Alacrity_Designated_Assignment_2023
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Date
Nov 24, 2024
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16
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BENEFITS
GUIDE
2023
DESIGNATED ASSIGNMENT
2
At Alacrity, we understand the important role that our
benefit programs play in the lives of our employees and their
families.
Alacrity would not be the successful company it is today without the
dedication of our hard-working employees. We are proud to offer a
comprehensive benefits package that is designed to insure and protect
you and your family against financial hardship and loss.
WELCOME
BENEFITS
to your
3
BENEFITS OFFERED
Summary
Find it on Page
Medical
Anthem
5
Health Savings Account
Anthem
6
Anthem Resources
Anthem
7
Dental
Sun Life
9
Vision
Sun Life
10
Flexible Spending Account
WEX
11
Employee Assistance Program
Sun Life
12
Travel Assistance and ID Theft Protection
Sun Life
13
Finding In-Network Providers
Anthem + Sun Life
15
JANUARY
NEW HIRE
OPEN ENROLLMENT
QUALIFYING LIFE EVENTS
Benefits are effective the 1st
of the month following 60
days of employment.
Through Greenshades
Enrollment System
Within 30 days of a
qualifying life event.
WHEN TO ENROLL
During the annual benefits
open enrollment period.
Within 30 days of a
qualifying life event.
Did you have any changes
in benefits or your family?
•
Marriage or Divorce
•
Birth or Adoption
•
You and/or your
dependents gain or lose
coverage by another
group health plan
•
Spouse’s Open
Enrollment
•
Death of a spouse or child
What should you know?
During Open Enrollment, you
will select to enroll or waive
the following benefits:
•
Medical Insurance
•
Dental Insurance
•
Vision Insurance
•
HSA contribution
amounts
•
FSA contribution amounts
•
Open Enrollment is
Dec. 1 - 8, 2022
•
Benefits begin on
Jan. 1, 2023
Through Greenshades
Enrollment System
Through Greenshades
Enrollment System
ENROLLING IN YOUR BENEFITS
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4
WHAT DOES THAT WORD MEAN?
We admit it, benefits can be hard to understand.
Here are some common benefit words and their definitions
to help you as you read through this guide.
TERM
DEFINITION
Annual Deductible
Jan 1 through Dec 31
The amount you are required to pay per calendar year before certain benefits are paid for
by the plan.
Once you meet the deductible amount, expenses are covered by the plan
based on the coinsurance percentage.
This deductible starts over every January 1st.
Annual Out-of-Pocket
Maximum
Jan 1 through Dec 31
The most you pay in a calendar year for covered services that are subject to coinsurance/
copays.
The deductible is included in this amount.
If you reach the annual out-of-pocket
maximum, the plan pays 100% of covered in-network eligible expenses for the remainder
of the plan year.
Office visits and prescription copays are included in the annual out-of-
pocket maximum for our medical plans.
This maximum starts over every January 1st.
Balance Billing
When you are billed for the difference between the provider’s actual charge and the
amount reimbursed under the medical or dental plan.
This occurs when you go outside
of the preferred provider network. Balance billing does not apply towards out-of-pocket
maximum.
Coinsurance
The percentage you pay for covered expenses.
Copayments or Copays
The flat dollar amount you pay for certain in-network services.
Explanation of Benefits
(EOB)
Provides information about how your claim was processed by the insurance company.
The EOB details what portion of the claim was paid by the insurance company and what
portion is your responsibility.
Health Savings Account
(HSA)
A special, tax-advantaged interest bearing account to help plan and pay for qualified health
care expenses (including plan deductible) while covered by a qualified high deductible
health plan.
In-Network
A group of doctors, hospitals and other healthcare providers that contract with a plan
vendor to provide quality healthcare services at favorable rates.
Preferred Provider
Organization (PPO)
A healthcare arrangement designed to provide healthcare services at a discounted cost for
members to use designated providers (the network), but which also provides coverage (at
a lower level) for services received from providers that are not part of the network.
Usual, Customary,
and Reasonable (UCR)
Charges
UCR charges are determined by your health plan vendor and are based on the range of
fees charged by doctors with comparable training and experience for the same or similar
service in your area.
