2020 Open Enrollment Guide - Explain My Benefits ...
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2020 Open Enrollment Guide
2 Open Enrollment Guide Table of Contents Benefit Resource Center ......................................................................................................................................... 3 A Message to Our Employees ................................................................................................................................. 4 Benefits for You & Your Family ............................................................................................................................... 5 EMB Enroll ............................................................................................................................................................... 6 Medical Benefits Overview ..................................................................................................................................... 7 Prescription Discounts .......................................................................................................................................... 12 Baer's Furniture’s Wellness Initiatives .................................................................................................................. 13 Health Savings Accounts ....................................................................................................................................... 14 Health Savings Accounts – Frequently Asked Questions...................................................................................... 15 Health Savings Accounts – Frequently Asked Questions...................................................................................... 16 Health Savings Accounts Banking Information ..................................................................................................... 17 Dental Insurance ................................................................................................................................................... 18 Vision Insurance .................................................................................................................................................... 19 Voluntary Life and Accidental Death & Dismemberment Insurance ................................................................... 20 Voluntary Disability Insurance .............................................................................................................................. 21 Voluntary Critical Illness ....................................................................................................................................... 22 2020 Payroll Deductions ....................................................................................................................................... 23 Supplemental Benefits .......................................................................................................................................... 24 Supplemental Benefits .......................................................................................................................................... 25 Contacts ................................................................................................................................................................ 36 Important Legal Notices........................................................................................................................................ 37 This brochure summarizes the benefit plans that are available to Baer's Furniture Company, Inc. eligible employees and their dependents. Official plan documents, policies and certificates of insurance contain the details, conditions, maximum benefit levels and restrictions on benefits. These documents govern your benefits program. If there is any conflict, the official documents prevail. These documents are available upon request through the Human Resources Department. Information provided in this brochure is not a guarantee of benefits.
3 Open Enrollment Guide
Benefit Resource Center
Call the Benefit Resource Center (“BRC”), We’re Here to Help!
We speak insurance. Our Benefits Specialists can help you with:
Deciding which plan is the best for you
Benefit plan & policy questions
Eligibility & claim problems with carriers
Information about claim appeals & process
Allowable family status election changes
Transition of care when changing carriers
Claim escalation, appeal & resolution
Medicare basics with your employer plan
Coordination of benefits
Finding in-network providers
Access to care issues
Obtaining case management services
Group disability claims
Filing claims for out-of-network services
BRCSouth@usi.com | Toll Free: 855-874-0835 | Monday-Friday 8am-5pm EST
4 Open Enrollment Guide A Message to Our Employees The Benefits Open Enrollment Period Is Here! Baer’s Furniture is committed to provide a comprehensive benefits package to our employees for the following year. As healthcare costs continue to rise, Baer’s Furniture strives to keep pace with healthcare trends and to provide choices for medical insurance to meet the needs of our employees and to manage the increased costs. Considering present inflation and increased government regulation, we are very pleased to announce a minimal annual increase in the cost of medical insurance for our employees. All other insurance plans will continue for the next year with no increase in current premium costs. We will have our open enrollment meetings to provide information about our benefits at all our locations. It is very important that all our employees attend a meeting to be informed. Family members are welcome to attend as well. We will continue to use our online benefits system with Explain My Benefits to renew enrollment or make changes in benefits for 2020. All the information and pricing will be available when the portal is open during the first two weeks of December 2019. The Baer Family.
5 Open Enrollment Guide
Benefits for You & Your Family
Baer's Furniture is pleased to announce our 2020 When and How Do I Enroll?
benefits program. Please read the information Open enrollment meetings will begin to be
provided in this guide carefully. For full details conducted in November. Our enrollment portal will
about our plans, please refer to the summary plan open in December.
descriptions. Listed below are the Baer's Furniture
benefits available during open enrollment: All eligible employees are required to complete the
Medical enrollment process, even if you do not wish to make
Dental any changes to your benefits.
Vision
Short Term Disability You can sign up for Benefits at any of the following
Long Term Disability times:
Voluntary Life • After completing initial eligibility period;
Wellness Plan • During the annual open enrollment period;
Accident Insurance • Within 30 days of a qualified family-status
Critical Illness change.
If you do not enroll at one of the above times, you
Who is Eligible? must wait for the next annual open enrollment
Full-Time employees working at least 30 hours a period.
week and their eligible dependents may participate
in the Baer's Furniture benefit program. When is My Coverage Effective?
The effective date for your benefits is January 1,
Generally, for the Baer's Furniture benefit program, 2020. If you are a New Hire your benefit effective
dependents are defined as: date will be first of the month following 60 days.
Your spouse, unless you are legally
separated or divorced, domestic partner
same or opposite gender;
Changing Coverage During the Year
You can change your coverage during the year when
Your married or unmarried natural
you experience a qualified change in status, such as
children, step-children living with you,
marriage, divorce, birth, adoption, placement for
legally adopted children and any other
children for whom you have legal adoption, or loss of coverage. The change must be
guardianship, reported to the Human Resources Department
Newborn to age 30. within 30 days of the event. The change must be
A dependent who is older than 26 years of consistent with the event.
age, but less than 30 years of age may be For example, if your dependent child no longer
eligible for medical benefits through the meets eligibility requirements, you can drop
end of the calendar year with no coverage only for that dependent.
qualifications or coverage restrictions.
6 Open Enrollment Guide
EMB Enroll
WHEN IS OPEN ENROLLMENT?
Online Benefit Enrollment system open: December 2nd – 13th
All Enrollments must be completed using EMB ENROLL.
HOW TO ENROLL IN YOUR BENEFITS
1. Access the On-Line Enrollment at: www.explainmybenefits.com/baers
2. Review your Benefit Guide along with the brochures and videos on the page.
3. Click the Open Enrollment Button
4. Please follow the instructions on the page and proceed to your enrollment
5. Complete your enrollment
6. IMPORTANT: RECORD YOUR CONFIRMATION NUMBER _________________________
IMPORTANT THIS YEAR: All benefit eligible employees must confirm a benefit enrollment using EMB
ENROLL whether you are electing benefits, keeping benefits the same, making changes, or waiving all
benefits. This is a requirement this year.
HOW YOU CAN BE PREPARED?
