Welcome, Braden Employees

Welcome, Braden Employees

Our Employee Benefits And Wellness Program

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:

  • Your legal spouse
  • Children up to age 26 (includes birth children, stepchildren, legally adopted children and children for whom legal guardianship has been awarded to you or your spouse)
  • Dependent children incapable of self-support due to mental or physical disability

New Employees

As a new, full-time employee (working 30 or more hours per week), your benefits will become effective: the day you start working.

Dependents are eligible to stay on a parent’s medical plan up to end of the month 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:

  • Change in your legal marital status (marriage, divorce or legal separation)
  • Change in the number of your dependents (for example, birth or adoption, or if a child is no longer an eligible dependent)
  • Change in your spouse’s employment status (resulting in a loss or gain in coverage)
  • Change in your employment status from full time to part time, or part time to full time, resulting in a gain or loss of coverage.
  • Entitlement to Medicare or Medicaid
  • Eligibility for coverage through the Marketplace
  • Change in your address or location that may affect the coverage for which you are eligible.

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

If you would like to make a change to your plan, you may do so during your open enrollment

12/8/2021 – 12/16/2021

HOW TO ENROLL

ANNUAL OPEN ENROLLMENT

If you would like to make a change to your plan, you may do so during your open enrollment.

12/8/2021 – 12/16/2021

We are using an online benefit administration system to capture your benefit elections. Our online enrollment systems is with Employee Navigator. 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:

  • Your social security number
  • Any dependent’s social security numbers and birth dates

Use your computer, smart phone or device to enroll using this company identifier:

XXXXXXXXXX

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

Medical Plan Options

Choose the Plan that is Best for You and Your Family

We will continue to offer four medical plans to provide choice for you and your family. This year, you will have another choice relative to the doctor and hospital you utilize and your payroll contribution.

Choosing a Doctor or Hospital

Price Protection

Price Protection option allows you to utilize any doctor or hospital without the worry if they are in-network or not.

Cigna Network

Cigna Network option will utilize the Cigna national network of providers. If you use an out-of-network provider your financial responsibility for the deductible, coinsurance and out-of-pocket maximum will be higher.

Price Protection

Price Protection option allows you to utilize any doctor or hospital without the worry if they are in-network or not.

Cigna Network

Cigna Network option will utilize the Cigna national network of providers. If you use an out-of-network provider your financial responsibility for the deductible, coinsurance and out-of-pocket maximum will be higher.

Also, we are very pleased to continue our wellness program in 2022. 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 2022. 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:

  • Plan 1 – $5,000 High Deductible Health Plan (HDHP)
  • Plan 2 – $3,000 High Deductible Health Plan (HDHP)
  • Plan 3 – $1,500 Traditional Copay Plan (TCP)
  • Plan 4 – $500 Traditional Copay Plan (TCP)
Plans: (Scroll sideways to see all 4 plans)
Network Benefits - 1/1/2022 - 12/31/2022Plan 1Plan 2Plan 3Plan 4
Network Benefits
1/1/2022 - 12/31/2022
Plan 1
$5,000 HDHP
Plan 2
$3,000 HDHP
Plan 3
$1,500 TCP
Plan 4
$500
TCP
ANNUAL DEDUCTIBLE:
Single
Family


$5,000
$10,000


$3,000
$6,000


$1,500
$3,000


$500
$1,000
OUT-OF-POCKET MAX:
Single
Family


$5,000
$10,000


$3,000
$6,000


$1,500
$3,000


$500
$1,000
COINSURANCE - Your Responsibility After Deductible0%0%20%20%
OFFICE VISIT COPAYS:
Primary (PCP)
Specialist
Subject To DeductibleSubject To Deductible

$20
$30


$15
$30
PRESCRIPTIONS:
Generic
Brand
Formulary
Specialty
Subject To DeductibleSubject To Deductible
$10
$30
$60
25% up to $350

