Transcription
2018Jefferson BenefitsGuidebook
IMPORTANT!Benefits Enrollment InformationOpen Enrollment for the 2018 Plan Year is processedexclusively online from October 16–30, 2017.All employees must go online during Open Enrollment and activelyelect benefits even if you want to keep the same level of coverage.The benefits you elect during open enrollment will remain in effectfor the entire plan year unless you experience a qualified life event.It's the employee's responsibility to contact HR Operations toreport the qualified event. Changes must be made within 30days of date of the event.New hire elections are processed exclusively onlineand must be made within 30 days of hire.
TABLE OF CONTENTSHUMAN RESOURCES2-4DENTAL PLANS25-26OnlineAccess Employee Self-ServiceYour Campus Key and PasswordHR Business PartnerTotal Compensation StatementEligibilityPart-Time Employee Benefit ProgramEligible DependentsProof of Dependents’ Status222223344Dental Plans at a GlanceDelta Dental of PACost of Coverage252626LIFE INSURANCE PLANS27-28HOW AND WHEN TO ENROLL FOR COVERAGE5-6Open EnrollmentChanging Your Benefits Due to a Life EventVerify Your ElectionsWhen Coverage Ends5556Basic Life and AD&D InsuranceSupplemental Life and AD&D InsuranceCost of CoverageSupplemental Insurance RatesConverting to an Individual PolicyAge ReductionMedical Evidence of InsurabilityImputed IncomeLong-Term Disability272727282828282828BUSINESS TRAVEL ACCIDENT INSURANCE28COBRA6COBRA Rates6How the Plan WorksCost of Coverage2828LIVEWELL@JEFF7-8DISABILITY PLANS29-31MEDICAL PLANS9-16Medical Plans at a GlanceTerms to KnowCost of CoveragePlatinum and Gold PPO PlansHow the Platinum and Gold Plans WorkThe JeffCare Hospital NetworkLivongo for DiabetesWhat is Not Covered?Platinum PPO Plan SummaryGold PPO Plan Summary9910111111121213-1415-16Short-Term DisabilityYour Short-Term Disability ChoicesHow the Short-Term Disability Plan WorksCost of CoveragePre-Existing ConditionsLong-Term DisabilityYour LTD Choices (Except Clinical Faculty)How the Long-Term Disability Plan WorksCost of CoveragePre-Existing ConditionsLTD Benefit PeriodLTD (Clinical Faculty)292929292930303030303131PRESCRIPTION PLAN17-21FLEXIBLE SPENDING ACCOUNTS32-33How the Plans WorkMedImpact Home DeliveryMandatory Generic DrugsPrescription Management ProgramsPrescription Benefits at a GlanceSave on PrescriptionsDomestic Pharmacy LocationsSmoking CessationFilling Prescription While AwayCharges Not CoveredOut-of-Pocket MaximumSelecting the Right Medical/Rx Plan for You171718181919192020202021Flexible Spending Accounts at a GlanceDiscovery Benefits Debit CardDiscriminationFSA StoreAdditional Information3233333333VOLUNTARY BENEFITS34YOUR OTHER BENEFITS35-37VISION PLAN23-24Retirement PlansTuition AssistanceDependent ScholarshipVacation or Earned Time Off35363637Davis Vision Benefits at a GlanceDavis Participating PartnersOut-of-Network BenefitsReimbursement ScheduleCost of Coverage2324242424BI-WEEKLY EMPLOYEE CONTRIBUTION RATE SHEET38BENEFITS SERVICE PROVIDER CONTACT LIST39TO COMPLETE THE ENROLLMENT PROCESS40For additional benefits information please view our website,hr.jefferson.edu. Click on benefits located in the menu onthe left side of the page.READY TO ENROLL? Go to page 40 for instructions.TABLE OF CONTENTS1
Human ResourcesONLINEThe Human Resources website, hr.jefferson.edu,provides you a wealth of benefit information and tools: Compare medical plans View benefit overviews and plan summaries Print forms Access policiesThrough the website you can access Employee Self-Service(ESS) to: View your current benefits Enroll in benefits Select and update your beneficiary designations View your pay stub Review and update your address and phone numberAccess EmployeeSelf-ServiceFROM WORKUsing Internet Explorer 11 or Google Chrome, go tohr.jefferson.edu and click on Employee Self-Service.Sign on with your campus key and password.FROM A NON-WORK COMPUTERGo to https://connect.tjuh.org and enter your campuskey and password. Click on Employee Self-Service andenter your campus key and password again.YOUR CAMPUS KEY AND PASSWORDNew employees can call IS&T at 215-955-7975 to obtaintheir Campus Key and password.HR BUSINESS PARTNERCan’t find an answer to your question on the HR website?Contact your HR Business Partner about