 |
||
|
Diocese of Palm Beach Benefits Reference Guide This guide is not a contract. The purpose of this enrollment guide is to provide summary information about your benefits. It does not fully describe each benefit. Please refer to the Pension Plan Document and Medical, Dental and Life Certificates of Coverage for complete details on plan provisions, exclusions and limitations. Every effort has been made to ensure that the information contained in this Guide is accurate: the provisions of the actual contracts will govern in the event of discrepancy. Routinely check your paycheck for accuracy and timeliness of deductions. Employees share responsibility for the accuracy of deductions with the Benefits Office and their bookkeepers. The Diocese of Palm Beach benefit program offers valuable protection to you and your family and provides you peace of mind as well. What is the annual enrollment period? The annual enrollment period is the time of year when employees review their benefit elections and make changes as necessary to ensure that their elections meet their needs for the coming year. This includes reviewing all of the benefits plans so that employees can take full advantage of the benefits offered. Any plan changes, including changes to the cost of the plan, are also announced during the annual enrollment period.
The annual enrollment period is an opportunity for all benefit eligible employees to:
· Enroll in a plan if not currently enrolled · Change coverage from one plan to another · Change enrollment status of eligible family members · Enroll in the Section 125 (Cafeteria) Plan
When is the annual enrollment period held? The annual enrollment period is held during the month of May (exact dates are announced each year). Benefit changes elected during the annual enrollment period are effective on August 1 of that year. What happens if I do not enroll or make changes to my benefits during the annual enrollment period? If you do not submit any changes during the annual enrollment period, you will be automatically re-enrolled in the same coverages already in effect. What is the effective date for payroll deduction for changes made during the annual enrollment period? Payroll deduction changes are effective on the first pay day in August. Can I make changes during the year other than during the annual enrollment period? You can make changes within 30 days of a change in status, or a qualifying event, during the year. A qualifying event is a change in your family status (marriage, divorce, death of your spouse or dependent, birth or adoption of your child, commencement or termination of employment of your spouse, you or your spouse’s unpaid leave of absence or change from full-time to part-time employment (or vice-versa), a significant change in you or your spouse’s health coverage attributable to your spouse’s employment, and such other events as the plan administrator determines will permit change or revocation of a benefit election. For more information, please contact the Benefits Office. Who do I notify if my mailing address or my name changes? You should notify the bookkeeper, at your entity, of any changes in mailing address or name change. You will need to provide a copy of a legal document reflecting your name change. Pastoral Center employees should notify the Benefits Office directly. There are two types of medical plans. How do I know which one is best for my family and me? You can make the best choice for a medical plan by considering a number of factors.
· How much do I want to pay for coverage? Currently, the cost for employee coverage under the Standard PPO plan is paid for by the employer. The employee pays a small percentage of the cost of the employee coverage under the Premium PPO plan. The employee pays for 100% of the cost for dependent coverage. The Premium PPO Plan offers richer benefits; therefore, the cost of this coverage is higher than the Standard PPO Plan. Your out-of-pocket expenses will be higher under the Standard PPO Plan because the benefits are lower than under the Premium PPO Plan. Also, the Standard PPO Plan offers higher out-of-pocket benefits; if you step out-of-network, the Premium PPO Plan will pay more. Study the Benefits Summary Comparison provided in your Blue Cross benefits packet. Look at the difference in the benefits paid by each plan. Before you select a plan, assess your family’s medical history; take a family inventory of medical needs and the likely uses over the next year. While you cannot predict all of your needs, it pays to make a list of all the services you expect to use in the coming year and then evaluate each plan according to your own list. Consider your anticipated out-of-pocket expenses, including co-payments. If possible, pick a plan that will provide you the services you need at a price you can realistically afford. Remember, by participating in the Section 125 (Cafeteria) Plan, you will reduce the taxable amount and will offset the actual cost of the benefit plan.)
·
What providers are under contract on the Standard and Premium
PPO Plans? · What is a PPO? A PPO, is a "Preferred Provider Organization", - NO gatekeeper necessary, may go to any physician in the network without a referral and in-network benefits will be payable. Includes out-of-network benefits after satisfaction of a deductible and coinsurance. · What is a co-pay? The amount of money the insured must pay to the In-network doctor, or to the pharmacist for medication; the insured's cost sharing of the treatment. · What is a Deductible? The initial amount the insured pays before any benefits are payable or reimbursement is made for some in-network and all out-of-network procedures.
· What is co-insurance? The amount the insured must pay in addition to what the medical plan pays. It is the sharing of the cost of medical care. Example: when an insured goes to an out of network doctor: After the insured deductible is meet; if the insured has 70/30 co-insurance, the insured would pay 30% of the allowed amount, plus any amounts charged by the physician above the allowed amount. The medical plan would pay 70% of the allowed amount. · What is stop-loss? The maximum amount the
insured would pay per calendar year. · What is the allowed amount? Medical plans enter into contracts with providers of service and establish allowed amounts under those contracts for in-network services. The medical plan then pays their percentage of the allowed amount. The insured pays their percentage of the allowed amount. For example: The allowed amount for an out-patient surgical procedure is $1000. The medical plan pays at 70% of $1000; the insured pays 30% of the $1000. All amounts charged by the provider above the $1000 allowed amount must be written off and not charged to the insured.
·
What is the deductible amount on our prescription plan and how
does it work?
There are three tiers – Generic, Preferred, and
Non-Preferred. The bcbsfl.com website contains the current Preferred
Medical List. A copy of the most current list can be found in your Blue
Cross benefits packet. The Non-Preferred Bran name drugs can be
purchased at a higher co-payment.
·
Can my 20 year old daughter be covered under my plan?
·
I am planning to go on vacation and I will need extra
medication while I am away. What do I do?
·
What should I do if my pharmacist tells me they cannot process my
prescription?
·
Do I have to use certain dentists under my dental plan? |
|
|
Arlene Meyer |
||
