mainvue homes employee benefits plan overview meeting date ...€¦ · 2018-2019 plan summary 2...

MainVue HomesEmployee Benefits Plan OverviewMeeting Date: 09/14/2018

Meeting Agenda 9/14/2018

Overview / Role of LBG Advisors

Open Enrollment Period / Qualifying Events

Medical Plan Highlights / Review (PPO/H.S.A)

Locating In-Network Providers

Health Savings Account (HSA)- Program Overview

Life, STD, LTD Overview

Eye-Med Vision Overview (SAME- No Change)

Life-Map Dental Overview (SAME- No Change)

Employee Assistance Program from Life-Map

(SAME- No Change)

Overview/ LBG Advisors

Overview / Role of LBG Advisors

LBG Advisors has worked with MainVue for 7 years

Our Role: Help design benefit plan Negotiate on companies behalf Help implement all programs Provide on-going education and support to employees moving

forward We are your advocate and extension of HR Department

All Contact information posted:

www. MainVueBenefits.com

Lead Consultant Account Manager Claims Assistance Office Location

Matt [email protected]

Kris [email protected]

Stacie [email protected]

Lynnwood WA

425.778.2800

Open Enrollment Information

Enrollment or Coverage Change Summary

Open Enrollment 9/7/18- 9/21/18

The 1x per year each employee can change their coverage levels without a qualifying event. (Next open enroll Sept 2019)

All Employees Must Login to Paycom and Confirm Benefits by 5pm on 9/21/18

Qualifying Events Throughout The Year

Any time you have a life event in your family you have 30 days to notify Human Resources and make a change to your enrollment

Qualified Events include:

Newborn baby or adoption

Marriage or divorce

Child is on their own plan or over age 26 and is no longer considered a dependent

If you fail to make this update you must wait until the next open enrollment period to make the change

Medical Plan Highlights

2018-2019 Plan Summary

2 Plan Options: H.S.A. or PPO (same as 2017/2018)

2018/2019 Estimated Increases: 7.0% PPO / 8.55% H.S.A.

MainVue pays employee cost and contributes to account for H.S.A. $83 per month ($1,000 for the plan year)

Medical Plan Overview PPO Plan HSA/High Deductible

Health Plan (HDHP)

Rate Information See rate sheets See rate sheets

Plan Design co-pay / co-insurance PPO Pay all expenses up until

deductible met (then

generally 80/20 until max

our of pocket)

Network Same as prior year plan Same as prior year plan

MainVue continues to pay 100% of employee premium on all benefit lines

Account n/a $1,000 account

contribution by MainVue

Select Schedule of Medical Benefits

Disclaimer: Please see provider insurance booklets and Summary Plan Description (SPD) for the detailed benefit description and exclusions. Summary Plan Description supersedes any information found in this employee benefits guide / education power-point. This is only a partial illustration or overview of the policy and is not a legal document. See SBC for out of network benefit levels. Above are in-network only.

In-Network Comparison PPO Plan H.S.A. / HDHP (New)

Office Visit- Primary Care $30 co-pay (see Regence SBC) Deductible, then plan pays 80%

Office Visit- Specialist $30 co-pay (see Regence SBC) Deductible, then plan pays 80%

Chiropractic 20% co-insurance (plan pays 80%) Deductible, then plan pays 80%

Rx (Generic, Brand, Specialty) Co-pay of $10 / $35 / $75 Deductible, then plan pays 80%

Urgent Care $30 co-pay preferred/ $45 co-pay participating Deductible, then plan pays 80%

Ambulance 20% co-insurance Deductible, then plan pays 80%

Emergency Room $100 co-pay then 20% co-insurance Deductible, then plan pays 80%

Hospital Room 20% co-insurance Deductible, then plan pays 80%

X-Ray / Blood Work No Charge first $400 / then 20% co-pay Deductible, then plan pays 80%

Imaging (CT, PET, MRI) No Charge first $400 / then 20% co-pay Deductible, then plan pays 80%

ACA PreventativeNo Charge In-Network

(see list on Regence.com)

No Charge In-Network

(see list on Regence.com)

Deductible (Individual / Family) $1,000 / $3,000

$1,500 / $3,000

(If on non-individual plan, must meet family

deductible amount for any benefits to begin –

See Regence SBC)

Max out of pocket (Ind. / Fam.) $4,500 / $9,000 $5,000 / $10,000

HSA/HDHP plan overview

What is a Health Saving Account (HSA)/ HDHP?

