open-enrollment-presentation-changes-only-website

Rollins College Benefits Open Enrollment Plan Year April 1, 2021 - March 31, 2022 Jennifer Addleman Director, Benefits & Wellbeing Lauren Mickler Assistant Director, Benefits & Wellbeing Resources Rollins.edu/human-resources/benefits Rollins.edu/human-resources/benefits/open-enrollment Rollins Benefits Guide Rollins.edu/human-resources/benefits icubabenefits.org 2021 – 2022 Medical Benefits Preferred PPO Medical Plan Benefits Summary Deductible (Individual/Family) Coinsurance Out-of-Pocket Maximum (Individual/Family – Includes all medical copays, deductibles and coinsurance) Blue Distinction Total Care PCP Teladoc (1-800-Teladoc) Convenient Care Clinics Urgent Care Center Physician/Specialist Office Visits Outpatient Therapy - PT, ST and OT Independent Clinical Labs (free standing facilities and office visits) Preventive Care Outpatient Diagnostic Imaging (MRI, MRA, CAT Scan, PET Scan) Emergency Room Services Ambulance In-Network Out-of-Network $2,500/$5,000 20% $4,000/$10,750 40% $4,000/$8,000 $7,500/$15,000 $0 N/A $5 Copay $10 Copay $30 Copay 20% 20% 0% - Quest 20% - Outpatient Setting 0% 40% AD* 40% AD* Not Covered Up to $500 Copay 40% AD* 40% AD* $300 Copay (waived if admitted) $250 Copay Durable Medical Equipment and Prosthetic Appliances 20% AD* 40% AD* Hospital Inpatient Mental Health & Substance Abuse Inpatient Outpatient 20% AD* 40% AD* 20% AD* 20% 40% AD* 40% AD* *After Deductible $4,000/$8,000 Deductible PPO Plan Benefits Summary In-Network Out-of-Network $4,000/$8,000 30% $8,000/$16,000 50% $5,350/$10,700 $10,700/$21,400 Physician Office Visits $25 Copay 50% AD* Specialist Office Visits Outpatient Therapy - PT, ST and OT Emergency Room Services Urgent Care Center Durable Medical Equipment and Prosthetic Appliances Hospital Inpatient Mental Health & Substance Abuse Inpatient Outpatient Blue Distinction Total Care PCP Teladoc (1-800-Teladoc) Convenient Care Clinics Independent Clinical Labs (free standing facilities and office visits) Preventive Care Outpatient Diagnostic Imaging (MRI, MRA, CAT Scan, PET Scan) Ambulance 50% AD* $35 Copay 50% AD* $30 Copay $300 Copay (waived if admitted) $50 Copay 30% ALD** 50% AD* 50% AD* 30% AD* Deductible (Individual/Family) Coinsurance Out-of-Pocket Maximum (Individual/Family Includes all medical copays, deductibles and coinsurance) 30% AD* $35 Copay $0 50% AD* 50% AD* N/A $5 Copay $10 Copay 0% - Quest 30% - Outpatient Setting 0% Not Covered Up to $500 Copay 50% AD* $250 Copay 50% AD* * After Deductible ** After Limited Deductible: $2,000 of the $4,000 Individual Deductible Knowledge = Savings No Cost No Deductible • Total Care Primary Care visits (Primary Care, Internist, Pediatrician) • Bone mineral density tests • Colonoscopies • EAP services for ALL employees • ICUBAcares assistance • Immunizations • In-network annual wellness exams • Mammograms • Medically necessary labs performed at Quest Diagnostics • Medically necessary preventive services • SurgeryPlus non-emergent surgeries • Ultrasounds of the breast • Advanced Imaging (MRI, CT scan, PET scan) • Chiropractic services • Common illnesses • Convenient Care Clinic (Minute Clinic) • Emergency Room • Emergency transportation • Maternity visits • Outpatient Mental Health/Substance abuse • PCP office visits • Physicals • Prescription drugs • Specialist visits • Therapy (Occupational, Physical, Speech) • Teladoc • Urgent Care Deductible Applies • • • • • • • • • • • • • • • Durable medical equipment Hearing aids Home health care Hospital delivery expenses for maternity Hospital expenses Hospital or out-patient surgery (unless through SurgeryPlus) In-patient mental health/substance abuse treatments Inpatient rehabilitation Outpatient facility charges Private duty nursing Prosthetic appliances Skilled nursing rehab TMJ Ultrasound (except breast ultrasound) X-ray All out of pocket (OOP) expenses apply to annual OOP maximum ICUBA Spending Accounts Employee Assistance Program 25 Employee Assistance Program Emotional Life Legal Financial Speak with a licensed clinician regarding life events to obtain an objective expert point of view over the phone, televideo or in the office sessions per issue per year per covered employee Obtain referrals for services needed by you or your dependents and save you time Access to retail, entertainment, travel and fitness discounts Gain expert council regarding a wide array of legal needs Access online legal