$10
$30
$60
25% up to $350
ALL OTHER EXPENSESSubject To DeductibleSubject To DeductibleSubject To DeductibleSubject To Deductible
MEDICARE PART D STATUSNot CreditableNot CreditableCreditableCreditable
PREVENTIVE CARE100% Covered100% Covered100% Covered100% Covered
EMERGENCY ROOMSubject To DeductibleSubject To Deductible$300 Copay; deductible waived for facility; then 20%$300 Copay; deductible waived for facility; then 20%
URGENT CARESubject To DeductibleSubject To Deductible$30 Copay; deductible waived for facility; then 20%$30 Copay; deductible waived for facility; then 20%
INPATIENT HOSPITALSubject To DeductibleSubject To DeductibleDeductible; then 20%Deductible; then 20%
OUTPATIENT SURGERYSubject To DeductibleSubject To DeductibleDeductible; then 20%Deductible; then 20%
Network Benefits 1/1/2022 - 12/31/2022High Deductible Health Plan $5,000 Your ResponsibilityHigh Deductible Health Plan $3,000 Your ResponsibilityCopay Plan $1,500 Your ResponsibilityCopay Plan $500 Your Responsibility
Network Benefits 1/1/2022 - 12/31/2022High Deductible Health Plan $5,000 Your ResponsibilityHigh Deductible Health Plan $3,000 Your ResponsibilityCopay Plan $1,500 Your ResponsibilityCopay Plan $500 Your Responsibility
Annual Deductible (embedded) Individual$5,000$3,000$1,500$500
Annual Deductible (embedded) Family$10,000$6,000$3,000$1,000
Out-of-Pocket Maximum (including deductible, copays & coinsurance) - Individual$5,000$3,000$3,000$1,500
Out-of-Pocket Maximum (including deductible, copays & coinsurance) - Family$10,000$6,000$6,000$3,000
Coinsurance In Network0%0%20%20%
Office Visit Copays - Primary (PCP)DeductibleDeductible$20 per visit$15 per visit
Office Visit Copays - SpecialistDeductibleDeductible$30 per visit$30 per visit
Prescription Drugs Copays: Retail/Mail Order Supply: 30/90 day - Tier 1: genericDeductibleDeductible$10/$20$10/$20
Prescription Drugs Copays: Retail/Mail Order Supply: 30/90 day - Tier 2: brandDeductibleDeductible$30/$75$25/$62.50
Prescription Drugs Copays: Retail/Mail Order Supply: 30/90 day - Tier 3: formularyDeductibleDeductible$60/$180$50/$150
Prescription Drugs Copays: Retail/Mail Order Supply: 30/90 day - Tier 4: specialtyDeductibleDeductible25% up to $35025% up to $350
Medicare Part D Creditable StatusCreditable means the Rx plan is as good as Medicare Part DNot CreditableCreditableCreditable
Preventive Care (Routine Exams, Colonoscopies, Immunizations, Well Baby Care & Mammograms)Covered at 100%Covered at 100%Covered at 100%Covered at 100%
Emergency Room (Charges outside of the facility could be billed separately)DeductibleDeductible$300 Copay; deductible waived for facility; then 20%$300 Copay; deductible waived for facility; then 20%
Urgent Care (Charges outside of the facility could be billed separately)DeductibleDeductible$30 Copay; deductible waived for facility; then 20%$30 Copay; deductible waived for facility; then 20%
Inpatient HospitalDeductibleDeductibleDeductible; then 20%Deductible; then 20%
Outpatient SurgeryDeductibleDeductibleDeductible; then 20%Deductible; then 20%

Cigna

Out-of-Network Benefits

Plans: (Scroll sideways to see all 4 plans)
Network Benefits 1/1/2022 - 12/31/2022High Deductible Health Plan $5,000 Your ResponsibilityHigh Deductible Health Plan $3,000 Your ResponsibilityCopy Plan $1,500 Your ResponsibilityCopy Plan $500 Your Responsibility
Out-of-Network BenefitsPlan 1
$5,000 HDHP
Plan 2
$3,000 HDHP
Plan 3
$1,500 TCP
Plan 4
$500 TCP
ANNUAL DEDUCTIBLE:
Single
Family


$10,000
$12,000


$6,000
$12,000


$3,000
$6,000


$1,000
$2,000
OUT-OF-POCKET MAX:
Single
Family


$30,000
$60,000


$9,000
$18,000


$10,000
$20,000


$3,000
$6,000
COINSURANCE30%30%50%50%
Network Benefits 1/1/2022 - 12/31/2022High Deductible Health Plan $5,000 Your ResponsibilityHigh Deductible Health Plan $3,000 Your ResponsibilityCopy Plan $1,500 Your ResponsibilityCopy Plan $500 Your Responsibility
Out-of-Network BenefitsHigh Deductible Health Plan $5,000 Your ResponsibilityHigh Deductible Health Plan $3,000 Your ResponsibilityCopay Plan $1,500 Your ResponsibilityCopay Plan $500 Your Responsibility
ANNUAL DEDUCTIBLE$10,000/$12,000$6,000/$12,000$3,000/$6,000$1,000/$2,000
OUT-OF-POCKET MAX$30,000/$60,000$9,000/$18,000$10,000/$20,000$3,000/$6,000
COINSURANCE30%30%50%50%

Employee Payroll Contributions

Price Protection

The Price Protection Program option will be less out of your paycheck.

Wellness Program

If you meet the Wellness Program goals, you will continue with lower payroll contributions, too!

Price Protection

The Price Protection Program option will be less out of your paycheck.

Wellness Program

If you meet the Wellness Program goals, you will continue with lower payroll contributions, too!

PRICE PROTECTION PROGRAM

Employee Bi-Weekly Payroll Contributions

DescriptionHigh Deductible Health Plan $5,000High Deductible Health Plan $3,000Copay Plan $1,500Copay Plan $500
DescriptionHigh Deductible Health Plan $5,000High Deductible Health Plan $3,000Copay Plan $1,500Copay Plan $500
With Wellness CreditNo Wellness CreditWith Wellness CreditNo Wellness CreditWith Wellness CreditNo Wellness CreditWith Wellness CreditNo Wellness Credit
Employee Only$63.65$73.65$82.38$92.38$136.46$146.46$159.16$169.16
Employee + Spouse$226.71$236.71$290.13$300.13$273.18$283.18$391.42$401.42
Employee + Child(ren)$136.95$146.95$153.71$163.71$227.08$237.08$262.73$272.73
Employee + Family$266.39$276.39$288.85$298.85$369.29$379.29$421.73$431.73
Plans: (Scroll sideways to see all 4 plans)
DescriptionHigh Deductible Health Plan $5,000High Deductible Health Plan $3,000Copay Plan $1,500Copay Plan $500
DescriptionEmployee
Only
Employee
+ Spouse
Employee
+ Child(ren)
Employee
+ Family
PLAN 1:
Wellness Credit
No Credit
$5,000 HDHP
$63.65
$73.65
$226.71
$236.71
$136.95
$146.95
$266.39
$276.39
PLAN 2:
Wellness Credit
No Credit
$3,000 HDHP
$82.38
$92.38
$290.13
$300.13
$153.71
$163.71
$288.85
$298.85
PLAN 3:
Wellness Credit
No Credit
$1,500 TCP
$136.46
$146.46
$273.18
$283.18
$227.08
$237.08
$369.29
$379.29
PLAN 4:
Wellness Credit
No Credit
$500 TCP

