2006 Employee Benefits Q&A
The information contained in this Q&A is intended as a summary of Caremark benefit plans. In the event of a discrepancy between this Q&A and legal documents, legal documents will govern.
Click on a link below to go straight to the section of your choice, or scroll through this document to see all questions.
Prescription Drug Plan
Flexible Spending Accounts
I just don’t have time to enroll. If I don’t do anything at all, will I have the same benefits in 2006 as I do right now?
No. This is not a “passive” enrollment – your 2005 selections do not automatically roll over into 2006. Without enrolling for 2006 benefits, the only benefits you will have are basic life insurance, business travel accident insurance, and short and long-term disability coverage. If you do not go to www.caremark.com/benefitsenrollment and select your 2006 benefits, you will not have medical, dental, supplemental life insurance, vision, etc., in 2006. Please take a moment to ensure your 2006 benefits enrollment is successful.
The 2006 premium information can be found on your personalized benefit enrollment screen, which is in Employee Self Service. Go to www.caremark.com/benefitsenrollment and click the “Enroll Here” button. From here click on “Continue to Self Service.” From there you will be taken to the PeopleSoft login screen, where you will need your Self Service ID and password. If you cannot locate your ID or password, contact FrontLine Services at 1-800-773-4003.
Where do I go to actually enter my enrollment?
Benefits Enrollment is one of the many features of Employee Self Service (ESS), and you must access ESS in order to enroll. In order to access the ESS PeopleSoft log in page, you must follow one of the options below. If you have lost or forgotten your User ID and/or password, please contact Frontline Services via email at email@example.com. Representatives are also available by phone at 1-800-773-4003, 24 hours a day for password resets.
• Option A: From the Carenet Homepage, go to Human Resources>Benefits>Enrollment>Enrollment Link. You will then come to the Self-Service Home Page, and must click on the link to Continue to Self Service.
• Option B: From the Carenet Homepage, go to the Human Resources tab, select Employee Self Service, and select Continue to Self Service.
• Option C: From the benefits enrollment site at www.caremark.com/benefitsenrollment, click on the Enroll Here box. You will access the ESS Home Page, and will need to click on Continue to Self Service. You will then enter the Peoplesoft Login page.
Enter your User ID and Password, which is the same as your Employee Self Service User ID and Password, or available by calling Frontline Services. User ID and Password are case sensitive.
Click Sign In. Once you are there, to access your benefits enrollment, you will need to click on Employee Self Service>Benefits>Benefits Enrollment. The Benefits Enrollment screen will appear, and if you have an open event, i.e. Open Enrollment, you will need to click on the Enroll button.
As you navigate through the enrollment screens, make sure you select the plans you wish to enroll in, and be sure to select any dependents that you wish to enroll in the various benefit plans. Pay close attention to which boxes you need to check or uncheck in order to ensure your dependents are properly enrolled. Once finished, you must authorize your benefit elections and submit them to the Benefits Department. If you do not reach the Submit Confirmation page, you have not submitted your choices to the benefits department, and none of your elections will be enetered.
As I was enrolling, my power went out. I do not know if my elections were entered or not. Is there any way to confirm that I will be enrolled in the benefits that I selected for 2006?
Yes. If Open Enrollment is not yet over, you can go back into the benefit enrollment session and re-enter your elections. However, please note that if you have already submitted your elections and you go back into the enrollment session, you will need to re-submit your elections, or your choices will not be entered.
In addition, about a week after Open Enrollment closes, you will receive a Confirmation Statement to your home. Please review this statement carefully, as this will be your last opportunity to make any changes, or correct any errors that may have occurred during your enrollment. Once the deadline to make changes to the Confirmation Statements has passed (the date will be printed on your statement), you will have no other opportunities to make changes to your benefits until 2007 Open Enrollemnt, or unless you experience a Qualified Family Status Change (QFSC).
Open Enrollment is over, but I made a mistake and I need to elect a different medical plan, and add Vision coverage. Is there any way I can do this?