A Health Savings Account (HSA):

Set aside a portion of your paycheck—before taxes—into bank account you own

Reduces Taxable Income (w2 decrease through payroll / tax form if direct contribution)*

Funds may be invested in mutual funds yielding tax free earnings* (see HealthEquity website for details and fund options– min balance $2,000)

Help you pay for qualified medical expenses for you and your dependents tax free

Rolls from year to year

It is your account – even if you leave MainVue

It can also help you plan for future medical expenses including Medicare premiums (run alongside your 401k)

An HSA PLAN is made up of two parts:

High Deductible Health Plan (min of $1350/$2700 min for 2018)

Health Savings Account

*LBG Advisors are not tax advisors. Please consult your tax advisor for details.

Health Saving Account (HSA) Details

MainVue will fund $83 per month into the HSA account for employees

Both employers and employee can contribute to HSA

2018 Limit $3,450 Ind. / $6900 Family (2019 $3500 / $7,000)

(Pro-Rated may apply if you are not participating in H.S.A. medical plan as of 12/1/19 – see IRS pub 502)

If 55 or older, add $1,000 to limits above

Employees:

Control HSA disbursements (not a reimbursement program)

Will receive a debit card for HSA funds or can use bill-pay feature online

Will be responsible to save all receipts for tax audit purposes

If you are disabled or reach age 65, you can receive non-medical distributions without penalty, but you must report the distribution as taxable income. Early withdrawals = 20% penalty

The list later in this PowerPoint shows common examples of qualified medical expenses. Complete lists of eligible and non-eligible expenses can be found in IRS Publication 502, which can be ordered from the IRS by calling 1-800-TAX-FORM (1- 800-829-3676) or by visiting www.irs.gov.

Acne treatment*AcupunctureAllergy & Sinus medication*Antacids*Antibiotic ointment*Anti-diarrheal*Antifungal foot cream*Anti-gas medication*Anti-itch cream/gel*Antiseptic* Asthma treatment*Bandages/gauzeBirthing classes or LamazeBlood pressure monitor Braces (knee, ankle, wrist)Breast pumpBurn cream*Chiropractic servicesCoinsurance Cold/hot packCold sore treatment*Cold/cough medication*Compression stockings

Contacts & solutionsCopaysCPAP machineCrutchesDeductiblesDental services Diabetic suppliesDiaper rash ointment*Digestive Aids*Drug addiction treatmentEar wax removal kits*Eye dropsFeminine Anti-Fungal/Anti-Itch*First Aid KitFlu shotsGroup therapyHearing aids & suppliesHemorrhoid medication*Hormone therapyHospital feesHumidifiersImmunizationsIncontinence supplies Individual counseling

Insect bite treatment*Lab workLactation ConsultantLactose intolerance pills*Laser eye surgeryLaxative*Lice treatment products*Massage therapyMedical records Motion sickness relief*Nasal stripsNaturopathic visitsOrthodontiaOrthotic insertsOxygen and equipmentPain relievers*Parasitic treatment*Physical examsPhysical therapy Pregnancy testPrenatal vitaminsPrescription drugsPrescription glassesReading glassesRespiratory Treatments*

Saline nasal spraySleep Aids & Sedatives*Sleep deprivation treatmentSmoking cessation products*Smoking cessation programs Speech therapyStool softener*ThermometerThroat lozenges*Vision careWalker Wart treatment*Wheelchair & repairX-rays

Here is a common list of expenses that are approved. Items marked with an asterisk (*) are considered over-the-counter (OTC) medicines or drugs and require a prescription for reimbursement.

Eligible Expenses

Keep Your Receipts!

Eligibility Rules

You are not eligible to contribute to H.S.A if:

If you are claimed as a dependent on someone else’s taxes

You are covered by any other health insurance policies that are not considered High-Deductible Health Plans (HDHPs)

You are currently on Medicare (previous H.S.A. funds can pay Medicare premiums A/B)

If you participate in an unlimited FSA or HRA through your employer oryour spouse’s employer, (Limited or Dependent FSA is allowed with H.S.A)

You and your spouse can each have an HSA if you both have high deductible coverage. If you have family HDHP coverage (Min 2018 deductible $1350 individual or $2700 family), the maximum contribution is split equally unless you and your spouse agree on a different division.

