Nextran Corporation strives to provide you and your family with a comprehensive benefits package that addresses your personal health and financial well-being. As an eligible employee of Nextran, you may elect to enroll in our group medical, dental, vision, life, and disability plans. Nextran also provides the opportunity for you to participate in medical and dependent care flexible spending accounts. These benefits and costs are explained to you in this packet. Please review it thoroughly. Your local HR Coordinator can help address any questions you may have.
This packet is intended to provide you with an overall summary of the benefits Nextran offers. Details regarding these plans can be found in the certificates of coverage. Language in the certificates of coverage will prevail over the wording in this document.
Who is Eligible?
Unless indicated otherwise, if you are a full-time employee (working 30 or more hours per week) you are eligible to enroll in the benefits described in this guide. For new hires, you are eligible for benefits the first of the month following a 30 day waiting period.
Dependents:
You must be legally married to your spouse to claim him/her as a dependent on Nextran’s group insurance plans. For health insurance, a child is considered a dependent at least through the end of the calendar year in which the child reaches the age of 26. Please refer to certificates of coverage to verify dependent age limits on other coverage.
Special Enrollment Notice for Dependent Children
Individuals whose coverage ended, or who were denied health insurance coverage (or were not eligible for coverage), because the availability of dependent coverage of children ended before attainment of age 26 are eligible to enroll in the Nextran Corporation Group Employee Plan. Individuals may request enrollment for such children for 30 days from the date of notice. Enrollment will be effective retroactively to January 1, 2012. For more information contact Lorie Flaris, HR Manager at 1-800-347-6225.
How to Enroll
All employees will need to complete Nextran’s internal enrollment form and return it to their local HR Coordinator. Other forms may be necessary if additional, supplemental coverage is being elected. (Your local HR Coordinator can clarify what additional forms you need, if any.) Once you make your elections for Nextran’s pre-tax benefit offerings, you will not be able to change them until the next open enrollment period unless you have a qualified change in status.
Medical
PPO / Plan Effective 1/1/12Carrier Name / BlueCross BlueShield of Alabama 800
Lifetime Maximum / Not applicable
Deductibles (CYD)
Individual / $350
Family / $1,500
Out of Pocket Maximum / Caps deductible and “other covered services” (does not cap in-network inpatient hospital co-pay, in-network outpatient hospital co-pay out of network physical therapy, occupational therapy, or DME.)
Individual / $2,750
Family / $8,250
Physician Office Services / IN / OUT
Primary Doctor Visits / $35 / CYD + 50%
Specialist Visits / $50 / CYD + 50%
Annual routine exams / $0 / Not Covered
Mammograms filed as preventative / $0 / $0
Diagnostic Lab, X-ray & Pathology (at Physician's Office) / $10 per x-ray, $0 for all others / CYD + 50%
Hospital Services
Outpatient Diagnostic Lab & X-ray, Pathology / $250 (Tier 1), $500 (Tiers 2/3) / CYD + 20% outside of Alabama
Out patient Surgery (Hospital) / $250 (Tier 1), $500 (Tiers 2/3) / CYD + 20% outside of Alabama
Hospital Per Admission / *$250 days 1-6 (Tier 1), $500 days 1-6 (Tiers 2/3) / $1,000 per admission plus 20%
Physician Visits/Consultations at (Inpatient) Hospital / *CYD / CYD + 50%
Physician Surgical Services / CYD / CYD + 50%
Emergency Room (Medical Emergency) / $250 / CYD + 20% outside of Alabama
Emergency Room (Accident) / $250 / CYD + 20%
Physician Services at ER / $50 / CYD + 50%
Coinsurance
Percentage / 100% / 80%/20%; 50%/50%
Prescription Card
Tier 1 / $15 / Not covered
Tier 2 / $50 / Not covered
Tier 3 / $75 / Not covered
Specialty Drugs (e.g., fertility) / Participant pays 50% per Rx until $5,000 OOP max per CY
*Note: Nextran will reimburse up to $1,000 of incurred in-patient hospital expenses (facility and/or physician services) per individual policy, and will reimburse up to $1,000 of incurred in-patient hospital expenses (facility and/or physician services) per covered person within a family policy, not to exceed $2,000 per family policy. Employee must submit a claim along with the Explanation of Benefits detailing such expenses to Corporate for reimbursement.
Your Medical Cost in 2012
In 2012, Nextran will absorb 60% of the increase in premiums for employees which significantly decreases the cost to you.
