OrthoArkansas - 2022 Flippable Benetifs Guide DRAFT

OrthoArkansas.com
Employee
Benefits
ENROLLMENT GUIDE
Plan year:
September 1, 2022 – August 31, 2023
Questions:
Human Resources Department
(501) 500-3500

Type to enter text
July 1, 2022
We believe that our employees are our most valuable asset and OrthoArkansas recognizes
that benefits are a valuable part of your total compensation package. Every year we work
to ensure that our employees have competitive benefits at an affordable price in order to
help you and your families stay healthy, feel secure, and maintain a positive work/life balance.
We work very closely with our employee benefit consultants at BXS Insurance to ensure
that the benefits we offer are best in class. After completing a thorough analysis of our
benefit options, OrthoArkansas will continue to use United Healthcare for our provider
network. Dental, Vision, Life, Disability, Accident, FinFit, and our Employee Assistance Program
will also be included in our benefits package.
We know that life gets busy but we encourage you to take time to review the material inside
this booklet to familiarize yourself with the benefits available to you. If you have
questions or need additional information, please contact our HR Department.
Thank you for all you do for OrthoArkansas and making a difference in the lives of our patients.
Sincerely,
Levi Bauer, MBA
Chief Executive Officer
2

CONTENTS
4 Important Contacts
5 Benefits Overview
7 Medical Insurance
11 Health Savings Account
13 Flexible Spending Accounts
15 Dental Insurance
16 Vision Insurance
17 Voluntary Accident Insurance
19 Voluntary Life Insurance
20 Disability Insurance
21 Life and Accidental Death & Dismemberment Insurance
22 Employee Assistance Program
23 Financial Wellness Program
25 Open Enrollment Instructions
31 Health Savings Account Enrollment
36 Flexible Spending Account Instructions
39 Glossary

IMPORTANT CONTACTS
BENEFIT CARRIER PHONE WEBSITE/EMAIL
Medical Insurance UMR 800-826-9781 www.umr.com
Pharmacy Coverage Southern Scripts 800-710-9341 www.southernscripts.net
Flexible Spending
Accounts
Health Savings
Account
PayChex 877-244-1771 paychexbenefitaccount@paychex.com
PayChex 877-244-1771 paychexhsa@paychex.com
Dental Insurance Delta Dental 800-462-5410 www.deltadentalar.com
Vision Insurance
Delta Dental /
Superior Vision
800-877-7195 www.deltadentalar.com
Life and AD&D Insurance Sun Life Financial 800-247-6875 www.sunlife-usa.net/claims/
Voluntary Life
Insurance
Sun Life Financial 800-247-6875 www.sunlife-usa.net/claims/
Disability Insurance Sun Life Financial 800-247-6875 www.sunlife-usa.net/claims/
Voluntary Accident
Insurance
Employee Assistance
Program
Financial Wellness
Plan
OrthoArkansas, P.A.
HR Manager
OrthoArkansas, P.A.
Payroll & Benefits Analyst
OrthoArkansas, P.A.
HR Generalist
MetLife 800-438-6388 www.metlife.com
MGISComplete
Anytime
866-301-9551 www.guidanceresources.com
Fin-Fit 800-928-7248 www.finfit.com
Paige Hadidon 501-978-2602 paige.hadidon@orthoarkansas.com
Sherry Kuebler
501-500-3500
x6893
sherry.kuebler@orthoarkansas.com
Laura Ness 501-978-2600 laura.ness@orthoarkansas.com
YOUR BXS INSURANCE ACCOUNT REPRESENTATIVES:
Ashley Bray
870-974-7424
Ashley.Bray@bxsi.com
DiAlma Young
870-974-7440
DiAlma.Young@bxsi.com
Brian Davidson
501-614-1188
Brian.Davidson@bxsi.com
4

BENEFITS OVERVIEW
ENROLLMENT
You can enroll in benefits or change your elections at the following times:
• 30 days prior to your initial eligibility date (as a newly hired employee)
• During the annual benefits open enrollment period
• Within 30 days of experiencing a qualifying life event
BENEFIT OPTIONS
We offer a comprehensive benefits package consisting of:
• Medical Insurance
• Prescription Plan
• Flexible Spending Accounts
• Health Savings Account
• Dental Insurance
• Vision Insurance
• Life and Accidental Death & Dismemberment Insurance
• Voluntary Life Insurance
• Disability Insurance
• Voluntary Accident Insurance
• Employee Assistance Program
• Financial Wellness Plan
5

