Custom Control Solutions 2022-23 Benefits Guide : simplebooklet.com

You must request a change to your benefitswithin 30 days of your life event (60 days forchanges involving Medicaid eligibility). Documentation may be required.Enroll nowYour benefit plans are in effect December 1 -November 30 each year. In general, there are threetimes you can make benefit selections:Making benefit selectionsGetting startedEligibility Enrolling in coverageFor youYou are eligible for benefits as a full-time employeeworking at least 30 hours per week.Your Spouse Your benefits begin on the first day of the monthfollowing 60 days of employment; this is youreffective date. Be sure to submit your selectionswithin your first 60 days of benefits eligibility. Your benefit selections will be in effect throughNovember 30. When you're first eligible Open Enrollment is your one chance each year toreview your coverage options and make changes toyour benefits.Your choices are in effect from December –November of the following year unless you have aqualifying life event. At Open Enrollmentmarriage or divorce, birth or adoption, death of a covered dependent, and a change in eligibility through Medicare,Medicaid, or a spouse or parent's coverage. Qualifying life events allow you to change yourcoverage during the year outside of OpenEnrollment. These include: If you have a qualifying life eventYou may also cover your eligible dependents whenyou elect coverage for yourself.Covering your familyMedical, dental and vision: until age 26regardless of student or marital statusChild life insurance: until age 21, or 26 if afull-time studentDependent children are eligible:You may cover your legal spouse.Your childrenCompany Code: CCSINC-FL

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Balance billingWhen you use an out-of-networkmedical or dental provider, theymay bill you the difference betweenwhat they charge and the amountyour insurance pays.Medical: balance billing is inaddition to – and does not counttowards – your out-of-pocketmaximum.CoinsuranceAfter you’ve met your deductible,you’re sometimes responsible for apercentage of the cost of themedical care, dental care, orprescription medication youreceived. This percentage iscoinsurance.CopayA flat fee you pay each time youreceive a copay-eligible medical,dental, or vision service orprescription medication. DeductibleThe amount you’re responsible forpaying in care expenses before themedical or dental plan starts payingdeductible-eligible expenses.In-networkIn-network care is always yourlowest-cost option. Networks aregroups of medical, dental, andvision providers, pharmacies, andfacilities that agree to discount thecost of their care or service.Out-of-pocket maximumThe most you’ll pay for covered in-network medical care in a year. Thisincludes your deductible, anycoinsurance or copays, andprescription drugs. The out-of-pocket maximum doesnot include your premium (theamount you pay for coverage), non-covered expenses, or out-of-network care that’s been balancebilled.Primary care physicianA primary care physician (PCP) isyour main medical doctor – usuallya general practitioner (GP), familydoctor, internist, OB/GYN, orpediatrician (for children).Referral/pre-authorizationSome specialty medical providersand services require a referral froma primary doctor. These may include- but are not limited to -cardiology, psychiatry, orthopedicsurgeons, rheumatology, surgery,and imaging (CT or MRI).Have questions? Your account manager is here tohelp you with all things benefits. Seetheir contact information on thenext page.How to handle medicalbills (4:46)Annual NoticesWe’re required to tell you about certainrights and responsibilities you have as anemployee of Custom Control Solutions Inc. You can request a paper copy at no chargefrom:Alex Werkeiser, HR Manager1.850.473.8704 | hr@ccsinc-florida.comDownload nowHelpful terms & resourcesGetting startedWe've removed as much jargon as possible.But you’ll probably still encounter some terms as you enroll in and use your benefits, and wewant you to be prepared!

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Medical insuranceUHCGroup: 00V85521.877.797.8812www.myuhc.com Dental insuranceMetLifeGroup: 59528521.800.275.4638www.metlife.comVision insuranceMetLifeGroup: 59528521.800.275.4638www.metlife.comLife and AD&D insuranceMetLifeGroup: 59528521.800.275.4638www.metlife.comContact informationGetting started1.850.439.5566 KRILEY@ONEDIGITAL.COMYour One Digital Account Manager, Kathleen Riley, is here tohelp you with claims, ID cards, coverage questions, and more!

