Download 2017 Employee Benefit Plans Renewal Booklet

GROUP PLANS
2017 Employee Benefit Plans Renewal Booklet
2017 Employee Benefit Plans Renewal Booklet
TABLE OF CONTENTS
2017 Plan Renewal Checklist ............................................................................................ 3
Online Resources for Employers ....................................................................................... 4
2017 Plan Changes and Updates ...................................................................................... 5
GuideStone Additional Benefits......................................................................................... 6
Build a Comprehensive Benefits Package.......................................................................... 7
Traditional PPO Plans.......................................................................................................... 8
Value Health 5000: GuideStone’s Economy PPO.............................................................. 11
Health Saver Plans .......................................................................................................... 13
Dental Plans...................................................................................................................... 15
Term Life and Accident Plans........................................................................................... 16
Disability Plans................................................................................................................. 17
Medicare-Coordinating Plans for Retirees ...................................................................... 18
2
2017 Plan Renewal Checklist
Use this checklist as your guide during the 2017 employee benefit plans renewal process.
REVIEW PLAN OPTIONS
Review this booklet and work with your relationship manager to design the best benefits strategy for your
organization.
REVIEW PLAN RATES
Review your 2017 Employee Benefit Rates Booklet, located in the Group Plans Re-enrollment section of
Employer Access Program (EAP).
DETERMINE YOUR PLAN SELECTIONS AND NOTIFY GUIDESTONE BY OCTOBER 13, 2016
• If you are renewing your program with no changes, simply notify your GuideStone relationship manager.
• If you are making plan changes, complete the customized Employer Annual Election Form, located in the
Group Plans Re-enrollment section of EAP.
–
Email the form to [email protected].
–
Fax to 1-866-692-6327 to the attention of your relationship manager by October 13, 2016.
–
You will receive a confirmation email from GuideStone once your elections have been received. It can
take up to three business days for your form to be processed.
REVIEW IMPORTANT NOTICES
Download notices directly from the Important Notices brochure or the Group Plans Re-enrollment section of EAP.
CONDUCT AN EMPLOYEE MEETING
In mid-October conduct a meeting to discuss changes, including details in coverage and plan offering changes,
and distribute required notices to your employees. Also provide the customized Employee Annual Change
Request form located in the Group Plans Re-enrollment section of EAP. Your employees will use this form to
complete any plan changes they wish to make for 2017.
SUBMIT EMPLOYEE ELECTIONS BY NOVEMBER 10, 2016
• If your employee is not making changes, do not submit the Employee Annual Change Request form.
–
If your employee makes a plan change for 2017, please submit the Employee Annual Change Request
form
»»
»»
»»
Via online: GuideStone.org/Re-enrollGroupPlans
By mail: GuideStone Financial Resources
Attn: Group Plans
2401 Cedar Springs Road
Dallas, TX 75201-1498
By fax: 1-866-692-6327
Important reminder: Due to HIPAA requirements, do not send the Employee Annual Change Request
form via email.
You can find an International Renewal Booklet, International Group Plans Enrollment Form and International
Employee Annual Change Request in the Group Plans Re-enrollment section of EAP. You can also find all
international notices in Important Notices.
3
Online Resources for Employers
We’re making employee benefits administration easy for you.
GuideStone.org/Re-enrollGroupPlans
• Access resources detailing program changes.
• Find documents to help your employees
enroll or change coverage.
• Submit your employees’ re-enrollment
elections with our web-based form.
SIMPLIFY YOUR ADMINISTRATIVE DUTIES
GuideStone.org/EmployerAccess
•
•
•
•
Access re-enrollment rates, forms and additional materials.
Pay your monthly bill.
Schedule and run reports.
Report employee salary changes.
FIND THE TOOLS YOU NEED
GuideStone.org/EmployerTools
•
•
•
•
Download important forms to distribute to employees.
Find documents to help your employees enroll or change coverage.
Review the Plan Administration Manual.
Access benefit information to distribute to employees.
HELP YOUR EMPLOYEES GET THE MOST FROM THEIR INSURANCE PLANS
GuideStone.org/GetTheMost
• Learn more about ID cards, prior authorization and more.
• Find answers to frequently asked questions about plan coverage.
• Take advantage of helpful tips to find more value in your plan.
STAY INFORMED ABOUT HEALTH CARE REFORM
GuideStone.org/HealthCareReform
•
•
•
•
4
Health Plan Information Reporting Fact Sheet with reference chart.
Learn how health care reform affects church plans.
Stay up-to-date with email alerts.
Find answers to frequently asked questions about the law.
2017 Plan Changes and Updates
MEDICAL PLANS
• Rates: Your 2017 Group Plans medical rates are available in the 2017 Employee Benefit Plans Rate Booklet
located in EAP.
BENEFIT CHANGES
• ID Cards: All participants will receive new ID cards.
• PPO Co-pay Changes: All plans now have the following co-pays:
– $10 / telemedicine
– $25 / primary care/retail clinic
– $45 / specialist
– $45 / chiropractic services
– $25 / mental health office and professional services
– $25 / comprehensive routine eye exam
• Emergency Room Co-pay Changes:
– All PPO plans now have a $250 emergency room co-pay.
• Health Saver 3000: The Health Saver 3000 is now a 90%/10% plan.
• Maximum Out-of-Pocket Adjustments:
– The maximum one individual may contribute to a family’s maximum out-of-pocket is now $7,150 for
individuals in the Health Saver 2800, Health Saver 3000 and Health Saver 5000.
– Several of the PPO plans have new maximum out-of-pocket limits. Please refer to GuideStone.org/ReenrollGroupPlans for additional details.
• Out-of-Network Charges:
– The out-of-network co-insurance maximums will increase on all plans, except Value Health 5000.
– The annual co-insurance maximum is now $20,000 for an individual or a family for Cigna Global
participants seeking out-of-network care in the United States.
