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KEYSOLUTION
TM
ENROLLMENT GUIDE
2015 Medical Plan Options and
Enrollment Information
Benefit Effective Date: 01/01/2015
Enrollment Period: 11/11/2014 through 11/28/2014
Enroll by phone at 800-865-9164, The call center is open 24/7
Enroll online at https://www.eenroller.net/login.asp?ST=FXST2233 any time during
enrollment period
Administered by Key Benefit Administrators, Inc.
PLAN DESIGNED FOR
THE EMPLOYEES OF
It’s time to choose...
... medical coverage or tax penalty?
Why
must i choose
between medical coverage
or paying a tax penalty?
The Affordable Care Act (ACA) requires all individuals to have at least “minimum
essential coverage” as of January 1, 2014, and beyond. If you do not have this
minimum coverage, then you may have to pay a penalty tax. By purchasing a plan
with “minimum essential coverage” through your employer, you can prevent being
taxed the “Individual Mandate” penalty tax.
What
are the
ACA
tax
penalties for people
without the required
minimum coverage?
What
“minimum
essential coverage” as
defined by ACA?
exactly is
The tax penalty is the “greater percentage of” your adjusted household income or
the combined per person penalty of each person in your family. This Individual
Mandate tax penalty also increases each year, as shown in the chart below.
Year
% of Income
Per Adult Penalty + Per Child Penalty
2014
1%
or
$95
$47.50
2015
2%
or
$325
$162.50
2016
and after
2.5%
or
$695
$347.50
The government has issued a list of Preventive and Wellness Benefits that must
be covered at 100% when obtained from a network provider and 40% from a
non-network provider. There are over 60 preventive services in all. These services
include immunizations, blood pressure screenings, diabetes and cholesterol
screenings, prenatal visits, and more.
See the Additional Information section at the end of this Guide for a
list of the “minimum essential” Preventive and Wellness Benefits.
TM
WHAT
COVERAGE IS BEING
OFFERED FOR THIS YEAR’S
ENROLLMENT?
Flexicrew Staffing Inc. is offering Employees the following coverage which satisfies the federally
mandated “minimum essential coverage” so you can avoid the ACA tax penalty:
•
MEC – Minimum Essential Coverage with Multiplan PPO
•
MVP – Minimum Value Plan with Multiplan PPO
•
MVP Preferred – Minimum Value Plan, with Multiplan PPO, and standard limited
medical benefits
WHAT
I
COVERAGE?
BENEFITS CAN
EXPECT WITH THIS
A MEC plan contains the Preventive and Wellness Benefits required by ACA to avoid tax
penalties. There are 63 preventive services that are covered at 100% in-network and 40% out-ofnetwork. You can find a full list of these services in the Addtional Information section later in this
Guide.
An MVP plan not only contains the Preventive and Wellness Benefits required by ACA, but it also
covers strategically selected medical benefits, including a nationally acclaimed patented Chronic
Disease Management (CDM) program, prescription drug coverage, and online access to
Explanations of Benefits, plan summaries, and much more.*
An MVP Preferred plan covers the Preventive and Wellness Benefits required by ACA plus
strategically selected medical benefits, including a nationally acclaimed patented Chronic
Disease Management (CDM) program, prescription drug coverage, and online access to
Explanations of Benefits and plan summaries. In addition, an MVP Preferred plan includes fullyinsured limited medical coverage for benefits such as daily inpatient stays, emergency room
visits, lab and x-rays, doctor visits, ambulance services, and group term life insurance.*
A Limited Medical plan offers additional coverage for services like hospital stays, surgery,
anesthesia, accidents, and more.
Your coverage also has the Multiplan Preferred Provider Organization (PPO) attached to it. When
you use the Multiplan PPO, services covered under your plan will be reimbursed at the higher innetwork percent. Also, all incurred charges will be discounted by Multiplan. So whether your
claim is incurred in or out of network, or even if it isn’t covered by your plan…the charges will
still be discounted.
