BLOUNT COUNTY GOVERNMENT EMPLOYEE - 2021 GUIDE
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Welcome to the 2021 Employee Benefits Guide Blount County Government recognizes the importance of benefits within the overall compensation package provided to all of our eligible employees. This year when we reviewed our employee benefits options, we focused not only on providing quality medical plans but also on controlling the cost and financial risk for our employees. Please review the following pages for a summary of our benefit offerings. TABLE OF CONTENTS Welcome & Table of Contents ............................................... 2 Contact Information ................................................................. 3 2021 At A Glance and Key Terms ........................................... 4 Care Coordinators .................................................................... 5 2nd MD ........................................................................................ 7 Understanding Your Medical Plan Options .......................... 8 Prescription Benefits ................................................................ 12 Care Options and When to Use Them ................................ 14 Convenient Care Plus ............................................................. 15 Flexible Spending Accounts (FSAs) ...................................... 17 Understanding Health Savings Account (HSAs) ................ 18 Dental Insurance ..................................................................... 20 Voluntary Vision Insurance..................................................... 21 Life Insurance and AD&D ...................................................... 22 Voluntary Coverages.............................................................. 23 Retirement ................................................................................ 27 Additional Services .................................................................. 29 Glossary of Terms and Video Links ....................................... 31 Important Notices .................................................................... 32 Throughout this booklet you will find video icons that will take you to resources that provide additional information on the benefits available to you. Blount County Government I 2
CONTACT INFORMATION If you have any questions regarding your benefits, please contact your Care Coordinators at Quantum Health, your Human Resources Department, or the CBIZ Service Center. Your Human Resources Department CBIZ Service Center 865.273.5780 865.251.5140 www.blounttn.org 9648 Kingston Pike, Ste 8 Knoxville, TN 37922 Care Coordinators Quantum Health Telemedicine www.blountcountybenefits.com Convenient Care Plus 1.866.952.0340 www.convenientcareplus.com 1.877.900.8701 Medical Allegiance BARInet www.askallegiance.com/blount www.barinet.com 1.855.999.1051 1.800.720.5831 Group Number: 2003090 Hours: Monday -- Friday 6 am -- 6 pm MST LTC Solutions—Long-Term Care Email: LTCiBenefitsTeam@ltc-solutions.com 2nd Opinion Medical Consultation 1.877.286.2852 2nd.MD www.2nd.MD/blountcounty Flexible Spending Account (FSA) 1.866.841.2575 Allegiance www.askallegiance.com/blount Prescription 1.855.999.1051 Magellan www.magellanrx.com Health Savings Account 1.888.202.1654 Health Equity Group Number: 2003090 www.healthequity.com 1.866.346.5800 Pay’d Health www.paydhealth.com Retirement Plan - 401(k) and 457(b) 1.877.869.7772 www.retirereadytn.gov 1.800-922-7772 Blount Discount Pharmacy 8:00 am—7:00 pm CST 865.681.0520 Retirement Plan - Defined Benefit Plan Dental Tennessee Consolidated Retirement System Delta Dental of Tennessee www.treasury.tn.gov/tcrs/ www.deltadentaltn.com 1.800.922.7772 1.800.223.3104 Group Number: 4207 Employee Assistance Program SupportLinc Vision www.supportlinc.com Superior Vision Username: blountcounty www.superiorvision.com 1.888.881.LINC (5462) 1.800.507.3800 Group Number: 29382 Employee Clinic Blount Memorial Physicians Group-Care Today Clinic Life, AD&D, and Supplemental Plans 266 Joule St. Alcoa, TN 37701 USAble Life 865.983.0093 https://group.usablelife.com/tn/blount- Operating Hours: county-government/ Monday - Friday: 7AM - 9PM 1.800.370.5856 Saturday, Sunday & Holidays: 8am - 6pm Group Number: 50032939 Closed Thanksgiving and Christmas Day 2021 Employee Benefits Guide I 3
2021 AT A GLANCE The plan year runs This year we will continue to offer three medical plans through Allegiance to January 1, 2021 - December 31, 2021 better provide for the needs of each of our employees and their families. There will be NO CHANGE to current plan benefits KEY TERMS Magellan RX will be the new vendor for our prescription coverage. Full-Time Employee: Defined as an employee working 30 or more hours per week. Full benefits include all benefits in accordance with Blount County Government policy. HOW TO MAKE CHANGES ● You are only allowed to make mid-year Part-Time Employee: Defined as an employee working 20 to 29 changes if one of the following Qualified hours per week. Partial benefits are provided in accordance Events occur: marriage, divorce, legal separation, birth or adoption of a child, with Blount County Government policy. change in child’s dependent status, death of spouse, child or other qualified dependent, change in residence due to an employment transfer for you or your spouse, commencement or termination Eligible Employees may enroll themselves in benefits as well as their eligible of adoption proceedings, or change in spouse’s benefits or employment status. dependents. Employees may select any of the tiers below when adding Your election changes must be submitted dependent coverage. See key terms below for coverage selection: to HR within 30 days of the qualifying Employee only: Employees may select this tier if they wish only to enroll event. themselves on the plan. Employee + Spouse: Employees may select this tier if they wish to enroll WAIVING COVERAGE themselves and their legal spouse on the plan. ● If you are declining enrollment for yourself or your dependents (including your Employee + Child(ren): Employees may select this tier if they wish to enroll spouse) because of other insurance themselves and one or more children on the plan. coverage, you may in the future be able to enroll yourself or your dependents in Family: Employees may select this tier if they wish to enroll themselves, their this plan, providing that you request legal spouse, and one or more children on the plan. enrollment within 30 days after your other creditable group or government sponsored coverage ends. COBRA New employees who are benefits eligible must enroll within 30 days of ● COBRA continuation is offered to covered employees, their spouses, their their date of hire. New employee benefits are effective the first of the former spouses, and their dependent month following 31 days of employment. children when group health coverage would otherwise be lost due to certain Children up to age 26 may be covered on your insurance plan, specific events. COBRA continuation regardless of dependent status. At the end of the month that the applies to Medical, Pharmacy, Dental, dependent turns 26, they will automatically be dropped from the Vision, and FSA. Qualified individuals may be required to pay for the entire premium insurance plan and offered COBRA coverage. A COBRA notice will be for coverage up to 102 percent of the mailed from the Medical carrier. cost of the plans selected and may continue for up to 18 months or 36 Retiree Coverage: You may be able to continue your coverage upon months (if applicable). retirement (medical, dental, vision, and a basic life benefit of $10,000). Please contact Human Resources for more information or guidelines. Blount County Government I 4
