1 Summary of EMPLOYEE Health BenefitsJBI, LTD Effective September 1, 2016
2 Health Plan Annual Open EnrollmentOpen enrollment every August Changes can be made to health coverage during open enrollment
3 HEALTH Benefit Resources User ID: unificare Password: Justice1 Coming Soon! – You will not need a password & user ID and will only include the following URL for the JBI, Ltd. Employee Benefit Website
4 Health Plan Annual Open Enrollment 9/1/2016Change Medical Plan at BCBS Change Vision from RSL/Eye-Med to Vision Service Plan (VSP) No Plan Changes to Dental, Life/AD&D, LTD, Voluntary Term Life, Accident, Medical/Bridge & Critical Illness insurance policies New Cancer policy through supplemental insurance – current participants will remain enrolled in current Cancer 1000 policy Eliminate Grandfather Class –MB will no longer be paid for by the company for employees hired prior to 9/1/2011– MB will continue at Employee cost with pre-tax dollars effective 9/1/2016 based on age at the time of initial enrollment under the MB (unless terminated during open enrollment)
5 What Benefits are Offered?Medical including Rx Blue Cross Blue Shield (BCBS) Dental Dearborn Vision Vision Service Plan (VSP) Basic Term Life/AD&D RSL Long Term Disability Voluntary Term Life Supplemental Insurance Colonial
6 Your Supplemental Insurance BenefitsAccident Cancer Medical Bridge Critical Illness
7 Other Services Available to You at No Cost with RSL24-hour Travel Assistance through On Call Identity Theft Recovery Services through National ID Recovery Bereavement Counseling services through HMSA
8 Your Per Paycheck (Bi-Weekly) ContributionsContributions for Medical, Dental, & Vision MedicalBridge is not included but available for purchase with Colonial Life Employee Only $43.20 Employee & Spouse $157.75 Employee & Child(ren) $159.23 Family $275.62
9 COBRA Rates for medical, dental, & vision EFFECTIVE 9/1/2016PER MONTH Employee Only: $636.41 EE & Spouse: $1,269.34 EE & Child(ren): $1,277.48 Family: $1,920.56
10 Your Medical Plan Blue Cross Blue Shield (BCBS)Nationwide more than 720,000 providers and 6,300 hospitals contracted with BCBS PPO G6521 –BCBS New Benefit Plan Effective 9/1/2016 BCBS Policy #120534
11 How do I find a contracting medical provider?Go to Provider finder at BCBSTX.COM Log on to your Blue Access for Members (BAM) account Call Customer Service (number located at back of ID card) BlueCard Worldwide available for international benefits (800)
12 Your Medical Plan Network BenefitsCalendar Year Deductible - $3,125 (3x family) Maximum OOP – $3,125
13 Your Medical Plan Network BenefitsOffice Visit Copay- $25 Specialist Visit Copay - $50 Office visit copay only applies to the doctor office visit All Copays such as office visit, specialist, prescription, urgent care apply to the Maximum Out of Pocket
14 Your Medical Plan Network BenefitsEmergency Room Visit - $400 Copay, then Deductible **Physician charges are subject to the deductible at the ER room Urgent Care Center Visit - $75 Copay * *Certain diagnostic procedures are subject to deductible Non-PPO urgent care provider benefits are paid at non-network benefit level
15 Lab & X-ray Deductible applies to Routine Lab & X-ray regardless of place of service Deductible applies for Lab & X-ray performed in the doctor’s office, at a free-standing lab, or an imaging center).
