JANUARY 1 2021 DECEMBER 31 2021 ANNUAL OPEN
JANUARY 1, 2021 – DECEMBER 31, 2021 ANNUAL OPEN ENROLLMENT
Annual Open Enrollment Monday November 30 th Through Friday December 4 th Telephonic & Online Enrollment Benefits Resources Annual Open Enrollment Guide Enrollment is Required Review your current elections and make changes for next year Benefits Service Center Mon – Thurs: 8 am – 6 pm Friday: 8 am – 5 pm 770 -295 -1100 Benefits Website www. jimellisbenefits. com Enrollment deadline is Friday, December 4 th at 5: 00 p. m. 2
Annual Open Enrollment Pre-Tax Benefits Continue • Medical (enrolled in the new plan) • Dental • Vision Enrollment is Required Post-Tax Benefits Continue • Voluntary Life Insurance / AD&D • Voluntary Disability • Accident & Critical Illness 3
What’s Changing Medical – Simple. Pay Health Single plan option All Other Benefits No changes Aetna National PPO network In-network only Copays based on quality of providers 4
Enrollment Information Active Enrollment Required If you don’t enroll: • Medical enrollment in new Simple. Pay Health plan at existing coverage level • All other benefits carry forward to next plan year 5
Medical Coverage 6
Medical Coverage 7
Medical Coverage 8
Medical Coverage 9
Medical Coverage Not all Doctors are the Same • Tremendous variation in quality among doctors • Hospital errors: 3 rd largest cause of death according to Johns Hopkins Simple. Pay Physician Quality Tiers • Complication rates • Readmission rates • Surgical infection rates 10
Simple. Pay Health Choice Meets Quality 11
Simple. Pay Health Know What you Owe Up Front • User-friendly doctor search tool • Corresponding member copays Simple. Pay Mobile App 12
Simple. Pay Health Know What you Owe Up Front • Dedicated Health Pro at your service • Available by phone or app messaging • Your resource for all aspects of your Simple. Pay Health Plan Simple. Pay 1 -800 -606 -3564 or Health Pro healthpro@simplepayhealth. com 13
Medical Network Information • Aetna Open Choice PPO Aetna. com/individuals-families/find-adoctor. html, then Find an Employer Plan • Extensive national network • No selection of PCP required • No referrals to specialists required • Health Pro or Simple. Pay app encouraged prior to services to ensure the best quality at the lowest cost 14
No Payment at Time of Service • No deductibles, no coinsurance • Copays only • You pay nothing at the physician’s office or pharmacy • Show your ID Card, and the plan pays the provider • You’ll receive one monthly statement 15
Simple. Pay Health Medical Plan Benefit Feature Tier 1 Tier 2 Deductible $0 Coinsurance $0 Out-of-Pocket Maximum Individual Family Office Visits Primary Care Physician Specialist Emergency Out-of. Network $95 $250 No coverage $8, 150 $16, 300 $15 $30 Preventive Care Hospitalization Inpatient Outpatient Tier 3 $45 $85 Covered 100% $1, 750 $4, 500 $2, 500 $6, 000 $500 (out-of-network covered as in-network, per ACA) 16
Simple. Pay Prescription Drug Benefit All Other Network Pharmacies CVS Walgreens Tier 1 - Generics $5 $15 $35 Tier 2 – Preferred Brand $20 $80 $160 Tier 3 – Non-Preferred Brand $40 $120 $240 Benefit Feature Retail Specialty Drugs $100 Mail Order Tier 1 - Generics $20 Tier 2 – Preferred Brand $80 Tier 3 – Non-Preferred Brand $160 17
Simple. Pay Prescription Drug Benefit Know What You Owe Up Front Use the app or contact the Health Pro to confirm the cost of medications by pharmacy Simple. Pay 1. Select the drug name Mobile App 2. Find out the cost depending on the pharmacy you choose 3. Pick up your script, pay $0 at pharmacy 1 -800 -606 -3564 or healthpro@simplepayhealth. com 18
Simple. Pay Monthly Statement • No Explanations of Benefits • No doctor or hospital bills • One monthly statement • Pay through the app or via check • Zero-interest member financing via payroll deduction available 19
Simple. Pay Health Monthly Statement • 1. 5% credit on future statements if paid in full within 30 days • Member may also pay minimum balance (not full balance) if desired • If no minimum payment within 30 days, member is enrolled in zero-interest member financing via payroll deduction. You may opt out of payroll deduction use a separate account for repayment if desired • Member Financing Authorization during Open Enrollment Balance Payment Plan Term (Months) Max Monthly Payment <$100 1 $99 $100 - $250 2 $125 $251 - $500 3 $167 $501 - $1, 00 4 $250 $1, 001 - $2, 000 6 $333 $2, 000+ 12 n/a 20 20