HEALTH CARE COORDINATORS Historically, you contacted your insurance company and physicians’ offices directly for questions related to your healthcare benefits and services - that is changing! As of January 1, 2021, your MyQHealth Care Coordinators are now your primary contact. DEDICATED SUPPORT Healthcare can be a difficult and costly journey that no one should have to navigate alone. We're with you every step of the way. Think of MyQHealth as your personal healthcare guide. They are nurses, clinicians and benefit specialists who take the time to get to know you and your family's unique health and wellness needs and then they work with your providers to ensure you get the best possible care. They fight for your care so you don’t have to. PERSONALIZED GUIDANCE From medical claims to check-ups to treatment plans, your Care Coordinators are here to help. MyQHealth’s mission is to provide you with a simpler, more affordable healthcare experience for all of your medical, dental, vision and prescription needs. BENEFITS EXPERTISE Figuring out what is or isn't covered by your plan can be confusing. Your Care Coordinators know your benefits from top to bottom. When you have questions, call them. You may have benefits you're not even aware of. CLAIMS SOLUTIONS There isn't a billing issue their claims specialists can't solve. They break down even the most complex claim so you always know exactly what has been paid and what is due. If you believe a claim has been unfairly denied, MyQHealth will do the research and either resolve it on your behalf or explain why it was denied. MOST COMMON ISSUES WE SOLVE Receiving ID cards Saving money on out of pocket Learning simple steps to costs improving your health Answering claims, billing and benefit questions Understanding how to get the Helping with medical needs - most out of your benefits anything that can make the Finding in-network providers healthcare process easier for Managing a health condition you EARLY INTRO Between December 1st and the plan effective date, January 1st, your Care Coordinators will be available by phone to answer general procedural or benefits questions. Please keep in mind they will not have access to your personal information, such as insurance claims or medical history, during this time. 2021 Employee Benefits Guide I 5
WHEN YOU DON’T KNOW WHERE TO BEGIN, START WITH US. IF THERE’S A BETTER WAY FOR YOU TO EXPERIENCE HEALTHCARE, WE’LL FIND IT. Think of us as your personal team of nurses, From replacing ID cards to more benefit experts and claims specialists who will complicated matters like claim do all we can to support your unique resolutions, no request is too big healthcare needs. Each time you contact us, or small for your MyQHealth you’ll talk to a real person who knows you, your benefits and your health history. Care Coordinators. We’re your one resource to contact whenever you need help with your medical, dental, wellness or pharmacy benefits. Empowered and resourceful, MyQHealth We also help confirm precertification for Care Coordinators do things like: services to make sure you’re always covered. Verify coverage Answer claims, Home Health and Oncology therapy Provide health- billing and benefits Hospice Dialysis education questions Skilled Nursing Mental Health/ resources Create health- Facility admissions Substance Abuse: Advocate for your improvement plans Transplants Partial care Hospitalization Help reduce MRI, MRA and PET Help manage unnecessary, out- scans Genetic Testing chronic conditions of-pocket costs Durable Medical Find in-network Equipment over providers $1500 Contact providers to discuss treatment Blount County Government I 6
MEDICAL INSURANCE HOW TO GET STARTED SELECT YOUR MEDICAL PLAN □ OPTION 1: Gold Plan □ OPTION 2: Silver Plan □ OPTION 3: Bronze Plan As a full-time employee of Blount County Government you have TIP: Get the most out of your insurance by using the choice between three medical plan options: two PPO plans in-network providers. and a Qualified High Deductible Health Plan (QHDHP). Regardless of the plan you select, your deductible will run from January 1−December 31. FREQUENTLY ASKED QUESTIONS To locate an in-network provider, go to How many hours do I need to work www.askallegiance.com/blount and click Find A Provider. to be eligible for medical insurance? Through the site, you will be able to access Blount County You must be a full-time employee Government’s PPO network. working a minimum of 30 hours per week on a regular basis. Will I receive a new Medical ID card? Healthcare BlueBook: Yes, all employees will receive a You may also visit Healthcare Bluebook to take advantage of new medical ID card for the 2021 plan year. significant savings on the most common medical procedures. Does the deductible run on All employees enrolling onto the health plan will have access to a calendar year or policy this price transparency tool. Prices of healthcare procedures year basis? often vary from 300% - 500%, within the same provider network A calendar year basis. and same region. How long can I cover my dependent Healthcare Bluebook provides detailed cost information on children? procedures at different facilities to give you the information you Dependent children are eligible need to be an informed consumer. Healthcare Bluebook also until the end of the month in which they turn age 26. provides a tool that measures the quality of healthcare provided by both hospitals and doctors. I just got hired. When will my benefits become effective? Color-coded results are displayed for members to see, so you Your medical insurance will begin can compare price and quality ranking: on the 1st of the month following thirty-one (31) days of employment for full-time employees. Blount County Government I 8