• Medicare Part D Creditable/Non-creditable Status: GuideStone’s health plans are evaluated each year
using the latest standards and methods to determine creditable coverage. For 2017, all plans except the
Value Health 5000 meet the requirements of creditable coverage for Medicare Part D.
PRESCRIPTION DRUG PLAN
• The PPO generic mail order co-pay decreased to $30.
• For all plans, after two retail fills of maintenance medications, there will be a $10 retail price increase.
Maintenance medications filled through Express Scripts home delivery will not be subject to the $10
increase. Oral contraceptives and other preventive medications defined by the Affordable Care Act and
covered by your GuideStone plan are exempt from the $10 increase. Additional details and examples of
how this change will affect your prescriptions can be found at GuideStone.org/HomeDelivery.
DENTAL PLANS
• Rates: Your 2017 dental plan rates are available in the 2017 Employee Benefit Plans Rate Booklet located
on EAP.
• Benefit Changes: Dental plans will now cover missing tooth replacement after the standard waiting
periods are met.
TERM LIFE, ACCIDENT AND DISABILITY PLANS
• There are no changes in GuideStone’s term life, accident and disability plans for 2017.
Please refer to GuideStone.org/Re-enrollGroupPlans for plan benefits and additional
information about the 2017 plan changes.
5
GuideStone Additional Benefits
Listed below are a few of the additional benefits that come with your GuideStone medical, dental,
term life and accident plans. For a list of all additional benefits, visit GuideStone’s Additional
Benefits web page. Please refer to your plan booklet for availability with your particular plan
and additional details.
HIGHMARK BCBS
MyCare Navigator — (1-888-BLUE-428) Your dedicated health advocate: MyCare Navigator can help your employees
find the right doctor, schedule appointments and much more.
Care Cost Estimator — Members can comparison shop for more than 1,600 common health care services, including
office visits. There are also options to plan for care choices and manage budgets. Log into your Highmark BCBS
account for details.
Teladoc — 1-800-TELADOC (1-800-835-2362) Most GuideStone PPO and HDHP medical plans include this telemedicine
option. Our alliance with Teladoc means you’ll have access to U.S. board-certified doctors and pediatricians all day,
every day — even holidays.
BlueCard World Wide — (1-800-810-BLUE) Employees traveling outside the United States have access to doctors
and hospitals in more than 200 countries and territories around the world.
Blue 365 — This is a member discount program that can help your employees save on products and services that
are not part of their insurance coverage.
All Clear ID — (1-855-229-0079) Highmark BCBS provides AllClear ID to help members who are victims of identity
theft. If you are enrolled in a Highmark BCBS health plan, you’re automatically enrolled in AllClear ID.
CIGNA DENTAL
Oral Health Integration Program (OHIP) — Enhanced benefits, including additional evaluations and preventive
treatments, may be available for participants who are pregnant or have been diagnosed with or treated for one
of the following health issues: cardiovascular disease, diabetes, stroke, head and neck cancer radiation, organ
transplants or chronic kidney disease.
Cigna Healthy Rewards® — Access discounts on a wide range of health and wellness products and programs.
Benefits include weight management programs; massage therapy; acupuncture; vision discounts on contacts,
glasses and frames; fitness club memberships and much more.
TERM LIFE AND ACCIDENT
Life Planning Financial & Legal Resources — This objective and personalized professional counseling service
includes one-on-one financial counseling, a written personal financial plan and access to Ceridian-licensed
counselors for your survivors in the event of your death or the diagnosis of a terminal illness.
Assist America — A 24-hour network of emergency medical and legal resources offering worldwide emergency
assistance to active employees and their families who are traveling.
Accelerated Death Benefit — Allows terminally ill participants with a life expectancy of 12 months or less to
receive up to 50% of the death benefit ($250,000 maximum) prior to death. Contact GuideStone for details.
DISABILITY
Survivor Benefits — If you die after receiving disability benefits for 180 or more consecutive days, your survivor
will receive a lump sum payment of three times your last month’s gross disability benefit.
­ ehabilitation and Return to Work Program — To encourage individuals to return to work as soon as they
R
become physically able, individuals receive an additional benefit for participating in a rehabilitation program.
6
Build a Comprehensive
Benefits Package
Are you giving your employees access to plans that fully protect their families? Talk with your
relationship manager about rounding out your employee benefits package with the products
listed below.
DENTAL
Dental plans designed to balance benefits and costs — that’s worth a smile! With three plan options, you can find
one to fit your ministry’s budget. All plans give you access to Cigna’s expansive nationwide dental network.
TERM LIFE AND ACCIDENT PLANS
Term life insurance is designed primarily to provide a financial safety net for your employees’ families during their
most crucial income-earning years. With stable rates for more than a decade, GuideStone’s term life plans can help
you protect your employees’ financial security — and their entire family.
Spouse, child and additional, optional employee term life coverages also are available at affordable rates. Adding
Accidental Death and Dismemberment (AD&D) or accident coverage can strengthen that protection — often for
just pennies a day.
SHORT- AND LONG-TERM DISABILITY
One in four workers will become disabled during their career, according to the Social Security Administration.
Disability insurance protects your employees’ paycheck, replacing a portion of their income during a disability.
Choose from our three short-term and long-term disability plans. You can coordinate short- and long-term disability
coverage to provide maximum protection for your employees.
VISION BENEFITS BY DAVIS VISION
GuideStone works exclusively with Davis Vision, one of the nation’s largest vision plan providers, to make it
affordable for you to offer Group Plans vision coverage. Davis Vision is an industry leader who has been providing
vision benefits for more than 50 years.
LONG-TERM CARE SOLUTIONS
At least 70% of people age 65 and older will require some long-term care services at some point in their lives,
according to the U.S. Department of Health and Human Services. When choosing long-term care, planning ahead
is crucial. GuideStone has selected ACSIA Partners to provide education and solutions.