When you receive in-network care, UCR charges do not apply.
You are
responsible for amounts over UCR for out-of-network care.
MEDICAL INSURANCE
5
HSA PLAN
IN-NETWORK
OUT-OF-NETWORK
Deductible
Individual | Family
$6,200 | $12,400
$18,600 | $37,200
Coinsurance
100%
70%
Out-of-Pocket Max
Individual | Family
$6,350 | $12,700
$22,225 | $44,450
Preventive Care
Covered 100%
Deductible then Coinsurance
Emergency Room
Deductible then Coinsurance
Urgent Care
Physician Office Visits
Prescription Drug
COST PER 26 PAYS
HSA PLAN
Salaried and Hourly Employees earning $64,999* and below Annually:
Employee
$85.38
Employee + Spouse
$429.69
Employee + Child(ren)
$378.04
Family
$722.35
Commission-Based Employees AND Salaried and Hourly Employees earning $65,000* and above Annually:
Employee
$196.15
Employee + Spouse
$540.46
Employee + Child(ren)
$488.81
Family
$833.12
This plan features an “embedded” deductible, meaning no one family member will accrue expenses exceeding
the Individual Deductible/Out of Pocket Maximums for the entire family. This removes significant cost share
exposure for any member who has dependents enrolled on their plan.
*$65,000 threshold is based on 2022 Annualized Income.
You can save money by staying in-network! Providers in the
Anthem Blue Access Network
have agreed to
charge lesser amounts for medical services. Visit anthem.com/find-care to find providers in your network!
STAY IN-NETWORK!
6
HEALTH SAVINGS ACCOUNT (HSA)
By enrolling in the
HSA plan
, you get access to a Health Savings Account (HSA). An HSA is a tax-advantage
savings account that can be used to pay for healthcare expenses. Money is automatically pulled from your
paycheck, deducted on a pre-tax basis, and deposited into this savings account. You pick the amount and
can change the amount, or stop deposits any time you would like. This savings account now becomes your
primary way of paying for out-of-pocket medical expenses through the year.
Quick facts video
about an HSA
HSA advantages:
http://bit.ly/HSAadvantages
HSA-eligible expenses:
http://bit.ly/HSAeligibleexpenses
Why you might choose an HSA:
http://bit.ly/HSAfacts
LEARN MORE!
ANNUAL CONTRIBUTIONS
HSA FACTS
YOU HAVE CONTROL
•
You can use the funds on medical, dental
and vision expenses for you and your
family.
•
There is no “use it or lose it” rule.
YOU SAVE ON TAXES
•
All money deposited is tax free.
•
Withdrawals for eligible expenses are
exempt from federal income tax.
•
You can earn interest tax free.
EXAMPLES OF ELIGIBLE EXPENSES
•
Office Visit Copays, Prescription Copays,
Orthodontia, Acupuncture, Hearing Aids
and Batteries, Infertility Treatment and
Feminine Hygiene Products
ANNUAL CONTRIBUTION LIMITS
2023
(Individual | Family)
$3,850
| $7,750
Individuals age 55 and older
are eligible to make catch-up
contributions of an additional
$1,000 annually.
WHO IS ELIGIBLE?
Anyone who fits
all
of the following conditions is eligible for our HSA:
✓
IS
enrolled in our HDHP medical plan.
x
IS NOT
enrolled
(and not planning to enroll) in: any other medical
plan that has copays, Medicare, Tri-Care, or Medicaid.
x
IS NOT
eligible to be claimed
as a dependent on someone else’s tax
return.
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7
With Sydney, you can find everything you need to know about your Anthem benefits
personalized and all in one place. Sydney makes it easier to get things done, so you can
spend more time focused on your health.
WITH JUST ONE CLICK, YOU CAN:
•
Find care and check costs
•
Check all benefits
•
See claims
•
Get answers even faster with the chatbot
•
View and use digital ID cards
THE SYDNEY APP
Provided by Anthem
MY HEALTH DASHBOARD
With My Health Dashboard on the Sydney Health mobile
app, it’s all about you. My Health Dashboard is tailored
to your individual health journey every step of the way!
