Benefits

Medical

Get a healthcare plan with benefits.
Selecting a medical plan for you and your family is one of the most important decisions you will make. This decision will involve balancing the total cost (premium + deductibles + copays + out-of-pocket costs) for each plan, along with other features, such as access to providers and facilities, pharmacy services, and special programs for managing specific medical conditions. Choosing the right plan ensures that you receive the medical benefits and services that matter to you and your family.

SCMH Hospital

PPO – How the plan works.
As a member of a PPO plan, you’ll be encouraged to use the network of preferred doctors. No matter which provider you choose, in-network healthcare services will be covered at a higher benefit level than out-of-network services. It’s important to check if your provider accepts your health plan so you receive the highest level of benefit coverage.

Benefits of a medical PPO:

  • You get the freedom to choose almost any medical facility or provider for your healthcare needs
  • You get a portion of out-of-network claims to be covered
  • You won’t need referrals before visiting a specialist

Questions to ask yourself about Medical PPOs.

  • Are your family’s doctors in the plan? If not, what will you have to pay out-of-pocket for office visits or other services your doctor prescribes?
  • Will you be able to use hospitals, labs and other facilities that are convenient to where you live or work?
  • What does the plan cover? What percentage of your health care costs will you have to cover? How much will you have to pay out of pocket for the medicines your family needs?

Dental

Put a smile on your face with easy access to dental care.

You know good health starts with healthy teeth and gums. Keep them that way with care that’s convenient and cost-effective through a dental plan.

Dental plans typically group covered procedures into categories that are referred to as a) Preventive, b) Basic and c) Major services. While it may vary by dental plan, the category to which a procedure has been assigned typically indicates the level of benefits that the plan provides. Below is a brief description of what is typically covered in each category.

Preventive typically covers services for cleanings, x-rays, fluoride treatments, and sealants.

Basic typically covers services for those types of treatments and procedures that are relatively straightforward in nature and don’t involve a significant laboratory expense for the dentist. Services such as emergency pain relief, fillings, and tooth extractions.

Major typically covers services for procedures and treatments that are relatively more complex in nature and often involve a dental laboratory expense. Services such as crowns, inlays, oral surgery, and bridgework.

Choosing the right plan ensures that you receive the dental benefits and services that matter to you and your family.

Dental PPO (DPPO) plan: Provides a narrow choice for higher level of benefits. DPPOs have a network of dentists and other providers who have agreed to charge less. If you choose from the network, you pay less than you would if you use a provider not in the network.

Dental PPO – How the plan works.
DPPOs provide members a little bit of everything – cost savings and great access. You get a wide network of dental providers who offer services at a discount plus access to out of network care. No matter which provider you choose, benefits are paid both for in- and out-of-network services. Keep in mind though, you will always get a higher benefit level at a lower fee in-network. There is no requirement for primary care dentists or specialist referrals, so you can choose care where and when you need it.

Questions to ask yourself about a Dental PPO:

  • Is your current dentist in the network?
  • If you use an out-of-network dentist, what is covered?
  • Is your dentist conveniently located to where you live or work?
  • What will you have to pay in-network and out-of-network for needed dental care?

Vision

See things straight with vision care insurance.

They say life begins at 20, 30, 40 and more, but so can faulty vision. And, while carrots can help, you won’t want to let good eye care slide. Keep the view clear with a vision care benefit.

How the plan works.
Vision insurance works with healthcare insurance to provide strong protection for your eyes. Use your healthcare plan to protect yourself against financial loss from an eye injury or disease. Use vision insurance like a wellness program to provide annual exams, glasses, contacts and other types of correction services.

Most plans require a small copay for covered services. You pay a premium and a copay each time you access the service. In some cases, a vision plan may also include a “deductible” — a fixed dollar amount you must pay your eye care provider before the plan pays benefits.