$159.16
$169.16

$391.42
$401.42

$262.73
$272.73

$421.73
$431.73

Cigna

Employee Bi-Weekly Payroll Contribution

Plans: (Scroll sideways to see all 4 plans)
DescriptionHigh Deductible Health Plan $5,000High Deductible Health Plan $3,000Copay Plan $1,500Copay Plan $500
DescriptionEmployee
Only
Employee
+ Spouse
Employee
+ Child(ren)
Employee
+ Family
PLAN 1:
$5,000 HDHP
Wellness Credit
No Credit
$82.75
$92.75
$294.72
$304.72
$178.04
$188.04
$346.31
$356.31
PLAN 2:
$3,000 HDHP
Wellness Credit
No Credit
$107.09
$117.09
$377.17
$387.19
$199.82
$209.82
$375.50
$385.50
PLAN 3:
$1,500 TCP
Wellness Credit
No Credit
$176.80
$186.80
$355.13
$365.13
$296.17
$306.17
$483.33
$493.33
PLAN 4:
$500 TCP
Wellness Credit
No Credit
$215.74
$225.74
$531.60
$541.60
$354.70
$364.70
$568.503
$578.50
DescriptionHigh Deductible Health Plan $5,000 - With Wellness CreditHigh Deductible Health Plan $5,000 - With NO Wellness CreditHigh Deductible Health Plan $3,000 - With Wellness CreditHigh Deductible Health Plan $3,000 - With NO Wellness CreditCopay Plan $1,500 - With Wellness CreditCopay Plan $1,500 - With NO Wellness CreditCopay Plan $500 - With Wellness CreditCopay Plan $500 - With NO Wellness Credit
Employee Only$82.75$92.75$107.09$117.09$176.80$186.80$215.74$225.74
Employee + Spouse$294.72$304.72$377.17$387.19$355.13$365.13$531.60$541.60
Employee + Child(ren)$178.04$188.04$199.82$209.82$296.17$306.17$354.70$364.70
Employee + Family$346.31$356.31$375.50$385.50$483.33$493.33$568.50$578.50

Medical Resources GPA Support & Mobile App

One Number to Call

1-800-716-2852

Email: myplan@gpatpa.com

You have questions about your benefits

Need help with a claim

Need to find a provider

One Number To Call

Our Member Care Team is ready to assist you no matter what you’re inquiring about: benefits information; assistance finding a doctor; or questions about a claim or bill. Your time is valuable, and we are committed to helping you get the most out of your health plan with just one call.

Complete Healthcare Guidance (Live & Digital Resources)

Get expert support to find the right provider for your needs. Compare providers based on quality metrics, cost and other information so that you can make an informed choice. Finally, no more random Internet searches – get real-time industry-leading data.

Health & Clinical Support

We will take care of your throughout your entire healthcare journey. Our team of experts will answer your questions and provide education regarding your treatment plan, diagnosis care options and medications. We can also assist you with scheduling appointments and obtaining your medical records.

GPATPA.com Website

Go to gpatpa.com and click on “Members” in the upper right hand corner of the homepage. You can then sign in or create an account to access all of your benefit information.

GPA provides an easy-to-navigate online portal and mobile app that gives you access to all of your key benefits information.

  • Review your account summary and plan benefits
  • Check claim status
  • Find and compare providers using metrics like quality and cost
  • View a temporary ID card
  • Ask questions about your plan

GPA Mobile App

Download the GPA Mobile App today through the Google Play Store or the Apple Store. Search for “Group Mobile Pension”, download the app for free, register and set up a user Id and password. It’s that simple!

Find A Cigna Provider

If you are choosing the Cigna Network option, you can find a provider at www.myCigna.com or call 1-800-716-2852 and GPA will help you.

PRICE PROTECTION & BILLING SUPPORT

Your health plan has built-in price protection to make sure you don’t overpay for care. GPA reviews your claims to make sure charges don’t exceed your plan’s allowance limits. If a provider does not accept your plan’s payment, they may send you a bill for the difference. You just need to compare it to your Explanation of Benefits (EOB). GPA will work to get it resolved.

Be sure to notify GPA right away if you have a question about a provider’s bill.

Call the member services, 800-716-2852, anytime you are asked to pay upfront or have questions.

FIND A PROVIDER

What if I need help finding a provider?

Finding the right provider for your needs is so important. GPA is here to help you get the most out of your health plan—just call 1-800-716-2852 for support.

My provider is stating that they don’t recognize my ID card. What do I do?

Explain that you have health benefits and request they call 1-800-716-2852 (the number on your ID card), to verify your eligibility status. You can call GPA at the same number if you have any difficulties.

What if a provider asks me to pay for my procedure upfront?

The only out-of-pocket expense you should pay, at the time of service, is a copay or deductible (if applicable). Please call GPA at 1-800-716-2852 to confirm amounts or if the facility will not perform treatment without additional funds.

Depending on your geographic location, you may have access doctors and hospitals in the Imagine Health and/or MultiPlan network. The above logos will show on your medical identification card if this applies to you. Group Pension Administrators (GPA) is available to assist you if you or your provider have any questions.