Your employees may be eligible for reduced rates and a simpler underwriting process. For more information, visit
ACSIA Partners’ website, LTCGuideStone.com, or call 1-877-582-4478.
MINISTRYWORKS PAYROLL SERVICES
GuideStone has teamed up with MinistryWorks® by Brotherhood Mutual, a ministry-exclusive service offering
payroll processing and payroll tax filing. MinistryWorks will also handle the required Affordable Care Act reporting
to ensure that you avoid penalties by staying in compliance with the law.
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Traditional PPO Plans
A preferred provider organization (PPO) plan allows your employees to receive a higher level of
benefits when they use participating doctors and health care facilities.
GuideStone provides comprehensive medical and prescription benefits designed to respect Christian convictions,
including sanctity of life. We offer the Blue Cross Blue Shield nationwide network, which is one of the largest in
the country.
Effective January 1, 2017
MEDICAL
BENEFITS
HEALTH
CHOICE
50001
HEALTH
CHOICE
40001
HEALTH
CHOICE
30001
HEALTH
CHOICE
25001
HEALTH
CHOICE
2000
HEALTH
CHOICE
1500
HEALTH
CHOICE
1000
HEALTH
CHOICE
500
Annual deductibles:
individual/family
$5,000/
$10,000
$4,000/
$7,000
$3,000/
$5,000
$2,500/
$5,000
$2,000/
$4,000
$1,500/
$3,000
$1,000/
$2,000
$500/
$1,000
$0/$0
Plan pays/individual
pays (co-insurance)
(after deductible)
70%/30%
or
80%/20%
80%/20%
70%/30%
or
80%/20%
80%/20%
80%/20%
80%/20%
80%/20%
80%/20%
80%/20%
Maximum out-ofpocket (medical
and prescription):
individual/family
(in-network services
only, including deductible, co-pays and
co-insurance)
$6,950/
$13,000
$6,950/
$12,700
$6,950/
$12,000
$6,950/
$11,000
$6,950/
$11,000
$6,750/
$10,000
$6,350/
$9,000
$6,000/
$7,500
$5,000/
$6,000
100%
100%
100%
100%
100%
100%
100%
100%
100%
$25/$45
$25/$45
$25/$45
$25/$45
$25/$45
$25/$45
$25/$45
$25/$45
$25/$45
$10
$10
$10
$10
$10
$10
$10
$10
$10
$50
$50
$50
$50
$50
$50
$50
$50
$50
Outpatient services
(CT scan, MRI, diagnostic) (after
deductible)
70% or
80%
80%
70% or
80%
80%
80%
80%
80%
80%
80%
Hospital inpatient
(including maternity) and outpatient
surgery facility (after
deductible)
70% or
80%
80%
70% or
80%
80%
80%
80%
80%
80%
80% after
$100 co-pay
Wellness and
preventive care
visit (in-network,
per Preventive Care
Schedule) (no co-pay)
Primary care or retail
clinic visit/specialist
visit co-pay
Telemedicine co-pay2
HEALTH
TODAY
Urgent care co-pay
See footnotes on page 11.
8
Traditional PPO Plans (continued)
MEDICAL
BENEFITS
Emergency room
services (per visit)
(deductible does not
apply)
Emergency room
services – care for
non-emergencies
(viewed as hospital
inpatient/outpatient charge) (after
deductible)
HEALTH
CHOICE
50001
HEALTH
CHOICE
40001
HEALTH
CHOICE
30001
HEALTH
CHOICE
25001
HEALTH
CHOICE
2000
HEALTH
CHOICE
1500
HEALTH
CHOICE
1000
HEALTH
CHOICE
500
HEALTH
TODAY
70% or
80% after
70% or
80% after
80% after
80% after
80% after
80% after
80% after
80% after $250 co-pay 80% after $250 co-pay $250 co-pay $250 co-pay $250 co-pay $250 co-pay $250 co-pay
$250 co-pay
$250 co-pay
70% or
80%
80%
70% or
80%
80%
80%
80%
80%
80%
80% after
$100 co-pay
• Inpatient/
intensive
outpatient
services (after
deductible)
70% or
80%
80%
70% or
80%
80%
80%
80%
80%
80%
80% after
$100 co-pay
• Office and
professional
services co-pay
$25
$25
$25
$25
$25
$25
$25
$25
$25
Chiropractic services
co-pay (20 visits
annually)
$45
$45
$45
$45
$45
$45
$45
$45
$45
Comprehensive routine eye exam co-pay
(one exam every 12
months)
$25
$25
$25
$25
$25
$25
$25
$25
$25
Mental health/
substance abuse:
See footnotes on page 11.
