Welcome, Dauby, O’Connor & Zaleski Employees
Welcome, Dauby, O’Connor & Zaleski 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 AND NEW HIRE 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 1,560 hours per year
Dependent:
New Employees
As a new, full-time employee (working a minimum of 1,560 hours per year), your benefits will become effective: first of the month, after 30 days, following the date you start working.
Dependents are eligible to stay on a parent’s medical plan up to the 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 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 not 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.
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:
Use your computer, smart phone or device to enroll using this company identifier:
DOZ
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
Our medical plan administrator is Imagine360. Imagine360 will be administering our built-in Price Protection Program which gives you the choice to utilize any doctor or hospital with no network penalties. The Price Protection Program will provide additional resources, such as:
- Care Navigation Services to help you find local doctors, hospitals and clinics
- Benefit Information and support with chronic diseases
- Savings for you and your family with Price Protection and billing support
- Online and mobile app resources to check claims, find a provider, access your ID card and more
- Telemedicine for unlimited, virtual emergency medical doctors.
Also, you will have a traditional provider network option available with Imagine360 and the Cigna Network.
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. 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. 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
Our plan anniversary is July—June, however, the deductible and out-of-pocket maximum accumulates January-December. If you change plans effective 7/1/2022, please know that you may be required to fulfill additional deductible and/or out-of-pocket expenses to meet your responsibility for the calendar year.
Your employer offers 4 medical options:
Plans: (Scroll sideways to see all 4 plans)
| Effective 7/1/2022 - 6/30/2023 | Plan 1 | Plan 2 | Plan 3 | Plan 4 |
|---|---|---|---|---|
| Effective 7/1/2022 - 6/30/2023 | Plan 4 $5,000 HDHP | Plan 2 $3,000 HDHP | Plan 3 $2,000 Traditional | Plan 1 $500 Traditional |
| ANNUAL DEDUCTIBLE (Embedded for All Plans): Single Family | $5,000 $10,000 | $3,000 $6,000 | $3,000 $6,000 | $500 $1,500 |
| OUT-OF-POCKET MAX (including deductible, copays & coinsurance): Single Family | $6,000 $12,000 | $4,000 $8,000 | $4,000 $8,000 | $2,500 $5,000 |
| COINSURANCE - In Network | 0% | 0% | 20% | 20% |
| OFFICE VISIT COPAYS: Primary (PCP) Specialist | Deductible; then 0% Deductible; then 0% | Deductible; then 0% Deductible; then 0% | $20 $40 | $20 $40 |
| PRESCRIPTIONS Retail 30 Day Supply: Generic Brand Formulary | Deductible All Tiers, then Copays: $10 $30 $60 | Deductible All Tiers, then Copays: $10 $30 $60 | Copays: $10 $25 $40 | Copays: $10 $25 $40 |
| PRESCRIPTIONS Mail Order 90 Day Supply: Generic Brand Formulary Specialty: Call SmithRx 844-454-5201 | Deductible All Tiers; $10 $75 $180 25% to $200 | Copays; $10 $75 $180 25% to $200 | Deductible All Tiers; $10 $65 $120 25% to $150 | Deductible All Tiers; $10 $65 $120 25% to $150 |
| MEDICARE PART D STATUS Creditable means the Rx plan is as good as or better than Medicare Part D | Not Creditable | Not Creditable | Creditable | Creditable |
| PREVENTIVE CARE Routine Exams, Screening Colonoscopies, Immunizations, Well Baby Care & Mammograms | 100% Covered | 100% Covered | 100% Covered | 100% Covered |
| EMERGENCY ROOM | Deductible, then 0% | Deductible, then 0% | $250 Copay | $250 Copay |
| URGENT CARE | Deductible, then 0% | Deductible, then 0% | $75 Copay | $75 Copay |
| INPATIENT HOSPITAL | Deductible; then 0% | Deductible; then 0% | Deductible; then 20% | Deductible; then 20% |
| OUTPATIENT SURGERY | Deductible; then 0% | Deductible; then 0% | Deductible; then 20% | Deductible; then 20% |
| Effective 7/1/2022 - 6/30/2023 | Plan 1 | Plan 2 | Plan 3 | Plan 4 |
|---|---|---|---|---|
