2019 U.S. Benefits Enrollment Guide - Enrollment Dates: December 3 to December 14, 2018 - Capital Power
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What’s in this guide The information contained in this enrollment guide ...of your Health will help you determine the best benefit options for you and your family. Introduction. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 Core Employee Benefits . . . . . . . . . . . . . . . . . . . . . . . . 7 How your Benefits program works . . . . . . . . . . . . . . . . . . 1 Medical Insurance Options . . . . . . . . . . . . . . . . . . . . . . . . 7 Benefits program. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 Medical Opt-Out Benefit . . . . . . . . . . . . . . . . . . . . . . . . . 15 Eligibility. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 Flexible Spending Accounts. . . . . . . . . . . . . . . . . . . . . . . 15 Paying for your benefits . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 Prior Authorization and Step Therapy. . . . . . . . . . . . . . . 17 When coverage begins and ends. . . . . . . . . . . . . . . . . . . 3 Telehealth . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18 When can I change my benefits? . . . . . . . . . . . . . . . . . . . 3 Dental Insurance. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18 Appealing a claim or coverage for a procedure. . . . . . . . 3 Vision Insurance . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20 Employer-Sponsored Benefits and Services. . . . . . . . . 20 Enrolling in the 2019 Benefits Program. . . . . . . . . . . 4 Benefits for living a well-balanced life. . . . . . . . . . . . . . . . 4 Voluntary Benefits. . . . . . . . . . . . . . . . . . . . . . . . . . . . . 22 Choose your coverage and dependents. . . . . . . . . . . . . . 4 Optional Life Insurance. . . . . . . . . . . . . . . . . . . . . . . . . . . 22 Enroll online. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5 Discount Programs . . . . . . . . . . . . . . . . . . . . . . . . . . . . 23 Who do I contact with online enrollment questions? . . . 5 Guardian Vision Discount Program. . . . . . . . . . . . . . . . . 23 What happens to my benefits if I don’t enroll?. . . . . . . . . 5 Discount Prescription Programs. . . . . . . . . . . . . . . . . . . 23 Changes to your Benefits Program . . . . . . . . . . . . . . 6 Your 2019 Monthly Cost. . . . . . . . . . . . . . . . . . . . . . . . 24 What’s new for 2019? . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6 What’s the same. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6 Carrier Contacts. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 26 Health Insurance Marketplaces – you have a choice . . . 6 b
Introduction Your benefits program is an important and valuable part of You have two choices for medical insurance: the Health your total rewards at Capital Power Corporation. It provides Savings Account option, which is a combination of a High specific Capital Power-paid benefits as well as a range of Deductible Health Plan (HDHP) and a Health Savings Account benefit options to choose from to meet your unique needs (HSA), or the Health Reimbursement Account option, which and those of your dependents. The program offers coverage combines a Preferred Provider Organization (PPO) plan with that helps you: a Health Reimbursement Account (HRA). The options treat deductibles and co-pays differently and have different premium Take charge of your health levels, enabling you to choose the one that’s right for you and Access appropriate treatment in the event of illness your family. Refer to the Medical Insurance Options section or injury of this guide for more information on making your choice. Receive financial benefits in the case of accident You also have the option to enroll in a Flexible Spending or death Account (FSA), through which you can set aside pre-tax Maintain income if you become disabled dollars for eligible health and dependent care expenses. Support your social, mental, physical and financial Capital Power offers dental and vision insurance that covers well-being to reach your personal goals routine check-ups and help cover the cost of additional services you may need, such as orthodontics, glasses How your Benefits program works and contacts. If you decide you need extra financial protection, you can The Capital Power Benefits program is designed to provide choose to purchase Optional Life insurance for you, your employees with options and choice. Your core employee spouse and your children. benefits include medical, dental and vision insurance. As a Capital Power employee, you are also automatically protected by employer-sponsored benefits including Basic Life insurance, Accidental Death & Dismemberment insurance, Opting out and Short-Term and Long-Term Disability income benefits. If you do not require medical insurance because you Other benefits you have access to at no cost include the are covered under another insurance program, you can Employee Assistance Program (EAP), Travel Assistance, choose to receive the annual opt-out benefit of $3,600, and a range of counseling and support services. which is treated as taxable income. You must re-certify that you have alternate coverage every year during open enrollment in order to receive the opt-out benefit. CAPITAL POWER 2019 U.S. BENEFITS ENROLLMENT GUIDE | 1
Benefits program Employer-Sponsored Core Employee Benefits Voluntary Benefits Benefits and Services Cost shared between 100% Company-paid 100% Employee-paid Capital Power and employee Medical Insurance Basic Life Insurance Flexible Spending Accounts Health Savings Accidental Death & Dismemberment Insurance Optional Life Insurance Account Option Short-Term Disability Health Reimbursement Account Option Long-Term Disability Dental Insurance Employee Assistance Program Vision Insurance Eligibility Paying for your benefits To be eligible for the Capital Power Benefits program: Capital Power covers the majority of the cost of all medical You must be: premiums, and subsidizes out-of-pocket costs for both medical • a permanent, full-time employee residing in the plan options by contributing to both the Health Reimbursement United States, or Account and Health Savings Account. You will pay out of • a permanent, part-time employee residing in the pocket for the employee share of your annual medical premium, United States who works at least 30 hours per week as well as for any expenses up to the annual out-of-pocket limit. Your dependents must be residents in the United States. If you would like additional optional insurance benefits, you Dependents may include: can purchase Optional Life insurance through payroll deduction. • Your legally married spouse or domestic partner Whenever you have urgent medical needs, consider whether • Children who are: the services of an Urgent Care center are appropriate – – Your natural, adopted or step child(ren) Urgent Care is much less costly than a visit to the emergency – Unmarried and under age 26 room. You can also reduce benefits costs by getting prior – Unmarried, of any age, and incapable of self-sustaining authorization from Cigna (Capital Power’s medical insurance employment by reason of mental or physical disability provider) for certain drugs and procedures to ensure the plan and depends on you for support, or will cover them. More information about prior authorization – Your domestic partner’s child who is not your child is available in the Prior Authorization and Step Therapy and depends on you for support section of this guide. By making smart choices, you can keep For full details, please refer to the Summary Plan Documents. costs down for you and the benefits program, which will ultimately keep the program sustainable into the future. 2 | 2019 U.S. BENEFITS ENROLLMENT GUIDE CAPITAL POWER
