Welcome, Braden Employees
Welcome, Braden 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 HIRES VIDEO
Welcome to our employee benefits program. We have designed a personalized video for you and your family to better understand all of the benefits offered to you.
At the same time, you’ll have an opportunity to meet the team from AHW that will be working with you. In addition to the video, we have designed the following benefit highlights to be user-friendly.
You can click on any topic you’re interested in vs having to scroll through the entire booklet.
ELIGIBILITY
Eligibility
Eligibility Definitions
Employee:
A full-time employee who is scheduled to work at least 30 hours per week
Dependent:
New Employees
As a new, full-time employee (working 30 or more hours per week), your benefits will become effective: the day you start working.
Dependents are eligible to stay on a parent’s medical plan up to end of the month they turn age 26, regardless of student status, employment status or marital status.
You can only change your benefit selections during the plan year if you have a qualifying life event.
Spousal Exclusion
Our medical plan does not have a spousal exclusion meaning that If you have a spouse that is able to obtain coverage through his/her employer or other means, they are eligible to participate in our group health plan.
Qualifying Life Events
When one of the following events occurs, you have 30 days from the date of the event to notify human resources and/or request changes to your coverage:
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:
Bierman
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
Imagine360’s (formerly Group Pension Administrators) Price Protection option allows you to utilize any doctor or hospital without the worry if they are in-network or not. Plus, Imagine360 will be available to you to assist with provider choice, understanding your explanation of benefits and being your advocate with providers.
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
Imagine360’s (formerly Group Pension Administrators) Price Protection option allows you to utilize any doctor or hospital without the worry if they are in-network or not. Plus, Imagine360 will be available to you to assist with provider choice, understanding your explanation of benefits and being your advocate with providers.
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
Your employer offers 4 medical options:
Plans: (Scroll sideways to see all 4 plans)
| Network Benefits - 1/1/2022 - 12/31/2022 | Plan 1 | Plan 2 | Plan 3 | Plan 4 |
|---|---|---|---|---|
| Network Benefits 1/1/2022 - 12/31/2022 | Plan 1 $5,000 HDHP | Plan 2 $3,000 HDHP | Plan 3 $1,500 TCP | Plan 4 $500 TCP |
| ANNUAL DEDUCTIBLE: Single Family | $5,000 $10,000 | $3,000 $6,000 | $1,500 $3,000 | $500 $1,000 |
| OUT-OF-POCKET MAX: Single Family | $5,000 $10,000 | $3,000 $6,000 | $1,500 $3,000 | $500 $1,000 |
| COINSURANCE - Your Responsibility After Deductible | 0% | 0% | 20% | 20% |
| OFFICE VISIT COPAYS: Primary (PCP) Specialist | Subject To Deductible | Subject To Deductible | $20 $30 | $15 $30 |
| PRESCRIPTIONS: Generic Brand Formulary Specialty | Subject To Deductible | Subject To Deductible | $10 $30 $60 25% up to $350 | $10 $30 $60 25% up to $350 |
| ALL OTHER EXPENSES | Subject To Deductible | Subject To Deductible | Subject To Deductible | Subject To Deductible |
| MEDICARE PART D STATUS | Not Creditable | Not Creditable | Creditable | Creditable |
| PREVENTIVE CARE | 100% Covered | 100% Covered | 100% Covered | 100% Covered |
| EMERGENCY ROOM | Subject To Deductible | Subject To Deductible | $300 Copay; deductible waived for facility; then 20% | $300 Copay; deductible waived for facility; then 20% |
| URGENT CARE | Subject To Deductible | Subject To Deductible | $30 Copay; deductible waived for facility; then 20% | $30 Copay; deductible waived for facility; then 20% |