| Effective 7/1/2022 - 6/30/2023 | Plan 4 $5,000 HDHP | Plan 2 $3,000 HDHP | Plan 3 $2,000 Traditional | Plan 1 $500 Traditional |
| ANNUAL DEDUCTIBLE (Embedded for All Plans): Single Family | $5,000 $10,000 | $3,000 $6,000 | $3,000 $6,000 | $500 $1,500 |
| OUT-OF-POCKET MAX (including deductible, copays & coinsurance): Single Family | $6,000 $12,000 | $4,000 $8,000 | $4,000 $8,000 | $2,500 $5,000 |
| COINSURANCE - In Network | 0% | 0% | 20% | 20% |
| OFFICE VISIT COPAYS: Primary (PCP) Specialist | Deductible; then 0% Deductible; then 0% | Deductible; then 0% Deductible; then 0% | $20 $40 | $20 $40 |
| PRESCRIPTIONS Retail 30 Day Supply: Generic Brand Formulary | Deductible All Tiers, then Copays: $10 $30 $60 | Deductible All Tiers, then Copays: $10 $30 $60 | Copays: $10 $25 $40 | Copays: $10 $25 $40 |
| PRESCRIPTIONS Mail Order 90 Day Supply: Generic Brand Formulary Specialty: Call SmithRx 844-454-5201 | Deductible All Tiers; $10 $75 $180 25% to $200 | Copays; $10 $75 $180 25% to $200 | Deductible All Tiers; $10 $65 $120 25% to $150 | Deductible All Tiers; $10 $65 $120 25% to $150 |
| MEDICARE PART D STATUS Creditable means the Rx plan is as good as or better than Medicare Part D | Not Creditable | Not Creditable | Creditable | Creditable |
| PREVENTIVE CARE Routine Exams, Screening Colonoscopies, Immunizations, Well Baby Care & Mammograms | 100% Covered | 100% Covered | 100% Covered | 100% Covered |
| EMERGENCY ROOM | Deductible, then 0% | Deductible, then 0% | $250 Copay | $250 Copay |
| URGENT CARE | Deductible, then 0% | Deductible, then 0% | $75 Copay | $75 Copay |
| INPATIENT HOSPITAL | Deductible; then 0% | Deductible; then 0% | Deductible; then 20% | Deductible; then 20% |
| OUTPATIENT SURGERY | Deductible; then 0% | Deductible; then 0% | Deductible; then 20% | Deductible; then 20% |
Cigna
Out-of-Network Benefits
Plans: (Scroll sideways to see all 4 plans)
| Network Benefits 1/1/2022 - 12/31/2022 | High Deductible Health Plan $5,000 Your Responsibility | High Deductible Health Plan $3,000 Your Responsibility | Copy Plan $1,500 Your Responsibility | Copy Plan $500 Your Responsibility |
|---|---|---|---|---|
| Out-of-Network Benefits | Plan 1 $5,000 HDHP | Plan 2 $3,000 HDHP | Plan 3 $2,000 Traditional | Plan 4 $500 Traditional |
| ANNUAL DEDUCTIBLE: Single Family | $10,000 $12,000 | $6,000 $12,000 | $4,000 $8,000 | $1,000 $3,000 |
| OUT-OF-POCKET MAX: Single Family | $12,000 $24,000 | $10,000 $20,000 | $8,000 $16,000 | $5,000 $10,000 |
| COINSURANCE | 30% | 30% | 40% | 40% |
| Network Benefits 1/1/2022 - 12/31/2022 | High Deductible Health Plan $5,000 Your Responsibility | High Deductible Health Plan $3,000 Your Responsibility | Copy Plan $1,500 Your Responsibility | Copy Plan $500 Your Responsibility |
|---|---|---|---|---|
| Out-of-Network Benefits | Plan 1 $5,000 HDHP | Plan 2 $3,000 HDHP | Plan 3 $2,000 Traditional | Plan 4 $500 Traditional |
| ANNUAL DEDUCTIBLE: Single Family | $10,000 $12,000 | $6,000 $12,000 | $4,000 $8,000 | $1,000 $3,000 |
| OUT-OF-POCKET MAX: Single Family | $12,000 $24,000 | $10,000 $20,000 | $8,000 $16,000 | $5,000 $10,000 |
| COINSURANCE | 30% | 30% | 40% | 40% |
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
| Description | High Deductible Health Plan $5,000 | High Deductible Health Plan $3,000 | Copay Plan $2,000 | Copay Plan $500 | ||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Description | Plan 4 High Deductible $5,000 | Plan 2 High Deductible $3,000 | Plan 3 Traditional Plan $2,000 | Plan 1 Traditional Plan $500 | ||||||||||||||||
| With 2 Wellness Credits | With 1 Wellness Credit | No Wellness Credit | With 2 Wellness Credits | With 1 Wellness Credit | No Wellness Credit | With 2 Wellness Credits | With 1 Wellness Credit | No Wellness Credit | With 2 Wellness Credits | With 1 Wellness Credit | No Wellness Credit | |||||||||
| Employee Only | $19.79 | $29.79 | $39.79 | $38.69 | $48.69 | $58.69 | $69.80 | $79.80 | $89.80 | $91.91 | $101.91 | $111.91 | ||||||||
| Employee + Spouse | $179.16 | $189.16 | $199.16 | $216.95 | $226.95 | $236.95 | $269.44 | $279.44 | $289.44 | $313.67 | $323.67 | $333.67 | ||||||||