MY HEALTH RECORDS
Keeping track of your individual and your family’s health
information is easier with the My Health Records feature
on the Sydney Health app and anthem.com. Now you
can see the full picture of your family’s health all in one
secure place!
THE SYDNEY APP FEATURES...
Scan the QR code with
your smartphone or
tablet
to learn how
to download the
Sydney Heath app. We
recommend all Anthem
members download this
free resource!
ACCESS YOUR ANTHEM ID CARD
RIGHT FROM YOUR PHONE OR COMPUTER
As an Anthem member, your member ID card is available
anytime
through
your
smartphone
or
computer.
Register at anthem.com or on the Sydney app to see
your digital ID card, anytime. You can use your member
ID to register online. New members may receive an
activation code to register after enrollment.
8
TELEHEALTH
LIVEHEALTH ONLINE
AN AFFORDABLE OPTION - FOR QUALITY MEDICAL CARE
LiveHealth Online gives you access 24 hours, 7 days a week to a U.S. board-
certified doctor through the convenience of phone, video, or mobile app visits.
All members on the medical plans have access to a medical provider over the
phone or online. This healthcare allows you to seek medical advice and be
treated right from the comfort of your own home.
•
Cold & Flu symptoms
•
Allergies
•
Pink eye
•
Bronchitis
•
Sinus problems
•
Stomachache
•
Bladder infection
•
Sore throat
•
Rash
GET THE CARE YOU NEED
Many medical conditions doctors can treat include:
GET STARTED TODAY!
Register online at livehealthonline.com
or
download the mobile app
HOW MUCH DOES IT COST?
Your Anthem plan includes benefits for video visits using
LiveHealth Online. Most medical visits will cost you $59 and will
apply to your medical deductible.
There is no difference in cost for weekends, holidays or late
night visits.
9
DENTAL INSURANCE
NEW PROVIDER!
This plan offers you the same coverage for in-network and out-of-network care. The difference is that because
Sun Life’s network of providers have agreed to charge a lesser rate, you’re paying less than with providers that
are out-of-network. Out-of-network providers will charge you based on the UCR, or usual & customary rates.
This rate is based on the 90th percentile dentists charge in the area.
To find a participating dentist online, visit
sunlife.com/findadentist
.
IN-NETWORK
Annual Deductible
$50 for each covered person, $150 per family
Annual Max Per Person
$1,250
Preventive Care
Covered 100%. No deductible (2 per calendar year)
Basic Care
Covered 80% after deductible
Major Care
Covered 50% after deductible
Orthodontic Care
up to age 26
Covered 50%
Lifetime Ortho Plan Max
$1,250
COST PER PAY (26 PAYS/YEAR)
Employee
$13.18
Employee + Spouse
$27.96
Employee + Child(ren)
$25.82
Family
$41.72
NET WORK : SUN LIFE DENTAL
WHAT DOES A BALANCE BILL LOOK LIKE?
Dr. Jones charges
$750 for a crown.
Since Dr. Jones isn’t in the
network, he has the right to bill
you for the $150 difference —
plus the coinsurance you still
have to pay.
On the other hand, if you visit an
in-network dentist, they have
already agreed to charge the $600
that the plan covers for crowns, so
there is no balance left over.
Your
Dental
Plan
Your dental plan
will only cover $600
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10
Alacrity offers a vision insurance plan through Sun Life. The plan offers in-and out of network benefits,
providing you the freedom to choose any provider. However, you will pay less out of pocket when you choose
a network provider.
To find an in-network doctor, visit
VSP.com
and select the Choice Network.
IN-NETWORK
OUT-OF-NETWORK
Exam
Every 12 months
$10 copay
up to $45
Lenses
Every 12 months
Single
Bifocal
Trifocal
Lenticular
$25 copay
up to $30
up to $50
up to $60
up to $100
Frames
Every 12 months
$130 allowance
up to $70
Contacts
Every 12 months
Elective
Medically Necessary
$130 allowance
$25 copay
up to $105
up to $210
COST PER PAY (26 PAYS/YEAR)
Employee
$2.68
Employee + Spouse
$5.36
Employee + Child(ren)
$6.04
Family
$9.50
NET WORK : VSP CHOICE
VISION INSURANCE
NEW PROVIDER!