benefits, policies,employee self-service and general payroll issues. Find outwho your HR Business Partner is by visiting Jefferson.edu/HRBPwhile on the network and then clicking the yellow box thatreads, “Who is my HR Business Partner.”TOTAL COMPENSATION STATEMENTTo see a comprehensive breakdown of the value of your benefitsincluding compensation, retirement savings, medical and timeoff, visit Employee Self-Service at myhr.jefferson.edu usingInternet Explorer 11 or a Google Chrome browser. Click onPayroll and Compensation and then select My Total Rewards.To see the value of your benefits, click on the Health andWellness tab beneath the pie chart.2HUMAN RESOURCESNEW HIRES: Make sure to enroll within 30 days of your hire date.
EligibilityAll regular full-time employees scheduled to work at least 35 hours per week andregular part-time Jefferson employees scheduled to work 20 or more hours per weekbut less than 35 in job classifications designated as benefit eligible can participatein the Jefferson Benefits Program. Waiting periods are noted below.BenefitsWaitingPeriodsFull-Time Faculty, Full-TimeSenior Administrators,Other Benefit Eligible Employees(20–40 hours per week)Full-TimeHouse Staffand Full-TimePostdoctoralFellows Medical Vision Dental Life and AD&D Short & LongTerm Disability(full-time only) Flexible SpendingAccounts1st of month on or after dateof hire or date you move toan eligible status1st day at workVoluntaryBenefits ProgramWhen your benefits begin depends on when you enroll.If you enroll between the 1st and 15th of the month,your benefits begin on the first of the following month. Ifyou enroll between the 16th and 31st of the month, yourbenefits begin on the first of the next following month.PART-TIME EMPLOYEE BENEFITS PROGRAMThe benefits program includes subsidized benefits for eligible part-time employeeswho elect to participate. You are eligible if you are a regular part-time employee in abenefit-eligible job classification scheduled to work 20 hours or more per week butless than 35.Eligible part-time employees may select options for Medical, Dental, Vision coverage,Life and Accidental Death and Dismemberment Insurance, Spousal and Child(ren)Life Insurance and the Flexible Spending Accounts. The medical and dental per paycontributions are higher for part-time employees. Part-time employees are not eligibleto participate in Jefferson’s Disability Programs beyond Earned Time Off accruals.READY TO ENROLL? Go to page 40 for instructions.ELIGIBILITY3
Eligible DependentsYou may enroll your eligible dependents in a Jefferson medical,dental, vision, life insurance or AD&D plan. Eligible dependentsinclude your spouse and children up to age 26.The Affordable Care Act regulations require us to report thesocial security number for all dependents covered under themedical plan. You will not be able to proceed with your onlinebenefit enrollment unless you enter your dependent’s SSN.PROOF OF DEPENDENT STATUSIf you choose to enroll your dependents in benefits, you willneed to submit dependent verification documentation within30 days from the date you add them as a dependent.This information should be sent to:HRquestions@jefferson.edu or Fax: (215) 503-7455If you do not provide the required documentation within30 days of enrollment, that dependent will no longer beentitled to benefits and will be removed from coverage.Who is not eligible for coverage? A former spouse A parent or grandchild who resides with you A legally domiciled adult and/or domestic partner, Any other person who does not meet the eligibilityrequirementsSee acceptable documentation below. Presently valid legal marriage certificate or license (must include date of marriage).Legally Married Spouse(any one of these documents) First page of your prior year Federal income tax return form 1040 that indicates“married filing jointly“ or “married filing separately“ (your spouses name mustappear on the tax form on the line provided after the “married filing separately“status). Financial information may be blocked out. Legal or hospital birth certificate showing the parent/child relationshipwith the employee. First page of prior year Federal income tax return form 1040 showing the childlisted as a dependent (financial information may be blocked out).Natural Child, Adopted Child orChild for whom you are the legalguardian under age 26*(any one of these documents) Baptism certificate showing the parent/child relationship with the employee. Official court order (divorce decree/custody agreement) showingthe parent/child relationship with the employee. Legal adoption papers showing the parent/child relationship with the employee. Legal guardianship papers issued by the courts showingthe guardian/child relationship.In addition, for a disabled child age 26 or older, an Application to Continue Coveragefor a Handicapped Dependent Child must be submitted to Independence Blue Cross.