Welcome, Applied Behavior Employees
Welcome, Applied Behavior Employees
Our Employee Benefits And Wellness Program
Table Of Contents
To make your life easier, click on the topics below to go directly to that information:
Annual Notices: Under federal law, we are required to provide or have available specific benefit notices for your review. All annual notices are available on our benefit administration platform or from Human Resources. If you would like to review the Annual Notices now, please CLICK HERE.
Disclaimer: This benefit guide provides highlights of the benefits available. Please request a copy of the plan certificate for additional coverage details, limitations, exclusions and restrictions. If any conflict shall arise between this document and the plan certificate, the plan certificate will govern in all cases.
OPEN ENROLLMENT VIDEO
Welcome to our employee benefits program. We have designed a personalized video for you and your family to better understand all of the benefits offered to you.
At the same time, you’ll have an opportunity to meet the team from AHW that will be working with you. In addition to the video, we have designed the following benefit highlights to be user-friendly.
You can click on any topic you’re interested in vs having to scroll through the entire booklet.
ELIGIBILITY
Eligibility
Eligibility Definitions
Employee:
A full-time employee
Dependent:
New Employees
As a new, full-time employee, your benefits will become effective: the first of the month, after 60 days, following the date 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:
You can only change your benefit selections during the plan year if you have a qualifying life event.
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:
Use your computer, smart phone or device to enroll using this company identifier:
ABAPROG
Log On To Enroll
You will receive an email from noreply@employeenavigator.com that provides your registration link and company identifier code. To access employee navigator, you will need to enter the credentials you used when you originally registered with Employee Navigator. If you cannot remember your credentials, use the forget password or forgot username option on the login screen, then follow the prompts. An email will be sent to the email address you originally provided during your registration. Keep in mind, it could be your work email OR your personal email account.
Go to (or click) https://www.employeenavigator.com/benefits/Account/Login to login to Employee Navigator
MEDICAL BENEFITS
Choose the Plan that is Best for You and Your Family
We will continue to offer two medical plans to provide choice for you and your family.
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 2 medical options:
Plans: (Scroll sideways to see all 2 plans)
| Plan Effective 1/1/2023 - 12/31/2023 | Traditional Plan 1 Your Responsibility | High Deductible Health Plan 2 Your Responsibility |
|---|---|---|
| Plan Effective 1/1/2023 - 12/31/2023 | Traditional Plan 1 Your Responsibility | High Deductible Health Plan 2 Your Responsibility |
| Annual Deductible (embedded) Individual | $4,500 | $5,000 |
| Annual Deductible (embedded) Family | $9,000 | $10,000 |
| Out-of-Pocket Maximum (including deductible, copays & coinsurance) - Individual | $6,500 | $6,500 |
| Out-of-Pocket Maximum (including deductible, copays & coinsurance) - Family | $13,000 | $13,000 |
| Coinsurance | 20% | 20% |
| Office Visit Copays - Primary (PCP) | $25 Copay | Deductible; then $30 |
| Office Visit Copays - Specialist | $50 Copay | Deductible; then $50 |
| Prescription Drugs Retail 30 day Supply Tier 1: generic Tier 2: brand Tier 3: formulary Tier 4: specialty | Copays: $10 $35 $70 $70 | Deductible; then Copays: $10 $35 $60 $60 |
| Prescription Drugs Mail Order 90 day Supply (in network only) Tier 1: generic Tier 2: brand Tier 3: formulary Tier 4: specialty | Copays: $25 $87.50 $175 $175 | Deductible; then Copays: $25 $87.50 $150 $150 |
| Medicare Part D Creditable Status Creditable means the Rx plan is as good as Medicare Part D | Creditable | Not Creditable |
| Preventive Care (Routine Exams, Colonoscopies, Immunizations, Well Baby Care & Mammograms) | 0% | 0% |
| Emergency Room | $250 Copay; then 20% | Deductible; then $250 Copay |
| Urgent Care | $100 Copay | Deductible; then $75 Copay |
| Inpatient Hospital | Deductible; then 20% | Deductible; then 20% |
| Outpatient Surgery | Deductible; then 20% | Deductible; then 20% |
