65
Monadnock Developmental Services Open Enrollment For Benefits Effective January 1, 2021
Monadnock Developmental Services
Open EnrollmentFor Benefits Effective January 1, 2021
Welcome to our 2021 Open Enrollment!
• We are very pleased to be offering the same benefits as 2021 with a few benefit enhancement changes:
• We are changing our Vision Carrier to DeltaVision
• The ElevateHealth Medical Plan will now have a Tier 2 “All Other Harvard Pilgrim Network” benefit where all services go to a deductible, (in addition to the current ElevateHealth Network) and the plan name will change to Elevate Options
• Virtual Telemedicine/e-visits with your established providers will be a $20 copayment per visit for both plans
• We will be offering a True Open Enrollment for Voluntary Life where everyone can enroll with no medical question asked up to the Guaranteed Issue amount
• All other benefits will remain the same as 2020
• NEW THIS YEAR! We will complete online enrollment using Employee Navigator
• The open enrollment window will be November 16 – December 1
Your 2021 Medical Plans
ElevateHealth Options
• $3000 Deductible
• Limited NH Network – 21 hospitals including Monadnock Community Hospital & Cheshire Medical Center
• NEW “All Other Harvard Pilgrim Network” benefit (in addition to the Limited NH Network) which includes all HPHC providers (but because the “All Other Harvard Pilgrim Network” services except mental health are subject to a $6000/$12000 deductible, there is significant financial advantage to stay in network!)
LP Plan
• $3000 Deductible
• Full Harvard Pilgrim New England Network – and National United HealthCare Network
• All Hospitals treated the same
FOR BOTH PLANS: MDS pays the first $1,000 of each deductibleMember pays the next $2,000 of each deductibleMaximum of 3 deductibles per family
4
ElevateHealth Options In Network Participating Ambulatory Surgical Centers - $100 Copay
• Dartmouth Hitchcock Surgery Center-Manchester and Nashua locations
• Elliot One Day Surgery Center
• Androscoggin Valley Hospital.
• Concord Ambulatory Surgery Center
• Concord Endoscopy Center
• Concord Eye Surgery
• Centers for Pain Solutions
• NH Eye Surgicenter
• The Surgery Center of Greater Nashua
• Wentworth Surgery Center
• Capital Orthopaedics Surgery Center –Concord and Derry locations
• Cottage Hospital
Please refer to the online directory for a full listing of participating Ambulatory Surgical Centers
Find Providers in Your Network
To find providers in your network, go to healthplansinc.com/members:
Log in to My Plan1
Click on your network underMy Provider Networks
2
Click Search for a Provider1
Select ElevateHealth Network or for PPO-LP, select Harvard Pilgrim Healthcare and United Healthcare Options PPO network to begin your search
2
or
Manage Your Plan at Home or On the Go with My Plan
Use your Member ID number to register for instant secure access to your plan information:
• Find doctors and hospitals in your network• Check the status of a claim• Review your benefits• Access your prescription drug plan• Print a claims history summary report• Submit a request for claims reimbursement• Print or submit forms • View, print, or order your member ID card
Network Pharmacy LocatorThe Southern Scripts pharmacy network consists of independent and retail pharmacies. The Network Pharmacy Locator Tool allows members to search for a list of pharmacies near a specific location that is inclusive to the Southern Scripts pharmacy network. To access the Network Pharmacy Locator, please visit the website below.
1. Enter your ZIP code2. The Southern Scripts Bin Number is 0154333. Enter your Group Code found on your
insurance/prescription card4. Select your search radius based on your ZIP code
* Specialty medications are limited to a 30-Day Supply.
Prescription Drug Plan
FirstChoice™ Pharmacy Network
Members of Southern Scripts have access to reduced prescription costs at participating FirstChoice™ pharmacies. FirstChoice™ pharmacies are noted with the FirstChoice™ logo on the Network Pharmacy Locator page.
Pharmacy is contracted for specialty medications
Pharmacy is contracted for vaccines.