CHANGING BENEFITS AFTER OPEN ENROLLMENT
You may pay your portion of your select coverages, and fund the flexible
spending accounts, on a pre-tax basis. Thus, due to IRS regulations, once you
have made your elections for the plan year, you cannot change your benefits
until the next annual open enrollment period. The only exception is if you
experience a qualifying event, and election changes must be consistent with
your life event.
To request a benefits change, notify Human Resources within 30 days of the
qualifying life event. Change requests submitted after 30 days cannot be
accepted. You may need to provide proof of the life event.
Qualifying life events include, but are not limited to:
• Marriage, divorce, or legal separation
• Birth or adoption of an eligible child
• Death of your spouse or covered child
• Change in your spouse’s work status that affects his or her benefits
• Change in your child’s eligibility for benefits
• Qualified Medical Child Support Order

MEDICAL INSURANCE
CARRIER: UMR
Plan Options: PPO plan or a High-Deductible Health Plan (HDHP)
Please refer to the official plan documents for additional information on coverage and exclusions.
COVERED BENEFITS
Calendar Year Deductible
Option 1
Traditional PPO
Choice Plus Network
Benefits Indicate Member Responsibility
Option 2
HDHP
Choice Plus Network
(Eligible for HSA)
IN-NETWORK OUT-OF-NETWORK IN-NETWORK OUT-OF-NETWORK
Individual $1,000 $3,000 $3,000 $6,000
Family $3,000 $9,000 $6,000* $12,000
Is there an individual deductible
within family coverage?
Out-of-Pocket Maximum
Yes
Individual $3,000 Unlimited $3,000 Unlimited
Family $9,000 Unlimited $6,000 Unlimited
Coinsurance (Member Pays) 20% 50% 0% 50%
Annual Cost Sharing Limit
Individual $7,350 Unlimited $3,000 Unlimited
Family $14,700 Unlimited $6,000 Unlimited
What’s included? Deductible, copays & coinsurance Deductible
Preventive Care 0%
Physician Services
No charge except
possible balance billing
No
0% 50% after deductible
Primary Care $20 copay 50% after deductible 0% after deductible 50% after deductible
Specialist $40 copay 50% after deductible 0% after deductible 50% after deductible
TeleDoc $20 copay 50% after deductible $45 copay 50% after deductible
Urgent Care $60 copay 50% after deductible 0% after deductible 50% after deductible
Emergency Room
Hospital Services
$250 copay + 20%
after deductible
$250 copay + 20%
after deductible
0% after deductible 50% after deductible
Inpatient 20% after deductible 50% after deductible 0% after deductible 50% after deductible
Outpatient 20% after deductible 50% after deductible 0% after deductible 50% after deductible
*High-Deductible Health Plan / Family Deductible - the Family Deductible must be satisfied before the plan pays at 100% as the
in-network level, or before coinsurance applies at the out of network level. The Family Deductible can be met by one family member
or a combination of family members. See Benefit Summary for a complete listing of benefits.
7

WHICH MEDICAL INSURANCE PLAN IS
RIGHT FOR YOU?
Choosing the right medical plan is an important decision. Take
the time to learn about your options to ensure you select the
right plan for you and your family.
THINGS TO CONSIDER
1. Do you prefer to pay more for medical insurance out of your
paycheck, but less when you need care?
2. Or, do you prefer to pay less out of your paycheck, but more
when you need care?
3. What planned medical services do you expect to need in the
upcoming year?
4. Are you able to budget for your deductible by setting aside
pre-tax dollars from your paycheck in an HSA or FSA?
5. Do you or any of your covered family members take
prescription medications on a regular basis?
MEDICAL RATES
COVERAGE LEVEL
Option 1
Traditional PPO
Bi-Weekly
(26 Pay Periods)
Option 2
HDHP Plan
(Eligible for HSA)
Bi-Weekly
(26 Pay Periods)
Employee Only $51.12 $12.78
EE & Spouse $265.68 $164.24
EE & Child(ren) $156.71 $80.75
EE & Family $437.41 $213.00
COMPARING YOUR MEDICAL PLAN OPTIONS
PPO
• Higher cost per paycheck
• Lower deductible
• Can fund a Health Care Flexible Spending
Account (FSA)
HDHP
• Lower cost per paycheck
• Higher deductible
• Can fund a health savings account (HSA)
8