When coverage begins and ends When can I change my benefits? Coverage begins During open enrollment For new employees, coverage begins on the first day Changes take effect on the first day of the benefit year of the month following the start date of your employment (which runs from January 1 to December 31 each year), (except for Optional Life insurance, which starts on the except for the Optional Life insurance, which takes effect approval date from the insurer, and the 401(k) plan, when approved by the insurer. which requires three months of service). Within 31 days following a qualifying life event If your dependent (other than a newborn child) is in Qualifying life events include: hospital when you first enroll, coverage begins on the date he or she returns home from the hospital. Marriage or after 12 consecutive months in a common-law relationship Divorce, legal separation, or the end of Enrolling as a new hire a common-law relationship As a new Capital Power employee, you will need to enroll within 31 days of your hire date. You will receive an email Adding a dependent child to your family through birth or adoption within the first 2 weeks of your employment from Morneau Sheppell with all the information you will need to enroll. Your spouse becomes eligible for coverage or If you have questions about enrollment, please contact loses their coverage Morneau Sheppell at 1.866.856.2000. The death of your spouse If you don’t enroll as a new hire, you will receive the Your child is no longer an eligible dependent and the default coverage, which is employee only coverage, number of your eligible dependents decreases from as follows: “employee and family” or “employee and child(ren)” to Medical insurance: Health Savings Account option “employee plus spouse” or “employee only” coverage Dental insurance: Opt out Change optional benefits at any time Vision insurance: Opt out Your optional insurance choices, HSA deferrals, and 401(k) You automatically receive Basic Life and Basic deferrals can be changed at any time. Optional insurance AD&D insurance, Short-Term and Long-Term changes may require proof of health and approval from the Disability coverage, and access to the Employee provider before being effective. Assistance Program. Appealing a claim or coverage for a procedure Coverage ends If Cigna denies coverage for a claim or procedure for you or At the end of the month following the date your one of your covered dependents, you must ask your doctor employment with Capital Power ends, except for life and to phone Cigna at 1.888.693.3297. Your doctor will conduct optional insurance, which end on your date of termination. a peer-to-peer review by speaking to a doctor at Cigna to For dependents, coverage ends when your coverage ends determine the most effective treatment or drug for your or on the date they no longer qualify as eligible dependents. condition. If a further appeal is required, please contact On termination, you will have 60 days to elect continuation Daniel Heesing, Pension and Benefits Consultant, of coverage through COBRA. at 780.392.5013 or DHeesing@capitalpower.com. Making tax-effective choices If you enroll in a Flexible Spending Account (FSA), you can set aside pre-tax dollars for eligible health and dependent care expenses. If you choose the Health Savings Account (HSA) option for medical insurance, Capital Power will contribute pre-tax dollars to an HSA in your name at the start of the benefit year as a lump sum, which you can use at any time, tax-free, to pay for eligible health care expenses. Or, leave the balance in the account and earn tax-free investment income within the HSA. Optional insurance can be purchased using after-tax income via payroll deduction. If you have medical insurance elsewhere, the annual opt-out benefit you receive is treated as taxable income. CAPITAL POWER 2019 U.S. BENEFITS ENROLLMENT GUIDE | 3
Enrolling in the 2019 Benefits Program Capital Power Corporation provides an employee benefits Dental: Enroll in individual and/or dependent program that helps our employees stay healthy, feel secure coverage, or opt out and maintain work/life balance. Our program represents a significant part of your total compensation. Vision: Enroll in individual and/or dependent coverage, or opt out Benefits for living a well-balanced life Flexible Spending Accounts (FSA): Choose how much you will contribute to your FSA(s) in 2019, As a Capital Power employee, your health and well-being are if anything. Read more about eligibility requirements in important to us. That’s why our benefits program, a cornerstone the Flexible Spending Accounts section of this guide of our Total Rewards program, helps ensure you and your loved ones live a well-balanced life. When choosing your Optional Life insurance: Enroll in individual and/or dependent coverage (subject to approval), update your benefits coverage, take charge of your health: keep in mind beneficiaries, or opt out what fits your and your family’s needs and consider steps you can take to create balance for your mental, physical, financial 401(k): Update your 401(k) deferral at enrollment or and social health. any time during the year. Remember your 401(K) plan deferral, beneficiaries and investments can only be updated at www.oaretirement.com or by calling 1-800-858-3829. Choose your coverage and dependents You can choose different dependents for medical, dental, vision and Optional Life insurance plans. Important dates Medical: Enroll in individual and/or dependent coverage December 3 to December 14, 2018 and decide whether to: Open enrollment for Capital Power benefits for 2019 • Choose the Health Savings Account option (and decide on your HSA contribution amount, keeping in mind that January 1, 2019 Capital Power’s HSA contribution depends on how many Benefits coverage period begins dependents you enroll in medical insurance), • Choose the Health Reimbursement Account option, or • Opt out and receive a $3,600 opt-out benefit (proof of medical coverage elsewhere required) 4 | 2019 U.S. BENEFITS ENROLLMENT GUIDE CAPITAL POWER