Prescription Drug Plan
Mail Order ServicesPostal Prescription Services
Hours of Operation:Monday-Friday6:00am - 6:00pm PST
Saturday9:00 AM - 2:00 PM PST
Contact:Toll Free:(800) 552-6694
Website:https://ppsrx.com
Name: Postal Prescription ServicesPharmacy NPI: 1528003910FAQs: https://www.ppsrx.com/topic/postal-prescription-service-faqs
Prescription Drug Plan
Cynthia
Mail Order ServicesPostal Prescription Services
Create an Account:
https://www.ppsrx.com/topic/account
Ordering New Prescriptions and Refills:
https://www.ppsrx.com/topic/refills
Adding a Patient:
https://www.ppsrx.com/topic/add-a-patient
Additional Resources:
https://www.ppsrx.com/topic/postal-prescription-service-faqs
Prescription Drug Plan
Variable Copay™
Variable Copay™ is a free program that utilizes manufacturer-provided coupons to
significantly reduce the cost on eligible medications. If your medication has a
Variable Copay™ opportunity and you attempt to fill your prescription at an
independent or retail pharmacy, the pharmacy will receive a rejection notice stating
“Variable Copay Opportunity Available: Please call (800) 710-9341.” The rejection
notice does not indicate that your medication is not covered but instead determines
that your medication is eligible for a manufacturer coupon that will reduce the cost
to you.
Prescription Drug Plan
Variable Copay™
CRx Specialty Solutions™ is the preferred Variable Copay™ Pharmacy,
who will fill your prescription, administer the Variable Copay™
program, and provide free services such as automated shipping and
refills. CRx Specialty Solutions™ will also contact your doctor when
additional refills are needed on your prescription.
Prescription Drug Plan
Contacting the Variable Copay™ Pharmacy24/7/365 support available
Should you have any issues regarding your prescription fulfillment, please call (800) 710-9341 to speak with a CRx Specialty Solutions™ Customer Care Specialist.
Name: CRx Specialty Solutions Pharmacy
Hours of Operation:Monday-Friday8:00am - 5:00pm CST
Contact:Toll Free: (877) 646-1716Fax: (318) 214-4190Website: crxspecialty.com
Prescription Drug Plan
Accessing the Southern Scripts Member Portal
To manage your prescriptions online, visit the website below and click on the link entitled Member Portal. Each registered member will have instant access to their benefits, prescriptions, cards, and more.
Prescription Drug Plan
Download our Mobile App
Southern Scripts knows that in this digital age, members want convenient and straightforward access to important pharmacy information.
That’s why we created a simple and fast way for members to track and manage prescriptions - all in the palm of their hand.
Our free app holds a digital member card, current and previous Southern Scripts prescription lists, and an integrated pharmacy locator.
Prescription Drug Plan
Your Pharmacy Benefit Covered Medications
Have questions regarding your covered medications? Please call our dedicated Customer Service Team at (800) 710-9341 for assistance.
Prescription Drug Plan
INTLMailOrder
INTLMailOrder is a voluntary prescription drug program that is available to eligible employees and their dependents enrolled in MDS’s health plan. This program provides your maintenance medications at no out of pocket expense.
• Go to www.IntlMailOrder.com or call Customer Service at 1-866-488-7874 to obtain an enrollment form.
• Submit a completed enrollment form; a new 3 month prescription for each medication and a copy of your photo identification.
• Mail or Fax to INTLMailOrder using the instructions on the enrollment form.
• 100% up to a total reimbursement of $150 per individual/$300 per family, per Calendar Year for weight loss clinics/programs such as Weight Watchers.
• Must be paid in the current Calendar Year for membership in that year, and the paid date must be within your dates of enrollment in this Plan 1/1/21-12/31/21.
Weight Loss Reimbursement Benefit
Your Health Resources
• Educational library
• Health quizzes and interactive tools
• Healthy pregnancy
• Kick the habit
• Lots more
Access Helpful Health and Wellness Resources
▪ Stream or download
free guided meditations
▪ Explore free learning
and practice videos
Mindfulness
Doctor On Demand
• For HPI members, Doctor on Demand can treat many common medical conditions through live online video. See and talk to a board-certified doctor from your home or office through your smartphone, tablet or computer. You and your family get a convenient way to receive care.
• PCP visits and 25 minute Psychology sessions are currently offered at no cost to you! This will remain in effect until 60 days after the end of the National emergency due to the COVID-19 epidemic. After that time your cost will be your regular copay.
