Benefits Blueprint. Medical, Dental & Vision. Life & Accidental Death & Dismemberment

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1 Benefits Blueprint Medical, Dental & Vision Life & Accidental Death & Dismemberment

2 elcome to the Marin Builders Association Benefits Program! Employee benefits are the foundation of your employees good health and financial protection. That s why the Marin Builders Association and a group of Construction Industry Exchanges and Associations have partnered with North Bay Builders Exchange (NBBE) to offer its members a comprehensive suite of employee benefits solutions. Your employees receive high quality, affordable coverage that has their needs in mind. With the Marin Builders Association Employee Benefits Program, each benefit is available on a stand-alone basis. You can customize the program to meet your business and human capital needs. This brochure provides a summary of the benefits available by group size from sole proprietor to groups of five or more employees as well as additional information. Ready to Build Your Benefits Blueprint? We re here to help! Simply contact us (see below) and we ll provide you with the tools you need to build your benefits blueprint and get your employees enrolled. Group Health Insurance Plan Membership Paula Krause paula@marinbuilders.com , ext. 104 Crystal & Company Joanie Gunning joanie.gunning@crystalco.com

3 Design: About the Details The chart below outlines the benefit plans and coverages available depending on group size. Group Size Sole Proprietors Benefit Plans/Coverage Available Medical & Dental Kaiser Permanente Platinum HMO 0/15 Silver DHMO 1,000/50 Gold HMO 0/30 Bronze DHMO 6,300/75 Gold HMO 500/35 Bronze HSA Compatible HMO 4,800/40% Medical Groups of 2 4 Employees Dental Vision Kaiser Permanente Platinum HMO 0/15 Silver DHMO 1,000/50 Gold HMO 0/30 Bronze DHMO 6,300/75 Gold HMO 500/35 Bronze HSA Compatible HMO 4,800/40% Premier PPO 500 ($20/$500 ded) Standard PPO 1000 ($30/$1,000 ded) Value PPO 1500 ($40/$1,500 ded) PPO 3500 ($35/$3,500 ded) PPO 5000 ($40/$5,000 ded) HSA 3000 (20%/$3,000 ded) Standard Dental Plan and Value Dental Plan Blue View Vision (Employer-Paid Plan or Employee-Paid Plan) Vision Service Plan (VSP) Employer-Paid Plan Basic Life and AD&D Insurance: Choice of $5,000, $10,000 or $25,000 Life / Accidental Death & Dismemberment (AD&D) Voluntary Life and AD&D Insurance l Employees: Elect up to 5x annual salary to maximum of $300,000 l Spouse: Elect up to 50% of employee amount to maximum of $100,000 l Dependent Child: Elect $2,500 increments up to $10,000; employee must participate to elect dependent coverage Medical Kaiser Permanente Platinum HMO 0/15 Silver DHMO 1,000/50 Gold HMO 0/30 Bronze DHMO 6,300/75 Gold HMO 500/35 Bronze HSA Compatible HMO 4,800/40% Premier PPO 500 ($20/$500 ded) Standard PPO 1000 ($30/$1,000 ded) Value PPO 1500 ($40/$1,500 ded) PPO 3500 ($35/$3,500 ded) PPO 5000 ($40/$5,000 ded) HSA 3000 (20%/$3,000 ded) Dental For Groups of 5 or More Employees Vision Life / Accidental Death & Dismemberment Premier Dental Standard Dental Value Dental Voluntary Dental Blue View Vision (Employer-Paid Plan or Employee-Paid Plan) Vision Service Plan (VSP) Employer-Paid Plan Basic Life and AD&D Insurance l Groups with 5 Employees: Choice of $5,000, $10,000 or $25,000 l Groups of 6 or More Employees: Choice of $5,000, $10,000 or $25,000 or $50,000 Voluntary Life and AD&D Insurance l Employees: Elect up to 5x annual salary to maximum of $300,000 l Spouse: Elect up to 50% of employee amount to maximum of $100,000 l Dependent Child: Elect $2,500 increments up to $10,000; employee must participate to elect dependent coverage