9
SPECIALTY
MAIL ORDER
RETAIL
Traditional PPO Plans (continued)
PRESCRIPTION
DRUG
BENEFITS3,4,5
HEALTH
CHOICE
50001
HEALTH
CHOICE
40001
HEALTH
CHOICE
30001
HEALTH
CHOICE
25001
HEALTH
CHOICE
2000
HEALTH
CHOICE
1500
HEALTH
CHOICE
1000
HEALTH
CHOICE
500
HEALTH
TODAY
Generic drug co-pay
$15
$15
$15
$15
$15
$15
$15
$15
$15
Preferred drug
co-pay6
$50
$50
$50
$50
$50
$50
$50
$50
$50
Non-preferred drug
co-pay6
$75
$75
$75
$75
$75
$75
$75
$75
$75
PRESCRIPTION
DRUG
BENEFITS3,4,5
HEALTH
CHOICE
50001
HEALTH
CHOICE
40001
HEALTH
CHOICE
30001
HEALTH
CHOICE
25001
HEALTH
CHOICE
2000
HEALTH
CHOICE
1500
HEALTH
CHOICE
1000
HEALTH
CHOICE
500
HEALTH
TODAY
Generic drug co-pay
$30
$30
$30
$30
$30
$30
$30
$30
$30
Preferred drug
co-pay6
$100
$100
$100
$100
$100
$100
$100
$100
$100
Non-preferred drug
co-pay6
$150
$150
$150
$150
$150
$150
$150
$150
$150
PRESCRIPTION
DRUG
BENEFITS3,4,5
HEALTH
CHOICE
50001
HEALTH
CHOICE
40001
HEALTH
CHOICE
30001
HEALTH
CHOICE
25001
HEALTH
CHOICE
2000
HEALTH
CHOICE
1500
HEALTH
CHOICE
1000
HEALTH
CHOICE
500
HEALTH
TODAY
Specialty generic
drug co-pay (up to
30-day supply)
$50
$50
$50
$50
$50
$50
$50
$50
$50
Specialty preferred
drug co-pay (up to
30-day supply)6
$75
$75
$75
$75
$75
$75
$75
$75
$75
Specialty nonpreferred drug
co-pay (up to 30-day
supply)6
$100
$100
$100
$100
$100
$100
$100
$100
$100
These plans do not constitute “creditable coverage” for Massachusetts residents.
1
Teladoc operates subject to state regulation and may not be available in certain states.
2
If the cost of the prescription is less than the co-pay, the participant pays the full cost of the prescription.
3
Retail available as 30-day supply, mail order as 90-day supply and specialty as 30-day supply through mail order.
4
Retail co-pays increase $10 after the 2nd retail fill of maintenance drugs. The co-pay increase does not accumulate toward the deductible or the maximum out-ofpocket limit.
5
If a non-generic drug is purchased when a generic is available, the participant must pay the generic co-pay plus the increase in drug cost of the non-generic drug
over its generic equivalent. The increase in drug cost does not accumulate toward the deductible or the maximum out-of-pocket limit.
6
10
Value Health 5000:
GuideStone’s Economy PPO
Value Health 5000 is an economy PPO plan offering exceptional coverage at a lower monthly rate
than most traditional PPO plans. Designed to offer protection from the full cost of catastrophic
claims, Value Health 5000 includes 100% coverage for certain wellness benefits and a more
limited coverage for doctor visits, prescription drugs and other health care services.
As our lowest-cost plan, it can be the right choice for healthy groups. It is also an alternative to Christian medical
sharing ministries. (For additional comparison information, please see Is a Medical Sharing Ministry the Best Use
of Your Health Coverage Dollars?)
As our lowest-cost health plan, it provides the excellent protection your employees need while lessening the impact
on your ministry’s budget.
HOW IS THIS PLAN DIFFERENT?
• Combined medical and prescription deductible: Participants pay 100% of medical and prescription
claims until they reach their deductible, at which time the plan begins to pay benefits.
• Co-pays for occasional doctor visits: Each person has three co-pay visits annually per visit type — at a
primary care/retail clinic for $60, at a specialist for $70 or at an urgent care for $120. For every additional
visit, the deductible applies and participants pay a 30% co-insurance. Telemedicine co-pays are $10 for each
use with unlimited consultations.
• Prescription drug benefits: After participants meet the combined medical and prescription deductible,
then they pay a co-pay for retail and mail-order prescriptions (see chart).
• No coverage for chiropractic or vision services: Participants are responsible for paying the full cost for
these services.
Effective January 1, 2017
MEDICAL BENEFITS
Annual deductibles: individual/family3
Plan pays/individual pays (co-insurance) (after deductible)
$5,000/$10,000
70%
Maximum out-of-pocket (medical and prescription): individual/
family (in-network services only, including deductible, co-pays
and co-insurance)
$7,150/$14,300
Wellness and preventive care visit (in-network, per Preventive
Care Schedule) (no deductible)
100%
Primary care or retail clinic/specialist/urgent care visit accumulates (per person)
$60/$70/$120 co-pay for visits
1–3; additional visits 70%
co-insurance after deductible
Telemedicine4
$10 co-pay (unlimited)
Outpatient services (CT scan, MRI, diagnostic) (after deductible)
70%
Hospital inpatient (including maternity) and outpatient surgery
facility (after deductible)
70%
See footnotes on page 13.
11
VALUE HEALTH 50001,2
Value Health 5000:
GuideStone’s Economy PPO
(continued)
Effective January 1, 2017
MEDICAL BENEFITS
VALUE HEALTH 50001,2
Emergency room services (per visit) (after deductible)
70%
Emergency room services – care for non-emergencies (viewed
as hospital inpatient/outpatient charge) (after deductible)
70%
Mental health/substance abuse (after deductible)
70%
PRESCRIPTION DRUG BENEFITS3,5,6
RETAIL
Individual/family deductibles
$5,000/$10,000
Generic drug co-pay
$25 after deductible
Preferred drug co-pay7
$50 after deductible
Non-preferred drug co-pay7
$75 after deductible
PRESCRIPTION DRUG BENEFITS3,5,6
MAIL ORDER
Individual/family deductibles
VALUE HEALTH 50001,2
$5,000/$10,000
Generic drug co-pay
$60 after deductible
$125 after deductible
Preferred drug co-pay7
Non-preferred drug co-pay (up to 30-day supply)
$185 after deductible
PRESCRIPTION DRUG BENEFITS3,5,6
VALUE HEALTH 50001,2
7
Individual/family deductibles
SPECIALTY
VALUE HEALTH 50001,2
$5,000/$10,000
Specialty generic drug co-pay
70% after deductible
Specialty preferred drug co-pay
70% after deductible
Specialty non-preferred drug co-pay (up to 30-day supply)7
70% after deductible
7
This plan does not constitute “creditable coverage” for Massachusetts residents.