| Employee + Child(ren) | $128.78 | $138.78 | $148.78 | $159.96 | $169.96 | $179.96 | $211.44 | $221.44 | $231.44 | $247.93 | $257.93 | $267.93 | ||||||||
| Employee + Family | $297.57 | $307.57 | $317.57 | $352.37 | $362.37 | $372.37 | $425.78 | $435.78 | $445.78 | $489.91 | $499.91 | $509.91 | ||||||||
Plans: (Scroll sideways to see all 4 plans)
| Description | High Deductible Health Plan $5,000 | High Deductible Health Plan $3,000 | Copay Plan $2,000 | Copay Plan $500 | ||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Description | Plan 4 High Deductible $5,000 | Plan 2 High Deductible $3,000 | Plan 3 Traditional Plan $2,000 | Plan 1 Traditional Plan $500 | ||||||||||||||||
| With 2 Wellness Credits | With 1 Wellness Credit | No Wellness Credit | With 2 Wellness Credits | With 1 Wellness Credit | No Wellness Credit | With 2 Wellness Credits | With 1 Wellness Credit | No Wellness Credit | With 2 Wellness Credits | With 1 Wellness Credit | No Wellness Credit | |||||||||
| Employee Only | $19.79 | $29.79 | $39.79 | $38.69 | $48.69 | $58.69 | $69.80 | $79.80 | $89.80 | $91.91 | $101.91 | $111.91 | ||||||||
| Employee + Spouse | $179.16 | $189.16 | $199.16 | $216.95 | $226.95 | $236.95 | $269.44 | $279.44 | $289.44 | $313.67 | $323.67 | $333.67 | ||||||||
| Employee + Child(ren) | $128.78 | $138.78 | $148.78 | $159.96 | $169.96 | $179.96 | $211.44 | $221.44 | $231.44 | $247.93 | $257.93 | $267.93 | ||||||||
| Employee + Family | $297.57 | $307.57 | $317.57 | $352.37 | $362.37 | $372.37 | $425.78 | $435.78 | $445.78 | $489.91 | $499.91 | $509.91 | ||||||||
Cigna
Employee Bi-Weekly Payroll Contribution
Plans: (Scroll sideways to see all 4 plans)
| Description | High Deductible Health Plan $5,000 | High Deductible Health Plan $3,000 | Copay Plan $2,000 | Copay Plan $500 | ||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Description | Plan 4 High Deductible $5,000 | Plan 2 High Deductible $3,000 | Plan 3 Traditional Plan $2,000 | Plan 1 Traditional Plan $500 | ||||||||||||||||
| With 2 Wellness Credits | With 1 Wellness Credit | No Wellness Credit | With 2 Wellness Credits | With 1 Wellness Credit | No Wellness Credit | With 2 Wellness Credits | With 1 Wellness Credit | No Wellness Credit | With 2 Wellness Credits | With 1 Wellness Credit | No Wellness Credit | |||||||||
| Employee Only | $29.55 | $39.55 | $49.55 | $54.34 | $64.34 | $74.34 | $91.17 | $101.17 | $111.17 | $120.11 | $130.11 | $140.11 | ||||||||
| Employee + Spouse | $220.31 | $230.31 | $240.31 | $265.65 | $275.65 | $285.65 | $333.27 | $343.27 | $353.27 | $388.59 | $398.59 | $408.59 | ||||||||
| Employee + Child(ren) | $159.59 | $169.59 | $179.59 | $199.24 | $209.24 | $219.24 | $259.38 | $269.38 | $279.38 | $303.10 | $313.10 | $323.10 | ||||||||
| Employee + Family | $366.20 | $376.20 | $386.20 | $437.72 | $447.72 | $457.72 | $519.70 | $529.70 | $539.70 | $604.42 | $614.42 | $624.42 | ||||||||
| Description | High Deductible Health Plan $5,000 | High Deductible Health Plan $3,000 | Copay Plan $2,000 | Copay Plan $500 | ||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Description | Plan 4 High Deductible $5,000 | Plan 2 High Deductible $3,000 | Plan 3 Traditional Plan $2,000 | Plan 1 Traditional Plan $500 | ||||||||||||||||
| With 2 Wellness Credits | With 1 Wellness Credit | No Wellness Credit | With 2 Wellness Credits | With 1 Wellness Credit | No Wellness Credit | With 2 Wellness Credits | With 1 Wellness Credit | No Wellness Credit | With 2 Wellness Credits | With 1 Wellness Credit | No Wellness Credit | |||||||||
| Employee Only | $29.55 | $39.55 | $49.55 | $54.34 | $64.34 | $74.34 | $91.17 | $101.17 | $111.17 | $120.11 | $130.11 | $140.11 | ||||||||
| Employee + Spouse | $220.31 | $230.31 | $240.31 | $265.65 | $275.65 | $285.65 | $333.27 | $343.27 | $353.27 | $388.59 | $398.59 | $408.59 | ||||||||
| Employee + Child(ren) | $159.59 | $169.59 | $179.59 | $199.24 | $209.24 | $219.24 | $259.38 | $269.38 | $279.38 | $303.10 | $313.10 | $323.10 | ||||||||
| Employee + Family | $366.20 | $376.20 | $386.20 | $437.72 | $447.72 | $457.72 | $519.70 | $529.70 | $539.70 | $604.42 | $614.42 | $624.42 | ||||||||
Medical Resources Imagine360 Support & Mobile App
One Number to Call
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.