Yes. About a week after Open Enrollment ends, you will receive a Confirmation Statement to your home. You will need to review this statement carefully, as this will be your last opportunity to make any changes, or correct any errors that may have occurred during your enrollment. If you find an error, and need to make a change to what is printed on your Confirmation Statement, you must contact the Caremark Benefits Center at 1-888-769-1717 before the deadline printed on the statement. Once the deadline to make changes to the Confirmation Statements has passed, you will have no other opportunities to make changes to your benefits until 2007 Open Enrollment, unless you experience a Qualified Family Status Change (QFSC). For more information on QFSC’s, please review page 8 of the 2006 Benefits Guide, or see below.
What is a Qualified Family Status Change (QFSC)? What kind of changes can I make to my benefits if I experience a QFSC?
A QFSC, or a Qualified Family Status Change, is a life event that provides you with the opportunity to make a change to your benefit elections. Examples of QFSC’s include:
• Marriage or divorce
• Birth or adoption
• Death of a spouse or dependent
• Change in employment status for you or your spouse
• Qualified Medical Child Support Order (QMCSOs)
• Any change in your child’s eligible dependent status which causes them to no longer be considered an eligible dependent under the health plans, such as getting married, turning 25, or being ages 19-24 and not a full-time student
• Significant change in employee or spouse’s health coverage and/or price
• Your dependent’s loss of eligibility
Changes due to a QFSC must be consistent with the QFSC event. For example, if you have a baby, you can add your baby as a dependent and begin coverage, however, you cannot change your coverage plan (i.e. switch from the Silver to the Gold plan).
QFSCs must be reported to the Caremark Benefits Center within 31 days of the effective date of the qualifying event, or a missed enrollment change opportunity will occur. For additional information on QFSCs, please contact the Caremark Benefits Center at 1-888-769-1717.
Are there any changes to the Medical Plan from 2005?
There will be no changes to the basic medical plan design for 2006, which means the deductibles, co-pays, and co-insurance remain the same in 2006. There are a number of plan improvements to be aware of:
• Larger discounts on lab work. In 2006 employees will pay nothing when they receive eligible lab services at a Quest Diagnostics® facility. They will have no out-of-pocket costs—no co-payments, no deductibles, and no co-insurance. Caremark pays the entire cost. Employees are not required to use a Quest facility, and if they don’t, the plan will pay the same as it does today. There is no penalty to the employee if they do not use Quest, only a benefit if they choose to use Quest.
• Reductions in urgent care costs. Beginning in 2006, First Health Urgent Care costs will be subject only to an Urgent Care co-pay, versus being subject to the annual deductible and co-insurance (which was the case in 2005).
• Acupuncture and Biofeedback services have moved to the list of “covered” items in the First Health Medical Plan, (subject to medical necessity and visit limits).
For more information on these enhancements, as well as the overall medical plan design, please see the 2006 Benefits Guide.
I understand that First Health is the medical plan administrator. I want to check to see if my physician is in the network—how can I do that?
You may use any of several tools available to you to locate a provider or determine whether your doctor is in the First Health network. Simply call 1-800-272-8931, and First Health specialist will assist you in locating a network provider near your home or office. First Health Member Services representatives are available 24 hours a day, 365 days a year.
You may also visit the First Health Web site at www.firsthealth.com, to look up providers and/or run custom directories that fit your individual needs. Keep in mind that you will need the following Client ID to access this site: CMB.
What does “open access” mean?
Open access means that as long as you use a doctor in the First Health network, you have direct or “open” access to physicians and specialists. In other words, you do not have to select a primary care physician, and wait for them to refer you to another physician. You go directly to the physician you feel you need to see, and as long as they are in the network, you will be reimbursed according to plan guidelines.
My family physician is not in the First Health network. What are my options?
Because First Health is a national health benefits company, a high percentage of health care providers are in its network. Most employees will find their current provider in the network; however, if your provider is not in the network, you may utilize the First Health Physician Nomination process, by contacting 1-800-272-8931, or visiting the First Health Web site at www.firsthealth.com.