| INPATIENT HOSPITAL | Subject To Deductible | Subject To Deductible | Deductible; then 20% | Deductible; then 20% |
| OUTPATIENT SURGERY | Subject To Deductible | Subject To Deductible | Deductible; then 20% | Deductible; then 20% |
| Network Benefits 1/1/2022 - 12/31/2022 | High Deductible Health Plan $5,000 Your Responsibility | High Deductible Health Plan $3,000 Your Responsibility | Copay Plan $1,500 Your Responsibility | Copay Plan $500 Your Responsibility |
|---|---|---|---|---|
| Network Benefits 1/1/2022 - 12/31/2022 | High Deductible Health Plan $5,000 Your Responsibility | High Deductible Health Plan $3,000 Your Responsibility | Copay Plan $1,500 Your Responsibility | Copay Plan $500 Your Responsibility |
| Annual Deductible (embedded) Individual | $5,000 | $3,000 | $1,500 | $500 |
| Annual Deductible (embedded) Family | $10,000 | $6,000 | $3,000 | $1,000 |
| Out-of-Pocket Maximum (including deductible, copays & coinsurance) - Individual | $5,000 | $3,000 | $3,000 | $1,500 |
| Out-of-Pocket Maximum (including deductible, copays & coinsurance) - Family | $10,000 | $6,000 | $6,000 | $3,000 |
| Coinsurance In Network | 0% | 0% | 20% | 20% |
| Office Visit Copays - Primary (PCP) | Deductible | Deductible | $20 per visit | $15 per visit |
| Office Visit Copays - Specialist | Deductible | Deductible | $30 per visit | $30 per visit |
| Prescription Drugs Copays: Retail/Mail Order Supply: 30/90 day - Tier 1: generic | Deductible | Deductible | $10/$20 | $10/$20 |
| Prescription Drugs Copays: Retail/Mail Order Supply: 30/90 day - Tier 2: brand | Deductible | Deductible | $30/$75 | $25/$62.50 |
| Prescription Drugs Copays: Retail/Mail Order Supply: 30/90 day - Tier 3: formulary | Deductible | Deductible | $60/$180 | $50/$150 |
| Prescription Drugs Copays: Retail/Mail Order Supply: 30/90 day - Tier 4: specialty | Deductible | Deductible | 25% up to $350 | 25% up to $350 |
| Medicare Part D Creditable Status | Creditable means the Rx plan is as good as Medicare Part D | Not Creditable | Creditable | Creditable |
| Preventive Care (Routine Exams, Colonoscopies, Immunizations, Well Baby Care & Mammograms) | Covered at 100% | Covered at 100% | Covered at 100% | Covered at 100% |
| Emergency Room (Charges outside of the facility could be billed separately) | Deductible | Deductible | $300 Copay; deductible waived for facility; then 20% | $300 Copay; deductible waived for facility; then 20% |
| Urgent Care (Charges outside of the facility could be billed separately) | Deductible | Deductible | $30 Copay; deductible waived for facility; then 20% | $30 Copay; deductible waived for facility; then 20% |
| Inpatient Hospital | Deductible | Deductible | Deductible; then 20% | Deductible; then 20% |
| Outpatient Surgery | Deductible | Deductible | 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 $1,500 TCP | Plan 4 $500 TCP |
| ANNUAL DEDUCTIBLE: Single Family | $10,000 $12,000 | $6,000 $12,000 | $3,000 $6,000 | $1,000 $2,000 |
| OUT-OF-POCKET MAX: Single Family | $30,000 $60,000 | $9,000 $18,000 | $10,000 $20,000 | $3,000 $6,000 |
| COINSURANCE | 30% | 30% | 50% | 50% |
| 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 | High Deductible Health Plan $5,000 Your Responsibility | High Deductible Health Plan $3,000 Your Responsibility | Copay Plan $1,500 Your Responsibility | Copay Plan $500 Your Responsibility |
| ANNUAL DEDUCTIBLE | $10,000/$12,000 | $6,000/$12,000 | $3,000/$6,000 | $1,000/$2,000 |
| OUT-OF-POCKET MAX | $30,000/$60,000 | $9,000/$18,000 | $10,000/$20,000 | $3,000/$6,000 |
| COINSURANCE | 30% | 30% | 50% | 50% |
Employee Payroll Contributions
Price Protection
The Price Protection Program option will be less out of your paycheck.
Wellness Program
If you meet the Wellness Program goals, you will continue with lower payroll contributions, too!
Price Protection
The Price Protection Program option will be less out of your paycheck.
Wellness Program
If you meet the Wellness Program goals, you will continue with lower payroll contributions, too!