Imagine360.com Website
Go to imagine360.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.
Imagine360 provides an easy-to-navigate online portal and mobile app that gives you access to all of your key benefits information.
mibenefits.imagine360.com
Download the Imagine360 Mobile App today through the Google Play Store or the Apple Store. Search for “mibenefits.imagine360.com”, 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 Imagine360 will help you.
PRICE PROTECTION & BILLING SUPPORT
Your health plan has built-in price protection to make sure you don’t overpay for care. Imagine360 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). Imagine360 will work to get it resolved.
Be sure to notify Imagine360 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. Imagine360 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 Imagine360 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 Imagine360 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. Imagine360 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, Imagine360 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. Imagine360 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, Imagine360 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 Imagine360 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 Imagine360.
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 United Concierge Medicine (UCM) at 1-844-484-7362, use the mobile app “SAM BY UCM” or go to goseesam.com.
Included with all medical plans
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.
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 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 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.
GRACE PERIOD
Our Flexible Spending Account includes a grace period from 1/1/2023—3/31/2023 to submit any qualified 2022 expenses for claims processing.
| Description | Regular Purpose Flexible Spending Account | Limited Purpose Spending Account |
|---|---|---|
| Description | Regular Purpose Flexible Spending Account | Limited Purpose Spending Account |
| Health Plan | Traditional Plan or Waiving Medical | High Deductible Health Plan |
| Qualified Expenses | Medical, Dental, Vision and Prescription with a doctor’s prescription | Dental and Vision |
| Tax Advantage | Pre-tax Contributions and Payments for Qualified Expenses | Pre-tax Contributions and Payments for Qualified Expenses; enrollment in a Health Savings Account (HSA) also accrues savings that are tax-deferred. |
| 2023 Contribution Limit | $2,850 | $2,850 |
| Dependent Care Spending Account | $5,000 | $5,000 |
Spending Account Debit Card
Visit www.SpendingAccounts.com for additional information
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 | $3,650 / $3,850 | |
| Family | $7,300 / $7,750 | |
| 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:
Set Up Your Account:
Contact Rebecca Kavanaugh, Director of Human Resources
rkavanaugh@dozllc.com
(317) 819-6108
| 2023 HSA Contribution Limits | ||
|---|---|---|
| Single | $3,650 / $3,850 | |
| Family | $7,300 / $7,750 | |
| 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
Our Pharmacy Benefit Manger (PBM) is SmithRx.
SmithRx has over 75,000 in-network retail pharmacies. For specific in-network pharmacy questions or to check whether your local pharmacy is in-network, please contact SmithRx’s dedicated Member Support team. SmithRx’s online Member Portal give you access to forms, pharmacy transactions and member support. When you register for an account, have your Imagine360 ID card handy.
Who is my mail-order service provider?
Contact Serve You DirectRx to set up your account.
· E-prescribe or Fax: Have your doctor electronically prescribe or fax your prescription to 1-866-494-0364. Faxed prescriptions may only be sent by a doctor’s office and must include patient information and diagnosis for timely processing.
· Phone: Your doctor can call in the prescription to 1-800-759-3203 with an IVR (interactive voice recognition) option.
· Prompt Delivery: Call Serve You DirectRx at 1-800-759-3203
· Call SmithRx Member Support if you need assistance.
Contact Information
Reach Out Anytime
Toll Free: (844) 454-5201
Website: www.mysmithrx.com/login and click “Create an Account”
Email: connect@smithrx.com
Where do I get my specialty medications?
Prescribed specialty medications covered by your plan benefits can be secured through SmithRx preferred specialty pharmacies.
To utilize the specialty pharmacy, simply call SmithRx Member Support to check coverage and start any necessary authorization processes.
Important Things To Know About Your Pharmacy Benefits
| Prior Authorization | 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. |
| 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. |
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).
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. Support will be provided to create action steps to help you achieve 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
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 Credits will reduce your Medical Premium Payroll Deductions
We are excited about our wellness program! By engaging now, we will provide you with a wellness premium credit to reduce your medical premium payroll contribution. You can continue to keep the credit when you participate in our wellness program and complete the criteria shown below. Best of health and wellness to you!
