zimmer biomet nw -...

1

Employee Benefit Guide

Plan Year: 8/1/2017—7/31/2018

www.ZBNWBenefits.com

Zimmer Biomet NW

Employee Benefits Guide

Valorie Ramaley

Director HR/ Finance [email protected] T: 800.321.6992 x.1003

Broker Contact Info

LBG Advisors LLC

Matt Christensen

E: [email protected]

T: (425) 778-2800

Employer Contact Info

Table of Contents

Employee Benefits Guide Introduction 3

Group Plan Coverage Eligibility 4

Employee Benefit Contacts 5

Network Information 6

Medical Benefits Summary 7

Prescription Drug Plan Summary 8

Dental Benefits Summary 9

Life Insurance Information 10

Vision 11

Coordination of Benefits 12

Section Page


Employee Benefits Guide Introduction

This benefits guide is meant to be an aid to help you

better understand the Zimmer-Biomet NW benefits

package and how to utilize it when you need to.

Zimmer-Biomet NW has retained the services of LBG

Advisors, LLC to help design the plan and assist em-

ployees in understanding how to use the plan.

This booklet will briefly highlight the major points of

the benefit plan Zimmer-Biomet NW sponsors and it

is not intended to replace your detailed insurance con-

tract or other insurance provider coverage booklets.

The information is provided for informative,

illustrative and comparative purposes only and should

be used for ‘casual’ reference. Your actual benefits are

subject to the terms and conditions of each insurance

carrier’s actual contract.

We at LBG Advisors, LLC are here for you and your

dependents and available to answer any questions you

may have regarding your benefits and coverage.

Please do not hesitate to contact us and use our

services if you have need.

Broker/Consultant Info:

LBG Advisors, LLC

4100 194th St SW, Suite 380

Lynnwood, WA 98036

Toll Free: (877) 485-2120

Fax: (877) 396-4283

Visit us at :

www.lbgadvisors.com

3

3

4

Group Plan Coverage Eligibility

Employee Benefit Guide

Determining Eligibility Employees and their dependents are eligible for coverage on the first of

the month following the waiting period of 30 days of employment.

How Do You and Your Dependents

Become Covered?

To become a covered person, you must complete and sign an enroll-

ment form within the first 31 days of the employer’s eligibility waiting

period as designated above. If you are adding a dependent after your

initial enrollment, you must complete and sign a new enrollment form

or an enrollment change form. You can obtain these forms from your

HR Department.

Plan Coverage Deadlines

Benefit enrollments and enrollment changes must be made either a)

during the annual open enrollment period (the month of November

before the plan year renews on January 1st), or b) within 31 days of the

end of the waiting period after one is hired full-time, or c) within 31 days

of a qualifying event.

Qualifying Events

1. A change in the employee’s legal marital status (includes marriage,

death of a spouse, divorce, legal separation, and annulment) as well as

change in status of domestic partners.

2. A change in the employee’s number of dependents (includes a new

birth, a new legal adoption or legal placement for adoption, and the

death of a child).

3. Loss or gain of other coverage.

If you have any other questions about plan eligibility,

deadlines, or qualifying events please ask your

HR Department.

4


To the right is a table showing the

contacts for employees listed by

plan component.

If you have questions regarding

your benefits, bills, or another re-

lated matter, please first call the

appropriate toll-free customer ser-

vice number.

If you have tried contacting your

plan and still cannot get resolution

to your issue, please call or email

LBG Advisors at :

Phone: 877-485-2120

Email: [email protected]

Cell: (206) 228-4587

Benefits Contact Overview:

Employee Benefits Contacts

Medical

Administrates the medical cover‐

age. Call this number for claims

help/customer service or if you

have any questions about the de‐

tails of your medical coverage and

claims information.

Meritain Health

(800) 925‐2272

(800) 566‐9311

www.MyMeritain.com

Local Medical Network

Provides the preferred provider net-

work for In-Network provider use. Call

this number for claims customer ser-

vice or if you have any questions about

the details of your provider network.

Aetna Choice POS II Network

(800) 343-3140

http://www.aetna.com/dse/

search?site_id=mymeritain

Prescription Coverage

Administrates the prescription drug

services. They also administrate the

mail order program, useful if you are

on maintenance drugs.

Magellan Health Services

(800) 424-5828

www.magellanhealth.com

Healthcare Plan Consultants

Oversees the benefits plan as a whole.

If you do not receive satisfaction from

any of the above company’s customer

service systems, please call us.

LBG Advisors, LLC

Matt Christensen, Lead Advisor

Kris : Client Services x 303

Stacie : Client Services x 314

Toll Free: (877) 485-2120

www.lbgadvisors.com

Life Insurance Guardian

888-600-1600

Dental

Administrates the dental plan. Call

this number for claims customer ser-

vice or if you have any questions about

the details of your provider network.