16 Dependent Children under 19Pediatric Dental & Pediatric Vision Integrated with Medical Plan Pediatric Dental & Vision benefits are included as part of the Medical Plan in addition to the Dental plan with Dearborn and the Vision plan with VSP For information on Pediatric Dental – please call number on dental ID card For information on Pediatric Vision – please call Davis-Vision at 800/ Refer to BCBC Medical Booklet for Specific Details
17 Your Prescription CoverageGenerics Plus Formulary List Employer Offered Metallic Small Group – Generics Plus 3 Tier Leaner Formulary List to Encourage Generic Utilization Preferred Retail Pharmacy Network Includes CVS, Walmart, HEB, Brookshire, & Access Health Access Health pharmacies can be located at MyPrime.com Lower Copays through Preferred Pharmacy Network
18 Your Retail Prescription Coverage (up to a 30 day supply)Preferred Retail Pharmacy Generic $10 Preferred Brand Name $40 Non-Preferred Brand Name $60 Specialty $60 Non-Preferred Retail Pharmacy Generic $15 Preferred Brand Name $50 Non-Preferred Brand Name $70 Specialty $70
19 Up to a 90 Day Supply Three Times Retail – Available at Preferred Pharmacy or through Mail Order Specialty Medications cannot be filled through Mail Order
20 PRESCRIPTION plan featuresPrior Authorization Step Therapy Preferred Drug List Quantity Limits Triessent Specialty Pharmacy Program
21 BCBS Health & Wellness ResourcesBlue Care Connection BlueExtras Personal Health Manager Condition Management Weight Management Tobacco Cessation Fitness Program 24/7 Nurseline Special Beginnings Online Healthcare Tools Be Smart – Be Well – Where awareness & prevention meet Hearing Discount Program Vision Discount Program Jenny Craig, Curves, Lifetime Fitness Seattle Sutton’s Healthy Eating Life Time Fitness Complementary Alternative Medicine
22 Prescription Vendor RegistrationRegister with BCBS for 24/7 access to your medical claims and account information Blue Access for Members (BAM) Prescription Vendor Registration
23 Your Dental Benefits Available through Dearborn National #FG1D1136Significant Savings to Utilize PPO Dentists (average discount 28%) Call phone number on ID card for a list of participating dentists
24 Your Dental Benefits Annual Limit - $1,000Calendar Year Deductible $50 individual (3x family) Preventative 100% - deductible waived Basic 80% & Major 50% Child Orthodontia - $1,000 lifetime
25 Features of your dental planTwo Preventive cleanings per calendar year PLUS Two Professional cleaning, scaling, & polishing cleanings per calendar year Full Mouth X-rays once every 36 months Fluoride to Age 19 (two per calendar year) Sealants to age 16 (one per unrestored permanent molar)
26 Features of your dental planSpace Maintainers & Sealants at 100% Composite (tooth-colored) fillings Once per surface per year No Missing Tooth Clause Crown & Bridge replacement Once every 5 years
27 Register with Dearborn National for 24/7 access to your Dental claims and account informationhttps://accessforindividuals.hcsc.net/registration/
28 Available through Vision Service PlanYour Vision Benefits Available through Vision Service Plan Group # Choice of Providers -- The decision is yours to make—choose a VSP doctor, a participating retail chain, or any out-of-network provider The largest network of independent eye doctors VSP vision insurance is accepted by more than 34,000 doctors nationwide
29 Your Vision Benefits To find a VSP provider, visit vsp.com or call Tell the provider you have VSP – No ID Card is necessary You can print ID card on vsp.com No claim forms to complete when you see a VSP network provider
30 Your Network Vision BenefitsRoutine Eye Exam - $10 Copay Contacts exam - up to $60 copay (in addition to exam copay) Materials - $10 Copay Glasses or Contacts
31 Your Network Vision BenefitsFrame Allowance - $150 Featured Frame Allowance - $170 Contact Allowance - $130 20% Discount on amounts over allowance or extra pair of glasses within 12 months of exam
32 Your Network Vision BenefitsFrequency of Vision Benefits Exam – Every 12 Months Lenses – Every 12 Months Frames – Every 24 Month
33 Your Network Vision BenefitsMinor Eye Medical Condition - $20 Copay Routine Retina Screening – Up to a $39 Copay
34 Special Offers through VSPSelect from Extensive List of Featured Brands & receive ADDITIONAL $20 Allowance for Featured Frames Examples of Featured Brands include Anne Klein, Calvin Klein, Nike, Nautica, & Valentino Rebates for contact lens, coupons, & other discounts