What happens if my physician refers me to another physician? Is it my responsibility to confirm that the physician I’m being referred to also participates in the First Health network?
Yes. While First Health encourages their network physicians to refer their patients to other network physicians, this may not always be possible. We recommend that members always confirm that the physician is a member of the First Health network. Likewise, if your physician refers you to a hospital, or instructs you to have lab work, x-rays, or other tests done at another facility, it is always the member’s responsibility to confirm that the hospital or facility participates in the First Health network. To find out, simply go to the electronic directory at the First Health Web site or call 1-800-272-8931 to speak with a First Health member services representative.
Can I access network providers while traveling?
Yes, you have access to providers in The First Health network throughout the United States. In fact, 90 percent of the entire U.S. population has access to network physicians and hospitals. No matter what the reasons are for being in another state -- vacations, business travel, or college -- you and your dependents can find providers who participate in the First Health network. Just make sure to have an ID card with you, and call the toll-free number printed on your ID card, or consult your provider directory.
If I am enrolled in one of the EPP (network only) plans and see an out-of-network physician, or have services performed at an out-of-network facility, will my claims be paid?
There is no level of benefit or insurance coverage if you do not stay in the network. However, in case of a true emergency, you should proceed directly to the nearest emergency room and your claims would be paid at the in-network level of reimbursement.
What is a co-pay?
This applies to certain services such as routine non-surgical physician office visits. For example, each time you visit the physician’s office in the Gold Plan, you pay $20.00 (Specialist is $35.00). Typically, that is all you pay for the physician visit.
What is the specialist co-pay?
The specialist co-pay applies to all physicians other than, general practitioners, family practitioners, pediatricians, internists, and OB/GYNs.
What is an annual deductible?
The annual deductible is the amount you pay each year before the Plan begins covering your medical expenses at the applicable co-insurance level. Deductibles do not apply to routine non-surgical physician office visit. Co-pays do not apply to your deductible.
What is the difference between an individual deductible and a family deductible?
The individual deductible is the amount any individual in a covered family pays before their medical bills are applied to the co-insurance. For example, in the Gold Plan, the individual deductible is $250 and the family deductible is $500.
Meeting the family deductible means that when any combination of family members collectively reach $500 towards the deductible in covered medical expenditures, then the entire family has met the deductible. For instance, if you have 5 people in your family, you could each have $100 in covered medical expenses going towards the deductible, and the family annual deductible would be met for the year. In this scenario, no individual person would have to get to $250, if the entire family collectively reached $500 first. A family will not have to pay more than $500 on an annual basis in deductibles on the Gold Plan. However, if one individual meets the $250 deductible and has additional expenses before the family deductible of $500 has been applied, the Plan will begin to pay covered expenses at the 90% co-insurance level for that individual.
What is co-insurance?
Co-insurance is the percentage of medical expenses shared by you and the Plan after you have met the deductible. It applies to procedures and medical expenses outside of a routine office visit. For instance, in the Gold Plan, once the deductible has been met, you will pay 10% of all eligible medical expenses at the negotiated rate and the Plan will pay 90% of all eligible medical expenses. For example, let’s say you have already met your deductible and your doctor wants you to have a test that costs $70. You would be responsible for 10% of the $70 bill, or $7.00. The Plan would pay the remaining $63.
Does co-insurance apply to all covered medical services?
No, it does not apply to services that have a co-pay associated with them such as physician office visits, and specialist co-pay visits.
Does co-insurance apply to the original fee associated with the medical service, or is it applied to the “network-negotiated rate”?
The employee only pays co-insurance on the network-negotiated rate. You will not be responsible for the amount the provider bills above the negotiated rate.
What is an out-of-pocket maximum?
