2020 OPEN ENROLLMENT is now closed.
Brennan Manna Diamond full-time employees are generally eligible for benefits effective on the first of the month following date of hire. Specific eligibility requirements are listed under each coverage type. Benefits are available for employees and their eligible dependents. Please see Human Resources to confirm your eligibility and offerings.
If you have any questions regarding your medical benefit plan with Cigna or any available resources contact Cigna One Guide® to get personalized, useful guidance.
Your personal guide will help you:
› Easily understand the basics of health coverage
› Check if your doctors are in-network to help you avoid unnecessary costs
› Get answers to any other questions you may have about the plan or provider networks available to you
Call 888.806.5042 to speak with a Cigna One Guide representative & reference your group number: 3343635
MEDICAL
Cigna
Policy #3343635
CUSTOMER SERVICE: 800.224.6224
www.mycigna.com
Eligibility:
All employees working 30 hours a week or more.
Plan Features |
In-Network |
| Deductible | Individual $3,000 / Family $6,000 |
| Coinsurance | 0% after deductible |
| Out-of-Pocket Maximum | Individual $4,000 / Family $8,000 |
| Preventive Care | 100% |
| Primary Care | Deductible then $30 Copay |
| Specialists | Deductible then $60 Copay |
| Urgent Care | Deductible then $75 Copay |
| Emergency Room | Deductible then $350 Copay |
RESOURCES
- Medical and Prescription Copays apply to the Out-Of-Pocket Maximum.
- See Benefit Summary and plan document for additional detail and non-network benefits.
MEDICAL -Cigna HDHP/HSA |
Effective 7/1/2020 – 6/30/2021
|
||
| Salary Information | Under $50,000 | $50,001 – $100,000 | $100,001 and over |
| Employee (Single) | $100.00 | $125.00 | $150.00 |
| Employee and Spouse | $175.00 | $225.00 | $300.00 |
| Employee and Child(ren) | $150.00 | $200.00 | $250.00 |
| Family | $200.00 | $300.00 | $400.00 |
| Tobacco Nicotine – Employee | $125.00 | $125.00 | $125.00 |
| Tobacco Nicotine – Spouse | $125.00 | $125.00 | $125.00 |
** Monthly rates based on base salary on 1/1/2020
HEALTH SAVINGS ACCOUNT (HSA)
Fifth Third Bank
CUSTOMER SERVICE: 800.350.5353
www.53hsa.com
Eligibility:
Eligible employees must be enrolled in the High Deductible Health Plan (HDHP), they cannot be enrolled in Medicare, & cannot be claimed as a dependent on another person’s tax return.
Account Type |
In-Annual Maximum |
| Employer Employee Only HSA Contribution* | $900 maximum |
| Employer Family HSA Contribution* | $1,800 maximum |
| Employee Only annual maximum for 2020** | $2,650** |
| Family annual maximum for 2020** | $5,300** |
*Participants enrolled in the HDHP HSA option will receive employer contributions based on participation in the BMD Preventive Care and Wellness Program.
**HSA Max Amounts are $3550 Single/$7100 Family (Combined amount combined: Employer + Employee contributions)
**Plus $1,000 catch-up if age 55 or older
This savings program saves taxes on IRS qualified medical, dental, and/or vision costs. The plan works like a personal expense account. You set aside a portion of your salary – before taxes. The money is saved or used to pay certain medical, dental and vision expenses not covered by insurance, including prescription drugs and some over-the-counter medications. Since the money is set aside pre-tax, you save on federal, state, Social Security and Medicare taxes. The amount set aside can be changed at any point in the calendar year by simply completing a direct deposit form. Money is saved in a personal, portable bank account and can be invested once reaching a set limit.
All accounts are subject to typical banking fees, as this is a type of personal checking account.
Watch a brief two minute video to learn about the advantages of a Health Savings Account (HSA).
PRESCRIPTION (Rx) DRUG COVERAGE
Cigna Value Formulary
Please refer to the current Cigna Prescription Drug List for further detail on what tier your prescription may be classified under and any limitations, exclusions, or terms of coverage. Cigna also offers mail order for a 90-day supply.