PRICE PROTECTION PROGRAM
Employee Bi-Weekly Payroll Contributions
With Wellness Credits | 6/1/2023 if Wellness Credit Goals are not met
| Description | High Deductible Health Plan $5,000 | High Deductible Health Plan $3,000 | Copay Plan $1,500 | Copay Plan $500 | ||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Description | High Deductible Health Plan $5,000 | High Deductible Health Plan $3,000 | Copay Plan $1,500 | Copay Plan $500 | ||||||||
| With Wellness Credit | No Wellness Credit | With Wellness Credit | No Wellness Credit | With Wellness Credit | No Wellness Credit | With Wellness Credit | No Wellness Credit | |||||
| Employee Only | $66.83 | $76.83 | $86.50 | $96.50 | $143.28 | $153.28 | $167.11 | $177.11 | ||||
| Employee + Spouse | $238.04 | $248.04 | $304.64 | $314.64 | $286.84 | $296.84 | $410.99 | $420.99 | ||||
| Employee + Child(ren) | $143.80 | $153.80 | $161.39 | $171.39 | $238.44 | $248.44 | $275.87 | $285.87 | ||||
| Employee + Family | $279.71 | $289.71 | $303.29 | $313.29 | $387.75 | $397.75 | $442.82 | $452.82 | ||||
Plans: (Scroll sideways to see all 4 plans)
| Description | High Deductible Health Plan $5,000 | High Deductible Health Plan $3,000 | Copay Plan $1,500 | Copay Plan $500 | ||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Description | High Deductible Health Plan $5,000 | High Deductible Health Plan $3,000 | Copay Plan $1,500 | Copay Plan $500 | ||||||||
| With Wellness Credit | No Wellness Credit | With Wellness Credit | No Wellness Credit | With Wellness Credit | No Wellness Credit | With Wellness Credit | No Wellness Credit | |||||
| Employee Only | $66.83 | $76.83 | $86.50 | $96.50 | $143.28 | $153.28 | $167.11 | $177.11 | ||||
| Employee + Spouse | $238.04 | $248.04 | $304.64 | $314.64 | $286.84 | $296.84 | $410.99 | $420.99 | ||||
| Employee + Child(ren) | $143.80 | $153.80 | $161.39 | $171.39 | $238.44 | $248.44 | $275.87 | $285.87 | ||||
| Employee + Family | $279.71 | $289.71 | $303.29 | $313.29 | $387.75 | $397.75 | $442.82 | $452.82 | ||||
Cigna
Employee Bi-Weekly Payroll Contribution
With Wellness Credits | 6/1/2023 if Wellness Credit Goals are not met
Plans: (Scroll sideways to see all 4 plans)
| Description | High Deductible Health Plan $5,000 - With Wellness Credit | High Deductible Health Plan $5,000 - With NO Wellness Credit | High Deductible Health Plan $3,000 - With Wellness Credit | High Deductible Health Plan $3,000 - With NO Wellness Credit | Copay Plan $1,500 - With Wellness Credit | Copay Plan $1,500 - With NO Wellness Credit | Copay Plan $500 - With Wellness Credit | Copay Plan $500 - With NO Wellness Credit |
|---|---|---|---|---|---|---|---|---|
| Employee Only | $111.02 | $121.02 | $128.38 | $138.38 | $225.63 | $235.63 | $265.93 | $275.93 |
| Employee + Spouse | $325.21 | $335.21 | $444.42 | $454.42 | $453.23 | $463.23 | $640.48 | $650.48 |
| Employee + Child(ren) | $191.78 | $201.78 | $240.65 | $250.65 | $379.11 | $389.11 | $429.41 | $439.41 |
| Employee + Family | $379.37 | $389.37 | $448.03 | $458.03 | $616.83 | $626.83 | $692.24 | $702.24 |
| Description | High Deductible Health Plan $5,000 - With Wellness Credit | High Deductible Health Plan $5,000 - With NO Wellness Credit | High Deductible Health Plan $3,000 - With Wellness Credit | High Deductible Health Plan $3,000 - With NO Wellness Credit | Copay Plan $1,500 - With Wellness Credit | Copay Plan $1,500 - With NO Wellness Credit | Copay Plan $500 - With Wellness Credit | Copay Plan $500 - With NO Wellness Credit |
|---|---|---|---|---|---|---|---|---|
| Employee Only | $111.02 | $121.02 | $128.38 | $138.38 | $225.63 | $235.63 | $265.93 | $275.93 |
| Employee + Spouse | $325.21 | $335.21 | $444.42 | $454.42 | $453.23 | $463.23 | $640.48 | $650.48 |
| Employee + Child(ren) | $191.78 | $201.78 | $240.65 | $250.65 | $379.11 | $389.11 | $429.41 | $439.41 |
| Employee + Family | $379.37 | $389.37 | $448.03 | $458.03 | $616.83 | $626.83 | $692.24 | $702.24 |
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.
