2022 Open Enrollment Health And Wellness Benefits

2022 Open EnrollmentHealth and Wellness Benefits1

Today’s Agenda1. Open Enrollment Details2. Benefits Program Overview3. Resources22

What is Open Enrollment?Open EnrollmentQualifying EventYour annual opportunity to: 30-day period Review benefit options Marriage or divorce Make benefit elections Birth or adoption of a child Add, remove, or change dependents Gain / Loss of coverage Update beneficiary designations Move out of or into a service area33

TimelineOpen Enrollment DatesBeginsEnds11/29/202112/10/2021Benefits EffectiveBeginsEnds01/01/202212/31/202244

Who is Eligible?EmployeesEligible dependentsFull time employees working at least 30hours a week. Your legal spouse or registered domesticpartner; or Your dependent children (including yourstep-child and legally adopted child) up toage 26; or Any dependent child who reaches the agelimit and is incapable of self-supportbecause of a mental or physical disability.55

How to enrollLogin to your portalworkforcenow.adp.com6

During OpenEnrollmentyou can elect, changeand waive YYFSAYYYOther VoluntaryBenefitsYYY7

Benefits Program SummaryMedicalAnthem, KaiserWhat’s new?DentalDelta Dental VisionEyeMedNo change to planofferings Life, AD&D &VoluntaryPrincipalIRS HSA contributionsmaximums increased for2022Travel AssistPrincipal MagellanEAPIRS Healthcare FSA andLimited Purpose FSAcontributions maximumshave increased for 2022Sec 125FSA & HSA8

2022 Employee Monthly ContributionsEMPLOYEEONLYEMPLOYEE SPOUSEEMPLOYEE CHILD(REN)EMPLOYEE FAMILYAnthem PPO 50 315 210 550Anthem HDHP w/HSA 50 255 170 445Employer HSA Funding 50 50 50 50Kaiser HMO (CA Only) 50 315 210 550 0 50 50* 110 0 0 0 0MedicalDentalDelta DentalVisionEyeMed*For Dental, EE one child is 50; EE two or more children would fall under Family ( 110).9

What is Newfront's role?Newfront is the benefits consultant for Summer Search. Think of us like anextension of your People Ops team working to ensure our vendors areproperly supporting members. Our benefits team is available at theemployee advocate line –Phone: 877-369-3173Email: summersearchbenefits@abdanswers.comWe are here to support you with your benefit needs M-F 5am – 8pm PST.1010

Who is Advantek?11Summer Search is self-funded which means Summer Searchtakes on the financial risk of providing certain healthcarebenefits to all employees. Employers who self-fund hire aThird Party Administer (TPA).A third-party administrator (Advantek) is the company thatprovides operational services such as claims processing andemployee benefits management. They can assist withescalating claim issues, or questions you have regarding thepre-authorization process.11

Who is RxBenefits?12Summer Search as a self-funded employer partners with athird-party administrator to help manage the pharmacyservices and network benefits for members.RX Benefits is our pharmacy benefit manager that partnerswith CVS/Caremark to bring you greater discounts, betteraccess, and improved member services. They can assistwith finding in network pharmacies, prior authorizations,mail order prescriptions, and general benefit questions.12

Medical plans13

HMO PlansHealth Maintenance Organization (HMO) plans cover medical care provided by anin-network physician. Your care is coordinated by a Primary Care Physician (PCP).HMO plans provide predictable costs such as copays and out-of-pocketmaximums.HMO Key Features Flat copay for most servicesCalifornia onlyYou designate a PCP, or one will be assigned for youIn-network coverage only; no coverage if member goes outside of medical groupor network (except for emergencies)1414

HMO ProcessVisit your PCP(Primary Care Physician)for any type of servicesTo see specialist, referral fromPCP is requiredYou can use your FSA topay for your copaysAll services are in-network only*Doesn’t apply to 15emergencies*15