Guardian

888-600-1600

Vision Guardian / VSP

888-600-1600

5


Other Info:

• Networks can change frequently and

providers can enter or exit a network

yearly (or even in the middle of the

year).

• The table to the right shows the

networks currently in place on your

benefit plan

• Please confirm network participation

with the network and your provider

• In network benefits are typically

better than out of network benefits

Please see provider insurance booklets and

Summary Plan Description (SPD) for the

detailed benefit description and exclusions. This

guide is not a guarantee of coverage or benefits.

Summary Plan Description supersedes any

information found in this employee benefits

guide.

This is only a partial illustration or overview of

the policy and is not a legal document.

Local and Out of Area Networks

Your plan has contracted with a different network based on

locations to customize the networks for the best selection of

preferred providers and hospitals .

Outside of Washington the network used will be Aetna National

Network.

To determine if a provider is in the network you can call the net-

work directly or visit the website. Patients will receive the highest

level of benefits available when a preferred provider is utilized

instead of a provider who is not.

Urgent Care Services

Urgent care facilities can often treat urgent needs without all of the has-

sle of the emergency room for a lower co-pay than the hospital.

Emergency Services—Out of Area Services

When you are out of service areas and need emergency care, simply go to

the nearest emergency facility and get the necessary care. These types of

services are considered In-Network as to the benefit levels for necessary

emergency services provided at any hospital.

Your Preferred Provider Organization (PPO)

PPO Network Overlay

PPO– Local network based on

location Aetna POS II Network

Washington

1 (800) 343-3140

www.aetna.com

PPO - Outside of Your State

Access:

Services rendered within the PPO

Network enjoy the highest levels of

benefits. Use this network if you are

outside WA area and need non-

emergency care.

Aetna

www.Aetna.com

Phone: 800-343-3140

6


Quick Notes:

Your medical insurance plan is

administrated by Meritain.

The PPO plan design carries a per

person calendar year deductible of

$500 and a individual maximum

out-of-pocket of $2,000 (both

figures assume Network Provider

use)

The coinsurance level begins after

the deductible has been reached,

again assuming you are using a

Network Provider. See percentages

in table to the right.

New H.S.A. as of 8/1/17 – deductible

must be satisfied before copay and

coinsurance applies. Preventative

still covered 100%







guide.



Medical Benefits Summary‐

Medical Benefits Summary (PPO)

ZB NW Participant

Deductibles per Calendar

Year*

PPO- $500 / $1500 (In network)

H.S.A $1300/ $2600 (In network)

Out-of-Pocket Maximum per

Calendar Year

PPO— $2,000 / $6.000 (In-Network)

H.S.A—$2,600 / $6,000 (In-Network)

Covered Services In‐Network Provider Non‐Network

Provider

Primary Care $20 copay 40% co-insurance

Professional Office Visits $35 copay 40% co-insurance

Preventative Care 100% Covered

(No Copay) 40% co-insurance

LAB and XRAY – 20% co-insurance 40% co-insurance

Inpatient Hospital Stay 20% co-insurance 40% co-insurance

Outpatient Surgery 20% co-insurance 40% co-insurance

Facility Fee/ Hospital Stay 20% co-insurance 40% co-insurance

Prenatal/ Postnatal 20% co-insurance 40% co-insurance

Emergency Room Services $100 co-pay + 20% co-

insurance 40% co-insurance

Urgent Care $40 copay 40% co-insurance

Ambulance Service 20% co-insurance 20% co-insurance

Most Other Covered Expenses 20% co-insurance 40% co-insurance

7


Quick Notes:

Your prescription Drug Program is

administered by Magellan Health

Services.

Contact Magellan at: 800-424-5828

www.magellanhealth.com

Please talk to your doctor about

using generic alternatives to brand

name drugs.

Please also talk to your doctor

about using Over The Counter

(OTC) drugs.

A full formulary is available from

Magellan Health Services.







guide.



Prescription Drug Program

Prescription Drug Program Summary

Rx Benefit

Tier 0:

OTC

Tier 1:

Generic

Tier 2:

Preferred

Brand Name

Tier 3:

Specialty

Retail Pharmacy

34 Day Supply

$5 co-

pay $25 copay $50 copay

20% copay

Up to max $400

per fill

Mail Order Phar-

macy

90 Day Supply

$15 co-

pay

$75 copay

$150 copay

20% copay

Up to max $400

per fill

8


Quick Notes:

Your Dental Benefits are

administered by Guardian

888-600-1600 Group # 00541304.

Staying in network may make your

total annual max benefit stretch

further.

Please remember to have your

dentist Pre-Authorize any large

procedure before you have that

procedure done.







guide.