Enroll online Who do I contact with online Go to https://cpcus.hroffice.com/ESS/ between enrollment questions? 9:00 a.m. EST on Monday, December 3, and 5 p.m. EST Contact online enrollment administrator Morneau Shepell: on Friday, December 14, 2018 to enroll: 1.866.856.2000 or cpc@hroffice.com. Choose your medical, dental, vision and Optional Life insurance coverage (subject to approval), or opt out What happens to my benefits Update beneficiary information if I don’t enroll? Make Health Savings Account Selections for 2019, If you don’t enroll online by the deadline and have not contacted if you choose this medical coverage option the Capital Power Benefits Support Line (operated by Make Flexible Spending Account selections for 2019 Morneau Shepell), you will receive the same benefits and levels of coverage for the same dependents that you selected To update your 401(k) deferral, go to www.oaretirement.com during 2018 enrollment. or call 1-800-858-3829. The coverage you select will take effect on January 1, 2019 and will be effective until December 31, 2019, unless you During this open enrollment, you will make benefit elect a level of Optional Life insurance for which you have selections that will be effective from January 1 to not yet been approved. Additional levels of optional insurance December 31, 2019. are effective on the day you are approved for coverage by the insurer. Outside open enrollment, you may only change coverage due to a qualified life event and you must do so within 31 days of the event. We encourage you to review all your benefits and make your selections wisely. Optional insurance, HSA elections (if eligible), and 401(k) deferrals can be updated at any time. CAPITAL POWER 2019 U.S. BENEFITS ENROLLMENT GUIDE | 5
Changes to your Benefits Program What’s new for 2019? Each year the benefits program is reviewed to ensure it • Improved vision care with more coverage for eye glass continues to be valuable and sustainable into the future. frames and contact lenses. For details on this improved Adjustments are made based on an annual market and coverage, please refer to the Vision Insurance section. program review. This year changes include: Vision care costs will increase slightly this year, please refer to the Your 2019 Monthly Cost section. • An increase in the medical insurance premiums for the Health Savings Account (HSA) and Health Reimbursement The HSA combined contribution limit set by the Internal Account (HRA) options paid by employees and Capital Revenue Services (IRS) will increase to $3,500 for Power to offset increases in plan costs. In 2019, premiums Employee only and $7,000 for Families in 2019. These will increase in both options and both you and Capital maximum amounts include Capital Power’s HSA contribution, Power will see these increases. The HSA option remains as well as any additional money you contribute to this the lower-cost choice for medical coverage, and if you account to support your overall well-being. choose this option, you will receive Capital Power’s full contribution to your HSA at the start of the benefit year. The Health Care Flexible Spending Account (HCFSA) employee contribution limit allowed under IRS regulations To learn more about which option may work best for you, will be increasing to $2,700 in 2019. please refer to the Core Employee Benefits section on the next few pages. For the new rates, please refer The 401(k) annual limit for 2019 is increasing to $19,000. to the Your 2019 Monthly Cost section. There is no increase to the catch up annual limit of $6,000. • The annual deductibles in the HRA option will increase What’s the same? in 2019. Both you and Capital Power will split absorbing the increase in these deductibles, with an equal increase Capital Power’s annual contribution to the HSA will remain to your employee out-of-pocket portion and the amount the same and be deposited at the start of the benefit year. Capital Power reimburses through your HRA. For There are no changes to deductibles or out of pocket the new HRA annual deductibles, please refer to the maximums under the HSA option. Health Reimbursement Account Option section. Your dental, Short-Term Disability, Long-Term Disability, • The HRA option will also now feature an embedded Life insurance and Optional Life insurance rates will remain deductible. If you cover family members on your medical the same. plan, each person will only be responsible for hitting his Your providers remain the same for all benefits. or her own individual deductible before the plan starts to pay benefits for that person. Currently, the HRA option The Dependent Care FSA (DCFSA) maximum will remain at $5,000 per household ($2,500 if you are married and has an aggregate deductible that requires an employee file taxes separately). and their family to hit the entire deductible before the plan pays benefits. Generally, the embedded deductible is more advantageous because individuals cover the Health Insurance Marketplaces – deductible sooner. you have a choice • Individual and family out of pocket maximums are also You have the option to compare Capital Power’s increasing under the HRA option. For these increased coverage with plans available through the health amounts, please refer to How Your Core Medical insurance marketplaces at www.healthcare.gov. If you Insurance Works With Each Option section. choose Marketplace coverage, you can enroll beginning November 1, 2018 for coverage starting in 2019. 6 | 2019 U.S. BENEFITS ENROLLMENT GUIDE CAPITAL POWER
Core Employee Benefits Medical Insurance Options PROVIDER: Cigna You have two choices for medical coverage: Health Savings Account option Core Medical Insurance High Deductible Health Plan (HDHP) + Health Savings Account (HSA) A tax-advantaged, portable savings account Health Reimbursement Account option Core Medical Insurance Preferred Provider Organization (PPO) + Health Reimbursement Account (HRA) An employer-paid account that covers part of the deductible Your core medical insurance will be a High Deductible Health understand your own medical insurance needs before making Plan (HDHP) or a Preferred Provider Organization (PPO) your choice. An HSA is a tax-advantaged savings account that depending on your choice of medical coverage. Both provide remains yours, no matter where you work. Capital Power traditional medical insurance that covers prescription drugs. contributes the full amount to your account at the start Your core medical insurance works in tandem with either the of the benefit year. You can choose to contribute as well, Health Savings Account (HSA) or the Health Reimbursement up to specified limits, and use it when you want to – your Account (HRA), depending on which option you choose. balance never expires and there are no HSA forfeitures. The HSA option offers several advantages that might be a Premiums and the treatment of co-pays and deductibles better fit for you than the HRA option, but it’s important to differ between the two options. EXAMPLE: An employee with family coverage would have the following premiums and deductibles in 2019, depending on which medical insurance option is chosen: Employee share Annual Annual of monthly deductible deductible Capital Power Prescription premium (in-network) (out-of-network) contributes (in 2019) drug co-pay HSA option $280.23 $6,000 $12,000 $3,000 (Deposited at Pay for all drugs out of the start of the year and pocket until you reach accessible right away) deductible, then pay co-pay HRA option $420.06 $7,500 $15,000 $5,250 (After satisfying Pay co-pay only the $2,250 employee portion of the deductible) CAPITAL POWER 2019 U.S. BENEFITS ENROLLMENT GUIDE | 7