Kaiser HMO (CA Only)MedicalHMONetwork onlyDeductible – Single/FamilyNoneOut of Pocket Max - Single 1,500 per memberOut of Pocket Max - Family 3,000 per familyOffice Visit 30 per visit copay PCP 30 per visit copay SpecialistEmergency Room 100 / visitInpatient Services (ex. hospitalization) 0Outpatient Services (surgery, mental health,behavioral health, or substance abuse) 30Retail(Up to 30-day supply)Prescription DrugsTier LevelTier 1Tier 2Tier 316Mail Order(up to 100-day supply) 10 20 25 50 25 50

PPO PlansA preferred provider organization plan is a network of physicians, specialists andhospitals that contract with and insurance carrier. PPO plans allow for referral-freeaccess to a broader choice of physicians and specialists.PPO plans allow individuals to seek care from non-contracted providers at a highercost.PPO Key Features In and out-of-network coverageDeductible must be met first then coinsurance is appliedDeductible is waived for doctors' visitsNationwide coverageSelf-refer to specialistDeductible is waived for pharmacy benefits and only co-pays apply1717

MedicalPPOAnthem PPOInOutDeductible - Single 250 750Deductible - Family 750 2250Out of Pocket Max - Single 3,000 per member 9,000 per memberOut of Pocket Max - Family 6,000 per family 18,000 per family 20 per visit40% after deductibleOffice VisitEmergency Room 150/visit 20%In patient services20%40%Outpatient services (surgery, xrays, blood work)20%40%Prescription DrugsTier LevelRetail(Up to 30-day supply)Mail Order(up to 90-day supply)Rx Deductible 0 0Tier 1 10 25Tier 2 30 90Tier 3 50 15018

What if I choose anout-ofnetworkprovider?IN-NETWORK PROVIDEROUT-OF-NETWORKPROVIDER 200 200 150 (negotiateddiscount) 160 (based on 80%UCR)Patient deductible; Individual 250 750Patient copay/coinsurance 2040% after deductibleInsurance pays the restBalance betweenallowed amount andprovider’s charge ( 40) 20 copay (ded. doesn’tapply) 200( 160 will apply to the 750 deductible)Provider’s charge for serviceAnthem allowed amountTotal patient responsibility19

HDHP HSA PlansHealth Savings Accounts (HSA) allow medical expenses to paid with pre-tax dollars.You can participate in an HSA if you are enrolled in a qualifying High Deductible HealthPlan (HDHP).HSA plan can be contributed to by employers and employees to pay for qualifiedmedical expenses.HDHP Key Features In and out-of-network coverage (same network as PPO)Deductible must be met first then coinsurance is appliedDeductible is only waived for preventive careNationwide coverageSelf-refer to specialistContribute pre-tax dollars into an HSA banking accountSave money for future healthcare costs2020

HDHP HSA PlanMedicalHDHPHSAInOutDeductible - Single 1,500 4,500Deductible - Family 3,000 9,000Out of Pocket Max - Single 3,000 9,000Out of Pocket Max - Family 6,000 18,00010% after deductible30% after deductibleOffice VisitEmergency Room 150/visit 10%In patient services10%30%Outpatient services (surgery, xrays, blood work)10%30%Prescription Drugs Tier Level(After Deductible)RetailMail Order(Up to 30-day supply)(up to 90-day supply)Rx Deductible 0 0Tier 1 15 37.50Tier 2 40 120Tier 3 60 18021

HSA OverviewA HSA is like a personal savingaccount, but it can only be used forqualified healthcare expenses. Tobe eligible, you must be enrolled ina HDHP.2222

HSA EligibilityYou cannot make HSA contributions if You have other disqualifying healthcoverage(including spouse enrollment in ageneral-purpose FSA)You are enrolled in Medicare*includes if married filing separatelyFSAYou are eligible to be claimed as adependent on someone else’s currentyear tax returnSpecial rules apply if you have receivedhealth benefits from Veterans Affairs orIndian Health Services2323