*For more MVP information, see the Additional Information section later in this Guide. It contains the ACArequired Preventive and Wellness Benefits, a list of CDM's coverage for 25 chronic conditions, and
important MVP plan exclusions. Other benefits and coverage levels can be found on the Schedule of
Benefits beginning on the next page.
See the next page for this year's coverage offering.
MEC & Limited Medical Schedule of Benefits
Plan Name
PPO Network
Minimum Essential Coverage
Minimum Essential Coverage
Required by ACA to avoid individual tax penalty. See the Additional
Information section of this Guide for covered services.
MEC
Multiplan
Preventive Services
Network
Non-Network
100%
40%
There are 63 preventive services covered at 100% under the required government list of Preventive and Wellness
Benefits when you visit a network provider. The benefits drop to 40% if you use an out-of-network provider.
Services covered include immunizations, blood pressure screenings, diabetes and cholesterol screenings, prenatal
visits for pregnant women and more.
Minimum Essential Coverage (MEC) provides first dollar coverage with access to one of the largest national
preferred provider organizations (PPO) available with great discount savings for MEC benefits. The network
savings can also be used for services not covered by the MEC. You will have access to a simple-to-use web portal
for your local or out-of-town provider look up to be sure your provider is in the PPO Network.
The MEC comes with a medical ID Card that needs to be presented to your medical provider at your time of service.
MVP Schedule of Benefits
MVP
MVP
Preferred
Multiplan
Multiplan
Limited Benefits
Plan Name
PPO Network
Minimum Essential Coverage
Network
Non-Network
Network
Non-Network
100%
40%
100%
40%
Network
Non-Network
Network
Non-Network
Deductible – Individual / Family
$0/$0
$500/$1,000
$0/$0
$500/$1,000
Coinsurance
100%
40%
100%
40%
N/A
$1,850/$12,700
N/A
% Covered for Wellness and Preventive Benefits
Required by ACA to avoid individual tax penalty. See the Additional
Information section of this Guide for covered services..
Minimum Value Benefits
Out-of-Pocket Maximum – Individual / Family $1,850/$12,700
Emergency Room Services - Covers emergency room services
including hospital facility and physician charges. For MRIs
performed during emergency room visit, a separate copay will not be
applied. If surgery, PT, or DME is required during emergency room
visit, they will be covered under emergency room benefit.
$400 copay
$400 copay
$400 copay
$400 copay
Primary Care Visit to Treat an Injury or Illness - Covers all physician
visits including office, outpatient, and inpatient charges. Copays
apply to physician visit charge only, and do not include other
services rendered at time of visit. Anesthesia benefit pays 20% of
Surgery benefit.
$15 copay
Ded/Coins
$15 copay
Ded/Coins
Specialist Visits - Covers physician visits in office, as outpatient, or
as inpatient. Copays apply to visit charge only and do not include
other services rendered at time of visit.
$25 copay
Ded/Coins
$25 copay
Ded/Coins
Imaging - Covers charges for CT, PET scans, MRIs, and the charges
for related supplies.
$400 copay
Ded/Coins
$400 copay
Ded/Coins
Laboratory Outpatient and Professional Services - Covers
professional components of labs, including office, outpatient, and
inpatient charges. A copay will apply to each lab charge.
$50 copay
Ded/Coins
$50 copay
Ded/Coins
X-rays and Diagnostic Imaging - Covers the professional components
of labs, including the office, outpatient, and inpatient charges. A
copay will apply to each x-ray or imaging charge.
$50 copay
Ded/Coins
$50 copay
Ded/Coins
Chronic Disease Management (CDM) - See the Benefit Details
section of this Guide for all covered 25 chronic conditions and their
minimum standards of care.
