Welcome, ACE Employees
Welcome, ACE Employees
Our Employee Benefits And Wellness Program
Table Of Contents
To make your life easier, click on the topics below to go directly to that information:
Annual Notices: Under federal law, we are required to provide or have available specific benefit notices for your review. All annual notices are available on our benefit administration platform or from Human Resources. If you would like to review the Annual Notices now, please CLICK HERE.
Disclaimer: This benefit guide provides highlights of the benefits available. Please request a copy of the plan certificate for additional coverage details, limitations, exclusions and restrictions. If any conflict shall arise between this document and the plan certificate, the plan certificate will govern in all cases.
OPEN ENROLLMENT VIDEO
Welcome to our employee benefits program. We have designed a personalized video for you and your family to better understand all of the benefits offered to you.
At the same time, you’ll have an opportunity to meet the team from AHW that will be working with you. In addition to the video, we have designed the following benefit highlights to be user-friendly.
You can click on any topic you’re interested in vs having to scroll through the entire booklet.
ELIGIBILITY
Eligibility
Eligibility Definitions
Employee:
A full-time employee who is scheduled to work at least 30 hours per week
Dependent:
New Employees
As a new, full-time employee (working 30 or more hours per week), your benefits will become effective: the first of the month, following the date you start working.
Dependents are eligible to stay on a parent’s medical plan until the day they turn age 26, regardless of student status, employment status or marital status.
You can only change your benefit selections during the plan year if you have a qualifying life event.
Spousal Exclusion
Our medical plan does not have a spousal exclusion meaning that If you have a spouse that is able to obtain coverage through his/her employer or other means, they are eligible to participate in our group health plan.
Qualifying Life Events
When one of the following events occurs, you have 30 days from the date of the event to notify human resources and/or request changes to your coverage:
Your change in coverage must be consistent with your change in status. Please direct questions regarding specific life events and your ability to request changes to human resources.
HOW TO ENROLL
ANNUAL OPEN ENROLLMENT
You need to log into Employee Navigator to enroll or decline coverage. This is not a passive enrollment.
11/7/2022 – 11/18/2022
HOW TO ENROLL
ANNUAL OPEN ENROLLMENT
You need to log into Employee Navigator to enroll or decline coverage. This is not a passive enrollment.
11/7/2022 – 11/18/2022
We are using the same online benefit administration system, Employee Navigator, to capture your benefit elections. It is simple, secure and can be done in a few minutes from any computer or smart device with internet access. After enrolling online, you will have access to your benefit information anytime, from any computer.
To get started, you will need:
Use your computer, smart phone or device to enroll using this computer identifier:
AmericanCollege (no space)
Log On To Enroll
You will receive an email from noreply@employeenavigator.com that provides your registration link and company identifier code. To access employee navigator, you will need to enter the credentials you used when you originally registered with Employee Navigator. If you cannot remember your credentials, use the forget password or forgot username option on the login screen, then follow the prompts. An email will be sent to the email address you originally provided during your registration. Keep in mind, it could be your work email OR your personal email account.
Go to (or click) https://www.employeenavigator.com/benefits/Account/Login to login to Employee Navigator
MEDICAL BENEFITS
Choose the Plan that is Best for You and Your Family
We will continue to offer three medical plans to provide choice for you and your family.
Also, we are very pleased to continue our wellness program in 2023. Our program is designed to give you choices, so it fits your lifestyle and includes your family. The health coaching team from American Health & Wellness will continue to provide support with weight management, nutrition, wellbeing, exercise and more.
Also, we are very pleased to continue our wellness program in 2023. Our program is designed to give you choices, so it fits your lifestyle and includes your family. The health coaching team from American Health & Wellness will continue to provide support with weight management, nutrition, wellbeing, exercise and more.