11
FSA TAX SAVINGS EXAMPLE:
Annual FSA Contribution: $5,000
Tax Percentage: 25%
Tax Savings with FSA Contribution:
$5,000
x 0.25
$1,250
By contributing $5,000 to a Dependent Care FSA, an
individual would save $1,250 in Tax Liability.
ACCOUNT TYPE
ELIGIBLE EXPENSES
ELIGIBILITY
2023
CONTRIBUTION LIMITS
Dependent Care FSA
•
Daycare facility fees
(excluding transportation,
lunches and educational
services)
•
Before-school and after-
school care
•
Local day camp
If you have dependent children
under the age of 13 or dependents
of any age who are unable to care
for themselves, you can enroll
in this Dependent Care plan and
choose the amount you want to put
aside for dependent care.
An eligible care provider: cannot be
a dependent child who is claimed
as a dependent and is under the age
of 19, must meet the requirements
of your state, and must claim the
money as income when determining
their taxes at the end of the year.
A maximum of
$5,000
annually ($2,500 if married
and filing separate tax
returns)
DEPENDENT CARE
FLEXIBLE SPENDING ACCOUNT (FSA)
Alacrity
offers
a
Dependent
Care
Flexible
Spending Account (FSA), which enables you to
pay for eligible expenses with pre-tax dollars,
thereby lowering your taxable income. You
decide how much money to set aside on an
annual basis and your contribution amount will
be divided equally over each applicable pay
period.
USE IT OR LOSE IT RULE
Due to IRS regulations, any unused funds remaining in an FSA at the end of the plan year are forfeited. This is
known as the “Use It or Lose It” rule. You must incur expenses by the end of the plan year.
Administered by Wex
Life is full of challenges and sometimes balancing
it is difficult. We are proud to provide a confidential
program dedicated to supporting the emotional
health and well-being of our employees and their
families.
The Employee Assistance Program (EAP) is provided
at
no cost
to you. You and your eligible dependents
have access to 24/7 phone consultation with a
licensed mental health professional and referrals to
supportive resources.
View some of the resources a counselor can
address on the right side.
FOR 24/7 ASSISTANCE:
800-460-4374
guidanceresources.com
ASSISTANCE PROGRAM
EMPLOYEE
Provided by Sun Life
AN EAP CAN ADDRESS THE FOLLOWING ISSUES:
WORK & CAREER
SUBSTANCE ABUSE & ADDICTION
FINANCIAL WELLNESS
FAMILY & RELATIONSHIPS
LEGAL ASSISTANCE
EMOTIONAL WELL-BEING
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Assist America will arrange for the care of children
left unattended as the result of a medical emergency
and pay for any transportation costs involved in such
arrangements.
If a member is traveling alone and will be hospitalized
for more than seven days, Assist America will provide
economy, round-trip, common carrier transportation
to the place of hospitalization for a designated family
member or friend.
Assist America will assist with the logistics of returning
a member’s remains home in the event of his or her
death during travel.
Other non-medical emergency assistance services include:
•
Return of Vehicle
•
Lost Luggage & Document Assistance
•
Legal & Interpreter Referrals
•
Emergency Message Transmission
•
Bail Bond & Emergency Cash Coordination
•
Emergency Trauma Counseling
•
Pre-trip Information
For more information, visit www.assistamerica.com.
Calls to Assist America’s Operations Center are evaluated
by medical personnel and referred to qualified doctors
and/or hospitals.
Assist America fosters prompt hospital admission outside
the United States by validating the member’s health
coverage or by advancing funds to the hospital as needed.
If adequate medical facilities are not available locally,
Assist America will use whatever mode of transport,
equipment and personnel necessary to evacuate a
member to the nearest facility capable of providing a high
standard of care.
Assist America’s medical personnel will maintain regular
communication with the member’s attending physician
and/or hospital and relay information to the family, as
appropriate.
If a member still requires medical assistance upon being
discharged from a hospital, Assist America will repatriate
them home or to a rehabilitation facility with a medical or
non-medical escort, as necessary.