100%
Ded/Coins
100%
Ded/Coins
Generic Prescription Drugs
$15 copay
Ded/Coins
$15 copay
Ded/Coins
Preferred Brand Drugs
$25 copay
Ded/Coins
$25 copay
Ded/Coins
Non-Preferred Brand Drugs
$75 copay
Ded/Coins
$75 copay
Ded/Coins
Mail-order Drugs
2.5 x copay
Ded/Coins
2.5 x copay
Ded/Coins
Employee Term Life - Except for groups domiciled in CA, CT, HI,
NJ, NY
$10,000
$10,000
Fully-Insured Limited Medical Indemnity Benefits
Daily In-Hospital - 31 days per confinement
$500 / Day
Inpatient Surgical Benefit - 1 day per year
$500 / Day
Outpatient Surgical Benefit - 1 day per year
$250 / Day
Minor Outpatient Surgical Benefit -
$50 / Day
Anesthesia - 20% of Surgical Benefit
Accident - 5 days per year
Hospital Admission - 1 day per year
ICU - 31 days per year
Critical Illness Life AD&D -
$300 / Day of accident
treatment
$1,000 / Admission
$500 / Day
$5,000 Benefit
$10,000 Benefit
KEYSOLUTION
WHAT ARE MY COSTS FOR THIS COVERAGE?
TM
Voluntary Employee Contribution Rates
MEC
MVP
MVP
Preferred
Employee
$12.63
$21.32
$35.30
Employee + Spouse
$18.33
$44.43
$73.26
Employee + Child(ren)
$37.74
$43.43
$64.22
Family
$43.45
$67.79
$100.88
Weekly Rates
Your employer is paying a portion of your premium. The above rates represent
just your portion of the cost.
Rates assume cost is currently and will continue to be remitted in advance of
the effective date.
Rates include administration fee for continuation.
HOW AND WHEN CAN I ENROLL FOR THIS COVERAGE?
The effective date for this coverage is 01/01/2015. The enrollment period is 11/11/2014 through 11/28/2014. New
Employees are eligible for benefits after they have worked long enough to meet their company's
eligibility requirement. Flexicrew Staffing Inc. 's eligibility requirement is 90 days. If you
have worked long enough to be eligible for benefits, and you work the required number
of 30 hours per week, you are eligible to sign up for this coverage.
Benefit staff designated by Flexicrew Staffing Inc. can answer your enrollment
questions and provide any forms you may need to fill out to elect coverage.
•
To enroll over the phone, call 800-865-9164, The call center is open 24/7.
•
To enroll online, go to https://www.eenroller.net/login.asp?ST=FXST2233 anytime day
or night during the enrollment period to sign up for coverage.
Enroll by contacting BeneTrac at 1-800-865-9164. The call center is open and
staffed 24/7.
You can also enroll through internet access at
https://www.eenroller.net/login.asp?ST=FXST2233.
Your user name is the first six letters of your last name and the last four
digits of your social security number. Your password is the last four
digits of your social security number.
Frequently Asked Questions
»
FREQUENTLY ASKED QUESTIONS
KEYSOLUTION
HOW DO I KNOW I'M ELIGIBLE TO ENROLL FOR THIS COVERAGE?
All Employees who have worked long enough to meet their company's eligibility requirement, and who
work the required minimum number of 30 hours per week, are eligible to enroll. Eligible dependents
include spouses and children or stepchildren, under age 26.
C A N I S I G N U P F O R C O V E R A G E AT A N Y T I M E ?
Provided you are eligible for this coverage, you can enroll per the instructions given on the previous page
under “How and When Can I Enroll for This Coverage.” If you do not elect coverage as explained, you
will not be able to enroll until the next open enrollment period unless you experience a qualifying event.
W H AT I F I W A N T M O R E B E N E F I T S T H A N T H I S C O V E R A G E O F F E R S ?
Because the coverage offered is not a Major Medical plan, it may not be for everyone. Individuals are
free to go to the marketplace and purchase broader coverage if needed. However, a subsidy may not be
available if the plan your employer has made available meets the ACA Affordability provisions.
H O W A R E M Y P R E M I U M S PA I D ?
Premiums will be taken through payroll deductions. If you miss a payroll deduction as a result of
absence or lack of work, you risk being terminated from the plan. If terminated, you will not be eligible
to re-enroll until the next open enrollment period unless you experience a qualifying event.
