Benefits Effective 1/1/2015-12/31/2015 012

Benefits Effective 1/1/2015-12/31/2015 012
To maintain affordable, quality benefit plans, Paychex - PEO and our partners have agreed to the specific employer contribution and
participation requirements outlined below.
Medical Insurance Requirements
General Requirements – applies to all Carriers
 Client contributions, waiting period and plan selections may only be changed at initial offering or at annual enrollment.
Maximum waiting period for all Carrier plans is 60 days.
 All Medical Carriers have a $10,000 life insurance policy through Aetna on the employee only.
Contribution Requirements – applies to all Carriers
 Minimum employer contribution is 50% of the lowest employee-only rate offered to employees.*
 As the coverage level increases, the employer contribution must be greater than or equal to the contribution for the
previous coverage level.
 If offering dual carriers, the minimum employee-only rate for client contributions will be by Carrier
* Note: Health Care Reform may require different contribution requirements based on each client’s situation. The client
should consult their legal counsel and/or tax professional for additional guidance.
Carrier Requirements
Aetna
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50% of eligible employees are required to participate with a minimum of 5 enrolled.
Available only to clients located in AR, CA, CT, DE, DC, MD, NC, NJ, Metro NY, OH, OK, PA, RI, SC,
TN, TX, VA.
Employees located outside the states listed above are offered the Core PPO, Prime PPO, Ultra PPO or Ultra HDHP PPO plans.
When those plans are not available the Indemnity plan will be offered.
Metro NY consists of the following counties: Bronx, Kings, Nassau, New York, Queens, Richmond, Rockland, Suffolk and
Westchester. In NY, outside of these counties and where Empire is offered, only the OOA plans are offered.
Metro plans are no longer offered nationally but only to employees located in states where the plans are offered.
Florida Blue (Blue Cross Blue Shield)
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75% of eligible employees are required to participate with a minimum of 5 enrolled.
Available only to clients located Florida and at least 50% of enrollment must be in Florida.
Employees outside Florida are only offered the PPO plans. (Coverage in HI available)
Client must choose at least one PPO plan if they have employees outside of FL. 055071, 05773 and 05781 not available in MA.
Packages apply to all clients:
o Package A – HMO 50, 61, 59, 60 and/or PPO 03768, 03769, 05771, 05773, 05192
o Package B – HMO 49, 50, 54, 61, 62, and/or PPO 05771, 05773, 05781, 05192
Empire (Blue Cross Blue Shield)
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Groups must have a minimum of 10 eligible and at least 7 enrolled.
Client must have 75% of eligible employees after waivers and 50% of all eligible enrolled.
Available only to clients in Mid-Hudson and Upstate regions of New York.
Only one rate band is available due to community rating.
Vision plan included in the medical plan
o Mid-Hudson and Upstate Empire – Rates are based on client location.
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Plans and rates are national allowing clients to have the same plans and rates in all states with
the exception of HI which will have its own plan applied.
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3 plans including OOA PPO may be offered with <20 enrolled, 4 plans including OOA PPO
may be offered with >20 enrolled.
Kaiser
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75% of eligible employees are required to participate with a minimum of 5 enrolled.
Available only to clients located in California or Georgia.
In CA, Kaiser may be offered alongside Aetna.
Kaiser GA will not be permitted to be alongside Humana in the same client.
To offer Kaiser Plans, 75% of full-time eligible employees must reside in the state of California or Georgia and must reside in a
Kaiser HMO network.
For clients whose carrier does not offer coverage in HI, employees in Hawaii are offered the Kaiser plan.
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Tufts
 75% of eligible employees are required to participate with a minimum of 5 enrolled.
 Available only to clients located in Massachusetts.
 Employees located outside Massachusetts are offered PPO plans. (Coverage in HI available)
 Client may only elect a maximum of two (2) plans to offer its employees.
 Client must offer “like with like”, i.e., Basic must stay with Basic, High must stay with High, Low must stay with Low
(for clients offering both an HMO and PPO option to employees.)
Humana
 50% of eligible employees are required to participate with a minimum of 5 enrolled.
 Available only to clients located in Georgia, Kentucky and Nevada.
 Clients outside of GA, KY or NV with 80% of employees located in GA, KY, and/or NV may also offer Humana.
 Client must offer at least one NPOS plan if an employee or dependent resides out of the client state.
 Employees located outside of the GA, KY, and NV will be offered the NPOS plan if employee resides in that network,
if not employee will be offered the Indemnity plan.
 No coverage is available to employees in HI, MD, ME, or NH.
United HealthCare
 75% of eligible employees are required to participate with a minimum of 4 enrolled.
 Available to only clients located in AZ, CO, IA, IL, IN, KS, MO, NE, NM, OR, WA.
 Employees located outside these states are offered the same plans. Rates are based on client location.
 Maximum of 4 plans per client and cannot offer the W8Z with the OLS.
 OMH and ON5 not available in MA.
No Coverage States
 Clients located in AL, AK, ID, LA, ME, MI, MN, MT, ND, NH, SD, UT, VT, WI, WV, WY.
 Clients in this states are automatically approved to self-retain, no information needs to be sent to UW for approval.
SRC
 No contribution or participation requirements. Only one (1) SRC plan per client.