MONTHLY PREMIUMS Gold Plan Full Monthly Premium Employer Contribution Employee Monthly Cost Employee Only $731.00 $573.00 $158.00 Employee + Spouse $1,677.00 $1,315.00 $362.00 Employee + Child(ren) $1,649.00 $1,294.00 $355.00 Family $1,704.00 $1,337.00 $367.00 Silver Plan Full Monthly Premium Employer Contribution Employee Monthly Cost Employee Only $674.00 $573.00 $101.00 Employee + Spouse $1,547.00 $1,315.00 $232.00 Employee + Child(ren) $1,522.00 $1,294.00 $228.00 Family $1,572.00 $1,337.00 $235.00 Bronze Plan Full Monthly Premium Employer Contribution Employee Monthly Cost Employee Only $637.00 $573.00 $64.00 Employee + Spouse $1,463.00 $1,315.00 $148.00 Employee + Child(ren) $1,439.00 $1,294.00 $145.00 Family $1,488.00 $1,337.00 $151.00 SPOUSAL SURCHARGE A spousal surcharge of $50 will be applied in addition to the above Employee + Spouse and Family rates if the employee’s spouse works full time equivalent hours and has other coverage available through his or her own employer (with a deductible of $2,000 or less), and chooses to enroll in the Blount County Government Plan instead of their own coverage available. The spousal surcharge does not apply to spouses who are not employed or whose employers do not offer health insurance. The spousal surcharge is not applicable to coverage for children. The surcharge is designed to encourage spouses to use their own available health coverage and to contribute to the added cost of covering spouses who choose not to do so. A spousal surcharge of $250 will be applied in addition to the above Employee + Spouse and Family rates if the employee’s spouse works full time equivalent hours and has other coverage available through his or her own employer that offers monetary incentives if he or she waives their health plan and chooses to enroll in the Blount County Government Plan instead of their own coverage available. The spousal surcharge does not apply to spouses who are not employed or whose employers do not offer health insurance. The spousal surcharge is not applicable to coverage for children. The surcharge is designed to encourage spouses to use their own available health coverage and to contribute to the added cost of covering spouses who choose not to do so. 2021 Employee Benefits Guide I 9
MEDICAL PLAN OPTIONS IN-NETWORK BENEFITS Gold Plan Silver Plan Bronze Plan Calendar Year Deductible $750 / $1,500 $1,500 / $3,000 $3,000 / $6,000 Individual / Family Deductibles incurred in the last quarter of the calendar year (October 1 thru December 31) will carry over to next year’s calendar year deductible Supplemental Accident First $300 paid at 100% Percentage Payable 85% after deductible 85% after deductible 100% after deductible (unless otherwise stated) Out-of-Pocket Maximum $3,000 per covered person $4,500 / $9,000 $3,000 / $6,000 Individual / Family The out-of-pocket maximum includes deductibles and medical copayments, but excludes cost containment penalties, amounts paid for non-covered services, or reductions in allowed amounts as a result of seeking service from an out-of-network provider. PERVENTIVE CARE Preventive Care 100%, no deductible 100%, no deductible 100%, no deductible Preventive/Routine Lab and X-Ray 100%, no deductible 100%, no deductible 100%, no deductible Pap Smear and Mammogram 100%, no deductible 100%, no deductible 100%, no deductible Prostate Screening 100%, no deductible 100%, no deductible 100%, no deductible Child Immunizations 100%, no deductible 100%, no deductible 100%, no deductible Adult Immunizations 100%, no deductible 100%, no deductible 100%, no deductible Colonoscopies 100%, no deductible 100%, no deductible 100%, no deductible PHYSICIAN SERVICES $25 copay - Primary Care Office Visits 85% after deductible 100% after deductible $45 copay - Specialist 100% covered after Diagnostic X-ray and Lab 85% after deductible 100% after deductible Office Visit Copay Allergy Injections 85% after deductible 100% covered 100% after deductible Inpatient Services 85% after deductible 85% after deductible 100% after deductible Outpatient Services 85% after deductible 85% after deductible 100% after deductible 100% covered after Outpatient and Office Surgery 85%, no deductible Office Visit Copay 100% after deductible FACILITY SERVICES Inpatient Services 85% after deductible 85% after deductible 100% after deductible Outpatient Services 85% after deductible 85% after deductible 100% after deductible Outpatient Surgery 85%, no deductible 85% after deductible 100% after deductible Outpatient Advanced Imaging (PET, MRI, MRA, CAT, SPECT) In a hospital, 85% after deductible 85% after deductible 100% after deductible freestanding facility or clinic 85% after deductible, then 85% after deductible, then Emergency Room/Services $150 copay (copay waived if $150 copay (copay waived if 100% after deductible admitted) admitted) Blount County Government I 10
MEDICAL PLAN OPTIONS IN-NETWORK BENEFITS Gold Plan Silver Plan Bronze Plan OTHER SERVICES Skilled Nursing Facility 85% after deductible 85% after deductible 100% after deductible (limited to 100 days per calendar year) Hospice Care 85% after deductible 85% after deductible 100% after deductible Home Health Care 85% after deductible 85% after deductible 100% after deductible (limited to 80 visits per calendar year) Chiropractic Care* (limited to 25 visits per calendar year) 85% after deductible $45 Specialist copay 100% after deductible *Only the in-network deductible applies. X-rays are covered for the initial visit only. Physical, Occupational, Speech, Audiology, and Cognitive Therapy (visits in excess of 20 per type of therapy 85% after deductible $45 Specialist copay 100% after deductible per calendar year require prior authorization) Urgent Care 85% after deductible $45 Specialist copay 100% after deductible Durable Medical Equipment 85% after deductible 85% after deductible 100% after deductible Prosthesis 85% after deductible 85% after deductible 100% after deductible (requires prior authorization) Ambulance 85% after deductible 85% after deductible 100% after deductible Maternity 85% after deductible 85% after deductible 100% after deductible Non-Surgical TMJ 85% after deductible 85% after deductible 100% after deductible (limited to $1,500 per calendar year) Transplant Services 85% after deductible 85% after deductible 100% after deductible (requires prior authorization) MENTAL HEALTH, CHEMICAL, AND ALCOHOL DEPENDENCY SERVICES Inpatient services require pre-admission certification Inpatient Facility 85% after deductible 85% after deductible 100% after deductible Inpatient Physician 85% after deductible 85% after deductible 100% after deductible Outpatient Facility 85% after deductible 85% after deductible 100% after deductible Outpatient Physician 85% after deductible 85% after deductible 100% after deductible Office Visit 85% after deductible $25 PCP copay 100% after deductible Please Note: While all three plans give you the option of using out-of-network providers, you can save money by using in-network providers because Allegiance has negotiated significant discounts with them. The benefit percentage will be the same for in-network providers both inside and outside of Blount County. If you choose to go out-of-network, you’ll be responsible for the difference between the actual charge and the Allegiance UCR (Usual, Customary and Reasonable) charge, plus your out-of-network deductible and coinsurance. Medical Plan Sum- Deductible / Copay / Coinsurance / Out-of-Pocket HDHP vs. PPO 2021 Employee Benefits Guide I 11