MEDICAL PLAN OPTIONS
Your employer offers 4 medical options:
Plans: (Scroll sideways to see all 3 plans)
| Plan Information Effective 1/1/23-12/31/23 In Network Benefits | Plan 1: High Deductible Health Plan (HSA) | Plan 2: Traditional PPO Plan | Plan 3: High Deductible Health Plan (HSA) | |||
| Choice Plus | Navigate Premier | |||||
| Annual Deductible (embedded): Individual Family | $3,000 $6,000 | $2,000 $6,000 | $3,000 $6,000 | |||
| Out-of-Pocket Maximum (including deductible, copays and coinsurance): Individual Family | $3,700 $7,400 | $5,000 $10,000 | $6,500 $13,000 | |||
| Coinsurance - In Network | 0% | 20% | 20% for Premium Care Physicians / 40% | |||
| Office Visit Copays: Primary (PCP) Specialist | Deductible; then $30 Deductible; then $50 | $25 Copay $40 Copay | Deductible; then 20%/40% Deductible; then 20%/40% | |||
| Prescription Drugs Retail 30 day Supply Tier 1: generic Tier 2: brand Tier 3: formulary | Deductible All Tiers; $10 $35 $60 | Copays: $10 $35 $60 | Deductible All Tiers; $10 $35 $60 | |||
| Prescription Drugs Mail Order 90 day Supply (in network only) Tier 1: generic Tier 2: brand Tier 3: formulary | Deductible All Tiers; $25 $87.50 $150 | Copays: $25 $87.50 $150 | Deductible All Tiers; $25 $87.50 $150 | |||
| Medicare Part D Creditable Status Creditable means the Rx plan is as good as Medicare Part D | Creditable | Creditable | Creditable | |||
| Preventive Care Routine Exams, Screening | Covered at 100% | Covered at 100% | Covered at 100% | |||
| Emergency Room Charges outside of the facility could be billed separately | Deductible; then $250 / visit | $250 Copay / visit; then 20% | $250 Copay; then Deductible; 20% | |||
| Urgent Care Charges outside of the facility could be billed separately | Deductible; then $75 / visit | $75 Copay / visit | Deductible & Coinsurance | |||
| Inpatient Hospital | Deductible; then 0% | Deductible; then 20% | $500 Copay; Deductible; then 20% | |||
| Outpatient Surgery | Deductible; then 0% | Deductible; then 20% | $250 Copay; Deductible; then 20% | |||
| Single/Family | Single/Family | |||||
| Out-of-Network Benefits: Annual Deductible Out-of-Pocket Maximum | $5,400/$10,800 $10,800/$21,600 | $4,000/$12,000 $10,000/ $20,000 | Not Applicable Not Applicable | |||
| Coinsurance | 30% | 40% | Not Applicable | |||
| Plan Information Effective 1/1/23-12/31/23 In Network Benefits | Plan 1: High Deductible Health Plan (HSA) | Plan 2: Traditional PPO Plan | Plan 3: High Deductible Health Plan (HSA) | |||
| Choice Plus | Navigate Premier | |||||
| Annual Deductible (embedded): Individual Family | $3,000 $6,000 | $2,000 $6,000 | $3,000 $6,000 | |||
| Out-of-Pocket Maximum (including deductible, copays and coinsurance): Individual Family | $3,700 $7,400 | $5,000 $10,000 | $6,500 $13,000 | |||
| Coinsurance - In Network | 0% | 20% | 20% for Premium Care Physicians / 40% | |||
| Office Visit Copays: Primary (PCP) Specialist | Deductible; then $30 Deductible; then $50 | $25 Copay $40 Copay | Deductible; then 20%/40% Deductible; then 20%/40% | |||
| Prescription Drugs Retail 30 day Supply Tier 1: generic Tier 2: brand Tier 3: formulary | Deductible All Tiers; $10 $35 $60 | Copays: $10 $35 $60 | Deductible All Tiers; $10 $35 $60 | |||
| Prescription Drugs Mail Order 90 day Supply (in network only) Tier 1: generic Tier 2: brand Tier 3: formulary | Deductible All Tiers; $25 $87.50 $150 | Copays: $25 $87.50 $150 | Deductible All Tiers; $25 $87.50 $150 | |||
| Medicare Part D Creditable Status Creditable means the Rx plan is as good as Medicare Part D | Creditable | Creditable | Creditable | |||
| Preventive Care Routine Exams, Screening | Covered at 100% | Covered at 100% | Covered at 100% | |||
| Emergency Room Charges outside of the facility could be billed separately | Deductible; then $250 / visit | $250 Copay / visit; then 20% | $250 Copay; then Deductible; 20% | |||
| Urgent Care Charges outside of the facility could be billed separately | Deductible; then $75 / visit | $75 Copay / visit | Deductible & Coinsurance | |||
| Inpatient Hospital | Deductible; then 0% | Deductible; then 20% | $500 Copay; Deductible; then 20% | |||
| Outpatient Surgery | Deductible; then 0% | Deductible; then 20% | $250 Copay; Deductible; then 20% | |||
| Single/Family | Single/Family | |||||
| Out-of-Network Benefits: Annual Deductible Out-of-Pocket Maximum | $5,400/$10,800 $10,800/$21,600 | $4,000/$12,000 $10,000/ $20,000 | Not Applicable Not Applicable | |||
| Coinsurance | 30% | 40% | Not Applicable | |||
Employee Payroll Contributions
Premium contributions will be deducted from your paycheck on a pre-tax basis.