1
This plan is not considered “creditable coverage” under Medicare Part D for active participants age 65 and older. Participants in this
plan could incur late enrollment penalties from Medicare.
2
Plan deductible must be met before co-insurance applies. The maximum out-of-pocket limit includes the deductible and co-insurance
for eligible, in-network services.
3
Teladoc operates subject to state regulation and may not be available in certain states.
4
Retail available as 30-day supply, mail order as 90-day supply and specialty as 30-day supply through mail order.
5
Retail co-pays increase $10 after the 2nd retail fill of maintenance drugs. The co-pay increase does not accumulate toward the
deductible or the maximum out-of-pocket limit.
6
If a non-generic drug is purchased when a generic is available, the participant must pay the generic co-pay plus the increase in drug
cost of the non-generic drug over its generic equivalent. The increase in drug cost does not accumulate toward the deductible or the
maximum out-of-pocket limit.
7
12
Health Saver Plans
GuideStone’s Health Saver plans are federally-qualified High Deductible Health Plans (HDHPs),
which are designed to be paired with a tax-advantaged Health Savings Account (HSA). The
Health Saver plans provide a consumer-directed option, intended to help your employees become
savvier health care consumers.
Note: If you do not intend to pair the Health Saver plans with an HSA, they may not be the right
plans for your organization.
HOW ARE THESE PLANS DIFFERENT?
• Health Saver plans do not have co-pays for doctor visits and prescription drugs. Participants pay 100% of
medical and prescription drug claims until they’ve reached the plan’s deductible; then the plan pays at the coinsurance level.
• Participants are required to pay the full $40 consultation fee for telemedicine until they have met their
deductible requirements.
• If an employee has individual-only coverage, he or she must meet the individual deductible before any claims
will be paid by GuideStone, and then the individual maximum out-of-pocket limit applies before claims will
be paid at 100%. If an employee has coverage with one or more dependents, the employee and his or her
dependents must meet the plan’s family deductible before any claims will be paid for anyone in the family,
and then the family maximum out-of-pocket limit applies. However, an individual is not required to contribute
more than the ACA limit of $7,150.
THE HSA ADVANTAGE
An HSA is an investment vehicle that allows for an individual to invest money on a pretax basis for eligible medical
expenses. You may only open an HSA and make contributions to it if you are enrolled in a qualified HDHP.
Employers can help offset the impact of no co-payments by offering contributions to their employees’ HSA accounts.
The HSA has a triple tax advantage, established by the IRS:
1. Participants are not taxed on contributions.
2. Earnings from contributions are not taxed.
3. Withdrawals are not taxed, as long as they are used for qualified medical expenses.
Participants may not open an HSA if they are:
• Covered by any non-qualified health plan (PPO plan with co-pays)
• Enrolled in Medicare
• Claimed as a dependent on another individual’s tax return
For more information about an HSA available through Highmark, visit HighmarkBCBS-HSA.com.
13
Health Saver Plans (continued)
Effective January 1, 2017
HEALTH SAVER
28001,2
HEALTH SAVER
30001,2
HEALTH SAVER
50001,2
$2,800/$5,600
$3,000/$6,000
$5,000/$10,000
80%/20%
90%/10%
100%/0%
$5,800/$11,6003
$6,000/$12,0003
$5,000/$10,0003
Wellness and preventive care (in-network, per
Preventive Care Schedule) (no deductible)
100%
100%
100%
Primary care or retail clinic/specialist visit
80%
90%
100%
Telemedicine4
80%
90%
100%
Urgent care
80%
90%
100%
Outpatient services (CT scan, MRI, diagnostic)
80%
90%
100%
Hospital inpatient (including maternity) and outpatient
surgery facility
80%
90%
100%
Emergency room services (per visit)
80%
90%
100%
Emergency room services – care for non-emergencies
(viewed as hospital inpatient/outpatient charge)
80%
90%
100%
Mental health/substance abuse
80%
90%
100%
Chiropractic services (20 visits annually)
80%
90%
100%
Prescription drug program5,6,7
80%
90%
100%
MEDICAL BENEFITS
Annual deductibles: individual/family
Plan pays/individual pays (co-insurance) (after
deductible)
IN-NETWORK
Maximum out-of-pocket (medical and prescription):
individual/family (in-network services only, including
deductible, co-pays and co-insurance)
These plans do not constitute “creditable coverage” for Massachusetts residents.
1
Plan deductible must be met before co-insurance applies. The maximum out-of-pocket limit includes the deductible and co-insurance
for eligible, in-network services.
2
Maximum out-of-pocket for family coverage: An individual is not required to contribute more than the ACA limit of $7,150.
3
Teladoc operates subject to state regulation and may not be available in certain states. Participants are required to pay the full $40
consultation fee until they have met their deductible/co-insurance requirements.
4
Retail available as 30-day supply, mail order as 90-day supply and specialty as 30-day supply through mail order.
5
Retail cost increases $10 after the 2nd retail fill of maintenance drugs. The cost increase does not accumulate toward the deductible
or the maximum out-of-pocket limit.
6
If a non-generic drug is purchased when a generic is available, the participant must pay the generic co-pay plus the increase in drug
cost of the non-generic drug over its generic equivalent. The increase in drug cost does not accumulate toward the deductible or the
maximum out-of-pocket limit.
7
14
Dental Plans
Offering a dental plan to your employees can help them budget for their family’s dental care and
make better health choices.