How an HDHP HSA WorksYou can use the money in your HSA for your share of expenses at any time.135You pay100% of all costsThen you paycoinsurance andcopaysOnce you meetyour OOP maximumall in-network costsare covered24Until you meetyour annual deductibleUntil you meetyour out-of-pocketmaximum2424

Advantages of HSAsTax Benefits Pre-Tax contributions Tax-Free withdrawals Tax-Free earningsFlexibilityLong Term Savings Account is yours tokeep wherever yougo Money earnsinterest in theaccount Money in the accountnever “expires” Money can beinvested in mutualfunds Can be used for avariety of expensesnot covered by yourplan i.e., medical,dental and vision2525

2022HSAHSAContributions2022ContributionsAnnual IRS Limit 3,650 totalSingleSummer Search contributes 600 / annuallyYou can contribute up to 3,050Additional“catch-up”contributionsfor ages 55-65 1,000Annual IRS Limit 7,300 totalFamilySummer Search contributes 600 / annuallyYou can contribute up to 6,70026 1,000

Differences Between HSA, FSA, LPFSAHSAFSALPFSACan anyone use it?Only if you have a HDHP andmeet certain criteriaOnly if your employer offers itYou are only eligible toparticipate if you’re enrolledin a High Deductible HealthPlan (HDHP)Who contributesmoney into it?You do, but your employermay also contributeYou doYou doWhat happens tothe money afterthe year is up?It stays in the account untilyou use itYou lose it(with a few exceptions)You lose it(with a few exceptions)Can you use it topay for yourmonthlypremiums?NoNoNoWhat’s the point?To save pre-tax dollars forupcoming health expensesat any point in the futureTo save pre-tax dollars forupcoming health expensesthis yearTo save pre-tax dollars forupcoming Dental and Visionexpenses this year2727

Support forMental Healthand WellnessHelp is available and treatment works.Your mind and body are connected. Youdeserve care that supports your totalhealth—mind, body, and spirit. If youstruggle with depression, anxiety,addiction, or other mental or emotionalissues that interfere with your daily life, youcan get help through your medical plan.2828

Medical Plan - Outpatient ServicesIn-NetworkOut-of-Network* 30 copayNot Covered 20; deductible waived40%; deductible waivedYou can submit forreimbursement for out ofnetwork claims and will be paidat the out of network benefitlevel.10%; after deductible( 1,500ind./ 3,000fam)30%; after deductible( 4,500ind; 9,000fam)You can submit forreimbursement for out ofnetwork claims and will be paidat the out of network benefitlevelKaiser HMOAnthem PPOAnthem HDHP (HSA)Member ConsiderationsIn network MH providers canbe challenging to find. Werecommend you check out theKaiser MH resources.*You as the customer will have to pay the provider at point of service and submit a claim form directly to Advantek forreimbursement of services. You can access the claim form here on our benefits website.29

Anthem/Advantek OON Reimbursement ProcessYou as the customer will have to pay the provider at point of service and submit a claim form directly toAdvantek for reimbursement of services. Below are the details steps you will need to take for reimbursement.1.Pay your therapist at point of service2. Ask your therapist for a superbill or have your therapist complete the Advantek Medical Claim Form3. Submit your superbill or Medical Claim Form with payment receipt to one of the following methods. Mail: Advantek Benefit Administrators P.O. BOX 45007 Fresno, CA 93718 Fax Number: (559) 228-5460 Email Address: claims@advantekbenefit.com Advantek will process the claim and mail you a reimbursement check. The process can take upto 6 weeks.A superbill is an itemized form, used by healthcare providers in the United States, which details services providedto a patient. It is the main data source for creation of a healthcare claim, which will be submitted to payers(insurances, funds, programs) for reimbursement. All required information will need to be included if yourtherapist is providing a superbill for Advantek to process the reimbursement.30

Employee Assistance ProgramAre you getting the most out of your EAP? It’s counseling servicesthat are free and designed to address significant life problems.Services include: Education Legal & Financial Dependent Care & Care Giving Lifestyle & Management Work & Life Matters3 sessions per person, perincident, each year.(800) x3131