4 Foundation: About the Options Kaiser Permanente (Medical) With Kaiser Permanente, employees have access to Kaiser hospitals and medical centers in California. Employees can enroll in a Kaiser plan if they live or work within 30 miles of a California Kaiser facility. The plans available are Health Maintenance Organizations (HMOs). With an HMO, employees choose a Primary Care Physician (PCP) to coordinate their care. Employees will need to get a referral from their PCP to see a specialist. There are three types of HMO plans available: Copay only plans Deductible + copay plans Deductible + coinsurance plan with a Health Savings Account (HSA) Note: HMO plans cover in-network services only except in a true emergency. (Medical, Dental, Vision, Life & Accident) Medical. With, employees have access to Preferred Provider Organizations (PPOs). With a PPO, employees can receive covered care either in-network or out-of-network. Employees do not need to select a PCP for care and they do not need to get a referral to see a specialist. Employees have greater flexibility with a PPO than with an HMO; however, out-ofpocket costs are higher when utilizing network providers. Employees can choose the High Deductible Health Plan PPO with a Health Savings Account (HSA). An HSA allows employees to set aside money on a pre-tax basis (up to IRS limits) to help offset out-of-pocket health care expenses. Or, employees can use it as a savings vehicle to pay for future health care expenses. Dental: With the Anthem dental plans, employees may choose any dentist in- or out-of-network; however, in-network dentists accept negotiated fees that are 10%-35% below the average charges in an employee s community, thus lowering out-of-pocket costs. The dental plans cover a wide range of services including diagnostic and preventive, basic and major restorative services. Some plans also cover orthodontia services. Vision: Through Anthem s Blue Vision plan, employees have access to over 45,000 vision care ophthalmologists and optometrists. The plan provides comprehensive coverage for eye exams and eye wear. Life & Accident: Employees and their beneficiaries can receive valuable financial protection in the event of death or serious accident. Marin Builders Association members can choose to offer basic and/or voluntary life and accident coverage. Vision Service Plan (Vision) Vision Service Plan (VSP) is the nation s leading provider of eye care benefits. There are more than 48 million individuals with access to VSP coverage. The VSP network is so comprehensive that more than 90% of individuals have access to a VSP provider within 10 miles of their home. Marin Builders Association members must have five or more employees to be able to offer the VSP benefit.

5 Framework: About Implementation Members of the Marin Builders Association are welcome to apply for their own group s benefit program at any time during the year. You can choose from a comprehensive suite of options that include medical, dental, vision and life insurance coverage. Participation Requirements To offer the benefits program to your employees, you must be a Marin Builders Association member and have been in business a minimum of one full calendar quarter. If you meet this criteria, you must provide: State quarterly payroll reports (DE-9C) Proof of payroll or other acceptable official ownership documents Wage information to determine eligibility of part-time, temporary or seasonal employees Note: Some additional restrictions apply. Below is additional information that may be helpful as you consider this program. Get Guidance During Each Phase We are here to help...before, during and after implementation. We can: Provide a product analysis to help you identify the best plans for your business. Help you during the enrollment process. Assist you with day-to-day administration of your benefits program going forward. Think of us as your one-stop choice for employee benefits. So whether your company is small or large, we can customize a benefit solution to meet your specific business needs. Not only will your business benefit from our exceptional service, but a strong benefits program will also help attract and retain the best employees. Eligibility for Plan Enrollment Eligible employees must be employed full time (working 20 or more hours per week) and must appear on the State Quarterly Payroll Reports (DE-9C); or be an active company owner or corporate officer actively at work. They must have also satisfied the company s waiting period. Employees may enroll a legally married spouse/domestic partner and child(ren) up to age 26. About the Rates We will provide you with a personalized quote based on the plans you wish to offer, the employee s age and the location (zip code) of the employee group. Our rates include an administrative fee as well as a 2% program fee, which goes to support the Association. For More Information For details about benefits, eligibility, participation requirements, rates and more, please contact Paula Krause, at , ext. 104 or paula@ marinbuilders.com. When Benefits Become Effective The plan year runs from April 1 through March 31. Open enrollment for making changes to benefits is typically held in February/March each year for an April 1 effective date. Once you have decided which plans to offer, coverage will be effective on the first of the month following your company s waiting period.

6 Finishing Touches: Other Important Information Compliance & Legislation The health plans offered in the Marin Builders Association Employee Benefits Program comply with applicable state and federal legislation, including: The Patient Protection and Affordable Care Act (PPACA, or ACA) of 2010 American Recovery and Reinvestment Act of 2009 as amended on December 19, 2009 by the Department of Defense Appropriations Act of 2010 Consolidated Omnibus Budget Reconciliation Act (COBRA) of 1986 Family and Medical Leave Act of 1993 Uniformed Services Employment and Re-Employment Rights Act (USERRA) of 1994 Health Insurance Portability & Accountability Act (HIPAA) of 1996 Newborns and Mothers Health Protection Act of 1997 Women s Health and Cancer Rights Act of 1998 Continuation of Benefits Replacement Act of 1998 (California State Law) (Cal-COBRA) Medicare Prescription Drug Improvement and Modernization Act of 2003 Mental Health Parity Act of 1997 Paul Wellstone-Pete Domenici Mental Health Parity & Addiction Equity Act of 2008 Centers for Medicare and Medicaid Services (Reporting Compliance) Michelle s Law (effective January 1, 2009) Group Health Insurance Plan Membership Paula Krause paula@marinbuilders.com , ext. 104