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In-network careCEK3COJCCOIDNetwork name:UHC ChoiceUHC ChoiceUHC Choice PlusAnnual Deductible (DED)Out-of-pocket maximum$7,000 per person $14,000 family max$8,550 per person $17,100 family max$3,000 per person $6,000 family max$6,500 per person $13,800 family max$1,500 per person $3,000 family max$5,500 per person $11,000 family maxPre-tax account availability Preventive carePrimary care visitSpecialist visit100% covered$40 copay$90 copay100% covered$30 copay$80 copay100% covered$25 copay$90 copayUrgent careEmergency roomInpatient hospital careOutpatient$50 copayDED then you pay 50%DED then you pay 50%DED then you pay 50%$40 copay$750 copayDED then you pay 20%DED then you pay 20%$50 copay$500 copay$1,250 copay$500 copayPrescription drugsTier 1Tier 2Tier 3Tier 4(30 days)$10 copay $40 copay$150 copay$300 copay(30 days)$10 copay $40 copay$150 copay$300 copay(30 days)$10 copay $40 copay$150 copay$300 copayOut-of-network careAnnual deductible Out-of-pocket maximum Not ApplicableNot ApplicableBalance billing applies$5,000 / $10,000 $9,000 / $18,000Your cost for coverageEmployee onlyEmployee + SpouseEmployee + Child(ren)Employee + FamilyPer paycheck (24)$25.00$288.61$249.07$512.67Per paycheck (24)$74.00$377.84$332.27$636.11Per paycheck (24)$112.00$440.74$391.43$720.16See plan detailsMedical insuranceSee plan detailsSee plan detailsFind a ProviderThe information shown in this presentation is an illustrative summary only. The underlying plan contract or document governs all aspects of the plan. Finalrates are dependent on actual enrollment, insurance carrier or plan rules, plan selection, and eligibility criteria. Please refer to the plan document, contract,and other notices contained in this document, applications, and other corresponding communications for additional information.what you pay for the plan, what you pay when you get care, how out-of-network care is covered, andyour annual maximum cost for care (out-of-pocket maximum).All plans cover in-network preventive care at 100%, prescription drugs, andinclude an annual limit on your expenses. The differences are: Select from three medical options through UnitedHealthcare.See your plan documents for out-of-network benefits.The deductible and out of pocket max are based on a CALENDAR year (Jan 1 - Dec 31).

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Dental insuranceThe information shown in this presentation is an illustrative summary only. The underlying plan contract or document governs all aspects of the plan. Finalrates are dependent on actual enrollment, insurance carrier or plan rules, plan selection, and eligibility criteria. Please refer to the plan document, contract,and other notices contained in this document, applications, and other corresponding communications for additional information.Stay in-network to avoid balance billing (the difference between what an out-of-network provider charges and the amount your insurance pays). You'll get in-network preventive care at 100% along with coverage for basicand major dental services.Orthodontic care is not covered.Your dental coverage is through MetLife.Learn about dental care categoriesIn-network careDental planNetwork name:Preferred Dentist ProgramAnnual Deductible (DED)$50 per person $150 family maxAnnual maximum benefit$1,250 per person Preventive care100% coveredBasic careDED then you pay 20%Major careDED then you pay 50%Orthodontic careCoverageLifetime maximum benefitNot coveredN/AYour cost for coverageEmployee onlyEmployee + SpouseEmployee + Child(ren)Employee + FamilyPer paycheck (24)$7.23$23.36$25.02$44.45See plan detailsThe deductible and benefit max are based on a CALENDAR year (Jan 1 - Dec 31).

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Vision insuranceYour vision plan covers either glasses (lenses and frames) or contact lenses each year. If you receive contact lenses, they will be instead of your glasses benefit.In-network careBase planNetwork name:National PPOAnnual eye exam (every 12 months)$10 copayMaterials copay(lenses & frames)$25 copayLenses (every 12 months)Included in materials copayFrames(every 24 months)$130 allowanceContact lenses(every 12 months)$130 allowanceYour cost for coverageEmployee onlyEmployee + SpouseEmployee + Child(ren)Employee + FamilyPer paycheck (24)$4.73$9.47$8.02$13.23See plan detailsYou'll get an annual exam with coverage for lenses and frames, or contacts inlieu of glasses.Your vision coverage is through MetLife.The information shown in this presentation is an illustrative summary only. The underlying plan contract or document governs all aspects of the plan. Finalrates are dependent on actual enrollment, insurance carrier or plan rules, plan selection, and eligibility criteria. Please refer to the plan document, contract,and other notices contained in this document, applications, and other corresponding communications for additional information.Benefits and frequencies are based on your last date of service.

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Custom ContrSee plan detailsFor youFor your spouseFor your child(ren)Coverageincrements$10,000$5,000$1,000, $2,000,$4,000, $5,000, or$10,000Coveragemaximum5x your annualearnings to $500,000$100,000$10,000Medicalquestion limit$50,000$25,000$10,000You may also purchase additional coverage for you, your spouse, and youreligible child(ren). Additional life and AD&D insuranceSee plan detailsLife insurance pays a benefit if you pass away while you're covered. AccidentalDeath and Dismemberment (AD&D) insurance offers additional support if youpass away or are seriously injured due to an accident.Financial peace of mind through MetLife.Life and AD&D insuranceyour beneficiary if you passaway due to an accidentyou a partial benefit if youlose specified bodily functions(sight, limbs, etc.)What's AD&D?Accidental death anddismemberment (AD&D)insurance may pay:Make sure to designate a beneficiary for your life insurance coverage to ensureyour family is cared for according to your wishes.Medical question limitWhen you’re first eligible (a newhire), you can purchaseadditional life insurance up tothis limit without any medicalquestions required. Medical questions and approvalwill be required for all futureincrease and purchase requests.The benefit plan information shown in this guide is illustrative only. To the extent the benefit plan information summarized herein differs from the underlyingplan details specified in the insurance documents that govern the terms and conditions of the plans of insurance described in this guide, the underlyinginsurance documents will govern in all cases.Basic life and AD&D insuranceCustom Control Solutions Inc provides life and AD&D insurance at no cost toyou.Age reduction 35% at age 65 and an additional 15% at age 70.Basic lifeBasic AD&DCustom Control Solutions Inc provides$15,000$15,000

Custom Control Solutions 2022-23 Benefits Guide

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