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W 2 Consultants Benefits Enrollment Guide 4/1/2016 through 3/31/2017

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Page 1: Benefits Enrollment Guide - Login OMSoms.pyramidci.com/oms5.0/OnBoarding/Templates/FTS/Pyramid... · 2016-04-01 · (30 day supply) Mail-Order Tier 1 Mail-Order Tier 2 Mail-Order

W2 Consultants

Benefits Enrollment Guide4/1/2016 through 3/31/2017

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TABLE OF CONTENTS

General Information 1

Understanding your Benefits 2

Health Savings Account (HSA) 3

Health Plan Summary and Contributions 4

Dental & Vision Plan Summary and Contributions 5

Basic Life, Voluntary Life, Disability, Critical Illness & Telemedicine 6

Who is Northwestern Benefit Corporation? 7

Contact Information 8

Notes 9

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Pyramid Consulting, Inc 1

GENERAL INFORMATION

Benefit EligibilityAll regular, full-time employees who work a minimum of 20 hours per week are eligible for benefits. Dependents eligible for coverage include your spouse and any of your children to age 26 (age 19 for dental + vision unless full time student).

EnrollmentNew employees are eligible to participate in the benefits plan on the first of the month following 30 days of employment. Any elections you make during your initial enrollment can only be changed with a Qualifying Event or during open enrollment.

Changing Your CoverageWhen you enroll in the employee benefits program, you will have an option to make premium payments with pre-tax dollars through the Section 125 Plan. Please note that unless you opt out of the Section 125, you and/or your dependents cannot be terminated from the benefits plan for any reason other than a qualifying event or until the beginning of the next plan year, April 1.

You can change your health or dental coverage during the plan year only within 30 days of a change in status / Qualifying Event. In most cases, only changes consistent with the Qualifying Event can be made. For example, if you have a baby, you can add the baby to your health coverage, but you cannot enroll yourself in dental because that decision is not related to the Qualifying Event.

The following is a list of Qualifying Events:• Marriage, divorce or death of yourself or a dependent • Birth or adoption of a dependent child • Change in the employee, spouse or a dependents child’s employment status • Loss of dependent status

• Change in the employee, spouse or a dependent child’s residence that would affect eligibility for coverage • Employee’s receipt of a qualified medical child support order or letter from the Attorney General ordering the employee to provide (or allowing the employee to drop) medical coverage for a child

• Changes made by a spouse or dependent child during his/her annual enrollment period with another employer • The employee, spouse or dependent child becoming eligible or ineligible for Medicare or Medicaid • Significant employer or carrier initiated changes or cancellation of the employee, spouse or dependent child’s coverage.

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Actively at WorkSome insurance plans require you to be actively at work for coverage or an increase in coverage to take effect. Actively at work means you are performing all of the regular duties of your job at your worksite on a scheduled work day. If you are on sick leave, vacation, other type of leave or holiday, you are not actively at work.

COBRAThe Consolidated Omnibus Budget Reconciliation Act allows you and/or covered dependents to extend health, dental and/or vision coverage beyond the date on which eligibility would normally end. You pay the full premiums plus a 2% administrative fee for this extended coverage.

Coinsurance or Cost SharingHow the cost of a health or dental expense is shared between you and the plan after you pay your deductible.

CopaymentA set dollar amount you pay for an office visit or prescription drug. The remaining cost is covered by the plan.

DeductibleThe amount of money you must pay toward health, or dental expenses for each family member each year before health or dental benefits are payable in most cases. Deductible amounts vary according to benefit plan. After you have paid your deductible, future expenses are covered at the coinsurance amount. Copayments do not count toward the deductible.

FormularyA group of brand name drugs that the plan can obtain for a lower cost than other brand-name drugs. You pay a lower copayment for a formulary drug than for a non-formulary drug. Each plan has its own formulary, so a particular drug may be on one plan’s formulary but not on another’s. Generally, at least one therapeutically acceptable drug for every type of condition is on a plan’s formulary.

Here Are Some Terms You’ll Need to Know to BetterUnderstand and Be Able to Select Certain Coverages

UNDERSTANDING YOUR BENEFITS

Out-of-Pocket MaximumThe most you will have to spend each plan year for each covered family member for the annual deductible and your coinsurance. Once you've met the out-of-pocket maximum on yourself or a covered dependent, the plan pays 100% of remaining expenses for you or the dependent for the rest of that plan year.