1. Please have the dates of birth and social security numbers of dependents when you enroll.
2. Look for emails, brochures and other information to be distributed prior to your Open Enrollment!!!
3. View Benefit Resource Portal for more information about the Open Enrollment Process, review your
benefit guide and learn about the voluntary benefits offered.
www.explainmybenefits.com/baers
7 Open Enrollment Guide
Medical Benefits Overview
Baer's Furniture offers 2 medical plans the HNOnly (Core Plan) and the HNOption w/ HSA (Buy Up). Both plans
utilize the Aetna provider network. In order to verify a participating provider please visit ww.mymeritain.com,
Scroll down to the Provider Network Finder, enter provider network name: Aetna. Once you click Aetna, start
your search. One can chose from provider types, hospitals and facilities, medical conditions or procedures.
The chart on the following page is a brief outline of the plan. Please refer to the summary plan description for
complete plan details.
Dual Option
HNOnly (Core Plan) HNOption w/HSA (Buy Up)
Benefit Coverage ScheduleofBenefits In-NetworkBenefits
In-Network
Plan Year / Contract Year Basis Calendar Year Calendar Year
Deductible (Individual / Family) $5,500 / $11,000 $2,500 / $5,000
Maximum Out-of-Pocket
$6,350 / $12,700 $4, 500 / $ 6,750
(Individual / Family)
Deductible, coinsurance, Deductible, coinsurance,
Out of Pocket Max Includes
copays & Rx copays & Rx
Lifetime Major Medical Maximum Unlimited Unlimited
Coinsurance 50% 80%
Preventative
Wellness 100% 100%
Copays
Open Access Yes Yes
Office Visits/Consultations for
$35 copay 20% after CYD
llness/Injury
Specialist Visits $75 copay 20% after CYD
Inpatient Hospital 50% after CYD 20% after CYD
Outpatient Surgery 50% after CYD 20% after CYD
Emergency Room $300 copay 20% after CYD
Urgent Care $50 copay 20% after CYD
Complex Diagnostic $300 copay 20% after CYD
Prescriptions*
RX Deductible (per calendar year) $200 Individual / $400 Family CYD
Retail Pharmacy (30 Day Supply) $15/$20/50% 30%/30%/50%
Mandatory Mail Order
$30/$40/50% 30%/30%/50%
(90 day supply)
Out of Network
Deductible (Ind/Fam) $5,000 / $10,000
Maximum Out-of-Pocket (Ind/Fam) $10,000 / $20,000
Not Covered
Lifetime Major Medical Maximum Unlimited
Coinsurance 60%
CYD: Calendar Year Deductible
*After two retail fills for maintenance medication the member would be notified that they must use the mail order pharmacy or
local CVS retail pharmacy for any future fills of their maintenance medication.
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Baer’s Furniture Company, Inc.
Teladoc is the on-demand healthcare solu on that
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Great health means peace of mind
Common conditions treated:
With Teladoc, you can talk to a doctor 24/7/365 by
phone, online video or mobile app. Use Teladoc for Allergies Rash/skin infec ons
medical advice and care when: Bronchi s Sinus infec ons
Cold/flu Stomachache/
Your primary care doctor is not open. diarrhea
Headaches/migraines
You are at home, traveling or do not want to take Urinary tract
Eye/ear infec on
me off work to see a doctor. infec ons
You need a prescrip on or refills*.
*Please note, there is no guarantee you will be prescribed Our members love Teladoc
medicaƟon. “We had a good experience with the doctor. She
called and talked to me, and gave great service. I
Highly qualified, experienced doctors had no problem picking up my prescription. This is a
When you use Teladoc, your medical questions will really good service.”
be answered by a highly qualified doctor. Teladoc
doctors are: Contact a Teladoc physician at 1.800.362.2667, or by
Experienced—with an average of over 10–15 years visiting www.MyDrConsult.com.
in practice.
© 2015 Teladoc, Inc. All rights reserved. Teladoc and the Teladoc logo are
Progressive—using the latest technology to registered trademarks of Teladoc, Inc. and may not be used without wri en
permission. Teladoc does not replace the primary care physician. Teladoc does not
provide excellent care. guarantee that a prescrip on will be wri en. Teladoc operates subject to state
regula on and may not be available in certain states. Teladoc does not rescribe
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Specially trained in telemedicine. right to deny care for poten al misuse of services. Teladoc phone consulta ons are
available 24 hours, 7 days a week while video consulta ons are available during the
hours of 7am to 9pm, 7 days a week.
10/22/2019
Baer's Furniture Prescription Drug Benefits
Maintenance Medications Requirement – Effective January 1,
2019 Maintenance
Medications
Effective January 1, 2019, all maintenance medications must be
obtained through CVS or WellDyneRx Prescription Delivery Service
Maintenance medications
pharmacy provider. WellDyneRx offers free delivery of medications to
are prescription drugs
your home, work or doctor’s office.
commonly used to treat
chronic or long-term
If you and/or your covered dependent(s) are taking a maintenance
conditions. These
medication, please follow the important steps detailed below to start
conditions usually require
filling your prescriptions with WellDyneRx.
regular, daily use of
medicines.
Important Things to Do
Examples of maintenance
1. Register for WellDyneRx Prescription Delivery Service
medications are those used
You will need to create an account by providing your insurance, to treat conditions such as:
contact, health, and payment information. Register online or by mail: • Asthma
• Online: www.WellDyneRx.com • Depression
• Mail: Complete and mail the enclosed registration form. You • Diabetes
will need to provide a payment method before ordering your • High blood pressure
first prescription by entering a credit, debit, FSA, or HSA card • High cholesterol
online or by calling Member Services at 1-888-479-2000.
2. Ask your doctor to send a NEW 90-day prescription to
WellDyneRx. Prescriptions cannot be transferred from a retail
pharmacy.
• E-prescribe: WellDyneRx Prescription Delivery
• Fax: 1-877-221-1259 or 1-888-830-3608
For more information about WellDyneRx Prescription Delivery Service,
visit our website at www.WellDyneRx.com.
Sincerely,
WellDyneRx
Enclosure: WellDyneRx Prescription Delivery Registration Form
Member Materials
UNDERSTANDING
STEP THERAPY
Your WellDyneRx Benefit Plan
Medicines can be expensive, and WellDyneRx provides ways to help members
manage their prescription drug costs. Your benefit plan uses one of these options,
called step therapy.
