Part-time ACA Benefits
Plan Year 2021
2
Our Mission
Right Care
Right Time
Right Place
We are One Elara Caring
Benefits Eligibility
Part-time employees, as defined by the Affordable Care Act (ACA, or health care reform), have the opportunity to enroll in medical, dental, vision,
voluntary life and voluntary short-term disability benefits. This applies to employees averaging 30 hours per week in a 12-month period.
• You must make your elections in Workday during the 30-day eligibility period.
• You become a Participant by completing the online benefit election form and a salary reduction form to pay for benefits elected.
• If your application is not received within 30 days from the eligibility date, you will
not be eligible for coverage until the next Open Enrollment Period unless you
experience a qualifying life event.
Dependent Eligibility & Verification
Eligible dependents include:
•
Your spouse or domestic partner (same sex or opposite sex)•
A child under the age of 26•
A disabled child over age 26•
Any other child included as an eligible dependent under the PlanElara Caring has a mandatory dependent verification process. If you elect coverage for your eligible dependents, you will be required to upload supporting documents in
Workday.
Required Documentation
•
Dependent Child - birth certificate, foster care record or adoption records.•
Spouse or Domestic Partner - marriage license or domestic partnership affidavit.Making Elections
You will receive an inbox message in Workday with an invitation to enroll in benefits. You must enroll in
benefits
within 30 days from your eligibility date.Using your Benefits
Our plan has been enhanced for 2021 to allow participants to enroll in benefits which will be effective the first of the month after completing 30 days of continued
employment.
•
This is a quick turn-around time after onboarding is complete.
•
Because of this quick eligibility period, it is important to note that you may not have insurance cards or be in the carrier’s systems for up to 10 business days due to timing of electronic data files.
•
Please plan accordingly to ensure this delay does not cause you any
inconvenience.
Additional Surcharges
Spousal Surcharge - $100 per month
• If your spouse is eligible for medical coverage through his/her own employer but is enrolled in an Elara Caring medical plan as your dependent, you will pay a $100 surcharge per month on your medical premiums.
Tobacco Surcharge - $100 per month
• If you are a current tobacco user or have used tobacco in the previous 3 months, you will pay $100 tobacco surcharge on your medical premium.
These surcharges only apply to medical coverage
Medical Insurance
CO-PAYS
Blue Cross Blue Shield of Texas American Worker Elite Premium Enhanced Minimum Essential Coverage
Employee Only $300.00 $175.00 $75.00 $25.00
Employee + Spouse $701.74 $520.21 $365.56 $103.43
Employee + Children $684.20 $489.32 $347.00 $93.21
Family $998.82 $764.44 $530.56 $200.89
Copays Copays
Primary Care $20 $30 $40 Plan Pays $75 per day (6
days/yr. for office, specialist &
urgent care combined)
Specialist $40 $50 $60
Urgent Care $75 $100 $145
Emergency Room $150 $250 $400 Plan Pays $100 per day (3 days/yr) Prescription Deductible Prescription Deductible Prescription Drug
Deductible N/A
$100.00 (Does not apply to generic)
$200.00 (does not
apply to generic) $100/300
Retail (up to 30 days) $15/45/75/150 $15/45/75/150 $15/45/75/150 $10 co-pay/ Discount only Mail-In (up to 90 days) $30/90/150/300 $30/90/150/300 $30/90/150/300 Savings available only
Annual Deductible Annual Deductible
Deductible $1,000.00 $3,000.00 $5,000.00 N/A
Premium rates shown are monthly.
Per pay-period rates will vary depending on your pay frequency.
Your per-pay period premium will be deducted every paycheck of the year.
Dental
Blue Cross Blue Shield of Texas
Low Mid High
Employee Only $14.02 $35.56 $38.81
Employee + Spouse $50.71 $80.78 $87.01
Employee + Children $51.50 $82.03 $88.36
Family $80.66 $128.49 $138.40
PLAN DESIGN & DEDUCTIBLES Annual Deductible
(Individual/family) $50/$150 $50/$150 $50/$150
Annual Maximum Benefit $1,000.00 $2,000.00 $2,000.00
Type I: Preventive Services (e.g.,
exams, X-rays, cleanings) Plan pays 100% Plan pays 100% Plan pays 100%
Type II: Basic Services (e.g., fillings, extractions)
Plan pays 80%
after the deductible is met
Plan pays 80% after the deductible is met
Plan pays 80% after the deductible is met Type III: Major (e.g., root canal,
crowns, bridgework, dentures) N/A Plan pays 50% after the deductible is met
Plan pays 50% after the deductible is met
Orthodontia N/A N/A Plan pays UP TO 50%
for both adults /children
Orthodontia Lifetime Maximum N/A N/A $1,500.00
Premium rates shown are monthly.
