Alacrity_Designated_Assignment_2023

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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.