| Regular Purpose Flexible Spending Account | ||
|---|---|---|
| Health Plan | Traditional Plan or Waiving Medical | |
| Qualified Expenses | Medical, Dental, Vision and Prescription with a doctor’s prescription | |
| Tax Advantage | Pre-tax Contributions and Payments for Qualified Expenses | |
| 2023 Contribution Limit | $1,000 | |
| Dependent Care Spending Account | $5,000 | |
BPC Benefits Debit Card
Rollover Feature
Our FSA plan has a $500 rollover feature. This allows up to $500 in unspent funds to roll from one plan year into the next. Rolled funds are integrated into the new plan year election, without impact on the $1,000 maximum. Rollover dollars are limited to up to $500 per year.
Online & Mobile App Capabilities
Visit www.bpcinc.com/participants/home or call (877) 272-8880
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 | |
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 | |
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.
How To Set Up A Health Savings Account?
If you are enrolled in the HDHP $3,000 or HDHP $5,000 medical plan, you have the option of opening an Health Savings Account with First Internet Bank. This is optional. If you already have an existing HSA account, you can use that account.*
Opening an HSA with First Internet Bank can be done online:
- Go to https://www.firstib.com/personal/bank/health-savings-accounts/
- Scroll down the page and click the green button: “Open an Account” and follow the directions
- After you account is opened, please contact Human Resources, so that your HSA account details can be added to Paylocity*
*It is your responsibility to communicate the account and routing number to Bierman Autism Centers. Until this information is received, nothing will be deducted from your paycheck and deposited into your Health Savings Account. When opening an account, you will be prompted to select the type of product you would like. Most people select the “Free Checking” option.
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 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
*1/1/2023 OPEN ENROLLMENT: if you met the 2022 wellness program goals for the wellness credit, your 2023 medical premium payroll deductions will be reduced for all of 2023. In order to keep your wellness credit in 2024, be sure to complete at least one of the wellness credit action items by the dates below.
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 to keep your credit for 2024.
Wellness Credit #2
Monthly Wellness Activities
Participate in one wellness activity every month from 1/1/2023 – 10/31/2023 to qualify for the 2024 wellness credit.
DEADLINE: 10/31/2023
Wellness activities include:
Seminars, Group Coaching Circles and Challenges
Need More Time?
Didn’t earn the wellness credit in 2022? Bierman Autism Centers would like to offer you a second chance to earn your credit on June 1, 2023, you must either submit your physical exam results from 1/1/2022—5/31/2023 or participate in one wellness activity per month from 1/1/2023—5/31/2023.
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 6/1/2023 | Hired After 6/1/2023 | ||
| 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 | In-Network High Plan | In-Network Low Plan | |||
| Preventive Expenses | > Exams and cleanings (once/6 months) > X-rays (full mouth once/60 months) > Fluoride treatment (once/6 months) > Sealants to age 16 (once/36 months) > Space maintainers to age 16 | Covered at 100% | Covered at 100% | ||
| Basic Expenses | > Fillings > Periodontal maintenance > Repair/maintenance of crowns > Denture repairs > Anesthesia > Simple and Surgical Extractions | Covered at 80% | Covered at 50% | ||
| Major Expenses | > Bridges & dentures > Single crowns > Complex extractions > Periodontal surgery > Inlays, onlays & veneers > Endodontics (root canal) > Scaling & Root Planing (per quadrant) | Covered at 50% | Not Covered | ||
| Deductible: Single Family | --------------------------------> | $50 $150 | $50 $150 | ||
| Calendar Year Maximum | --------------------------------> | $1,000 (Includes Max Rollover) | $750 (Rollover Not Included) | ||
| Out-Of-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 | High Deductible Health Plan $3,000 | Copay Plan $500 | |||
|---|---|---|---|---|---|
| Benefit Summary | In-Network High Plan | In-Network Low Plan | |||
