speech

Cost Covered by NSW Not Covered

Hospital Services

Inpatient Cost Covered by NSW Not Covered

Outpatient Surgery Cost Covered by NSW Not Covered

Emergency Room (if not admitted to hospital)

$100 Copay Not Covered

Urgent Care Cost Covered by NSW Not Covered

Mental Health & Substance Abuse

Inpatient Cost Covered by NSW Not Covered

Outpatient – Individual Cost Covered by NSW Not Covered

Outpatient – Group Cost Covered by NSW Not Covered

Prescription Drugs (30-day supply/retail and preferred retail pharmacies; 90-day supply/mail-order)

Generic Cost Covered by NSW Not Covered

Brand Cost Covered by NSW Not Covered

Specialty Cost Covered by NSW Not Covered The above information is a summary only. Please refer to your Evidence of Coverage for complete details of Plan benefits, limitations and exclusions.

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Chiropractic/Acupuncture Benefits – Landmark Healthplan (provided with and mirrors enrollment in Nonstop Wellness) Your Employer Group has contracted with Landmark Healthplan of California, Inc. (Landmark) to provide you with a combined chiropractic and acupuncture benefit that requires the use of Participating Chiropractors and Acupuncturists. You can obtain a list of Participating Chiropractors and Acupuncturists through a continuously updated directory on Landmark’s Web site at www.LHP-CA.com under the “Member” option. You may also call Landmark’s Customer Service Department at 1-800-298-4875 for referrals to Participating Practitioners in your area.

Free Language Assistance is Available If you need help in understanding your Landmark chiropractic or acupuncture benefits or need help to handle an issue about your benefits, please contact Landmark’s Customer Service Department at 1-800-298-4875 between 5:30am and 5pm, Monday through Friday, for help. We can also help you in languages other than English. If you or your dependents would like Landmark and your doctor to use a specific language when speaking or writing to you, please go to http://www.LHP-CA.com/Survey.aspx on the Internet and complete Landmark’s brief language preference survey. The survey only takes about 3 minutes to complete and your answers will be strictly confidential. If you prefer to complete a paper copy of this survey, you may request one by writing to us at:

Landmark Healthplan of California, Inc. Attn: QM Dept. – SURVEY

P.O. Box 130028 Sacramento, CA 95853

SUMMARY OF BENEFITS

Office Visit $0 copay

Maximum Annual Visits 30 visits

X-ray Services* $75 annual maximum benefit

Emergency Care** Same copayment as office visit

Durable Medical Equipment Purchase or Rental*** $50 annual maximum benefit

Acupuncture Herbal Therapies**** $5 copayment per bottle / $500 annual max benefit

* X-ray Services must be prescribed by a Participating Chiropractor ** Services provided by Non-Participating Practitioners are covered for Emergency Services only *** Durable Medical Equipment must be prescribed by a Participating Chiropractor **** Herbal therapies must be prescribed by a Participating Acupuncturist

http://www.lhp-ca.com/

http://www.lhp-ca.com/Survey.aspx

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Dental Benefits – Cigna Dental insurance coverage is provided by Cigna. Cigna’s PPO network is the largest nationwide. Contracted dentists will only charge their negotiated fee for services, this means lower out-of-pocket costs for you.

Dental PPO The PPO plan gives you the freedom to see any dentist but members will receive the greatest savings when staying in-network.

Dental HMO DHMO members pay a fixed copay for each covered service. Member must select a General Dentist to oversee all services. Referrals to Specialty Care Dentists are managed by the General Dentist (Primary Care Dentist).

SUMMARY OF BENEFITS

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Vision Benefits – Cigna Vision insurance coverage is provided by Cigna. The Cigna Vision network offers preferred provider access points nationwide in retail, neighborhood, medical and professional settings. Cigna Vision preferred providers offer the best value with exclusive discounts and one-stop shopping which includes exams and a great selection of eyewear.

SUMMARY OF BENEFITS

In-Network Out-of-Network

$10 copay Plan pays up to $45

$10 copay

Lens Replacement (every calendar year) Reimbursement Varies

Single Vision Plan pays up to $32

Bifocal Plan pays up to $55

Trifocal Plan pays up to $65

Frame Replacement (every calendar year) Plan pays up to $130 Plan pays up to $80

Contact Lenses (in lieu of glasses, every calendar year)

Group No. 3338640 1-866-494-2111 www.cigna.com

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Life and Disability Insurance – Mutual of Omaha Foothill Community Health Center offers Life and AD&D Insurance coverage through Mutual of Omaha for all eligible employees. Life and Disability benefits are fully paid by Foothill Community Health Center.