Beginning April 1st, both medical and prescription drug copayments will apply toward the out-of-pocket maximum.

PCP/SpecialistA primary care physician (PCP) is a general or family practitioner, an internal medicine doctor, a pediatrician or an obstetrician/gynecologist. All other doctors under these plans are considered specialists.

Reasonable and CustomaryThe lowest of:

• The usual charge by the doctor, dentist or other provider of the services or supplier for the same or similar services or supplies.

• The usual charge of most other doctors, dentists or other providers of similar training or experience in the same geographic area for the same or similar services or supplies, or the actual charge for the services or supplies.

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HEALTH SAVINGS ACCOUNT (HSA)

Health Savings Accounts (HSA) Health Savings Accounts are individually owned bank accounts. Pyramid simply provides a means to make a pre-tax contribution from your paycheck into your personal HSA.

Because of our relationship with Cigna, many of HSA Bank’s, our HSA financial institution, fees have been waived or reduced. Plus, Cigna offers you the ability to talk about both your HSA and Health Plan needs in one call!

If you choose the HSA eligible plan, your demographic information will be sent over to Cigna, who will automatically send it over to HSA Bank. HSA Bank will use this information to verify your identity and establish your HSA account on your behalf. If for some reason HSA Bank is unable to verify your identity, they may reach out to you for additional information.

Once your account is established, HSA Bank will mail you the applicable account information including the account number, customer service information, and more.

Account Requirements Because HSA Bank is opening a bank account (financial) in your name, they must be able to confirm your identity first. They will use the demographic information provided during your enrollment such as name, date of birth, social security number, and address.

Please note, if you list a PO Box as your primary address, HSA Bank will likely reach out to you for additional information to verify your identity.

Making HSA Deferrals You can cancel HSA deferrals at any time.

You can start or re-start, upon confirmation from HSA Bank of an open account, HSA deferrals as of the first of any following month.

Want to Make Pre-Tax HSA Deferrals? Your HSA is a personal bank account.

The financial institution requires those employees who wish to defer monies into a HSA to complete the set up of your individual Health Savings (bank) Account.

How to Open Your HSA Account Once you have completed the steps of establishing your Health Savings Account, you will receive your account information in the mail from HSA Bank.

Your HSA deferral election will be pended (referred to as “EOI” requirements) until we receive confirmation that your Health Savings Account is ‘active and reflects an open status.’

2016 HSA Calendar Year Contributions Limits • Individual Health Plan Coverage: $3,350

• Family Health Plan Coverage: $6,750

• Catch Up Contribution for ages 55-65: $1,000

Want help to determine how much to defer? Visit HSA Bank's website for educational materials, FAQs, and savings calculators.

Once enrolled as an HSA Bank Member: HSA Bank, the financial institution offering you banking services for your HSA, provides additional member and account holder information at www.hsabank.com/hsabank/education. You can access detailed and personal information about your benefits by creating a user ID & secure log-in at www.mycigna.com. This site also provides you with access to your banking account transactions.

You can also access your account information, such as deposits, withdrawals, account balances, and more on the myCigna smart phone app.

Notice to Employees Deferring Monies into a Health Savings Account

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HEALTH PLAN SUMMARY AND CONTRIBUTIONS

Calendar Year Deductible• Individual• Family

Out-of-Pocket Maximum(Includes deductible)• Individual• Family

Coinsurance

Office Visit Copay• Primary• Specialist • Preventive Care

Hospital/Inpatient Services

Emergency Room Service

Urgent Care

Outpatient Services

Prescription DrugsRetail Tier 1 Retail Tier 2 Retail Tier 3 (30 day supply)

Mail-Order Tier 1 Mail-Order Tier 2 Mail-Order Tier 3 (90 day supply)

Maximum Lifetime B e nefits

In-Network

$2,600 $5,200

$2,600$5,200

100% Deductible Deductible Plan pays 100%

Deductible Deductible

Deductible

Deductible

Unlimited

In-Network

$2,500 $5,000

$3,750$7,500

80% (Member pays 20%) 80% (No plan deductible) 80% After deductible Plan pays 100%