C A N I C A N C E L C O V E R A G E AT A N Y T I M E ?
When premiums are paid with pre-tax dollars through payroll deductions as part of a Section 125
Savings Plan, you will not be able to change these elections until the next annual enrollment period,
unless you have a qualifying event. However, when premiums are paid with post-tax dollars, you can
cancel coverage at any time.
IF I DO ENROLL, HOW DO I USE MY BENEFITS?
After enrollment, our claims administrator, Key Benefit Administrators (KBA), will send you a benefit kit
and an ID card. Simply present this ID card to your provider at the time of service. This card contains all
the information your provider needs to submit your claims to KBA for processing. You can also use the
information on this card to contact KBA for any questions you might have. KBA's contact information
and website are on the back of this Guide.
I S T H E R E A N Y T H I N G I S H O U L D P A Y S P E C I A L AT T E N T I O N T O S O I K N O W
A B O U T S E R V I C E S T H AT A R E N O T C O V E R E D ?
Be sure to read the MVP exclusions listed in the Additional Information section at the back of this
Guide. Note especially MVP exclusions regarding inpatient hospitalization, outpatient surgical centers
and charges, specialty drugs such as chemotherapy, and mental health and substance abuse.
WHEN WILL KBA SEND ME A BENEFIT KIT AND ID CARD?
KBA will mail your benefit kit and ID card soon after you have enrolled and your first payment has
been made.
W H AT O T H E R I N F O R M AT I O N I S A V A I L A B L E T O M E S O I U N D E R S T A N D
MY COVERAGE?
For further details on the coverage being offered by Flexicrew Staffing Inc., see the Additional
Information section of this Guide.
TM
A d d i t i o n a l I nf o r m at io n
MEC Preventive and Wellness Benefits
A l i s t o f t h e “ mi n im u m e s s e n tia l c o v e r a g e ” r e q u i r e d b y A C A
15 Covered Preventive Services for Adults (ages 18 and older)
1. Abdominal Aortic Aneurysm one time screening
for age 65-75
2. Alcohol Misuse screening and counseling
3. Aspirin use for men ages 45-79 and women ages
55-79 to prevent CVD when prescribed by a physician
4. Blood Pressure screening
5. Cholesterol screening for adults
6. Colorectal Cancer screening for adults starting at age 50
limited to one every 5 years
7. Depression screening
8. Type 2 Diabetes screening
9. Diet counseling
10.HIV screening
11.Immunizations vaccines (Hepatitis A & B, Herpes Zoster,
Human Papillomavirus, Influenza (flu shot), Measles, Mumps
Rubella, Meningococcal, Pneumococcal, Tetanus, Diptheria,
Pertussis, Varicella)
12. Obesity screening and counseling
13. Sexually Transmitted Infection (STI) prevention counseling
14. Tobacco Use screening and cessation interventions
15. Syphilis screening
22 Covered Preventive Services for Women, Including Pregnant Women
1. Anemia screening on a routine basis for pregnant women
2. Bacteriuria urinary tract or other infection screening for
pregnant women
3. BRCA counseling and genetic testing for women at higher risk
4. Breast Cancer Mammography screenings every year for
women age 40 and over
5. Breast Cancer Chemo Prevention counseling for women 6. Breastfeeding comprehensive support and counseling from
trained providers, as well as access to breastfeeding supplies,
for pregnant and nursing women.
7. Cervical Cancer screening 8. Chlamydia Infection screening 9. Contraception: Food and Drug Administration-approved
contraceptive methods, sterilization procedures, and patient
education and counseling, not including abortifacient drugs
10. Domestic and interpersonal violence screening and
counseling for all women
11. Folic Acid supplements for women who may become pregnant
when prescribed by a physician
12.
13.
14.
15.
16.
20.
21.
22.