Choose which option works for you Your choice will depend on what makes the most financial sense for you and your family. The HSA and HRA options have different deductibles, out of pocket maximums and monthly premiums and operate differently in the way co-pays and expenses apply toward the deductibles. Here are a few of the differences between each option: Health Savings Account option Health Reimbursement Account option In most cases, you cover your deductible first, For most expenses, you cover co-pays first, then pay co-pays and coinsurance then satisfy your deductible The deductible is an aggregate amount for you and your family The deductible is embedded. Each covered individual must members and the total must be met before co-pays apply and only meet the individual deductible amount before the plan the plan starts to pay coinsurance for any person starts to pay coinsurance for that person. You can use the HSA for any out-of-pocket costs associated You can start using your HRA after you have satisfied your with your medical, dental, or vision coverage which includes portion of the deductible your deductible Lower employee premiums Higher employee premiums Capital Power contributes to your HSA; you have the option Only Capital Power contributes to your HRA to contribute to your HSA HSA account balance can earn interest tax-free and can Money in an HRA does not earn interest and cannot be invested be invested You can roll over your HSA account balance if you don’t use Any remaining account balance at the end of the year it all in a single year cannot be carried over to the following year You own the money in your HSA and can take it with you If you leave Capital Power, you forfeit your Capital Power HRA if you leave Capital Power If you participate in an HSA, you can open a Dependent Care You can participate in a Health Care Flexible Spending FSA; you cannot use an FSA for medical expenses if you Account and a Dependent Care FSA have an HSA Use your HSA balance to pay for medical expenses tax-free Use your HRA balance to pay for medical expenses now or in the future – if you leave Capital Power, take your once you reach your portion of the deductible HSA with you You pay the full cost of prescription drugs up to your deductible, You pay the co-pay only for prescription drugs then you pay the co-pay only. The money in your HSA can be used for prescription drug costs. If you and your covered dependents have typically low medical In comparison, if you have high or frequent prescription drug and prescription costs, under the HSA option your medical costs, you may find the HRA option more cost effective, as premiums would be lower, but you would pay the full cost of you will only pay the co-pay each time you fill a prescription. all prescription drugs until you reach the annual deductible. After reaching the deductible, you would pay only the co-pay whenever you fill a prescription. You can use the money that you and Capital Power deposit into your HSA to help cover out-of-pocket expenses. 8 | 2019 U.S. BENEFITS ENROLLMENT GUIDE CAPITAL POWER
How your core medical insurance works with each option This chart gives a side-by-side look at the amounts payable Remember, you get the most out of your medical plan by using under the Health Savings Account option or the Health an in-network provider. To see if your provider participates in Reimbursement Account option when you use in-network the Cigna network – or to find one who does – log in to your and out-of-network providers for each option. plan member account at www.myCigna.com to see a directory of providers. Health Savings Account option Health Reimbursement Account option Core medical (HDHP + HSA) (PPO + HRA) insurance In-network Out-of-network In-network Out-of-network Deductible • Individual* $2,000 $4,000 $2,500 $5,000 • Family* $6,000 $12,000 $7,500 $15,000 Out of pocket maximum (includes deductible) • Individual* $2,500 $5,000 $3,000 $6,000 • Family* $6,850 $13,700 $9,000 $18,000 Prescription drugs out of pocket maximum • Individual* Included in Included in $500 Not • Family* maximum above maximum above $1,000 applicable 90% covered 70% covered $25 co-pay; 70% covered Physician visit after deductible after deductible $50 specialist after deductible 70% covered 100% covered after deductible 100% covered 70% covered Preventive care (no co-pay, (Labs and x-rays: (no co-pay, after deductible no deductible) 100%, no co-pay, no deductible) no deductible) 90% covered 70% covered 90% covered 70% covered Hospitalization after deductible after deductible after deductible after deductible Emergency room 90% covered after deductible $150 co-pay Prescription drugs Deductible then (Retail/mail order) co-pay: Co-pay: Generic** $10 / $20 $10 / $20 Not covered Not covered Preferred*** $20 / $40 $20 / $40 Non-preferred † $35 / $70 $35 / $70 Specialty § $150 / N/A $150 / N/A * Per covered individual, up to a family/combined maximum as shown ** Generic: Drug will be the lowest cost alternative resulting in the lowest tier co-pay *** Preferred: Drug will be on Cigna’s formulary list. Drugs on this list will result in the middle tier co-pay † Non-preferred: Drug will NOT be on the formulary list resulting in the highest tier co-pay § Specialty: Specialty medications are typically high-cost drugs that are used to treat complex conditions CAPITAL POWER 2019 U.S. BENEFITS ENROLLMENT GUIDE | 9
Which services are subject to the deductible? Below is a chart that shows examples of what is subject to the deductible and what is paid by your account based on the medical insurance option you select. Many services only require a co-pay at the time of service. Health Savings Account option Health Reimbursement Account option Medical care provided Subject to Co-pay HSA Subject to Co-pay HRA deductible? applies? eligible? deductible? applies? eligible? In-network primary Yes No Yes No Yes No care office visit In-network specialist Yes No Yes No Yes No office visit Emergency room Yes No Yes No Yes No facility charge In-network lab work performed in an Yes No Yes Yes No Yes outpatient facility In-network inpatient Yes No Yes Yes No Yes hospital stay Yes (In-network only; Yes Prescriptions Yes Yes No No After deductible (In-network only) satisfied) When you see an in-network provider: You have access to the same in-network providers • Your provider will file all claims directly with Cigna. If you regardless of which medical insurance option chose the Health Savings Account option and you want you select. to use your HSA to cover your expenses, present your HSA debit card at the time of payment. • Cigna will review the claim submitted by the hospital or If your provider is out-of-network other provider, and make any payment directly to them. If your provider is not currently in Cigna’s network, you This payment is based on the benefits in your health plan can send your provider’s name, title, address, phone and the amount of funds in your HRA (if you chose the number and email address to Daniel Heesing at Health Reimbursement Account option). DHeesing@capitalpower.com. Cigna will be asked to • You will receive an Explanation of Benefits that breaks review your provider to find out whether they meet the down how much of the bill you are responsible for. You in-network criteria. might have a deductible to cover, in which case the provider will bill you directly. 10 | 2019 U.S. BENEFITS ENROLLMENT GUIDE CAPITAL POWER