| Preventive Expenses | Exams and cleanings (once/6 months), X-rays (full mouth once/60 months), Fluoride treatment (once/6 months), Sealants to age 16 (once/36 months) & Space maintainers to age 16 | Covered at 100% | Covered at 100% | ||
| Basic Expenses | Fillings, Periodontal maintenance, Repair/maintenance of crowns, Denture repairs, Anesthesia & Simple and Surgical Extractions | Covered at 80% | Covered at 50% | ||
| Major Expenses | Bridges & dentures, Single crowns, Complex extractions, Periodontal surgery, Inlays, onlays & veneers, Endodontics (root canal) & Scaling & Root Planing (per quadrant) | Covered at 50% | Not Covered | ||
| Deductible: Single Family | -----------------> | $50 $150 | $50 $150 | ||
| Calendar Year Maximum | -----------------> | $1,000 (Includes Max Rollover) | $750 (Rollover Not Included) | ||
| Out-Of-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. | ||||
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
Network DentalGuard Preferred
1-800-600-1600
Dental Employee Bi-Weekly Contribution
| Dental Buy-Up | Dental Care | |
|---|---|---|
| Dental Buy-Up | Dental Care | |
| Employee Only | $11.74 | $4.23 |
| Employee + Spouse | $30.52 | $14.79 |
| Employee + Child(ren) | $37.56 | $18.78 |
| Employee + Family | $56.10 | $29.35 |
| Dental Buy-Up | Dental Care | |
|---|---|---|
| Dental Buy-Up | Dental Care | |
| Employee Only | $11.74 | $4.23 |
| Employee + Spouse | $30.52 | $14.79 |
| Employee + Child(ren) | $37.56 | $18.78 |
| Employee + Family | $56.10 | $29.35 |
VISION BENEFIT SUMMARY IN-NETWORK
(Scroll sideways to see all options)
| High Plan | Low Plan | ||||||
|---|---|---|---|---|---|---|---|
| High Plan | Low Plan | ||||||
| Allowances | Benefit Frequency | Discounts | Benefit Frequency | ||||
| Eye Exam | $0 copay | Every 12 months | $0 copay | Every 12 months | |||
| Lenses: Single Vision, Lined Bifocal, Lined Trifocal & Lenticular | $0 copay | Every 24 months | 20% off retail price | Not Applicable | |||
| Contact Lenses Elective Medically Necessary Evaluation & Fitting (in lieu of eyeglass lenses and/or frames) | $0 copay $120 maximum 15% discount off usual & customary fee | Every 24th months | No discounts No discounts 15% discount off usual & customary fee | Not Applicable | |||
| Frames | $120 retail maximum plus | Every 24 months | 20% off retail price | No limit if within 12 months of eye exam | |||
| Network | VSP | Find A Provider www.GuardianAnyTime.com | |||||
| Out-of-Network Benefits | Out-of-network benefits are allowed, however, copays and maximums are less. Employees using out-of-network providers may be responsible for additional fees. | ||||||
| High Plan | Low Plan | ||||||
|---|---|---|---|---|---|---|---|
| High Plan | Low Plan | ||||||
| Allowances | Benefit Frequency | Discounts | Benefit Frequency | ||||
| Eye Exam | $0 copay | Every 12 months | $0 copay | Every 12 months | |||
| Lenses: Single Vision Lined Bifocal Lined Trifocal Lenticular | $0 copay | Every 24 months | 20% off retail price | Not Applicable | |||
| Contact Lenses Elective Medically Necessary Evaluation & Fitting (in lieu of eyeglass lenses and/or frames) | $0 copay $120 maximum 15% discount off usual & customary fee | Every 24th months | No discounts No discounts 15% discount off usual & customary fee | Not Applicable | |||
| Frames | $120 retail maximum plus | Every 24 months | 20% off retail price | No limit if within 12 months of eye exam | |||
| Network | VSP | Find A Provider www.GuardianAnyTime.com | |||||
| Out-of-Network Benefits | Out-of-network benefits are allowed, however, copays and maximums are less. Employees using out-of-network providers may be responsible for additional fees. | ||||||
Vision Employee Bi-Weekly Contribution
| Vision High Plan | Vision Low Plan | |
|---|---|---|
| Vision High Plan | Vision Low Plan | |
| Employee Only | $4.35 | $0.42 |
| Employee + Spouse | $7.23 | $0.95 |
| Employee + Child(ren) | $7.50 | $0.95 |
| Employee + Family | $11.95 | $1.73 |
| Dental Buy-Up | Dental Care | Vision High Plan | Vision Low Plan | |
|---|---|---|---|---|
| Dental Buy-Up | Dental Care | Vision High Plan | Vision Low Plan | |
| Employee Only | $11.74 | $4.23 | $4.35 | $0.42 |
| Employee + Spouse | $30.52 | $14.79 | $7.23 | $0.95 |
| Employee + Child(ren) | $37.56 | $18.78 | $7.50 | $0.95 |
| Employee + Family | $56.10 | $29.35 | $11.95 | $1.73 |
LIFE INSURANCE BENEFITS
Basic Life & Accidental Death & Dismemberment (AD&D)
We provide basic life and accidental death and dismemberment insurance at no cost for our employees.