Gestational diabetes screening
Gonorrhea screening
Hepatitis B screening for pregnant women
Human Immunodeficiency Virus (HIV) screening and counseling
Human Papillomavirus (HPV) DNA Test: HPV DNA testing
every three years for women with normal cytology results who
are 30 or older
Osteoporosis screening over age 60
Rh Incompatibility screening for all pregnant women and
follow-up testing
Tobacco Use screening and interventions
and expanded counseling for pregnant tobacco users
Sexually Transmitted Infections (STI) counseling
Syphilis screening
Well-woman visits to obtain recommended preventive services*
*Includes routine prenatal visits for pregnant women.
17.
18.
19.
26 Covered Services for Children
1. Alcohol and Drug Use assessments
2. Autism screening for children limited to two screenings
up to 24 months
3. Behavioral assessments for children limited to 5 assessments
up to age 17.
4. Blood Pressure screening 5. Cervical Dysplasia screening
6. Congenital Hypothyroidism screening for newborns
7. Depression screening for adolescents age 12 and older
8. Developmental screening for children under age 3, and
surveillance throughout childhood
9. Dyslipidemia screening for children
10. Fluoride Chemo Prevention supplements for children without
fluoride in their water source when prescribed by a physician
11. Gonorrhea preventive medication for the eyes of all newborns
12.Hearing screening for all newborns
13.Height, Weight and Body Mass Index measurements
for children
14.Hematocrit or Hemoglobin screening for children
15. Hemoglobinopathies or sickle cell screening for newborns
16. HIV screening for adolescents
17. Immunization vaccines for children from birth to age 18;
doses, recommended ages, and recommended populations vary:
Diphtheria, Tetanus, Pertussis, Hepatitis A & B, Human
Papillomavirus, Inactivated Poliovirus, Influenza (Flu Shot),
Measles, Mumps, Rubella, Meningococcal, Pneumococcal,
Rotavirus, Varicella, Haemophilus influenzae type b
18. Iron supplements for children up to 12 months when
prescribed by a physician
19. Lead screening for children
20. Medical History for all children throughout development
Ages: 0 to 11 months, 1 to 4 years, 5 to 10 years, 11 to 14
years, 15 to 17 years
21. Obesity screening and counseling
22. Oral Health risk assessment for young children up to age 10
23. Phenylketonuria (PKU) screening in newborns
24. Sexually Transmitted Infection (STI) prevention counseling
and screening for adolescents
25. Tuberculin testing for children
26. Vision screening for all children under the age of 5
A d d i t i o n a l I nf o r m at io n
MVP Chronic Disease Management
C h r o n i c Di s e a s e s a n d t h e mi n im u m s ta n d a r d s o f l ab o r at o r y
a n d d ia g n o s ti c p r o c e d u r e s c o v e r e d b y M V P p l a n s
Chronic Disease
Services
Asthma
2 Office exams per plan year *Spirometry
Atherosclerosis (Peripheral Vascular Disease)
1 Office exam per plan year *Lipid Panel
Atrial Fibrillation
1 Office exam per plan year *EKG, *Prothrombin times
Chronic Obstructive Pulmonary Disease
2 Office exams per plan year *Spirometry
Chronic Renal Insufficiency
2 Office exams per plan year *Creatinine, *Complete blood count
(CBC), *Electrolytes, *Urine protein, *Serum calcium,
*Serum phosphorus, *Lipid panel
Congestive Heart Failure
2 Office exams per plan year *BUN, *Creatinine, *Potassium
Coronary Artery Disease
1 Office exam per plan year *Lipid panel, *EKG, *Cholesterol
Diabetes
2 Office exams per plan year *Glycohemoglobins,
*Microalbumin, *Lipid panel
Epilepsy
1 Office exam per plan year
Human Immunodeficiency Virus Infection
1 Office exam per plan year *T-Cell/CD-4 counts,
*PPD, *HIV quantifications, *Complete blood count (CBC),
*Pap smear (women only)
Hyperlipidemia