35 Register with VSP 24/7 access to your VISION claims and account information
36 Your SURVIVOR & DISABILITY BENEFITSReliance Standard Life (RSL) Basic Life/AD&D - $50,000 Long Term Disability – 60% of salary to $6,000/month after 90 days of disability Paid for by JBI, Ltd. Option to Purchase Additional Term Life/AD&D Insurance
37 Option to Purchase Voluntary Term Life/AD&D InsuranceAvailable through Reliance Standard Life (RSL) Choices of life insurance, for Employee and/OR Spouse in increments of $10,000 to $500,000 Rate based on Age as of Sept. 1st (adjusts once per year)
38 Option to Purchase Voluntary Term Life/AD&D InsuranceSpouse coverage based on Spouse Age (not EE Age) Portability Included (at different rates) Paid by Employee – After Tax Dollars Child Life Only coverage $10,000 $1.62 per month or $.75 bi-weekly
39 Employee under age 60 - $100,000 (60-70 $10,000) Spouse under age 60- $50,000 Voluntary Term Life Guarantee Issue available if Enrollment occurs when 1st Eligible
40 Colonial Life Supplemental InsuranceColonial pays you directly… in addition to health insurance Benefits are Portable Even if you Terminate At Issue Age Individual Policies
41 COLONIAL LIFE SUPPLEMENTAL INSURANCEColonial pays you directly, in addition to health insurance 30 day waiting period for Cancer, Critical Illness, & Wellness/Health Screenings Colonial benefits are at the same rates if you terminate & wish to continue coverage Guaranteed Renewable
42 Colonial Supplemental InsuranceSupplemental Policies are Individual Policies Minimal Underwriting Duplication of Colonial Policies Not Permissible Colonial does not Coordinate with your Medical Insurance policy
43 Accident Policy $50 Health Screening after waiting periodPays for Doctor Visits, ER, Urgent Care, X-ray, Hospital Admission, Accidental Death & more Premiums Paid with Pre-Tax Dollars Includes Children in Sports $50 Health Screening after waiting period GA & CT – No wellness Illinois, Ohio, South Carolina very comparable PA has higher rates but slightly higher benefits Florida has lower rates but higher benefits Indiana, Kentucky, & New York have comparable rates but higher benefits Accidental Death: TX, IL, OH, PA, SC, TN, CT, & NJ = $25K GA & NY & FL = $40K KY = $50K IN = $75K
44 ACCIDENT Cost Example for Family Coverage$ Net Annual Cost OR $9.46/Month in 25% Tax Bracket Assuming pre-tax savings & utilizing 4 wellness/health screening One Accident Claim can Pay for Entire Year’s Premium
45 ACCIDENT EXAMPLES OF ELIGIBLE BENEFITSAccident Emergency Treatment Accidental Death Coma Fracture Hospital Admission & Surgery Accidental Dismemberment TX Limits Accident Emergency Treatment within 72 hours - $125 Followup - $50 (3 visits) Accidental Death - $25,000 EE & Spouse; Child $5,000 Hospital Admission - $1,000 + $225/day for 1 year; ICU $2,000 + $450 for 15 days Coma - $10,000 Accidental Death $40K in GA, FL, & NY; $50K in KY; $75K in IA
46 ACCIDENT EXAMPLES OF ELIGIBLE BENEFITS Refer to Outline of Coverage for Complete ListConcussion Ambulance Physical Therapy Prosthetics Tendon/Ligament/Rotator Cuff Medical Imaging TX Limits Concussion - $60; Ambulance $200 (air $2,000); PT $25 for 10 days; Prostethics - $500 to $1,000 Transportion $500/trip (3 rounds); Medical Imaging $150/once CY
47 Accident Health Screening$50 Health Screening benefit per year per person after 30 day waiting period Some Examples of Eligible health screening for Accident policy Blood test for Triglycerides Serum Cholesterol Test for HDL/LDL Levels Mammogram Fasting Blood Glucose Test Pap Smear Blood Test for Colon Cancer Stress test on bike/treadmill PSA Review Hospital Confinement (Medical Bridge) Outline of Coverage
48 Medical Bridge (Hospital Income)Hospital Confinement - $1,000 lump sum per hospital admission – Option to purchase $2,000 admission Outpatient Surgery - $500 or $1,000 per covered procedure (maximum $1,500/year) Same accident or sickness within 90 days – continuation of previous confinement Covers pregnancy (policy must be in force for 10 mos.) Review MB Outline of Coverage for Specific Details
49 Medical Bridge (HOSPITAL INCOME)Minimal Underwriting Pre-Existing Condition - Not Covered for first 12 Months Special Exception if Enrolling during 9/1/2016 Open Enrollment Period Guarantee Issue / No Medical Underwriting Required for Employee & Spouse Subject to 12 Month Pre-Existing Special Exception for New Employees who Enroll when 1st Eligible Guarantee Issue / No Medical Underwriting Required for Employee & Spouse Pre-existing Exclusion Waived for Employee (not waived for Spouse) Special Exceptions do not apply to dependent children