Rx Alternatives
You may be able to save additional money on some commonly used prescription medications by participating in discount programs available through local retailers. Discount programs vary by pharmacy and may be subject to change without notice. Some programs require membership prior to discounts applying.
Examples of Discount Programs Include:
- Publix Pharmacies – FREE 14 day supply on select antibiotics
- Target/WalMart/Sam’s Club - $4.00 for 30 day supply of select prescriptions
- K-Mart - $15.00 for 90 day supply of select prescriptions
- Walgreens - $12.00 for 90 day supply of select prescriptions
- Harris Teeter - $9.99 for 90 day supply of select prescriptions
- Food Lion - $4.00 for 30 day supply of select prescriptions
- CVS – 20-30% on various prescriptions
- Costco – discounts vary by prescription
Please contact the pharmacy directly for a list of covered medication and for any other questions you may have concerning their discount programs.
Employee Assistance Program (EAP)
(password = connect)
1-877-757-7587
Nextran Corporation provides an Employee Assistance Program that is available to all Nextran employees, regardless of whether or not any other coverage is purchased through Nextran Corporation. All specialists are licensed EAP professionals. Our EAP is equipped to help provide resources for (among other things) addictions, depression, stress/anxiety, and marital problems. An EAP representative is available 24 hours a day, 7 days a week and 365 days a year. This is available at no cost to you.
Dental
1`-800-627-4200
Nextran offers three dental plans; you may select the dental plan that best fits the needs for you and your family.
Guardian - Triple OptionHIGH / MIDDLE / LOW
PPO 505/U1 / PPO 505/UD / PPO 505/NA
Benefits / In Network / Out of Network / In Network / Out of Network / In Network / Out of Network
Deductible / $50 per person / $100 per person / $50 per person / $100 per person / $50 per person / $100 per person
Waived for Preventive / Yes / Yes / Yes / Yes / Yes / No
Plan Year Max / $1,250 / $1,250 / $1,000 / $1,000 / $1,000 / $1,000
Preventive Services
Office Visit / 100% / 100% / 100% / 100% / 100% / 100%
Oral Exams / 100% / 100% / 100% / 100% / 100% / 100%
Bitewing X-rays / 100% / 100% / 100% / 100% / 100% / 100%
Cleanings / 100% / 100% / 100% / 100% / 100% / 100%
Fluoride Treatment / 100% (to age 14) / 100% (to age 14) / 100% (to age 14) / 100% (to age 14) / 100% (to age 14) / 100% (to age 14)
Sealants / 100% (to age 16) / 100% (to age 16) / 100% (to age 16) / 100% (to age 16) / 100% (to age 16) / 100% (to age 16)
Basic Services
Resin Restorations / 100% / 80% / 90% / 80% / 80% / 50%
Extractions / 100% / 80% / 90% / 80% / 80% / 50%
Endodontics / 100% / 80% / 90% / 80% / 80% / 50%
Periodontics / 100% / 80% / 90% / 80% / 80% / 50%
Major Services
Crowns / 60% / 50% / 60% / 50% / 50% / 25%
Pontics / 60% / 50% / 60% / 50% / 50% / 25%
Partials / 60% / 50% / 60% / 50% / 50% / 25%
Complete Dentures / 60% / 50% / 60% / 50% / 50% / 25%
Orthodontia
Orthodontic treatment / Not covered / Not Covered / Not Covered
Benefit Waiting Periods
Late entrants - Basic 6 mos; Major 12 Months
Note: Guardian offers a rollover feature in all 3 plans.
For the high option, if you spend less than $600 of benefit in the calendar year and use in-network providers, you may roll-over $450 of unspent benefit to increase the maximum allowed benefit amount for the following year. If you use out-of-network providers, this roll-over benefit drops to $300. The maximum rollover account limit is $1,250.
For the low and middle options, if you spend less than $500 of benefit in the calendar year and use in-network providers, you may roll over $350 of unspent benefit to increase the maximum allowed benefit amount for the following year. If you use out-of-network providers, this roll-over benefit drops to $250. The maximum rollover account limit is $1,000.