What is step therapy?
Step therapy is a program that helps you and your doctor choose medicine that is right for you.
WellDyneRx has certain medicines that we recommend you try first when treating some
health conditions. Trying certain drugs first before trying others is called step therapy.
»» Step One Drugs – Lower-cost options
This first step requires you to use a lower-cost medicine before you can use a more
expensive Step Two drug. The lower-cost options are usually generic medicines. They can
provide the same health benefits as higher-cost medicines.
»» Step Two Drugs – Brand name drugs
Step Two drugs are brand name medicines that usually cost more than Step One or generic
medicines. They’re recommended only if a Step One medicine doesn’t work for you.
What if my doctor prescribes a Step Two drug?
When a pharmacist puts your prescription into the system, they receive an alert if the
medication is part of the step therapy program.
Your pharmacy will not automatically change your prescription if you have a Step Two drug.
Your doctor must write a new prescription for you to switch to a Step One drug. If your doctor
thinks a Step One drug is not a good choice for you, they can request approval of a Step Two
medicine from WellDyneRx.
If you have questions about your pharmacy benefits, please visit www.WellDyneRx.com and
click “Members” or call the Member Services number shown on your member ID card.
Y our benefit plan uses tools such as step therapy
that can help control your costs.
For questions, please contact WellDyneRx Member
Services at the number listed on your ID Card.
www.WellDyneRx.com
6.2018 © WellDyneRxADVANCED SPECIALTY
PHARMACY SERVICES
US Specialty Care, WellDyneRx’s wholly-owned specialty pharmacy, is an industry-leading provider of
specialty medications. We are committed to providing personalized care to each member, ensuring
they have the tools necessary to understand and manage their condition. We will work with you, your
doctors and nursing staff to create a personalized treatment plan that will provide you with the best
possible outcomes. Our experienced pharmacy staff will provide you with complete patient support.
Working together to improve your health
US Specialty Care understands that patients who use specialty medications require special,
personalized care, that’s why we will pair you with a Patient Care Advocate. Your Patient Care
Advocate will work with you to deliver the right care. Our pharmacy fully supports you through:
»» Medication delivery: We know that getting your medication on time is important. Your
medications will be carefully packaged in a temperature controlled pack and discreetly
shipped to ensure confidentiality and stability.
»» Insurance and financial assistance coordination: US Specialty Care will coordinate your
benefits and insurance coverage, assist with obtaining prior authorizations, and identify
additional options to lower costs. When possible, they will direct you to grants and/or other
financial assistance to help bridge benefit gaps.
»» Expert Support: Once you enroll, you will be assigned a Patient Care Advocate who is familiar
with your disease state. Your Patient Care Advocate will provide you with the support needed
to manage your condition and schedule prescription refills.
Getting started
To get started, ask your doctor to send your prescription to US Specialty Care electronically or by fax to
800-530-8589. Your doctor can also speak with our experienced team of pharmacists by calling 800-
641-8475. Your Patient Care Advocate will contact you to help you enroll in our specialty pharmacy
program, schedule your medication delivery, and help you manage your medical supplies.
With US Specialty Care, you’ll have the peace of mind knowing that you have access to the
medications, tools and resources to manage your health. To learn more about US Specialty Care,
contact us at 800-641-8475 or visit www.USSpecialtyCare.com.
www.USSpecialtyCare.com
9.2018 © WellDyneRx12 Open Enrollment Guide
Prescription Discounts
Baers Furniture is always looking to protect its employees pockets when it can. Take a look at the various
pharmacy discounts available to you simply for being a consumer. You do not need to be a member of the
medical plan in order to participate in any of these programs. For more information please visit the websites
below and keep in mind that certain restrictions will apply.
Publix offers a variety of prescription medications free for as long as your doctor prescribes them, 30 days’
worth at a time. Those include:
• Metformin (for diabetes).
• Lisinopril (for high blood pressure).
• Amlodipine (for high blood pressure and angina).
Publix also offers a free 14-day supply of some common antibiotics:
• Amoxicillin
• Ampicillin
• Sulfamethoxazole/Trimethoprim (SMZ-TMP)
• Ciprofloxacin (excluding Ciprofloxacin XR)
• Penicillin VK
Visit: www.publix.com
Walmart $4 Prescriptions. Save big on 30-day generic medications & spend just $10 on 90-day
prescriptions. No insurance necessary. Find your medication list at: www.walmart.com
GoodRx gathers current prices and discounts to help you find the lowest cost pharmacy for your
prescriptions. The average GoodRx customer saves $276 a year on their prescriptions.
• GoodRx is 100% free.
• No personal information required.
Visit their website at www.goodrx.com or download their app.13 Open Enrollment Guide
Baer's Furniture’s Wellness Initiatives
As most of you now know, Baer’s Furniture launched a new employee wellness program in 2015 which
offered employees the opportunity to save on their future medical premiums.
Participating in the Baer’s Furniture Wellness Program helps all of us better manage or avoid chronic
conditions such as hypertension, diabetes, high cholesterol, and depression, which can subtract years from
our lives. The journey toward a better lifestyle is never easy, however with support, commitment, and
consistency, each of us can achieve our individual health and wellness goals. Today, it is more important than
ever to take an active role in your personal health and therefore, Baer’s Furniture wants you to know that we
are here to provide the tools and incentives to help.
Going to see your doctor for a yearly wellness exam is one of the best ways to manage your health. Preventive
care often leads to identifying health problems early and increasing your chances for successful treatment
and/or cure. Now that these services are covered by all health plans, it's just that much easier to achieve and
maintain optimal health.
Just 3 steps to improve your health and save…..
Step 1 Complete an annual physical with your primary care physician (PCP). Your doctor will need to
complete & sign the company-provided Physician Form to confirm you had your annual physical. Physician
visits completed between November 1, 2019 & October 31, 2020 will be accepted. If enrolled in the health
plan, your annual physical and standard preventive lab work should be covered in full once every 365 days.
Step 2 Complete the Preventive Screening form. Take the preventive screening form to your scheduled
doctor’s visit to be completed and signed by the attending physician. One exam needs to be completed
between November 1, 2019 & October 31, 2020. For the list of screenings that are accepted please refer to
the wellness packet.