H.S.A. vs PPO (Example #1)

Employee Only Coverage – 2 office visits per year (low usage)

PPO Cost

$30 per office visit = $60

HDHP(H.S.A.) Cost

$150 (est.) per office visit = $300 Company Contribution of $1,000 to H.S.A. Account H.S.A. account would cover entire $300 $700 left over rolls forward (employee owned bank account)

Employee could fund another $2,450 into H.S.A. account thus lowering their taxable income by substantial amount (similar to 401k deduction) -$3450 annual limit less $1,000 Mainvue Contribution


Employee Only Coverage – 2 office visits per year + 4 fills of $500 brand medication (Medium Usage)

PPO Cost $30 per office visit = $60 $75 co-pay x 4 fills = $30 Total paid = $360

HDHP (H.S.A.) Cost

$150 (est.) per office visit = $300 $1200 for medication (100% up to deductible $1500) $160 for medication after deductible (20% of final $800) Total paid = $1660 Less Company H.S.A. contribution of $1,000 Net Paid = $660

Employee could fund another $2,450 into H.S.A. account thus lowering their taxable income by substantial amount (similar to 401k deduction) - $3450 annual limit less $1,000 Mainvue Contribution

In example above, PPO would have been better option with total cost being $360 vs. $660.


Family of 4 Coverage – 2 office visits per year per x 4 members(low usage)

PPO Cost $30 per office visit = $60 4 family members x $60 = $240 Total paid $240

HDHP(H.S.A.) Cost

$150 (est.) per office visit = $300 4 family members x $300 = $1200 Company Contribution of $1,000 to H.S.A. Account H.S.A. account would cover entire $1000 of $1200 Net cost to employee = $200

Employee could fund another $5,900 into H.S.A. account thus lowering their taxable income by substantial amount (similar to 401k deduction)

PPO Family Premium Share is $212.80 more per month ($2553.60 per year)


Family Coverage – 3 office visits per year per member + large facility bill such as $25,000 knee surgery (higher usage)

PPO Cost

$30 per office visit = $90

4 family members x $90 = $360

Knee Surgery Deductible = $1,000

Knee Surgery 10% Co-Insurance on balance of $24,000= $2,400

Total Cost = $3760

HDHP(H.S.A.) Cost

$150 (est.) per office visit = $450

4 family members x $450 = $1800

Knee Surgery Family Deductible = $1200 (remaining up to $3,000)

Knee Surgery 10% Co-Insurance on balance of $23,800= $2,380

Total Cost = $5380

Less Company H.S.A. Contribution of $1,000

Total Net Cost Before H.S.A. Funding/ Tax Savings = $4380

Employee Funds $4380 into H.S.A. and saves 20% in tax of $876

Final Net Cost = $3504 (H.S.A. better option)

PPO Family Premium Share is $212.80 more per month ($2553.60 per year)

Important to Remember on H.S.A: Family deductible must first be satisfied for additional benefits to apply (i.e. one person could use up the entire $3,000), then 90/10 or 80/20 formula applies

Ineligible Expenses

Generally speaking, things that are hygienic or cosmeticin nature are not eligible. Some Items that are hygienic:

Toothbrushes

Toothpaste

Toiletries

Some items that are cosmetic:

Veneers

Teeth whitening / bleaching

Cosmetic Surgery

Locating A Provider: Medical

Finding In-Network Provider

Step 1: www.Regence.com

Step 2: Click “Find a Doctor”

Step 3: Sign in as member (or Visitor Find A Doctor)

Step 4: WA – select Preferred Innova or H.S.A 2.0

Step 4: TX – select National Bluecard PPO

Alternative for Texas or When Traveling:

Step 1: http://provider.bcbs.com/Step 2: Enter first 3 digits of card or Select Blue Card PPO / EPO

*It’s critical that you ensure your doctors are covered in network to receive in-network benefits and discount pricingUtilizing Out of Network providers will result in lower benefits and balanced billing to participant.

Doctor on Demand Tele-Health Service

Your health plan includes telehealth powered by Doctor On Demand, a national leader in quality care.

You can talk to any of Doctor On Demand’s board-certified physicians any time by video chat using your computer or the app—24 hours a day, 7 days a week, 365 days a year.

Members who want to access Doctor on Demand will need to register at doctorondemand.com to set up an account

Individuals on the Innova (PPO) plan the cost will be $10 and HSA $49 for medical

Dr on Demand also offers Behavioral health via video chat. Normal copay’s apply for Innova, but for HSA the cost is $79/25 minutes.