Plans: (Scroll sideways to see all 3 plans)
| Your Contribution | ||||||
|---|---|---|---|---|---|---|
| Effective 1/1/22-12/31/22 | Plan 1: High Deductible Health Plan (HSA) | Plan 2: Traditional PPO Plan | Plan 3: High Deductible Health Plan (HSA) | |||
| Choice Plus | Navigate Premier | |||||
| Employee Only | $50.43 | $76.86 | $45.12 | |||
| Employee + Spouse | $192.86 | $261.93 | $172.57 | |||
| Employee + Child(ren) | $181.49 | $246.49 | $162.40 | |||
| Employee + Family | $275.27 | $370.01 | $246.31 | |||
| Your Contribution | ||||||
|---|---|---|---|---|---|---|
| Effective 1/1/22-12/31/22 | Plan 1: High Deductible Health Plan (HSA) | Plan 2: Traditional PPO Plan | Plan 3: High Deductible Health Plan (HSA) | |||
| Choice Plus | Navigate Premier | |||||
| Employee Only | $50.43 | $76.86 | $45.12 | |||
| Employee + Spouse | $192.86 | $261.93 | $172.57 | |||
| Employee + Child(ren) | $181.49 | $246.49 | $162.40 | |||
| Employee + Family | $275.27 | $370.01 | $246.31 | |||
Find a Provider / Choose a Provider
NAVIGATE PRIMARY CARE PHYSICIAN (PCP) SELECTION
- Make sure you pick a primary care physician (PCP) in the United Healthcare Network when you enroll
- You will need to get an online referral from your PCP before you see another physician or specialist
- Make sure your providers are part of the network as there are no benefits when you go out-of-network
Navigate Premium Designation: The physician meets the UnitedHealth Premium program quality and cost-efficient care criteria.
Telemedicine
Employees and their family members can see and speak to a doctor 24/7 using a mobile device or computer. If needed, a prescription can be sent to your local pharmacy. No appointment necessary—and usually takes less than 20 minutes.
Virtual Visits – a telehealth option to talk to a doctor by phone or video, 24/7. Sign up at myuhc.com.
Plan Information
Which plan is right for you?
| High Deductible Health Plan | Traditional Plan |
|---|---|
| High Deductible Health Plan | Traditional Plan |
| Lower Payroll Deductions | Higher Payroll Deductions |
| Deductible Applies First | Copays Apply First |
| Pre-Tax and Tax Benefits: contributions reduce your taxable income; enrollment in a Health Savings Account (HSA) also accrues savings that are tax-deferred and distributions for qualified medical expenses are tax-free. | Pre-Tax Benefit: contributions reduce your taxable income |
| Great way to save pre-tax dollars if you don’t expect significant health issues. | Manage your budget with copays if you expect to utilize the medical plan and have multiple prescriptions. |
Routine Preventive Exam
Our medical plans cover one annual preventive (wellness) examination at 100%, when no diagnostic issues are identified. Appropriate biometric screenings based on age or risk status are covered at 100%.
Upon any diagnosis, future tests and exams are not considered preventive.
Plan Information
What is an embedded deductible?
A medical plan with an embedded deductible tracks both the individual and family deductible. An individual with healthcare needs and family coverage will not have to meet the entire family deductible before the plan begins to pay for services.
Urgent Care Facility vs. Hospital Emergency Room
If you are faced with a sudden illness or injury, making an informed choice on where to seek medical care is crucial to your personal and financial well-being. Below are examples (not all inclusive) of when the Hospital Emergency Room should be used vs. an Urgent Care Facility. remember, certain Urgent Care conditions may be treatable without Telemedicine service.
| Hospital Emergency Room This should be used for health conditions that require a high level of care. | Urgent Care Facility This is an extension of your primary care physician. |
|---|---|
| Hospital Emergency Room This should be used for health conditions that require a high level of care. | Urgent Care Facility This is an extension of your primary care physician. |
| Compound Fracture | Controlled bleeding |
| Deep Knife or Gunshot Wound | Diagnostic services (x-ray, lab tests) |
| Moderate to Severe Burns | Ear Infections |
| Poisoning or suspected poisoning | High fever or the flu |
| Seizures or loss of consciousness | Minor broken bones (toes, fingers) |
| Serious head, neck or back injuries | Severe sore throat or cough |
| Severe abdominal pain | Sprains or strains |
| Severe chest pain or difficulty breathing; Signs of heart attack or stroke | Skin rashes and infections |
| Suicidal or homicidal feelings | Urinary tract infections |
| Uncontrollable bleeding | Vomiting, diarrhea or dehydration |
Be sure to review the details about your financial responsibility when using a Hospital Emergency Room vs. an Urgent Care Facility. Be an informed consumer and know your benefit options. In an emergency, call 911 and go to the Hospital Emergency Room.