* Legal birth certificate showing parent/child relationship to the spouse ofemployee and valid legal marriage certificate between the employee and spouse. First page of prior year Federal income tax return form 1040 showingthe child listed as a dependent (financial information may be blocked out).**Stepchild under age 26(any one of these documents)* Court order (divorce decree/custody agreement) showing jointor shared legal custody by your spouse.** A Qualified Medical Child Support Order (QMCSO) that identifies the childas requiring benefit coverage through the employee’s spouse.**In addition, for a disabled child age 26 or older, an Application to Continue Coveragefor a Handicapped Dependent Child must be submitted to Independence Blue Cross.*If you are an employee providing documentation for a child of your spouse, documentationmust also include any one of the documents listed for spouse even if your spouse is not coveredby the Jefferson benefit plans.**4ELIGIBLE DEPENDENTSNEW HIRES: Make sure to enroll within 30 days of your hire date.
How And When ToEnroll For CoverageNew hires must enroll in benefits within 30 days from date of hire. Employees that havea status change must enroll in benefits within 30 days of becoming eligible for benefits.You will need to enroll in benefits online using Employee Self-Service (ESS). The benefitsyou choose will remain in effect until December 31 of that year.If you do not want Jefferson medical coverage, you must go online and waivecoverage. Otherwise, you will be enrolled in the Gold PPO Plan at employeeonly coverage.OPEN ENROLLMENTEvery fall you will have an opportunity to make changes to your benefits duringOpen Enrollment. Any changes you make at Open Enrollment take effect on theupcoming January 1.Verify YourElectionsYou will be able to verify yourelections one business day aftersubmitting an event by logginginto Employee Self Service. Click on Benefits Click on Benefits Summary Fill in applicable date,i.e. for future coverage,you must enter future date Click GoCHANGING YOUR BENEFITS DURING THE YEAR DUE TO A LIFE EVENTYou can only change your benefit elections during the year if you have a life event,as defined by the IRS. That is why it is important to review your choices carefully toensure the benefits you choose will meet the needs of you and your family throughoutthe year. If you have a life event, you can only make a change to your coverage that isconsistent with the life event. For example, if you get married, you may add your spouseto medical coverage, but may not switch medical plans. Any change you make must bemade within 30 days of the event.Life Events include: Marital status change (marriage, divorce, death of spouse) Change in number of dependents (birth, adoption, death of dependent) You or one of your covered dependents gain or lose other benefits coverage Any other event recognized under applicable law and regulations as a reasonto change an election under the Benefits ProgramMarriage, birth or adoption life events can be submitted through Employee Self-Service.Any required documentation must be submitted to HR Operations within 30 days of theevent. Contact HR Operations at 215-503-4772, press Option 8, and then Option 1 toreport other life event changes.READY TO ENROLL? Go to page 40 for instructions.ENROLLMENT5