50 Medical Bridge / Hospital Income Wellness$50 Wellness benefit per year (2 per family) after 30 day waiting period Some Examples of Eligible Wellness/health screening for MB Colonoscopy, Mammogram, Pap Smear, PSA, Serum, Cholesterol Test for HDL/LDL, Fasting Blood Glucose Test, Blood test for Triglycerides, Ultrasound, CA 15-3, CA 125, CEA, Serum Protein Electrophoresis, Stress test on bike/treadmill, & Chest X-ray Review Hospital Confinement (Medical Bridge) Outline of Coverage
51 CANCER POLICY Pays you Income if diagnosed with Cancer –Review Cancer Outline of Coverage CANCER POLICY Premiums paid with pre-tax dollars $100 Cancer screening/wellness per covered person 30 day waiting period Optional Riders available Specified Disease Initial Diagnosis Progressive Payment Pays you Income if diagnosed with Cancer – Examples Include Hospital Confinement Ambulance Nursing Services Radiation/Chemotherapy Experimental Treatment Transportation/Lodging Surgical Procedures
52 Cancer Supplemental PolicyColonial’s new Cancer policy is Cancer Assist Cancer 1000 no longer available for new participants as of 9/1/16 Existing Cancer 1000 participants automatically remain under current Cancer 1000 policy If participant requests to replace Cancer 1000 with Cancer Assist, 30 day waiting period waived with policy transfer if approved
53 CANCER POLICY Cancer Screening Benefit TestAdditional Invasive Diagnostic Procedure Ambulance Hospital Confinement Extended Care
54 CANCER POLICY Initial Diagnosis of Skin Cancer Medical ImagingTreatment Benefits including Radiation/Chemotherapy Surgical Procedures Transportation/Lodging
55 Cancer Wellness PART 1 – Wellness Pays $100 per person per calendar year after 30 day waiting period Colonoscopy & Virtual colonoscopy Mammography Pap Smear & ThinPrep pap test PSA (blood test for prostate cancer) Serum Protein Electrophoresis (blood test for Myeloma) CA 15-3 (blood test for breast cancer) CA125 (blood test for ovarian cancer) CEA (blood test for colon cancer) Flexible sigmoidoscopy Hemoccult stool analysis Thermography Chest x-ray Bone Marrow Aspiration/Biopsy Biopsy of Skin Lesion Breast Ultrasound PART II – Pays you $100 for additional invasive diagnostic procedure (as a result of an abnormal cancer screening test) CANCER ASSIST also includes Various Health Screening tests as part of Wellness
56 Cancer Assist Health Screening Eligible Under WellnessCANCER ASSIST also includes Health Screening tests as part of $100 Wellness Benefit N/A to existing Cancer1000 policies Blood Test for Triglycerides Carotid Doppler ECHO, EKG, ECG Fasting Blood Glucose Serum Cholesterol for HDL/LDL Levels Bike/Treadmill Stress Test
57 Critical Illness Pays 100% of Lump Sum Benefit Heart Attack StrokeReview Critical Illness Outline of Coverage Pays 100% of Lump Sum Benefit Heart Attack Stroke Major Organ failure End State Renal - Kidney failure Coma Blindness Permanent Paralysis due to Covered Accident Occupational effectious HIV or Hepatitis B, C, D Pays 25% for Coronary Artery Bypass Graft Surgery
58 Critical Illness 30 Day Waiting PeriodReview Critical Illness Outline of Coverage 30 Day Waiting Period Premiums are based on Your Age, Tobacco Status, Amount of Coverage, and enrollment location Pre-existing limitation generally for12 months Maximum benefit amount is reduced by 50% on anniversary date after age 75 Premiums paid with After Tax Dollars
59 Critical Illness Review Critical Illness Outline of Coverage You select Lump Sum benefit between $5,000 to $75,000 in $1,000 increments Maximum Policy benefit is Three (3X) Initial Lump Sum Family coverage includes Spouse at 50% and children at 25% of name insured Includes Subsequent Diagnosis $50 health screening per person/year after 30 day waiting period
60 Critical illness Health Screening$50 Health Screening benefit per year per person after 30 day waiting period Few Examples of Eligible health screening for Critical Illness Policy Blood test for Triglycerides Serum Cholesterol Test for HDL/LDL Levels Mammogram Pap Smear Fasting Blood Glucose Test Blood Test for Colon Cancer (CEA) PSA Review Hospital Confinement (Medical Bridge) Outline of Coverage
61 Colonial Life InsuranceUniversal Life Builds cash value Pays 5.1% interest on cash buildup Rider includes Long term Care & Nursing Home Level Term Life 10, 20, & 30 Year Level Term Available Accidental Death Option $10,000 Children Term -$2.08 bi-weekly Universal Life & Level Term Life are paid with After Tax Dollars