Health Savings Account option PROVIDER: Cigna (core medical insurance) and HSA Bank (Health Savings Account) You may open and contribute to an HSA as long as you are • Use the money in your HSA to pay for qualified health care, not covered by any other health plan outside Capital Power dental, and vision expenses, including your deductible and (including your spouse’s Health Care Flexible Savings coinsurance, for yourself and covered dependents. Or, leave Account), not enrolled in Medicare A/B or TRICARE, and the balance in your HSA for as long as you wish – you’ll not claimed as a dependent on another individual’s tax return. pay no tax on any investment income within the account. If you choose this option: • You can also use the HSA to pay for eligible medical expenses not covered by your core medical insurance. • Capital Power will contribute pre-tax dollars as a lump sum at the start of the year to a Health Savings Account (HSA) • If you opt out of coverage, change jobs or retire, you can in your name. If you are a new hire, your HSA deposit will take your HSA with you. be prorated based on your hire date. • You may also contribute to your HSA to put additional money aside for unexpected medical expenses now or in the future. Contributions Capital Power’s contributions Your contributions Capital Power will deposit the company contribution into your You may choose to contribute to your HSA via payroll deduction HSA as a lump sum at the start of the benefit year. The deposit which will be deposited bi-weekly through normal pay. amount depends on how many dependents are covered under your core medical insurance. Your contributions and Capital Power’s contributions count toward the Internal Revenue Service (IRS) HSA 2019 contribution limit. In the following table, we have calculated the maximum contribution you can make to your HSA in 2019 to remain with the IRS limits. HSA Contributions and Maximums for 2019 Core medical insurance coverage level Capital Power’s m Maximum employee Combined HSA Lump-su contribution deposit contribution contribution limit * Employee $1,000 $2,500 $3,500 Employee + spouse $2,000 $5,000 $7,000 Employee + child(ren) $2,000 $5,000 $7,000 Employee + family $3,000 $4,000 $7,000 * This limit is set by the Internal Revenue Service (IRS) each year. The limit includes employee and employer contributions. It is your responsibility to remain within your IRS contribution limit. Capital Power does not monitor your contributions to ensure you remain within the limit. For more information about IRS restrictions around HSAs, read the 2019 U.S. Benefits Frequently Asked Questions document, available on the enrollment site. CAPITAL POWER 2019 U.S. BENEFITS ENROLLMENT GUIDE | 11
Catch-up contributions If you are age 55 or older, you may make an additional $1,000 Common HSA-eligible expenses contribution each year to save for expenses during retirement. • Office visits If your spouse has an HSA, your combined contributions • Surgery, lab work, radiology (minus the catch-up contributions) must not exceed the • Prescription drugs 2019 family contribution limit of $7,000. • Dental and orthodontia Using your HSA • Vision You will receive an HSA debit card from Cigna to pay for • Personal long-term care insurance premiums eligible expenses; you have the option to purchase an HSA Visit www.Cigna.com/expenses for a full list of checkbook as well. eligible expenses. Use the money in your HSA tax-free for qualified out-of-pocket expenses you incur any time after the date your HSA was established – this year or in future years. Don’t worry about using Tax savings The HSA is tax-advantaged in several ways: the full contribution amount in your HSA in a single year: your HSA dollars roll over from year to year. If you use the account for 1. You won’t pay tax on money you or Capital Power non-eligible expenses, you will be subject to a 20% penalty if you contribute to your HSA. are under age 65, and you will owe income tax on the expenses. 2. Any interest or investment income you earn in the Any HSA dollars you use for eligible medical expenses will count account grows tax-free. toward your annual core medical insurance deductible. The dollars 3. Withdraw your account balance at any time tax-free you do not use remain in your account and earn interest tax-free. to pay for eligible expenses. EXAMPLE: Gabrielle has a gross income of $70,000. She has no dependents and receives $1,000 from Capital Power in 2019 in her HSA. She decides to contribute $2,500 in 2019 to maximize her combined HSA contribution limit of $3,500, which is set by the IRS. By the end of 2019, she earned $170 in investment income and interest in her account, which she decides to withdraw tax-free at the end of the year to pay for medical expenses. The example below shows how contributing to an HSA can provide Gabrielle with more spendable income: Without HSA With HSA Gross income $70,000 $70,000 Total HSA contributions (tax-free) $0 –$3,500 Gross taxable income $70,000 $66,500 Estimated taxes on gross taxable income: Federal, State, FICA (assume 20%) –$14,000 –$13,300 After-tax earnings $56,000 $56,700 Investment earnings within HSA (tax-free) $0 + $170 Overall spendable income $56,000 $56,870 Increase in spendable income with HSA None $870 Log in to www.myCigna.com to access an HSA calculator a monthly fee of $2.25 will be deducted from your balance. to determine your tax savings and potential future value This fee is waived if your monthly balance exceeds $3,000. of your HSA based on the contributions you make today. Log in to www.myCigna.com to make online transactions, Retain all your expense receipts in case you are audited upload and save receipts, access a life stage modeling tool, by the IRS. Expense tracking tools are also available at an online library of videos and education materials, an www.myCigna.com. interactive FAQ and IRS and tax resources. About HSA Bank and your account Earning interest and investing your HSA balance If you choose the Health Savings Account option for your HSA Bank offers two self-directed investing platforms for medical coverage, you will receive a welcome package from investing your HSA balance: TD Ameritrade for stocks, bonds HSA Bank with more information. and mutual funds, and Devenir for mutual funds. Some fees apply. Your account with HSA Bank will have many features of a standard For more information about opening an investment account, bank account: you will receive regular account statements, and log in to www.myCigna.com. 12 | 2019 U.S. BENEFITS ENROLLMENT GUIDE CAPITAL POWER