PRESCRIPTION BENEFITS (INCLUDED WITH MEDICAL) Employees enrolled in the Blount County Government health plan have prescription drug coverage included as part of the health plan benefits. Prescription benefits are administered by the health plan’s prescription benefit manager (PBM), which is Magellan. Benefit information for your prescription drug coverage is included on your medical ID card from Allegiance - a separate ID card is not needed. Magellan has thousands of participating pharmacies in their network. As a way to save time and money, members can choose to fill a 90-day supply of medications for chronic conditions either through Magellan’s mail order service or at any in-network pharmacy location. Regardless of your choice, you will experience a lower out of pocket cost! You can visit the Magellan RX website to obtain more information about both of these convenient options. Medical - Gold and Silver Plans Prescription Drugs Retail - 30 day supply Mail Order - 90-day supply Out-of-Pocket Maximum $2,000 per person (separate from medical plan) Generic $10 copay $20 copay 30% coinsurance, up to a 30% coinsurance, up to a Preferred Brand maximum copay of $60 maximum copay of $120 40% coinsurance, up to a 40% coinsurance, up to a Non-Preferred Brand maximum copay of $100 maximum copay of $200 50% coinsurance, up to a Specialty Not available maximum copay of $200 Medical - Bronze Plan Prescription Drugs Retail - 30 day supply Mail Order - 90-day supply Out-of-Pocket Maximum Included with the Medical Plan Out-of-Pocket Maximum Covered at 100% after Covered at 100% after Generic deductible deductible Covered at 100% after Covered at 100% after Preferred Brand deductible deductible Covered at 100% after Covered at 100% after Non-Preferred Brand deductible deductible Covered at 100% after Specialty Not available deductible Blount County Government I 12
PRESCRIPTION BENEFITS (CONTINUED) Additional Prescription Drug Benefit (paydhealth Program) Your prescription drug plan has been enhanced to offer you the opportunity to substantially reduce your out-of-pocket cost for specialty drugs. Effective January 1, 2021, Blount County Government will be adding to it’s prescription drug plan a program through paydhealth called the Select Drugs and Products Program. This enhancement will provide additional support to plan participants who are prescribed specialty drugs and products. Select Drugs and Products Program Participation is required of those plan participants seeking coverage for products included on the Select Drugs and Products List. All products included in the program require prior authorization. A Reimbursement Case Coordinator from the program will assist you with accessing and making these high cost specialty drugs affordable. If you are taking a specialty medication, you will be contacted by paydhealth. They will provide you with the necessary forms to complete and return. Once the paperwork has been completed an advocate will contact you to finalize the process. This process must be completed prior to any prescriptions being filled. The Specialty Contact Center may be reached toll-free at (877) 869-7772 from 8 a.m. to 8 p.m. CT, Monday through Friday. 2021 Employee Benefits Guide I 13
QUICK TIPS ON CARE BLUECROSS OPTIONS BLUESHIELD Primary Care vs Urgent Care vs ER CARE OPTIONS AND TIPS While we recommend that you seek routine medical care from your primary care physician whenever possible, there are alternatives available to you. Services may vary, so it’s a good idea to visit the healthcare provider’s website. Be sure to check that the facility is in-network by calling the toll-free number on the back of your medical ID card, or by visiting www.blountcountybenefits.com. PRIMARY CARE For routine, primary/ preventive care or non-urgent ● Routine, primary/ treatment, we recommend going to your doctor’s office. preventive care PRIMARY Your doctor knows you and your health history and has ● Non-urgent treatment CARE access to your medical records. You may also pay the least ● Vaccinations amount out of pocket. ● Screenings TELEMEDICINE (CONVENIENT CARE PLUS) Telemedicine lets you see and talk to a doctor from ● Cold/flu ● Rash your mobile device or computer without an appointment, ● Diarrhea ● Sinus anytime and anywhere! Convenient Care Plus brings you TELEMEDICINE Problems care from the comfort and convenience of your home or ● Fever wherever you are. Download the app once your benefits become active! CONVENIENCE CARE ● Common infections (ear These providers are a good alternative when you are not infections, pink eye, strep able to get to your doctor’s office and your condition is not throat) urgent or an emergency. CONVENIENCE CARE ● Flu shots They are often located in malls or retail stores (such as CVS ● Pregnancy tests Caremark, Walgreens, Wal-Mart and Target), and generally serve patients 18 months of age or older without an appointment. Services may be provided at a lower out-of- pocket cost than an urgent care center. ● Sprains ● Minor URGENT CARE URGENT ● Small cuts infections Sometimes you need medical care fast, but a trip to the CARE emergency room may not be necessary. ● Strains ● Sore throats During office hours, you may be able to go to your doctor’s office. Outside regular office hours—or if you can’t be seen by your doctor immediately—you may consider going to an Urgent Care Center, where you can generally be ● Spinal injuries treated for many minor medical problems faster than at an ● Heavy bleeding ● Difficulty emergency room. EMERGENCY ROOM ● Large open breathing wounds ● Major burns EMERGENCY ROOM ● Chest pain An emergency medical condition is any condition (including severe pain) which you believe that without immediate medical care may result in serious injury or is life threatening. If you believe you are experiencing a Emergency services are always considered medical emergency, go to the nearest in-network. If you receive treatment for an emergency in a emergency room or call 911, even if your symptoms are not described here. CALL 9-1-1 non-network facility, you may be transferred to an in- network facility once your condition has been stabilized. Blount County Government I 14
CONVENIENT CARE PLUS A Convenient Care Plus membership allows 24/7 unlimited access to a healthcare provider for basic illnesses such as cold and flu, infections, pink eye, sore throat, allergies, and more. You are eligible for this benefit the first of the month following 31 days of employment. Depending on the membership level that you select, your plan will include some or all of the following features: Telemedicine– 24/7/365 telephone access to a licensed physician Generic RX Prescription Plan– Several medications are covered at no charge CCP Patient Advocate– Helps navigate healthcare and insurance issues Medical Bill Saver– Negotiates medical bills or balances over $400 Clinic Visits - See a healthcare provider in person for minor illnesses and injuries at one of the network clinics for a $30 copay (level 2 only; see the app for a list of network providers). Services Level 2 Level 3 Unlimited Telemedicine Unlimited Clinic Visits Generic Prescriptions Member Plans & Fees Blount County Premium Contribution - Full Time Employees Only $5 / month $5 / month Employee Cost - Individual & Individual + 1 $11.50 / month $6 / month Employee Cost - Family $26.50 / month $6 / month Clinic Visit Fee $30 / visit N/A GENERIC RX PROGRAM Members can obtain the following generic medications at no charge using the CCP formulary. 2021 Employee Benefits Guide I 15