FSA & HSA
Flexible Spending Account
A Flexible Spending Account (FSA) allows you to set aside pre-tax payroll deductions to pay for out-of-pocket health care expenses such as deductibles, copays and coinsurance, as well as dependent care expenses. Depending on your health plan election, you may be eligible for a regular purpose FSA. Below outlines the differences:
Unused funds are lost each calendar year. Budget wisely, once you pledge your FSA payroll deduction, you cannot change it for the calendar year.
| Description | Regular Purpose Flexible Spending Account | Dependent Care Spending Account |
|---|---|---|
| Description | Regular Purpose Flexible Spending Account | Dependent Care Spending Account |
| Health Plan | Traditional Plan or Waiving Medical | Not Applicable |
| Qualified Expenses | Medical, Dental, Vision and Prescription with a doctor’s prescription | Dependent care services while you are at work. Dependents is a child under the age of 13 or an adult dependent who can’t take care of themselves. The dependent must live with you and be claimed as a dependent on your tax return. |
| Tax Advantage | Pre-tax Contributions and Payments for Qualified Expenses | Pre-tax Contributions and Payments for Qualified Expenses |
| 2023 Contribution Limit | $3,050 | $5,000 |
FSA Debit Card
Online & Mobile App Capabilities
Visit www.letscatapult.org
Health Savings Account
Your Health Savings Account (HSA) is tax free. The money in your account is yours to use to pay for eligible health care expenses when you are enrolled in a qualified high deductible health plan. Unused funds roll over year-to year.
What is a Health Savings Account?
A HSA is an individual health care bank account that you can use to pay out-of-pocket health care expenses with pre-tax dollars. You will own and administer your account and there are no “use it or lose it” restrictions like a Flexible Spending Account (FSA). HSAs allow you to save and “roll over” money if you do not spend it in the calendar year. The money is yours if you change health plans or jobs. You can open and fund a HSA when you meet the following guidelines:
| 2023 HSA Contribution Limits | ||
|---|---|---|
| Single | $3,850 | |
| Family | $7,750 | |
| Catch-up (ages 55+) | $1,000 | |
The Internal Revenue Service (IRS) places a limit on the maximum contributions each year from yourself or any other contributor.
Qualified Expenses
You can use your HSA funds to pay for medical, dental and vision expenses, i.e., surgery expenses, prescriptions, chiropractor, dental treatment, etc.
Non-qualified expenses will be taxed plus a 20% tax penalty under IRS regulations.
PHARMACY BENEFITS
We are using the United Healthcare Advantage pharmacy formulary that includes broader coverage. For additional information about your prescription needs and review of the Prescription Drug List (PDL).
Call the member phone number on your health plan ID card. Visit your plan’s member website listed on your health plan ID card to:
USING YOUR PHARMACY PLAN
Prior Authorization
Some drugs, and certain amounts of some drugs, require an approval before they are eligible to be covered under your medical plan. Even if a drug is listed or on a formulary, you should check your schedule of benefits to verify it is a covered benefit.
You will receive the greatest savings by using in-network providers.
Generic Drugs
When a patent or exclusivity expires on a Food and Drug Administration (FDA)-approved drug, other companies can make the drug in a generic form.
The FDA requires generic drugs have the same high quality, strength, purity and stability as brand-name drugs. On average, the cost of a generic drug is 80-85% lower than the brand-name equivalent.
WELLNESS PROGRAMS & SERVICES
Wellness Disclaimer: Before beginning any health and wellness program, you should seek the advice of your physician or other qualified health provider with any questions that you may have regarding a medical condition or potential medical condition. Also, you should never disregard professional medical advice, or delay seeking medical advice or treatment. Any wellness program participant further understands that the recommendations made to you by the American Health & Wellness Health Coach is not intended to diagnose, treat, prescribe, cure or prevent any disease.
Your Health Coaching Team
American Health & Wellness health coaches are graduates of accredited colleges with bachelor degrees in nursing, kinesiology, exercise science and have a collection of certifications amongst them, i.e., Certified Integrative Nutritional Health Coach; Lifestyle Health Coaching; Wellcoaches® Health & Wellness Coach; ACSM Certified Exercise Physiologist; Certified Health Coach through Health Coaching Institute and Certified Stress Management Coach (CSMC).
Email: wellness@americanhw.com
What Is Health Coaching?
Your Health Coach will provide wellness education on a variety of subjects via seminars, videos, social media, group coaching circles and challenges. The information should empower and inspire you to make choices that improve your physical, mental and emotional wellbeing!
Your Health Coach cares about you and is here to help you maximize your personal strengths. Your health coach will help you to provide you actionable steps in support of achieving your health goals. Motivation, positivity and wellbeing will be the focus for health improvement and maintenance.
Seminars / Videos
Monthly seminars are engaging, inspiring and relevant and FUN! Seminars will be available for viewing either virtually or recorded. If you miss a seminar you can contact your health coach for the recorded version.
