2013 benefits open enrollment guide - Jones Lang LaSalle

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MetLife +1 800 942 0854 Ways to save on dental costs • Get regular exams and cleanings; they’re covered by the plan at 100 percent, and regular check-ups may prevent future problems. • Use your HSA or FSA to pay for your out-of-pocket dental expenses. • Visit a dentist in the MetLife network to receive services at a discounted rate. • For more information and to register and create an account, go to http:// welcometouhc.com/JLL. Dental The chart below outlines features of the dental plan. If you do not make an election during Open Enrollment, your 2013 coverage will be the same as your current election and you will be eligible for the new increased benefit amounts. NO ID CARDS ARE ISSUED Dental plan features Annual deductible • Employee: $50 • Employee +1: $150 • Family: $150 Annual benefit maximum How the plan works Predetermination of Benefits Orthodontia (adults and children) Preventive services are not subject to deductible. $2,000 Preventative services are included as part of the annual benefit maximum. After any applicable deductible, the plan pays the following percentage of eligible expenses, subject to reasonable and customary charge limits. • Preventive Services 100% (semi-annual exams, X-rays and cleanings) • Basic Services 80% (fillings, root canal excluding molars, periodontics) • Major Services 50% (dentures, inlays/onlays, crowns, bridges, oral surgery, dental implants) If charges for a course of treatment will exceed $200, a treatment plan should be submitted to MetLife for review ahead of time. The dentist will receive an estimate of the plan’s benefits, which you should review together. Plan pays 50%, up to $2,000 lifetime maximum per person Does not apply to annual benefit maximum. Employee monthly contribution Contribution Band Employee Employee+1 Family One $11.08 $26.97 $48.40 Two $10.20 $24.79 $44.36 Three $9.99 $24.29 $43.49 Page 36
Vision – Two Options When you enroll in one of the medical plan options, you are automatically eligible for one eye exam every calendar year. This exam should be billed though your medical plan. There is no benefit for glasses or contact lenses. For more information on coverage please refer to your medical plan section in the Benefits Summary Guide on Connect. Save on vision expenses • Visit providers in the VSP network for the greatest savings. • Use your HSA or FSA to pay for your out-of-pocket vision expenses. Enroll for additional vision coverage through Vision Services Plan (VSP) and receive additional, comprehensive vision benefits. NO ID CARDS ARE ISSUED. Employee monthly contribution Feature VSP Provider Non-VSP Provider Your monthly contribution Employee: $7..34 Employee +1: $10.45 Family: $18.73 How to obtain benefits Employee: $7.34 Employee +1: $10.45 Family: $18.73 Schedule an appointment with a VSP doctor of your choice. You may have an exam every 12 months and may obtain frames every 24 months and lenses every 12 months OR contact lenses every 12 months. You do not need an ID card. To find a VSP doctor near you, call +1 800 877 7195 or visit the VSP website at www. vsp.com. Eye exam You pay $10 Reimbursement up to $25 for exam Glasses Contact lenses You pay $20 for glasses (lenses and frames) up to a frame value of $170. For frames more than $170, you pay the difference less a 20% discount on any amount over $170. The plan pays up to a certain scheduled amount for lenses and frames. You are responsible for the difference. Claim submission is required. Plan provides $130 allowance toward the full cost. Medically necessary contact lenses are covered in full. Laser vision correction Plan offers a discount. Contact VSP at +1 800 877 7195 VSP +1 800 877 7195 www.vsp.com Page 37
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Page 17 and 18: Comparing the PPO plans Medical Exp
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2013 benefits open enrollment guide - Jones Lang LaSalle

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