| Benefits | Details |
|---|---|
| Benefits | Details |
| Coverage Amount | $100,000 |
| Insurance Carrier | Guardian |
| Age Reduction Rule | Benefit reduces by 35% at age 65, 60% at age 70, 75% at age 75 and 85% at age 80 |
| Portability | Allows you to take coverage with you if you terminate employment. Age and timeline restrictions apply, see Human Resources for information. |
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: $200,000, less than 65 years old; $50,000, 65-69; $10,000, 70+ $10,000 minimum to $500,000 maximum ($10,000 increments) Spouse: $30,000, less than 65 years old; $10,000, 65-69; $0, 70+ $5,000 minimum to $250,000 maximum or up to 100% of employee coverage ($5,000 increments) Spouse cost based on employee’s age band; Spouse coverage ends at age 70 $10,000 Child: $1,000 to $10,000 in $1,000 increments, not to exceed 100% of employee coverage (14 days to 26 years). Same rate and coverage for all children. |
| Insurance Carrier | Guardian |
| Age Reduction Rule | Benefit reduces by 35% at age 65, 60% at age 70, 75% at age 75 and 85% at age 80 |
| Portability | Allows you to take coverage with you if you terminate employment. Age and timeline restrictions apply, see Human Resources for information. |
| Evidence of Insurability | Evidence of Insurability is required for employees that do not elect the benefit when initially eligible or for coverage amounts over the Guaranteed Issue amount. |
| Details |
|---|
| Details |
| GUARANTEED COVERAGE AMOUNT & BENEFIT MAXIMUMUS: Employee: $200,000, less than 65 years old; $50,000, 65-69; $10,000, 70+ $10,000 minimum to $500,000 maximum ($10,000 increments) Spouse: $30,000, less than 65 years old; $10,000, 65-69; $0, 70+ $5,000 minimum to $250,000 maximum or up to 100% of employee coverage ($5,000 increments) Spouse cost based on employee’s age band; Spouse coverage ends at age 70 $10,000 Child: $1,000 to $10,000 in $1,000 increments, not to exceed 100% of employee coverage (14 days to 26 years). Same rate and coverage for all children. |
| INSURANCE CARRIER: Guardian |
| AGE REDUCTION RULE: Benefit reduces by 35% at age 65, 60% at age 70, 75% at age 75 and 85% at age 80 |
| PORTABILITY: Allows you to take coverage with you if you terminate employment. Age and timeline restrictions apply, see Human Resources for information. |
| EVIDENCE OF INSURABILITY: Evidence of Insurability is required for employees that do not elect the benefit when initially eligible or for coverage amounts over the Guaranteed Issue amount. |
INCOME PROTECTION BENEFITS
Other than medical and life insurance, disability insurance is one of the most important benefits you can elect. If you are disabled and unable to work, short term and long term disability insurance can help replace lost income and make a difficult time a little easier. Disability benefits are available to full-time employees. PTO/vacation time may be required to meet the elimination period before benefits begin. Evidence of Insurability is required for employees that do not elect the disability benefits when initially eligible for coverage.