| Plan Effective 1/1/2023 - 12/31/2023 | Traditional Plan 1 Your Responsibility | High Deductible Health Plan 2 Your Responsibility |
|---|---|---|
| Plan Effective 1/1/2023 - 12/31/2023 | Traditional Plan 1 Your Responsibility | High Deductible Health Plan 2 Your Responsibility |
| Annual Deductible (embedded) Individual | $4,500 | $5,000 |
| Annual Deductible (embedded) Family | $9,000 | $10,000 |
| Out-of-Pocket Maximum (including deductible, copays & coinsurance) - Individual | $6,500 | $6,500 |
| Out-of-Pocket Maximum (including deductible, copays & coinsurance) - Family | $13,000 | $13,000 |
| Coinsurance | 20% | 20% |
| Office Visit Copays - Primary (PCP) | $25 Copay | Deductible; then $30 |
| Office Visit Copays - Specialist | $50 Copay | Deductible; then $50 |
| Prescription Drugs Retail 30 day Supply Tier 1: generic Tier 2: brand Tier 3: formulary Tier 4: specialty | Copays: $10 $35 $70 $70 | Deductible; then Copays: $10 $35 $60 $60 |
| Prescription Drugs Mail Order 90 day Supply (in network only) Tier 1: generic Tier 2: brand Tier 3: formulary Tier 4: specialty | Copays: $25 $87.50 $175 $175 | Deductible; then Copays: $25 $87.50 $150 $150 |
| Medicare Part D Creditable Status Creditable means the Rx plan is as good as Medicare Part D | Creditable | Not Creditable |
| Preventive Care (Routine Exams, Colonoscopies, Immunizations, Well Baby Care & Mammograms) | 0% | 0% |
| Emergency Room | $250 Copay; then 20% | Deductible; then $250 Copay |
| Urgent Care | $100 Copay | Deductible; then $75 Copay |
| Inpatient Hospital | Deductible; then 20% | Deductible; then 20% |
| Outpatient Surgery | Deductible; then 20% | Deductible; then 20% |
Employee Payroll Contributions
Wellness Program
We appreciate you! Remember, participating in the wellness program reduces your medical premium costs. Premium contributions will be deducted from your paycheck on a pre-tax basis. Your level of coverage elected will determine your bi-weekly contributions.
Employee Bi-Weekly Payroll Contribution
Plans: (Scroll sideways to see all 2 plans)
| Description | Your Contribution WITHOUT Wellness Credits Per Pay Period | Your Contribution WITH Both Wellness Credits Per Pay Period | Your Annual Savings With Both Wellness Credits | Your Contribution WITHOUT Wellness Credits Per Pay Period | Your Contribution WITH Both Wellness Credits Per Pay Period | Your Annual Savings With Both Wellness Credits | ||||
|---|---|---|---|---|---|---|---|---|---|---|
| Benefits | Traditional Plan 1 | High Deductible Health Plan 2 | ||||||||
| Description | Your Contribution WITHOUT Wellness Credits Per Pay Period | Your Contribution WITH Both Wellness Credits Per Pay Period | Your Annual Savings With Both Wellness Credits | Your Contribution WITHOUT Wellness Credits Per Pay Period | Your Contribution WITH Both Wellness Credits Per Pay Period | Your Annual Savings With Both Wellness Credits | ||||
| Employee Only | $96.46 | $86.81 | $250.80 | $56.46 | $50.81 | $146.80 | ||||
| Employee + Spouse | $207.22 | $186.50 | $538.77 | $179.11 | $161.20 | $465.69 | ||||
| Employee + Child(ren) | $197.62 | $177.86 | $513.81 | $178.85 | $160.97 | $465.01 | ||||
| Employee + Family | $332.62 | $299.36 | $864.81 | $269.63 | $242.66 | $701.04 | ||||
| Description | Your Contribution WITHOUT Wellness Credits Per Pay Period | Your Contribution WITH Both Wellness Credits Per Pay Period | Your Annual Savings With Both Wellness Credits | Your Contribution WITHOUT Wellness Credits Per Pay Period | Your Contribution WITH Both Wellness Credits Per Pay Period | Your Annual Savings With Both Wellness Credits | ||||
|---|---|---|---|---|---|---|---|---|---|---|
| Benefits | Traditional Plan 1 | High Deductible Health Plan 2 | ||||||||
| Description | Your Contribution WITHOUT Wellness Credits Per Pay Period | Your Contribution WITH Both Wellness Credits Per Pay Period | Your Annual Savings With Both Wellness Credits | Your Contribution WITHOUT Wellness Credits Per Pay Period | Your Contribution WITH Both Wellness Credits Per Pay Period | Your Annual Savings With Both Wellness Credits | ||||
| Employee Only | $96.46 | $86.81 | $250.80 | $56.46 | $50.81 | $146.80 | ||||
| Employee + Spouse | $207.22 | $186.50 | $538.77 | $179.11 | $161.20 | $465.69 | ||||
| Employee + Child(ren) | $197.62 | $177.86 | $513.81 | $178.85 | $160.97 | $465.01 | ||||
| Employee + Family | $332.62 | $299.36 | $864.81 | $269.63 | $242.66 | $701.04 | ||||
Medical Resources GPA Support & Mobile App
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.
