myBenefits Open Enrollment Demo |
1. myBenefits Open Enrollment Form Demo
Employee Benefits Program
For the period beginning 1/1/2016
Health Insurance Overview – 3 Plan Options with Humana:
Plan 1 – Base Plan (TN Smpcty PPO 14 OPT 3 Silver $50/$100 OV)
Deductible: In / Out of Network
Individual - $0 / $5,000
Family - $0 / $10,000
Out of Pocket: In / Out of Network
Individual - $6,350 / $19,050
Family - $12,700 / $38,100
Coinsurance: 100% / 50%
Annual Wellness: 100% Covered in Network
Prescription Drug:
Level 1- $10
Level 2 - $40
Level 3 - $70
Office Visit: In - $50 Copay & $100 Specialist / Out – Ded then 50%
Inpatient Hospitalization: $1500 Copay for every 3 days
Outpatient Surgery: $1500 Copay
Emergency Room: $600 Copay (Waived if Admitted)
Tier Weekly Contribution
Individual - $22.04 (-$2.30)
EE / Spouse - $44.08 (-$4.61)
EE / Child(ren) - $40.79 (-$5.46)
Family - $62.86 (-$14.97)
Plan 2 – Old Silver Plan (TN 100/70 PPO 14 Copay OPT 3 Silver $30/$65 OV)
Deductible: In / Out of Network
Individual - $1,500 / $4,500
Family - $3,000 / $9,000
Out of Pocket: In / Out of Network
Individual - $6,350 / $19,050
Family - $12,700 / $38,100
Coinsurance: 100% / 70%
Annual Wellness: 100% Covered in Network
Prescription Drug:
Level 1- $10
Level 2 - $45
Level 3 - $70
Office Visit: In - $30 Copay & $65 Specialist / Out – Ded then 30%
Inpatient Hospitalization: Deductible and then coinsurance
Outpatient Surgery: Deductible and then coinsurance
Emergency Room: $250 Copay (Waived if Admitted)
Tier Weekly Contribution
Individual - $53.45 (+$29.11)
EE / Spouse - $106.90 (+$58.21)
EE / Child(ren) - $98.90 (+$52.65)
Family - $152.38 (+$74.55)
Plan 3 – Old Gold Plan (TN 100/50 Smpcty PPO 14 OPT 1 Gold $30/$55 OV)
Deductible: In / Out of Network
Individual - $0 / $5,000
Family - $0 / $10,000
Out of Pocket: In / Out of Network
Individual - $6,350 / $19,050
Family - $12,700 / $38,100
Coinsurance: 100% / 50%
Annual Wellness: 100% Covered in Network
Prescription Drug: Level 1 - $10, Level 2 - $35, Level 3 - $55
Office Visit: In - $30 Copay & $55 Specialist / Out – Ded then 50%
Inpatient Hospitalization: $350 Copay for every 3 days
Outpatient Surgery: $350 Copay
Emergency Care: $250 Copay (Waived if Admitted)
Tier Weekly Contribution
Individual - $63.54 (+$32.98)
EE / Spouse - $127.09 (+$61.97)
EE / Child(ren) - $117.58 (+$55.72)
Family - $181.15 (+$77.03)
All three plans come with Vision: Exam/Lenses/Frames every12 Months, $15 Copay for Exam, $20 for Materials
*(Please refer to Benefit Summaries for detailed schedule of benefits of both plans)
Dental Insurance Overview – Lincoln Financial Group
Annual Deductible (Waived for Diagnostic & PreventativeServices)
$50 Per Member Per Calendar Year
$150 Per Family Per Calendar Year
A – Exams, X-rays and Cleanings 100%
B – Basic Restorative, Basic & Major Endodontics, Basic & Major Periodontics, Basic & Major Oral Surgery 80%
C – Major Restorative, Implants and Prosthodontics 50%
Benefit Maximum Per Calendar Year $1500
Tier Weekly Contribution
Individual - $1.44 (+0.06)
EE / Spouse - $3.39 (+0.19)
