Employee Benefit Overview - July 1, 2020 Presented by: Waterford Country ...
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July 1, 2020
Employee Benefit Overview
Presented by:
Table of Contents
Introduction 3
Benefit Options 3
Eligibility 4
Medical Insurance 5
Health Savings Accounts 6
Health Reimbursement Accounts 7
Telemedicine and EAP 8
Dental Insurance 9
Vision Insurance 10
Life and Disability Insurance 11
Flexible Spending Accounts 12
Value Added Benefits 13
Online Enrollment Instructions 14-17
Contacts 18
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2
Waterford Country School Our Mission Waterford Country School is dedicated to doing whatever it takes to enrich the lives of children and strengthen families through specialized programs, resources, and community services. Our Guiding Principles Waterford Country School holds as its core value, interpersonal relationships based upon respect, compassion and hope among all persons at all levels. WCS focuses on developing a team of staff who possess the skills and talents to enable them to establish caring relationships with children and families, leading towards positive change and the enhancement of their overall well-being. Our Benefits Our mission to provide quality services and programs to our clients depends on you, every day. We realize that our staff is our most important asset and because of that, we strive to make our agency a great place to work. The following pages describe some of the benefits we provide to help keep you and your family healthy and protected. Waterford Country School is committed to offering competitive insurance benefits that provide meaningful protection to you and your family. Please take the time to thoroughly review your employee benefit plan, as it is an important part of your overall compensation package. The HR department is available to assist you with any questions you may have. Your Benefit Options Below is a listing of the insurance benefits offered. Medical & Pharmacy Coverage Our medical provider is Harvard Pilgrim. We offer an HSA-qualified High Deductible Health Plan (HDHP) as well as two alternative HRA programs. Health Savings Accounts and Flexible Spending Accounts Our HSA and FSA banking partner is HealthEquity. You may be eligible to open a Health Savings Account if you enroll in our High Deductible Health Plan. Some restrictions apply; please see Human Resources if you have questions. Dental Coverage A voluntary dental plan is offered through United Healthcare, our dental provider. Vision Coverage A voluntary vision plan is offered through Anthem, our vision provider. Employee Basic Life, Accidental Death (AD&D) and Voluntary Life, AD&D Insured by Anthem Life, Waterford provides basic life insurance coverage on employees with the ability through payroll deduction to buy voluntary life insurance for employees, spouses and eligible dependents. Long Term Disability Long term disability income replacement benefits are provided at no cost to the employee insured by Anthem Life. 3
Eligibility & Enrollment
Employees who work at least 30 hours per week are eligible to participate in Waterford Country
School Medical plans. You must work at least 32 hours per week to be eligible for all other benefits.
Newly-hired employees can join on the first of the month following 60 days of employment.
Eligible Dependents
Many of the benefit plans also offer coverage for your eligible dependents. Eligible dependents
include:
● Your biological children;
● Your stepchildren;
● Your legally adopted children;
● Any children for whom you are responsible under court order;
Dependent age restrictions apply. Plan requirements are as follows:
Dependent Age Rule When Coverage Ends
Coverage ends on the last day of the
month in which you, and your covered
To age 26 without regard to dependents, are no longer eligible.
Medical Insurance employment, student or marital status Dependent children can remain on the
plan through the end of the Plan Year
(6/30) in which they turn age 26.
Coverage ends on the last day of the
month in which you, and your covered
To age 26 without regard to dependents, are no longer eligible.
Dental Insurance employment, student or marital status Dependent children can remain on the
plan through the end of the month in
which they turn age 26.
Coverage ends on the last day of the
month in which you, and your covered
dependents, are no longer eligible.
To age 26 without regard to
Vision Insurance employment, student or marital status Dependent children can remain on the
plan through the end of the month the
dependent ceases to be an eligible
dependent.
Coverage ends on the last day of the
month in which you, and your covered
dependents, are no longer eligible.
Life Insurance To age 26
Dependent children can remain on the
plan through the end of the month the
dependent ceases to be an eligible
dependent.
