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Details of JBI, Ltd.'s health benefits, open enrollment, coverage options, contributions, and medical plans for employees. Explore various supplemental insurance benefits and services. Make informed choices for your well-being.
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Summary of EMPLOYEE Health Benefits JBI, LTD Effective September 1, 2017
Open Enrollment Health Plan Annual Open Enrollment • Open enrollment every August • Changes can be made to health coverage during open enrollment
Password No Longer Required with New URL Health Benefit Resources www.thediamondbenefitgroup.com/jbi-ltd/
Annual Health Plan Open Enrollment Effective 9/1/2017 • Offer a Choice of Two Medical Plan Options at BCBS – One Gold and One Silver • No Plan Changes to Dental, Vision Life/AD&D, LTD, Voluntary Term Life, Accident, Cancer & Critical Illness supplemental insurance policies • New MedicalBridge plans with enhanced outpatient surgery benefits (Existing MB participants automatically continue current MB with option to elect new MB policy)
Accident Medical Bridge Cancer Critical Illness Your Supplemental Insurance Benefits
Other Services Available to You with RSL • 24-hour Travel Assistance through On Call • Identity Theft Recovery Services through National ID Recovery • Bereavement Counseling services through HMSA
Employee Contributions Per Pay Period EE Contributions for Medical, Dental, & Vision Effective 9/1/2017 Silver Option EE Only $45.44 EE & SP $165.97 EE & CH $167.50 FAM $289.91 Gold Option EE Only $81.02 EE & SP $237.13 EE & CH $238.66 FAM $396.67
COBRA Rates for Medical, Dental, & Vision Effective 9/1/2017 Silver Option EE Only $669.42 EE & SP $1,335.36 EE & CH $1,343.82 FAM $2,020.15 Gold Option EE Only $754.57 EE & SP $1,505.66 EE & CH $1,514.12 FAM $2,275.62
Your Medical Plan • Blue Cross Blue Shield (BCBS) • Nationwide more than 720,000 providers and 6,300 hospitals contracted with BCBS • Choice of Two Medical PPO Plans: Gold G617CHC Silver S607CHC • BCBS Policy #120534
How do I find a contracting provider? Go to Provider finder at BCBSTX.COM Log on to your Blue Access for Members (BAM) account Call Customer Service (# located at back of ID card) BCBS Global Core (formerly known as BlueCard Worldwide) available for international benefits (800) 810-2583 www.bcbsglobalcore.com
Gold Option Office Visit Copay $30 Specialist Copay $50 Deductible $3,000 Inpatient Copay $200 * Outpatient Copay $150 * Coinsurance 100% Maximum OOP $3,000 Maximum Family Deductible 3X Maximum Family OOP 3X Silver Option Office Visit Copay $30 Specialist Copay $50 Deductible $3,050 Inpatient Copay $250 * Outpatient Copay $200* Coinsurance 80% Maximum OOP $6,500 Maximum Family Deductible 3X Maximum Family OOP 2X Your PPO Medical Plan Options at a GlanceGold & Silver Network Benefits *Inpatient & Outpatient Copays apply AFTER the calendar year deductible & subject to the 20% coinsurance for the Silver option
Out-of-Pocket Maximum (OOP) Once you have satisfied your Out-of-Pocket Maximum, you will not be responsible for any additional eligible costs - eligible claims will be covered at 100% for rest of calendar year Deductible and Your Portion of the Coinsurance are both applied to the OOP Maximum All PPO Copays (Rx, OV, Specialist, ER, Urgent Care, Inpatient, Outpatient) are applied to the PPO OOP Maximum Your costs are substantially higher costs if you go outside the network Review your SBC for Deductible, OOP Max, & Coinsurance levels outside the network
Gold Option You pay $50 Copay Your Cost $50 Silver Option You pay $50 Copay Your Cost $50 Gold versus Silver OptionYou visit a PPO Cardiologist for Consultation
Gold Option You Pay Deductible of $3,000 You have already met the Out-of-Pocket (OOP) maximum so the Inpatient Copay does not apply Coinsurance is 100% / 0% - You pay 0% Your Cost $3,000 Silver Option You Pay Deductible of $3,050 You Pay Inpatient Copay of $250 Coinsurance is 80% / 20% - You pay 20% You Pay 20% until you meet the OOP Maximum – Your 20% will max out at $3,200 Your Cost $6,500 ($3,050 + $250 + $3,200) Gold versus Silver OptionYou are admitted to PPO hospital - bill is $75K
Gold Option You Pay Deductible of $3,000 You have already met the met the Out-of-Pocket (OOP) maximum so the Outpatient Copay does not apply Your Cost $3,000 Silver Option You Pay Deductible of $3,050 You Pay Outpatient Copay of $200 You Pay 20% of remaining $1,750 ($5,000 minus $3,050 minus $200 = $1,750) / 20% is $350 Your Cost $3,600 ($3,050 + $200 + $350) Gold versus Silver OptionYou have PPO outpatient surgery - bill is $5K
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)
MDLIVE.com/bcbstx Virtual Visits Call MDLIVE (888) 680-8646 MDLIVE.com/bcbstx Office Visit Copay (based on CPT code) Connect online for real-time consultation with board-certified doctor or therapist Prescriptions sent electronically to pharmacy
Your Medical PlanNetwork Benefits • Office visit copay only applies to the doctor office visit • All Copays such as office visit, specialist, prescription, urgent care, inpatient admission, outpatient surgery, & emergency room apply to the Maximum Out of Pocket
Your Medical Plan Urgent Care in Network – Gold option - $75 copay Silver option - $75 copay Important to Ask Questions about how the provider is licensed and what they include as part of the copay Certain diagnostic procedures are subject to deductible at Urgent Care Center provider Non-PPO urgent care provider benefits are paid at non-network benefit level