Why choose Vision Care benefits?
You might want to consider vision benefits if:

  • You schedule annual vision checkups
  • You wear glasses or contact lenses
  • You would consider getting LASIK or PRK surgery

Questions to ask yourself about Vision Care:

  • What is covered by health insurance (i.e. does it cover annual eye exams)?
  • What are my costs for exams, glasses and contacts?
  • Will this plan help minimize my costs?
  • What are my out-of-pocket expenses for office visits or other services my eye doctor recommends?

Basic Life and A&D

Protect your loved ones financial future with Basic Life Insurance.
All of us have a lifestyle that takes income. When you family loses yours, will they be ok? Your employer offers this benefit at no cost to you. All you have to do is enroll.

How the plan works.
Basic Life Insurance offers a financial benefit to loved ones when you pass.

What is a beneficiary?
Your beneficiary is the person (or persons) or legal entity (entities) who receives a benefit payment if you die while you are covered by the policy. You must select your beneficiary when you complete your enrollment application. Please note: your beneficiary selection is legally binding.

Supplemental Life

Why would I need supplemental life insurance?
Supplemental Life Insurance provides affordable financial security for your loved ones. It is especially important coverage if your family depends on your income. The money can be used for final expenses, help to replace your lost income, cover debts, pay your mortgage, fund a child’s education, and more.

Can I get Supplemental Life Insurance coverage for my spouse or children?
Yes. You can purchase coverage for your spouse and children at the levels your employer provides.

How the plan works.
Supplemental Life Insurance is coverage that you pay for. It is in addition to your basic life insurance benefit provided by your employer. Supplemental life insurance pays your beneficiary (see below) a benefit if you die while you are covered.

How much life insurance do I really need?
According to U.S. News & World Report’s website, common wisdom holds that you should plan on having seven to ten times your annual income as a starting point for life insurance.

Questions to ask yourself about Life Insurance:

  • How much will my family need if they no longer have my income?
  • What are my debts and planned expenses such as a home, college education, auto loans, and credit cards?
  • How long do I expect to live?
  • How long should the life insurance benefits last?

Supplemental Spouse Life Insurance

Why would I need spouse supplemental life insurance?
Spouse supplemental life insurance provides affordable financial security for your loved ones. It is especially important coverage if you depend on your spouse’s income. The money can be used for final expenses, help to replace your lost income, cover debts, pay your mortgage, fund a child’s education, and more.

How the plan works.
Spouse supplemental life insurance is coverage that you pay for. Spouse supplemental life insurance pays you as the beneficiary if your spouse were to pass away.

Questions to ask yourself about Life Insurance:

  • How much will my family need if we no longer have my spouse’s income?
  • What are my debts and planned expenses such as a home, college education, auto loans, and credit cards?
  • How long should the life insurance benefits last?
  • Does our lifestyle increase the chance of an accidental death?

Child Life Insurance

Why would I need supplemental life insurance for my children?
Supplemental child life insurance provides affordable financial security for your loved ones. Child life insurance can assist you during the untimely death of a loved one, by helping to pay for medical bills, funeral expenses or setting up a charitable organization.

How the plan works.
Supplemental child life insurance is coverage that you pay for. In order to enroll in supplemental child life you must have supplemental life insurance coverage on yourself.

Short Term Disability

Keep the paychecks coming with Short Term Disability.

We all love a break from work – vacation, holidays, even a goof off day. But when the reason is to recover from an injury or illness, it’s just no fun – especially if your paycheck stops.

How the plan works.
If you can’t work due to an illness or accident, the plan provides you income over a number of weeks. Short Term Disability usually begins after you have used other benefits that could be available like paid sick or personal time.

What are the chances you’ll be out? Here are the facts:

  • 1 in 3 working Americans will become disabled for 90 days or more before age 65 (1)
  • 1 in 8 workers will be disabled for 5 years or more (1)
  • Just over 1 in 4 of today’s 20 year-olds will become disabled before they retire (2)

Long Term Disability

Get paid over the long haul with Long Term Disability coverage.

