2. Benefit Effective Dates
ADP Total Source plan year is effective from June 1st to May 31st
each year
Deductible and out-of-pocket maximums are effective from
January 1st to December 1st each year
3. Making Changes to your Benefits
You can make changes to your Pre-Tax benefit elections during the
following times:
Open Enrollment
Employee would make changes during the Spring months for an
effective date of June 1st.
Qualifying Event under Section 125 of IRS Code
Employee must request Qualifying Event (QE) change and complete
required enrollment change forms no later than 60 days from the date
of the QE.
Examples of Qualifying Events:
Change in Marital Status such as marriage, divorce, separation
Addition in Dependents such as birth, adoption, court order
Change in Employment such as hiring, termination, beginning/ending of
unpaid leave
4. ABT Benefits Include:
ABT Employee
Paid Paid
Medical Insurance a
Dental Insurance a
Vision Insurance a
Disability Insurance a
Life Insurance a
401(k)/Profit Sharing a
Health Savings Account (HSA) If applicable
Flexible Spending Accounts (FSA) a
Voluntary Benefit Programs a
Employee Assistance Program (EAP) a
Special Discounts a
5. ABT Medical Health Plan Summary
UHC-CP S1-B UHC-HDHP S4A UHC-HDHP S4B UHC-ChHMO EDGE8DP
Traditional HDHP - A HDHP - B HMO
Employee Pays Employee Pays Employee Pays Employee Pays
$2,500 Individual $2,850 Individual $3,500 Individual $2,500 Individual
Deductible
$5,000 Family $5,700 Family $7,000 Family $7,500 Family
Out of Pocket Max $6,000 Individual $5,000 Individual $7,000 Individual $5,000 Individual
(Includes Deductible) $12,000 Family $10,000 Family $14,000 Family $10,000 Family
Coinsurance 70% 80% 80% 100%
PCP $25 Copay 80% after deductible 80% after deductible $30 Copay
$30 Copay / 80% after
Specialist Visit $50 Copay 80% after deductible 80% after deductible
deductible
100% after deductible +
Hospital 70% after deductible 80% after deductible 80% after deductible
$500
Emergency Room $150 Copay 80% after deductible 80% after deductible $250 Copay
Medications $10 Copay Deductible then $10 Deductible then $10 $15 Copay
Brand Name Drug $35 Copay Deductible then $35 Deductible then $35 $45 Copay
Non-Formulary $60 Copay Deductible then $60 Deductible then $60 $85 Copay
Employee’s Monthly
Contribution
Employee Only $0.00 $0.00 $0.00 $0.00
Employee + Spouse $433.00 $362.00 $312.00 $408.00
Employee + Child(ren) $379.00 $316.00 $272.00 $356.00
Employee + Family $798.00 $667.00 $574.00 $751.00
Employer Monthly HSA
$0.00 $62.00 $106.00 $0.00
Contribution
6. Traditional vs. High Deductible
Traditional Plan can mean less out of pocket for normal office visits and
emergencies.
If you choose the Traditional Plan (S1-B) :
1. One person cannot pay more than the individual deductible/out of
pocket
2. This plan has copays for PCP, Specialist, Urgent Care, Emergency
Room and Prescription Drugs
3. Routine preventive care and the associated lab work is paid at 100%
- you pay nothing out of pocket.
4. Lab work done for the purpose of a sick visit is subject to the
deductible and coinsurance (unless billed by your physician, in which
case it is covered by your copay).
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7. Traditional vs. High Deductible
High Deductible requires you to save money for doctor visits. You need to
be a disciplined saver.
If you choose one of the two High Deductible Plans (S4-A and S4-B)
remember:
1. The family limits apply to one person when the medical plan covers
more than one person. One person pays the full family deductible and
out of pocket maximum.
2. These plans do not have first dollar coverage for any services (other
than preventive care), meaning you pay the full deductible before UHC
begins paying a benefit.
3. Routine preventive care and the associated lab work is paid at 100% -
you pay nothing out of pocket.
4. Lab work done for the purpose of a sick visit is subject to the deductible
and coinsurance of the plan.
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8. HMO Plan
An HMO plan offers health care services that are provided by a Health Maintenance Organization.