Per pay-period rates will vary depending on your pay
frequency.
Your per-pay period premium will be deducted every
paycheck of the year.
Vision
Superior Vision
MONTHLY PREMIUMS
Employee Only $6.10
Employee + Spouse $12.20
Employee + Children $14.39
Family $22.04
PLAN FEATURES FREQUENCY IN NETWORK OUT-OF-NETWORK
Examination 12 months $10 copay $37 reimbursement
Lenses
Single 12 months $15 copay Up to $26 reimbursement
Bifocal 12 months $15 copay Up to $34 reimbursement
Trifocal 12 months $15 copay Up to $50 reimbursement
Progressive 12 months $15 copay Up to $34 reimbursement
Frames 24 months $15 copay; up to
$150 allowance Up to $60 reimbursement
Contact Lenses (In lieu
of glasses) 12 months
Medically necessary;
plan pays 100%.
Elective; plans pays up to $150 allowance
Medically necessary: up to $210 allowance.
Elective: Up to $120 allowance
Premium rates shown are monthly.
Per pay-period rates will vary depending on your pay frequency.
Your per-pay period premium will be deducted every
paycheck of the year.
Vision
Superior Vision includes Hearing Health Care Plan
• Superior Vision Members have access to Your Hearing Network, for a savings of up to 40% off national average selling prices for brand name hearing aids.
• Includes the latest advanced technology, including Bluetooth wireless capabilities and hands-free connectivity for smartphones.
Hearing Exam FREE
Trial Period 60-day money back guarantee
Follow-up Care 1 year
Warranty 4-year service, including 1 year of loss and damage
protection
Batteries 4-year supply included with each hearing aid
purchase
Life Insurance - Supplemental
Employee Life Insurance
• Employee only coverage is available in increments of $10,000, up to $500,000. The
guarantee issue is $200,000. This means that you will be able to elect and be immediately covered (on your effective date) for up to $200,000 without providing evidence of insurability.
Spouse Life Insurance
• Spouse life insurance is available in increments of $5,000, up to a maximum of $250,000 or 100% of employee life insurance election. The guaranteed issue for a spouse is $30,000 without evidence of insurability. Rate is based on age of employee.
Child Life Insurance
• Child life insurance is available for an amount of $10,000. This is for children 6 months – 26 years. Infants under 6 months are covered for $500.
Lincoln Financial
Short-Term Disability
Short-term disability insurance provides a monetary benefit that replaces part of your lost income when you become unable to work due to a qualifying illness or injury.
Elimination Period Benefits are payable after a period of 7 calendar days due to injury or sickness.
Maximum Duration Short-term disability benefits will end at the end of the disability or the end of the 13thweek of disability, whichever comes first.
Definition of Disability You will be considered disabled if you are unable to perform the duties of your “own job.”
Partial Disability Benefits Partial disability benefits can be payable if your earnings are between 20 and 80% of your pre-disability earnings.
Successive Disability
If you become disabled for the same condition within 14 days following your prior disability, your benefits will continue under the same claim.
Lincoln Financial
When Can I Change My Benefits?
Qualifying Life Events – Must be submitted within 30 days of event
• Marriage or divorce
• Birth or adoption of a child
• Child reaching the maximum age limit
• Death of a spouse, domestic partner or child
• Change in child custody
• Change in coverage election made by your spouse or domestic partner during his/her employer’s Open Enrollment period
• You or your dependents’ gain or loss of coverage on another plan
It is your responsibility to provide appropriate documentation and make changes to your benefit elections in Workday within 30 days of the event.
401(k) Plan
Full-time and part-time employees are eligible for 401(k) Plan benefits
• You must have completed 6 months of service and be at least 21 years of age to enroll.
• 401(k) Plan administration is provided by Fidelity Investments including enrollment, contribution amount selection, and investment selection.
• Fidelity will send you a reminder postcard when it is time to enroll.
• Contact Fidelity via www.401k.com or by calling 800-835-5097.
Fidelity