An out-of-pocket maximum is a safety net to limit your out-of-pocket liability. An out-of-pocket maximum is the total amount you pay out of your own pocket for eligible expenses in one calendar year before the Plan begins to pay 100% of your covered medical expenses. Deductibles and physician office co-pays do not apply to the out-of-pocket maximum. The out-of-pocket maximum only applies to the co-insurance portion of your expenses. For example, in the Gold Plan, your out-of-pocket maximum is $1250 for an individual and $2500 for a family. Keep in mind that in this plan, you only pay 10% of each medical bill and the Plan pays 90%. Once you have reached an out-of-pocket cost of $1,250 for any one individual during a calendar year, you have reached your individual out-of-pocket maximum. The plan will then begin to pay 100% of the cost for that individual through the end of the year.
What is the difference between an individual out-of-pocket maximum and a family out-of-pocket maximum?
The individual out-of-pocket maximum is the amount any individual in a covered family pays in co-insurance before their eligible medical bills are covered at 100%. Under the Gold Plan, your annual individual out-of-pocket maximum is $1250 and your family out-of-pocket maximum is $2500.
Meeting the family out-of-pocket means that when any combination of family members collectively reach $2500 in co-insurance towards the out-of-pocket maximum, then the entire family has met the annual out-of-pocket maximum. For instance, if you have six people in your family, you could each have spent $333.33 in co-insurance, and the family out-of-pocket maximum would be met for the year. In this scenario, no single person would have to get to $1250, if the whole family collectively reached $2500 first. A family will not have to pay more than $1250 for any individual or $2500 collectively in co-insurance before the Plan begins to pay 100% for all covered medical expenses.
To illustrate an out-of-pocket maximum, let’s assume that you are enrolled in the Gold plan and you incur an in-patient hospital stay that costs $20,000.
Total Bill $20,000
Step #1 Pay the hospital-per-admission co-pay - 150
Step #2 Meet your annual deductible - 250
Step#3 Apply the remaining bill towards co-insurance (x10%) $ 1,965
Step#4 Consider the individual out-of-pocket maximum ($1,250).
You only owe $1,250 in co-insurance. You have now met your individual out-of-pocket maximum, which saved you $715 in co-insurance.
Now that you have met your annual individual deductible and your annual individual out-of-pocket maximum, you will not have to meet them again for the remainder of the plan year. Your co-insurance share has now been changed from 10% to 0%, which means your future eligible co-insurance expenses are paid at 100%.
What is an emergency room co-pay?
An emergency room co-pay is the amount you pay each time you visit the emergency room. In the Gold Plan, your emergency room co-pay is $100. After paying the emergency room co-pay of $100, all other charges are subject to deductibles and 10% co-insurance. [If you are admitted to the hospital, the emergency room co-pay is waived and the hospital stay is subject to your deductible and co-insurance a hospital per admission co-pay of $150 will also apply.]
Alternatives to avoid ER costs:
• Doctor’s Office
• Urgent Care (must be in network)
• First Health 24-Hour Nurse Line at 1-800-272-8931
What if I go to the doctor, pay the co-pay, and then the doctor decides to do additional lab work and/or x-rays?
Medically necessary tests such as lab work and x-rays are subject to the applicable deductible and the co-insurance based on your plan. The amount you pay for the co-insurance counts towards your out-of-pocket maximum. However, if you doctor uses a Quest Diagnostics® facility, you will have no out-of-pocket costs—no co-payments, no deductibles, and no co-insurance. Caremark pays the entire cost.
What will be my co-insurance responsibility on a $1000 outpatient/inpatient covered medical expense?
It will depend on the plan that you elect. In the Gold Plan, it would be $75, after the deductible. If your bill (after negotiated fees) were $1000, it would be calculated as follows: Subtract the $250 deductible (if you had not already met the deductible), which leaves $750. Co-insurance of 10% is applied to the remaining $750, which totals $75. The plan pays the remaining $675. If your deductible has already been met, the plan pays $900 and you pay $100.
Who is responsible for ensuring I am using an in-network provider and/or facility?
You as the participant have sole responsibility for verifying the in-network status of any provider, physician, or facility each time you seek medical treatment.
What preventative/wellness services are covered under the First Health Medical Plans, and what will these services cost?