PRESCRIPTION DRUGS
PHARMACY BENEFIT MANAGER: Southern Scripts
PRESCRIPTION
DRUGS
RETAIL
Option 1
Traditional PPO
MAIL ORDER
(90 day supply)
RETAIL
Option 2
HDHP
(Eligible for HSA)
MAIL ORDER
(90 day supply)
Generic $10 copay $20 copay 0% after deductible 0% after deductible
Brand Name
Specialty
Greater of $30
copay or 30%
Greater of $30
copay or 30%
$60 copay 0% after deductible 0% after deductible
$60 copay 0% after deductible 0% after deductible
9

PRESCRIPTION DRUGS
10

HEALTH SAVINGS ACCOUNT
CARRIER: PayChex
If you enroll in the High-Deductible Health Plan (HDHP), you may be eligible to
fund a Health Savings Account (HSA). An HSA is a personal health care savings
account that you can use to pay out-of-pocket health care expenses with pre-tax
dollars. Your contributions are tax free and the money remains in the account
for you to spend on eligible expenses no matter where you work or how long it
stays in the account.
WHO IS ELIGIBLE?
You are eligible to open and fund an HSA if:
● You are enrolled in the UMR HDHP plan (Option 2)
● You are not covered by a non-HSA plan, health care FSA, or health reimbursement arrangement
● You are not eligible to be claimed as a dependent on someone else’s tax return
● You are not enrolled in Medicare
● You have not received Veterans Administration Benefits in the last three months
HSA CONTRIBUTIONS
● Contributions to a health savings account (including the
employee contributions) cannot exceed the annual IRS
contribution maximums.
● Employees age 55+ by 12/31/2022 may contribute additional
funds to their HSA (up to $1,000 in 2022).
● You must open your HSA through PayChex to receive
contributions.
$3,650 for 2022
$7,300 for 2022
$1,000
$3,850 for 2023
$7,750 for 2023
for 2022 & 2023
INDIVIDUAL
ALL
OTHER TIERS
AGE 55+
CATCH-UP
CONTRIBUTION
11

HEALTH SAVINGS ACCOUNT Continued
MAXIMIZE YOUR TAX SAVINGS
• Contributions to an HSA are tax-free and can be made through payroll deduction on a pre-tax
basis.
• This money in your HSA (including interest and investment earnings) grows tax-free.
• As long as you use the funds to pay for qualified medical expenses, the money is spent tax-free.
YOU INDIVIDUALLY OWN YOUR HSA
• You own and administer your HSA.
• You determine how much you will contribute to your account and when to use the money to
pay for eligible health care expenses.
• You can change your contributions at any time during the plan year without a qualifying event.
• Like a bank account, you must have a balance in order to pay for eligible health care expenses.
• Keep all receipts for tax documentation.
• An HSA allows you to save and “rollover” money from year to year.
• The money in the account is always yours, even if you change health plans or jobs.
• There are no vesting requirements or forfeiture provisions.
ACCESSING YOUR HSA FUNDS
Debit Card: Draws directly from your HSA and can be used to pay for eligible expenses at your
doctor’s office, pharmacy, or other locations where you purchase health related items or services.
USE YOUR HSA TO PAY QUALIFIED MEDICAL EXPENSES
• You can use your HSA money to pay for eligible expenses now or in the future.
• Funds in your HSA can be used for your expenses and those of your spouse and eligible
dependents, even if they are not covered by the UMR HDHP Plan (Option 2).
• Eligible expenses include deductibles, doctor’s office visits, dental expenses, eye exams,
prescription expense and LASIK eye surgery.
• A complete list of eligible expenses can be found at www.irs.gov.
$7,200
INDIVIDUAL
ALL
OTHER TIERS
AGE 55+
CATCH-UP
CONTRIBUTION
12