Save Up To $520
Wellness Credit #1
$10 per pay
Wellness Physical Exam
Visit your physician for a wellness physical exam AND submit the results form to your health coach by 5/31/2023 to keep your credit for the 2023-2024 plan year.
Wellness Credit #2
$10 per pay
Monthly Wellness Activities
Participate in four wellness activities from 7/1/2022—5/31/2023 to earn your credit for the 2023-2024 plan year.
Wellness activities include:
Seminars, Group Coaching Circles and Challenges
Special Offer 7/1/2022 – 12/31/2022
If you did not earn your wellness credits for the plan year beginning 7/1/2022, you will have another opportunity to earn the credits.
1. Complete 4 wellness activities and submit your wellness physical exam form by 12/31/2022 and DOZ will reduce your medical premium for the last six months of the wellness program (1/1/2023—6/30/2023).
2. To earn wellness credits for the 7/1/2023—6/30/2024 wellness year, you will need to complete an additional 4 wellness activities AND submit an eligible wellness physical exam form.
New Hires
We are glad you have joined our team. If you enroll in the medical plan, you will automatically receive the wellness credits applied to your medical premium upon your effective date.
To keep your wellness credits for 2024, you will need to complete the criteria in the New Hire grid.
| New Hire Grid | ||||
|---|---|---|---|---|
| New Hires | Hired Before 8/1/2023 | Hired After 8/1/2023 | ||
| Wellness Credit #1 Wellness Physical Exam | Turn in your exam results by 10/31/2023 | Automatically eligible | ||
| Wellness Credit #2 Activity | Participate in one wellness activity every month through 10/31/2023 | Automatically eligible | ||
| Result | Your medical premiums will be reduced in 2024 | |||
Confidentiality
To protect your privacy and protected health information, American Health & Wellness (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 | In-Network Low Plan | |||
|---|---|---|---|---|---|
| Benefit Summary | Base Plan | Buy-Up Plan | |||
| Preventive Expenses | > Exams and cleanings (2 in a calendar year) > Prophylaxis (2 in a calendar year) > X-rays (full mouth once/60 months) > X-rays (bitewings once in any 12 consecutive months) > Fluoride treatment to age 14 (limited to 2 treatments in a calendar year) > Sealants to age 16 (once/36 months) | Covered at 100% | Covered at 100% | ||
| Basic Expenses | > Fillings > Periodontal maintenance (once/3 months)* > Simple extractions > Repair/maintenance of crowns, bridges and dentures > Space maintainers/Harmful habit appliances (under age 16 and limited to the initial appliance only) *shared frequency with cleanings | Covered at 50% | Covered at 100% | ||
| Major Expenses | > Bridges & dentures > Endodontic services (root canal) > Implants > Single crowns > Complex extractions > General anesthesia > Periodontal services and surgery > Inlays, onlays & veneers | Covered at 25% | Covered at 60% | ||
| Orthodontia | Dependent Children to age 19 Only; Lifetime Maximum per Child | Not Covered | Covered at 50% $1,000 | ||
| Deductible | Single / Family | $50 / $150 | $50 / $150 | ||
| Calendar Year Maximum Per Covered Person | Maximums for preventive, basic and major procedures are combined. Some of your unused annual benefit maximum can be carried over to the next year. To qualify, you must have had a dental service performed within the calendar year and used less than the maximum threshold of $600. If the qualification is met, the threshold is carried over to next year’s maximum benefit. | $1,000 | $1,250 | ||
| Out-Of-Network | 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. The Buy-Up Plan pays out-of-network services at the 95th percentile of usual and customary. | ||||
| Benefit Summary | In-Network High Plan | In-Network Low Plan | |||
|---|---|---|---|---|---|
| Benefit Summary | Base Plan | Buy-Up Plan | |||
| Preventive Expenses | > Exams and cleanings (2 in a calendar year) > Prophylaxis (2 in a calendar year) > X-rays (full mouth once/60 months) > X-rays (bitewings once in any 12 consecutive months) > Fluoride treatment to age 14 (limited to 2 treatments in a calendar year) > Sealants to age 16 (once/36 months) | Covered at 100% | Covered at 100% | ||
| Basic Expenses | > Fillings > Periodontal maintenance (once/3 months)* > Simple extractions > Repair/maintenance of crowns, bridges and dentures > Space maintainers/Harmful habit appliances (under age 16 and limited to the initial appliance only) *shared frequency with cleanings | Covered at 50% | Covered at 100% | ||
| Major Expenses | > Bridges & dentures > Endodontic services (root canal) > Implants > Single crowns > Complex extractions > General anesthesia > Periodontal services and surgery > Inlays, onlays & veneers | Covered at 25% | Covered at 60% | ||
| Orthodontia | Dependent Children to age 19 Only; Lifetime Maximum per Child | Not Covered | Covered at 50% $1,000 | ||
| Deductible | Single / Family | $50 / $150 | $50 / $150 | ||
| Calendar Year Maximum Per Covered Person | Maximums for preventive, basic and major procedures are combined. Some of your unused annual benefit maximum can be carried over to the next year. To qualify, you must have had a dental service performed within the calendar year and used less than the maximum threshold of $600. If the qualification is met, the threshold is carried over to next year’s maximum benefit. | $1,000 | $1,250 | ||
| Out-Of-Network | 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. The Buy-Up Plan pays out-of-network services at the 95th percentile of usual and customary. | ||||
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 | In-Network Only Rollover Amount | Maximum Rollover Account Limit |
|---|---|---|---|---|
| Plan Annual Maximum | Threshold | Maximum Rollover Amount | In-Network Only Rollover Amount | Maximum 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 Maximum | Threshold |
|---|---|
| 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
Dental Guard Preferred Network
1-888-482-7342
NO ID CARD NEEDED
Your dentist only needs your social security number and the Guardian Group ID# 00457997 to confirm your eligibility.