| Details | Short Term Disability | Long Term Disability |
|---|---|---|
| Details | Short Term Disability | Long Term Disability |
| Benefit | 60% of your pre-disability base salary to a maximum weekly benefit of $1,000 | 60% of your pre-disability base salary to a maximum monthly benefit of $5,000 |
| Waiting (Elimination) Period | Benefits begin on the 1st day for accident, 8th day for illness | Benefits begin after 90 days |
| Benefit Duration | 13 weeks after elimination period | Normal Social Security Retirement Age |
| Benefits Based On | Your own occupation | Your own occupation for the first 24 months; any occupation thereafter |
| Pre-existing Conditions Limitation | Not Applicable | 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 | XXXX contributes 50% of the cost for this coverage | 100% Employee Paid |
| Insurance Carrier | Guardian | Guardian |
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 and Benefit Maximums | Employee: $20,000 (choose lump sum benefit of $5,000, $10,000, $15,000 or $20,000) Spouse: $10,000 (limit to 50% of employee benefit) Child: 25% of employee benefit |
| Covered Conditions | Cancer (invasive, carcinoma, skin), Vascular (heart attack, stroke), Kidney and other organ failure, ALC, Coma, Parkinson's Disease, Burns, Alzheimer's Disease, Multiple Sclerosis, Childhood Conditions (see plan highlights on Employee Navigator for a complete list and benefits) |
| Wellness 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 | Principal |
| 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) |
| Evidence of Insurability | Evidence of Insurability is required for employees that do not elect the benefit when initially eligible. |
Critical Illness policies have exclusions and limitations that may impact the eligibility for or entitlement to benefits under each covered condition. The certificate of coverage provides full details. This policy will not pay for diagnosis of a listed critical illness that is made before the covered person’s Critical Illness insurance effective date with the carrier.
Accident Insurance
Accident Insurance is available to our employees and eligible dependents. The coverage is for off the job accidents. Benefits are paid directly to the insured and can be used under their discretion for medical or household expenses. Benefits are paid on a schedule basis for most accidents.
| Benefits | Details |
|---|---|
| Benefits | Details |
| Accidental Dealth | Employee: $50,000 Spouse: $25,000 Child: $10,000 |
| Covered Accidents/Expenses | Accidental Dismemberment, Air Ambulance expense, Ambulance expenses, Blood, Accidental Burns, Child Organized Sports, Concussions, Dislocations, Fractures, Hospitcal ICU Admission, Lacerations (see plan highlights on Employee Navigator for a complete list of benefits) |
| Scheduled Payment Examples | Ambulance: $200 Concussion: $200 Dislocations: Schedule up to $5,000 Fractures: Schedule up to $6,000 Hospital Admission: $1,000 |
| Insurance Carrier | Guardian |
| Portability | Allows the employee to take the coverage with them if employment has ended (application timeline applies, see Human Resources) |
Accident policies have exclusions and limitations that may impact the eligibility for or entitlement to benefits under each covered accident. The certificate of coverage provides full details. This policy will not pay for diagnosis of a listed accident that occurs before the covered person’s Accident insurance effective date with the carrier. Exclusions include, but not limited to, accident related to covered person being legally intoxicated, armed aggression, service in the armed forces, suicide or attempted suicide, travel, air travel, professional sports, hang gliding, bungee jumping, parachuting, ballooning, substance abuse, etc.
| Payroll Contributions Bi-Weekly | ||
|---|---|---|
| Payroll Contributions Bi-Weekly | ||
| Employee | $5.61 | |
| Employee + Spouse | $9.12 | |
| Employee + Child(ren) | $9.29 | |
| Employee + Family | $12.79 | |
Hospital Indemnity
Hospital Indemnity insurance can help pay for non-medical expenses such as transportation to treatment facilities and everyday expenses like groceries, rent or mortgage payments. The benefit can also pay for medical plan deductibles, co-pays and other out-of-pocket medical expenses. This insurance is compatible with a Health Savings Account medical plan. Benefits are paid directly to the insured.
| Benefits | Details |
|---|---|
| Benefits | Details |
| Hospital/ICU Admission | $1,000 per admission to a maximum of one admission per year, per insured. Family maximum: 3 admissions per year, per covered family |
| Hospital/ICU Confinement | $100 per day to a maximum of 15 days per year, per insured |
| Treatments Covered | Hospital Admission benefits are not payable for birth within the first nine months of obtaining this coverage |
| Treatment of Normal Pregnancy | Hospital Admission benefits are not payable for birth within the first nine months of obtaining this coverage |
| 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 even 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. |
Hospital Indemnity plans have exclusions and limitations that may impact the eligibility for or entitlement to benefits. The certificate of coverage provides full details.