62 Register with Colonial Life for 24/7 access to your Supplemental insurance claims and account information Select policyholder website
63 Section 125 Components 1. Health Plan Premiums2. Pre-Tax Out of Pocket Health Expenses - Health FSA (Previously referred to as FlexMed & Medical FSA) 3. Pre-Tax Dependent Day Care Expenses - Dependent Care FSA (Previously referred to as FlexCare)
64 Do you know how much you pay in Taxes?FICA – 7.65% PLUS Your Federal Income Tax Rate Depending on where you live… You may also pay State & Local Taxes
65 Saving Advantages of Pre-TaxWhat does it take to earn $200 in a Low Tax Bracket? 15% Tax Bracket Gross Earnings $258.56 FICA (7.65%) $ FIT $ Net Earnings $200.00 You pay $58.56 in Taxes! Saving Advantages of Pre-Tax
66 What if I am in a higher Tax Bracket?What does it take to earn $200? 25% Tax Bracket Gross Earnings $296.95 FICA (7.65%) $ FIT $ Net Earnings $200.00 You pay $96.96 in Taxes! Saving Advantages of Pre-Tax
67 When do the Tax Brackets usually change?MARRIED FILING JOINTLY 15% to 25% at $75,300 25% to 28% from $75,301 to $151,900 28% to 33% from $151,901 to $231,450 SINGLE FILER 15% to 25% at $37,650 25% to 28% from $37,651 to $91,150 28% to 33% from $91,151 to $190,150 2016 Marginal Tax Brackets
68 I already pay my health premiums with pre-tax dollars … What else can I do to lower my taxes?
69 Health FSA Dependent Care FSA Max. $5,000 per yearConsider Setting up Flexible Spending Accounts (Plan Year = Calendar Year) Health FSA Max. $2,550 per year Dependent Care FSA Max. $5,000 per year
70 What is Health Flexible Spending Account?A Pre-Tax Health Spending Account Spending Account to pay for out of pocket medical, dental, & vision expenses (not covered by ANY insurance) Health FSA is for You & Your dependents, even if not covered under medical plan Funds are available 1st day of the plan year if you incur an eligible expense & file a claim
71 You cannot claim the tax deduction for medical expenses and Health FSAMedical Expenses must exceed 10% of income to be eligible for a tax credit Legislation changed amount from 7.5% to 10% in 2013 Age 65 & older postponed until 2016 for increase
72 Health FSA Examples IRS Section 213Prescription Copays Office Visit Copays Deductible Coinsurance (Your Portion) Vision Orthodontia Effective January 1, 2011 Over-the-Counter (OTC) not covered under Health FSA (except when medically required)
73 Examples NOT covered by Health FSAPre-payment of Services Supplements Health Club Dues Sonicare Products Cosmetic Over the Counter (OTC) Excluded 2011 (unless you have a prescription)
74 What is Dependent Care FSA?A Pre-Tax Dependent Day Care Account Reimburses for daycare costs for your child (up to age 13 years) or a disabled adult you are legally responsible Eligible if You & Your spouse (if married) are working or are full-time students You must incur & file an eligible claim - Funds are available ONLY once deposited in the account
75 Tax Credit versus Dependent Care FSATax Credit $3,000 per child (max. 2 children) Tax Credit % 20% to 35% depending on salary Dependent Care FSA $5,000 maximum limit Tax Savings = Federal Tax Bracket % FICA
76 You Cannot claim both the tax credit & use Dependent Care FSA Which is better in your situation?
77 What is better for me? (Tax Credit versus Dependent Care FSA)Depends on your income, number of children, & child care costs Complete the Flex Worksheet You may choose Dependent Care FSA OR take a year-end tax deduction – (but not both)
78 Register with UnitedHealthcare 24/7 access to your FSA claims and account information
79 IRS Rules All Elections are made Prospectively No changes unless Life Changing Event Use it or Loose It Health FSA changes only at new Plan Year (January 1st of each year)
80 What is a Life Changing Event?Your Marriage or Your Divorce Birth or Adoption of Your Child Death / Termination of your dependent relationship Change of Job/Job Status by You or Your Spouse Other situations as determined by IRS
81 Plan Year for Flexible Spending AccountsCalendar Year - January 1st to December 31st Plus a 2 ½ month grace period Equals 14 ½ months to Incur eligible Claims
82 How do I obtain Reimbursement?Incur an Eligible Expense during the Plan Year AND File a Claim with our FSA Administrator UHC
83 FSA Administrator UnitedHealthcare (UHC) Participant Call Center 877/
84 Questions ? Human Resources Manager, Bob KimbrellHealth Benefits Consultant, Debbie Fleck