FLEXIBLE SPENDING ACCOUNTS
CARRIER: PayChex
OrthoArkansas offers two flexible spending account (FSA) options – the health care FSA and
the dependent care FSA – that allow you to pay for eligible health care and dependent care
expenses with the pre-tax dollars.
Log into your account at www.paychex.com to view your account balance(s), calculate tax
savings, view eligible expenses, download forms, view transaction history, and more.
HEALTH CARE FSA
• Set aside pre-tax money from your paycheck to pay for eligible out-of-pocket expenses, such
as deductibles, copays, and other health-related expenses, that are not paid by the medical,
dental, or vision plans.
• Over-the-counter (OTC) medications are eligible for reimbursement without a prescription.
DEPENDENT CARE FSA
• Set aside pre-tax money from your paycheck for daycare expense to allow you and your
spouse to work or attend school full time.
• Eligible dependents are children under age 13 or a child over 13, spouse, or elderly parent
residing in your house who is physically or mentally unable to care for himself or herself.
• Examples of eligible expenses are daycare facility fees, before and after-school care, and
in-home babysitting fees (income must be reported by your care provider).
HEALTH CARE FSA
for 2022 & 2023
$2,850 $5,000
DEPENDENT CARE FSA
for 2022 & 2023
married filing jointly or
single / head of household
$2,500
married filing separately
13

FLEXIBLE SPENDING ACCOUNTS Continued
HOW DOES AN FSA WORK?
You decide how much to contribute to each FSA on a plan year basis up to the maximum allowable
amounts. Your annual election will be divided by the number of pay periods and deducted evenly on
a pre-tax basis from each paycheck throughout the year.
You will receive a debit card from PayChex, which can be used to pay for eligible health care expenses
at the point of service. If you do not use your debit card or if you have dependent care expenses to
be reimbursed, submit a claim form and a bill or itemized receipt from the provider to PayChex. Keep
all receipts in case PayChex requires you to verify the eligibility of a purchase.
THINGS TO CONSIDER
• Both healthcare and dependent care FSA dollars are use it or lose it.
• You cannot take income tax deductions for expenses you pay with your FSA(s)
• You cannot stop or change your FSA contribution(s) during the plan year unless you experience a
qualifying life event.
SPECIAL FSA ACCOUNT FEATURES
RUNOUT
Runout is the 90 days
(March 31st) after your plan
year ends during which you
may submit last year’s
expenses to be reimbursed
with last year’s FSA funds.
GRACE PERIOD
No Grace Period
ROLLOVER
You have the ability to
roll over up to $500
from one plan year to
the next.
14

ELECTION
DENTAL INSURANCE
CARRIER: Delta Dental
● You will pay less out of pocket when you choose an in-network provider.
● Locate an in-network provider at www.deltadentalar.com.
● Be sure to ask for a pre-treatment estimate.
● Out-of-network providers can balance bill, or bill you for the difference between
the provider’s charge and the allowed amount.
BI-WEEKLY
(26 Pay Periods)
Employee Only $0.00
EE & Spouse $14.64
EE & Child(ren) $20.01
EE & Family $34.71
Employers pays 100% of employee only
dental premium.
COVERED BENEFITS IN-NETWORK OUT-OF-NETWORK
Deductible (per calendar year) $50 per person, 3 per family $50 per person, 3 per family
Annual Plan Benefit Maximum $2,000 per covered member $2,000 per covered member
Diagnostic/Preventive Care (deductible waived)
Oral exams, prophylaxis, fluoride, sealants
Basic Services
Fillings, oral surgery, periodontics, simple extractions,
space maintainers
Major Services
Crowns, inlays/onlays, bridges, dentures
100% 90%
80% 72%
50% 45%
Orthodontia Services (Dependent Children to age 19) 50% 45%
Lifetime Orthodontia Plan Max $2,000 $2,000
*Annual Maximum Carryover
To be used in conjunction with annual maximum
$500 per year/
$2,000 per lifetime
$500 per year/
$2,000 per lifetime
*How to view your rollover amount?
Log into the Delta Dental’s Consumer Toolkit, a secure online tool for access to eligibility information, current benefits
information, temporary ID cards, claims information and more.
1. Visit www.deltadentalar.com/toolkits
2. Click on the Consumer link
3. Complete the requited fields and follow the on-screen instructions to register as a new user (you will need the
subscriber’s member ID).
4. Select your username and password.
15