• You need to download the app now and then you will be prepared when someone in the family needs medical care.
• Most prescriptions can be instantly sent to your nearest pharmacy.
Virtual Behavioral Health Visits with Doctor On Demand
Doctor on Demand also offers behavioral health care. The most common conditions that Doctor on Demand treats are • Depression• Relationship issues• Workplace stress• Social anxiety,• Addiction• Trauma• LossThe service is not meant for crisis or emergency situations. Anyone experiencing a crisis or emergency should call 911 or go to the nearest emergency room.
To get started, visit doctorondemand.com to set up an account, or download the app on your smartphone.
AchieveHealth™ Comprehensive Pain Management Program
If you are dealing with chronic and/or acute pain, the AchieveHealth Comprehensive Pain Management Program gives you access to a dedicated case manager who will provide you individual support and help you to better manage your pain.Your Case manager will work with you to:• Manage Pain• Increase mobility• Develop positive health behaviors and pain management strategies• Improve your quality of lifeThe program might be right for you if you have:• A musculoskeletal diagnosis• A scheduled surgery• Recently had surgery• Chronic Pain• Acute painParticipation is free and voluntary for eligible members. If you are eligible a case manager may contact you to discuss if the program is right for you.
Wellness 2021
MDS Wellness 2021
• MyAchieveWell• Earn $100 for having an annual physical with your primary care provider –
proof must be presented to Priscilla Brisson• Employees will be entered into a raffle for each quarter they accumulate a
minimum of 100 points on the MyAchieveWell portal
• Lower ‘Wellness’ Premiums• Partcipate in HPI’s MyAchieve Well – evaluated quarterly
• Lower ‘Tobacco Free’ Premiums• Certify that you (and other adults in your household) are tobacco free, or
participate in a tobacco cessation program – evaluated quarterly
Dental
26
Dental Plan Details
• Plan renews on January 1st through December 31st to synch with other benefits• $1500 maximum is refreshed again on January 1st
Northeast Delta Dental PPO Network
Dentist Premier Network
Dentist Non-Network
Dentist
Preventive Services - cleanings, evaluations, x-rays 100% 100% 100%
Basic Services - Fillings, oral surgery, gum disease 80% 80% 80%
Major Services - Crowns, dentures 50% 50% 50%
Orthodontics (for dependent children to age 19)
Ortho Lifetime Maximum: $1500 per person50% 50% 50%
Fee Schedule Fee Schedule,
No Balance Billing
Fee Schedule, No Balance Billing
Fee Schedule, Balance Billing
Deductible ( Individual / Family ) Applies to Basic and Major Services only $25 / $75 $25 / $75 $25 / $75
Short plan year maximum (7/1/20 – 12/31/20)New plan year maximum (1/1/21 – 12/31/21)
$1,500 per member (Combined Maximum)$1,500 per member (Combined Maximum)
27
Dental Plan Details
• PPO plus Premier Network: Stretch your annual maximum dollars by using a dentist in the PPO or Premier network!• Save money on your dental care• Lower your out-of-pocket dental expenses
• On the Northeast DeltaDental website: www.nedelta.com• Click Find a Dentist in the Patients section• Enter general information about location and network type then click
SEARCH • Search both PPO network and Premier network
Voluntary Vision
NEW: Delta Voluntary Vision Plan
• Hardware Only Plan
• DeltaVision uses the EyeMed Provider Network with a broad mix of independent providers, local optical retailers and nationally recognized retailers to include LensCrafters, Pearle Vision, Sears Optical, Target Optical and JCP Optical.
• There are also on-line, in-network benefits using ContactsDirect.com and/or Glasses.com
• Please note that once the vision benefit is elected, you are locked into the benefit for the plan year
• Vision cards will be mailed to each subscriber (2 cards/subscriber). The cards will be coming from EyeMed, not DeltaVision!!