TELEHEALTH Access to a nurse or doctor 24/7. Call 877-900-8701 No travel, no waiting and no missed work! Speak to a nurse/doctor from home or work by phone or video. Get treatment for common conditions such as allergies, sore throat, infections and more. Prescriptions sent electronically to your local pharmacy. ON-SITE VISITS $30 visit fee - Level 2 only Call 877-900-8701 to see a healthcare provider in person at one of our approved local clinics. Most of our clinics offer extended evening and weekend hours for your convenience. Same-day visits are available at most of our provider locations. $150 CCP maximum cap coverage per visit. The member is responsible for charges above $150. GENERIC RX PROGRAM Visit www.convenientcareplus.com for the most updated list of episodic medications available to our members. PATIENT ADVOCACY Your membership gives you additional health and wellness resources. Core Advocacy: Personal Health Advocates help you and your family navigate healthcare and insurance-related issues, 24/7 / 365 Medical Bill Saver: Negotiates medical bill son balances over $400 INTERNET IDENTITY GUARD Level 2 only To register and activate, log onto www.convenientcareplus.com and click on the Internet Identity Guard button/icon. Your membership gives you access to secure email accounts, digital vault, safe browsing (VPN) and Identity monitoring. Identity monitoring $1 million insurance benefit & unlimited restoration and recovery from identity theft. ID CARD Member ID # on card below to be handwritten by member in this format– FML+10 digit phone number (Initials from First, Middle and Last name– ex: JQP5556667788 Blount County Government I 16
FLEXIBLE SPENDING ACCOUNT (FSA) What is a Flexible Spending Account? 2020 Maximum Contributions *2021 Maximum has not yet been released FLEXIBLE SPENDING ACCOUNT Health Care Flexible Spending Account $2,750 max This account enables you to pay medical, dental, Dependent Care Expense Account $5,000 max vision, and prescription drug expenses that may or may not be covered under your insurance program Medical FSA Carryover $550 max (or your spouse’s) with pre-tax dollars. You can also DEPENDENT CARE EXPENSE ACCOUNT pay for dependent health care, even if you choose This account gives you the opportunity to single (vs. family) coverage. redirect a portion of your annual pay on a pre-tax basis to pay for dependent care The total amount of your annual election is available expenses. An eligible dependent is any to you up front, reducing the chance of having a member of your household for whom you large out-of-pocket expense early in the plan year. can claim expenses on your Federal Note: You can rollover up to $550 of unused funds to Income Tax Form 2441, “Credit for Child the next year. Any remaining amounts over $550 will and Dependent Care Expenses.” Children be forfeited. must be under age 13. Eligible Expenses Examples Care centers which qualify include dependent care centers, preschool ● Alcoholism treatment ● Laboratory fees educational institutions, and qualified ● Artificial limbs ● Licensed osteopaths individuals (as long as the caregiver is not a ● Ambulance ● Licensed practical nurses family member and reports income for tax ● Braces ● Orthodontia purposes). ● Chiropractors ● Orthopedic shoes Before deciding to use the Dependent ● Coinsurance and copayments ● Obstetrical expenses Care Expense Account, it would be wise to ● Contact lens solution ● Oxygen compare its tax benefit to that of claiming ● Contraceptives ● Prescription drugs a child care tax credit when filing your tax return. You may want to check with your ● Crutches ● Podiatrists tax advisor to determine which method is ● Dental expenses ● Psychiatric care best for you and your family. Any unused ● Dentures ● Psychologist expenses portion of your account balance at the ● Dermatologists ● Routine physical end of the plan year is forfeited. ● Diagnostic expenses ● Seeing-eye dog expenses How the Health Care Flexible Spending ● Eyeglasses, including exam ● Smoking cessation fee programs Account Works When you have out-of-pocket expenses ● Handicapped care and ● Sterilization and reversals support (such as copayments and deductibles), ● Nutrition counseling ● Substance abuse treatment you can use your FSA debit card to pay ● Hearing devices and for these expenses at qualified providers. batteries ● Surgical expenses Reimbursement is issued to you through ● Hospital bills ● Prescribed vitamin supplements (medically direct deposit into your bank account, or ● Deductible Amounts necessary) if you prefer, a check can be issued to you. 2021 Employee Benefits Guide I 17
HEALTH SAVINGS ACCOUNT (HSA) WHAT ARE THE RULES? ● You must be covered under a Qualified Two ways you can put money into your HSA: High Deductible Health plan (QHDHP) in order (1) Regular payroll deductions on a pre-tax to establish an HSA (Bronze plan). basis and (2) lump-sum contributions of any ● You cannot establish an HSA if you or your amount, anytime, up to the maximum limit. spouse also have a medical FSA, unless it is a Limited Purpose FSA. ● You cannot be enrolled in Medicare UNDERSTANDING A HEALTH SAVINGS or Tricare due to age or disability. ACCOUNT (HSA) ● You cannot set up an HSA if you have insurance coverage under another plan, for WHAT IS AN HSA? example your spouse’s employer, unless that A savings account where you can either direct pre- secondary coverage is also a qualified high tax payroll deductions or deposit money to be used deductible health plan. to pay for current or future qualified medical ● You cannot be claimed as a dependent under expenses for you and/or your dependents. Once someone else’s tax return. money goes into the account, it’s yours to keep— the HSA is owned by you, just like a personal WHAT ELSE SHOULD I KNOW? checking or savings account. ● SAVE: You can invest up to the IRS’s annual contribution limit. Contributions are based on a THE HSA CAN ALSO BE AN calendar year. The contribution limits for 2021 INVESTMENT OPPORTUNITY. are $3,600 for Single and $7,200 for Family Depending upon your HSA Contribute coverage. If you’re age 55 or older, you are up to allowed to make extra contributions each account balance, your account can grow tax-free $3,600 year ($1,000). Single, or ● GROW: The contributions grow tax-free and in an investment of your choice (like an interest- $7,200 come out tax-free as long as you utilize the funds for approved services based on the IRS Family Publication 502, (medical, dental, vision bearing savings account, a expenses and over-the-counter medications money market account, a with a