Health Reimbursement Account option This option includes an HRA through Cigna. Under this To receive reimbursement, all you need to do is show your option, Capital Power subsidizes the Cigna Preferred Provider provider your Cigna ID card. Any eligible deductible amount Organization (PPO) in-network deductible. When you receive will be applied automatically to your HRA. care for any in-network services and after you have satisfied The chart below shows the amount you are responsible to your portion of the deductible, HRA dollars are used to pay cover toward meeting the deductible, and what the HRA for the remainder of your expenses. will reimburse depending on your level of coverage: Employee Employee Employee Employee Employee HRA DEDUCTIBLE CHART only & spouse & one child & children & family Core medical insurance annual $2,500 $5,000 $5,000 $7,500 $7,500 in-network deductible Employee portion – annual $750 $1,500 $1,500 $2,250 $2,250 Capital Power portion – annual $1,750 $3,500 $3,500 $5,250 $5,250 (HRA reimbursement amount) The Health Reimbursement Account option comes with an embedded deductible If you enroll in the Health Reimbursement Account (HRA) option and stay in the network, Capital Power will cost share the deductible with you. EXAMPLE: Ken has family coverage, he covers himself, his wife and his daughter on the HRA option. While Ken’s wife and daughter have had minimal claims this year, Ken ends up seeing a specialist several times for consultations and surgery. The total in-network costs eligible for the deductible end up around $8,000. With the HRA option, his medical insurance includes a family in-network deductible of $7,500. Since the HRA is embedded, Ken has to satisfy the individual deductible of $2,500, and his portion of the deductible under the HRA is $750. Once Ken has paid $750 of his own claims towards the deductible, Capital Power’s HRA pays the next $1,750 until he fully satisfies the individual annual deductible of $2,500. He then is reimbursed at 90% until he is out of pocket another $500 at which point he reaches the $3,000 individual out of pocket maximum. Any further in-network costs he incurs would be covered 100% by the plan for the remainder of the year except for prescription drugs which have their own out of pocket maximum. Ken’s family members will each need to satisfy their own individual deductibles within their family coverage similar to Ken, up to the plan’s out of pocket maximum. HRA Family and employee coverage $7,500 family in-network deductible $7,500 family deductible ($2,500 per individual) Ken has to satisfy this embedded deductible $9,000 family out of pocket maximum $2,500 individual in-network deductible ($3,000 per individual) His portion Capital Power’s portion Then… $750 $1,750 • The plan pays 90%, Ken pays 10% until he pays another $500. • He’s 100% covered when he reaches the individual out of pocket Paid $750 Capital Power pays maximum of $3,000. the rest of the $2,500 deductible – • His family members will each need to satisfy their own individual no reimbursement in-network deductibles like Ken, up to the plan’s out of pocket maximum. form necessary CAPITAL POWER 2019 U.S. BENEFITS ENROLLMENT GUIDE | 13
Which would you choose? JASON (mid-twenties) I’m single, healthy and I enjoy riding my motorcycle in my free time. I choose the Health Savings Account option because: I don’t visit the doctor very often, so I like that the HSA option has lower premiums. Also, I like that I receive the full amount of my HSA at the start of the benefit year because I can start paying for my first expense with this money and covering my annual deductible with company money right away. If something were to happen on one of my motorcycle trips, I could be on the hook for a large hospital bill. I like the fact that unlike an HRA, I don’t lose my HSA balance every year if I don’t use it. I can build it up year to year to year to help pay for an unexpected hospital bill. Plus, by choosing the HSA over the HRA, I can use the money I save on premiums to fund my HSA. CINDY (late thirties) I’m married with two kids, one of whom has a chronic illness. I choose the Health Reimbursement Account option because: Over the past few years, I have typically exceeded my portion of the core medical insurance deductible (mostly due to my daughter’s condition), so my family’s expenses have been mostly covered. I like the way the HRA works, especially because I pay only the prescription co-pays rather than having to pay for prescriptions in full until I meet the deductible, and then paying the co-pays, as I would if I chose the HSA option. For extra peace of mind, I will purchase Optional Life insurance for me and my husband to protect our family from financial hardship if something were to happen to either of us. DENNIS (early sixties) I’m divorced and nearing retirement. I choose the Health Savings Account option because: Since my divorce, it’s been tough to save enough for my medical expenses in retirement. I plan to make catch-up contributions to my HSA, and will use my accumulated HSA to supplement my medical expenses in retirement. In the meantime, I’m using my core medical insurance plan to cover my current medical expenses, although I may use some of my HSA dollars to pay my deductible. I also like the fact that I receive my lump-sum deposit at the beginning of the year because I start earning investment income sooner. JASMINE (mid-fifties) I’m married and I have coverage under my husband’s medical plan. I choose to opt out of medical coverage because: My husband’s medical plan provides benefits that are sufficient for the two of us, and I will receive $3,600 for opting out. However, I still have dental and vision coverage and I continue to receive access to great benefits like Basic Life Insurance, the Employee Assistance Plan and more. 14 | 2019 U.S. BENEFITS ENROLLMENT GUIDE CAPITAL POWER
Urgent Care versus ER – where to go? As a general rule, if your condition is a true emergency, in that it is life-threatening, trauma-related, requires x-rays, or requires a surgical procedure, go to the emergency room immediately or dial 911. However, because ER visits can be expensive (around three times the cost of a visit to Urgent Care), some conditions can be better suited to an Urgent Care center. If your condition is non-life threatening and you don’t have time to visit your doctor, you can visit an Urgent Care center for help with: fever, flu, cold, cough, sore throat, vomiting, diarrhea, stomach pain, cuts and severe scrapes, minor injuries and burns, sports injuries, and more. Medical Opt-Out Benefit Flexible Spending Accounts No Coverage Option for medical and prescription Flexible Spending Accounts (FSAs) enable you to set aside drug coverage money on a pre-tax basis for eligible expenses. Two types of FSA are available: a Health Care Flexible Spending Account Capital Power offers an incentive payment if you choose (HCFSA), which you can use for eligible medical, dental “No Coverage” under the medical plan. If you make this and vision care expenses, and a Dependent Care Flexible election, your opt-out benefit will be added to your paycheck Spending Account (DCFSA) for eligible expenses related in equal amounts over the course of the year if you provide to childcare and eldercare. proof of medical insurance elsewhere. The annual opt-out benefit is $3,600 and is treated as Eligibility taxable income. All employees may contribute to a DCFSA. Reminder: you must re-certify every year during open Your eligibility for a HCFSA depends on which core medical enrollment to receive the opt-out benefit. insurance option you choose. If you choose the HSA option, you will not be able to use the FSA for medical expenses due to IRS restrictions. Which types of FSA CORE MEDICAL INSURANCE OPTION Example of eligible expenses can you choose? • Day care Health Savings • Summer day camps Dependent Care FSA Account option • Babysitters • Eldercare expenses Health Reimbursement • Coinsurance, co-pays, deductibles Account option • Eyeglasses, contact lenses, laser eye surgery Health Care FSA • Prescription drugs and some over the counter medicines and supplies • Dental treatments For a full list of eligible expenses, visit www.payflex.com. CAPITAL POWER 2019 U.S. BENEFITS ENROLLMENT GUIDE | 15