DeltaVision Hardware Plan Network Benefit Non-Network Benefit
Frames $150 allowance, then 20% off balance $75
Standard Plastic Lenses (Single/Bifocal/Trifocal)(See additional lens options/costs on benefit summary)
Member pays $10, plan pays balance $25/$40/$55
Conventional Contact Lenses $150 allowance, then 15% off balance $120
Disposable Contact Lenses
$150 allowance, member pays balance$120
Frequency – Lenses or Contacts/Frames 12/ 24
Vision Plan DesignHardware Only
31
DeltaVision New Bi-Weekly Rates
Employee Only $2.72
Employee/Spouse or Employee/Child
$4.67
Family or Employee/Children $8.36
DeltaVision Bi-Weekly Premiums
Flexible Spending Accounts (FSA)
FLEXIBLE SPENDING ACCOUNTS
33
Flexible Spending Accounts Allow You to Set Aside Pre-Tax Dollars to Pay for Out-of-Pocket Medical (FSA)
• For You & Your Spouse
• For Your Eligible Dependents
• Participation in your Employer’s Health Plan is Not Required
• Medical Maximum for 2021: $2750
• Dependent Care Maximum for 2021: $5000
FLEXIBLE SPENDING ACCOUNTS
34
• For plans beginning in 2021 you can carryover $550 of unused funds in your Health FSA at the end of the plan year.
• The money you put in an FSA is not taxed, so assuming you pay a combined 40% state and federal tax rate, you’re saving 40% off healthcare expenses funded through the account.
• If you chose not to participate in the FSA program because of the "use-or-lose" mandate, it's time to take another look.
FLEXIBLE SPENDING ACCOUNTS
35
Examples of Qualified Health Flexible Spending Account Expenses
• Deductibles
• Co Payments
• Vision Care
• Dental Care
• Chiropractic
• Birth Control
• Hearing Care
• Acupuncture
• Orthodontia
• Counseling
• Prescription Drugs
• Medical Supplies
• Elective Surgery (e.g. Laser Keratotomy)
FLEXIBLE SPENDING ACCOUNTS
36
Over the counter (OTC) Medications
• Diabetic management supplies - including insulin
• Hearing aid supplies
• Foot therapy supplies
• Band-aids
• Contraceptives
Over 27,000 OTC items can be purchased without a prescription.
Here are some examples:
Flexible Spending Accounts
37
Examples of Expenses that are not Reimbursable from Your Health Flexible Spending Account
• Vitamins or Supplements (unless they have been prescribed to treat a medical condition)
• Personal Hygiene Items
• Cosmetics
• Teeth Whitening
• Veneers
FLEXIBLE SPENDING ACCOUNTS
38
Dependent Care Assistance Plan
• Allows Participants who incur Child and Dependent Care Expenses to Pay up to $5,000 per Calendar Year with Pre-Tax Dollars
• All Expenses Must be Reported on IRS Form 2441 with accompanying Form W10
FLEXIBLE SPENDING ACCOUNTS
39
Qualified Dependent Care Expenses
• Care for Children Under Age 13
• Care of a Disabled Dependent
• Daycare
• Summer Camp
• Pre-School
• After School Programs
FLEXIBLE SPENDING ACCOUNTS
40
The Following Dependent Care Expenses are notEligible for Reimbursement
• Over Night Camps
• Educational Expenses for Kindergarten and above
FLEXIBLE SPENDING ACCOUNTS
41
Dependent Care Eligibility
• You are a single parent; or
• You have a working spouse; or
• Your spouse is a full-time student for at least five months during the year while you are working; or
• Your spouse is disabled and unable to provide for his or her own care
FLEXIBLE SPENDING ACCOUNTS
42
Flex Plan Reminders
• Expenses must be incurred during the Plan Year, after you become a participant.
• If you or your spouse are participating in an FSA, you may not contribute to an HSA unless the FSA reimburses only vision and dental expenses (Limited Purpose FSA).
• You may only change your election during the Plan Year if you have a Qualifying Status Change Event (see next screen).
FLEXIBLE SPENDING ACCOUNTS
43
Qualifying Status Change Events
• Change in Legal Marital Status
• Change in Number of Dependents
• Change in Employment Status or Work Schedule of You or Your Spouse
• Dependent Satisfies/Ceases to Satisfy Dependent Eligibility Requirements
• Entitlement to Medicare or Medicaid
• Judgment, Decree or Court Order
FLEXIBLE SPENDING ACCOUNTS
44
Reimbursement – How it Works
1. Use your Prepaid ABG Benefits Card:
• Great for your cash flow: No paying for your medical expenses out-of-pocket first, and then waiting for your reimbursements.