Wellness services eligible for reimbursement under your First Health medical coverage include:
• Eye and Hearing Exams
• Well-Child Care Visits
• Routine OB/Gyn Exams
• Mammograms (age 40 and over)
• Colonoscopies (age 50 and over)
• Various other AMA age recommended screenings
The rate of reimbursement for these services will vary depending on which medical option you have chosen. For instance, when enrolled in the Gold Plan, your cost for a physical will be the cost of the physician co-pay, or $20. The same holds true for well-child care visits, immunizations, and routine OB/Gyn exams. If your physical or routine exam involves tests or lab work done outside of the physician’s office, those would be subject to the deductible and co-insurance. Routine mammograms are covered at 100%.
Will mental health services be covered?
Yes. Mental or behavioral health services will be offered through the medical plans. Behavioral health benefits will feature both in- and out-of-network benefits. All services will require preauthorization.
When I call First Health, what identifying information will I be required to provide?
When you call First Health you will be required to provide your social security number to the First Health Member Services Representative. Your social security number is required as a means to authenticate access to your personal health information. In addition, the First Health Member Services Representative needs your social security number to make a call note detailing the date of your call, your questions, and the information that was provided to you.
When you call the Caremark Benefits Center (CBC), however, you will only be required to provide your Employee ID number and your name. The CBC Representative has the ability to search the database by your name and will authenticate access to your personal information with your ID number. Here, also, a call note will be made detailing the date of your call, your questions, and the information that was provided to you.
What dependents are eligible for enrollment in the Caremark benefit plans?
Your eligible dependents are limited to the following:
• Your spouse
• Your domestic partner
• Your unmarried, natural, legally adopted, or step child(ren) up to age 19
• Your unmarried, natural, legally adopted, or step child(ren) up to age 25 if they are a full-time student
• Your unmarried, natural, legally adopted, or step, incapacitated child(ren), provided they were declared incapacitated by the age of 18
Ineligible dependents are all those which are not included in the list above, including, but not limited to;
• Foster children
• Children of domestic partners
• Children for which you have guardianship, but have not been legally adopted
• Parents and grandparents
• Aunts and uncles
If I am enrolled in the PPO will I be covered out of state?
Yes, you have access to providers in the First Health network throughout the United States. In fact, 90 percent of the entire U.S. population has access to network physicians and hospitals. No matter what the reasons are for being in another state -- vacations, business travel, or college -- you and your dependents can find providers who participate in the First Health network. Just make sure to have an ID card with you, and call the toll-free number printed on your ID card, or consult your provider directory.
In addition, when you are enrolled in the PPO plan, you may use any physician, anywhere, and there will still be some level of coverage for eligible out-of-network expenses.
Prescription Drug Plan
Are there any changes to the Prescrition Drug plan from 2005?
The basic prescription drug plan design will remain the same however, there was an improvement to the Disease Management Program. As of January 1, 2006, our CarePatterns® program will offer three more Disease Management Programs:
• Hypertension Program
• Chronic Pain Program
• Depression Program
In addition, new for 2006, CarePatterns® will offer a “no effort enrollment,” called the CarePatterns® Opt-Out Program. Participants identified through medical algorithims are automatically enrolled in the Disease Management Program, and contacted by a member of the CarePatterns® Clinical Team. The initial call will intorduce participants to the proram and explain the level of service and coaching they may expect to receive. Of course participants my elect to “opt-out” of the program. If they don’t however, a CarePatterns Clinician will continue to work with them to improve their knowledge, improve their health, and ultimately, help them experience a better quality of life. The CarePatterns® Program is completely confidential and HIPAA compliant. For more information on CarePatterns® and other diseases that are a part of this program, please review the 2006 Benefits Guide.
I’m trying to enroll in my benefits now, but I don’t see an option for the Prescription Drug plan. Does that mean I am not eligible?
No. The Prescription Drug plan does not show up in the benefits enrollment session because when you (and your covered dependents) are enrolled in any of the medical options, you (and your covered dependents) are automatically enrolled in the Caremark prescription drug plan.