Simple. Pay - Three Simple Steps 1 Find your physician and desired price 2 Show your Simple. Pay ID Card at time of service 3 Receive your Simple. Pay statement 21
Simple. Pay Member Portal Features Health Rewards • Contact your Health Pro • Earn points towards gift cards • Find a Doctor or Pharmacy and compare costs • Claims and Statements • Redemption in Virgin Pulse Store or donation • Member ID Card • Clinical Programs • Healthy habit trackers • Challenges • Nutrition and sleep guides Virgin Pulse App 22
Virtual Primary Care For Medical Employees and Dependents 24/7 virtual physician care $0 cost Dedicated Care Team Best-in-class doctors No paperwork, no wait time Prescription refills Voluntary offering for employees Not enrolled in Jim Ellis medical plan 23
Virtual Primary Care Acute Care Colds, flu, bacterial and viral infections, dermatological issues, sprains, aches, pains Preventive Care COVID-19 Care Patient questions Virtual symptom screening Medical guidance and testing coordination Chronic Care Allergies Asthma Diabetes High and low blood pressure Gastrointestinal issues Back and muscular pain 24
Jim Ellis Wellness Program Jim Ellis cares about the health of its employees Avoid the Surcharges! Complete Biometric Screening Complete the Non-Tobacco Affidavit $25 surcharge for tobacco users Tobacco cessation program option available $25 surcharge for employees who don’t complete the annual biometric screening More information is coming soon 25
Anthem Dental Plan � No changes to benefits or premiums for 2021 � Extensive provider network � Anthem. com � Dental Complete Plan Name � Stay in-network to avoid being balance billed � Out-of-network paid at the 80 th % of Usual and Customary 26
Dental Plan Benefits Summary Preventive Services Exams, cleanings, bitewing x-rays, full mouth x-rays, fluoride 100% No Deductible Basic Services Sealants, space maintainers, amalgam and composite fillings, 80% $50 individual deductible $150 family deductible Major Services Root canals, periodontal surgery and maintenance, scaling and root planning, crowns, and oral surgery 50% $50 individual deductible $150 family deductible Annual Maximum Benefit per Person $5, 000 Orthodontic Care Maximum Lifetime Benefit Person (children up to age 19 only) $1, 000, covered at 50% * Out-of-network reimbursement level is the 80 th percentile of usual and customary. 27
Anthem Dental Plan Enhancements Accidental Injury Benefit Coverage at 100%, no deductible or coinsurance up to the dental plan annual maximum Anthem. com resources “Ask a Dental Hygienist” Cost Estimator tool International Emergency Dental Program Services paid at 100% - no waiting periods, no reduction in dental plan maximum 28
Vision Plan Benefits Summary � No changes for 2021 � Exam benefit once per calendar year o $20 standard exam copay In-Network • Receive the benefit at time of service • Lower out-of-pocket costs � $250 frame benefit once per calendar year � $250 lens benefit once per calendar year � Additional copays apply for options • File a claim for reimbursement � Anthem Vision Network • Higher out-of-pocket costs � � www. anthem. com Blue View Vision Out-of-Network • Pays a minimal reimbursement benefit according to schedule 29
Employer-Paid Basic Life Insurance Jim Ellis provides basic life coverage at no cost for all benefit-eligible employees Important Complete an active enrollment election and review or update your life insurance beneficiary(ies) 30
Voluntary Life Insurance Voluntary Life Coverage Options Employee $10, 000 increments To the lesser of $500, 000 or 5 x earnings Spouse $5, 000 increments To the lesser of 50% of the employee amount or $100, 000 Child(ren) Flat $10, 000 benefit New elections and increases at Open Enrollment require Health Questions Benefits and Premiums Reduce Based on Age At age 65 Benefits reduce by 35% At age 70 Benefits reduce by 50% 31
Life Insurance Continuation: Termination • Portability o For voluntary life insurance, at least 12 months of coverage o Individual term life policy, no health questions o For employee and spouse coverage o Applies to employees under age 65, insured for 12 months o Must apply within 31 days of date employment ends • Conversion o Individual whole life policy, no health questions o For basic and voluntary life insurance o Must apply within 31 days of date employment ends 32
Disability Coverage • An income replacement benefit if you are unable to work due to an illness or accident • Short Term Disability (STD) provides temporary coverage • Long Term Disability (LTD) provides a benefit to age 65 or normal retirement age if you remain disabled 33