Effective January 1, 2017
PREMIER DENTAL
CARE PLAN
CHOICE DENTAL
CARE PLAN
CIGNA DENTAL
CARE DHMO
PLAN
Employee only
$39.33
$29.13
$26.66
Employee + spouse
$80.45
$56.96
$45.11
Employee + child(ren)
$80.45
$56.96
$62.99
Employee + family
$137.34
$104.16
$74.07
MONTHLY RATES
DENTAL PLAN BENEFIT COMPARISON
PREMIER DENTAL
CARE PLAN1
CHOICE DENTAL
CARE PLAN1
CIGNA DENTAL CARE
DHMO PLAN3,4
Providers
May use any provider
or save with network
providers
May use any provider
or save with network
providers
Must use only providers
in the network
$50
$50
No deductible
Annual maximum benefit (per person)
$1,500
$1,200
No annual maximum
Preventive and diagnostic care (Class I)
100%
90%
$5 office visit co-pay +
applicable fee (if any)3
Basic restorative care (Class II)
80%
70%
$5 office visit co-pay +
applicable fee (if any)3
Major restorative care (Class III)
50%
50%
$5 office visit co-pay +
applicable fee (if any)3
Orthodontia (Class IV)
50% with a lifetime
maximum benefit of
$1,000
50% with a lifetime
maximum benefit of
$1,000
$5 office visit co-pay +
applicable fee (if any)3
Waiting periods
6 to 24 months for
certain services
6 to 24 months for
certain services
None
Deductible (per person per year)2
Coverage percentages are based on reasonable and customary charges.
Deductibles apply to basic and major services for the Premier Dental Care and Choice Dental Care plans.
3
Fees are based on the Cigna Dental Care DHMO Plan Patient Charge Schedule (K1-V9).
4
Cigna Dental Care DHMO Plan participating dentists are not available in all areas.
1
2
HELPFUL PLANNING TIPS:
• The Premier Dental Care Plan and the Choice Dental Care Plan both allow you to use any provider and
receive benefits. However, the plans also allow you to take advantage of cost savings through Cigna’s dental
network.
• With the Cigna Dental Care DHMO Plan (not available in all areas), you must select a primary care provider
or dental office in the Cigna Dental Care DHMO network to receive benefits.
• To find a PPO or HMO dental network provider in your area, call 1-800-CIGNA24 or visit mycigna.com.
• Based on your effective date of coverage under the Premier Dental Care and Choice Dental Care plans, the
following waiting periods apply:
– 6 months — Endodontic services, denture adjustments and, for children under 16 years of age, stainless
steel or plastic crowns
– 12 months — Complex oral surgery, periodontic services or orthodontic services
– 24 months — Crowns, inlays, onlays, labial veneers and partial or full dentures
15
Term Life and Accident Plans
Nearly seven in 10 American households would be in immediate financial jeopardy if the primary
income provider died, according to LIMRA, an industry research group. And fewer than half of
all American households have life insurance — a 50-year low.
Help your employees protect their families’ financial security with GuideStone’s term life and accident
insurance plans.
Effective January 1, 2017
EMPLOYEE TERM LIFE PLAN1
Coverage amounts
Guaranteed standard issue is $5,000 increments from $10,000 to $50,000, a flat amount of $100,000, or one to four
times annual salary. Additional term life coverage is also available with medical underwriting.
Coverage maximum
Lesser of eight times salary or $750,000
Benefit reduction at age 65
(active employee)
Reduces to 65% of current amount (but will not reduce below $20,000)
Retirement
Maximum of $20,000 or coverage amount at retirement, whichever is less
SPOUSE TERM LIFE PLAN1
Coverage amounts
$5,000 increments
Coverage maximum
50% of Employee Term Life Plan coverage up to a maximum benefit of $250,000
CHILD TERM LIFE PLAN1
Coverage amounts
$10,000
Coverage maximum
Coverage continues to age 26
ACCIDENTAL DEATH AND DISMEMBERMENT (AD&D) (EMPLOYEE ONLY)1
Benefit
Pays you or your beneficiary if you die or suffer a specified loss (eyesight, speech, hearing, hand or foot) in an accident
Coverage amount
Equals Employee Term Life Plan benefit amount
SUPPLEMENTAL ACCIDENTAL DEATH AND DISMEMBERMENT (EMPLOYEE AND SPOUSE)1
Benefit
Pays you or your beneficiary if you die or suffer a specified loss (eyesight, speech, hearing, hand or foot) in an accident
Employee coverage amount
$25,000 increments up to a maximum of $500,000
Spouse coverage amount
50% of employee coverage amount
Plans are not available to participants working in the following countries: Afghanistan, Algeria, Central African Republic, Chad, Congo, East
Timor, Eritrea, Iran, Iraq, Kenya, Lebanon, Pakistan, Somalia, South Sudan, Sudan, Syria, Tanzania, Uganda, Uzbekistan or Yemen.
1
16
Disability Plans
One in three workers will become disabled before retirement — most by a disability caused by a
common illness like joint pain, cancer and chronic diseases. Having disability insurance allows
your employees to protect their most valuable financial asset — their paycheck.
Effective January 1, 2017
LONG-TERM DISABILITY PLANS1
ECONOMY
CHOICE
PREMIER
Elimination period
180 days
90 days
90 days
Benefit percentage
Up to 60% of monthly
earnings
Up to 60% of monthly
earnings
Up to 60% of monthly
earnings
$7,500 per month
$15,000 per month
$15,000 per month
2 years own
occupation
2 years own
occupation
3 years own
occupation
Family
Family
Self
Self-reported mental/nervous limitation
12 months
12 months
24 months
Rehabilitation & Return to Work Program
Included
Included
Included
Maximum benefit period
ADEA I
ADEA I
ADEA II
Maximum monthly benefit
Definition of disability
Social Security integration
For more information regarding the Age Discrimination Employment Act (ADEA), please visit our Disability
FAQs on GuideStoneInsurance.org.