My prescription requires me to use Durable Medical Equipment (DME) as part of my drug therapy program. How does this work with the Caremark Prescription Drug plan?
Durable Medical Equipment (DME) is not covered under the Caremark Prescription Drug plan. You must coordinate all DME coverage with your medical plan. Prior to using the DME, you must make sure that the facaility is in-network.
What are my options for getting my maintenance prescriptions refilled?
You may contact RxRequest at 1-866-284-9226, or visit the Caremark Web site at www.caremark.com. Both are available 24 hours a day, 7 days a week.
Who should I contact if I have questions about my prescription drug coverage?
If you have questions about the Prescription Drug plan, you should contact Caremark Customer Service at 1-866-284-9226, or go online to www.caremark.com.
What is the difference between the Alternate Plan and the DHMO Plan?
The Alternate Plan, administered by First Health, allows you to see the dentist of your choice, but offers additional savings when you visit an in-network dentist. Features of the Alternate Plan include:
• Freedom of Choice among dentists
• No office visit co-pay
• 100% preventative care coverage, 80% basic care coverage, and 50% major dental work coverage
• Deductibles, annual limits, and lifetime limits associated with this plan
• In addition, new for 2006, dental sealants have been moved to the list of “covered” items in the First Health Dental Plan, subject to age limits
The DHMO Plan, administered by CIGNA, has many features and an extensive reimbursement of services schedule. With this plan, you are required to select a Primary Care Dentist. To do so, simply call the CIGNA Dental office locator at 1-800-367-1037, or visit the dental directory at www.cigna.com. Features of the DHMO plan include:
• In general, two preventative visits every twelve months, at no charge.
• Other dental services, including basic and major dental treatments are reimbursed according to the Patient Charge Schedule. This schedule can be found by visiting www.cigna.com and registering or logging into your account, or by accessing the Benefits Enrollment Web site at www.caremark.com/benefitsenrollment, and clicking on the Vendor Information tab.
I underwent a dental procedure, and was prescribed some medications in conjunction with that procedure. Are the drugs/medications covered by either of the dental plans?
No. Drugs and medications prescribed in conjuction with a dental procedure are not covered by either dental plan. All drugs and medications are subject to the provisions of the Prescription Drug Plan.
If I am in an accident that requires dental teratment, is that covered by either of the dental plans?
No. Accidents that result in necessary dental treatment are not covered under the dental plan. Consult your medical plan for information regarding dental accidents. An accidental injury does not include damage caused by biting or chewing.
I am enrolled in the Vision Plan, but I don’t have an ID card. Can I still receive an eye exam or purchase eyewear from a network provider at the neogtiated rates?
Yes you can. When you contact your provider to set up the appointment, simply provide the primary insured’s (employee’s) Social Security number, the patient’s name and date of birth, and identify yourself as having Cole Vision coverage. In additon, you may print your own replacement card by accessing the Cole Managed Vision Web site at www.colemanagedvision.com. From there, you will need to access the Find a Provider section, and clicking the link to the replacement card.
Is LASIK surgery covered under the Cole Vision Plan?
Discounts are available on the surgeon’s lowest advertised price, if you schedule the procedure through the NuVision LASIK Network™. The initial consultation is alwys free of charge, even if you choose not to proceed with the LASIK surgery. To schedule a free evaluation with a participating NuVision LASIK Network™ surgeon in your area, you must contact 1-888-705-2020.
In addition, please keep in mind that LASIK surgery is considered an eligible expense under the Health Care Flexible Spending Account.
Flexible Spending Accounts
What are the advantages of the Health Care Flexible Spending Account?
A Health Care Flexible Spending Account, also known as a Health Care Reimbursement Account, lets you set aside pre-tax dollars from your paycheck to cover eligible health care expenses not reimbursed by your medical plan that you or your dependents may have. The dollars are not taxed, even after they are reimbursed.