If a member needs a replacement prescription while
traveling, Assist America will help in filling that prescription.
Please cut on dotted line to remove card.
GLOBAL EMERGENCY
SERVICES
Reference #
01-AA-SUL-100101
If you require assistance when traveling 100 miles from your
permanent residence, or in another country, call Assist America’s
Operations Center at:
+1 609 986 1234
(outside USA - Collect Call)
+1 800 872 1414
(inside USA - Toll Free)
Or email at: medservices@assistamerica.com
TRAVEL ASSISTANCE SERVICES
With your Sun Life coverage, you receive an emergency travel assistance program
and ID-theft protection services provided by Assist America.
This travel emergency assistance program immediately connects you to doctors,
hospitals, pharmacies and other services if you experience a medical or non-medical
emergency while traveling 100 miles away from your permanent residence, or in
another country. One simple phone call to Assist America will connect you to:
• A state-of-the-art 24/7 Operations Center
• Experienced, multilingual crisis management professionals
• Worldwide emergency response capabilities
• Air and ground ambulance service providers
CONGRATULATIONS!
TRAVEL EMERGENCY ASSISTANCE
DISCLAIMER
Medical Consultation, Evaluation & Referral
Foreign Hospital Admission Assistance
Emergency Medical Evacuation
Medical Monitoring
Medical Repatriation
Prescription Assistance
Return of Mortal Remains
Compassionate Visit
Care of Minor Children
Value-added services are not available in New York. Value-added services
are not insurance, are offered only on specific lines of coverage, and
carry a separate charge, which is added to the cost of the insurance. The
cost is included in the total amount billed. Emergency Travel Assistance
is provided by Assist America®. Identity Theft Protection is provided by
SecurAssist®, an Assist America program. Sun Life is not responsible or
liable for care, services, or advice given by any provider or vendor of the
Services. Sun Life reserves the right to discontinue any of the Services
at any time. Employers who provide group insurance coverage and make
available value added services within an I.R.C. Section 125 cafeteria plan
should consult a tax professional to determine whether those services are
Qualified Benefits for Section 125 plans. In all states except New York,
group insurance policies are underwritten by Sun Life Assurance Company
of Canada (Wellesley Hills, MA). GVASBCH-EE-039 SLPC 29750
ID THEFT PROTECTION SERVICES
CONDITIONS
Assist America will not provide services in the following
instances:
• Travel undertaken specifically for securing medical
treatment
• Travel by a Participant’s spouse when it is for the benefit
of the spouse’s employer (spouse business travel)
• Injuries resulting from participation in acts of war or
insurrection
• Commission of unlawful act(s)
• Attempt at suicide
• Incidents involving the use of drugs unless prescribed by
a physician
• Transfer of member from one medical facility to another
medical facility of similar capabilities and providing a
similar level of care
Assist America will not evacuate or repatriate a member:
• Without medical authorization
• With mild lesions, simple injuries such as sprains, simple
fractures, or
mild sickness which can be treated by local
doctors and do not prevent the member from continuing
his/her trip or returning home
• With a pregnancy over 28 weeks
• With mental or nervous disorders unless hospitalized
Services will not be provided for the following types of travel:
• Trips exceeding 90 days from legal residence without
prior notification to Assist America (separate purchase of
Expatriate Coverage is available at www.assistamerica.
com/expatriate)
While assistance services are available worldwide,
transportation response time is directly related to the
location/jurisdiction where an event occurs. Assist America
is not responsible for failing to provide services or for delays
in the delivery of services caused by strikes or conditions
beyond its control, including by way of example and not
by limitation, weather conditions, availability of airports,
flight conditions, availability of hyperbaric chambers,
communications systems, or where rendering of service is
limited or prohibited by local law or edict.
All consulting physicians and attorneys are independent
contractors and not under the control or responsibility of
Assist America.
is a registered service mark of Assist America, Inc.
08.19.pdf
Please cut on dotted line to remove card.
Please provide the following information
when you call:
• Your name, phone number and relationship to the patient
• Patient’s name, age, gender
• The Assist America reference number
• Name, location and phone number of hospital or treating
doctor if applicable
Attention: This card is not a medical insurance card. All services must be provided
by Assist America. No claims for reimbursement will be accepted. The holder of
this card is a member of Assist America and is entitled to its medical and personal
services.