Payroll Contributions
Pet Insurance
XXXXX offers Pet Insurance through Nationwide. Nationwide offers plans that would cover your furry friend at different levels of protection. Pricing of the pet insurance plan is based on which plan option you select, the state you live in, and the type of pet being covered. Nationwide does not base rates off of the breed or age of your dog, which is a huge benefit to you! If you are interested in electing coverage for your pet.
Answer question about pet species and zip code. Choose product and enter payment and once sign up, send confirmation to Human Resources for payroll deductions to take place.
My Pet Protection plan highlights for dogs and cats
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.
MetLife Auto & Home
Just like medical, premiums and out-oof-pocket expenses for auto and home insurance are going up. From auto accidents to natural disasters, there has been an increase in the severity and frequency of incidents. And without the right coverage, an accident or storm can be devastating to your employees’ financial wellbeing. With MetLife Auto & Home®, you can give your employees access to the protection they need to stay prepared for the unexpected. And the support they need to get back on track.
After medical, auto and home insurances rank among the top 5 must-have benefits for employees.
Employees saved an average of $562 on auto insurance when they switched to MetLife Auto & Home.
Personalized protection for the right fit
Everyone has different needs at different stages of life. That’s why we offer a wide range of products and services – providing the flexibility for your employees to choose what’s right for them.
Valuable savings on coverages employees need
Finding more money within a monthly budget to get the right benefits can be challenging for most employees. By offering auto and home through your group benefits program, you can give them access to valuable group discounts. And when employees save on coverage they already have, it gives them more options to get the right protection. Best of all, our simple, convenient solutions like payroll deduction help them balance their monthly budget.
MetLife Legal
A Nationwide Network of Attorneys
MetLife Legal Plans is a voluntary group legal plan that can help employers increase the value of their benefits offerings by providing employees with convenient access to affordable legal services. Plan members may receive services through a nationwide network of more than 18,500 attorneys, or from an out-of-network attorney.
Extensive Legal Services
MetLife Legal Plans provides easy, direct access to a national network of attorneys who provide telephone advice and office consultations on an unlimited number of personal legal matters and fully covered services for the most frequently needed person al legal matters (excluding employment issues). Participants may also receive service from out-of-network attorneys. Examples of covered legal services include:
Network attorneys are carefully selected and monitored by MetLife Legal Plans, and have an average of 25 years of experience in the practice of law.
Digital Estate Planning Solution
MetLife offers employees the ability to choose an attorney for estate planning or create their own plan through our digital estate planning solution. With digital estate planning solution, employees are taken through a simple, guided process to complete wills, living wills and/or power of attorney, in as little as 15 minu5tes.
Retirewise
Education is your greatest tool! The workshops are delivered by experienced, licensed third party financial professionals who meet stringent credentials requirements. Visit: MetLife.com/plansmartsolutions.com
As a foundation to MetLife’s PlanSmart® workshop series, Retirewise®, an award-winning program, can play an important and fundamental role in your employees’ financial and retirement planning. The program delivers objective information that covers a broad spectrum of financial and related topics from basic investing concepts to the importance of having a will.
The program is divided into four parts:
1. Building the Foundation
2. Creating and Managing Wealth
3. Establishing Your Retirement Income Stream
$. Making the Most of What You Have
MetLife has an arrangement with third party financial professionals to deliver the program. These specially trained local financial professionals deliver each session and are available for an optional one-on-one educational consultation. No matter what age, background or stage of planning your employees are in – there is something for everyone to learn.
Employee Assistance Program (EAP)
This is provided to you at NO COST and is confidential. You are allowed up to three face-to-face visits per family member, per year, with a doctoral psychologist or other behavioral health professional. We care about you and your family’s total health management. For that reason, we are providing you access to an Employee Assistance Program at no cost to you.
WorkLifeMatters can offer help with:
Dependent Care & Care Giving
Lifestyle & Fitness Management
Education
Working Smarter
Legal & Financial
EAP Provider Information
www.ibhworklife.com
Username: Matters
Password: wlm70101
Call: 1-800-386-7055
Annual Notices: Under federal law, we are required to provide or have available specific benefit notices for your review. All annual notices are available on our benefit administration platform or from Human Resources. If you would like to review the Annual Notices now, please CLICK HERE.
Disclaimer: This benefit guide provides highlights of the benefits available. Please request a copy of the plan certificate for additional coverage details, limitations, exclusions and restrictions. If any conflict shall arise between this document and the plan certificate, the plan certificate will govern in all cases.