Challenges
ACE Wellness will be offering quarterly wellness challenges through the MoveSpring app. Challenges focus areas will range from exercises, nutrition, employee engagement, mindfulness, friendly competition and fun!
Group Coaching
Group coaching circles are a safe place to connect with others who have the same goal in mind as you. Facilitated by your Health Coach, group coaching has proven results in providing momentum to help you manage and meet your goals. The meetings are held 16 times a month at different times and days for your convenience. Your health coach will text you the link to join.
Text Reminders From Your Health Coach
Your American Health & Wellness Health Coach will text you reminders of upcoming seminars, challenges & group coaching circles. Add AHW Texts to your contacts: (765) 256-6400.
Our Wellness Program
We are pleased to continue our voluntary wellness program administered by American Health & Wellness (AHW) in collaboration with ACE Wellness. We believe our program is fun, motivating and give us all new ideas and tools to maintain and improve our health.
We are excited to partner with you on your health and wellness journey!
Here’s how our program works:
2023 Wellness Program Criteria
| Choose Your Wellness Activity | Deadline | Earn |
|---|---|---|
| Choose Your Wellness Activity | Deadline | Earn |
| Participate in one wellness activity every month between 1/1/23—12/31/23: 1. Attend Wellness Seminars or Recorded Seminars (max 6) 2. Annual Physical—Go to your doctor for your yearly preventive exam. Give a special form to your Physician’s Office and turn the form into your Health Coach when completed. BONUS—earn an additional $25 gift card for getting your exam! 3. Join Group Coaching Circles 4. Attend a Wellness Forum—Health Coaches answering your questions about health & wellness! (Offered Quarterly) 5. Challenges! Download the MoveSpring app to join in on our quarterly challenges and compete against your co-workers (Offered Quarterly) | 12/31/23 | Earn a $200 Reward in January 2024 as either a taxable bonus on your paycheck or an HSA contribution. (New Hires amount will be pro-rated based on hire date) |
Participate In At Least 1 Activity Each Month!
American Health & Wellness Group health coaches are graduates of accredited colleges degreed in kinesiology/exercise science and have 5-10 years experience coaching/motivating individuals.
AHW Health Coach
Paige Horgan
Senior Health Coach
phorgan@americanhw.com
317-571-1600
Confidentiality
To protect your privacy and protected health information, American Health & Wellness Group (AHW) administers our wellness program. All health coaches are HIPAA (Health Insurance Portability and Accountability Act) certified. This means the information you share with your health coach is private and secure.
Nicotine Cessation
If you are a current nicotine user and ready to quit, there are options available to help.
Take Charge
Taking charge of your health starts with getting your annual, preventive exam to know your biometric numbers. Your weight, cholesterol, blood pressure and blood glucose numbers are key indicators of health. Your health coach will help you review your physician results and help create a lifestyle plan if you need to improve your numbers.
DENTAL BENEFIT SUMMARY
(Scroll sideways to see all options)
| Benefit Summary | In-Network High Plan | ||
|---|---|---|---|
| Benefit Summary | In-Network Plan | ||
| Preventive Expenses | > Exams and cleanings (two times per calendar year) > X-rays (full mouth once every 60 months) > Bitewing (once per calendar year) > Fluoride treatment to age 19 (once per calendar year) > Sealants to age 19 (one per tooth every 24 months) | Covered at 100%, no deductible | |
| Basic Expenses | > Fillings and stainless steel crowns > General anesthesia > Simple/Complex oral surgery and procedures > Non-surgical Periodontics, including scaling and root planing (once per quadrant every 24 months) > Periodontal surgical procedures (once per quadrant every 36 months) > Simple/Complex Endodontics (root canal) > Space maintainers to age 19 | Covered at 80% | |
| Major Expenses | > Repairs to dentures, bridges, crowns > Crowns (each 84 month per tooth) if cannot be restored by filling > Inlays, Onlays (every 84 months per tooth) > Bridges, Dentures | Covered at 50% | |
| Deductible: Single Family | --------------------------------> | $50 $150 | |
| Calendar Year Maximum | --------------------------------> | $1,500 | |
| Orthodontia | 50%, child up to age 19 | $1,500 Lifetime Maximum | |
| Out-Of-Network | In and out-of-network benefits are paid at the same coinsurance percentages, but all benefits are paid based on the discounted PPO fees. In-network claims are processed with Principal’s regular PPO savings. Employees using out-of-network providers may be responsible for the difference between the discounted PPO fees and the out-of-network dentist’s regular fees for the services performed. | ||
| Benefit Summary | High Deductible Health Plan $3,000 | ||
|---|---|---|---|
| Benefit Summary | In-Network Plan | ||
| Preventive Expenses | Exams and cleanings (two times per calendar year), X-rays (full mouth once every 60 months), Bitewing (once per calendar year), Fluoride treatment to age 19 (once per calendar year), Sealants to age 19 (one per tooth every 24 months) | Covered at 100% | |
| Basic Expenses | Fillings and stainless steel crowns, General anesthesia, Simple/Complex oral surgery and procedures, Non-surgical Periodontics, including scaling and root planing (once per quadrant every 24 months), Periodontal surgical procedures (once per quadrant every 36 months), Simple/Complex Endodontics (root canal), Space maintainers to age 19 | Covered at 80% | |
| Major Expenses | Repairs to dentures, bridges, crowns, Crowns (each 84 month per tooth) if cannot be restored by filling, Inlays, Onlays (every 84 months per tooth), Bridges, Dentures | Covered at 50% | |
| Deductible: Single Family | -----------------> | $50 $150 | |
| Calendar Year Maximum | -----------------> | $1,500 | |
| Orthodontia | 50%, child up to age 19 | $1,500 Lifetime Maximum | |
| Out-Of-Network | In and out-of-network benefits are paid at the same coinsurance percentages, but all benefits are paid based on the discounted PPO fees. In-network claims are processed with Principal’s regular PPO savings. Employees using out-of-network providers may be responsible for the difference between the discounted PPO fees and the out-of-network dentist’s regular fees for the services performed. | ||
How maximum rollover works
Depending on a plan’s annual maximum, if claims made for a certain year don’t reach a specified threshold, then the set maximum rollover amount can be rolled over.