Dental Employee Bi-Weekly Contribution
| Dental Buy-Up | Dental Care | |
|---|---|---|
| Base Plan | Buy-Up | |
| Employee Only | $8.10 | $20.41 |
| Employee + Spouse | $16.44 | $41.43 |
| Employee + Child(ren) | $23.25 | $53.39 |
| Employee + Family | $33.92 | $79.48 |
| Dental Buy-Up | Dental Care | |
|---|---|---|
| Base Plan | Buy-Up | |
| Employee Only | $8.10 | $20.41 |
| Employee + Spouse | $16.44 | $41.43 |
| Employee + Child(ren) | $23.25 | $53.39 |
| Employee + Family | $33.92 | $79.48 |
VISION BENEFIT SUMMARY IN-NETWORK
(Scroll sideways to see all options)
| High Plan | Low Plan | ||||||
|---|---|---|---|---|---|---|---|
| Benefit Summary | Base Plan* *Covered person must remain enrolled in the Base Plan for two years. | Buy-Up Plan | |||||
| Copay | Benefit | Copay | Benefit | ||||
| Eye Exam | $20 copay | Once every other calendar year | $10 copay | Once every calendar year | |||
| Lenses | $20 for single vision, bifocal, trifocal, lenticular | Once every other calendar year | $25 for single vision, bifocal, trifocal, lenticular | Once every calendar year | |||
| Contact Lenses (in lieu of eyeglass lenses and/or frames) | > $20 copay if medically necessary > $130 max (copay waive) if elective + 15% discount | Once every other calendar year | > $20 copay if medically necessary > $130 max (copay waive) if elective + 15% discount | Once every calendar year | |||
| Frames | $130 retail maximum + 20% off balance | Once every other calendar year | $130 retail maximum + 20% off balance | Once every calendar year | |||
| Network | DavisVision | VSP | |||||
| Out-of-Network Benefits | Out-of-network benefits are allowed, however, copays and maximums are less and some plan limitations may apply. Employees using out-of-network providers may be responsible for additional fees. | ||||||
| High Plan | Low Plan | ||||||
|---|---|---|---|---|---|---|---|
| Benefit Summary | Base Plan* *Covered person must remain enrolled in the Base Plan for two years. | Buy-Up Plan | |||||
| Copay | Benefit | Copay | Benefit | ||||
| Eye Exam | $20 copay | Once every other calendar year | $10 copay | Once every calendar year | |||
| Lenses | $20 for single vision, bifocal, trifocal, lenticular | Once every other calendar year | $25 for single vision, bifocal, trifocal, lenticular | Once every calendar year | |||
| Contact Lenses (in lieu of eyeglass lenses and/or frames) | > $20 copay if medically necessary > $130 max (copay waive) if elective + 15% discount | Once every other calendar year | > $20 copay if medically necessary > $130 max (copay waive) if elective + 15% discount | Once every calendar year | |||
| Frames | $130 retail maximum + 20% off balance | Once every other calendar year | $130 retail maximum + 20% off balance | Once every calendar year | |||
| Network | DavisVision | VSP | |||||
| Out-of-Network Benefits | Out-of-network benefits are allowed, however, copays and maximums are less and some plan limitations may apply. Employees using out-of-network providers may be responsible for additional fees. | ||||||
Vision Employee Bi-Weekly Contribution
| Vision High Plan | Vision Low Plan | |
|---|---|---|
| Contributions | Base Plan Vision - Cost Per Pay | Buy-Up Plan Vision - Cost Per Pay |
| Employee Only | $2.50 | $4.50 |
| Employee + Spouse | $4.20 | $7.57 |
| Employee + Child(ren) | $4.28 | $7.72 |
| Employee + Family | $6.78 | $12.22 |
| Vision High Plan | Vision Low Plan | |
|---|---|---|
| Contributions | Base Plan Vision - Cost Per Pay | Buy-Up Plan Vision - Cost Per Pay |
| Employee Only | $2.50 | $4.50 |
| Employee + Spouse | $4.20 | $7.57 |
| Employee + Child(ren) | $4.28 | $7.72 |
| Employee + Family | $6.78 | $12.22 |
FIND AN EYE DOCTOR
www.GuardianAnytime.com
Choose Davis Vision or VSP depending on your plan election.
