2013 Employee Benefits Guide
Large Group - Georgia
Getting Started
Each year 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, you can elect to enroll in our group medical, dental, vision, Flexible Spending, life and disability plans. These benefits and costs are explained to you in this guide. Please review the information thoroughly. Should you have any questions, please see your local Human Resources Coordinator for help.
This guide is intended to provide you with an overall summary of the benefits Nextran Corporation has to offer. 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?
If you are a full-time employee working 30 hours or more per week, you are eligible to enroll in the benefits described in this guide.
The following family members are also eligible for medical, dental, and voluntary life: legal spouse and children under age 26.
Dependent children who meet certain eligibility requirements as outlined in the Summary of Plan Description may be covered on the medical plan until age 30.
When to Enroll
You will be eligible for benefits the first of the month following 30 days from your date of hire. Once you enroll, you will not be able to change your elections until the next open enrollment period, unless you experience a qualifying change in status (i.e., divorce, birth or adoption of a child, change in a child’s dependent eligibility, death of a spouse or child, change in residence due to an employment transfer, change in spouse’s benefits or employment status, loss of other coverage)
Please note: You must complete and return Nextran’s internal enrollment form to your local HR Coordinator even if you are declining benefits.
Preparing for Enrollment
Realistically assess your needs and make a list.
While you cannot predict all your needs, it pays to make a list of all the services you expect to receive and then evaluate each plan according to your own list. Ask yourself the following:
- Am I willing to pay a higher medical insurance premium in exchange for lower financial exposure, i.e. the “high option” medical plan or should I consider a lower premium plan with the understanding that I may end up paying more out of pocket if I have a need for major medical services during the year, i.e. the “low option” medical plan?
- How important is it to me to have co-pays for physician office visits, even if the total financial exposure for major medical expenses may potentially be more expensive than a plan with no co-pays for office visits?
- Do I have any known dental work that may be covered in a more cost-effective manner under a different dental plan? Do I want to change to a lower coverage/lower cost dental plan because I have no known extensive dental needs?
- What other predictable medical costs should I consider when determining how much to set aside in a Flexible Spending Account? (Example: What are my estimated Rx costs; upcoming dental needs? Will I be purchasing contacts or glasses?)
Medical Plans
The High Option plan currently in effect for 2012 will be renewed for 2013 without change to coverage levels, reimbursements, or premium costs. As a reminder, the Cigna High Option Plan caps an individual’s (in-network) exposure at $2,500, and a family’s (in-network) exposure at $5,000 for the calendar year. Those incurring eligible expenses beyond these amounts must request reimbursement from Nextran.
Although the High Plan provides limited coverage outside of the network, out of network expenses are not eligible for reimbursement from Nextran. Nextran strongly discourages your use of out-of-network services and providers.
The Low Option plan will be enhanced in 2013. Similar to the high option, no additional premium costs will be passed on to you – however, co-pays have been added for physician and specialist office visits. As a reminder, the Low Option provides coverage for in-network services only.
Cigna Healthcare / High Plan (1)(*expenses artificially capped by back-end HRA) / Low Plan
Benefits / In-Network / Out-of-Network
(subject to balance billing!) / In-Network Only
Deductible / Amount You Pay / Amount You Pay
Per Person / $3,500* / $7,000 / $5,500
Coinsurance % / 30%* / 50% / 100%
Preventive Care / $0 / 50% / $0
PCP Office Visit / Deductible + 30% / Deductible + 50% / $50 co-pay
Specialist Office Visit / Deductible + 30% / Deductible + 50% / $150 co-pay
Emergency Room / Deductible + 30% / Deductible + 30% / Deductible
Urgent Care / Deductible + 30% / Deductible + 50% / Deductible
Hospitalization / Deductible + 30% / Deductible + 50% / Deductible
Out-of-Pocket Maximum
Per Person / $4,500* / $9,000 / $5,500
Prescription Drugs / $20/$55/$100/$140 / 50% / $20/$55/$100/$140
(1) (1) Cigna will continue to administer any remaining front-end HRA balances that have been rolled over from prior years.
Pre-Existing Conditions
If you are enrolling in the CIGNA health plans for the first time, please be advised any condition you have been diagnosed with or taking medications for will be excluded from coverage for 12 months unless you can provide a Certificate of Credible Coverage showing proof of previous coverage. (Dependents under age 19 are excluded from this limitation.)
*Health Reimbursement Account (Back – End Reimbursement)
The back-end health reimbursement account (HRA) is an account funded by Nextran that caps an individual’s in-network deductible and co-insurance exposure to $2,500 and a family’s in-network deductible and co-insurance exposure to $5,000 for those electing the High Option plan. After you or your family have incurred expenses in excess of $2,500 (individual) or $5,000 (family) during the 2013 calendar year, you may submit a request for reimbursement to Nextran during the months of July 2013, October 2013 and February, 2014.