Select your FSA contribution amount for 2019 The amount you choose to contribute is taken out of your Your only opportunity to make elections for your FSA is during paycheck in equal amounts each pay period. The maximum open enrollment – you may not change your elections during HCFSA election is $2,700 per year; the maximum DCFSA the benefit year. Any changes will be effective January 1, 2019. election is $5,000 per household per year. If your spouse How Flexible Spending Accounts help you save money contributes to a DCFSA and you file separate tax returns, the maximum you can each contribute to a DCFSA will be $2,500 The example below applies to the HCFSA, but the concept is in order to avoid IRS penalties. Money in an FSA does not similar for the DCFSA. This example is for illustrative purposes rollover every year – any unused FSA amounts are forfeited at only. Every situation varies and it is recommended you consult year end. You have access to the full amount of your election a tax advisor for all tax advice. from January 1 each year – you don’t have to wait until your contributions have reached that amount to be able to use the balance in your account. EXAMPLE: Jason has a gross income of $100,000. He wears contact lenses, takes daily prescription medication and plans to have routine medical and dental checkups throughout the year. He chose the Health Reimbursement Account option for his core medical insurance, which means he is eligible to open a HCFSA. Jason plans to contribute the maximum $2,700 to his HCFSA because his expenses are eligible for reimbursement from the HCFSA. The example below shows how contributing to a HCFSA can provide Jason with more spendable income: Without HCFSA With HCFSA Gross income $100,000 $100,000 HCFSA contributions (tax-free) $0 –$2,700 Gross taxable income $100,000 $97,300 Estimated taxes: Federal, State, FICA (assume 20%) –$20,000 –$19,460 After-tax earnings $80,000 $80,540 Increase in spendable income None $540 By contributing $2,700 to his HCFSA, Jason has $540 more The savings calculator at www.payflex.com can help you spendable income because any contributions to the HCFSA calculate unreimbursed health and dependent care expenses (and the DCFSA) are made before tax is deducted. to help you determine your FSA contributions. Click on the “individuals” tab, then “calculate your savings”, then scroll down to find the calculator. 16 | 2019 U.S. BENEFITS ENROLLMENT GUIDE CAPITAL POWER
Prior Authorization and Step Therapy Prior authorization is a cost control process, supported by As an example, if you are prescribed one of the Step Therapy Capital Power, in which certain drugs and procedures require drugs, you will try the most cost-effective, appropriate Cigna’s approval before the cost of a treatment or procedure medications available (typically, generics or lower-cost is covered by the medical plan. This enables Cigna to review brands) before more expensive brand-name versions are your treatment before they will cover it to ensure it is medically approved for coverage. necessary and appropriate for your condition. The program includes medications used to treat the following medical conditions: Cigna also operates a program that helps keep costs down for everyone: Step Therapy. This is a program that requires • ADD/ADHD • High cholesterol less expensive prescriptions, most often generic drugs, are • Allergies • Mental health tried before more expensive options are explored, unless it’s • Breathing problems • Osteoporosis medically necessary to start with a more expensive alternative. • Bladder problems • Pain (narcotic and non-narcotic • Depression pain relievers) • Emerging therapies • Skin conditions Step Therapy Process • Heartburn/ulcer • Sleep disorders Step 1 Doctor prescribes you a new prescription drug • High blood pressure Whenever you fill a prescription for a medication included in this program, you and your doctor will receive a letter from Cigna describing the steps you need to follow before you Step 2 You fill the prescription at the pharmacy refill your medication. If your doctor believes an alternative medication isn’t right for you for medical reasons, they can request that you seek Cigna’s prior authorization of your doctor’s prescribed drug for medications included in the You and your doctor receive a letter from Cigna Step 3 Step Therapy program. stating that you must try a lower cost alternative drug before filling your next prescription To find out if your prescribed medication is part of the Step Therapy program, log in to www.myCigna.com and navigate to the prescription drug list. You will see a (ST) symbol next to all Step Therapy medications. Your doctor contacts Cigna through the It’s a good idea to check with Cigna before you have a Your doctor peer-to-peer review medical procedure to ensure it is covered. However, if the prescribes a lower process to explain Step 4 prescribed drug or treatment is denied, you can appeal it cost alternative why you are treatment medically unable – ask your doctor to contact Cigna (1.888.693.3297) to to take the lower conduct a peer-to-peer review of your treatment plan with cost alternative a physician from Cigna to determine the most effective treatment or drug for your condition. If a further appeal is required, please contact Daniel If your doctor prescribes one of the medications included in Heesing, Pension and Benefits Consultant, at the program, you will be able to fill your prescription initially. 780.392.5013 or DHeesing@capitalpower.com. However, you and your doctor will receive a mailed letter saying you need to try a less expensive alternative the next time your prescription is filled, unless there is a medically relevant reason why the less expensive alternative cannot be taken. While it may not be the process you are accustomed to, this extra step helps ensure you and Capital Power only pay for medically-necessary prescriptions, which allows Capital Power to keep costs sustainable and to continue offering the coverage you receive today. Without these provisions, the benefits program would soon become unaffordable for you and Capital Power. CAPITAL POWER 2019 U.S. BENEFITS ENROLLMENT GUIDE | 17