physician’s prescription). wide variety of mutual ● OWN: Your unused contributions roll over from funds—or all three). Of course, your funds are year to year and can be taken with you if you always available if you need them for qualified leave your current job. health care expenses. ● CHOOSE: If you use the money for non-qualified expenses, then the money becomes taxable and subject to a 20% excise tax penalty (like in YOUR FUNDS CAN CARRY OVER an IRA account). AND EVEN GROW OVER TIME. The money always belongs to you, even if you ● There is no penalty for distributions following death, disability (as defined in IRC 72), or cease employment with Blount County, and attainment of Medicare eligibility age, but unused funds carry over from year to year. You taxes would apply for non-qualified never have to worry about losing your money. That distributions. means if you don’t use a lot of health care services ● If your healthcare expenses are more than your now, your HSA funds will be there if you need them HSA balance, you need to pay the remaining cost another way, such as a credit card or in the future - even after retirement. personal check. You can request reimbursement later, after you have HSA FUNDS CAN BE USED FOR YOUR FAMILY. accumulated more money in your account. You can use your HSA for your spouse and tax But save your receipts in case you are ever audited! dependents for their eligible expenses - even if they’re not covered by your medical plan. Blount County Government I 18
YOU CAN USE HSA FUNDS FOR IRS-APPROVED ITEMS SUCH AS: FREQUENTLY ASKED QUESTIONS: ● Doctor's office visits ● Dental services ● Eye exams, eyeglasses, laser surgery, What will I pay at contact lenses and solution the pharmacy with the HSA ● Hearing aids qualified plan options? ● Orthodontia, dental cleanings, and fillings You will pay the actual discounted cost of the drug ● Prescription drugs and some over-the- counter medications (with a physician’s until you satisfy your prescription) calendar year deductible in ● Physical therapy, speech therapy, and full. chiropractic expenses More information about approved items, plus additional details about the HSA, is available at irs.gov. What will I pay at the physician’s office with the Every time you use your HSA, save your HSA qualified plan? receipt in case the IRS asks you to prove You’ll provide your ID card at the time your claim was for a qualified expense. If of the visit and the physician’s office will you use HSA funds for a non-qualified submit the claim to Allegiance. You will expense, you will pay tax and a penalty on not owe anything at the time of the visit. those funds. Later you’ll receive an Explanation of The HSA is your personal account and Benefits (EOB) from Allegiance that contains your personal funds. It can be shows the charges discounted based considered an asset by a creditor and on their contract with the physician. garnished as applicable. When you receive a bill from the physician’s office, you pay the portion As an HSA account holder, you will be of the discounted cost you are required to file a Form 8889 with the IRS responsible each year. This form identifies any for as shown on the EOB. contributions, distributions, or earned interest associated with your account. Where can I get a copy of an EOB? You can access all of your EOB information, as well as obtain other important information, by logging on to www.blountcountybenefits .com What is a Health Savings Account? 2021 Employee Benefits Guide I 19
HOW TO FIND A DENTIST To find a Delta Dental provider in your area, visit DENTAL INSURANCE www.deltadentaltn.com ● Scroll down to “Find a Dentist” ● Select a specialty and “Delta Dental PPO” ● Enter your zip code and click “Find a Dentist” Dental benefits are effective the first of the month following 31 days of full time employment. As an ● You can apply additional filters to narrow your search or leave them blank for a complete directory employee at Blount County Government, your dental benefits are provided through Delta Dental of Tennessee under a PPO Plan. The benefit levels are the same in- network and out-of-network. If services are provided by an in-network provider, your provider agrees to a negotiated charge and you will not be responsible for balance billing. Additionally, the provider’s office will file a claim for you so there is no paperwork for you to complete. Dental services are divided into four coverages. Preventive procedures include exams, x-rays and preventive care and is paid entirely by the plan. Basic procedures include basic restorative treatment, endodontics, oral surgery, and periodontics. Major procedures include complex restorative surgeries and prosthodontics. Orthodontia refers to orthodontic procedures. As a member of Delta Dental of TN, you have access to the nation’s largest dental networks: Delta Dental PPO and Delta Dental Premier. With 3 out of 4 dentists participating, these two networks provide great access to care as well as the privilege of reduced rates through Delta Dental’s agreed upon fees with dentists. When seeing a dentist in either the PPO or Premier networks, you cannot be balance billed - giving you added savings. You are also free to visit non-network dentists, but you may be balance billed. If services are provided by a non-network provider, charges in excess of the 80th percentile of usual and customary charges will be your responsibility. Please be sure to consult either the online directory or call Delta Dental Customer Service (800.223.3104) to confirm that your dentist is in the network. Dental Plan Summary What is Dental Insurance? Delta Dental Full Monthly Premium Employer Monthly Employee Monthly Contributions Deduction Employee Only $26.57 $21.57 $5.00 Family (Employee + Dependents) $83.31 $21.57 $61.74 In-Network Plan Year Annual Deductible Individual / Family $50 / $150 Plan Year Annual Maximum Benefit $1,200 per covered person Orthodontia Lifetime Maximum $1,000 (12 month waiting period) Preventive Services 100% , deductible does not apply Basic Services 80% after deductible Major Services 50% after deductible Orthodontia Services (children only, to age 19) 50%, deductible does not apply Blount County Government I 20