Dental Benefits Summary

Dental Benefits ‐ Guardian

Annual Max. Benefit $1,500 per member

Orthodontia Lifetime Benefit

(Dependent Children only) $1,000 per member

Dental Benefit Coinsurance Levels

Class A

Preventive Services

100%

Oral Evaluations

Prophylaxis and Fluoride

Bitewings (adult/child)

Sealants

All Other X-Rays-Panoramic 1 every 5

years

Class B

Basic Services

80%

Consultations

General Anesthesia

Fillings and Restorations

Oral Surgery

Simple and Surgical Extractions

Root Canal

Deductible: $50 individual -$150 family

Class C

Major Services

50%

Bridges and Crowns

Dentures and Implants

Inlays and Onlays

Deductible: $50 individual -$150 family

Class D

Orthodontia

50%

9


Quick Notes:

The group term life coverage is

provided by the Guardian







guide.



Ancillary Group Coverage:

Life Insurance Information

Guardian

Life ‐ AD&D

Basic Life Coverage

Amount

Your Basic Life coverage amount is $10,000, $20,000, or

$50,000 depending on your employee class. See human

resource department for additional details.

Basic AD&D Cover‐

age Amount

For a covered accidental loss of life, your Basic AD&D

coverage amount is equal to your Basic Life coverage

amount. For other covered losses, a percentage of this

benefit will be payable.

Benefits and Features

Waiver of Premium If you become totally disabled while insured under this

plan and under age 60, and complete a waiting period of

180 days, your Basic and Additional Life Insurance may

continue without premium payment until age 65 pro-

vided you give us satisfactory proof that you remain to-

tally disabled.

Accelerated Benefit If you become terminally ill, you may be eligible to re-

ceive up to 75 percent of your combined Basic and Addi-

tional Life benefit to a maximum of $500,000.

Portability If your insurance ends because your employment termi-

nates, you may be eligible to buy portable group insur-

ance coverage.

Conversion If your insurance ends or reduces, you may be eligible to

convert your life insurance to an individual life insur-

ance policy without submitting proof of good health.

Age Reductions Basic Life and AD&D insurance coverage amounts re-

duce by 35 percent at age 65 and by 50 percent at age

70.

10


Quick Notes:

You do not need a member card.

Just tell provider you have Metlife

Vision.

Members can go to any licensed

vision specialist and receive cover-

age. Just remember your benefit

dollars go further when you stay in

network.

Costco Optical Available (see grid)

Walmart or Sam’s club will process

claims even though they are out of

network.

Members receive additional 20%

savings on amount that you pay

over allowance (some locations

may not participate– check with

customer service)

See Vision Tab on benefits website

for full details , official insurance

provider document., and out of

network reimbursement amounts.

Ancillary Group Coverage:

Vision Coverage Information

Guardian / VSP

Vision

Provider Search VSP.com

Phone: 888-600-1600

Benefits and Features

Eye Exam

(once every 12 mon)

Exam, dilation, prescription, and refraction for glasses.

Covered in full after $10 copay.

Retinal Imaging Up to $39 copay on routine retinal screening when

performed by a private practice provider.

Frames

(once every 24 mon)

Allowance up to $130 after $25 copay.

Costco Frames $70 Allowance after $25 copay.

Standard Corrective

Lenses (once every

12 months)

Single vision, lined bifocal, lined trifocal, lenticular.

Covered in full after $25 Copay.

Standard Lens

Enhancements

(once every 12

months)

Polycarbonate (child up to 18) and UV Coating. Covered in full after $25 copay.

Contacts

(once every 12 mon)

Contact fitting and evaluation. Covered in full with max copay of $60. Elective Lenses $130 allowance Necessary Lenses: Covered in full after eyewear copay.

Coverage Termina‐

tion

Coverage will terminate when you terminate employment

with this policyholder or at your retirement.

11

12

The Zimmer‐Biomet NW benefit plan is the

“primary” insurance for the employee.

If a spouse or dependent has other medical cov-

erage through an employer or other source, that

“plan” is the primary insurance to the spouse or

dependent.

The Zimmer‐Biomet NW plan does offer coor-

dination of benefits as a secondary payer to de-

pendents that have primary medical coverage

through an employer or other source.

If an employee has “secondary” coverage

through a spouse, dependent upon the plan de-

sign of the spouse’s coverage, they may be able

to submit an “Explanation of Benefits” (EOB) to

the spouses coverage for coordination of bene-

fits if the spouse's plan allows.

Coordina�on of Benefits

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

This guide is not a guarantee of coverage or benefits.

Summary Plan Description supersedes any information found in this employee benefits guide.

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.

12

zimmer biomet nw -...

Documents