4
Medical Insurance — Harvard Pilgrim
HSA Plan 7 HRA Plan 5 HRA Plan 4
Non-Embedded (3 free)
Embedded
In Network Annual $3,000 Individual $2,000 per Individual $3,000 per Individual
Deductible $6,000 Family $4,000 per Family $6,000 per Family
HSA Funding: Up front HRA Funding: First $500 HRA Funding: $1,000
$500, then $25 per of Employee of Employee
paycheck Deductible Deductible
In Network Annual Out-
of-Pocket Maximum $4,000 Individual $4,000 Individual $6,000 Individual
(includes Deductible $8,000 Family $8,000 Family $12,000 Family
and Coinsurance)
Routine Preventive Care
/ Screenings No Cost No Cost No Cost
Office Visits
• Primary Care No cost after 3 free for PCP, No cost $30 Copay
• Specialist deductible after deductible $45 Copay
• Urgent Care No cost after No cost after $75 Copay
• Emergency Room deductible deductible $150 Copay
Inpatient Hospital No cost after No cost after 20% after deductible
deductible deductible
Outpatient Surgery No cost after No cost after 20% after deductible
deductible deductible
Prescription Drugs – Tier 1: $3 Tier 1: $3 Tier 1: $3
Retail 30 Day Supply Tier 2: 30% to $25 Tier 2: 30% to $25 Tier 2: 30% to $25
Tier 3: 20% to $50 Tier 3: 20% to $50 Tier 3: 20% to $50
Tier 4: 20% to $150 Tier 4: 20% to $150 Tier 4: 20% to $150
*After Deductible
Out of Network N/A $5,500 Individual $6,000 Individual
Deductible $11,000 Family $12,000 Family
Out of Network
N/A 50% 50%
Coinsurance
Out of Network Out of N/A $9,500 Individual $12,000 Individual
Pocket Max. $19,000 Family $24,000 Family
Payroll Deductions (Per Pay Period)
Plan 7 Plan 5 Plan 4
Employee Only $15.00 $35.00 $60.00
Employee + Child(ren) $40.00 $90.00 $140.00
Employee + Spouse $80.00 $145.00 $210.00 5
Employee + Family $100.00 $210.00 $310.00
Health Savings Accounts (HSA)
HealthEquity
If you elect to participate in the High Deductible Health Plan and you are not covered under any non-
qualified medical coverage, including a healthcare flexible spending account, you may be able to open a
Health Savings Account. If eligible, Waterford Country School will fund a $500 seed; reviewed annually,
and a $25 per pay employer contribution.
Individually Owned Account
As the owner and administrator of your Health Savings Account, you determine how much you
contribute, when to use your money to pay eligible expenses, and when to reimburse yourself. An
HSA allows you to save and grow your balance if you do not spend it - there is no “use it, or lose it”
provision with an HSA. The money in this account is always yours, even if you change health plans,
change jobs, or retire.
There are Triple Tax Savings with an HSA
● Contributions, made through payroll deductions to an HSA are pre-tax
● The money in your account grows tax-free, and
● As long as the funds are used to pay for qualified medical expenses, they are spent tax-free.
Funding Limits
The IRS limits the annual amount that can be contributed to an HSA. For 2020, the maximum contributions,
including any amount you contribute or Waterford Country School contributes, for these accounts are: $3,550
for single coverage and $7,100 for all other coverage levels.(Anyone age 55+ can contribute an additional
$1,000 in the form of a “catch up” contribution.) For 2021, the IRS has announced the limits will be increased
to $3,600 for single coverage and $7,200 for all other coverage levels.
6
Health Reimbursement Account (HRA)
HealthEquity
A Health Reimbursement Arrangement (HRA) is an employer-funded account that helps employees pay for
qualified medical expenses not covered by their health plans.
If you elect to participate in one of the HRA plans, there is a deductible. In order to help offset the cost, WCS
will pay the first $500 of the employee deductible for HRA Plan 5, and the first $1,000 for HRA Plan 4.
How your HRA works
Harvard will look at your claim, for the first $500 of your deductible if you are on plan HRA 5/$1,000 if you
are on HRA 4. Harvard Pilgrim, through HealthEquity, will pay your provider directly. The remainder of the
employee deductible and 100% of dependent deductible(s) will be your responsibility. You will receive a bill
directly from the provider.
7
Telemedicine
What is Doctor On Demand?
Using Doctor On Demand Online, you can have a private and secure video visit with a
board-certified doctor 24/7 on your smartphone, tablet or computer with a webcam. It’s a quick and
easy way to get the care you need with no appointments or long wait times.
There is a $49 fee associated with each Online visit if you’re on the HSA
or the HRA 5 plan. And there is a $30 fee if you are on HRA 4 plan.
Get The Care You Need
Commonly treated medical conditions include:
● Cold & flusymptoms ● Skin inflammations
● Allergies & asthma ● Sinus & respiratory infections
● Bronchitis & sore throat ● Ear infection
● And more! (Including Pediatric and
Behavioral Health Care)
Doctor On Demand (800) 997-6196 www.doctorondemand.com
Employee Assistance Program — Resource Advisor through
Anthem Life
The help you need – when you need it most. 24/7 support, advice and resources.