1 Office exam per plan year *Lipid panel, *Cholesterol
Hypertension
2 Office exams per plan year
Hyperthyroidism
1 Office exam per plan year
*Thyroid stimulating hormone (TSH), *Thyroxine (T4)
Hypothyroidism
1 Office exam per plan year
*Thyroid stimulating hormone (TSH), *T4
Metabolic Syndrome
1 Office exam per plan year
*Lipid panel, *Glucose FBS or Hemoglobin A1c (HgbA1c)
Multiple Sclerosis
2 Office exams per plan year
Parkinson’s Disease
2 Office exams per plan year
Polymyalgia Rheumatica
2 Office exams per plan year *Erythrocyte sedimentation rate
(ESR) or C-reactive protein (CRP) *Complete blood count (CBC)
Pre-diabetes
1 Office exam per plan year
*Lipid panel, *Glucose FBS or Hemoglobin A1c (HgbA1c)
Pulmonary Hypertension (unrelated to COPD)
2 Office exams per plan year
COPD WITH PULMONARY HYPERTENSION/
COR Pulmonale
2 Office exams per plan year
*Spirometry, *12 months of supplemental 02 Tx
Rheumatoid Arthritis
1 Office exam per plan year *Complete blood count (CBC)
Sleep Apnea
1 Office exam per plan year
Chronic Venous Thrombotic Disease
2 Office exams per plan year
Ulcerative Colitis (Inflammatory Bowel Disease)
1 Office exam per plan year *Complete blood count (CBC), *LFT
*The services listed above are the standard laboratory and diagnostic procedure for each chronic disease.
A d d i t i o n a l I nf o r m at io n
MVP Exclusions
E x c l u s i o n s a n d l imitati o n s t o a n m v p p l a n
There are Exclusions applicable to the Minimum Value Benefits listed on the MVP Schedule of Benefits in this Guide... per the list
below. If you choose an MVP plan, a plan document with detailed descriptions of all exclusions will be made available to
you after enrollment. Please refer to this plan document for Exclusion details.
1. Hospital inpatient services are not covered under
the Minimum Value Benefits of an MVP-only plan.
Hospitalization is available only under an MVP Preferred or
Preferred Plus plan.
2. Ambulatory Surgical Center services are not covered.
3. Specialty drugs are not covered.
4. Mental/Behavioral Health and Substance Abuse Disorder
Outpatient services are not covered with the exception of
services covered under the plan’s MEC benefits.
5. Rehabilitation Speech Therapy services are not covered.
6. Rehabilitative Occupational and Rehabilitative Physical
Therapy services are not covered.
9. Charges that are not for the care or treatment of an accident
or illness except as specifically provided for in this plan.
10. Treatment made necessary as the result of illegal use
of narcotics or use of hallucinogens in any form unless
prescribed by a physician or as provided herein.
11. Treatment made necessary by or a disability arising from
war, declared or undeclared, or any act of war. An act of
terrorism will not be considered an act of war, declared or
undeclared.
12. Treatment or services provided by anyone other than a
healthcare provider as defined herein unless specifically
stated in the plan.
7. Skilled Nursing Facility services are not covered.
13. Investigatory and experimental treatment, services, and
supplies.
8. Outpatient Surgery Physician/Surgical services are not
covered.
14. Organ transplants.
*Please refer to your plan document for a detailed description of all exclusions.
KEYSOLUTION
TM
Customer Service Contacts
KEYSOLUTION™
ACA-COMPLIANT PLANS
Administered by KBA
Claims: Key Benefit Administrators, Inc.
PO Box 129, Fort Mill, SC 29716
Website: kba.keyfamily.com
PPO NETWORK
Offered through Key Benefit Administrators, Inc.
Multiplan PPO Network
1.888.342.7427 or www.multiplan.com
E N R O L L M E N T I N F O R M AT I O N
Enrollment Period:
11/11/2014 through 11/28/2014
Enroll by phone at 800-865-9164,
The call center is open 24/7.
Enroll online at:
https://www.eenroller.net/login.asp?ST=FXST2233