Need Assistance? Call 1-800-716-2852

Need Assistance? Call 1-800-716-2852

Why is an Explanation of Benefits (EOB) so important?

When a claim is processed, GPA will issue an Explanation of Benefits or EOB to you and the provider. This EOB explains how your claim was processed. The most important area on the EOB is the Patient Responsibility (see image).

Healthcare providers can have excessive markups, often way beyond what their actual costs are. GPA will perform a detailed audit to review your medical claims for any errors and overcharges to eliminate these excessive mark-ups and ensure you pay only what is allowed within your plan.

This helps save you money.

Once a review of the claim is complete, GPA will send the provider a fair and reasonable payment. Most of the time, providers will accept the payment that is sent to them.

If a provider bills you for more than the amount they are sent, it is called a balance bill. To be clear, the provider is asking you to pay more than what the plan allows. If you receive a balance bill, contact GPA immediately using the phone number on your benefits ID card.

So, how do you know if you’ve been balance billed?

If you receive a bill from a hospital or doctor, the first thing you want to do is locate your Explanation of Benefits. If the amount billed does not match the amount your EOB, says you may owe, you may have a balance bill.

A balance bill is usually the difference between what the provider has billed and the Allowable Claim Limit paid by the Plan. If you think you have a balance bill or are unsure, contact GPA.

So, how do you know if you’ve been balance billed?

If you receive a bill from a hospital or doctor, the first thing you want to do is locate your Explanation of Benefits. If the amount billed does not match the amount your EOB, says you may owe, you may have a balance bill.

Billing Questions and Balance Bill Support

Proactive Guidance & Support

A dedicated member advocate who gives regular updates, answers your questions and oversees the process for you.

Legal Support

Legal representatives who work on your behalf to resolve balance bills.

Provider Support

Contacts providers on your behalf and updates you on the progress of your claim.

Billing Questions and Balance Bill Support

Proactive Guidance & Support

A dedicated member advocate who gives regular updates, answers your questions and oversees the process for you.

Legal Support

Legal representatives who work on your behalf to resolve balance bills.

Provider Support

Contacts providers on your behalf and updates you on the progress of your claim.

Telemedicine

Call 1-888-691-7867 or go to fshealth.com and use the last 4 digits of your SSN to login

  • One click call for treatment or triage—no waiting rooms!
  • Available 24×7 by app, website and phone
  • Your prescription sent to your pharmacy
  • Contact a physician in minutes, with guaranteed consult follow-up
  • Addresses minor issues to serious medical concerns
  • Providers referrals for diagnostic tests

Included with all medical plans

Plan Information

Which plan is right for you?

High Deductible Health PlanTraditional Plan
High Deductible Health PlanTraditional Plan
Lower Payroll DeductionsHigher Payroll Deductions
Deductible Applies FirstCopays 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.

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.

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 FractureControlled bleeding
Deep Knife or Gunshot WoundDiagnostic services (x-ray, lab tests)
Moderate to Severe BurnsEar Infections
Poisoning or suspected poisoningHigh fever or the flu
Seizures or loss of consciousnessMinor broken bones (toes, fingers)
Serious head, neck or back injuriesSevere sore throat or cough
Severe abdominal painSprains or strains
Severe chest pain or difficulty breathing; Signs of heart attack or strokeSkin rashes and infections
Suicidal or homicidal feelingsUrinary tract infections
Uncontrollable bleedingVomiting, 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 or a limited 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.

Regular Purpose Flexible Spending Account
Health PlanTraditional Plan or Waiving Medical
Qualified ExpensesMedical, Dental, Vision and Prescription with a doctor’s prescription
Tax AdvantagePre-tax Contributions and Payments for Qualified Expenses
2022 Contribution Limit$1,000
Dependent Care Spending Account$5,000
  • Pre-tax benefit account used to pay for dependent care services while you are at work
  • Dependent is a child under 13 years of age and adult dependents who can’t take care of themselves
  • Dependents must live with you and be claimed as a dependent on your tax return

BPC Benefits Debit Card

  • Works like a credit card, except it has a stored value instead of a credit limit
  • Stored value is your available balance for HSA or allowed FSA
  • No transaction or PIN numbers
  • Only valid merchant codes are “open” for card use, i.e., pharmacy, doctor’s office. Non-approved merchant codes are declined, i.e, gas station, restaurant
  • Stacked technology allows one single benefit card to be used for the HSA and Limited Purpose FSA or just the FSA (if enrolled in the traditional plan)

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:

  • You are covered by a HSA eligible high deductible health plan (HDHP)
  • You are not covered by your spouse’s health plan that is not a HSA qualified HDHP, FSA or health reimbursement account (HRA)
  • You are not eligible to be claimed as a dependent on someone else’s tax return
  • You are not enrolled in Medicare, Medicaid or TRICARE
  • You have not received Department of Veterans Affairs medical benefits in the past 90 days
2022 HSA Contribution Limits
Single$3,650
Family$3,650
Catch-up (ages 55+)$1,000

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.

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:

  • You are covered by a HSA eligible high deductible health plan (HDHP)
  • You are not covered by your spouse’s health plan that is not a HSA qualified HDHP, FSA or health reimbursement account (HRA)
  • You are not eligible to be claimed as a dependent on someone else’s tax return
  • You are not enrolled in Medicare, Medicaid or TRICARE
  • You have not received Department of Veterans Affairs medical benefits in the past 90 days
2022 HSA Contribution Limits
Single$3,650
Family$3,650
Catch-up (ages 55+)$1,000

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

Included With All Medical Plans

Effective 1/1/2022, our Pharmacy Benefit Manager will be Southern Scripts for all of the medical plans.