Your Medical Plan Emergency Room Visit in Network – Copay Applies first, then Deductible • Gold option - Copay $400, then Deductible • Silver option - Copay $500, then Deductible **Physician charges are subject to the deductible at the ER room
Dependent Children under 19 Pediatric Dental & Pediatric Vision Integrated with Medical Plan Pediatric Dental & Vision benefits are included as part of the Medical Plan in additionto 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 800/350-1534 Refer to BCBC Medical Booklet for Specific Details
Your Prescription Coverage Prescription Coverage - Same for Gold & Silver Option Preferred Retail Pharmacy Network Includes Walgreen’s, Walmart, HEB, Brookshire, & Access Health Access Health pharmacies can be located at MyPrime.com Lower Copays through Preferred Pharmacy Network
Prescription Formulary List https://www.bcbstx.com/member/prescription-drug-plan-information/drug-lists Select Employer-Offered Metallic Plans: Small Group Select 5 Tier
Your Retail Prescription Coverage (up to a 30 day supply) Preferred Retail Pharmacy Generic $0 Non-Preferred Generic $10 Preferred Brand Name $50 Non-Preferred Brand Name $100 Participating Retail Pharmacy Generic $5 Non-Preferred Generic $15 Preferred Brand Name $60 Non-Preferred Brand Name $110
Mail-Order Program (up to a 90 day supply) Preferred Generic - $0 Copay Non-Preferred Generic - $30 Copay Preferred Brand Name - $150 Non-Preferred Brand Name - $300 Specialty Medications cannot be filled through Mail Order
Specialty Pharmacy Program Specialty Pharmacy Provider - $150 Other Pharmacy – 50% Limited to a 30-day supply Specialty Medications cannot be filled through Mail Order
PRESCRIPTION plan features Prior Authorization Step Therapy Preferred Drug List Quantity Limits Triessent Specialty Pharmacy Program
BCBS Health & Wellness Resources Blue Care Connection BlueExtras Hearing Discount Program Vision Discount Program Jenny Craig, Curves, Lifetime Fitness Seattle Sutton’s Healthy Eating Life Time Fitness Complementary Alternative Medicine • 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
Register with BCBS for 24/7 access to your medical claims and account informationBlue Access for Members (BAM) www.bcbstx.com/member/register Prescription Vendor Registration www.myprime.com
Your Dental Benefits Available through Dearborn National #FG1D1136 Significant Savings to Utilize PPO Dentists (average discount 28%) Call phone number on ID card for a list of participating dentists
Your Dental Benefits • Annual Limit - $1,000 • Calendar Year Deductible $50 individual (3x family) • Preventative 100% - deductible waived • Basic 80% & Major 50% • Child Orthodontia - $1,000 lifetime
Features of your dental plan • Two Preventive cleanings at 100% no deductible per calendar year • PLUS two Periodontal cleanings (including scaling & polishing) with periodontal history • Periodontal cleanings 80% after deductible 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)
Features of your dental plan • Space Maintainers & Sealants at 100% • Composite (tooth-colored) fillings Once per surface per year • No Missing Tooth Clause • Crown & Bridge replacement Once every 5 years
Register with Dearborn National for 24/7 access to your Dental claims and account information https://accessforindividuals.hcsc.net/registration/
Your Vision Benefits Available through Vision Service Plan - Group #30069274 • Choice of Providers -- 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
Your Network Vision Benefits Frequency of Vision Benefits Exam – Every 12 Months Lenses – Every 12 Months Frames – Every 24 Month
Your Network Vision Benefits • Routine Eye Exam - $10 Copay • Contacts exam - up to $60 copay (in addition to exam copay) • Materials - $10 Copay Glasses or Contacts
Your Network Vision Benefits • Frame Allowance - $150 • Featured Frame Allowance - $170 • Contact Allowance - $130 • Minor Eye Medical Condition - $20 Copay • Routine Retina Screening – Up to a $39 Copay • 20% Discount on amounts over allowance or extra pair of glasses within 12 months of exam
To find a VSP provider, visit vsp.com or call 800.877.7195 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 Your Vision Benefits
Special Offers through VSP • Select 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
24/7 access to your VISION claims and account information Register with VSP www.vsp.com
Your Survivor & Disability Benefits • Reliance 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
Option to Purchase Voluntary Term Life/AD&D Insurance • Available through Reliance Standard Life (RSL) • Choices of life insurance, for Employee and/ORSpouse in increments of $10,000 to $500,000 • Rate based on Age as of Sept. 1st (adjusts once per year)
Option to Purchase Voluntary Term Life/AD&D Insurance • Spouse 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
Colonial Life Supplemental Insurance Colonial pays you directly, in addition to health insurance 30 day waiting period for Cancer, Critical Illness, & Wellness/Health Screenings Colonial benefits are at the Issue Age if you terminate & wish to continue coverage Guaranteed Renewable
Colonial Life Supplemental Insurance • Supplemental Policies are Individual Policies • Minimal Underwriting • Duplication of Colonial Policies Not Permissible • Colonial does not Coordinate with your Medical Insurance policy