80% After deductible

80% After deductible

80% After deductible

80% After deductible

$15 Copay $35 Copay $60 Copay $30 Copay $70 Copay $120 Copay Unlimited

Out-of-Network

$5,200 $10,400

$6,550$13,100

70% (Member pays 30%) 70% After deductible 70% After deductible 70% After deductible

70% After deductible Deductible

Deductible

70% After deductible

Unlimited

Out-of-Network

$5,200 $10,400

$6,550$13,100

60% (Member pays 40%)

60% After deductible60% After deductible 60% After deductible

60% After deductible

80% After deductible

80% After deductible

60% After deductible

Unlimited

Medical – Cigna Open Access - HDHP: HSA Eligible Open Access - Hybrid

“Pharmacy paid at 100% after deductible is met”

“Pharmacy paid at 100% after deductible is met”

“Prescription drugs are not tied to the medical deductible”

“Prescription drugs are not tied to the medical deductible”

Medical Contributions (per pay period) HDHP Hybrid Employee $82.24 $83.95 Employee + Spouse $390.16 $396.60 Employee + Children $319.90 $325.02 Family $583.93 $594.30

*The primary difference between the two options is the deductible, coinsurance and prescription drug copays. The Hybrid plan has an individual deductible (for up to 2 people) and the HDHP has an aggregate family deductible.

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Vision – Humana Humana is the carrier for vision insurance. Humana offers you one of the largest vision care networks in the industry, with a wide selection of experienced ophthalmologist, optometrist, and opticians. For a list of participating vision providers, go to www.humanavisioncare.com In-Network Out-of-Network Exam $15 Copay $40 Allowance Lenses (per pair): $15 Copay, then Single Paid in full $33 Allowance Bifocal Paid in full $50 Allowance Trifocal Paid in full $65 Allowance Contact Lenses Elective $150** Allowance Medically Necessary* Paid in full $280 Allowance Frames $45 Wholesale $57 Retail **If you prefer contact lenses, the plan provides an allowance for your contacts instead of lenses and frames.

Frequency Exam/Lenses/Frames Every 12 months/Every 12 months/Every 24 months Contributions (per pay period) Employee $3.30 Employee + Spouse $6.58 Employee + Child(ren) $6.25 Family $9.82

Dental – Cigna Cigna is the carrier for dental insurance. The Cigna plan features an excellent network of dentists and allows you the flexibility to choose your dentist. However, choosing an in-network dentist will typically save you money and stretch your annual maximum further. For a list of participating dental providers, go to www.cigna.com.

PPO HMO

Deductible Individual $50 N/A Family $150 N/A Office Visit Fee N/A $5 Coinsurance Preventive 100% Most covered at 100% Basic 80% Refer to patient charge Major 50% schedule for exact Orthodontia 50% copays (Dependent Child to age 19) Lifetime Ortho Maximum $1,000 N/A Calendar Year Maximum $1,500 N/A

Contributions (per pay period) Employee $9.16 Employee + Spouse $27.65 Employee + Child(ren) $31.52 Family $54.21

DENTAL & VISION PLAN SUMMARY AND CONTRIBUTIONS

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Voluntary Short Term Disability – Cigna Weekly Benefit Percentage 60% Maximum Weekly Benefit $1,500 Benefit Waiting Period 7 Days for sickness & accident (benefits begin immediately if hospitalized) Maximum Benefit Period 12 Weeks Voluntary

Voluntary Long Term Disability – Cigna Monthly Benefit Percentage 60% Maximum Monthly Benefit $15,000 Benefit Waiting Period 90 Days Maximum Benefit Period Depending on your age at the time of disabilityVoluntary

Telemedicine - FlexCare With Telemedicine through FlexCare, you have the ability to access a certified physician around the clock. Some highlights are included below:

You can talk to an actual physician 24 | 7 | 365 Provides much needed convenience EX. On vacation, traveling for work, busy schedules, short-term prescription refills Best used for common issues EX. Flu, allergies, pink eye, ear infections, sinus infections, UTIs 90% of issues are resolved Currently operates in 49 of 50 states (not active in Arkansas) Consultations are absolutely free (you only pay for the prescription)