Eligible expenses associated with your medical plan include, but are not limited to:
• All applicable co-pays
• Prescription Drug co-pays
• Over-the-counter drugs
• Medical expenses that may not be covered or limited by your medical plan
Please remember that there are many other expenses eligible for reimbursement under the Health Care Flexible Spending Account including, dental, vision exams, prescription eyeglasses, contact lenses, etc. IRS regulations stipulate that you must incur the expense during the respective calendar year and submit for reimbursement by March 31 of the following year.
If I have not enrolled my dependents in a Caremark medical plan, may I still apply their eligible expenses towards a Health Care Flexible Spending Account?
Yes. Any eligible expenses you or your eligible dependents incur may be applied towards your Health Care Flexible Spending Account even if you elect no coverage under the medical and/or dental plans. For example, prescription eyeglasses, deductibles, and co-insurance under a non-employee spouse’s health plan would be considered eligible.
I understand FlexBen was acquired by WageWorks, and that WageWorks will be the new Caremark FSA adminstrator. I was enrolled in the FlexBen FSAs in 2005, and have enrolled in the WageWorks FSAs for 2006. How does the migration affect me?
As with most acquisitions, there is some important information regarding the transition that you should be aware of:
• All claims for expenses incurred in 2005 must be submitted to FlexBen
• Your current FlexBen Direct Card will not work after December 31, 2005
• Beginning January 1, 2006, all Healthcare and Dependent Care claims should be submitted to WageWorks
• Beginning in 2006, the Dependent Care FSA will not offer a debit card – all claims must be filed through paper claims or by utilizing the “Pay My Provider” feature detailed below
If you have any questions about the WageWorks program, what is considered an eligible expense, using the card, or submitting claims, you may contact the WageWorks customer service team at 1-877-924-3967, email questions to help@WageWorks.com, or visit their website at www.wageworks.com.
Can the WageWorks Debit Card be used to purchase prescriptions through the Caremark Mail Order Facility?
Yes. The WageWorks Debit Card may be used to purchase prescriptions through the Caremark Mail Order Facility.
Who/What is considered an Eligible Provider under the Dependent Care Flexible Spending Account?
Eligible Providers are those who meet the business and licensing requirements of your state. The services may be as informal as care provided by your neighbor, as long as the provider claims the money received for services as income when determining their taxes at the end of the year. You will also need to obtain the provider’s federal identification/social security number for inclusion on your own tax filing and claim form. The list of eleigible providers includes:
• Day care facility fees (excluding transportation, lunches, educational services)
• Before and after school care
• Summer day camp
• Baby-sitter, nanny, au pair - income must be claimed by your care provider
• Family day care home - income must be claimed by your care provider
• Senior in adult day care center
• Home Health Agency
How does the Pay My Provider feature work?
You may want to take advantage of the Pay My Provider feature for both your eligible healthcare and child care expenses. WageWorks can send these providers a check directly from your FSA account each month. If you are interested in this convenient feature, simply visit the WageWorks Web site at www.wageworks.com and select “Request Pay My Provider”. After answering a series of questions relating to your provider’s address, etc., you will have the ability to send checks from your FSA accounts directly to your provider. All payments requested by the 15th of the month will be paid to your provider by the 25th of the same month. If you do not have access to the Internet you may contact the WageWorks customer service team at 1-877-924-3967.
I am enrolled in both the Healthcare and Dependent Care FSAs. If I experience a Qualified Family Status Change (QFSC) next year, will I be able to change the amount of my contributions to these accounts?
Yes and no. The only time you can change your contribution to the Healthcare FSA is during the annual Open Enrollment period, so please take that into consideration when planning your annual contribtuion. On the other hand, you can make a change to the Dependent Care FSA if you experience a QFSC that would be consitent with changing the amount of your Dependent Care contribution, such as the birth of a child. Changes must be made by contacting the Caremark Benefits Center at 1-888-769-1717 within 31 days of the qualifying event, per IRS regulation, or they will not be allowed. Please refer to the 2006 Benefits Guide for more information.