When Coverage EndsFOR YOUJefferson benefit coverage ends for you upon the following events: Medical, vision and dental benefits end on the last day of themonth in which your employment ends or you no longermeet the applicable eligibility requirements of the plans Life insurance, disability and FSA benefits end on the dateyour employment ends or you no longer meet the applicableeligibility requirements of the plansFOR YOUR DEPENDENTSJefferson benefit coverage ends for your dependents on the date: Your coverage ends Your dependent no longer meets the definition of aneligible dependent You remove a dependent from coverage due to a life eventCoverage may also end if you stop making required payments,you misrepresent your dependent’s eligibility status or the plan ends.COBRACOBRA requires continuation coverage to be offered to covered employees, their spouses, their former spouses and their dependentchildren when group health coverage would otherwise be lost due to certain specific qualifying events. The chart below shows thespecific qualifying events, the qualified beneficiaries and maximum coverage period.Qualifying EventQualifiedBeneficiariesMaximum Period ofContinuation CoverageTermination (for reasons other than gross misconduct)or reduction in hours of employmentEmployee, Spouse,Dependent Child18 monthsEmployee enrollment in MedicareSpouse, Dependent Child36 monthsDivorce or legal separationSpouse, Dependent Child36 monthsDeath of employeeSpouse, Dependent Child36 monthsLoss of “dependent child” status under the planDependent Child36 monthsOnce the qualifying event has been reported to HR Operations, the qualified beneficiary will receive a COBRA notice in the mail to thehome address on record by our third party administrator, Discovery Benefits. For more information on COBRA, visit the DOL website,“An Employees’ Guide to Health Benefits under COBRA” at www.dol.gov/ebsa/pdf/cobraemployee.pdf, contact Discovery Benefits at866-451-3399 or your HR Business Partner.Monthly CostPlatinum PPOGold PPODavis VisionPlatinumDentalGoldDentalBeneficiary Only 551.82 524.28 6.32 31.89 27.75Beneficiary Spouse 1,241.34 1,179.12 10.85 63.77 55.52Beneficiary Child(ren) 1,048.56 995.52 10.85 ( 15.67) 71.74 62.45Beneficiary Family 1,765.62 1,676.88 15.67 95.65 83.276COVERAGENEW HIRES: Make sure to enroll within 30 days of your hire date.
Livewell@JeffREDBRICK HEALTHThe LiveWell@Jeff program was established to enhance the quality of life ofJefferson employees by promoting healthy lifestyles and reducing the risk ofillness by using Jefferson’s wide range of educational and clinical resources.Jefferson has partnered with RedBrick Health to create a rewards program withan interactive online employee portal.PROGRAM REQUIREMENTSStep 1: Tell Us More About YourselfComplete your online health assessmentby September 1, 2018. It’s a shortquestionnaire about your health thatonly takes a few minutes to complete.You’ll see your strengths and identifyareas where you can improve.ELIGIBILITYAll benefits-eligible employees of Jefferson, and members of 1199C enrolledin a Jefferson-sponsored medical plan, are eligible to participate in theLiveWell@Jeff program.2018 WELLNESS CREDITSFor employees and spouses who completed LiveWell@Jeff wellness programrequirements by September 1, 2017, you will receive a wellness credit of 15per pay. Your covered spouse can earn an additional 10 per pay, regardlessof which medical plan you enroll in beginning January 2018.NEW PROGRAM YEAR: OCTOBER 1, 2017 – SEPTEMBER 1, 2018We are excited to introduce a new way to earn financial rewards beginningOctober 1, 2017. Real-Time Rewards allows employees to earn wellness points forcompleting healthy activities throughout the year. Once you complete your healthassessment and biometric screening, you can instantly redeem your points for up to 60 in gift cards (1 point 1). Additionally, employees who complete the online healthassessment and biometric health screening by September 1, 2018 will be eligible forwellness credits in 2019.Step 2: Know Your NumbersGet a health screening to get a betterpicture of your health and submit yourrecords to RedBrick Health by September1, 2018. These will remain confidentialand Jefferson will not have access to anyindividual’s health records. It may take upto two weeks for your screening resultsto appear on your wellness portal.Step 3: Real-Time Rewards (optional)Earn wellness dollars throughout theyear when participating in healthyactivities. Once you complete youronline health assessment and biometrichealth screening, you can instantlyredeem up to 60 in gift cards.How the Portal WorksBenefits-eligible employees, and members of 1199C enrolled in a Jeffersonsponsored medical plan, can create an account at MyRedBrick.com/Jefferson.The RedBrick wellness portal is where you will complete the Health Assessment,record your healthy activities, and access health information and tools.RedbrickHealthMobile AppTake RedBrick Health withyou on the go! The RedBrickApp gives you a fast and easyway to track your daily activities,make progress on your healthimprovement journey, andearn all the rewards of betterhealth. The activation code is:“jefferson”READY TO ENROLL? Go to page 40 for instructions.LIVEWELL@JEFF7