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.
BILLING SUPPORT
FIND A PROVIDER
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 the number on your ID card to verify your eligibility status. You can call 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 the number on the back of your ID card to confirm amounts or if the facility will not perform treatment without additional funds.
Why is an Explanation of Benefits (EOB) so important?
When a claim is processed, an Explanation of Benefits or EOB will be sent to you and the provider. This EOB explains how your claim was processed. The most important area on the EOB is the Patient Responsibility.
Healthcare providers can have excessive markups, often way beyond what their actual costs are. A detailed audit will be performed 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.
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, call the phone number on your benefits ID card.
Telemedicine
United Concierge Medicine
Your health plan has partnered with United Concierge Medicine (also known as UCM) to provide you access to Emergency Medicine providers 24/7/365. These services can save you and your family valuable time and money by avoiding unnecessary trips to the doctor’s office, urgent care and ER.
You and your covered dependents will have unlimited access to Emergency Medicine, Board Certified, compassionate Physicians and Physician Assistants via phone and secure video conference. They can diagnose, treat, prescribe medications when appropriate, order labs/diagnostic imaging and make recommendations to the best specialist in the area if needed.
UCM does not replace your Primary Care Provider for well visits or any Specialist for a chronic illness/disease; however, for all other illness and injury, consider calling UCM first. Download the UCMnow App as this is the best way to reach out for a consult whenever you need them. Complete your profile online now to save you time when you need this service.
You choose how to start a consult:
SAM by UCM Mobile APP
www.goseesam.com
1-844-484-7362
Included with all medical plans
Plan Information
Which plan is right for you?
| Traditional Plan | High Deductible Health Plan |
|---|---|
| Traditional Plan | High Deductible Health Plan |
| Higher Payroll Deductions | Lower Payroll Deductions |
| Copays Apply First | Deductible Applies First |
| Pre-Tax Benefit: contributions reduce your taxable income | 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. |
| Manage your budget with copays if you expect to utilize the medical plan and have multiple prescriptions. | Great way to save pre-tax dollars if you don’t expect significant health issues. |
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.
HSA
Health Savings Account Service Provider
Our preferred provider is BPC, however, you can use any bank.
*You must submit your HSA bank account information to Accounting in order to make pre-tax payroll contributions to your account. Submission of account information should be done via the Employee Direct Deposit Enrollment Form.
Matching Feature
Applied Behavior Center for Autism will be matching up to
$300 annually of the amount that you contribute to your
Health Savings Account for 2023. The contribution will be
done once per calendar trimester.*
Include the ABC contribution in your overall contribution to avoid
exceeding the 2023 limit.
Online & Mobile App Capabilities
Visit www.bpc.wealthcareportal.com Click Register
For pre-tax contributions, once you have an account number, fill out the Employee Direct Deposit Form found on Employee Navigator and submit it to; Accounting@appliedbehaviorcenter.org
Health Savings Account
Your Health Savings Account (HSA) is tax free. The money in your account is yours to use to pay for eligible health care expenses when you are enrolled in a qualified high deductible health plan. Unused funds roll over year-to year.
What is a Health Savings Account?