• No need to file claim forms.
• Save Your Receipts: You must submit receipts upon request.
FLEXIBLE SPENDING ACCOUNTS
45
Reimbursement – How it Works
2. File a Manual Claim Form
• Enter Your Claim online: Log into your secure web portal, enter and submit your claim information and upload your receipts, or you can fax your receipts with your confirmation page.
• Submit A Paper Claim: Fill out our claim form then fax, mail, or email the completed form along with your eligible receipts (see next page) to American Benefits Group.
FLEXIBLE SPENDING ACCOUNTS
46
Submitting a Manual Claim
Completed, Signed Claim Form including the following information:
• Dates the Service was Provided
• Name of the Provider of the Service
• Nature of Service Provided
• Name of the Recipient of the Service
• Copies of Receipts
FLEXIBLE SPENDING ACCOUNTS
47
Receiving Your Reimbursement
Reimbursements for manual claims are issued every Tuesday –claims received in our office no later than Noon (EST) on Fridays typically are processed for reimbursement the following Tuesday.
• Funds will be deposited to your bank account on Wednesday; or
• A check will be mailed to you (where applicable).
FLEXIBLE SPENDING ACCOUNTS
48
Benefits Card Reminders
• Use Only for eligible expenses that were Incurred during
your Plan Year (or the “Grace Period” if applicable).
• Keep Your Receipts: IRS Requirement!
• If asked to select “Debit” or “Credit” always choose
“Credit” the card has no PIN.
• No cash advances.
FLEXIBLE SPENDING ACCOUNTS
49
Administer Your Flexible Spending Accounts Online at www.amben.com/WealthCare
New Users Need To Register
If you have registered Enter Your User ID/Name and Click continue.
TIP: Bookmark This Page
FLEXIBLE SPENDING ACCOUNTS
50
Get Your Benefits On The Go!ABG Smart Mobile App
• Check Available Balances 24/7
• View Account Activity
• Submit Claims and Upload Receipt
Images Taken With Your Mobile Device
• Available for Smart Phones and Tablets
For more information www.amben.com/WealthCareMobile
Customer [email protected]
800-499-3539 • www.amben.com/WealthCare
FLEXIBLE SPENDING ACCOUNTS
FLEXIBLE SPENDING ACCOUNTS
The Hartford: Group Life/AD&D, LTD & Voluntary Life/AD&D Overview
Ancillary Benefits through The Hartford
• The Hartford Benefits – Plan Year January 1st through December 31st
• Group Life/AD&D
• Group Long Term Disability
• Voluntary Life
• Voluntary AD&D
The Hartford Life / AD&D & Disability InsurancesMonadnock Developmental Services Paid Benefits
Please make sure your Beneficiary Elections are up to date and designated with Human Resources
Life / AD&D
Full Time Employees 1 x salary up to maximum of $50,000
Eligibility 37.5 + hours per week; 1st of month after 90 days
Guarantee Issue $50,000
Benefit Reduction 35% @ age 65, 50% at age 70
Long Term Disability
Waiting Period 90 day waiting period
Percentages of Income Replaced 60% of salary
Maximum Benefit Up to $6,000 per month
Eligibility 37.5 hours per week; 1st of month after 90 days
True Open Enrollment Opportunity for Voluntary Life and Voluntary AD&D – this year only!!
Voluntary Life Voluntary AD&D
Employees Employees can purchase up to 5x salary in
increments of $10,000 not to exceed $500,000
Employees can purchase up to 5x salary in
increments of $10,000 not to exceed $500,000
Spouse Spouses can purchase 50% of the employee
amount in increments of $5,000, up to $250,000
(Please note Spousal Rates are calculated based
on Employee’s age)
Spouses can purchase 50% of the employee
amount in increments of $5,000, up to $250,000
(Please note Spousal Rates are calculated
based on Employee’s age)
Evidence of Insurability
Employees who elect over $200,000 or spouses
who elect over $30,000 NEED TO ANSWER
MEDICAL QUESTIONS
No Medical Questions for AD&D
Children Coverage for dependent children is a maximum of
$10,000 in increments of $2,000
Coverage for dependent children is a maximum of
$10,000 in increments of $2,000
Eligibility and
Payroll Deductions
Eligibility: 35 hours per week; FOM after 90 days
Payroll Deductions: Please see HR for your payroll deduction costs for Voluntary Life and Voluntary AD&D
The HartfordPortability and Conversion
When you leave employment, either voluntarily or involuntarily – Human Resources provides information on two ways to keep your life insurance coverage: Portability and Conversion. The Hartford offers Portability and Conversion for both the Voluntary Life and the Employer Paid Life plans.
