2. Welcome to ABT’s Open Enrollment for Plan Benefit Year 2013-2014.
This year we will still offer the Traditional Plan and both High-
Deductible Health Plans as we did last year but we are excited to
announce that we have added one additional Health Plan option for
you to choose from. We have added a HMO (Health Maintenance
Organization) Plan.
ADPTS plan year is effective from June 1st to May
31st
Deductible and out-of-pocket maximums are effective
from January 1st through December 31st.
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
7. 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 Per Pay
Period Contribution
Employee Only $0.00 $0.00 $0.00 $0.00
Employee + Spouse $199.85 $167.08 $144.00 $188.31
Employee + Child(ren) $174.92 $145.85 $125.54 $164.31
Employee + Family $368.31 $307.85 $264.92 $346.62
Employer Monthly HSA
$0.00 $62.00 $106.00 $0.00 **
Contribution
Refer to your Summary Plan Description ** ABT may match up to $22 per
month – see slide 20
8. Traditional vs. High Deductible
The 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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9. Traditional vs. High Deductible
High Deductible requires you to save money for doctor visits. You need to
be a disciplined saver. We recommend you use a Health Savings Account
to save for medical. There are many long-term tax advantages to the HSA.
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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10. 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 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, except in the case of having to go to Emergency.
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.
*** The stipulation for the HMO plan is the out of NC
employees that choose the Edge HMO can’t exceed
25% of the total group on benefits. For example is we
had 20 employees on benefits overall, we could have as
many as 5 on the Edge HMO that live out of state.
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12. 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
Refer to your Summary Plan Description
14. 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.
Refer to your Summary Plan Description
15. Per Pay Period
Deductions
Vision – VSP
Employee $2.88
Employee + Spouse $5.76
Employee + Children $6.17
Employee + Family $9.85
21. 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 $2,500 maximum in FSA Medical.
• If you select the HMO Health Plan, ABT may reimburse you up to $22.00 towards your FSA account.
Refer to your Summary Plan Description
22. 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
24. 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
26. Health Savings Accounts (HSA)
• HSA’s are accounts that allow you to pay for certain medical care expenses with pretax
dollars.
• With an HSA account, there is no requirement to spend the money within a certain time.
You can use it any time and take it with you when you retire or are no longer with ABT.
• Deposits to your HSA come directly from your paycheck, deposits made on your own or
from ABT. ABT contributes $62.00 per month if you select option HDHP-A and $106.00
per month if you select option HDHP-B to YOUR savings plan. This money is yours to
keep. The only requirement is that you open up an HSA account. Which comes with a
credit card you can use to pay medical bills with.
• HSA Contribution maximum limits for 2013 are $3,250 for Individuals and $6,450 for
Family.
• HSA catch-up contributions (age 55 or older) can be made any time during the year in
which the HSA participant turns 55. The catch-up contribution amount is $1,000.
Refer to your Summary Plan Description
27. Employee Assistance Program (EAP)
NEW! 24-hour toll free number dedicated to
ADP TotalSource worksite employees: 1-888-231-7015
We all need to talk to someone from time to time…
• 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
• All worksite employees and their dependents are eligible
• Up to 3 face-to-face visits annually with licensed, certified counselor
at no cost to the employee.
• Voluntary and Confidential Service. ABT has no knowledge of any use
of this service.
28. Employee Personal Discounts
• Program offers discounts from brand name retailers
• Cell phone discounts: Sprint-18%, AT&T-22%, Verizon-15%, T-mobile-10%
• Employees leverage ADP’s buying power to save money and time
• Real Estate & Financial Services
• Sign up for premium-level savings on luxury brands**
** Available at a
modest monthly fee
29. About MyTotalSource.com
▪ Secure Access 24/7
▪ View your paycheck
▪ View your benefits
▪ View & change direct deposit, tax withholdings
and update your personal profile
▪ Link to the personal discount
programs
▪ Access from your computer and your
smart phone or tablet
30. Who do I call with questions?
• Employee Service Center – 1-800-554-1802
• Specific Benefit Questions – Call the Providers listed on fact sheet for that plan.
• Greg Blackport – 1-336-553-0727
• Amy Shirley – 1-336-369-3675
When is the Due Date to complete enrollment?
• Monday, April 22, 2013
How do I elect my benefits?
You have two options to elect benefits:
• Log on at www.mytotalsource.com, select the Myself tab along the top, then select
Benefit Enrollment on the right side
• Call the Employee Service Center at 1-800-554-1802 and they can walk you through
enrollment
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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.