1-888-482-7342
NO ID CARD NEEDED
Your dentist only needs your social security number and the Guardian Group ID# 00457997 to confirm your eligibility.
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 | $25,000 |
| Insurance Carrier | Guardian |
| Age Reduction Rule | 50% reduction 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.
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. During open enrollment, if an employee is already enrolled in the Voluntary Life benefit, the employee may elect to increase coverage of up to $50,000 per enrollment period, not to exceed the guarantee issue amount (no medical questionnaire needed).
| Benefits | Details |
|---|---|
| Benefits | Details |
| Guaranteed Coverage Amount and Benefit Maximums | Employee: $150,000, under age 65; $10,000, age 65-69; $0, 70+ $10,000 minimum to $500,000 maximum ($10,000 increments) Spouse: $50,000, under age 65; $5,000 age 65-69; $0, 70+ $5,000 minimum to $250,000 maximum, not to exceed employee coverage($5,000 increments) Rates based on employee’s age; Coverage ends at age 70 Child: $10,000 $1,000 increments to a maximum of $10,000 for covered children ages 14 days to 26 years old Same rate and coverage for all children |
| Insurance Carrier | Guardian |
| Age Reduction Rule | 35% reduction at age 65; 60% at age 70; 75% at age 75; 85% at age 80 |
| 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. |
| Benefits | Details |
|---|---|
| Benefits | Details |
| Guaranteed Coverage Amount and Benefit Maximums | Employee: $150,000, under age 65; $10,000, age 65-69; $0, 70+ $10,000 minimum to $500,000 maximum ($10,000 increments) Spouse: $50,000, under age 65; $5,000 age 65-69; $0, 70+ $5,000 minimum to $250,000 maximum, not to exceed employee coverage($5,000 increments) Rates based on employee’s age; Coverage ends at age 70 Child: $10,000 $1,000 increments to a maximum of $10,000 for covered children ages 14 days to 26 years old Same rate and coverage for all children |
| Insurance Carrier | Guardian |
| Age Reduction Rule | 35% reduction at age 65; 60% at age 70; 75% at age 75; 85% at age 80 |
| 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 plus bonus and commission to a maximum weekly benefit of $1,250 | 60% of your pre-disability base salary plus bonus and commissions to a maximum monthly benefit of $10,000 |
| Waiting (Elimination) Period | Benefits begin after 14 days for accident and sickness | Benefits begin after 90 days |
| Benefit Duration | Up to 11 weeks after elimination period | Normal Social Security Retirement Age |
| 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% Employee Paid |
| Insurance Carrier | Guardian | Guardian |
| Evidence of Insurability | Evidence of Insurability is required for employees that do not elect the benefit when initially eligible. | Evidence of Insurability is required for employees that do not elect the benefit when initially eligible. |
| Benefits Based On | N/A | Your own occupation for the first 24 months; any occupation thereafter |
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.
| Benefits | Details |
|---|---|
| Benefits | Details |
| Guaranteed Coverage Amount | Employee: $15,000 (choose lump sum benefit of $5,000, $10,000, $15,000 or $20,000) Spouse: $7,500 (limit to 50% of employee benefit) Child: 25% of employee benefit |
| Covered Conditions | Cancer (invasive, carcinoma, skin) Vascular (heart attack, stroke), Kidney and Other Organ Failure, ALS, 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 Benefit | Provides 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 Carrier | Guardian |
| Pre-existing Condition Limitation | 3 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) |
| Age Reduction Rule | Benefit reduces by 50% at age 70 |
| Evidence of Insurability | Evidence of Insurability is required for employees that do not elect the benefit when initially eligible, if you are electing an amount that exceeds the Guaranteed Coverage Amount, and as well for all applicants age 70+ regardless of the elected amount. |
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.
Payroll Contribution – Log into Employee Navigator for your cost of this coverage.