Step 3 Send both forms to Wellworks on or prior to November 1, 2020. Submit BOTH your physician form and
preventive screening form together to Wellworks. See instructions listed on the forms regarding how to send
them.
*New hires: Hired after 5/1/20 will receive incentive.
By completing the above steps, you will receive…
Incentives: For completing the annual physical and the preventive screening form, you will receive a discount
on your medical premiums beginning January 1, 2021.
Your health plan is committed to helping you achieve your best health. Rewards for participating in a wellness program are available
to all employees. If you think you might be unable to meet a standard for a reward under this wellness program, you might qualify for
an opportunity to earn the same reward by different means. Contact us 954-946-8001 ext. 215 and we will work with you (and, if you
wish, with your doctor) to find a wellness program with the same reward that is right for you in light of your health status.
Be Healthy & Save!14 Open Enrollment Guide
Health Savings Accounts
A health savings account (HSA) is an account funded to help you save for future medical expenses not covered
by your insurance plan, including the deductible, coinsurance and even vision and dental expenses. You must
be enrolled in an HSA compatible health plan to be eligible, there are certain advantages to putting money into
these accounts, including favorable tax treatment and the ability to roll unused funds over from year to year.
Who Can Have an HSA?
Any adult can contribute to an HSA if you:
· Have coverage under an HSA-qualified, high-deductible health plan (HDHP)
· Have no other first-dollar medical coverage (other types of insurance, including specific injury or
accident, disability, dental care, vision care, or long-term care insurance are permitted)
· Are not enrolled in Medicare or Tricare
· Cannot be claimed as a dependent on someone else’s tax return
Contributions to your HSA would be made by you. The total contributions are limited annually. If you make a
contribution, you can deduct the contributions (even if you do not itemize deductions) when completing your
federal income tax return. Contributions to the account must stop once you are enrolled in Medicare. However,
you can keep the money in your account and use it to pay for medical expenses tax-free.
HDHPs
You must have coverage under the Baer's Furniture HDHP to open and contribute to an HSA.
HSA Contributions
You can make a contribution to your HSA each year that you are eligible. Contributions from all sources can be
no more than:
· Self-only coverage: $3,550 in 2020
· Family coverage: $7,100 in 2020
Individuals ages 55 and older can also make additional “catch-up” contributions. The maximum annual catch-
up contribution is $1,000.15 Open Enrollment Guide Health Savings Accounts – Frequently Asked Questions How do I manage my HSA? Your Health Savings Account (HSA) is your account; the HSA dollars are your dollars. Since you are the account holder or HSA beneficiary, you manage your HSA account. You may choose when to use your HSA dollars or when not to use your HSA dollars. HSA dollars pay for any eligible expense. Most commonly, the HSA account holder will use HSA dollars to pay the out-of-pocket expenses (i.e., deductible and coinsurance) associated with their high deductible plan. What expenses are eligible for reimbursement from my HSA? HSA dollars may be used for qualified medical expenses incurred by the account holder and his or her spouse and dependents. Qualified medical expenses are outlined within IRS Section 213(d). In summary the IRS Section 213(d) states that “the expense has to be primarily for the prevention or alleviation of a physical or mental defect or illness”. In addition to qualified medical expenses, the following insurance premiums may be reimbursed from an HSA: · COBRA premiums · Health insurance premiums while receiving unemployment Benefits · Any health insurance premiums paid, other than for a Medicare supplemental policy, by individuals ages 65 and over Are dental and vision care qualified medical expenses under an HSA? Yes, as long as these are deductible under the current rules. For example, cosmetic procedures, like cosmetic dentistry, would not be considered qualified medical expenses. What expenses are NOT eligible for reimbursement from my HSA? The following expenses may not be reimbursed from an HSA: · Premiums for Medicare supplemental policies · Expenses covered by another insurance plan · Expenses incurred prior to the date the HSA was established · Over-the-counter drugs purchased without a prescription (except insulin) What is a coverage gap? This is the gap between total out-of-pocket expenses associated with your high-deductible health plan and your HSA dollars. For example, assume that you have a $2,000 deductible, a $4,000 maximum out-of-pocket, and either you or your employer has contributed $2,000 to your HSA account. If your medical costs incurred exceed $4,000 for the year, then you are financially obligated to pay the difference between your total maximum out-of-pocket ($4,000) and your HSA balance ($2,000) - ($4,000 - $2,000 = $2,000) What happens when my HSA funds run out? You may be financially responsible for any eligible medical expenses that fall within the coverage gap. Can I use my HSA dollars for non-eligible expenses? Money withdrawn from an HSA account to reimburse non-eligible medical expenses is taxable income to the account holder and subject to a 20 percent tax penalty - unless over age 65, disabled or upon death of the account holder. When can I start using my HSA dollars? You can use your HSA dollars immediately following your HSA account activation and once contributions have been made.
16 Open Enrollment Guide Health Savings Accounts – Frequently Asked Questions How do I pay my physician or network facility at time of service with my HSA dollars? You may request that the network provider submit your claim to your health plan. You should make sure that your provider has your most up-to-date insurance information. Once the medical claim has been processed, if applicable, out-of-pocket expenses will be billed. At this time, you may choose to use your HSA Debit card to pay for any out-of-pocket expenses, or you may choose to pay with your own money and receive reimbursement at a later date. You should always ask that your medical claim be submitted to the health plan before you seek reimbursement from your HSA. This procedure will ensure that provider discounts are applied. Also, remember to keep all medical receipts and Explanation of Benefits (EOBs) for tax purposes. What if I have HSA dollars left in my account at year-end? The money is yours to keep. It will continue to be available for you and your health care costs next year. What happens to my HSA dollars if I leave Baer's Furniture? The funds are yours to keep. You may elect one of the following options: · Leave your funds in your current HSA account · Transfer your funds to an HSA with your new employer · Transfer your funds to another qualifying account within 60 days Can I use the money in my account to pay for my dependents’ medical expenses? You can use the money in your account to pay for medical expenses for yourself, your spouse or your dependent children. You can pay for the unreimbursed expenses of your spouse and dependent children even if they are not covered by your HDHP. Can couples establish a “joint” account and both make contributions to the account, including “catch-up” contributions? “Joint” HSA accounts are not permitted. Each spouse should consider establishing an account in their own name. This allows you both to make catch-up contributions when each spouse is 55 or older. My employer offers an FSA – can I have both an FSA and an HSA? You can have both types of accounts, but only under certain circumstances. General Flexible Spending Accounts (FSAs) will probably make you ineligible for an HSA. If your employer offers a “limited purpose” (limited to dental, vision or preventive care) or “post-deductible” (pay for medical expenses after the plan deductible is met) FSA, then you can still be eligible for an HSA. Can I shift my IRA funds to my HSA? Owners of individual retirement accounts that are enrolled in a high-deductible health plan can shift IRA funds to an HSA without facing a tax penalty. The IRS allows a one-time transfer that does not exceed your maximum HSA contribution limit. Can I borrow against the money in my HSA? No. You may not borrow against it or pledge the funds in it. For more information on prohibited activities see Section 4975 of the Internal Revenue Code.