Disability Coverage Short Term Disability Long Term Disability Benefit Amount 60% of weekly earnings 60% of monthly earnings Maximum Benefit $500 / week (tax-free) $5, 000 / month (tax-free) 13 weeks To age 65 or Social Security Normal Retirement Age 1 st day due to injury 8 th day due to illness 91 st day of disability Maximum Benefit Period Benefits Begin Premiums based on age New elections at open enrollment require health questions 34
Pre-Existing Condition Limitation The disability plan does not cover disabilities due to pre-existing conditions What is a pre-existing condition? A condition for which you have been treated or diagnosed during the 12 months prior to your disability effective date. 35
Voluntary Critical Illness • Provides a flat dollar benefit for diagnosis of a covered illness • Covered Diagnoses o Cancer o Heart attack o Stroke o Carcinoma in situ Employees From $5, 000 to $30, 000 o Major organ failure Spouses (< 70) From $5, 000 to $15, 000 o End state renal failure Children $1, 000, $2, 500, $5, 000, or $10, 000 o And more Benefit Reduction Reduced at age 70 36
Voluntary Critical Illness • Health Screening Benefit o $50 Employee o $50 Spouse o $25 Child(ren) • Covered Preventive Screenings o Mammograms o Chest X-rays o Colonoscopies o PSA o And more 37
Voluntary Accident � Financial benefit to help cover the cost of unexpected accident � Unexpected injury that results in medical treatment � Hospital Care o Confinement, surgery, admission � Accident Care o Doctor visits, x-rays, therapy � Common Injuries � Sports Accident Benefit o Additional 25% benefit as a result of organized sporting activity 38
Employee Assistance Program (EAP) • Counseling o 24/7 toll-free access o Face-to-face counseling with local professionals • Online Resources o Advice and services, financial calculators, legal library, and more • Identity Theft Services o Unlimited fraud and recovery services o Support with credit correction Free, confidential help to deal with life’s challenges • Support for Loss of Loved One 39
Identity Theft • Identity and credit monitoring • High-risk transaction alerts • Dark web monitoring • 24/7 Privacy Advocate remediation • Social media monitoring • Financial threshold monitoring • Digital exposure reports • $1 million identity theft insurance policy Coverage Level Weekly Cost Semi-Monthly Cost Employee Only $2. 30 $4. 98 Family $4. 14 $8. 98 40
Ready to Enroll? 2 Ways to Enroll in Non-Medical Benefits: Online or By Phone Online Enrollment • www. totemtools. com • Forgot Your username Link Telephonic Enrollment • Call the Benefits Service Center at 770 -295 -1100 • Review current benefits • Follow instructions and create your case sensitive Password • Complete next year elections • User ID: Last Name + DOB (mmddyyyy) • Assistance during the year for benefits questions • Access the system using your newly created password • Monday – Thursday 8 am to 6 pm and Friday from 8 am to 5 pm • Scroll down and click Begin Event Please confirm your email address! You will receive a Confirmation Statement via email after you enroll. 41
Can Spouses Enroll? • If the Benefits Service Center receives a call from a spouse, BSC will request that the employee provide authorization to speak with the spouse • A current employee authorization is required every year • Spouses are not able to change life insurance beneficiary information on employee’s behalf 42
Benefit Resources Benefits Service Center: 770 -295 -1100 • Call anytime for benefits questions, claims assistance, qualifying life events, and more • Hours: Monday – Thursday 8 am to 6 pm and Friday from 8 am to 5 pm Benefits Website: www. jimellisbenefits. com | Email: benefits@jimellisbenefits. com • Plan information, documents, and links • Certificates of Coverage, Benefit Summaries, and plan documents Open Enrollment Guide: Available on the benefits website 43
Annual Open Enrollment Prepare for Open Enrollment • Review Enrollment Guide • Have SSNs available for newly added dependents • Call or go online to enroll and review current coverages and life insurance beneficiary(ies) • All medical plan members - new Simple. Pay ID cards • Medical Members – serious ongoing treatment or scheduled surgery? Call the Benefits Service Center • Look for wellness program information coming soon o Biometric screening event and deadline for non-tobacco affidavit 44
Questions? 45
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