Accident Insurance
Accident Insurance is available to our employees and eligible dependents. The coverage is for off job accidents.
| Benefits | Value Plan | Advantage Plan |
|---|---|---|
| Benefits | Value Plan | Advantage Plan |
| Accidental Dealth | Employee: $10,000 Spouse: $5,000 Child: $5,000 | Employee: $25,000 Spouse: $12,500 Child: $5,000 |
| Covered Accidents/Expenses | Accidental Dismemberment, Air Ambulance expenses, Ambulance expenses, Blood, Accidental Burns, Child Organized Sports, Concussions, Dislocations, Fractures, Hospital ICU Admission, Lacerations, (see plan highlights on Employee Navigator for a complete list and benefits) | Accidental Dismemberment, Air Ambulance expenses, Ambulance expenses, Blood, Accidental Burns, Child Organized Sports, Concussions, Dislocations, Fractures, Hospital ICU Admission, Lacerations, (see plan highlights on Employee Navigator for a complete list and benefits) |
| Wellness Benefit | $50 per year for completing certain routine wellness screenings or procedures and registration of a covered child in an organized sport (see plan highlights for example procedures) | $50 per year for completing certain routine wellness screenings or procedures and registration of a covered child in an organized sport (see plan highlights for example procedures) |
| Chiropractic Visits | $50 per visit up to 6 visits | $50 per visit up to 6 visits |
| Emergency Room Treatment | $200 | $200 |
| Insurance Carrier | Guardian | Guardian |
| Portability | Allows the employee to take the coverage with them if employment has ended (application timeline applies, see Human Resources) | 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 | Value | Advantage |
|---|---|---|
| Payroll Contributions Bi-Weekly | Value | Advantage |
| Employee | $6.16 | $7.98 |
| Employee + Spouse | $10.55 | $13.50 |
| Employee + Child(ren) | $10.75 | $13.58 |
| Employee + Family | $15.14 | $19.10 |
Pet Insurance
If you have a pet, you can consider buying pet insurance through Nationwide. Preferred pricing is provided for our group. Benefit enrollment is available all year. Each pet is issued an individual policy through Nationwide, and you can use any veterinarian. SEE THE NATIONWIDE PET INSURANCE FLYERS ON EMPLOYEE NAVIGATOR FOR ADDITIONAL DETAILS.
Enrolling is easy:
My Pet Protection covers so much, it’s easier to say “what’s not covered?
Some policy exclusions may apply. Wellness, routine and preventive care covered with My Pet Protection with Wellness policy.
Some policy exclusions may apply. Wellness, routine and preventive care covered with My Pet Protection with Wellness policy.
Employee Assistance Program (EAP)
This is provided to you at NO COST and is confidential. 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.
Employee Assistance Program (EAP) Consultative Services
Face-to-face counseling – up to 3 visits per employee/household member per issue
Telephonic Counseling – unlimited, 24/7 consultations with master’s and doctoral-level counselors
Bereavement – support available through telephonic or face-to-face sessions; online resources available on EAP website
Online Modules and Coaching – learn, develop, and practice new skills to improve mental fitness; includes a well-being check, online modules selected specifically for you, and up to 3 coaching sessions
EAP Website Resources – comprehensive website that includes articles, videos, FAQs, etc.; additionally, individuals can chat online with an EAP consultant or email an EAP counselor through the website
Work/Life Assistance & Resources
Work/Life services – unlimited 24/7 access to Work/Life specialists (subject matter experts) in the areas of: family and care giving, health and wellness, emotional well-being, daily living, balancing work and life responsibilities
Child and Elder Care Referral – unlimited telephonic consultation with a Work/Life specialist (part of Work/Life services)
Employee discounts – access to discounts on a large number of products and services, from gym memberships to dental, vision and pharmacy items, entertainment, restaurants, computers, cars, and much more
Medical Bill Negotiation Tools – information and guidance on negotiating medical bills
Resources For Managers
Introductory employee orientation – complimentary webinars with on-site orientation available for additional hourly fees
Employee Assistance Program (EAP) Consultative Services*
Legal Consultation – unlimited telephonic support and free initial 30-minute face-to-face consultation with an attorney; with a 25% discount on attorney services thereafter; online legal forms; extensive online law library
Financial Consultation – unlimited telephonic support for financial problems or planning needs: 30 days of financial coaching; extensive online financial library and calculators
ID Theft – free consultation with a trained Fraud Resolution specialist who will assist with ID theft resolution and education; ID theft educational materials available online
Will Preparation – online self-service documents available on EAP website: 30-minute consultation (part of Legal Consultation offering) can be used for estate planning/will preparation
Legal Document Preparation – online self-service documents availabe on the EAP website
Tax Consultation – tax questions only can be answered as part of the Financial Consultation offering
Online Self-Service Documents – examples include, but are not limited to living trust, will, power of attorney, deeds
Your EAP is WorkLifeMatters provided by the Guardian Life Insurance Company of America and Uprise Health
Phone (24/7):
1-800-386-7055
Email:
eapcounselor@uprisehealth.com
Web:
www.ibhworklife.com
User Name: Worklife
Password: 70101
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.