Assist America offers prevention and resolution tools to
safeguard your data and restore its integrity if it is used
fraudulently. These services include:
24/7 Access to Identity Protection Experts
You have 24/7 direct emergency access to ID Theft Protection
experts who can provide guidance in dealing with identity fraud
issues.
Credit Card and Document Registration
Register your details using our secure website to store
information from credit cards, banks and other important
document in a single, centralized and secured location.
Internet Fraud Monitoring
Upon registration, we use a real-time web-crawling technology to
monitor any sign of your registered personal data on suspicious
sites. You will receive automatic warning notifications if it is
discovered that your data is being used fraudulently.
24/7 Identity Fraud Support
If you are a victim of identity fraud, a dedicated ID Theft
Protection expert will guide you in mitigating the consequences
of the fraud. Your caseworker will also notify credit and debit
card issuers if your credit or debit card(s) is lost or stolen.
To activate these identity protection services, visit:
www.assistamerica.com/sunlife
DOWNLOAD THE MOBILE APP
Access a wide range of global emergency assistance
services from your phone by downloading the FREE Assist
America Mobile App for iPhone and Android.
The Mobile App’s features include:
• Tap for Help:
One-touch call to our 24/7 Operations Center
• Pre-Trip Information:
Access detailed country-specific
information to prepare your trip
• Digital ID Card:
Your Assist America membership card is
stored inside the App
• Travel Alerts:
Receive alerts on urgent global situations
that may impact travel
• Travel Status Indicator:
This feature indicated when you
are eligible for services
• Embassy & U.S. Pharmacy Locator:
Locate the nearest
embassy/consulate of 23 countries around the world and
the nearest pharmacies in the U.S.
• Available in 7 Languages:
English, Spanish, Arabic,
Mandarin, Thai, Bahasa, and French
Complete the set-up process by entering your Assist America
reference number
01-AA-SUL-100101
.
15
IMPORTANT CONTACTS
Benefits Offered
PROVIDER
PHONE
WEBSITE/EMAIL
Medical and HSA
Anthem
Call the number on the
back of your card
www.Anthem.com
Dental
Sun Life
800-442-7742
www.sunlife.com
Vision
Sun Life + VSP
800-877-7195
www.vsp.com
Employee Assistance
Program
Sun Life
800-460-4374
www.guidanceresources.com
Dependent Care FSA
WEX
800-492-0669
www.wexinc.com
Human Resources
Alacrity
888-887-8070
benefits-info@alacritysolutions.com
FIND AN IN-NETWORK PROVIDER
MEDICAL |
ANTHEM
1.
Visit
anthem.com/find-care
2.
Log in with either your Anthem login credentials or by using your Identification Number listed on your
Anthem ID card
3.
Select a specialization and enter your zip code.
4.
You can then narrow your search event further and/or review details such as the expected cost of
certain procedures and if they are accepting new patients.
DENTAL |
SUN LIFE
1.
Visit
www.sunlife.com/findadentist
.
2.
Follow the prompts to find a dentist in your area who participates in the PPO network. You do not need
to select a dentist in advance. The PPO network for your plan is the Sun Life Dental Network® with
130,000+ unique dentists.
VISION |
SUN LIFE
There are three ways to find an in-network doctor:
1.
Visit
vsp.com
and select the Choice network.
2.
Call VSP at 800-877-7195.
3.
Download the VSP mobile app, Benefit Tools, and search for a doctor near you.
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The information in this Enrollment Guide is presented for illustrative purposes and is based on information provided
by the employer.
The text contained in this Guide was taken from various summary plan descriptions and benefit
information.
While every effort was taken to accurately report your benefits, discrepancies or errors are always possible.
In case of discrepancy between the Guide and the actual plan documents, the actual plan documents will prevail.
All
information is confidential pursuant to the Health Insurance Portability and Accountability Act of 1996.
IMPORTANT LEGAL NOTICES
affecting your health plan
coverage
Scan the QR Code for important notices relative to
your employee benefits.