Website: https://www.doctorondemand.com/regence-wa

Life, STD/LTD Overview

Life Insurance

No Change in Coverage-Staying with Life-Map

Company pays 100% of employee premium

Disclaimer: Please see LifeMap provider insurance booklets and Summary Plan Description (SPD) for the detailed benefit description and exclusions. Summary Plan Description supersedes any information found in this employee benefits guide / education power-point. This is only a partial illustration or overview of the policy and is not a legal document.

Benefit Information

Life / AD&D 1 x Covered Annual Earnings

Overall Maximum $225,000

Employee Leaves Coverage is terminated

Age Reduction Formula Please see Official LifeMap Benefit Overview

Short Term Disability

No Change in Coverage- Staying with LifeMap



Benefit (weekly) Information

Elimination Period 14 days

Weekly Max Benefit $2,000

Benefit Percentage 60%

Max Disability Period 11 weeks

Long Term Disability

No Change in Coverage- Staying with LifeMap


Long term disability begins after short-term disability ends. You can receive up to 60% of your pre-tax monthly earnings to a maximum of $6,000 a month. These benefits will last until your social security normal retirement age (SSNRA)


Benefit Information

Elimination Period 90 DAYS

Monthly Max Benefit $6,000

Benefit Percentage 60%

Max Disability Period SSNRA

Vision Overview

Eye-Med Vision

No Change- Staying with EyeMed


For provider assistance: EyeMed.com or 866.800.5457

Retailers in-network: Pearle Vision, Lens Crafters, Target, Sears, JCP, Fred Meyer, Glasses.com, ContactsDirect.com, Macys, Ray-Ban.com

Disclaimer: Please see Eye-Med provider insurance booklets and Summary Plan Description (SPD) for the detailed benefit description and exclusions. Summary Plan Description supersedes any information found in this employee benefits guide / education power-point. This is only a partial illustration or overview of the policy and is not a legal document.

Benefit Information Information

Well Vision Exam 1 Per 12 months Co-pay $10

Frames 1 per 24 months $175 allowance

Lens 1 per 12 months included in prescription

Contacts 1 per 12 months $175 Allowance

Dental Overview

Life Map Dental / Ortho

Plan Summary Payment Levels

In-Network Out of Network

(90% of reasonable and customary)

Class A – Diagnostic & Preventive

Exams, Prophys, X-rays (No Deductible!)100% 100%

Class B – Restorative

Restorations, Endodontics, Periodontics, (including

Periodontal Maintenance). Oral Surgery

80% 80%

Class C – Major

Crowns, Dentures, Partials, Bridges 50% 50%

Annual Maximum Per Person

effective/end date$2000 $2000

Deductible

Per person/per benefit period

Annual family maximum

(Applies to B&C Above)

$50

$150

$50

$150

Child Ortho$1500 $1500

(paid at 90th percentile unc)

LifeMap Dental

Pre-Authorization Process

If your dental care will be extensive, you may ask your dentist to complete and submit a request for an estimate, sometimes called a “predetermination of benefits.”

This will allow you to know in advance what procedures are covered, the amount LifeMap Dental will pay and your financial responsibility.

A predetermination of benefits is not a guarantee of payment.

EAP Overview

LifeMap: Employee Assistance Program

Unlimited telephone access to EAP professionals 24 hours a day, seven days a week for items including:

Emotional well-being

Family and relationships

Legal and financial

Healthy lifestyles

Work and life transitions

Stress and resiliency

Depression

Grief

Gambling and other addictive behavior

Legal assistance and financial services

Will preparation

Legal library & online forms

Dependent and Elder Care assistance & referral services

4 Specialist Visits Covered per year (see website)

Contact / Support Information

LBG Advisors

Matt Christensen or Kris Kirkpatrick

T: 425-778-2800 or 877-485-2120

E: [email protected]

E: [email protected]

www.MainVueBenefits.com

Contact Tab

Submit a Question through website

LBG Advisors Disclaimers

Employee Benefits Guide / Employee Education PPT

Please see provider insurance booklets and Summary Plan Description (SPD) for the detailed benefit description and exclusions

This guide / power-point overview is not a guarantee of coverage or benefits

Summary Plan Description supersedes any information found in this employee benefits guide / education power-point

This is only a partial illustration or overview of the policy and is not a legal document

LBG Advisors does not provide coverage

While this guide is believed to be accurate as of the date of first use, plan designs, coverages and vendors may change during or at the end of the plan year. Please consult your HR department for updates to your plan and coverage

LBG Advisors does not provide legal or tax advice

mainvue homes employee benefits plan overview meeting date ...€¦ · 2018-2019 plan summary 2...

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