Your Dental Cost in 2012
HIGH OPTIONWeekly / Semi-Monthly
Employee Only / $6.18 / $13.40
Employee & Spouse / $14.76 / $31.97
Employee & Child(ren) / $13.38 / $29.00
Family / $21.96 / $47.58
MIDDLE OPTION
Weekly / Semi-Monthly
Employee Only / $5.80 / $12.56
Employee & Spouse / $13.84 / $29.98
Employee & Child(ren) / $12.55 / $27.20
Family / $20.59 / $44.62
LOW OPTION
Weekly / Semi-Monthly
Employee Only / $3.87 / $8.38
Employee & Spouse / $9.21 / $19.97
Employee & Child(ren) / $8.36 / $18.12
Family / $13.71 / $29.71
Vision
1-800-749-5855
Vision insurance for yourself and your dependents is available through HumanaCompbenefits. Although there are out-of-network benefits, they are limited.
Services
/ In-networkExams
Materials / $10 copay
$15 copay
Contact lens allowance / $105
Frequency
Exams
Lenses
Frames / 12 months
12 months
24 months
Discounts / Available for LASIK and for a second pair of eyeglasses
Benefits are subject to certain limitations. Additional information can be obtained through your local HR Coordinator or by referring to your vision certificate of coverage.
Your Vision Cost in 2012
Weekly / Semi-MonthlyEmployee Only / $1.50 / $3.25
Employee & Spouse / $3.00 / $6.50
Employee & Child(ren) / $2.85 / $6.18
Family / $5.90 / $12.79
Life, AD&D Insurance
800-423-2765
Basic Group Life and AD&D Insurance
Nextran Corporation provides you with a Life and AD&D (Accidental Death and Dismemberment) insurance benefit of $20,000. Lincoln Financial insures our life insurance plan. A reduction in benefit occurs at age 65.
This benefit is provided by Nextran Corporation atno cost to you.
Supplemental Life Insurance (Employee)
In addition to Basic Life and AD&D, if you meet the eligibility requirements, Nextran Corporation provides you with the opportunity to purchase supplemental life insurance in increments of $10,000 to a maximum of $300,000 (or 5x your salary, whichever is less.) For employees 70 and older, the maximum coverage is $50,000.
Should you purchase optional life insurance when you are first eligible for benefits, a certain amount may be available to you without submitting evidence of insurability. This is called the Guarantee Issue amount. For those under the age of 70, the guarantee issue amount is $100,000. For those ages 70-74, the guarantee issue amount is $20,000. There is no guarantee issue amount for those 75+ years of age.
Please note: If you do not enroll when you are FIRST eligible for life insurance coverage, you are not guaranteed to be eligible for coverage at a later date.
The supplemental life insurance plan is insured by Lincoln Financial Insurance Company. At age 65, a reduction schedule will apply.
Supplemental Family Life Insurance Benefit
Should you opt to purchase optional life insurance on yourself, you may also purchase additional (supplemental) insurance for your dependent spouse in increments of $5,000. Dependent child coverage is a flat $10,000 benefit for each child regardless of the number of children. Supplemental life insurance for dependents is not available unless you first purchase additional, optional life insurance on yourself.
Dependent Spouse: / 50% of employee’s basic and optional benefit up to $150,000. Guarantee Issue amount is $30,000 for spouses under the age of 60. There is no guarantee issue amount for spouses 60+ yrs of age. Reduction schedules apply at age 65.Dependent Children: / $10,000
Dependent children are eligible for coverage to age 19, or if they are a full time student, to age 25. From age 14 days to 6 months, the benefit is $250.
The Supplemental Life and Dependent Life insurance benefit is paid for entirely by the employee.
Pricing will be provided by your benefits coordinator.
Short & Long Term Disability
800-423-2765
Nextran understands the devastating financial effect that you and your family would experience in the event that you would be unable to work for an extended amount of time. Therefore, Nextran offers both short and long term coverage options should you find yourself in such unfortunate circumstances.
Please note: This coverage is separate from your medical insurance which has no disability provision.
Benefit Amount
In the event that you become disabled off the job, the Nextran Short Term Disability Plan will provide 60% of your earnings to a maximum of $1,000/week beginning on the 15th day. STD benefits do not apply to injuries that occur on the job – workers’ compensation covers this period of time. In the event that you become totally disabled, on or off the job for over 180 days, the Nextran LTD plan will provide you with 60% of your earnings, not to exceed $6,000 per month, up to your “normal social security retirement age.” This benefit would be offset by other income sources, such as social security and workers’ compensation.
Disability Earnings:
Figured from the income box on the W-2 form from the prior calendar year. It includes the insured employee’s income before taxes and any deductions for pre-tax contributions to a Section 125 Plan, flexible spending account and 401(k) Plan.