• Counseling
• Legal
• Financial Planning
Resourceadvisor.anthem.com 1.888.209.7840 Name: AnthemResourceAdvisor
8
Dental Insurance — United Healthcare
You are provided with the option of electing dental insurance through United
Healthcare.
While you may choose any dentist, using dentists participating in the network will lower your out-of-pocket expenses.
Dentists not in the network may bill you for charges above reasonable and customary payments from United.
For a listing of participating providers visit: www.myuhc.com.
Benefit In Network Out of Network
Deductible $50 Individual / $150 Family *does not apply to preventive care
Preventive Care 100% 100%
Basic Care 100% 80%
Major Care 60% 50%
Annual Maximum $2,000 per person (applies to all tiers)
Bi-weekly Employee Contribution
Employee Only Employee + Spouse Employee + Child(ren) Employee + Family
$8.18 $31.66 $31.66 $31.66
9
Vision Insurance — Anthem
Waterford Country School offers you, and your eligible dependents, vision coverage through
Anthem’s Blue View Vision Plan. When you receive care from a participating provider, you’ll receive
the greatest benefits and money-saving discounts. You can also choose to seek care outside of the
network, where you’ll receive a pre-determinedallowance towardservices. Highlights of our vision program
are as follows:
Vision Plan
In-Network Out-of-Network
Benefit
(Member Cost) (Reimbursement)
Exam (Once every calendar year) $20 copay Up to $48
Frames
$130 allowance, then 20%
Frames (One pair every calendar year) Up to $64 allowance
off any remaining balance
Standard Plastic Lenses (Once every calendar year, lenses or contact lenses)
Single/Bifocal/Trifocal Lenses $20 copay Up to $36/$54/$69
Contact Lens (Once every 12 months, instead of eyeglass lenses)
$130 allowance, then 15% off
Conventional Up to $105
any remaining balance
Disposable $130 allowance (no Up to $105
additional discount)
Bi-Weekly Employee Contributions
Employee Only Employee + Spouse Employee + Child(ren) Family
$1.16 $2.78 $2.78 $2.78
10
11LifeandDisabilityInsurance— Anthem Life
Employee Basic Life
You will receive both life and accidental death and dismemberment (AD&D) coverage for yourself
fully paid for by Waterford Country School as outlined below. The AD&D amount is equal to the
amount of Group term life insurance in force
Benefits are reduced by 35% at age 65 and by an additional 15% at age 70.
Covered Employee Benefit
Benefit Amount 1x Your Annual Earnings
Minimum Benefit $10,000
Maximum Benefit $100,000
Supplemental Life
In addition to the group life insurance that Waterford Country School provides, you have the
option of purchasing additional life insurance for yourself, your spouse and/or your child(ren). The
coverage is available at group rates and through the convenience of payroll deduction. Please
keep in mind that in order to enroll a spouse and/or child(ren), you must enroll yourself.
Employee Spouse Dependent Child(ren)
Minimum Benefit $10,000 $5,000 $5,000
Maximum Benefit 100% of employee’s elected benefit,
5x annual salary up to $300,000 $10,000
up to $150,000
Increments $10,000 $5,000 $5,000
100% of employee’s elected benefit,
Guaranteed Issue 5x annual salary, up to $150,000 $10,000
up to $25,000
Long-Term Disability
Waterford Country School provides income replacement insurance for employees who are out of work
due to a non-work related illness or injury after 90 calendar days. This coverage is provided at no cost
to you and will pay 60% of your monthly income (up to a monthly maximum of $3,000). This benefit is
fully paid for by Waterford Country School.
11Flexible Spending Accounts
HealthEquity
(Please note, that the healthcare FSA program is not available to employees who are enrolled
in our high deductible health HSA plan, or anyone eligible to receive and/or contribute money
into a health savings account (HSA).
A great way to plan ahead and save money over the course of a year is to participate in the
Flexible Spending Account (FSA) program. This program allows you to redirect a portion of your
salary, on a pre-tax basis, into reimbursement accounts (healthcare and/or dependent care). Pre-
tax means the dollars you use for eligible expenses are exempt from taxation.
Money from your healthcare account can be used to pay for medical expenses, prescriptions, and
dental/vision expenses that have not been reimbursed by any insurance plan. Money in a
dependent care account allows you to pay with pre-tax dollars for dependent care expenses that
enable you to work by providing care for your child before/after school and during summers.