Information on Health ScreeningsThere are four ways to complete your Health Screening:Your Own ProviderOnsite at Jefferson LabsLabCorpOnsite ScreeningsComplete your Health Screening using your own provider. Have your provider completethe Health Screening Form (available on your wellness portal) and submit to RedBrick.You can schedule your health screening at any time throughout the year at the JeffersonOutpatient Lab by calling 1-800-JEFF-NOW. The lab will submit your results directly to RedBrick.Complete your health screening at a participating LabCorp. Print a prepaid voucher and searchfor a participating LabCorp lab on your wellness portal.Onsite health screenings at Jefferson will be available every spring.Information onReal-Time RewardsIn addition to earning wellness credits for 2019, employeescan qualify for gift cards by participating in healthy activities.Earn wellness points for each activity and instantly redeemup to 60 in gift cards once you complete your twoprogram requirements.Some activities are self-reported, while others will beawarded by RedBrick upon completion of a program.Visit www.jefferson.edu/livewell for more information.Examples of Healthy Activites (1 point 1)Annual Physical 10 pointsEXOS Program 15 pointsRedBrick Track 1 point/dayDental Exam 10 pointsBehavior ModificationProgram 15 pointsLunch & Learn 5 pointsVision Exam 10 pointsNutrition Program 15 pointsFinancial Wellness 5 pointsPreventative Screenings 10 pointsRedBrick Journey 15 pointsHealth/Wellness Fair 5 pointsRedBrick Challenge 10 pointsCommunity Walks/Runs 15 pointsVolunteer/Donate Blood 5 points8LIVEWELL@JEFFNEW HIRES: Make sure to enroll within 30 days of your hire date.
Medical PlansMEDICAL PLANS AT A GLANCEJefferson gives you a choice of two medical plansadministered through Independence Blue Cross: Platinum PPO Gold PPOIn 2018, you have a choice of four coverage categories.This is a change from our previous structure. Employee only Employee Child(ren) Employee Spouse FamilyTerms to KnowAllowableAmountCoinsuranceCopayDeductibleOut of PocketMaximumPre-existingLimitationsHere are some important terms to help you understand how the plans pay benefits.Our benefit plans pay expenses based on the allowable amount. This is the average charge, or “goingrate” for a specific service in a geographic area. Network providers have agreed to accept the allowableamount, while out-of-network providers may charge above the allowable amount. With an Outof Network provider, you may be responsible for the amount over the allowable amount, in additionto any deductibles, coinsurance or copays your plan requires.The percentage of an eligible expense the plan pays (such as 70%).You pay the remaining percentage (such as 30%) and this counts toward the out-of-pocket maximum.The flat dollar amount you pay for some services (such as 20) at the time care is received.Copays count toward the out-of-pocket maximum.The amount of eligible expenses you pay before the plan pays benefits.The deductible counts toward the out-of-pocket maximum.This is the maximum amount you or your family must pay in coinsurance, copays and deductiblestoward eligible expenses in a calendar year. Generally, when you reach the out-of-pocket maximumthe plan will pay 100% for most eligible expenses.The medical plans do not restrict benefits based on pre-existing conditions.READY TO ENROLL? Go to page 40 for instructions.MEDICAL PLANS9