A HSA is an individual health care bank account that you can use to pay out-of-pocket health care expenses with pre-tax dollars. You will own and administer your account and there are no “use it or lose it” restrictions like a Flexible Spending Account (FSA). HSAs allow you to save and “roll over” money if you do not spend it in the calendar year. The money is yours if you change health plans or jobs. You can open and fund a HSA when you meet the following guidelines:
| 2023 HSA Contribution Limits | ||
|---|---|---|
| Single | $3,850 | |
| Family | $7,750 | |
| Catch-up (ages 55+) | $1,000 | |
| The Internal Revenue Service (IRS) places a limit on the maximum contributions each year from yourself or any other contributor. | ||
Qualified Expenses
You can use your HSA funds to pay for medical, dental and vision expenses, i.e., surgery expenses, prescriptions, chiropractor, dental treatment, etc.
Non-qualified expenses will be taxed plus a 20% tax penalty under IRS regulations.
What is a Health Savings Account?
A HSA is an individual health care bank account that you can use to pay out-of-pocket health care expenses with pre-tax dollars. You will own and administer your account and there are no “use it or lose it” restrictions like a Flexible Spending Account (FSA). HSAs allow you to save and “roll over” money if you do not spend it in the calendar year. The money is yours if you change health plans or jobs. You can open and fund a HSA when you meet the following guidelines:
| 2023 HSA Contribution Limits | ||
|---|---|---|
| Single | $3,850 | |
| Family | $7,750 | |
| Catch-up (ages 55+) | $1,000 | |
| The Internal Revenue Service (IRS) places a limit on the maximum contributions each year from yourself or any other contributor. | ||
Qualified Expenses
You can use your HSA funds to pay for medical, dental and vision expenses, i.e., surgery expenses, prescriptions, chiropractor, dental treatment, etc.
Non-qualified expenses will be taxed plus a 20% tax penalty under IRS regulations.
PHARMACY BENEFITS
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:
Interactive Formulary provides:
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 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. |
Save Money On Your Prescriptions
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:
OR
Wellness Credit #1
Wellness Physical Exam
Visit your physician for a wellness physical exam AND submit the results form to your health coach by 10/31/2023.
Wellness Credit #2
Monthly Wellness Activities
Participate in at least five wellness activities within 11/1/2022—10/31/2023 to earn your 2024 credit.
Wellness activities include:
Seminars, Group Coaching Circles and Challenges
| New Hire Grid | ||||
|---|---|---|---|---|
| New Hire Criteria: | Hired Before 5/1/2023 | Hired After 5/1/2023 | ||
| Wellness Credit #1 Wellness Physical Exam | Turn in your exam results by 4/30/2023 | Turn in your exam results by 10/31/2023 | ||
| Wellness Credit #2 Activity | Earn your credit early by participating in three wellness activities by 4/30/2023. Remember, you will need to complete 5 total by 10/31/2023. | Participate in three wellness activities by 10/31/2023 | ||
| Result | Your medical premiums will be reduced 7/1/2023 | Your medical premiums will be reduced 1/1/2024 | ||
Confidentiality
To protect your privacy and protected health information, American Health & Wellness Group (AHW) administers our wellness program. All health coaches are HIPAA (Health Insurance Portability and Accountability Act) certified. This means the information you share with your health coach is private and secure.
Nicotine Cessation
If you are a current nicotine user and ready to quit, there are options available to help.
Take Charge
Taking charge of your health starts with getting your annual, preventive exam to know your biometric numbers. Your weight, cholesterol, blood pressure and blood glucose numbers are key indicators of health. Your health coach will help you review your physician results and help create a lifestyle plan if you need to improve your numbers.