17 Open Enrollment Guide Health Savings Accounts Banking Information Opening your Health Savings Account Follow the steps below to open your Health Savings Account (HSA). Step 1: Medical Plan Enrollment Enroll in the Baer’s HSA compatible HDHP Plan. Step 2: Contribution Determine how much you plan to contribute to your HSA account before taxes. Step 3: HSA Establishment Varies by bank, use their instructions. Chose a bank of your choice, open and deposit money into your HSA right away so you are prepared if you have a health event. You or anyone else can deposit money into the HSA at any time.
18 Open Enrollment Guide
Dental Insurance
Baer's Furniture offers two dental plans through Guardian. Guardian’s DHMO is an in-network only dental
plan. There are no benefits for out-of-network dentists. There are no plan maximums or deductibles.
The DPPO Plan allows you to use in-network or out-of-network benefits. If out-of-network dentists are used,
you will be responsible to pay the difference between Guardian’s allowed amount and what the dentist may
charge.
Guardian Guardian
DHMO 30 Low Plan DPPO K7 Buy Up Plan
Benefit Coverage ScheduleofBenefits In-NetworkBenefits Out-of-NetworkBenefits
Deductible
Individual $0 $50 $100
Family $0 $150 $300
Waived for Preventive Care N/A Yes Yes
Annual Maximum
Per Person Unlimited $1,000 $1,000
Diagnostic & Preventive CDT Codes No Charge Deductible Waived Deductible Applies
Exams D0120
Cleanings D1110
Fluoride D1203 $0 100% 80%
X-Rays D0272
Sealants D1351
Regular Restorative Services CDT Codes Various copays apply Deductible Applies Deductible Applies
Amalgam Fillings D2150 $0
Extractions Single Tooth D7140 $0
80% 70%
Endodontics (Root Canal) D3320 $120 - $170
Periodontics (Gum Disease) D4211 $0
Major CDT Codes Various copays apply Deductible Applies Deductible Applies
Crowns D2791 $395
Bridges D6211 $381 - $575 50% 40%
Dentures D5110 $381 - $575
Orthodontia
Age Limitation Child to age 19
Not Covered Not Covered
Lifetime Maximum $2,500 - $2,80019 Open Enrollment Guide
Vision Insurance
Baer's Furniture provides Vision Insurance through Guardian. The chart below is a brief outline of the plan.
Please refer to the summary plan description for complete plan details.
Benefit Coverage Guardian
Vision
Copay In-Network Benefits Out-of-Network Benefits
Routine Exams (Annual) $15 copay $50 Allowance
Vision Materials
Materials Copay $25 copay
Lenses Covered every 12 months
Single $48 Allowance
Bifocal $25 copay $67 Allowance
Trifocal $86 Allowance
Contact Lenses Covered every 12 months
Elective 85% of amount over $120 $105 Allowance
Medically Necessary $0 $210 Allowance
Frames Covered every 24 months
Covered Services 80% of amount over $120 $48 Allowance
Members receive additional fixed copayments on lens options including anti-reflective and Scratch-
Lens Options resistant coatings. After copay, standard polycarbonate available at no charge for dependents less
than 19 years old. (Tints, coating, UV, anti-reflective lenses, polycarbonate & progressive lenses)
Courtesy discount on a second pair of eyeglasses. This discount is available for 12 months after the
Additional Pairs covered eye exam and available through the Davis Vision Network provider who sold the initial pair
of eyeglasses.
Laser Vision Correction Up to 25% off the usual charge or 5%. No discounts off promotional price.20 Open Enrollment Guide
Voluntary Life and Accidental Death & Dismemberment
Insurance
Baer’s Furniture provides all active employees working 30 or more hours per week the option to purchase life
insurance coverage through a group plan with Mutual of Omaha.
The chart below provides an overview of the plan.
Benefit Coverage Voluntary Term Life/AD&D
Eligible Employees All Full-Time employees working 30 hours or more
Employee Minimum: $10,000, Maximum: 5x annual salary, up to $300,000
Spouse Minimum: $5,000, Maximum: 100% of employee benefit, up to $150,000
Dependent Life Minimum: $10,000, Maximum: 100% of employee benefit, up to $10,000
Employee: 5x annual salary, up to $200,000
Guarantee Issue Spouse: 100% of employee benefit, up to $30,000
Dependent: 100% of employee benefit
Accelerated Death Benefit 80% death benefit, $240,000 max
Waiver of Premium Benefit Yes
Portable / Convertible Yes, without having to provide Evidence of Insurability
At age 70, amounts reduce to 65%
Benefit Reduction
At age 75, amounts reduce to 30%
AD&D For you and your spouse;
(Accident Death & Dismemberment) The Principal Sum amount is equal to the amount of life insurance benefit.
The only time you can enroll in guaranteed issue voluntary life insurance, is at the date you first become
eligible to enroll. If you do not enroll then and later decide that you would like to enroll, you may be required
to complete a medical questionnaire and go through medical underwriting. The insurance carrier reserves the
right to decline coverage based on medical information obtained on the medical questionnaire.21 Open Enrollment Guide
Voluntary Disability Insurance
Baer’s Furniture provides all active employees working 30 or more hours per week the option to purchase
Short Term and Long-Term Disability coverage through a group plan. When you enroll in short term or long-
term disability you pay the full cost through payroll deductions.
In the event you become disabled from a non-work-related injury or sickness, disability benefits are provided
as a source of income. You are not eligible to receive short-term disability benefits if you are receiving
workers’ compensation benefits.