HOW TO FIND A PROVIDER VOLUNTARY VISION To find a provider in your area, visit superiorvision.com INSURANCE ● Click on “Find an eye care professional” at the top of the page ● Enter your location, coverage type, Superior National The Blount County vision plan covers routine eye care, Network, and click search. including eye exams and eyeglasses (lenses and frames) or contacts. When you choose an in-network provider for your eye exam and materials, you are responsible for the copay only. If you choose a provider that is not in network, Superior Vision will reimburse you according to the plan’s non-network benefit schedule (listed below under “Out-of-Network Provider”). Superior Vision has contracted with providers who specialize in the highly publicized elective procedures of Radial Keratotomy (RK), Photo Refractive Keratotomy (PRK), and LASIK to provide a 20% discount off their usual customary surgical fee for members. Go to www.superiorvision.com to find an in-network provider near you, and to order and print I.D. cards. Vision Plan Summary What is Vision Insurance? Full Monthly Employer Monthly Employee Monthly Premium Contribution Deduction Employee $8.88 N/A $8.88 Employee & Spouse $17.53 N/A $17.53 Employee & Child(ren) $17.18 N/A $17.18 Employee & Family $26.15 N/A $26.15 In-Network Out-of-Network Vision Exam Covered every 12 months Ophthalmologist (M.D.) Covered in full after $10 copay Plan pays up to $34 Optometrist (O.D.) Plan pays up to $26 Frames Plan pays up to $125 after $10 copay Plan pays up to $65 Covered every 24 months Lenses Covered every 12 months Single Plan pays up to $32 Bifocal Plan pays up to $46 Covered in full after $10 copay Trifocal Plan pays up to $57 Lenticular Plan pays up to $90 Progressive Plan pays up to $46 Contact Lenses Covered every 12 months - in lieu of glasses Medically necessary Covered in full Plan pays up to $210 Cosmetic (Elective) Plan pays up to $120 Plan pays up to $100 Standard Contact Lens Fitting Exam Fee* $25 copay Not covered Specialty Contact Lens Fitting Exam Fee $50 allowance Not covered *Standard contact lens fitting fee applied to an existing contact lens user who wears disposable, daily wear, or extended lenses only. The specialty contact lens fitting fee applies to new contact lens wearers and/or a member who wears toric, gas permeable, or multi-focal lenses. For the specialty fit, the member is responsible for any charges over $50. 2021 Employee Benefits Guide I 21
LIFE INSURANCE AND AD&D Beyond providing financial security for your loved ones, life insurance can also offer you: financial REVIEW YOUR protection for your loved ones or business, LIFE INSURANCE POLICY supplemental retirement income, protection from long-term care expenses, and many more. □ Basic Life / AD&D □ Supplemental Life / AD&D Consider your options with your loved ones in mind. BASIC LIFE / AD&D What is Term Life Insurance? Basic Life/AD&D Insurance is a County provided benefit offered at no cost to you through USAble Life Insurance Company. The coverage amount is one times your annual salary up to a maximum of $50,000. The definition of earnings is based on your prior year’s W-2. AD&D Insurance pays an additional percentage of the amount of your life insurance benefit based on a specific list of losses such as loss of life, limb, or sight due to an accident. You are eligible for this benefit the first of the month following 31 days of full-time employment. If you have questions or need to update your beneficiaries, please contact the Human Resources Department. *Benefits reduce by 50% of the original amount at age 70, and further reduce by 70% of the original amount at age 75, and 80% of the original amount at age 80. *some exclusions apply Upon becoming ineligible for group insurance (ex: leaving employment), you may be eligible to convert your Basic Life benefit to an Individual Whole Life policy. This must be done within 31 days after the date your insurance ends. The rate for the converted policy is based on the age of the individual at the time of conversion. Contact Human Resources or USAble Life for more information. VOLUNTARY TERM LIFE Voluntary Term Life can be purchased for you and your spouse in increments of $10,000 up to $300,000 (not to exceed 7x annual earnings). Coverage is also available for children up to $10,000. The guaranteed issue amount for employees is $200,000; spouse is $30,000; and child(ren) is $10,000. *All life insurance amounts are subject to age reductions, and terminates at retirement - see plan documents for details. *Voluntary spouse and child coverage can only be purchased if the employee has elected coverage and cannot exceed employee’s elected amount. *Amounts in excess of the guaranteed issue amounts require medical underwriting (EOI). *Children can be covered until they reach age 26. If you do not enroll in voluntary life insurance coverage upon initial eligibility (within 31 days of your date of hire), you may be asked to complete an Evidence of insurability form if you wish to enroll (or increase your coverage) at a later date. Upon becoming ineligible for group insurance (ex: termination of employment), you may be eligible to port or convert your current coverage. This must be done within 31 days after the date your insurance ends. Contact Human Resources or USAble Life for more information. Blount County Government I 22
VOLUNTARY COVERAGES Hospital Procedure/Service Select First-Day Hospital $750 Confinement (10 per year) □ Hospital Care □ Cancer Care Daily Hospital Confinement (per day, up to 180 days) $150 Intensive Care Confinement HOSPITAL CARE $225 (per day, up to 15 days) This plan provides a reassuring layer of financial Ground Ambulance (3 per $120 protection for you and your family by paying you cash to year) cover the unexpected expenses in the event of Air Ambulance (3 per year) $750 hospitalization. Benefits are paid directly to you, with no coordination of benefits with the medical plan. The plan Surgical Benefit (based on surgical schedule) - examples: provides coverage for hospitalization, intensive care, Coronary Bypass $1,000 ambulance, and wellness. It is portable; you can take it with you even if you leave employment. Coverage is Appendix Removal $220 available for you, your spouse, and eligible dependents. Gallbladder Removal $284 What is Hospital Care? Anesthesia 5% of surgical benefit Preoperative Visit 1.5% of surgical benefit Second Surgical Opinion 1.5% of surgical benefit CANCER CARE Diagnostic Procedure (per $50 procedure, up to 3 per year) What is Cancer Care? Emergency Treatment (3 per N/A year) USAble Life’s Cancer Care Plan can help offset the out-of- Physician Office Visit (5 per pocket medical and non-medical expenses related to N/A year) cancer that most medical plans don’t cover. This coverage provides benefits that you can use to help with the loss of Wellness Benefit Select income, child care, lodging and meals, deductibles and Annual Benefit Amount $45 copays, and much more. A lump sum benefit is paid to the To promote healthier routines, insureds can receive an annual payment for member upon first diagnosis of a covered cancer. You can having covered health screenings and tests, such as a mammogram, Pap choose policy amounts in $5,000 increments up to $50,000. test, PSA (prostate-Specific Antigen) test, and colonoscopy. This plan is portable; you can take if with you even if you leave Blount County. The plan pays YOU directly in the event Percentage of Policy of a covered cancer diagnosis or treatment. Coverage is Cancer Care Coverage Amount available for you, your spouse, and eligible dependents and premiums are payroll deducted. Spouse and dependent Cancer Diagnosis 100% coverage cannot exceed the amount of employee Bone Marrow Transplant 100% coverage elected. It includes recurrent benefit which extends coverage to a second covered diagnosis, enabling Prostate Cancer and/or 30% insured employees to receive benefits up to 200% of the Carcinoma In Situ plan’s value. To promote healthier routines, insureds can Skin Cancer Diagnosis 10% receive an annual payment of $100 for having covered health screenings and tests, such as mammogram, Pap test, $75 lifetime, one-time Cancer Vaccine PSA test, and colonoscopy. payment If enrolled in cancer care, you cannot enroll in the critical care & Cancer Treatment & $50/month, up to 12 cancer policy. Care months 2021 Employee Benefits Guide I 23