Prescription Drug Coverage |
HDHP HSA |
| Prescription Drug Deductible | Plan Deductible |
| Retail (30-day) | $10/$40/$70 |
| Specialty (30-day supply only) | 25% to $200 |
| Mail Order (90-day) | $20/$120/$210 |
RESOURCES
DENTAL
Anthem Dental Complete
Eligibility:
All employees working 30 hours a week or more
Dependent Age Limit:
Dependents can be covered up to age 26.
TYPE OF SERVICE |
PPO
|
| Deductible | Individual $50/Family $150 |
| Policy Year Maximum | $1,000/$1,000 |
| Diagnostic & Preventive Services Bitewing & Full Mouth X-Rays; Cleanings; Oral Exams; Sealants (per tooth) |
100%/100% |
| Basic Services Fillings (one surface); General Anesthesia; Scaling & Root Planing (per quadrant); Simple Extractions |
80%/80% |
| Major Services Crowns, Inlays, Endodontics Root Canal, dentures |
50%/50% |
| Orthodontia Dependents age 8-19 50%/50% |
50%/50% |
Coverage Tier |
Per Month Contributions |
| Employee (Single) | $28.56 |
| Employee and Spouse | $57.16 |
| Employee and Child(ren) | $59.87 |
| Family | $91.71 |
For provider look-up and to register for your individual account, reference www.Anthem.com
VISION
Anthem Blue View
Eligibility:
All employees working 30 hours a week or more
Dependent Age Limit:
Dependents can be covered up to age 26.
RESOURCES
Type of Service |
In-Network/Non-Network |
| Exam Benefit eligible every 12 months |
$5 Copay/Up to $42 |
| Lenses Benefit eligible every 12 months |
$10 Copay/Up to $40: single, $10 Copay/Up to $60: bifocal, |
| Frames Benefit eligible every 24 months |
$10 Copay/Up to $45 |
| Contacts Benefit eligible every 12 months |
$130 Allowance/Up to: $105 elective, $210 necessary |
For provider look-up and to register for your individual account, reference www.Anthem.com
Coverage Tier |
Pretax Per Month Contributions |
| Employee (Single) | $3.33 |
| Employee and Spouse | $6.66 |
| Employee and Child(ren) | $7.13 |
| Family | $11.39 |
VOLUNTARY LIFE and AD&D
Eligibility:
All full-time employees excluding Owners & Partners.
Life Insurance Plan
This life insurance plan provides financial protection for your beneficiary(ies) by paying a benefit in the event of your death. The amount your beneficiary(ies) receive(s) is based on the amount of coverage in effect just prior to the date of your death according to the terms and provisions of the plan. You also have the opportunity to have coverage for your dependents.
Benefits
for you:
Amounts in $10,000 increments up to Guaranteed Issue amount of $100,000
Benefit cannot exceed 5x annual earnings or $500,000. Evidence of Insurability is required for any amount over $100,000 or any increase in current enrolled volume. If the option to elect voluntary coverage was previously waived, then EOI will also be required to enroll.
for your dependents:
SPOUSE – Amounts in $5,000 increments up to Guaranteed Issue amount of $25,000
Benefit cannot exceed the volume elected for the employee up to the plan maximum of $500,000. Evidence of Insurability is required for any amount over $25,000 or any increase in current volume. If the option to elect voluntary coverage was previously waived, then EOI will also be required to enroll.
CHILDREN – Amounts in $2,000 increments up to the Guarantee Issue amount of $10,000
Benefit cannot exceed the volume elected for the employee up to the plan maximum of $10,000.
The information in this Benefits Summary is presented for illustrative purposes and is based on information provided by the employer. The text contained in this Summary was taken from various summary plan descriptions and benefit information. While every effort was taken to accurately report your benefits, discrepancies, or errors are always possible. In case of discrepancy between the Benefits Summary and the actual plan documents the actual plan documents will prevail. All information is confidential, pursuant to the Health Insurance Portability and Accountability Act of 1996. If you have any questions about this summary, contact the Human Resources.