| Plan Annual Maximum | Threshold | Maximum Rollover Amount | Maximum Rollover Account Limit |
|---|---|---|---|
| Plan Annual Maximum | Threshold | Maximum Rollover Amount | Maximum Rollover Account Limit |
| $1,500 Maximum claims reimbursement | $750 Claims amount that determines rollover eligibility | $375 Additional dollars added to a plan's annual maximum for future years | $1,875 The limit that cannot be exceeded within the maximum rollover account |
| Plan Annual Maximum | Threshold |
|---|---|
| Plan Annual Maximum | $1,500 Maximum claims reimbursement |
| Threshold | $750 Claims amount that determines rollover eligibility |
| Maximum Rollover Amount | $375 Additional dollars added to a plan's annual maximum for future years |
| Maximum Rollover Account Limit | $1,875 The limit that cannot be exceeded within the maximum rollover account |
Dental Employee Bi-Weekly Contribution
| Dental Buy-Up | |
|---|---|
| Dental Plan | |
| Employee Only | $6.56 |
| Employee + Spouse | $22.34 |
| Employee + Child(ren) | $23.59 |
| Employee + Family | $38.25 |
| Dental Buy-Up | |
|---|---|
| Dental Plan | |
| Employee Only | $6.56 |
| Employee + Spouse | $22.34 |
| Employee + Child(ren) | $23.59 |
| Employee + Family | $38.25 |
VISION BENEFIT SUMMARY IN-NETWORK
(Scroll sideways to see all options)
| High Plan | |||
|---|---|---|---|
| Vision Plan | |||
| Copay | Benefit Frequency | ||
| Eye Exam | $10 copay | Once Every 12 Months | |
| Lenses: Single Vision, Lined Bifocal, Lined Trifocal & Lenticular | $25 | Once Every 12 Months | |
| Contact Lenses (in lieu of eyeglass lenses and/or frames) | $25 copay if medically necessary $130 max (copay waive) if elective 20% off balance over allowance | Once Every 12 Months | |
| Frames | $130 retail max + 20% off balance | Once Every 24 Months | |
| Network | Find An Eye Doctor www.vsp.com 1-800-877-7195 VSP Choice | VSP | |
| Out-of-Network Benefits | Out-of-network benefits are allowed, however, copays and maximums are less. Employees using out-of-network providers may be responsible for additional fees. | ||
Vision Employee Bi-Weekly Contribution
| Vision High Plan | |
|---|---|
| Vision Plan | |
| Employee Only | $3.56 |
| Employee + Spouse | $7.13 |
| Employee + Child(ren) | $6.22 |
| Employee + Family | $9.78 |
LIFE INSURANCE BENEFITS
Basic Life & Accidental Death & Dismemberment (AD&D)
We provide basic life and accidental death and dismemberment insurance at no cost for our employees.
| Benefits | Details |
|---|---|
| Benefits | Details |
| Coverage Amount | $50,000 |
| Insurance Carrier | Principal |
| Age Reduction Rule | Benefit reduces by 35% at age 65; 50% at age 70 |
Beneficiary Designation is the person you designate to receive your life insurance benefits in the event of your death. During your enrollment, you will be asked to provide a primary and contingent beneficiary.
Will Prep
Protect your family, your finances and your future.