Qualifying dependents include children under the age of 13 and/or dependents who live with you
who are physically or mentally incapable of self-care. (You must be able to claim these
dependents on your tax return.)
Plan Maximums
For the 2020-2021 plan year, the maximum you may contribute into a healthcare account is $2,750
and the maximum you may contribute dependent care account is $5,000 ($2,500 if you are married
and filing separate returns).
Deadlines for Claim Reimbursement
For the 2020-2021 plan year, claims incurred between 7/1/20 and 6/30/21, can be submitted up
until 9/30/21 under the 90-day run out provision. Remaining balances up to $500 in your
healthcare FSA can be rolled over to the following plan year. (The rollover provision does not
apply to dependent care accounts.)
12Value Added Benefits
Through Harvard Pilgrim
Gym Reimbursement
If you’re a member of Harvard Pilgrim and belong to a qualified health and fitness club for
four months in a calendar year, we’ll reimburse you up to $150 — for you or your dependents
covered under your plan.
Discounts & Savings
• Vision
• Hearing
• Healthy Eating
• Dental
• Fitness
• Holistic Wellness
• Quit Smoking
• Family & Senior Care
13Online Enrollment
Employee Navigator
Employee Navigator Login and
Registration Instructions for first time
users:
1. Go to www.employeenavigator.com
2. Click on “Login” on the right hand corner
3. If you are a new user, click on “Register as
a new user”
4. Enter the requested fields
First Name
Last Name
Company Identifier –190009
Pin (last 4 Digits of SSN/ ID)
Birth Date
You will be prompted to create a username
and password. Be sure to keep this
information safe and confidential for future
access. It is recommended to use your email
address as your username. If you are a new
employee you will be asked to complete
several onboarding tasks prior to being able to
enroll.
14Online Enrollment
Employee Navigator
Employee Navigator Open Enrollment
1. When logging into Employee Navigator, click “Start Enrollment” to begin the Open Enrollment process.
2. Verify Personal information is correct and fill in any required fields that are missing. Once everything is verified
and complete, click Save & Continue towards the bottom of the screen.
3. Add dependents that will be enrolled in any of the plans by clicking the “Add Dependent” button. The
information needed for a dependent is: First and Last Name, Relationship, Gender, Date of Birth and Social
Security. Once completed, click the Save & Continue button.
15Online Enrollment
Employee Navigator
4. Enroll in the plans. The first plan you will be able to enroll in is Medical. Check off any dependents
that you want to be covered. As each dependent is added to the coverage, the cost per pay
period will adjust to the appropriate amount.
5. “Details” and “Compare” buttons are tools that help determine the best plan for you.
6. To enroll in a benefit, click on the plan and click Save & Continue.
7. If you do not want to enroll in the plan, click the “Don’t want this benefit?” button at the bottom
of the screen. Repeat this same process for each plan offered during Open Enrollment.
8. After going through all the plans, complete any life beneficiary or PCP tasks that may be required.
16Online Enrollment
Employee Navigator
9. If there are any tasks that are incomplete when the Enrollment Summary is reached,
an orange box will appear notifying you that your enrollment is not complete. Any tasks
on the left that have an orange bullet point are the tasks that still need to be completed.
10. If all tasks are complete, then click the “Click to Sign” button.
11. Your will see an Enrollment Summary box acknowledging your signature was accepted and
enrollment submitted.
17Contacts
Important Contact Information For additional assistance, please contact HR.
Benefit Provider Phone Website
Medical / Rx Harvard Pilgrim 1-888-333-4742 www.harvardpilgrim.org
Dental United Healthcare 1-800-445-9090 www.myuhc.com
Vision Anthem 1.866.723.0515 www.anthem.com
Life, AD&D-LTD Anthem Life 1.800.813.5682 www.anthem.com
FSA HealthEquity 1-866-346-5800 www.healthequity.com
HRA HealthEquity 1-866-346-5800 www.healthequity.com
HSA HealthEquity 1-866-346-5800 www.healthequity.com
Employee
Anthem 1.888.209.7840 ResourceAdvisor.Anthem.com
Assistance
Program (EAP)
Every effort has been made to ensure the accuracy of the information in the Employee Benefit Overview. Plan provision
summaries contain only highlights.
If there is a discrepancy between this overview and the plan documents, the plan documents will govern.
Although Waterford Country School intends to continue all benefits in their present form, they reserve the right to
amend, suspend, or terminate in whole or part, any or all of the plans at anytime. If any changes are made, you will be
notified promptly.
The Schuster Group
Jackie Zielinski– Senior Account Manager
jzielinski@schustergroupne.com
860.507.8891 18You can also read