VISION INSURANCE
CARRIER: Delta Dental / NETWORK: Superior Vision
● You will pay less out of pocket when you choose an in-network provider.
● Locate an in-network provider at www.deltadentalar.com.
● You must submit a claim form for out-of-network expenses.
● LASIK surgery discounts available
ELECTION
BI-WEEKLY
(26 Pay Periods)
Employee Only $4.74
EE & Spouse $8.76
EE & Child(ren) $9.48
EE & Family $13.29
Employee is responsible for 100% of the
vision premium.
COVERED BENEFITS IN-NETWORK OUT-OF-NETWORK
Eye Exam (every 12 months) $10 copay $36 allowance
Standard Plastic Lenses (every 12 months)
Single / Bifocal / Trifocal / Lenticular
Frames (every 12 months)
Applicable to 1 set of frames
$10 copay $28 / $42 / $56 / $78 allowance
$150 allowance $70 allowance
Contact Lenses – in lieu of glasses (every 12 months)
Contact lens fitting – subject to copay
Elective
Medically Necessary
$150 allowance
Plan Pays 100%
$100 allowance
$210 allowance
16

VOLUNTARY ACCIDENT INSURANCE
CARRIER: MetLife
Accident insurance supplements your existing medical insurance in case you are have an accident;
medical insurance alone may not be enough to cover your expenses. The plan pays a cash benefit
during the term of your coverage following a covered accident and could help cover:
●
●
●
●
Out-of-pocket expenses such as copays and deductibles
Transportation
Lodging costs
Emergency room expenses
Benefit Type
Metlife Accident-Insurance Pays YOU
Injuries
Fractures $200—$8,000
Dislocations $200—$8,000
Second and Third Degree Burns $175—$10,000
Concussions $250
Cuts/Lacerations $50—$400
Eye Injuries $300
Medical Services & Treatments
Ambulance $300—$1,000
Emergency Care $75—$150
Non-Emergency Care (Initial Care) $75
Physician Follow-Up $75
Therapy Services (including physical therapy) $35
Medical Testing Benefit $150
Medical Appliances $75—$750
Inpatient Surgery $150—$1,500
Hospital coverage (Accident)
Admission
$1,000 per accident
Confinement
$200 a day (non-ICU) - up to 31 days
$200 a day (ICU) - up to 31 days
Inpatient Rehab—(paid per accident)
$150 a day, up to 15 days
Accidental Death
Employee receives 100% of amount shown,
$25,000
spouse receives 50% and children receive 20%
$75,000 for common carrier
of amount shown.
Dismemberment, Loss & Paralysis
Dismemberment, Loss & Paralysis
$500—$30,000 per injury
Additional Benefit
Health Screening Benefit
$50 (1x per year)
17

VOLUNTARY ACCIDENT INSURANCE Rates
CARRIER: MetLife
ACCIDENT
INSURANCE ELECTION
EMPLOYEE CONTRIBUTION
BI-WEEKLY
(26 Pay Periods)
Employee Only $5.49
EE & Spouse $10.85
EE & Child(ren) $12.61
EE & Family $15.41
18

VOLUNTARY LIFE INSURANCE
CARRIER: Sun Life Financial
Voluntary Life Insurance is offered through your employer but is paid by the employee.
Employee Benefit
● $10,000 increments to up to 5x salary, not to exceed $500,000
● Guarantee Issue Amount: $200,000 (not available if previously waived)
● If you currently have coverage and your benefit amount is under $200,000, you may increase
your life insurance by an incremental amount of $10,000 or $20,000 without medical
questions each year up to the guarantee issue amount.
● If you are currently enrolled and your benefit is $200,000 or more and you wish to increase
the benefit amount, medical questions will be required.
● If you waived coverage during your New Hire eligibility period and want to elect coverage
now, medical questions will be required and subject to approval.
Spouse Benefit
● $5,000 increments to up to $250,000, not to exceed 100% of employee’s life amount
● Guarantee Issue Amount: $100,000 (not available if previously waived)
● If your spouse currently has coverage and the benefit amount is under $100,000, spousal
coverage can be increased by one incremental amount of $10,000 without medical questions
each year up to the guarantee issue amount.
● If your spouse is currently enrolled and their benefit is $100,000 or more and you wish to
increase the benefit, medical questions will be required.
● If you waived coverage during your New Hire eligibility period and want to elect coverage
now, medical questions will be required.
Child(ren) Benefit
● Child from birth to 14 days: $250
● Child from 15 days to 6 months: $1,000
● Child from 6 months to age 21, or to age 25 if unmarried or a full-time student: $10,000
Accelerated Life Benefit: You may receive up to 70% of your voluntary life benefit if you are
determined to be terminal within the next 12 months.
AD&D Seat Belt: Pays an additional 25% of coverage up to $25,000 if death occurs in an
automobile accident while wearing a seatbelt.
A&D Air Bag: Pays an additional 10% of coverage up to $5,000 if seat belt benefit is paid and if an
airbag was also in place and inflated on impact.
REMINDER
Review your beneficiary designations
19