Call ARAG: 800-546-3718 to register using your group policy number: 1104702 | www.aragwills.com/principal
Resources to help with: Will Preparation | Healthcare Power of Attorney | Durable Power of Attorney Living Will |
Medical Treatment Authorization for Minors
Voluntary Life & Accidental Death & Dismemberment (AD&D)
Employees can purchase additional life insurance at group rates. Rates are age banded based on $1,000 of covered benefit. An open enrollment period will be available to you and your enrolled dependents each year. You and your dependents can request an increase of one benefit increment per year up to the guaranteed coverage amount without evidence of insurability.
| Benefits | Details |
|---|---|
| Benefits | Details |
| Guaranteed Coverage Amount and Benefit Maximums | GUARANTEED COVERAGE AMOUNT & BENEFIT MAXIMUMS: Employee: $150,000, under age 70; $10,000, age 70+ $10,000 minimum to $500,000 maximum ($10,000 increments) Spouse: $30,000, under age 70; $10,000, age 70+ $5,000 minimum to $200,000 maximum or up to 50% of employee coverage ($5,000 increments) Spouse cost based on spouse’s age band Child: $10,000 - Options of $5,000 or $10,000 for covered children ages 14 days to 26 years old. Live newborn to 14 days: $1,000 benefit Same rate and coverage for all children. |
| Insurance Carrier | Principal |
| Age Reduction Rule | 35% reduction at age 65; 50% at age 70 |
| Portability / Conversion | Allows the employee to take the coverage with them if employment has ended (application timeline and age limitations apply, see Human Resources) |
| Evidence of Insurability | Evidence of Insurability is required for employees that do not elect the benefit when initially eligible or for coverage amounts over the Guaranteed Issue amount. |
INCOME PROTECTION BENEFITS
Other than medical and life insurance, disability insurance is one of the most important benefits you can elect. If you are disabled and unable to work, short term and long term disability insurance can help replace lost income and make a difficult time a little easier. Disability benefits are available to full-time employees. PTO/vacation time may be required to meet the elimination period before benefits begin.
| Details | Short Term Disability | Long Term Disability |
|---|---|---|
| Details | Short Term Disability | Long Term Disability |
| Benefit | 60% of your pre-disability base salary to a maximum weekly benefit of $1,500 | 60% of your pre-disability base salary to a maximum monthly benefit of $10,000 |
| Waiting (Elimination) Period | Benefits begin on the 15th day | Benefits begin after 90 days |
| Benefit Duration | Up to 11 weeks after elimination period | Normal Social Security Retirement Age |
| Benefits Based On | Your own occupation | Your own occupation for the first 24 months; any occupation thereafter |
| Pre-existing Conditions Limitation | Any condition/symptom for which you, for three months prior to the coverage in this plan, consulted with a physician, received treatment, or took prescribed drugs. Coverage exclusion for the pre-existing condition applies for the first 12 months of coverage. | Any condition/symptom for which you, for three months prior to the coverage in this plan, consulted with a physician, received treatment, or took prescribed drugs. Coverage exclusion for the pre-existing condition applies for the first 12 months of coverage. |
| Contribution | 100% Employee Paid | 100% Employer Paid |
| Insurance Carrier | Principal | Principal |
| Evidence of Insurability | Evidence of Insurability is required for employees that do not elect the benefit when initially eligible. | Not Applicable |
Travel Assistance (AXA)
Provided by AXA, offers a suite of services to help you in your time of need. Includes: help with lost/stolen items while traveling and provides assistance with medical and dental needs. Access this service when traveling 100+ miles away from home for up to 120 consecutive days. If a medical emergency interrupts a trip, employees can get help from AXA. This includes emergency medical transportation, transportation for a family member, and transportation home.
Who is eligible? Employees, Spouses and Dependent Children.
Website or mobile app: axa-assistance.us
Phone: 312-935-3500
ADDITIONAL BENEFITS
Critical Illness Insurance
Employees can purchase additional coverage for covered conditions and receive a lump sum payment. Payments are for first and second diagnosis of any qualified Critical Illnesses listed under the plan’s covered conditions. Benefits are paid directly to the insured and can be used under their discretion for medical or household expenses. See Summary for additional details.