EE / Child(ren) - $3.32 (+0.18)
For the period beginning 1/1/2016
Health Insurance Overview – 3 Plan Options with Humana:
Plan 1 – Base Plan (TN Smpcty PPO 14 OPT 3 Silver $50/$100 OV)
Deductible: In / Out of Network
Individual - $0 / $5,000
Family - $0 / $10,000
Out of Pocket: In / Out of Network
Individual - $6,350 / $19,050
Family - $12,700 / $38,100
Coinsurance: 100% / 50%
Annual Wellness: 100% Covered in Network
Prescription Drug:
Level 1- $10
Level 2 - $40
Level 3 - $70
Office Visit: In - $50 Copay & $100 Specialist / Out – Ded then 50%
Inpatient Hospitalization: $1500 Copay for every 3 days
Outpatient Surgery: $1500 Copay
Emergency Room: $600 Copay (Waived if Admitted)
Tier Weekly Contribution
Individual - $22.04 (-$2.30)
EE / Spouse - $44.08 (-$4.61)
EE / Child(ren) - $40.79 (-$5.46)
Family - $62.86 (-$14.97)
Plan 2 – Old Silver Plan (TN 100/70 PPO 14 Copay OPT 3 Silver $30/$65 OV)
Deductible: In / Out of Network
Individual - $1,500 / $4,500
Family - $3,000 / $9,000
Out of Pocket: In / Out of Network
Individual - $6,350 / $19,050
Family - $12,700 / $38,100
Coinsurance: 100% / 70%
Annual Wellness: 100% Covered in Network
Prescription Drug:
Level 1- $10
Level 2 - $45
Level 3 - $70
Office Visit: In - $30 Copay & $65 Specialist / Out – Ded then 30%
Inpatient Hospitalization: Deductible and then coinsurance
Outpatient Surgery: Deductible and then coinsurance
Emergency Room: $250 Copay (Waived if Admitted)
Tier Weekly Contribution
Individual - $53.45 (+$29.11)
EE / Spouse - $106.90 (+$58.21)
EE / Child(ren) - $98.90 (+$52.65)
Family - $152.38 (+$74.55)
Plan 3 – Old Gold Plan (TN 100/50 Smpcty PPO 14 OPT 1 Gold $30/$55 OV)
Deductible: In / Out of Network
Individual - $0 / $5,000
Family - $0 / $10,000
Out of Pocket: In / Out of Network
Individual - $6,350 / $19,050
Family - $12,700 / $38,100
Coinsurance: 100% / 50%
Annual Wellness: 100% Covered in Network
Prescription Drug: Level 1 - $10, Level 2 - $35, Level 3 - $55
Office Visit: In - $30 Copay & $55 Specialist / Out – Ded then 50%
Inpatient Hospitalization: $350 Copay for every 3 days
Outpatient Surgery: $350 Copay
Emergency Care: $250 Copay (Waived if Admitted)
Tier Weekly Contribution
Individual - $63.54 (+$32.98)
EE / Spouse - $127.09 (+$61.97)
EE / Child(ren) - $117.58 (+$55.72)
Family - $181.15 (+$77.03)
All three plans come with Vision: Exam/Lenses/Frames every12 Months, $15 Copay for Exam, $20 for Materials
*(Please refer to Benefit Summaries for detailed schedule of benefits of both plans)
Dental Insurance Overview – Lincoln Financial Group
Annual Deductible (Waived for Diagnostic & PreventativeServices)
$50 Per Member Per Calendar Year
$150 Per Family Per Calendar Year
A – Exams, X-rays and Cleanings 100%
B – Basic Restorative, Basic & Major Endodontics, Basic & Major Periodontics, Basic & Major Oral Surgery 80%
C – Major Restorative, Implants and Prosthodontics 50%
Benefit Maximum Per Calendar Year $1500
Tier Weekly Contribution
Individual - $1.44 (+0.06)
EE / Spouse - $3.39 (+0.19)
EE / Child(ren) - $3.32 (+0.18)
Family - $5.