DISABILITY INSURANCE
CARRIER: Sun Life Financial
SHORT-TERM DISABILITY INSURANCE
Short-Term Disability (STD) insurance is designed to help you meet your financial
needs if you become unable to work due to a non-work related illness or injury.
This is a voluntary plan; employees are responsible for 100% of the cost.
Premiums are calculated as a percentage of your annual base salary. Benefit may
be offset due to other benefits such as paid sick leave, workers’ compensation.
●
●
●
●
●
Benefit Amount: 60% of base weekly salary up to $1,500 per week
Minimum Benefit Amount: $15 per week
Elimination Period: 8 th day Accident/Illness
Benefit Durations: Up to 12 weeks
Pre-Existing Condition Waiting Period: 3 Months / 12 Months
LONG-TERM DISABILITY INSURANCE
Long-Term Disability (LTD) insurance is automatically provided to all
benefits-eligible employees at no cost. LTD insurance is designed to help you
meet your financial needs during longer disability periods.
●
●
●
Benefit Amount: 60% of base monthly salary up to a defined maximum
amount (varies by Job Class; please contact HR)
Elimination Period: 90 days from the onset of your disability injury/illness
Benefit Durations: Until Social Security Normal Retirement Age
20

LIFE and ACCIDENTAL DEATH &
DISMEMBERMENT INSURANCE
CARRIER: Sun Life Financial
GROUP LIFE and ACCIDENTAL DEATH & DISMEMBERMENT
(AD&D) is automatically provided to all benefits-eligible employees at no cost.
If you die as a result of an accident, your beneficiary would receive both the life
and the AD&D benefit.
● Life Insurance Amount: Contact HR Department for details
● Benefit Reduction Schedule: 65% at age 65 and 50% at age 70
REMINDER
Review your beneficiary designations
21

EMPLOYEE ASSISTANCE PROGRAM
CARRIER: MGISComplete Anytime
All employees, regardless of enrollment in other benefits, have 24/7 access to
confidential support, guidance, and resources at no cost to you!
SERVICES INCLUDE:
● Confidential Emotional Support
● Work-Life Solutions
● Legal Guidance
● Financial Resources
● Online Support
● Free Online Will Preparation
Contact MGISComplete Anytime
PHONE: 866-301-9551
WEBSITE:
APP:
WEB ID:
www.guidanceresources.com
GuidanceResources*Now
MGISComplete
24 Hour
Support & Resources
22

FINANCIAL WELLNESS PROGRAM
CARRIER: FinFIt
23

Copay vs HDHP
COPAY PLAN vs. HIGH-DEDUCTIBLE
Which plan is right for me?
HEALTH PLAN
What is a Copay Plan?
Copay Plan
Overview
• Higher Monthly Premiums
• Lower Deductibles
• FSA eligible
• Has Fixed Dollar Amounts (called “copays”) when
you go in for medical services
• Copay plans will usually have a coinsurance on
higher ticket services, like hospital stays,
maternity care, x-rays, etc.
Does this Plan make sense for me?
Copay plans may make sense for people who don’t
make many trips to the doctor, but want the security
of first dollar coverage.
Copay plans also tend to work well for people who
don’t have the budget to pay the full price of a
medical bill or prescription out-of-pocket or for
people who are willing to pay more each month for
peace of mind knowing how much they will pay
when they visit the doctor.
Perks of a Copay Plan
• Lower deductible
• Co-pay plans will still have a deductible and
out-of-pocket maximum. Co-pays usually do
not count towards the deductible, but they do
count towards your annual out-of-pocket
maximum. If you reach your out-of-pocket
maximum, the insurance company pays 100%,
eliminating the need to pay your co-pays.
What is a HDHP?
High Deductible Health Plan (HDHP)
Overview
• Lower Monthly Premiums
• Higher Deductibles
• HSA eligible
• Deductible has to be met before insurance
company pays their portion (coinsurance)
Does this Plan make sense for me?
HDHPs tend to work well for people who don’t go to
the doctor often or don’t expect medical expenses
on a regular basis.
HDHPs may also make sense for people who know
they’ll meet their deductible early in the year and
who can afford to pay the deductible over the course
of the year (sometimes in one lump sum).
Perks of HDHP
• Lower Monthly Premiums than Copay plans
• If you have an HDHP, you’re often eligible for
a health savings account (HSA). This is
essentially a tax advantaged savings account
where you can put money aside to help cover
qualified healthcare expenses.
24