| Benefits | Details |
|---|---|
| Benefits | Details |
| Guaranteed Coverage and Benefit Maximums | Employee: $20,000 - choose lump sum benefit of $5,000, $10,000, $15,000 or $20,000 ($5,000 increments) Spouse: $10,000 - $2,500 minimum to $50,000 maximum up to 50% of employee's benefit ($2,500 increments) Child: Automatically covered for 25% of employee’s benefit |
| Covered Conditions (First Occurrence / Second Occurrence) | Cancer-Invasive (100% / 100%) Cancer-Carcinoma in situ (25% / 25%) Heart Attack (100% / 100%) Major Organ Failure (100% / 100%) Stroke (100% / 100%) Childhood conditions (cerebral palsy, cleft lip, Down syndrome, Muscular Dystrophy (100% / 0%) |
| Wellness Benefit | $50 benefit for each covered person who has an eligible health screening test performed, once per calendar year. |
| Insurance Carrier | Principal |
| Pre-existing Condition Limitation | 6 month look back period, 12 month exclusion period |
| Portability | Allows the employee to take the coverage with them if employment has ended (application timeline applies, see Human Resources) |
| Evidence of Insurability | Evidence of Insurability is required for employees that do not elect the benefit when initially eligible. |
Critical Illness policies have exclusions and limitations that may impact the eligibility for or entitlement to benefits under each covered condition. The certificate of coverage provides full details. This policy will not pay for diagnosis of a listed critical illness that is made before the covered person’s Critical Illness insurance effective date with the carrier.
Accident Insurance
Accident Insurance is available to our employees and eligible dependents. The coverage is for on and off job accidents for employee and off the job for spouse. Benefits are paid directly to the insured and can be used under their discretion for medical or household expenses. See Summary for additional details.
| Benefits | Details |
|---|---|
| Benefits | Details |
| Accidental Dealth | Employee: $25,000 Spouse: $12,500 Child: $6,250 |
| Covered Accidents/Expenses | Accidental Dismemberment, Coma, Concussion, Dislocation, Fracture, Internal Injuries, Ruptured Disc with Surgical Repair (See Summary on Employee Navigator for a complete list and benefit) |
| Scheduled Payment Examples | Concussion: $500 Knee cartilage injury with surgical repair: $1,500 Fracture—Hip, skull, thigh: $10,000 |
| Insurance Carrier | Principal |
| Portability | Allows the employee to take the coverage with them if employment has ended (application timeline applies, see Human Resources) |
Accident policies have exclusions and limitations that may impact the eligibility for or entitlement to benefits under each covered accident. The certificate of coverage provides full details. This policy will not pay for diagnosis of a listed accident that occurs before the covered person’s Accident insurance effective date with the carrier. Exclusions include, but not limited to, accident related to covered person being legally intoxicated, armed aggression, service in the armed forces, suicide or attempted suicide, travel, air travel, professional sports, hang gliding, bungee jumping, parachuting, ballooning, substance abuse, etc.
| Payroll Contributions Bi-Weekly | ||
|---|---|---|
| Payroll Contributions Bi-Weekly | ||
| Employee | $7.01 | |
| Employee + Spouse | $9.90 | |
| Employee + Child(ren) | $11.53 | |
| Employee + Family | $17.17 | |
Employee Assistance Program (EAP)
We care about you and your family’s total health management. For that reason, we are providing you access to an Employee Assistance Program at no cost to you. The service provides guidance for personal issues that you might be facing and information about other concerns that affect your life, whether it is a life event or on a day-to-day basis.
No matter where you are on your journey, there are times when a little help can go a long way. From checking off daily tasks to working on more complex issues, your program offers a variety of resources, tools and services available to you and your household members. Your program is here to help you along the journey of life. No situation is too big or too small. When you and your household members need assistance, reach out anytime and we will help get you on the right path to meet your needs.
Your life’s journey – made easier
Key features
Core services
Counseling – Help for challenges such as anxiety, grief, depression, relationships and more. Meet with a counselor in-person, by text message, live chat, phone or video.
Coaching – Set, define and reach your goals with the help of a coach. Receive individualized support to handle work stress, parenting, weight loss and more.
Self-care programs – Digital emotional wellness tools to build resilience, manage stress, improve mood, sleep better or simply find daily inspiration.
Here’s how to get started
Legal assistance, financial coaching and identity theft resolution
Expert consultation to help with your legal, financial and identity theft needs. Access a free online library with resources for identity theft resolution, budgeting, debt management, family law, wills and more.
Work-life services
Save time and money on life’s most important needs. Specialists provide expert guidance and personalized referrals to service providers including childcare, adult care, education, home improvement, consumer information, emergency preparedness and more.
Workplace stress
Numerous studies show that job stress is a major source of stress for American adults. Causes of stress include workload, relationships and juggling work and personal issues. Your program offers many resources to help you better manage your stress.
Employee Assistance Program
Up to 5 in-person sessions per concern
1-800-356-7089 (TTY 711)
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Annual Notices: Under federal law, we are required to provide or have available specific benefit notices for your review. All annual notices are available on our benefit administration platform or from Human Resources. If you would like to review the Annual Notices now, please CLICK HERE.
Disclaimer: This benefit guide provides highlights of the benefits available. Please request a copy of the plan certificate for additional coverage details, limitations, exclusions and restrictions. If any conflict shall arise between this document and the plan certificate, the plan certificate will govern in all cases.