Effective January 1, 2017
SHORT-TERM DISABILITY PLANS2
ECONOMY3
CHOICE
PREMIER
Elimination period
14 days
7 days
7 days
Benefit percentage
Up to 60% of weekly
earnings
Up to 60% of weekly
earnings
Up to 60% of weekly
earnings
24 weeks
12 weeks
12 weeks
Minimum weekly benefit
$25 per week
$25 per week
$25 per week
Maximum weekly benefit
$500 per week
$500 per week
$500 per week
Any sickness or injury
that prevents active
work for more than
14 days
Any sickness or injury
that prevents active
work for more than
7 days
Any sickness or injury
that prevents active
work for more than
7 days
Maximum period of benefits
Definition of disability
Long term disability plans are not available to participants working in the following countries: Afghanistan, Algeria, Central African Republic,
Chad, Congo, East Timor, Eritrea, Iran, Iraq, Kenya, Lebanon, Pakistan, Somalia, South Sudan, Sudan, Syria, Tanzania, Uganda, Uzbekistan or
Yemen.
2
Short-term disability plans are only available within the United States.
3
The Economy Short Term Disability Plan has a longer benefit period than the Choice and Premier Short Term Disability plans to provide
benefits throughout the longer elimination period under the Economy Long Term Disability Plan.
1
17
Medicare-Coordinating Plans for Retirees
Our Medicare-coordinating plans combine one-stop convenience with a great price.
They include both medical and prescription drug coverage. Choose which one works best for you.
SENIOR PLUS PLAN OR CARE PLUS PLAN MEDICAL BENEFITS
Effective January 1, 2017
PLAN FEATURE
MEDICARE SERVICES — PART A
Hospital stay
• 100% days 1–60
(after deductible)
• Costs over $322/day
for days 61–90
• Costs over $644/day
for days 91–150
PLAN PAYS
• 50% of Part A
deductible (for
every benefit
period)
YOU PAY
• $644 (50% of the
Part A deductible)
• $322/day for days
61–90
• $644/day for days
91–150 (lifetime
reserve days)
• 100% after reserve
days are depleted
Skilled nursing facility • 100% days 1–20
care
• Costs over $161/day
for days 21–100
PLAN FEATURE
MEDICARE SERVICES
— PART B
MEDICARE PAYS1
MEDICARE PAYS1
• All costs after 150
days
• Not a covered
benefit
• $161/day for days
21–100
• 100% after 100 days
PLAN PAYS
YOU PAY
Medical services and
supplies
• 80% of Medicare• Remaining 20% of • $166 (Part B
approved amounts for Medicare-approved
deductible)
covered services
amounts for
covered services
Clinical laboratory
services/tests for
diagnostic procedures
• 100% of Medicare• Nothing (Medicare
approved amounts for covers at 100%)
covered services
• Costs above
Medicare-approved
amounts or services
not covered by
Medicare
Medicare payment amounts are based on the 2016 schedule. The 2017 schedule will be updated
by Medicare in October 2016, which may result in changes.
1
18
Medicare-Coordinating Plans for Retirees
(continued)
SENIOR PLAN OR CARE BASIC PLAN MEDICAL BENEFITS
Effective January 1, 2017
PLAN FEATURE
MEDICARE SERVICES — PART A
Hospital stay
• 100% days 1–60
(after deductible)
• Costs over $322/day
for days 61–90
• Costs over $644/
day for days 91–150
(lifetime reserve
days)
PLAN PAYS
• 50% of Part A
deductible (for
every benefit
period)
YOU PAY
• $644 (50% of the
Part A deductible)
• $322/day for days
61–90
• $644/day for days
91–150 (lifetime
reserve days)
• 100% after reserves
are depleted
Skilled nursing facility • 100% days 1–20
care
• Costs over $161/day
for days 21–100
PLAN FEATURE
MEDICARE SERVICES
— PART B
MEDICARE PAYS1
MEDICARE PAYS1
• All costs after 150
days
• Not a covered
benefit
• $161/day for days
21–100
• 100% after 100 days
PLAN PAYS
Medical services and
supplies
• 80% of Medicare• Not a covered
approved amounts for benefit
covered services
Clinical laboratory
services/tests for
diagnostic procedures
• 100% of Medicare• Not a covered
approved amounts for benefit
covered services
YOU PAY
• $166 (Part B
deductible)
• Remaining 20% of
Medicare-approved
amounts for covered
services
• Costs above
Medicare-approved
amounts or services
not covered by
Medicare
Medicare payment amounts are based on the 2016 schedule. The 2017 schedule will be updated
by Medicare in October 2016, which may result in changes.
1
19
Medicare-Coordinating Plans for Retirees
(continued)
SENIOR PLUS PLAN AND SENIOR PLAN PRESCRIPTION DRUG BENEFITS —
COVERAGE STAGES
Effective January 1, 2017
PRESCRIPTION
DRUG BENEFITS
Initial Coverage Stage
(Total drug spend of
$3,700)
SENIOR PLUS PLAN
SENIOR PLAN
• Participant pays co-pays for generic
drugs
• Participant pays co-pays for covered
generic drugs
• Participant pays co-pays for brandname drugs
• Participant pays either 25% of drug
costs for preferred drugs or 40% of
drug costs for non-preferred drugs
COVERAGE STAGES
• Plan pays balance of drug costs
Coverage Gap
(“donut hole”)
(Total participant outof-pocket cost reaches
$4,950)
• The total of these costs (participant
co-pays plus plan payment for
drugs) adds up toward the Coverage
Gap
• Plan pays balance of drug costs
• Participant pays co-pays for generic
drugs
• Participant pays co-pays for covered
generic drugs
• Participant pays co-pays for brandname drugs
• Participant pays either 25% of drug
costs for preferred drugs or 40% of
drug costs for non-preferred drugs
• Plan pays balance of drug costs
• The total of participant co-pays
and the 50% brand-name drug
pharmaceutical manufacturer
discount adds up toward the
Catastrophic Coverage Stage1
• The total of these costs (participant
co-pays plus co-insurance plus plan
payment for drugs) adds up toward
the Coverage Gap
• Plan pays balance of drug costs
• The total of participant co-pays,
preferred/non-preferred drug coinsurance and the 50% brand-name
drug pharmaceutical manufacturer
discount adds up toward the
Catastrophic Coverage Stage1
Catastrophic Coverage • Participant pays the greater of $3.30 • Participant pays the greater of $3.30
Stage
or 5% of the total cost for a generic
or 5% of the total cost for a generic
(Plan resets to Initial
drug (with a maximum not to exceed drug (with a maximum not to exceed
the standard cost-sharing amount
Coverage Stage
the standard co-payment during the
during the Initial Coverage Stage)
January 1)
Initial Coverage Stage)
• Participant pays the greater of
$8.25 or 5% of the total cost for
a preferred or non-preferred drug
(with a maximum not to exceed
the standard co-payment during the
Initial Coverage Stage)
• Participant pays the greater of
$8.25 or 5% of the total cost for a
preferred or non-preferred drug
• Plan pays the balance of drug costs
for the duration of the year
• Plan pays the balance of drug costs
for the duration of the year
Brand-name drugs (preferred and non-preferred) are subject to an automatic 50% discount at
the pharmacy. Participant does not need to take action; this subsidy is paid by pharmaceutical
companies and applied automatically.