OPEN ENROLLMENT INSTRUCTIONS
Flex BenAdmin
STEP 1 – Get Online: Enter the following address into your browser: www.paychexflex.com
STEP 2 – Navigate to Benefits Administration
● Your user name
● Your password
● If you do not have a username, please click the following link to
create a user name
www.paychexflex.com/Login/Registration.aspx and choose
“Sign-Up”
● If you forgot your username or password, choose “Forgot
Username or Password?”
● Issues logging into Paychex Flex, call 888-246-7500
STEP 3 – Agree to the Legal Notice
25

OPEN ENROLLMENT INSTRUCTIONS Cont’d
Flex BenAdmin
STEP 4 – Review your personal information to ensure accuracy
1
To make
changes, click
the link to
update your
personal
information.
You can also
change your
password in this
area
3
Click to add family members
2
Click to make
changes for
spouse and
dependents
4
STEP 5 – Enroll in Benefits
● If your enrollments have not been previously set up, you can make your selections by following the instructions
below.
1
Click a link
under Quick
Links to
review a
particular
category of
benefits
2
Click to add yourself and your
dependents to the plan, or to
decline the benefit
● On the next screen, choose the family members that you would like to enroll
Enroll a family member
by checking the box
26

OPEN ENROLLMENT INSTRUCTIONS Cont’d
Flex BenAdmin
● You will then be shown the plans that you may enroll in and the cost to you, per pay check
4
Select
your plan
Employee Cost: $XXX.XX (Semi-Monthly)
Employee Cost: $XXX.XX (Semi-Monthly)
5
● Your plan election for that benefit will be shown along with the carrier arbitration language. Review the information
and either click Cancel, Go Back to make changes, or I Agree to move on.
6
● Repeat this step for ALL lines of coverage that you would like to enroll in.
27

OPEN ENROLLMENT INSTRUCTIONS Cont’d
Flex BenAdmin
STEP 6 – Name Beneficiaries:
● For both Basic Term Life and Voluntary Term Life, you must name a beneficiary(ies).
1 Sun Life Core Life/AD&D Plan
Go to the
Benefit
Section
2
Under
Manage
Benefit, click
Add/Change
Beneficiary
● Enter the name of your beneficiaries and click Continue
3
Enter
Beneficiary
name
4
28

OPEN ENROLLMENT INSTRUCTIONS Cont’d
Flex BenAdmin
STEP 7 – Review and Finalize Benefit Elections
● At this point, your benefit elections are shown in each benefit block or by clicking the links under the
Benefits heading in the menu on the left.
● Review all selections and make changes if necessary, by clicking Manage Benefits.
● A summary of your cost for benefits will be listed at the bottom of the page.
Amounts per (Bi-Weekly) pay period
● Click Review & Finalize
● On the next screen, review the summary of your elections.
● When you are finished, click the button to finalize your elections!
$XXX.00
1
2
Review all
personal
information and
plan choices
Click Return to My
Benefits to make
changes
Amounts shown are per (Semi-Monthly) pay period
Amounts shown are per (Semi-Monthly) pay period
$XXX.XX
$XXX.XX
$XXX.XX
YOU ARE NOT OFFICIALLY ENROLLED IN BENEFITS UNTIL YOU CLICK THIS BUTTON
4
3
Click Agree to
finalize elections
29