Short-Term Disability Insurance
Baer's Furniture offers a short-term disability option through Mutual of Omaha Insurance Company This
benefit covers 60% of your weekly base salary up to $1,000/week. The benefit begins after 14 days of injury or
illness and lasts up to 11 weeks. Please see the summary plan description for complete plan details.
Benefit Coverage Short-Term Disability
Employee Definition All Full-Time employees working 30 hours or more
Weekly Benefit 60% of your before-tax weekly earnings, up to $1,000
Elimination Period On the 15th day of your disabling injury or illness
Any condition you receive medical attention for in the 3 months prior to your effective date of
Pre-Existing Limitation
coverage that results in a disability during 6 months of coverage, would not be covered.
Duration of Benefits Up to 11 weeks
Long-Term Disability Insurance
Baer's Furniture offers long-term income protection through Mutual of Omaha Insurance in the event you
become unable to work due to a non-work-related illness or injury. This benefit covers 60% of your monthly
base salary up to $5,000 Benefit payments begin after 90 days of disability. See Certificate of Coverage for
benefit duration. Please see the summary plan description for complete plan details.
Benefit Coverage Long-Term Disability
Employee Definition All Full-Time employees working 30 hours or more
Monthly Benefit 60% of your before-tax monthly earnings, up to $5,000
Elimination Period 90 days
Duration of Benefits If you become disabled prior to age 62, benefits are payable to age 65, your Social Security
Normal Retirement Age or 3.5 years, whichever is longest. At age 62 (and older), the benefit
period will be based on a reduced duration schedule.
Own Occupation 2 years
Pre-Existing Conditions Any condition you receive medical attention for in the 3 months prior to your effective date of
coverage that results in a disability during 12 months of coverage, would not be covered.
The only time you can enroll in Long Term Disability is at the date you first become eligible to enroll. If you do not enroll
then and later decide that you would like to enroll, you will be required to a complete a medical questionnaire and go
through medical underwriting. The insurance carrier reserves the right to decline coverage based on medical
information obtained on the medical questionnaire.22 Open Enrollment Guide
Voluntary Critical Illness
The signs pointing to a critical illness are not always clear and may not be preventable, but our coverage can
help offer financial protection in the event you are diagnosed. Mutual of Omaha Insurance group voluntary
critical illness coverage provides a lump-sum cash benefit to help you cover the out-of-pocket expenses
associated with a critical illness.
Benefit Category & Condition Voluntary Critical Illness
Heart/Circulatory:
Heart Attack, Heart Transplant, Stroke: 100%
Heart Valve Surgery, Coronary Artery Bypass, Aortic Surgery: 25%
Organ
Major Organ Transplant/Placement on UNOS List, End-Stage Renal 100%
Failure:
Acute Respiratory Distress Syndrome (ARDS): 25%
Childhood/Developmental (Benefits only available to children)
Cerebral Palsy, Structural Congenital Defects, Genetic Disorders, 100%
Congenital Metabolic Disorders, Type 1 Diabetes:
Cancer
Cancer (Invasive) 100%
Bone Marrow Transplant 50%
Carcinoma in Situ, Benign Brain Tumor 25%
Coverage Minimum Guarantee Issue Maximum
For you (Available as a flat benefit) $10,000 $10,000 $10,000
Spouse (Available as a flat benefit) $10,000 $10,000 $10,000
Child(ren) (Benefit for each child) N/A $3,000 $3,00023 Open Enrollment Guide
2020 Payroll Deductions
The Charts below show the bi-weekly payroll deduction amounts for each of the benefits offered.
Medical
Employee Bi-Weekly Contributions
HNOnly HNOnly HN Option HN Option
Aetna
with wellness without wellness HSA with wellness HSA without wellness
Employee $44.00 $64.00 $72.00 $104.00
Employee & Spouse $399.00 $432.00 $408.00 $506.00
Employee & Child(ren) $298.00 $354.00 $357.00 $453.00
Family $623.00 $720.00 $714.00 $800.00
Dental
Employee Bi-Weekly Contributions
Guardian DHMO 30 Low Plan DPPO K7 Buy Up Plan
Employee $5.62 $15.96
Employee & Spouse $11.24 $33.40
Employee & Child(ren) $12.51 $40.02
Family $18.14 $53.44
Vision
Employee Bi-Weekly Contributions
Vision
Employee $2.75
Employee & Spouse $4.63
Employee & Child(ren) $4.72
Family $7.47
Please note that rates for voluntary life, voluntary STD, voluntary LTD, critical care, accident, and group
universal life will be available on the EMB enrollment site24 Open Enrollment Guide
Supplemental Benefits
Accident and Universal Life
Customer Service: 1-800-918-8877
Claims: 1- 877-201-9373
Employee & Employee &
Trustmark Employee Family
Spouse Children
Bi-weekly Rates $9.50 $16.14 $22.92 $29.58
Sample rates are shown for illustrative purposes only; actual payroll deduction amount may vary based on rounding calculations.
American Public Life Group Hospital Indemnity Insurance.
Customer Service & Claims: 1-800-256-8606
Employee & Employee &
Bi-Weekly Rates Employee Family
Spouse Children
Plan 1 $9.87 $18.35 $13.27 $21.44
Plan 2 $14.99 $27.81 $20.89 $33.35
The premium and amount of benefits vary dependent upon plan selected at time of application. Premium includes the plan selected and any
applicable rider premium.
*For questions on claims or benefits contact applicable carrier above for the supplemental benefits.
Note: Please see your Benefits Representative for a Beneficiary Designation Form.