Life Insurance/Disability Coverage
In 2005, I elected $20,000 in Supplemental Life Insurance. This year, I’d like to increase my election to $100,000, but that option is not available on my enrollment screen. Why not?
You may purchase additional Employee Life Insurance up to five times your benefit pay, in addition to your Basic Life Insurance. The first time you are eligible to enroll, you may elect up to $150,000 of Supplemental Life Insurance (within the five times benefit pay rule). If you do not take advantage of that option upon initial enrollment, any subsequent elections/increases to Supplemental coverage will be limited to one level increase per enrollment opportunity, i.e. the annual Open Enrollment period, or during an eligible Qualified Family Status Change.
In addition, please note that if you enroll in any amount of Supplemental coverage above $150,000 an EOI would be required, regardless of whether or not this is your first enrollment opportunity. It is important to note that while you are waiting for your EOI to be approved, you will have the highest level of coverage available without an EOI.
My spouse and I both work for Caremark. Can we both carry Spouse Life Insurance? Can we both carry Child Life Insurance?
No. If both you and your spouse are Caremark employees, then you may not elect Spouse Life coverage, as you are both eligible for Basic Life and Supplemental Life Insurance. In addition, if both you and your spouse are Caremark employees, only one of you may cover your child(ren) under Child Life Insurance.
How do I apply for Short Term Disability (STD)?
Should you need to request a medical leave of absence and/or apply for STD, you must contact UnumProvident, our Plan administrator, at 1-866-779-1041, as soon as possible to report your claim and obtain the necessary paperwork. At that point, you will be provided with forms that both you and your attending physician(s) need to complete and submit for approval, including a medical certification form. You should also contact your Supervisor and local Human Resources Department.
What is considered a Pre-existing Condition under Long Term Disability (LTD), and what does that mean for me?
Under LTD, you have a pre-existing condition if:
• You received medical treatment, consultation, care or services including diagnostic measures, or took prescribed drugs or medicines in the 3 months just prior to your effective date of coverage; or
• You had symptoms for which an ordinarily prudent person would have consulted a healthcare provider in the 3 months just prior to your effective date of coverage; and
• The disability begins in the first 12 months after your effective date of coverage.
If you are deemed to have a pre-existing condition, you would not be eligible for any of the Long Term Disability benefits for any absence that pertains to that condition.
I understand that my Short Term Disability (STD) and Basic Long Term Disability (LTD) Insurances are paid 100% by the Company. I’m interested in obtaining some additional Long Term Disability coverage. What are my options?
In addition to the Company paid Short Term and Long Term Disability benefits, you are also eligible to purchase an additional 15% of coverage through the Long Term Disability Buy-Up Plan. This plan, provided by UnumProvident, allows you to insure a greater percentage of your earnings (65%, up to a monthly maximum of $10,000), and enjoy discounted group rates only available through Company-sponsored plans.
Voluntary Benefit Plans
Who is eligible to be enrolled in, and receive the Long Term Care (LTC) benefits?
Enrollment eligibility is offered to all full time and part time benefit eligible employees, and their spouses, domestic partners, parents, parents-in-law, grandparents, and grandparetns-in-law. Please refer to the 2006 Benefits Guide for more information on Long Term Care benefits.
I am interested in enrolling in the Aflac plans; however, I am unclear as to how those will coordinate with my current medical coverage.
All three of the Aflac plans offered by Caremark, the Personal Accident Indemnity Plan, the Cancer Protector Plan, and the Hospital Indemnity Plan, offer supplementary medical coverage to all benefit eligible employees. The basic design of these plans is to offset any medical expenses by paying cash directly to the enrolled participant, regardless of what your primary medical coverage may cover/pay.
Once you are enrolled in an Aflac paln, your coverage is portable, which means your premium will not change, and you can take this coverage with you, in the event that you leave Caremark. The premiums for the Aflac plans are 100%employee-paid, but are based off of employer-group discounts. You can learn more about all three of the Aflac plans by reviewing the 2006 Benefits Guide.