DENTAL BENEFIT SUMMARY
(Scroll sideways to see all options)
| Benefit Summary - In Network | PPO or Premier Dentist | Non Network Dentist | |||
|---|---|---|---|---|---|
| Benefit Summary | In-Network High Plan | In-Network Low Plan | |||
| Preventive Expenses | > Exams and cleanings (twice per calendar year) > Fluoride treatment (twice per calendar year<16 years old) > Space maintainers (one per area per 5 year period up to age 16) > Sealants (once per tooth per 3 year period up to age 16) > X-rays (bitewing once per calendar year) > X-rays (full mouth once per 3 years) | Covered at 100% | Covered at 100% | ||
| Basic Expenses | > Emergency Palliative Treatment > Fillings and Crown Repair > Endodontic Services (root canal) > Periodontal maintenance > Simple Extractions > Other Basic Services | Covered at 80% | Covered at 80% | ||
| Major Expenses | > Oral Surgery > Crowns, Inlays, Onlays and Veneers > Relines and Repairs (prosthetic appliances) > Bridges, Implants, Dentures | Covered at 50% | Covered at 50% | ||
| Orthodontia | > Dependent Children Only, through age 18 and under > Lifetime Maximum per child | Covered at 50% $1,000 | 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. Delta Dental PPO Dentist: If at least one covered service is paid in a Calendar Year and the total benefit paid does not exceed $1,000 in that Calendar Year, $600 will carry over to the next Calendar Year’s Maximum Payment. This amount will accumulate from one Calendar Year to the next, but will not exceed $1,500. Delta Dental Premier and Non Network Dentist: If at least one covered service is paid in a Calendar Year and the total benefit paid does not exceed $1,000 in that Calendar Year, $500 will carry over to the next Calendar Year’s Maximum Payment. This amount will accumulate from one Calendar Year to the next, but will not exceed $1,500. If no covered services are paid during a Calendar Year, all accumulated carryover amounts from previous Calendar Years will be forfeited. | $2,000 | $2,000 | ||
| 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. | ||||
| Benefit Summary - In Network | PPO or Premier Dentist | Non Network Dentist | |||
|---|---|---|---|---|---|
| Benefit Summary | In-Network High Plan | In-Network Low Plan | |||
| Preventive Expenses | > Exams and cleanings (twice per calendar year) > Fluoride treatment (twice per calendar year<16 years old) > Space maintainers (one per area per 5 year period up to age 16) > Sealants (once per tooth per 3 year period up to age 16) > X-rays (bitewing once per calendar year) > X-rays (full mouth once per 3 years) | Covered at 100% | Covered at 100% | ||
| Basic Expenses | > Emergency Palliative Treatment > Fillings and Crown Repair > Endodontic Services (root canal) > Periodontal maintenance > Simple Extractions > Other Basic Services | Covered at 80% | Covered at 80% | ||
| Major Expenses | > Oral Surgery > Crowns, Inlays, Onlays and Veneers > Relines and Repairs (prosthetic appliances) > Bridges, Implants, Dentures | Covered at 50% | Covered at 50% | ||
| Orthodontia | > Dependent Children Only, through age 18 and under > Lifetime Maximum per child | Covered at 50% $1,000 | 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. Delta Dental PPO Dentist: If at least one covered service is paid in a Calendar Year and the total benefit paid does not exceed $1,000 in that Calendar Year, $600 will carry over to the next Calendar Year’s Maximum Payment. This amount will accumulate from one Calendar Year to the next, but will not exceed $1,500. Delta Dental Premier and Non Network Dentist: If at least one covered service is paid in a Calendar Year and the total benefit paid does not exceed $1,000 in that Calendar Year, $500 will carry over to the next Calendar Year’s Maximum Payment. This amount will accumulate from one Calendar Year to the next, but will not exceed $1,500. If no covered services are paid during a Calendar Year, all accumulated carryover amounts from previous Calendar Years will be forfeited. | $2,000 | $2,000 | ||
| 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. | ||||
FIND A DENTIST
www.deltadentlain.com
1-800-524-0149
- Check benefits
- Review claims and amounts used
toward maximum - Print ID cards (your dentist only
needs your social security number
and your group ID# to confirm your
eligibility)
Dental Employee Bi-Weekly Contribution
| Dental Bi-weekly Payroll Deduction | |
|---|---|
| Dental Bi-weekly Payroll Deduction | |
| Employee Only | $14.02 |
| Employee + Spouse | $31.95 |
| Employee + Child(ren) | $30.28 |
| Employee + Family | $49.27 |
| Dental Bi-weekly Payroll Deduction | |
|---|---|
| Dental Bi-weekly Payroll Deduction | |