The only time you can enroll in guaranteed issue voluntary life insurance, is at the date you first become eligible to enroll. If you do not enroll then
and later decide that you would like to enroll, you will be required to complete a medical questionnaire and go through medical underwriting. The
insurance carrier reserves the right to decline coverage based on medical information obtained on the medical questionnaire.25 Open Enrollment Guide Supplemental Benefits Baer’s Furniture provides Supplemental Limited Benefit Group Hospital Indemnity insurance through American Public Life. This benefit helps cover out-of-pocket expenses related to Hospital Confinement and/or medically necessary Outpatient Treatment related to an injury or sickness. Summary of Benefits Plan 1 Plan 2 Daily Hospital Confinement Benefit (per day) $100 $100 Benefit Riders Intensive Care/Coronary Care Unit Rider (per day) $200 $200 Annual First Occurrence Hospital Rider (per calendar year) $1,000 $2,000 Base Policy Daily Hospital Confinement Benefit-Pays a daily indemnity benefit when a covered person is confined as an inpatient in a Hospital for at least 24 hours for a covered injury or sickness. The maximum benefit period for any one period of confinement is 180 days unless the confinement is due to a mental or emotional disorder. When the confinement is due to a mental or emotional disorder, the maximum benefit period for any one period of confinement will not exceed 30 days. The Hospital confinement must be at the direction of or under the supervision of a physician for benefits to be payable. Exclusions APL does not cover Hospital confinements or other losses in the policy or riders: due to hernia, adenoids, tonsils, varicose veins and appendix. For the complete listing of exclusions please refer to your benefit booklet from American Public Life. Termination of Policy APL may end the coverage of a policyholder if fewer persons are insured than the policyholder’s application requires. The policyholder or APL may terminate the policy on any premium due date after the first policy anniversary date, subject to 60 days written notice. Premium Changes The premium rates may be changed by APL on the first anniversary date of the policy or any premium due date thereafter. Benefit Rider(s) All riders are part of the policy/certificate to which it is attached and are subject to all the provisions, conditions, limitations and exclusions of the policy/certificate that are not in conflict with the provisions of the rider. Intensive Care/Coronary Care Unit Rider Pays a daily indemnity benefit when a covered person is confined in a Hospital’s intensive care or coronary care unity due to a covered injury or sickness. The maximum benefit period for any one period of confinement in an intensive care or coronary care unit is 20 days. Each period of confinement must be separate by at least 30 days. This benefit pays in addition to the Hospital confinement benefit. A step-down unit is not considered an intensive care unit. Annual First Occurrence Hospital Rider Pays an indemnity benefit the first time in a calendar year a covered person is confined as an inpatient in a Hospital. The Hospital confinement must be due to a covered injury or sickness; begin while this rider is in force; and be at the direction of and under the supervision of a physician. The benefit is payable once each calendar year for each covered person and the first day of confinement must be in a calendar year the rider is in effect in order for the benefit to be payable. Termination of Rider(s) Coverage The rider(s) will terminate: when the insured’s coverage terminates under the policy/certificate to which the rider is attached; when any premium for the rider is not paid by the end of the grace period; or when the insured gives APL a written request to terminate the rider. Coverage on a dependent terminates under the rider when the dependent ceases to meet the definition of dependent as defined in the policy/certificate.
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2020 Special Benefits Opportunity for
Baer’s Furniture Employees
Protect your family, finances and future with these
valuable benefits from Trustmark.
Trustmark Universal LifeEvents® Insurance
with Accelerated Death Benefit for Long-
Term Care Services
Two-in-one protection to fit your needs.
Trustmark Universal LifeEvents is permanent
life insurance. In addition to providing a death
benefit, it can help pay for long-term care
services. Universal LifeEvents® gives you a higher
death benefit during your working years and an
accelerated death benefit that never reduces.
Your price won’t increase due to age, and your
policy builds cash value over time.
Death benefit reduces to one-third at the latter of age 70 or the
15th policy anniversary.
You get a higher benefit for the same rate with Up to double your max life insurance benefit!
Universal LifeEvents than you would with a Example: $50,000 policy
standard plan. It’s more affordable because the
death benefit reduces after age 70 (when you
may need it less.) Your benefits to help with Collect 4% of your benefit amount per month
long-term care never reduce.
$50,000 for up to 25 months to help pay for long-term
care services.
Universal Death Living
LifeEvents Benefit Benefits Plus, if you collect living benefits, your full death
$50,000
benefit is still available for beneficiaries.
Before Age 70 $50,000 $50,000
After Age 70 $16,667 $50,000
$100,000 Total max benefit!
Benefit amounts shown are samples and not a guarantee.
See reverse for more information on available benefits.
Voluntary BenefitsTrustmark Accident Insurance
Accidents happen – you can be prepared.
Accident insurance from Trustmark pays you
to help with the cost of covered accidents, at
work or outside of work. It can help with stuff like
medical co-pays and deductibles, getting to and
from the hospital, and your everyday expenses.
It covers accidental injuries like broken bones,
burns and concussions. It also covers services
like using an ambulance, checking into a hospital
and getting physical therapy. Benefits are paid
in cash, and you can use them for whatever you
need most. You can also get paid for certain
health screening tests.
With all Trustmark plans: Trustmark®: 100+ Years of Service
and Financial Strength
Take your policy with you if you change Trustmark was founded in 1913 by railroad
jobs or retire. employees who wanted to provide more
security for injured or disabled coworkers.
asy payments with automatic
E They formed an association called
payroll deduction. Brotherhood of All Railway Employees and
for more than a century since, Trustmark
Apply for family members. has provided reliable insurance protection to
workers and families across the nation. With
Benefits paid in addition to any other a personalized, caring approach to insurance,
insurance you have. Trustmark today remains committed to the
same principles that inspired those founding
Cash benefits to use however you like. workers: helping people increase their well-
being and achieve peace of mind.
You care.
We listen.
Products underwritten by Trustmark Insurance Company, Lake Forest, Illinois. In New York, Universal Life and Universal LifeEvents are underwritten by Trustmark Life
Insurance Company of New York, Albany, New York. Trustmark®, LifeEvents®, Trustmark Critical HealthEvents® and Trustmark Paycheck Protect® are registered trademarks
of Trustmark Insurance Company. Trustmark Hospital StayPaySM is a trademarks of Trustmark Insurance Company. Underwriting conditions may vary, and determine
eligibility for the offer of insurance. A waiting period may apply before benefits are payable. Benefits may not be available in all states; benefits, availability, exclusions
and limitations may vary by state and may be named differently. Pre-existing condition limitations may apply. For more details on costs, coverage details and available
benefits, speak with a benefit counselor or enroller and/or consult additional pre-enrollment materials; you may also write to the company. Your policy/certificate and
outline of coverage, if applicable, will contain complete information.
Products underwritten by Trustmark Insurance Company
and Trustmark Life Insurance Company of New York.