Processing Information

Group Number: Reference Member ID Card
Cardholder ID Format: Reference Member ID Card
Bin Number: 015433
PCN: SSN (Southern Scripts Network, Not SSN#)
PBM: Southern Scripts

Hours of Operation

24/7/365 Support Available

Mon-Fri: 6AM-10PM (CST)
Saturday: 8AM-6PM (CST)
Sunday: 8AM-5PM (CST)

Contact Information

Reach Out Anytime

Toll Free: (800) 710-9341
Fax: (318) 214-4190
Website: southernscripts.net

The Southern Scripts app includes all of its core features to seamlessly provide a simple and fast way to track and manager your prescriptions. The app unifies all of your pharmacy information in one convenient place.

The Southern Scripts app includes access to:

  • Member ID
  • Group ID
  • Group Name
  • Utilization Summary
  • Deductible Amount
  • Prescription History
  • Pharmacy Locator
  • Drug Price Check
  • Formulary Search
  • Prior Authorization

Interactive Formulary provides:

  • Tier the medication falls under
  • Whether the medication is specialty or not
  • Clinical edit (coverage) the medication may require

Login to Southern Scripts website:

https://www.southernscripts.net/member-directory.php

Enter your Group Number on your ID card:

(TEST can be used as the Group Number while waiting for your ID card)

Important Things To Know About Your Pharmacy Benefits

Prior AuthorizationGeneric Drugs
Prior AuthorizationSome 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.
Generic DrugsWhen 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.
Generic Drugs
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.
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.

Save Money On Your Prescriptions

  • GoodRx gathers current prices and discounts to help you find the lowest cost pharmacy for your prescriptions.
  • GoodRx is 100% free. No personal information required.
  • Go to www.goodrx.com/how-goodrx-works to learn more.

This is a discount program and does not apply to your deductible or coinsurance.

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 Group 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).

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 partner with you to maximize your personal strengths. Support will be provided to create action steps to support achieving your health goals. Motivation, positivity and wellbeing will be the focus for health improvement and maintenance.

Seminars

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

Several times a year, we will be offering challenges using the MoveSpring app. We will be focused on activity, nutrition, positive support and fun. Best of all, there will be prizes! Your spouse is welcome to join!

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.

Social Media Community

With our closed Facebook group, you will want to stay informed and connected. And, have a safe place to share your successes! The coaches post weekly interesting articles, recipes, and relevant news about your company’s wellness program! Don’t hesitate to share your wellness journey with us!

Wellness Credit will reduce your medical premium payroll deductions*

*1/1/2022 OPEN ENROLLMENT: if you met the 2021 wellness program goals for the wellness credit, your 2022 medical premium payroll deductions will be reduced for all of 2022.

In order to keep your wellness credit in 2023, be sure to complete at least one of the wellness credit action items by the dates shown here.

Need More time?

For those of you who didn’t earn the wellness credit in 2021, XXXX will continue the wellness credits until 6/30/2022. To keep your credit as of July 1, 2022, you must:

  • Go for your physical exam from 1/1/2021—6/30/2022

OR

  • Participate in one wellness activity per month from 1/1/2022—6/30/2022

Earn the 2023 Wellness Credit
Wellness Physical Exam

Visit your physician for a wellness physical exam in 2022 to earn your credit for 2023.

OR

Earn the 2023 Wellness Credit
Monthly Wellness Activities

Participate in one wellness activity every month from 1/1/2022—11/30/2022 to earn your credit for 2023. Deadline: 11/30/2022 Wellness activities include: Seminars, group coaching circles and challenges!


We encourage you to participate in our wellness program, and if you do, your medical premium payroll deductions for 2023 will be reduced if you have met one or both wellness credits during the 2022 plan year.

NEW HIRES: You will have 6 months following your medical insurance effective date to obtain your annual wellness exam and submit the results form for your health coach or to participate in one wellness activity per month.

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 SummaryIn-Network High PlanIn-Network Low Plan
Benefit SummaryIn-Network High PlanIn-Network Low Plan
Preventive Expenses> Exams and cleanings (once/6 months)
> X-rays (full mouth once/60 months)
> Fluoride treatment (once/6 months)
> Sealants to age 16 (once/36 months)
> Space maintainers to age 16
Covered at 100%Covered at 100%
Basic Expenses> Fillings
> Periodontal maintenance
> Repair/maintenance of crowns
> Denture repairs
> Anesthesia
> Simple and Surgical Extractions
Covered at 80%Covered at 50%
Major Expenses> Bridges & dentures
> Single crowns
> Complex extractions
> Periodontal surgery
> Inlays, onlays & veneers
> Endodontics (root canal)
> Scaling & Root Planing (per quadrant)
Covered at 50%Not Covered
Deductible:
Single
Family
-------------------------------->
$50
$150

$50
$150
Calendar Year Maximum-------------------------------->$1,000
(Includes Max Rollover)
$750
(Rollover Not Included)
Out-Of-NetworkEmployees 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 SummaryHigh Deductible Health Plan $3,000Copay Plan $500
Benefit SummaryIn-Network High PlanIn-Network Low Plan
Preventive ExpensesExams and cleanings (once/6 months), X-rays (full mouth once/60 months), Fluoride treatment (once/6 months), Sealants to age 16 (once/36 months) & Space maintainers to age 16Covered at 100%Covered at 100%
Basic ExpensesFillings, Periodontal maintenance, Repair/maintenance of crowns, Denture repairs, Anesthesia & Simple and Surgical ExtractionsCovered at 80%Covered at 50%
Major ExpensesBridges & dentures, Single crowns, Complex extractions, Periodontal surgery, Inlays, onlays & veneers, Endodontics (root canal) & Scaling & Root Planing (per quadrant)Covered at 50%Not Covered
Deductible:
Single
Family
----------------->
$50
$150