| Employee Only | $14.02 |
| Employee + Spouse | $31.95 |
| Employee + Child(ren) | $30.28 |
| Employee + Family | $49.27 |
VISION BENEFIT SUMMARY IN-NETWORK
(Scroll sideways to see all options)
| Benefit Summary - In Network | |||
|---|---|---|---|
| Benefit Summary - In Network | |||
| Benefit | Copay | Benefit Frequency | |
| Eye Exam | $10 | Once every 12 months | |
| Lenses | $25 for single vision, bifocal, trifocal, lenticular | Once every 12 months | |
| Contact Lenses (in lieu of eyeglass lenses and/or frames) | > Covered in full after $25 copay if medically necessary > $130 allowance if elective > Fit evaluation copay is up to $60 | Once every 12 months | |
| Frames | $130 allowance. An extra $20 allowance on featured designer brands for frames. 20% savings on any amount above the retail allowance. | Once Every 24 months | |
| Network | VSP Choice | ||
| 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. | ||
| Benefit Summary - In Network | |||
|---|---|---|---|
| Benefit Summary - In Network | |||
| Benefit | Copay | Benefit Frequency | |
| Eye Exam | $10 | Once every 12 months | |
| Lenses | $25 for single vision, bifocal, trifocal, lenticular | Once every 12 months | |
| Contact Lenses (in lieu of eyeglass lenses and/or frames) | > Covered in full after $25 copay if medically necessary > $130 allowance if elective > Fit evaluation copay is up to $60 | Once every 12 months | |
| Frames | $130 allowance. An extra $20 allowance on featured designer brands for frames. 20% savings on any amount above the retail allowance. | Once Every 24 months | |
| Network | VSP Choice | ||
| 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 Bi-weekly Payroll Deduction | |
|---|---|
| Vision Bi-weekly Payroll Deduction | |
| Employee Only | $2.53 |
| Employee + Spouse | $5.06 |
| Employee + Child(ren) | $5.42 |
| Employee + Family | $8.65 |
| Vision Bi-weekly Payroll Deduction | |
|---|---|
| Vision Bi-weekly Payroll Deduction | |
| Employee Only | $2.53 |
| Employee + Spouse | $5.06 |
| Employee + Child(ren) | $5.42 |
| Employee + Family | $8.65 |
NO ID CARD NEEDED
Your eye doctor only needs your social security number and the Delta Dental Group ID# 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 | $20,000 |
| Conversion | Allows the employee to take the coverage with them if employment has ended (application timeline and age limitations apply, see Human Resources) |
| Insurance Carrier | MetLife |
| Age Reduction Rule | Benefit reduces by 35% at age 65; and to 50% of the original amount 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.
| Benefits | Details |
|---|---|
| Benefits | Details |
| Guaranteed Coverage Amount and Benefit Maximums | Employee: $100,000 Increments of $10,000 minimum to the lesser of 5 times your basic annual earnings or $300,000 Spouse: $30,000 Increments of $5,000 minimum to overall maximum of $100,000 up to 50% of employee coverage Child: $10,000 Flat Amount: $1,000, $2,000, $4,000, $5,000 or $10,000; same rate and coverage for all children age 6 months to 26 years if full time student. |
| Insurance Carrier | MetLife |
| Age Reduction Rule | None |
| Portability | Allows the employee to take the coverage with them if employment has ended (application timeline and age limitations apply, see Human Resources) |
| Evidence of Insurability | Evidence of Insurability is required for employees that do not elect the benefit when initially eligible or for coverage amounts over the Guaranteed Issue amount. |
| Benefits | Details |
|---|---|
| Benefits | Details |
| Guaranteed Coverage Amount and Benefit Maximums | Employee: $100,000 Increments of $10,000 minimum to the lesser of 5 times your basic annual earnings or $300,000 Spouse: $30,000 Increments of $5,000 minimum to overall maximum of $100,000 up to 50% of employee coverage Child: $10,000 Flat Amount: $1,000, $2,000, $4,000, $5,000 or $10,000; same rate and coverage for all children age 6 months to 26 years if full time student. |
| Insurance Carrier | MetLife |
| Age Reduction Rule | None |
| Portability | Allows the employee to take the coverage with them if employment has ended (application timeline and age limitations apply, see Human Resources) |
| Evidence of Insurability | Evidence of Insurability is required for employees that do not elect the benefit when initially eligible or for coverage amounts over the Guaranteed Issue amount. |
Employee Assistance Program (EAP)
We care about you and your family’s total health management. For that reason, we are providing you access to an Employee Assistance Program at no cost to you.
WorkLifeMatters can offer help with:
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.