OPEN ENROLLMENT INSTRUCTIONS Cont’d
Flex BenAdmin
STEP 8 – Print a copy of the summary of your elections for your records
Click to Print
Amounts shown are per (Semi-Monthly) pay period
$XXX.XX
$XXX.XX
Amounts shown are per (Semi-Monthly) pay period
$XXX.XX
$XXX.XX
REMEMBER: Open Enrollment must be completed by the deadline or
you may not be able to enroll yourself and/or your eligible dependents until our
next open enrollment, or a qualifying event occurs.
This summary of benefits is not intended to be a complete description of the terms of OrthoArkansas, P.A.’s insurance benefit plans. Please refer to the
plan document(s) for a complete description. Each plan is governed in all respects by the terms of its legal plan document, rather than by this or any
other summary of the insurance benefits provided by the plan. In the event of any conflict between a summary of the plan and the official document,
the official document will prevail. Although OrthoArkansas, P.A. maintains its benefit plans on an ongoing basis, OrthoArkansas, P.A. reserves the right
to terminate or amend each plan, in its entirety or in any part at any time.
30

HEALTH SAVINGS ACCOUNT (HSA)
ENROLLMENT
31

HEALTH SAVINGS ACCOUNT (HSA)
ENROLLMENT
32

HEALTH SAVINGS ACCOUNT (HSA)
ENROLLMENT
33

HEALTH SAVINGS ACCOUNT (HSA)
ENROLLMENT
34

HEALTH SAVINGS ACCOUNT (HSA)
ENROLLMENT
35

FLEXIBLE SPENDING ACCOUNTS (FSA)
INSTRUCTIONS
PayChex
36

FLEXIBLE SPENDING ACCOUNTS (FSA)
INSTRUCTIONS Cont’d
PayChex
37

FLEXIBLE SPENDING ACCOUNTS (FSA)
INSTRUCTIONS Cont’d
PayChex
38

GLOSSARY
Coinsurance: You share of the cost of a covered health care service, calculated as a percent (for example,
20%) of the allowed amount for the service, typically after you meet your deductible. For instance, if your
plan’s allowed amount for an office visit is $100 and you’ve met your deductible (but haven’t yet met your
out-of-pocket maximum), your coinsurance payment of 20% would be $20. Your plan sponsor or employer
would pay the rest of the allowed amount.
Copay: The fixed amount, as determined by your insurance plan, you pay for health care services received.
Deductible: The amount you owe for medical services before your medical insurance or plan sponsor
(employer) begins to pay its portion. For example, if your deductible is $3,000, your plan does not pay
anything until you’ve met your $3,000 deductible for covered health care services. This deductible may not
apply to all services, including preventive care. Preventive care is 100% covered by the plan.
Employee Contribution: The weekly amount you pay for your insurance coverage.
Explanation of Benefits (EOB) / Personal Health Statement (PHS): A statement sent by your insurance carrier
that explains which procedures and services were provided, how much they cost, what portion of the claim
was paid by the plan, and what portion is your liability, in addition to how you can appeal the insurer’s
decision. These statements are also posted on the carrier’s website for your review.
Flexible Spending Accounts (FSA): An option that allows participants to set aside pre-tax dollars to pay for
certain qualified expenses during a specific time period (usually a 12-month period).
Health Care Cost Transparency: Also known as Market Transparency or Medical Transparency. Health care
provider costs can vary widely, even within the same geographic area. To make it easier for you to get the
most cost-effective health care products and services, online cost transparency tools, which are typically
available through health insurance carriers, allow you to search an extensive national database to compare
costs for everything from prescription drugs and office visits to MRIs and major surgeries.
Health Savings Account (HSA): A personal health care bank account funded by your or your employer’s
tax-free dollars to pay for qualified Medical expenses. You must be enrolled in a HDHP to open an HSA. Funds
contributed to an HSA roll over from year to year and the account is portable, meaning if you change jobs,
your account goes with you.
High Deductible Health Plan (HDHP): Plan option that provides choice, flexibility and control when it comes
to spending money on health care. Preventive care is covered at 100% with in-network providers, there are
no copays, and all qualified employee-paid Medical expenses count toward your deductible and your
out-of-pocket maximum.
In-Network: In-network providers are doctors, hospitals and other providers that contract with your
insurance company to provide health care services at discounted rates.
Out-of-Network: Out-of-network providers are doctors, hospitals and other providers that are not contracted
with your insurance company. If you choose an out-of-network doctor, services will not be provided at a
discounted rate and your cost sharing (deductibles and coinsurance) will increase.
Out-of-Pocket Maximum: The maximum amount of money you will pay for medical services during the plan
year. The out-of-pocket maximum is the sum of your deductible and coinsurance payments.
39

OrthoArkansas, P.A.
HUMAN RESOURCES | 501.500.3500