$50
$150
Calendar Year Maximum----------------->$1,000
(Includes Max Rollover)
$750
(Rollover Not Included)
Out-Of-NetworkEmployees 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 MaximumThresholdMaximum Rollover AmountIn-Network Only Rollover AmountMaximum Rollover Account Limit
Plan Annual MaximumThresholdMaximum Rollover AmountIn-Network Only Rollover AmountMaximum Rollover Account Limit
$1,000
Maximum claims reimbursement


$500
Claims amount that determines rollover eligibility

$250
Additional dollars added to a plan's annual maximum for future years
$350
Additional dollars added if only in-network providers were used during the benefit year
$1,000
The limit that cannot be exceeded within the maximum rollover account
Plan Annual MaximumThreshold
Plan Annual Maximum$1,000
Maximum claims reimbursement
Threshold$500
Claims amount that determines rollover eligibility
Maximum Rollover Amount$250
Additional dollars added to a plan's annual maximum for future years
In-Network Only Rollover Amount$350
Additional dollars added if only in-network providers were used during the benefit year
Maximum Rollover Account Limit$1,000
The limit that cannot be exceeded within the maximum rollover account

FIND A DENTIST

www.GuardianAnytime.com


Network DentalGuard Preferred
1-800-600-1600

Dental Employee Bi-Weekly Contribution

 Dental Buy-UpDental Care
Dental Buy-UpDental Care
Employee Only$11.74$4.23
Employee + Spouse$30.52$14.79
Employee + Child(ren)$37.56$18.78
Employee + Family$56.10$29.35
 Dental Buy-UpDental Care
Dental Buy-UpDental Care
Employee Only$11.74$4.23
Employee + Spouse$30.52$14.79
Employee + Child(ren)$37.56$18.78
Employee + Family$56.10$29.35

VISION BENEFIT SUMMARY IN-NETWORK

(Scroll sideways to see all options)

 High PlanLow Plan
High PlanLow Plan
AllowancesBenefit FrequencyDiscountsBenefit Frequency
Eye Exam$0 copayEvery 12 months$0 copayEvery 12 months
Lenses: Single Vision, Lined Bifocal, Lined Trifocal & Lenticular$0 copayEvery 24 months20% off retail priceNot Applicable
Contact Lenses
Elective
Medically Necessary
Evaluation & Fitting
(in lieu of eyeglass lenses and/or frames)

$0 copay
$120 maximum
15% discount off usual & customary fee
Every 24th months
No discounts
No discounts
15% discount off usual & customary fee
Not Applicable
Frames$120 retail maximum plusEvery 24 months20% off retail priceNo limit if within 12 months of eye exam
NetworkVSPFind A Provider
www.GuardianAnyTime.com
Out-of-Network BenefitsOut-of-network benefits are allowed, however, copays and maximums are less. Employees using out-of-network providers may be responsible for additional fees.
 High PlanLow Plan
High PlanLow Plan
AllowancesBenefit FrequencyDiscountsBenefit Frequency
Eye Exam$0 copayEvery 12 months$0 copayEvery 12 months
Lenses:
Single Vision
Lined Bifocal
Lined Trifocal
Lenticular
$0 copayEvery 24 months20% off retail priceNot Applicable
Contact Lenses
Elective
Medically Necessary
Evaluation & Fitting
(in lieu of eyeglass
lenses and/or frames)

$0 copay
$120 maximum
15% discount off
usual & customary fee
Every 24th months
No discounts
No discounts
15% discount off
usual & customary fee
Not Applicable
Frames$120 retail maximum plusEvery 24 months20% off retail priceNo limit if within
12 months of eye exam
NetworkVSPFind A Provider
www.GuardianAnyTime.com
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 PlanVision Low Plan
Vision High PlanVision Low Plan
Employee Only$4.35$0.42
Employee + Spouse$7.23$0.95
Employee + Child(ren)$7.50$0.95
Employee + Family$11.95$1.73
 Dental Buy-UpDental CareVision High PlanVision Low Plan
Dental Buy-UpDental CareVision High PlanVision Low Plan
Employee Only$11.74$4.23$4.35$0.42
Employee + Spouse$30.52$14.79$7.23$0.95
Employee + Child(ren)$37.56$18.78$7.50$0.95
Employee + Family$56.10$29.35$11.95$1.73

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.

BenefitsDetails
BenefitsDetails
Coverage Amount$100,000
Insurance CarrierGuardian
Age Reduction RuleBenefit reduces by 35% at age 65, 60% at age 70, 75% at age 75 and 85% at age 80
PortabilityAllows you to take coverage with you if you terminate employment. Age and timeline restrictions apply, see Human Resources for information.

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.

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.