Cost of CoverageThe bi-weekly cost varies based on the: Medical option you choose Number of dependents you choose to cover Smoker status for you and your spouse Wellness program participation for you and your spouse Whether or not your covered spouse is eligiblefor medical coverage through another employerIf you’re enrolled in the medical plan and attest to being a smoker,you will be charged a 25 per pay premium. If your spouse smokes,a 25 per pay smoker premium will apply for spouses enrolled in themedical plan. During the online enrollment process, you will answerquestions regarding you and your spouse’s smoker status. The premiumswill apply if you indicate you or your spouse smokes or if you do notanswer the question, and enroll your spouse in the medical plan.MEDICAL CONTRIBUTION RATES—PER PAY PERIODFull-Time EmployeesPLATINUM PPOGOLD PPOEmployee Only 48 39Employee Spouse 109 90Employee Child(ren) 99 75Family 170 140PLATINUM PPOGOLD PPOEmployee Only 115 100Employee Spouse 241 214Employee Child(ren) 220 200Family 362 314Part-Time Employees10COST OF COVERAGEResearch shows that there is a growingtrend for employer plans to chargemore to cover spouses who have accessto health insurance through anotheremployer. In reviewing our plans,we’ve found that Jefferson covers morespouses — taking on a larger medicalresponsibility than other employers.If your spouse has medical coverageavailable through another employerand you choose to cover your spouseunder a Jefferson medical plan, you willpay an additional 40 per pay for thecoverage. During the online enrollmentprocess, you’ll be asked if your spousehas coverage available through anotheremployer. The charge will only apply ifyour spouse has other available coverageor if you do not answer the question,and enroll your spouse in medical.Your cost for the medical plan isdeducted from your pay on a pre-taxbasis. The rates shown here are priorto any credits or premiums.NEW HIRES: Make sure to enroll within 30 days of your hire date.
Platinum and Gold PPO PlansHOW THE PLATINUM AND GOLD PLANS WORKThe Platinum and Gold PPO medical plans allow complete freedom of choice ofproviders. Research shows that a patient with a relationship with a PCP has bettercoordinated care, better outcomes, with less cost and waste. For both the Platinumand the Gold Plans, Primary Care Office copays under Tier 1 (Home) are free.Referrals are not required with the medical plans.The Platinum PPO plan provides a high level of comprehensive coverage, with 100%coverage for services through Home facilities. You will pay more per pay period forthe Platinum PPO plan.The Gold PPO plan is a lower-level coverage option that still provides importantprotections and costs less per pay period. You will pay a modest deductible for Homefacility services and pay overall higher out-of-pocket costs when you go to the doctor.It is important to note that infertility and hearing aid services are not covered by theGold PPO plan.You decide which network to choose a provider from when seeking medical care. Tier 1 Home ( ): You receive care from a home JeffCare network provider Tier 2 Non-Home ( ): You receive care from a non-home JeffCare network provider Tier 3 ( ): You receive care from a Personal Choice provider Tier 4 ( ): You receive care from an out-of-network providerIf you receive care at a JeffCare network facility or a JeffCare network provider,you receive the highest level of benefits. This higher level of benefit is only availableif the service is available through a JeffCare network provider.HOSPITAL NETWORKThe JeffCareHospital NetworkThe network of providers is identical in both plans.Visit www.jeffnetworks.org and click on 2018 forthe most up-to-date listing of facilities and providersin Tiers 1 and 2. Go to www.ibx.com to search forproviders in the Personal Choice network.READY TO ENROLL? Go to page 40 for instructions.Tier 1 (Home) TJUH, JHN, Methodist Abington, Lansdale Aria Kennedy Bala Endoscopy Center Rothman OrthopedicSpecialty Hospital Main Line Health HospitalsTier 2 (Non-Home) Nemours Wills Eye (Center City only) Doylestown MageeMEDICAL PLANS11