1
20
Medicare-Coordinating Plans for Retirees
(continued)
CARE PLUS PLAN AND CARE BASIC PLAN PRESCRIPTION DRUG BENEFITS —
COVERAGE STAGES
Effective January 1, 2017
PRESCRIPTION
DRUG BENEFITS
Initial Coverage Stage
(Total drug spend of
$3,700)
CARE PLUS PLAN
CARE BASIC PLAN
• Participant pays co-pays for generic
drugs
• Participant pays co-pays for covered
generic drugs
• Participant pays co-pays for brandname drugs
• Participant pays either 25% of drug
costs for preferred drugs or 40% of
drug costs for non-preferred drugs
• Plan pays balance of drug costs
COVERAGE STAGES
• The total of these costs (participant
co-pays + plan payment for drugs)
adds up toward the Coverage Gap
Coverage Gap
(“donut hole”)
(Total participant outof-pocket cost reaches
$4,950)
• Plan pays balance of drug costs
• The total of these costs (participant
co-pays plus co-insurance plus plan
payment for drugs) adds up toward
the Coverage Gap
• Participant pays the same co-pay as • Participant pays the same co-pay as
in the Initial Coverage Stage for Tier
in the Initial Coverage Stage for Tier
1 generics and pays 51% of all other
1 generics and pays 51% of all other
covered generic drugs
covered generic drugs
• Participant pays remaining 40% of
• Participant pays remaining 40% of
preferred and non-preferred drug
preferred and non-preferred drug
costs after a 50% pharmaceutical
costs after a 50% pharmaceutical
manufacturer discount and 10% plan
manufacturer discount and 10% plan
benefit
benefit
• Participant out-of-pocket costs
plus the 50% pharmaceutical
manufacturer discount add up
toward the Catastrophic Coverage
Stage
• Participant out-of-pocket costs
plus the 50% pharmaceutical
manufacturer discount add up
toward the Catastrophic Coverage
Stage
Catastrophic Coverage • Participant pays the greater of 5% of • Participant pays the greater of 5% of
Stage
drug costs or $3.30 for generic
drug costs or $3.30 for generic
(Plan resets to Initial
• Participant pays the greater of 5% of • Participant pays the greater of 5% of
Coverage Stage
drug costs or $8.25 for brand-name
drug costs or $8.25 for brand-name
January 1)
drugs
drugs
• Plan pays the balance of drug costs
for the duration of plan year
21
• Plan pays the balance of drug costs
for the duration of plan year
Medicare-Coordinating Plans for Retirees
(continued)
SENIOR PLUS PLAN AND SENIOR PLAN PRESCRIPTION DRUG BENEFITS
Effective January 1, 2017
RETAIL
PART D
MAIL ORDER
SENIOR PLAN
QUANTITIES
(DAYS’ SUPPLY)
31
60
90
31
60
90
Generic
$10
$20
$30
$10
$20
$30
Preferred
$40
$80
$120
25%
25%
25%
Non-preferred
$65
$130
$195
40%
40%
40%
Specialty
$75
$150
$225
25%
25%
25%
PART D
22
SENIOR PLUS PLAN
SENIOR PLUS PLAN
SENIOR PLAN
QUANTITIES
(DAYS’ SUPPLY)
31
60
90
31
60
90
Generic
$8
$16
$24
$8
$16
$24
Preferred
$30
$60
$90
25%
25%
25%
Non-preferred
$50
$100
$150
40%
40%
40%
Specialty
$75
$150
$225
25%
25%
25%
Medicare-Coordinating Plans for Retirees
(continued)
CARE PLUS PLAN AND CARE BASIC PLAN PRESCRIPTION DRUG BENEFITS
Effective January 1, 2017
RETAIL
PART D
MAIL ORDER
CARE BASIC PLAN
QUANTITIES
(DAYS’ SUPPLY)
31
60
90
31
60
90
Generic
$10
$20
$30
$10
$20
$30
Preferred
$40
$80
$120
$40
$80
$120
Non-preferred
$65
$130
$195
$65
$130
$195
Specialty
$75
$150
$225
$75
$150
$225
PART D
23
CARE PLUS PLAN
CARE PLUS PLAN
CARE BASIC PLAN
QUANTITIES
(DAYS’ SUPPLY)
31
60
90
31
60
90
Generic
$8
$16
$24
$8
$16
$24
Preferred
$30
$60
$90
$30
$60
$90
Non-preferred
$50
$100
$150
$50
$100
$150
Specialty
$75
$150
$225
$75
$150
$225
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