Telehealth If you are enrolled in one of the medical insurance options, you automatically receive access to MDLIVE, a service that To access medical advice through MDLIVE, call provides convenient, 24/7 remote medical advice 365 days 1.888.726.3171 or visit www.mdlive.com/cignaselect . a year from a board-certified doctor by phone or online You can also download the MDLIVE App to visit with a video chat. Doctors at MDLIVE are available to talk to you – doctor using your mobile device. no matter where you are located – about common conditions such as fevers, cold and flu, infections, allergies, pink eye, urinary tract infections and more. MDLIVE doctors can give you a diagnosis and prescribe medications if needed. Dental Insurance PROVIDER: Guardian Capital Power offers dental insurance that covers routine To find out if your provider is in the Dental Guard Preferred check-ups and additional services needed for your health. Network or to find one that is, call 1.800.627.4200 or go to There has been no change to the plan’s coverage, and Capital www.guardiananytime.com and click on “Find a Provider”, Power continues to share the cost of dental premiums with which is located on the homepage. you to keep our plan sustainable. You have the option to pay a monthly premium, or to opt out of dental coverage. In-network Dental Guard BENEFIT Out-of-network* Preferred Network $50 for each covered person $100 for each covered person Annual deductible ($150 maximum per family) ($300 maximum per family) Preventive services (Exams, cleanings, x-rays) 100% 100% Preventive services (Deductible waived) Yes No Basic services (Fillings, simple extractions) 100% 80% Major services (Root canals, crowns) 60% 50% Annual maximum benefit $2,000 $1,250 Orthodontia 50%, up to $1,500 lifetime maximum * Out-of-network benefits are paid based on Maximum Plan Allowance (MPA) and you may be responsible for the difference between the provider’s usual fee and the MPA. 18 | 2019 U.S. BENEFITS ENROLLMENT GUIDE CAPITAL POWER
Guardian College Tuition Benefit Rewards Program Members that enroll in dental coverage with Guardian can To learn more about the program, register and verify eligibility register in the College Tuition Benefit Rewards Program and requirements, go to www.Guardian.CollegeTuitionBenefit.com earn 2,000 Tuition Rewards annually. You receive an additional or call 215.839.0119. The registration UserName is your bonus (2,500) after participating in the program for four years. Guardian Plan Number 387665 and the password is Each Tuition Reward is equivalent to a one dollar reduction on Guardian. Please note, you must register within the next the tuition to be paid. You can use your College Tuition Benefit 12 months to receive the first year of Tuition Rewards. Once Rewards to reduce undergraduate tuition for your dependents registered, you can add eligible dependents. at SAGE Scholar Consortium colleges (over 380 private colleges). Rewards can be given to children, grandchildren, nieces, nephews and Godchildren. Guardian PPO Dental Plan Rollover Feature Members can save their annual maximum dollars for a time In future years, if your dental expenses exceed the regular annual when they need it. With the maximum rollover feature, maximum, Guardian will use your MRA to pay those additional Guardian will roll over a portion of each insured dental expenses. Even better, if a member uses only preferred providers member’s unused annual maximum (amount is based on the during the benefit year (January 1 to December 31), Guardian out-of-network maximum) into a personal Maximum Rollover will increase the amount credited to your MRA. Account (MRA). To find out your current rollover amount, call Guardian at 1.800.627.4200. Plan annual Out-of-network/combo In-network maximum Maximum rollover Threshold maximum* maximum rollover amount rollover amount amount limit $1,250 $600 $300 $450 $1,250 * If the plan has a different annual maximum for PPO benefits vs. non-PPO benefits, ($2,000 PPO/$1,250 non-PPO for example) the non-PPO maximum determines the maximum rollover plan. To be eligible for a Maximum Rollover, you must have at least one claim in the plan year, with total claims not exceeding the threshold amount. EXAMPLE A: EXAMPLE B: EXAMPLE C: Year 1 – Paid claims: $400 Year 1 – Paid claims: $300 Year 1 – Paid claims: $800 (all in-network) (mixed in- and out-of-network) The paid claims exceed the $600 The paid claims do not exceed the The paid claims do not exceed the threshold, therefore no additional $600 threshold and all the claims $600 threshold, therefore $300 is money is added to the MRA . were in-network, therefore $450 is added to the MRA for use in year 2. added to the MRA for use in year 2. CAPITAL POWER 2019 U.S. BENEFITS ENROLLMENT GUIDE | 19
Vision Insurance PROVIDER: Guardian – Vision Service Plan Eye care not only helps you see better, but routine check-ups Capital Power offers eye care benefits through the Guardian can detect early signs of many different illnesses, including Vision Service Plan, which includes routine vision exams, diabetes. There has been no change to the plan’s coverage. lenses, frames and contact lenses. Capital Power continues to share the cost of vision premiums with you to keep our plan sustainable. You have the option to pay a monthly premium, or to opt out of vision coverage. BENEFIT In-network Out-of-network Eye exam (every 12 months) $10 co-pay Up to $50 $25 co-pay; $150 allowance; Frames (every 24 months) Up to $48 20% discount over $130 Up to $48 for single lenses, $25 co-pay for single, bifocal Lenses (every 12 months) $67 for bifocal lenses and and trifocal lenses $86 for trifocal lenses Contacts (every 12 months, in lieu of frames and lenses) Up to $150 Up to $120 Employer-Sponsored Benefits and Services PROVIDER: The Hartford (no change) Disability Income Benefits All Capital Power employees automatically receive the Capital Power provides full-time employees with Short- and following employer-sponsored benefits, starting the day Long-Term Disability income benefits, and pays the full cost you meet eligibility for the Capital Power benefits program. of this coverage. In the event you become disabled from a non-work-related injury or sickness, disability income benefits The following benefits are provided at no cost to you: are provided as a source of income. You are not eligible to Life Insurance receive Short-Term Disability benefits if you are receiving Basic Life Insurance is provided at two times your annual workers’ compensation benefits. Short-Term Disability is base salary or pay to a $500,000 maximum benefit. coordinated with other disability benefits you may be receiving, such as state-mandated programs and federal, state, and local Accidental Death & Dismemberment Insurance government programs. Accidental Death and Dismemberment (AD&D) insurance is provided at two times your annual base salary or pay to a $500,000 maximum benefit. Short-Term Disability Long-Term Disability 1st day of a non-work accident Benefits begin After 90 days 8th day of illness Benefit duration 13 weeks from date of disability Until Social Security normal retirement age Percentage of income replaced 100% 662/3 % Maximum benefit 90 day coverage $15,000 per month 20 | 2019 U.S. BENEFITS ENROLLMENT GUIDE CAPITAL POWER
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