Portability
• Allows your life insurance to continue 100%, 75% or 50% of the amount you had through your group plan.• You have coverage until you retire or reach Social Security Normal Retirement Age (SSNRA) by paying the
required premium• Reason for leaving cannot be illness, injury or retirement• Premiums for Portability may be higher than your Employer Group plan rate and they increase every 5
years (years in which your age on your birthday ends in 5 or 0)• Application needs to be sent to The Hartford within 91 days of term date
Conversion
• Allows you to convert your coverage to a whole life policy• Doesn’t end at a certain age and can be purchased even when sick or disabled• Premiums for a Life Conversion policy are substantially higher than your Employer Group plan rates• Application needs to be sent to The Hartford within 91 days of term date
The Hartford Additional Life Benefit Information
Accelerated Death Benefit
• Provides the option to withdraw a percentage of your life insurance coverage if diagnosed with a terminal illness.
• The death benefit will be reduced by the amount withdrawn.
(see certificate for qualifications and specifics)
Waiver of Premium
Life insurance can be continued, without payment of premiums, for an insured person who:
• Becomes totally disabled while insured and before reaching age 60
• Remains totally disabled for at least 9 months in a row
• Benefit terminates at SSNRA
The Hartford additionally offers the following complimentary benefits
• Funeral Planning and Concierge Services
• Estate Guidance Will Services
• Beneficiary Assist Counseling Services
• Travel Assistance Services with ID Theft Protection and Assistance
• The Hartford Ability Assist EAP Service
SEE HUMAN RESOURCES FOR BROCHURES ON THESE BENEFITS
The HartfordAdditional and Complimentary Add-On Benefits
EAP (Employee Assistance Program)
• You have access to an Employee Assistance Program (EAP) through the Hartford at no cost to you. This program is called “Ability Assist.”
• Ability Assist provides professional counseling for financial, legal and emotional issues. Included are three face-to-face sessions per year and unlimited phone access. These services are also available to spouses and dependent children and can include guidance from highly trained master’s and doctoral level clinicians.
• To register for Ability Assist and have access to hundreds of personal health topics and resources for child care, elder care, attorneys or financial planners go to www.guidance resources.com. Please see the benefit guide for more details.
EAP (Employee Assistance Program)
Introducing Employee Navigator
First Name
Last Name
****
01/01/1900
Employee Navigator
• Employee Navigator is your new online benefits enrollment system.
• Register for your new account by visiting:https://www.employeenavigator.com/benefits/Account/Register
• You’ll need your first & last name,• The company identifier MDSNH• Last 4 digits of your SSN• Your Date of Birth
• Create your account and then update your profile!
#########
Employee Navigator
• Start by reviewing your personal information and making updates as necessary.
• Update or add dependents to your account
• Review your plan options and Select which plan you would like for 2021!
• This webinar, the presentation slides, and information on your medical, dental, vision, flexible spending and life insurance plans can all be found online on a new MDS Intranet site. Stay tuned for how to access this new Intranet site!
• Open Enrollment runs from November 16 – December 1• This is the time of year to change your benefit elections, add new benefits, or
drop benefits for yourself or your family members
• If you are making a change to any benefits, please use our new Employee Navigator online system.
• This is a Passive open enrollment – if you do nothing, your benefits in 2021 will remain the same as in 2020 – however, you MUST re-enroll in Flexible spending every year, and everyone must turn in a Premium Offset Form.
• The MDS Premium Offset Form MUST be filled out by all employees and will be available on the MDS Intranet site.
Final Open Enrollment Reminders!
THANK YOU!