BenefitsDetails
BenefitsDetails
Guaranteed Coverage Amount and Benefit MaximumsEmployee:
$200,000, less than 65 years old; $50,000, 65-69; $10,000, 70+
$10,000 minimum to $500,000 maximum ($10,000 increments)

Spouse:
$30,000, less than 65 years old; $10,000, 65-69; $0, 70+
$5,000 minimum to $250,000 maximum or up to 100% of employee coverage ($5,000 increments)
Spouse cost based on employee’s age band; Spouse coverage ends at age 70 $10,000

Child:
$1,000 to $10,000 in $1,000 increments, not to exceed 100% of employee coverage (14 days to 26 years). Same rate and coverage for all children.
Insurance CarrierGuardian
Age Reduction RuleBenefit reduces by 35% at age 65, 60% at age 70, 75% at age 75 and 85% at age 80
PortabilityAllows you to take coverage with you if you terminate employment. Age and timeline restrictions apply, see Human Resources for information.
Evidence of InsurabilityEvidence of Insurability is required for employees that do not elect the benefit when initially eligible or for coverage amounts over the Guaranteed Issue amount.
Details
Details
GUARANTEED COVERAGE AMOUNT & BENEFIT MAXIMUMUS:

Employee:
$200,000, less than 65 years old; $50,000, 65-69; $10,000, 70+
$10,000 minimum to $500,000 maximum ($10,000 increments)

Spouse:
$30,000, less than 65 years old; $10,000, 65-69; $0, 70+
$5,000 minimum to $250,000 maximum or up to 100% of employee coverage ($5,000 increments)
Spouse cost based on employee’s age band; Spouse coverage ends at age 70 $10,000

Child:
$1,000 to $10,000 in $1,000 increments, not to exceed 100% of employee coverage (14 days to 26 years). Same rate and coverage for all children.
INSURANCE CARRIER:
Guardian
AGE REDUCTION RULE:

Benefit reduces by 35% at age 65, 60% at age 70, 75% at age 75 and 85% at age 80
PORTABILITY:

Allows you to take coverage with you if you terminate employment. Age and timeline restrictions apply, see Human Resources for information.
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. Evidence of Insurability is required for employees that do not elect the disability benefits when initially eligible for coverage.

DetailsShort Term DisabilityLong Term Disability
DetailsShort Term DisabilityLong Term Disability
Benefit60% of your pre-disability base salary to a maximum weekly benefit of $1,00060% of your pre-disability base salary to a maximum monthly benefit of $5,000
Waiting (Elimination) PeriodBenefits begin on the 1st day for accident, 8th day for illnessBenefits begin after 90 days
Benefit Duration13 weeks after elimination periodNormal Social Security Retirement Age
Benefits Based OnNot ApplicableYour own occupation for the first 24 months; any occupation thereafter
Pre-existing Conditions LimitationNot ApplicableAny 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.
ContributionXXXX contributes 50% of the cost for this coverage100% Employee Paid
Insurance CarrierGuardianGuardian

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.

BenefitsDetails
BenefitsDetails
Guaranteed Coverage and Benefit MaximumsEmployee:
$20,000 (choose lump sum benefit of $5,000, $10,000, $15,000 or $20,000)

Spouse:
$10,000 (limit to 50% of employee benefit)

Child:
25% of employee benefit
Covered ConditionsCancer (invasive, carcinoma, skin), Vascular (heart attack, stroke), Kidney and other organ failure, ALC, Coma, Parkinson's Disease, Burns, Alzheimer's Disease, Multiple Sclerosis, Childhood Conditions (see plan highlights on Employee Navigator for a complete list and benefits)
Wellness BenefitProvides a per year benefit for completing certain routine wellness screenings such as mammography, colonoscopy, pap smear, PSA. Benefits paid even if medical insurance is paying 100% of the cost:

Employee:$50
Spouse:$50
Child:$50
Insurance CarrierPrincipal
Pre-existing Condition Limitation3 month look back period, 12 month exclusion period
PortabilityAllows the employee to take the coverage with them if employment has ended (application timeline applies, see Human Resources)
Evidence of InsurabilityEvidence 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.

  • Premiums will be calculated by age with benefit options in Employee Navigator
  • Premiums are for Issue Age meaning the premium will not increase due to an insured aging
  • Spouse premium based on employee age
  • Child cost is included in the employee election

Accident Insurance

Accident Insurance is available to our employees and eligible dependents. The coverage is for off the job accidents. Benefits are paid directly to the insured and can be used under their discretion for medical or household expenses. Benefits are paid on a schedule basis for most accidents.

BenefitsDetails
BenefitsDetails
Accidental DealthEmployee: $50,000
Spouse: $25,000
Child: $10,000
Covered Accidents/ExpensesAccidental Dismemberment, Air Ambulance expense, Ambulance expenses, Blood, Accidental Burns, Child Organized Sports, Concussions, Dislocations, Fractures, Hospitcal ICU Admission, Lacerations (see plan highlights on Employee Navigator for a complete list of benefits)
Scheduled Payment ExamplesAmbulance: $200
Concussion: $200
Dislocations: Schedule up to $5,000
Fractures: Schedule up to $6,000
Hospital Admission: $1,000
Insurance CarrierGuardian
PortabilityAllows 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$5.61
Employee + Spouse$9.12
Employee + Child(ren)$9.29
Employee + Family$12.79

Hospital Indemnity

Hospital Indemnity insurance can help pay for non-medical expenses such as transportation to treatment facilities and everyday expenses like groceries, rent or mortgage payments. The benefit can also pay for medical plan deductibles, co-pays and other out-of-pocket medical expenses. This insurance is compatible with a Health Savings Account medical plan. Benefits are paid directly to the insured.