As a reminder: Out-of-network expenses are the sole responsibility of the employee and/or family. Prescription co-pays are not eligible for reimbursement.
Medical Insurance Employee Deductions
Nextran will continue to pay approximately 70% of the total cost of the health insurance for our employees.
Election / High Plan / Low PlanWeekly Deductions / Bi-Weekly Deductions / Semi-Monthly Deductions / Weekly Deductions / Bi-Weekly Deductions / Semi-Monthly Deductions
Employee (EE) / $25.90 / $51.80 / $56.12 / $17.31 / $34.62 / $37.50
EE + Spouse / $104.07 / $208.14 / $225.48 / $57.26 / $114.52 / $124.07
EE + Child(ren) / $88.41 / $176.82 / $191.56 / $46.52 / $93.04 / $100.80
EE + Family / $132.16 / $264.32 / $286.34 / $57.35 / $114.70 / $124.26
Additional Prescription Information
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. Discount programs are not insurance. Please contact each pharmacy directly for any additional questions.
· 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% to 30% discounts on various prescriptions
· Costco – discounts on various prescriptions
Dental Plans
We are pleased to announce that Nextran will continue to offer three dental Plan options through our current carrier, Guardian. All plans provide coverage for providers utilized outside of Guardian’s network; however, if you choose to seek services outside of Guardian’s network you will be responsible for claim filing and subject to balanced billing.
Guardian / High / Middle / LowIn-Network / Out-of-Network / In-
Network / Out-of-Network / In-Network / Out-of-Network
Annual Deductible
Individual/Family
(waived for Preventive) / $50/$150 / $100/$300 / $50/$150 / $100/$300 / $50/$150 / $100/$300
Preventive Services / 100% / 100% / 100% / 100% / 100% / 100%
Basic Services / 100% / 80% / 90% / 80% / 80% / 50%
Major Services / 60% / 50% / 60% / 50% / 50% / 25%
Annual Benefit Maximum / $1,250 / $1,000 / $1,000
Orthodontics / Not Covered
Annual Rollover / $450 staying in-network or $350 out-of-network / $350 staying in-network or $250 out-of-network / $350 staying in-network or $250 out-of-network
Max Rollover Bank / $1,250 / $1,000 / $1,000
Dental Plan Employee Deductions
There will be no change in premium costs for the dental plans. Existing prices are provided for your reference below. These amounts are deducted on a pre-tax basis and will remain the same until 2014 or unless you have a qualified change in status.
High / Middle / LowWeekly / Bi-Weekly / Semi-Monthly / Weekly / Bi-Weekly / Semi-Monthly / Weekly / Bi-Weekly / Semi-Monthly
Employee (EE) / $6.18 / $12.36 / $13.40 / $5.80 / $11.60 / $12.56 / $3.87 / $7.74 / $8.38
EE + Spouse / $14.76 / $29.52 / $31.97 / $13.84 / $27.68 / $29.98 / $9.21 / $18.42 / $19.97
EE + Child(ren) / $13.38 / $26.76 / $29.00 / $12.55 / $25.10 / $27.20 / $8.36 / $16.72 / $18.12
EE + Family / $21.96 / $43.92 / $47.58 / $20.59 / $41.18 / $44.62 / $13.71 / $27.42 / $29.71
Vision Plan
In 2013, Nextran will continue to offer the existing vision Plan through HUMANA. Although the plan provides some coverage for providers utilized outside of HUMANA’s network, this coverage is significantly less than the coverage available through in-network providers. There will be no change in costs to these benefits in 2013.
HumanaBenefits / In-Network / Out-of-Network
Allowance
Office Copay / $10 / $35
Materials Copay / $15 / n/a
Lenses / Single, Bifocal, Trifocal & Lenticular covered 100% after copay / $25 Single Lens
$40 Bifocal Lens
$60 Trifocal Lens
$100 Lenticular Lens
Frame Allowance / $40 Wholesale / $40 Retail
Frequency of Services / Lenses – Once every 12 months
Frames – Once every 24 months
Contact Lenses / $105 includes fitting & lenses
Lasik / Discounts available through TLC, LasikPlus and QualSight LASKI / N/A
Vision Plan Employee Deductions
Election / DeductionsWeekly / Bi-Weekly / Semi-Monthly
Employee Only / $1.50 / $3.00 / $3.25
Employee + Spouse / $3.00 / $6.00 / $6.50
Employee + Child(ren) / $2.85 / $5.70 / $6.18
Family / $5.90 / $11.80 / $12.79
Life Insurance
Basic Group Life and AD&D Insurance
Nextran Corporation provides you with a Life and AD&D (Accidental Death and Dismemberment) insurance benefit of $50,000. Lincoln Financial insures our life insurance plan. A reduction in benefit occurs at age 65.
This benefit is provided by Nextran Corporation at no 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
http://www.lfg.com
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.