documents Request ID theft prevention and resolution support Consult with a financial specialist regarding budgeting, retirement planning, college planning, taxes and much more Free & Confidential Call 877-398-5816 Welcome to Delta Dental Three plan options DeltaCare USA DHMO Delta Dental PPO – Base Plan Delta Dental PPO – Buy-Up Plan A dental election is encouraged to ensure you have appropriate coverage for yourself and your family in the new plan year DeltaCare USA DHMO Coverage details DHMO benefits include: Copays Composite fillings covered No missing tooth exclusion Implants covered Tooth whitening covered Note – DHMO is not available in all states Check plan summary for additional details Plan Year Max Unlimited Provider Options In network only Must select provider with Delta prior to having service Ortho Lifetime Max No maximum Patient costs Deductible – Individual Not applicable Deductible – Family Not applicable Preventive Services Copay determined by fee schedule Basic Services Copay determined by fee schedule Major Services Copay determined by fee schedule Orthodontia (Adult and/or Child) Copay determined by fee schedule Delta Dental PPO – Base Plan Coverage details Plan Year Max In Network Premier Network Out-of-Network $1500 $1500 $1500 Provider Options Ortho Lifetime Max In and out-of-network $1500 $1500 $1500 Patient costs Deductible Individual $75 $75 $100 Deductible Family $225 $300 $300 0% 50% 50% Basic Services 20% (AD)* 70% (AD)* 70% (AD)* Major Services 70% (AD)* 80% (AD)* 80% (AD)* 50% 50% 50% Preventative Services Orthodontia (child only) *AD = After Deductible PPO – Base Plan benefits include: Preventative Basic Major Orthodontia (child only) Delta Dental PPO – Buy-Up Plan Coverage details Plan Year Max In Network Premier Network Out-of-Network $2000 $2000 $2000 Provider Options Ortho Lifetime Max In and out-of-network $2000 $2000 $2000 Patient costs Deductible Individual $50 $50 $50 Deductible Family $150 $150 $150 0% 20% 20% Basic Services 20% (AD)* 50% (AD)* 50% (AD)* Major Services 50% (AD)* 70% (AD)* 70% (AD)* Orthodontia (Adult & Child) 50% 50% 50% Preventative Services *AD = After Deductible PPO – Buy-Up Plan benefits include: Preventative Basic Major Orthodontia (Adult and Child) Implants (included with Major services) Delta Plan Premiums Total Premium DeltaCare USA DHMO PPO Base Plan PPO Buy-Up Plan Employee Cost Employee Cost (Monthly) (Bi-Weekly) $0 $0 Employee $11.83 Employee + $23.73 $11.90 $5.49 Employee + Family $36.85 $25.02 $11.55 Employee $23.80 $11.97 $5.52 Employee + $55.32 $43.49 $20.07 Employee + Family $91.59 $79.76 $36.81 Employee $41.69 $29.86 $13.78 Employee + $83.04 $71.21 $32.87 Employee + Family $139.65 $127.82 $58.99 EYEMED Vision benefits 32 Your Vision Benefits Vision Rates Monthly Biweekly Employee $7.38 $3.41 Employee + Family $18.87 $8.71 $20 discount off contacts when you order from Contacts Direct Pet Insurance 34 How to get started: Click the Start Your Enrollment button located at the top of your home page Be sure to Email or Print your enrollment confirmation once complete! Who is an eligible dependent? Your legally recognized spouse or domestic partner Your natural child Your legally adopted child Your stepchild A child required to be covered pursuant to a Qualified Medical Child Support Order (QMCSO) A child with proof of legal guardianship who resides with you A foster child A child is a dependent until the end of the calendar year in which the age of 26 is attained or is over 26 years of age and is continuously incapable of self-support because of a Disability Reminders  Open Enrollment is February – February 12 until 5pm  You only need to participate in open enrollment if:  You want to continue or add a flexible spending account (FSA) (FSA amounts not roll over from year to year); or  You want to make changes to your benefits, including the selection of a new dental plan; or  You want to add or drop dependents  It is suggested that you review your benefits to be sure they are what you want for the new plan year Your current dental plan election will map to the closest type plan if no election is made  A review of your beneficiaries for your life insurance plan(s) is highly recommended Beneficiaries may be changed any time during the year at ICUBAbenefits.org  Dental will default to most similar Delta plan  Questions? humanresources@rollins.edu 407-646-2102 rollins.edu/human-resources/benefits/open-enrollment 38