BenefitsDetails
BenefitsDetails
Hospital/ICU Admission$1,000 per admission to a maximum of one admission per year, per insured. Family maximum: 3 admissions per year, per covered family
Hospital/ICU Confinement$100 per day to a maximum of 15 days per year, per insured
Treatments CoveredHospital Admission benefits are not payable for birth within the first nine months of obtaining this coverage
Treatment of Normal PregnancyHospital Admission benefits are not payable for birth within the first nine months of obtaining this coverage
Insurance CarrierGuardian
Pre-existing Condition Limitation3 month look back period, 12 month exclusion period
PortabilityAllows the employee to take the coverage with them even if employment has ended (application timeline and age limitations apply, see Human Resources)
Evidence of InsurabilityEvidence of Insurability is required for employees that do not elect the benefit when initially eligible.

Hospital Indemnity plans have exclusions and limitations that may impact the eligibility for or entitlement to benefits. The certificate of coverage provides full details.

Payroll Contributions

  • Premiums will be calculated in Employee Navigator by age and whether family members are covered
  • Premiums are for Attained Age meaning the premium will increase as an insured ages

Pet Insurance

XXXXX offers Pet Insurance through Nationwide. Nationwide offers plans that would cover your furry friend at different levels of protection. Pricing of the pet insurance plan is based on which plan option you select, the state you live in, and the type of pet being covered. Nationwide does not base rates off of the breed or age of your dog, which is a huge benefit to you! If you are interested in electing coverage for your pet.

Answer question about pet species and zip code. Choose product and enter payment and once sign up, send confirmation to Human Resources for payroll deductions to take place.

My Pet Protection plan highlights for dogs and cats

  • Cash back on eligible vet bills after $250 annual deductible is met
  • Choice of reimbursement – 50%, 70% and 90% options
  • $7,500 benefit to use that renews each year in full
  • Just two questions to determine cost: state and species
  • Preferred pricing does not increase due to get age or breed
  • Exclusive plans not available to the general market

My Pet Protection covers so much, it’s easier to say “what’s not covered?

  • Pre-existing
  • Boarding
  • Breeding
  • Waste disposal
  • Grooming and nail trim
  • Wellness, routine and preventive care

Some policy exclusions may apply. Wellness, routine and preventive care covered with My Pet Protection with Wellness policy.

  • Pre-existing
  • Boarding
  • Breeding
  • Waste disposal
  • Grooming and nail trim
  • Wellness, routine and preventive care

Some policy exclusions may apply. Wellness, routine and preventive care covered with My Pet Protection with Wellness policy.

MetLife Auto & Home

Just like medical, premiums and out-oof-pocket expenses for auto and home insurance are going up. From auto accidents to natural disasters, there has been an increase in the severity and frequency of incidents. And without the right coverage, an accident or storm can be devastating to your employees’ financial wellbeing. With MetLife Auto & Home®, you can give your employees access to the protection they need to stay prepared for the unexpected. And the support they need to get back on track.

After medical, auto and home insurances rank among the top 5 must-have benefits for employees.

Employees saved an average of $562 on auto insurance when they switched to MetLife Auto & Home.

Personalized protection for the right fit

Everyone has different needs at different stages of life. That’s why we offer a wide range of products and services – providing the flexibility for your employees to choose what’s right for them.

  • Auto
  • Home
  • RV
  • Renters
  • Flood
  • Condo
  • Boats
  • Landlord’s rental dwelling
  • Personal excess liability protection

Valuable savings on coverages employees need

Finding more money within a monthly budget to get the right benefits can be challenging for most employees. By offering auto and home through your group benefits program, you can give them access to valuable group discounts. And when employees save on coverage they already have, it gives them more options to get the right protection. Best of all, our simple, convenient solutions like payroll deduction help them balance their monthly budget.

Retirewise

Education is your greatest tool! The workshops are delivered by experienced, licensed third party financial professionals who meet stringent credentials requirements. Visit: MetLife.com/plansmartsolutions.com

As a foundation to MetLife’s PlanSmart® workshop series, Retirewise®, an award-winning program, can play an important and fundamental role in your employees’ financial and retirement planning. The program delivers objective information that covers a broad spectrum of financial and related topics from basic investing concepts to the importance of having a will.

The program is divided into four parts:

1. Building the Foundation
2. Creating and Managing Wealth
3. Establishing Your Retirement Income Stream
$. Making the Most of What You Have

MetLife has an arrangement with third party financial professionals to deliver the program. These specially trained local financial professionals deliver each session and are available for an optional one-on-one educational consultation. No matter what age, background or stage of planning your employees are in – there is something for everyone to learn.

Employee Assistance Program (EAP)

This is provided to you at NO COST and is confidential. You are allowed up to three face-to-face visits per family member, per year, with a doctoral psychologist or other behavioral health professional. 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.

WorkLifeMatters can offer help with:

Dependent Care & Care Giving

  • Adoption assistance
  • Before / after school programs
  • Day Care
  • Elder Care
  • In-home services

Lifestyle & Fitness Management

  • Anxiety & depression
  • Divorce & separation
  • Drugs & alcohol

Education

  • Admissions testing & procedures
  • Adult re-entry programs
  • College Planning
  • Financial aid resources
  • Finding a pre-school

Working Smarter

  • Career development
  • Effective managing
  • Relocation

Legal & Financial

  • Basic tax planning
  • Credit & collections
  • Debt counseling
  • Home buying
  • Immigration

EAP Provider Information

www.ibhworklife.com
Username: Matters
Password: wlm70101
Call: 1-800-386-7055


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.