BASIC LIFE, VOLUNTARY LIFE, DISABILITY, CRITICAL ILLNESS & TELEMEDICINE

Voluntary Life Insurance – Guardian Offers employees the option to purchase additional life insurance beyond what is covered under a basic life policy. Employees enrolled under a voluntary policy also have the option to purchase life coverage for a spouse and children. Life Benefit $10,000 increments to a maximum of $1,000,000

Spouse $5,000 increments to a maximum of $250,000

Child $1,000 increments to a maximum of $10,000Voluntary

Critical Illness & Cancer Coverage – Guardian Critical Illness Insurance will pay the insured a lump sum benefit up to $15,000 upon diagnosis of cancer, heart attack, stroke, end stage renal failure, major organ transplant, as well as other covered illnesses. This plan is individually owned and portable. The rate for this program will lock in based on the attained age at the time the policy is approved. This plan is underwritten and subject to pre existing condition.

Coverage Critical Illness

Critical Illness With Cancer Benefit Amount Up to $15,000 Conditions Percentage of lump sum 1st / 2nd OccuranceCancer type 1 100% / 50% (Invasive)Heart Attack 100% / 50% Kidney Failure 100% / 50% Organ Transplant 100% / 50% Stroke 100% / 50% Cancer type 2 25% / 0% (non-invasive) CABG* 25% / 0%

Spouse Benefit $5,000 or $10,000 lump sum benefit.Child Benefit** 50% of employees lump sum benefit.

Your plan also provides you with a wellness benefit for completing certin routine wellness screenings or procedures. The wellness benefit applies to the employee only. Please see the plan details page for specifics.

* Coronary Artery Bypass Graft (CABG)** Children 14 days to 23 years (25 if full time student)

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Northwestern Benefit Corporation of Georgia has been selected as Pyramid Consulting's broker and consultant for the employee benefit program. Northwestern Benefit Corporation of Georgia provides comprehensive employee benefits planning and represents all insurance carriers doing business in the marketplace. They will assist Pyramid Consulting with market analysis, including rate negotiations, plan design review, physician/provider network analysis, and employee contribution analysis. They will also assist with employee communication/education through meetings, problem resolution, employer support services and act as a reference resource regarding changing legislations and emerging trends in the benefits marketplace.

What will Northwestern Benefit do for you?

In order to help you get the most from your group benefits plans, Northwestern Benefit will assist you if you:

• Believe that your claim has not been paid properly

• Need further clarification on an insurance matter

• Have questions regarding a bill

• Have a question about a benefit

• Need help solving a benefit related problem

Your Northwestern Benefit Corporation of Georgia representative is ready to answer any of your benefits related questions.

WHO IS NORTHWESTERN BENEFIT CORPORATION?

Pam SmithIs your Benefit Services Specialist.Please contact her if you have any questions.

Phone: 404.846.3112Toll free: 800.304.6157Fax: 404.846.4085E-mail: [email protected]

Kristi KulisIs your Benefit Services Specialist.Please contact her if you have any questions.

Phone: 404.846.3131Toll free: 800.304.6157Fax: 404.846.3195E-mail: [email protected]

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CONTACT INFORMATION AND NOTES

Other Useful Contacts

Medical Cigna

Member Services: 1.888.84CIGNA www.cigna.com

Dental Cigna

Member Services: 1.888.84CIGNA www.cigna.com

Vision Humana

Member Services: 1.866.537.0229 www.humanavisioncare.com

Voluntary Life,

Critical Illness and Cancer Coverage Guardian

Member Services: 1.800.441.6455 www.guardianlife.com

STD & LTD

Cigna Member Services: 1.866.494.2111

www.cigna.com

Telemedicine FlexCare

Member Services: 1.800.TELA.DOC www.teladoc.com

COBRA Conexis

Member Services: 1.877.266.3947 www.conexismarketing.com

HSA Account

HSA Bank Member Services: 1.800.357.6246

www.mycigna.com | www.hsabank.com

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NOTES

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11100 Atlantis Place Alpharetta, GA 30022Phone: 678.514.3500 Toll-free: 877.248.0024 Fax: 678.840.2109

www.pyramidci.com