It’s hard to think about – not being able to work. And it happens more than you think. Consider this:

  • Over 37 million Americans are classified as disabled *1
  • 34.6 months is the average long-term disability absence *2

You have health insurance to cover your medical expenses, but what about your paycheck? Cover all the bases in the event of a disability and protect your income with Long Term Disability coverage (LTD).  

How the plan works.
If you have a lengthy illness or injury and can’t work, many benefits will run out. When that happens, LTD benefits provide up to 60% of your pre-disability income. Benefits begin when your disability is approved. They will continue as long as the plan considers you disabled or until you reach your maximum payout period.

Below are some common reasons for a Long Term Disability:

  • Cancer
  • Back disorders
  • Injuries
  • Mental Health
  • Heart and Lung disorders
  • Joint disorders

FSA

Spend money on healthcare bills and save on income taxes too.
It seems strange, but it’s true. Thanks to Uncle Sam, you can use the same money to pay for needed healthcare costs while you save on your taxes. Enter the Flexible Spending Account (FSA), a mighty little savings program that gives you double duty savings sure to stretch your wallet.

How the account works.
You can only save in an FSA through your employer. Contributions to the account are made from your paycheck before federal, social security and most state taxes are taken out. This reduces your overall taxable income and gives you immediate tax savings.

You decide on the annual contribution amount up to the annual limit of $2,700. The annual amount is divided evenly and deducted from each paycheck. Even though you contribute each pay period, the entire annual account amount is available for use on day one of the plan year. Any unused FSA funds up to $500 can be rolled over for use in the following year.

An FSA covers eligible expenses for you and all of your dependents, even if they are not covered under your primary medical plan.

Qualifying expenses include, but are not limited to:

  • Bandages
  • Chiropractic care
  • Contact lenses and cleaners
  • Co-pays, co-insurance and deductibles
  • Dental care
  • Diabetic supplies
  • Eyeglasses
  • Hearing aids
  • Laser eye surgery
  • Orthodontia
  • Pregnancy tests
  • Sunscreen

For a complete list of eligible expenses see IRS Publication 502: Medical and Dental Expenses.

Why choose a Healthcare Flexible Spending Account?
Just about anyone with anticipated out-of-pocket healthcare costs can benefit from the tax savings of this account.

Questions to ask yourself about a Flexible Spending Account.

  • Am I able to make a good estimate of my qualified expenses?
  • Am I enrolled in a High Deductible Health Plan with a Health Savings Account?

Dependent Care FSA

Pay for dependent care expenses and save on taxes too.
It’s true. Caregivers are known for their ability to juggle it all. Now you can let your money do the same thing. Use a Dependent Care Reimbursement Account (DCRA) to pay for expenses and save money on taxes at the same time.

How the account works.
Money contributed to a DCRA is saved pre-tax. The money comes out of your paycheck and goes into your account BEFORE social security and income taxes are taken out. The taxable income part of your paycheck is now reduced so you pay less in taxes and take home more. The money saved in the account is used to pay for care your loved ones need while you work.

Who’s covered:

  • Dependents under the age of 13
  • Older dependents, even adults, who are unable to care for themselves due to physical or mental health challenges

Qualifying dependent expenses include, but are not limited to:

  • Before school and after school care
  • Expenses for preschool/nursery school
  • Extended day programs
  • Au pair services (amounts paid for the actual care of the dependent)
  • Babysitter (in or out of the home)
  • Nanny services (amounts paid for the actual care of the dependent)
  • Summer day camp for your dependent under the age of 13
  • Elder day care expenses of a dependent adult

Be sure to check your plan documents for a complete list of dependent qualifications and eligible care expenses.

Why choose a Dependent Care Reimbursement Account?
You will benefit from a DCRA if you have young children or dependents needing care. You can deposit up to $5,000 per year. If you’re married and file separate tax returns, then your limit is $2,500. You should plan to spend all of the money in your account each year. But if you don’t, you can rollover up to $500.

Questions to ask yourself about a DCRA.

  • Are my dependent children or adults qualified?
  • Will the care be used so I can work?
  • Am I able to make a good estimate of qualified expenses?