An HMO is a network of doctors, hospitals, health care providers and pharmacies that offers
medical treatment at a reduced cost to members.
As a member of an Aetna HMO plan, you’ll be required to choose a primary care physician (PCP)
from a listing of doctors who are a part of the HMO network.
One important thing to remember about HMOs: you only have coverage with in-network
providers.
To find out if your provider is in-network, visit www.myuhc.com, select Find a Physician or
Facility, select UnitedHealthcare Select HMO and type in your providers name. Make sure the
Physician or Facility has a Two-Star Designation. See below for an example.
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9. Dental Options – Aetna PPO Max $1,000
Calendar Year Benefit Maximum $1,000
Preventive & Diagnostic Services 90% (deductible waived)
Basic / Restorative Services 60%
Major Services 50%
$1,000 (Maximum for children
Orthodontic Lifetime Maximum under age 20. Adult Ortho not
covered)
Calendar Year Individual Deductible $50
Calendar Year Familly Deductible $150
Per Pay Period Dental Premium (Voluntary Benefit)► Premium
Employee $11.95
Employee + Spouse $23.91
Employee + Child(ren) $25.62
Employee + Family $38.94
10. Vision Options
Benefit Copay Frequency
In-Network
Well Vision Examination $5 Once every 12 months
Single Vision, Lined Bifocal and $10 Once every 12 months
Lined Trifocal
Retail Allowance for Frames $180
Contact Lenses (instead of None Once every 12 months with an
glasses) allowance of $150
Lasik None $150 allowance for both eyes,
5-15% discount
Out-of Network
All Services N/A Services are reimbursed up to a
maximum amount depending on
service.
11. Per Pay Period
Deductions
Vision – VSP
Employee $2.88
Employee + Spouse $5.76
Employee + Children $6.17
Employee + Family $9.85
15. What are Flexible Spending Accounts (FSA)
• FSA’s are accounts that allow you to pay for certain medical and dependent
care expenses with pretax dollars.
• Employee contributions are deducted from each paycheck before Federal
Income and Social Security taxes are calculated.
• You will not pay taxes on eligible reimbursements.
• Contributions up to a $3,500 maximum in FSA Medical (thru 2012 enrollment).
Refer to your Summary Plan Description
16. Health Care FSA
• Allows you to pay for certain medically necessary expenses with pre-tax dollars.
• You may use the full plan year goal/pledge amount in your account. You are not
limited to your contributions to-date.
• Direct Deposit Reimbursements
18. Dependent Care FSA
Examples of eligible Dependent Care expenses are:
• Dependent Care costs for dependent under the age of 13
• Regardless of age if they are physically/mentally incapable of self care
Expenses for Dependent Care while at work include:
• Care provided in your home (not by another dependent)
• Qualified child care centers and after school programs
• Certified ‘away from home’ facilities (provided not more than 12 hours/day)
Note: Dependent Care FSA does NOT reimburse medical expenses
19. Employee Assistance Program (EAP)
NEW! 24-hour toll free number dedicated to
ADP TotalSource worksite employees: 1-888-231-7015
• All worksite employees and their dependents are eligible
• Initial assessment by an EAP counselor
• Referral to a provider best suited to deal with issue
• Up to 3 face-to-face visits annually with licensed, certified counselor
at no cost to individual
• Extensive Nationwide Network
• Voluntary and Confidential Service
• Assistance with Stress, Anxiety, Depression, Grief, ADD/ADHD, Eating
Disorders, Financial issues, Family Issues, Alcohol and Substance
Abuse Issues, Relationship Issues, Financial or Legal Counseling
20. Employee Personal Discounts
• Program offers discounts from brand name retailers
• Employees leverage ADP’s buying power to save money and time
• Discounts also available for your business needs
• Real Estate & Financial Services
• Sign up for premium-level savings on luxury brands**
** Available at a
modest monthly fee
21. About MyTotalSource.com
▪ Secure Access 24/7
▪ View your paycheck
▪ View your benefits
▪ View & change direct deposit, tax withholdings
& update your personal profile
▪ Link to the personal discount
programs
Notas del editor
Benefits are a significant component of your total compensation package, so let’s review the unique advantages you have as a participant in the ADP TotalSource Health & Welfare plan.