Age Reductions And Exclusions Your life insurance benefits and guarantee issue amounts are subject to age reductions. At age 65, amounts reduce to 65%. At age 70+, amounts reduce to 50%. Coverage terminates at retirement. Information about the AD&D exclusions for this plan will be included in the summary of coverage, which you will receive after enrolling. Please contact your employer if you have questions prior to enrolling

SUMMARY OF BENEFITS

Accident & Wellness – Aflac Voluntary benefits are provided to Foothill Community Health Center employees through AFLAC. Please visit Benefits website for plan details.

Accident Indemnity Advantage

Hospital Advantage Preferred

Special Health Event

Cancer Care

Retirement Savings/ 401(k) – Principal Financial

Flat $50,000 maximum amount Flat $50,000 maximum amount

Group No.: G000AZQX 800-655-5142 www.mutualofomaha.com

Group Numbers: Accident Indemnity Advantage-A35000 Hospital Advantage Preffered-A49000 Cancer Care-A78000 Special Health Event-A71000

Phone Number: 1-800-992-3522 Lee Young - leeaflac66 @gmail.com - 408-391-2124

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Foothill Community Health Center offers full time and part time employees, 21 years and over, access to participate in the company’s 401(k) with Principal Financial Group. Employees are eligible to participate after 90 days of hire. Employees are welcomed to contribute any percentage or specific amount of their paycheck to the 401(k) and FCHC will contribute up to 4%. Part-time employees must work minimum of 1,000 hours during the calendar year in order to be eligible for the 4% company match. For all eligible employees, the annual maximum contribution for 2018 is $18,500. For employees over the age of 50, the annual maximum contribution is $24,500. However, there is a cap on the match the agency offers. For employees whose annual wages (gross) reach $250,000 for the calendar year, the FCHC 4% match for that year will stop until the following year. Employees who reach this cap, can still choose to continue contributing to their 401(k) account with no match liability from FCHC. Employees have 100% ownership of their contribution to the 401(k), but if an employee leaves FCHC before three years of employment, the company will take back the funds contributed by the principal. The annual maximum contribution for 2018 is $18,500 for all eligible employees, and for employees over the age of 50 the annual contribution maximum is $24,500

Employee Assistance Program – Mutual of Omaha An Employee Assistance Program is available for all eligible employees through Mututal of Omaha’s Basic Enhanced Employee Assistance Program (EAP). The Mutual of Omaha EAP has trained professionals to work with you as you search for solutions to personal and workplace issues. Plan highlights include:

Unlimited phone access to EAP Professionals 24 hours a day, seven days a week.

Service for employees and eligible dependents

Three face-to-face sessions with a counselor

Legal Assistance and Financial Services

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Eligibility Requirements

Medical, Dental, and Vision Benefits begin the first of the month following 60 days. Regular full-time employees and employees who work 24+ hours/week are eligible. Eligible dependents are: Spouse or registered domestic partner; Children up to age 26; any dependent child who is incapable of self support because of mental or physical disability. For employees who show proof of secondary medical coverage and wish to waive their medical, dental and vision they will receive a monthly stipend of $100 per month. Foothill Community Health Center Open Enrollment is held every year. At Open Enrollment, you can make changes to your benefit plan elections such as adding or deleting your spouse and dependents and changing health plans. However, Qualifying Events (Marriage, Divorce, Birth or Adoption, Death and Loss of Coverage), allow you to make changes outside of the Open Enrollment period. If you experience a Qualifying Event after open enrollment, you must notify Human Resources within 30 days, otherwise you will be required to wait until the next Open Enrollment to make any changes to your benefit plan elections. If you have questions or unresolved issues after contacting member services at one of our insurance providers, you are welcome to reach out to HR, Filice (Dental/Vision), Nonstop (Medical) or Aflac (Accident & Wellness). They will answer any questions you may have concerning your employee benefits, claim problems and administrative issues.

Human Resources: Jiguett Sanchez Ana Robledo

[email protected] [email protected]

(408) 729-4290 (408) 729-4290

Filice Insurance: John Garcia Rosa Ceja

[email protected] [email protected]

(408) 238-1206 (408) 350-5720

Nonstop: Rachel Johnson [email protected] (503) 329-9119

Aflac: Lee Quisenberry [email protected] (800) 992-3522

foothill community health center / nonstop … wellness benefits snapshot...foothill community...

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