VOLUNTARY COVERAGES □ Critical Care & Cancer □ Accident Recovery Premiums are payroll deducted and paid entirely by you. Please contact the Human resources Department or USAble Life for more information or to enroll in one of these coverages. CRITICAL CARE & CANCER Coverage Percent of Policy Amount Cancer Diagnosis 100% USAble Life’s Group Critical Care Heart Attack/Stroke 100% insurance helps you to maintain financial Major Organ Transplant 100% security during the lengthy, expensive recovery period of a serious medical event such Bone Marrow Transplant 100% as cancer, heart attack, or stroke. It provides a End-Stage Renal Failure 100% lump sum benefit to help with the out-of-pocket medical and/or non-medical expenses of critical Burns (3rd degree, over at 100% least 50% of body) illness and/or cancer. You can choose policy amounts in $5,000 increments up to $50,000. This Specified Diseases* 100% plan is portable; you can take it with you even if Prostate Cancer and/or 30% you leave employment. Coverage is available for Carcinoma In Situ you, your spouse, and eligible dependents. Coronary Artery Bypass Surgery 30% Premiums are payroll deducted for your convenience. It includes recurrent benefit which Alzheimer’s Disease 30% extends coverage to a second covered diagnosis, Angioplasty/Stent 10% enabling insured employees to receive benefits up to 200% of the plan’s value. To promote healthier Skin Cancer Diagnosis 10% routines, insureds can receive an annual payment Cancer Vaccine $75 lifetime, one-time payment of $100 for having covered health screenings and tests, such as mammogram, Pap test, PSA test, Cancer Treatment & Care $50/month, up to 12 months and colonoscopy. *Specified diseases include ALS (Lou Gehrig’s Disease), Anthrax, Cholera, Encephalitis, Meningitis, Rocky Mountain Spotted and Typhoid Fevers, Tuberculosis, Primary Sclerosing Cholangitis (Walter Payton’s Disease) If enrolled in critical care & cancer coverage, you cannot enroll in the cancer care policy. What is Critical Care? ACCIDENT RECOVERY What is Accident Recovery? This plan provides lump sum benefits for covered accidents, such as benefits for fractures, concussions, emergency treatment, hospital confinement, and accidental death and dismemberment. These benefits can help with the out of pocket medical and non-medical expense associated with an accident. Coverage is provided 24 hours a day - no matter where the accident occurs. Coverage is guaranteed; no health questions or underwriting required. The plan is portable; you can take it with you even if you leave employment. Coverage is available for you, your spouse, and eligible dependents and premiums are payroll deducted. Benefits are provided for hospitalization, surgery, and follow-up with a physician. To promote healthier routines, insureds can receive an annual payment of $60, $75 or $105 (based on the plan you select) for having covered health screenings and tests, such as mammogram, Pap test, PSA test, and colonoscopy. Blount County Government I 24
VOLUNTARY COVERAGES □ Short-Term Disability □ Long–Term Disability What is Disability Insurance? Premiums are payroll deducted and paid entirely by you. Please contact the Human Resources Department or USAble Life for more information or to enroll in one of these coverages. SHORT-TERM DISABILITY A Short-Term Disability (STD) plan can give you financial protection and help replace a portion of your income if you become unable to work as a result of a covered illness, injury, or pregnancy. You can select the STD benefit that’s right for you, not to exceed 60% of your pre- disability earnings or a weekly amount of $750. Benefit amounts can be purchased in increments of $10. The minimum weekly benefit is $50. STD benefits begin the 15th day of an injury or illness and terminate after 13 weeks (90 days) of continuous disability due to covered accident or illness. LONG-TERM DISABILITY Because some disabilities continue for a significant amount of time, Long-Term Disability (LTD) coverage can help provide partial income replacement when you’re unable to work during a serious disability or extended illness. Your LTD benefit cannot exceed 60% of your pre- disability earnings (up to a monthly amount of $6,000), and can be purchased in increments of $100, LTD benefits start after you have been disabled for 90 days and can continue until you return to work, retire (up to age 65 or Social Security normal retirement age depending on the date of disability), or death. If you do not enroll in short term disability, long term disability, or voluntary life insurance coverage upon initial eligibility (within 31 days of your date of hire), you may be asked to complete an Evidence of Insurability form if you wish to enroll (or increase your coverage) at a later date. 2021 Employee Benefits Guide I 25
VOLUNTARY COVERAGES □ Long-Term Care New Voluntary Benefit! We are excited to announce that Blount County will be introducing Long-Term care insurance as a new voluntary benefit! Enrollment will run Monday, October 12th through Friday, October 30th. What is Long-Term Care? Long-term care assists you with your everyday activities. It can be received in an as- sisted living facility, nursing home or in your own home. This type of care is needed due to a cognitive or physical impairment which requires assistance with two out of the six Activities of Daily Living: eating, bathing, dressing, transferring, toileting, and continence. Some common reasons you may need this type of care are due to an accident (such as a car accident or injury), illness (such as cancer), aging, or a cognitive im- pairment (such as Alzheimer’s, dementia, or effects of a stroke). The costs for this type of care can approach $90,5201 per year. These expenses are not paid for by either group health insurance or disability plans while working and are only minimally covered by government programs such as Medicare upon retirement. Long-Term Care insurance (LTCi) is a way to help pay for the cost of your care so you will not have to rely solely on your savings, assets, family, or other means to pay for your care. Keep an eye out for additional information to come soon! To learn more contact LTC Solutions, Inc. LTCiBenefitsTeam@ltc-solutions.com (877) 286-2852 3Metlife Mature Market Institute, The 2012 MetLife Market Survey of Nursing Home, Assisted Living, Adult Day Service and Home Care Costs. Blount County Government I 26
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