Rated A- (Excellent) for financial strength by A.M. Best.
trustmarksolutions.com
©2019 Trustmark Insurance Company A112-2424_Baers (10-19)36 Open Enrollment Guide Contacts Have Questions? Need Help? Baer's Furniture is excited to offer access to the USI Benefit Resource Center (BRC), which is designed to provide you with a responsive, consistent, hands-on approach to benefit inquiries. Benefit Specialists are available to research and solve elevated claims, unresolved eligibility problems, and any other benefit issues with which you might need assistance. The Benefit Specialists are experienced professionals and their primary responsibility is to assist you. The Specialists in the Benefit Resource Center are available Monday through Friday 8:00am to 5:00pm Eastern & Central Standard Time at 855-874-0835 or via e-mail at BRCSouth@usi.com. If you need assistance outside of regular business hours, please leave a message and one of the Benefit Specialists will promptly return your call or e-mail message by the end of the following business day. Please note, the BRC cannot answer any questions for Supplemental Benefits with American Public Life, Trustmark or Critical Illness with Mutual of Omaha, as these products can be specific to the individual. Please contact those carriers directly. Please contact Human Resources to complete any changes to your benefits that are not related to your initial or annual enrollment. Carrier Customer Service BENEFITS PLAN CARRIER PHONE NUMBER WEBSITE Medical: HMO, PPO & RX Meritain Health - An Aetna Company 1-800-925-2272 www.meritain.com Dental: DHMO & DPPO Guardian 1-888-600-1600 www.guardiananytime.com Vision Guardian 1-888-600-1600 www.guardiananytime.com Voluntary Life AD&D Mutual of Omaha Insurance 1-800-877-5176 www.mutualofomaha.com Short Term Disability (STD) Mutual of Omaha Insurance 1-800-877-5176 www.mutualofomaha.com Long Term Disability (LTD) Mutual of Omaha Insurance 1-800-877-5176 www.mutualofomaha.com Voluntary Critical Illness Mutual of Omaha Insurance 1-800-877-5176 www.mutualofomaha.com Supplemental Benefits Trustmark Insurance Company 1-800-918-8877 www.trustmarksolutions.com Supplemental Benefits American Public Life 1-800-256-8606 www.ampublic.com
37 Open Enrollment Guide
Important Legal Notices
THE WOMEN’S HEALTH CANCER RIGHTS ACT OF 1998 (WHCRA)
If you have had or are going to have a mastectomy, you may be entitled to certain benefits under the Women’s Health and Cancer Rights Act of 1998
(WHCRA). For individuals receiving mastectomy-related benefits, coverage will be provided in a manner determined in consultation with the attending
physician and the patient, for:
All stages of reconstruction of the breast on which the mastectomy was performed;
Surgery and reconstruction of the other breast to produce a symmetrical appearance;
Prostheses; and
Treatment of physical complications of the mastectomy, including lymphedema.
These benefits will be provided subject to the same deductibles and coinsurance applicable to other medical and surgical benefits provided under this
plan.
NEWBORNS ACT DISCLOSURE - FEDERAL
Group health plans and health insurance issuers generally may not, under Federal law, restrict benefits for any hospital length of stay in connection with
childbirth for the mother or newborn child to less than 48 hours following a vaginal delivery, or less than 96 hours following a cesarean section. However,
Federal law generally does not prohibit the mother’s or newborn’s attending provider, after consulting with the mother, from discharging the mother or
her newborn earlier than 48 hours (or 96 hours as applicable). In any case, plans and issuers may not, under Federal law, require that a provider obtain
authorization from the plan or the insurance issuer for prescribing a length of stay not in excess of 48 hours (or 96 hours).
NOTICE OF SPECIAL ENROLLMENT RIGHTS
If you are declining enrollment for yourself or your dependents (including your spouse) because of other health insurance or group health plan coverage,
you may be able to enroll yourself and your dependents in this plan if you or your dependents lose eligibility for that other coverage (or if the employer
stops contributing toward your or your dependents’ other coverage). However, you must request enrollment within 30 days after your or your
dependents’ other coverage ends (or after the employer stops contributing toward the other coverage).
In addition, if you have a new dependent as a result of marriage, birth, adoption, or placement for adoption, you may be able to enroll yourself and your
dependents. However, you must request enrollment within 30 days after the marriage, birth, adoption, or placement for adoption.
Further, if you decline enrollment for yourself or eligible dependents (including your spouse) while Medicaid coverage or coverage under a State CHIP
program is in effect, you may be able to enroll yourself and your dependents in this plan if:
coverage is lost under Medicaid or a State CHIP program; or
you or your dependents become eligible for a premium assistance subsidy from the State.
In either case, you must request enrollment within 60 days from the loss of coverage or the date you become eligible for premium assistance. To request
special enrollment or obtain more information, contact person listed at the end of this summary.
MICHELLE'S LAW DISCLOSURE
Under the ACA, dependent children are covered by the group health plan until age 26. Baer’s Furniture group health plan extends dependent coverage
beyond the ACA requirements, to age 30, so long as the child is covered as a student. If your child has extended coverage as a student but loses their
student status because they take a medically necessary, leave of absence from school your child may continue to be covered under the plan for up to
one year from the beginning of the leave of absence. This is available if, immediately before the first day of the leave of absence, your child was (1)
covered under the plan and (2) enrolled as a student at a post-secondary educational institution (includes colleges and universities). To obtain more
information, contact person listed at the end of this summary.
NOTICE REGARDING WELLNESS PROGRAMS
Baer’s Furniture wellness program is a voluntary wellness program available to all employees. The program is administered according to federal rules
permitting employer-sponsored wellness programs that seek to improve employee health or prevent disease, including the Americans with Disabilities
Act of 1990, the Genetic Information Nondiscrimination Act of 2008, and the Health Insurance Portability and Accountability Act, as applicable, among
others. If you choose to participate in the wellness program you will be asked to complete a voluntary health risk assessment or "HRA" that asks a series
of questions about your health-related activities and behaviors and whether you have or had certain medical conditions (e.g., cancer, diabetes, or heart
disease). You will also be asked to complete a biometric screening, which will include a blood test for total cholesterol, HDL, LDL, Triglyercides,
Glucose. You are not required to participate in the blood test or other medical examinations.
However, employees who choose to participate in the wellness program will receive incentives. Although you are not required to participate in the
biometric screening (onsite or with your doctor), only employees who do so will receive the incentive.You can also read