Benefit Period
The Short Term Disability benefit has a maximum duration of 26 weeks, which coincides with the beginning of our Long Term Disability plan. Should you become totally or partially disabled and unable to return to work, the LTD benefit would continue until “normal social security retirement age.” Please be sure to review the certificate of coverage for complete details.
Pre-Existing Condition
If you have received treatment for any condition 3 months prior to the coverage effective date, you will need to be treatment-free for 6 months from your effective date before STD benefits will be paid and 12 months before LTD benefits will be paid for the pre-existing condition.
Short and Long Term Disability Plan Costs
Short and long term disability benefits are paid for by the employee. Pricing will be provided by your local benefits coordinator.
Short term or long term disability coverage is available without evidence of insurability upon your initial eligibility (1st of the month after 30 days) or during annual open enrollment.
Health Care and Dependent Care Flexible Spending Accounts
866-587-3539/
(To set up your account for the first time, use the first letter of your first name, first letter of your last name – both in capitals – and the last 5 digits of your SSN. The temporary password is “Password1” For example: Jane Doe with a SSN of 123456789 would have a user ID of JD56789)
Medical Expense Account
You may set aside up to $4,000 on a pre-tax basis to help pay for non-reimbursable medical related expenses such as: deductibles, co-insurance, prescription medication, vision exams, medical appliances, hearing exams, and dental (including orthodontia) expenses. A debit card will be provided to you. The full amount you elect for 2012 will be available for you on January 1, 2012. In 2012, you will no longer be able to use your medical FSA for most non-prescribed over- the-counter medications (e.g., Tylenol.) Other over-the-counter medical products (e.g., band aids, contact solution) remain eligible – however, you will need to pay for these items first and submit a manual reimbursement claim for these products. These changes have been made to comply with the 2011 Health Reform legislation requirements.
Dependent Care Account
You may set aside up to $5,000 per year for dependent care expenses. Unlike the medical expense account, funds will not be available to you in advance. Rather, the amount available to you will equal the amount you have set aside through payroll deduction at that time.
In both cases, any money remaining in your account after March 15, 2012 will be forfeited in accordance with current IRS regulations. Please refer to the separate pamphlet from Workable Solutions, Inc. for additional details.
Important Notice from Nextran Corporation About
Your Prescription Drug Coverage and Medicare
Please read this notice carefully and keep it where you can find it. This notice has information about your current prescription drug coverage with Nextran Corporation and about your options under Medicare’s prescription drug coverage. This information can help you decide whether or not you want to join a Medicare drug plan. If you are considering joining, you should compare your current coverage, including which drugs are covered at what cost, with the coverage and costs of the plans offering Medicare prescription drug coverage in your area. Information about where you can get help to make decisions about your prescription drug coverage is at the end of this notice.
There are two important things you need to know about your current coverage and Medicare’s prescription drug coverage:
- Medicare prescription drug coverage became available in 2006 to everyone with Medicare. You can get this coverage if you join a Medicare Prescription Drug Plan or join a Medicare Advantage Plan (like an HMO or PPO) that offers prescription drug coverage. All Medicare drug plans provide at least a standard level of coverage set by Medicare. Some plans may also offer more coverage for a higher monthly premium.
- Nextran Corporation has determined that the prescription drug coverage offered by our Plans currently available as of January 1, 2012 is, on average for all plan participants, expected to pay out as much as standard Medicare prescription drug coverage pays and is therefore considered Creditable Coverage. Because your existing coverage is Creditable Coverage, you can keep this coverage and not pay a higher premium (a penalty) if you later decide to join a Medicare drug plan.
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When Can You Join A Medicare Drug Plan?
You can join a Medicare drug plan when you first become eligible for Medicare and each year from November 15th through December 31st.
However, if you lose your current creditable prescription drug coverage, through no fault of your own, you will also be eligible for a two (2) month Special Enrollment Period (SEP) to join a Medicare drug plan.
What Happens To Your Current Coverage If You Decide to Join A Medicare Drug Plan?
If you decide to join a Medicare drug plan and are an active employee, your current Nextran coverage will not be affected. If you are retired and over age 65, Medicare would pay as primary.
If you do decide to join a Medicare drug plan and drop your current Nextran coverage, be aware that you and your dependents may not be able to get this coverage back.
When Will You Pay A Higher Premium (Penalty) To Join A Medicare Drug Plan?