Livongo for DiabetesEmployees and dependents enrolled in a Jefferson medical plan,and are diagnosed with type 1 or type 2 diabetes can enroll inthe Livongo for Diabetes program at no cost.Benefits Unlimited Test Strips at no cost shipped to your homewith no copays The Livongo connected meter provides real time tipsand uploads readings Livongo coaches are Certified Diabetes Educators whocan assist you with nutrition and lifestyle changes.To join or learn more: welcome.livongo.com/JEFFor call Livongo Member Support at (800) 945-4355*At this time the Livongo meter does not integrate with insulin pumps.If you use an insulin pump, please discuss the use of Livongo with yourhealthcare team.JeffConnectFast easy way to see a Jefferson Doctor! Go to jeffconnect.orgto enroll. Initiate a video visit on your computer or mobile device.Available 24/7/365.12MEDICAL PLANSWhat is Not Covered? Services not medically necessary Services or supplies which are experimental or investigativeexcept routine costs associated with clinical trials Reversal of voluntary sterilization Expenses related to organ donation for non-memberrecipients Alternative therapies/complementary medicine Dental care, including dental implants, and non-surgicaltreatment of temporomandibular joint syndrome (TMJ) Music therapy, equestrian therapy, and hippotherapy Treatment of sexual dysfunction not related to organic diseaseexcept for sexual dysfunction resulting from injury Routine foot care, unless medically necessary or associatedwith the treatment of diabetes Foot orthotics, except for orthotics and podiatric appliancesrequired for the prevention of complication associated withdiabetes Routine physical exams for non-preventative purposes suchas insurance of employment applications, college, orpremarital examinations Immunizations for travel or employment Service or supplies payable under Workers’ Compensation,Motor Vehicle Insurance, or other legislation of similar purpose Cosmetic services/supplies Self-injectable drugs Infertility Treatment under the Gold PPO Plan Hearing aid services under the Gold PPO PlanNEW HIRES: Make sure to enroll within 30 days of your hire date.
Platinum PPO Plan 2018 Plan SummaryBenefitsJeffCare HomeJeffCare Non-HomePersonal Choice NetworkOut-of-Network*Deductible (Individual)None 100 1,000 1,500Deductible (Family)None 300 3,000 4,500Benefit PeriodCalendar YearCalendar YearCalendar YearCalendar YearCoinsurance(percentage paid by plan excepthearing aid benefit)100% unlessotherwise noted100% unlessotherwise noted70% after deductible unlessotherwise noted60% after deductibleunless otherwise notedOut-of-Pocket Maximum***(Individual) 2,000 2,5004 3,5004 5,000Out-of-Pocket Maximum***(Family) 4,000 5,0004 7,0004 10,000Lifetime ��s Office Visits(Primary Care Services) 0 Copayment 15 Copayment 30 Copayment60% after deductibleDoctor’s Office Visits(Specialist Services) 30 Copayment 45 Copayment 60 Copayment60% after deductiblePreventative Carefor Adults & Children100%100%100%60% after deductiblePediatric Immunizations100%100%100%60% after deductibleRoutine GynecologicalExam/Pap (1 routine exam/paptest per calendar yearfor women of any age1)100%100%100%60% after deductibleMammogram100%100%100%60%Nutrition Counselingfor Weight Management(6 visits per calendar year1)100%100%100%100% after deductibleOutpatient DiagnosticServices (Routine Radiology) 15 Copayment 20 Copayment70%60% after deductibleOutpatient DiagnosticServices (Advanced Radiology –MRI/MRA/CAT/PET) 40 Copayment 60 Copayment70% after deductible60% after deductibleOutpatient DiagnosticServices (Laboratory)100% 10 Copayment 25 Copaymentper occurrence60% after deductibleAllergy Testing100%100%70% after deductible60% after deductibleAllergy Extract / Injections100%100%70% after deductible60% after deductibleMaternity (First OB Visit) 30 Copayment 45 Copayment 60 Copayment60% after deductibleMaternity (Hospital)6100% 350 Copaymentper admission370% after deductible360% after deductible2Contraceptives100%100%100%60% after deductibleInfertility Diagnosisand Treatment( 20,000 per lifetime1)100% afterapplicable copayment70% after deductibleand applicable copayment70% after deductibleand applicable copayment60% after deductible100% 250 Copayment70% after deductible60% after deductible100% 350 Copaymentper admission370% after deductible360% after deductible2 Professional
New hires must enroll in benefits within 30 days from date of hire. Employees that have a status change must enroll in benefits within 30 days of becoming eligible for benefits. You will need to enroll in benefits online using Employee Self-Service (ESS). The benefits you choose will remain in effect until December 31 of that year.