 Cannot be offered to a class of employees that is offered other medical insurance.
 This plan does not meet the minimum essential coverage and the actuarial value for full time employees.
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Not available to employees in MA, WA and VT.
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Health FSA – Not availability to employees enrolled in this plan.
Dental Insurance Requirements
Aetna Dental
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50% of eligible employees are required to participate.
DMO and FOC plans may be offered together or separately.
NJ employees must be offered the FOC either with or without the DMO.
FOC is not available in AK, LA, ND, SD, VT & WY, only PPO plan.
Humana Dental
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NO contribution or participation requirements
Plans available to full and part time employees in all states except NV.
Met Life Dental
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NO contribution or participation requirements.
2 PPO plans available
Aetna, Humana, or Met Life Dental may not be offered to the same class code; however they may be
offered to the same client in different classes.
Vision Insurance Requirements
 NO contribution or participation requirements.
 Discount plan available to all part time employees
Aetna Short-Term and Long-Term Disability Insurance Requirements
 Employer must pay for STD and LTD plans at 100%; employee contributions are not permitted.
 Only one (1) LTD and one (1) STD plan may be offered per class code.
 If a client offers a short-term disability (STD) plan and a long-term disability (LTD) plan together for a specific class code, the STD 13week plan and the LTD 90-day plan must be offered together, or the STD 26-week plan and the LTD 180-day plan must be offered
together. All full-time employees in that class code are automatically enrolled.
Employees who work in New York and Hawaii will automatically be enrolled in STD state plans
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Aetna Life Insurance Requirements
 Only one (1) employer-paid group life (GTL) plan may be offered per class code. All full-time employees listed in a class code the
client offers GTL, are automatically enrolled in GTL
 Voluntary, Spouse, and Child Life Insurance plans are automatically available to all full-time employees. Employee may only elect
SPI and CHI if they are enrolled in any life insurance. SPI can’t be more than 50% and CHI 40% of employee’s amount.
Miscellaneous Information
Self-Employed Individuals (SEIs) – Not taking wages.
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These employees must be in their own separate class code.
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These employees are NOT eligible for salary-based life insurance (i.e., 1x, 2x, etc. annual salary).
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These employees are NOT eligible for Aetna STD or LTD.
 BalanceWorks – BalanceWorks is an employee-assistance program (EAP) offered to the entire PEO employee base, free of charge.
 BalanceCare – BalanceCare is a health advocacy service provided to any employee enrolled in a PEO-sponsored medical plan.
 Working Advantage – Working Advantage offers exclusive discounts for various goods and services to the entire PEO employee base, free of
charge.
 Aetna Hospitalization – Two plan options available. This plan is available to all full time employees regardless of enrollment in a medical plan.
This plan does not offer comprehensive benefits. It provides limited hospitalization coverage. Clients may not contribute to this plan.
 Part Time Employees – May enroll in SRC (Life Insurance Included), Humana/Comp Benefits and Eye Med Discount Vision plan.
these employees are in their own separate class code and all benefits are post tax.
 Worksite Solutions - Voluntary Employee Benefits (Disability Income, Specified Condition and Accident and Sickness Hospitalization) offered
through our preferred vendor Combined Insurance.
State Requirements (Rules and Mandates)
California
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State-Mandated Short-Term Disability (incl. as a tax)
Maximum Wait Period for Benefits is 30 days
Hawaii
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State-Mandated Short-Term Disability (employee(s) are automatically enrolled in Paychex
Aetna STD plan)
Maryland
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Employers that, on at least 50% of its working days during the preceding calendar year
quarter, employed at least 2 but no more than 50 eligible employees, the majority of whom
employed in the state of Maryland, may not offer PEO medical plans
Massachusetts
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Ex-Spouse is eligible to be covered by the employee’s medical plan
Employers not permitted to offer SRC to employees
New Hampshire
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Employers not permitted to offer SRC to employees
New Jersey
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Employers must offer Aetna Dental Freedom of Choice (FOC) plan if they want to also offer
Aetna Dental DMO-only plan
State-Mandated Short-Term Disability (incl. as a tax)
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New York
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State-Mandated Short-Term Disability (employee(s) are automatically enrolled in Paychex
Standard Life STD plan)
Rhode Island
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State-Mandated Short-Term Disability (incl. as a tax)
Texas
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All Texas employees participating in a benefit plan, the Carrier must be notified within 3
days of the termination of an employee’s plan.
The Benefits Effective Date provided does not guarantee coverage. Benefits always start at the first of the month following the
employee’s wait period. Rather, Client understands the products and rates provided herein are, and remain, contingent, and
subject to Client’s continued compliance with the benefit eligibility requirements, which may be changed from time to time by PBS
and/or its carriers, required to participate in the applicable benefit plans including, but not limited to, those eligibility requirements
set forth in the Medical Fact Finder, the terms of which are incorporated herein by reference. If for any reason, Client cannot or
does not, at any time, meet the applicable benefit plan eligibility requirements, or if Client’s demographic information changes, or
inaccurate information was provided to PBS, PBS can, at its option, withdraw the availability of such plan(s) to Client, or terminate
the Agreement. Client understands that the rates above may include commissions payable to the PEO’s broker(s) of record and/or
benefit administration fees.
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