Welcome, General Hotels Employees
Welcome, General Hotels 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.
ENGLISH VERSION
Versión en español
Versión en español
ELIGIBILITY
Eligibility
Eligibility Definitions
Employee:
A full-time employee who is scheduled to work at least 30 hours per week
Dependent:
New Employees
As a new, full-time employee (working 30 or more hours per week), your benefits will become effective: the first of the month, after 30 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:
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. 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
10/27/2022 – 11/23/2022
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.
10/27/2022 – 11/23/2022
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 computer identifier:
GeneralHotels (no space is correct)
Log On To Enroll
You will receive an email from noreply@employeenavigator.com that provides your registration link and company identifier code. To access employee navigator, you will need to enter the credentials you used when you originally registered with Employee Navigator. If you cannot remember your credentials, use the forget password or forgot username option on the login screen, then follow the prompts. An email will be sent to the email address you originally provided during your registration. Keep in mind, it could be your work email OR your personal email account.
Go to (or click) https://www.employeenavigator.com/benefits/Account/Login to login to Employee Navigator
MEDICAL BENEFITS
Choose the Plan that is Best for You and Your Family
We will continue to offer three medical plans to provide choice for you and your family.
Also, we are very pleased to continue our wellness program in 2023. Our program is designed to give you choices, so it fits your lifestyle and includes your family. The health coaching team from American Health & Wellness will continue to provide support with weight management, nutrition, wellbeing, exercise and more.
Also, we are very pleased to continue our wellness program in 2023. Our program is designed to give you choices, so it fits your lifestyle and includes your family. The health coaching team from American Health & Wellness will continue to provide support with weight management, nutrition, wellbeing, exercise and more.
MEDICAL PLAN OPTIONS
Your employer offers 3 medical options:
Plans: (Scroll sideways to see all 3 plans)
| Network Benefits 1/1/2023 - 12/31/2023 | Traditional PPO Plan Your Responsibility | High Deductible Health Plan Your Responsibility | Preventive Only Plan Your Responsibility |
|---|---|---|---|
| Network Benefits 1/1/2023 - 12/31/2023 | Traditional PPO Plan Your Responsibility | High Deductible Plan Your Responsibility | Preventive Only Plan Your Responsibility |
| Annual Deductible (embedded) Individual | $2,500 | $3,000 | N/A |
| Annual Deductible (embedded) Family | $7,500 | $6,000 | N/A |
| Out-of-Pocket Maximum (including deductible, copays & coinsurance) - Individual | $6,000 | $6,000 | N/A |
| Out-of-Pocket Maximum (including deductible, copays & coinsurance) - Family | $12,000 | $12,000 | N/A |
| Coinsurance In Network | 20% | 20% | N/A |
| Office Visit Copays - Primary (PCP) | $30 | Deductible, then 20% | 2 Visits per year; $0 copay |
| Office Visit Copays - Specialist | $60 | Deductible, then 20% | N/A |
| Telemedicine/Virtual Mental Health—24x7 (Doctor Visit via Phone) | $0 | $0 | $0 |
| Prescription Drugs Copays: Retail/Mail Order Supply: 30/90 day - Tier 1: generic | $10/$25 | Deductible, then 20% | Preventive medications covered in full |
| Prescription Drugs Copays: Retail/Mail Order Supply: 30/90 day - Tier 2: brand | $35/$87.50 | Deductible, then 20% | Preventive medications covered in full |
| Prescription Drugs Copays: Retail/Mail Order Supply: 30/90 day - Tier 3: formulary | $60/$150 | Deductible, then 20% | Preventive medications covered in full |
| Prescription Drugs Copays: Retail/Mail Order Supply: 30/90 day - Tier 4: specialty | $100/$250 | Deductible, then 20% | Preventive medications covered in full |
| Medicare Part D Creditable Status (Creditable means the Rx plan is as good as Medicare Part D) | Creditable | Creditable | Not Creditable |
| Preventive Care (Routine Exams, Colonoscopies, Immunizations, Well Baby Care & Mammograms) | Covered at 100% | Covered at 100% | Covered at 100% |
| Emergency Room (Charges outside of the facility could be billed separately) | $250 copay, then 20% | Deductible, then 20% | N/A |
| Urgent Care (Charges outside of the facility could be billed separately) | $50 copay per visit | Deductible, then 20% | N/A |
| Inpatient Hospital | Deductible; then 20% | Deductible; then 20% | N/A |
| Outpatient Surgery | Deductible; then 20% | Deductible; then 20% | N/A |
| Out-of-Network Benefits - Deductible (Single/Family) | $5,000/$15,000 | $6,000/$12,000 | N/A |
| Out-of-Network Benefits - Out-of-Pocket (Single/Family) | $8,000/$24,000 | $12,000/$24,000 | N/A |
| Out-of-Network Benefits - Coinsurance (Single/Family) | 40% | 40% | N/A |
| Network Benefits 1/1/2023 - 12/31/2023 | Traditional PPO Plan Your Responsibility | High Deductible Health Plan Your Responsibility | Preventive Only Plan Your Responsibility |
|---|---|---|---|
| Network Benefits 1/1/2023 - 12/31/2023 | Traditional PPO Plan Your Responsibility | High Deductible Plan Your Responsibility | Preventive Only Plan Your Responsibility |
| Annual Deductible (embedded) Individual | $2,500 | $3,000 | N/A |
| Annual Deductible (embedded) Family | $7,500 | $6,000 | N/A |
| Out-of-Pocket Maximum (including deductible, copays & coinsurance) - Individual | $6,000 | $6,000 | N/A |
| Out-of-Pocket Maximum (including deductible, copays & coinsurance) - Family | $12,000 | $12,000 | N/A |
| Coinsurance In Network | 20% | 20% | N/A |
| Office Visit Copays - Primary (PCP) | $30 | Deductible, then 20% | 2 Visits per year; $0 copay |
| Office Visit Copays - Specialist | $60 | Deductible, then 20% | N/A |
| Telemedicine/Virtual Mental Health—24x7 (Doctor Visit via Phone) | $0 | $0 | $0 |
| Prescription Drugs Copays: Retail/Mail Order Supply: 30/90 day - Tier 1: generic | $10/$25 | Deductible, then 20% | Preventive medications covered in full |
| Prescription Drugs Copays: Retail/Mail Order Supply: 30/90 day - Tier 2: brand | $35/$87.50 | Deductible, then 20% | Preventive medications covered in full |
| Prescription Drugs Copays: Retail/Mail Order Supply: 30/90 day - Tier 3: formulary | $60/$150 | Deductible, then 20% | Preventive medications covered in full |
| Prescription Drugs Copays: Retail/Mail Order Supply: 30/90 day - Tier 4: specialty | $100/$250 | Deductible, then 20% | Preventive medications covered in full |
| Medicare Part D Creditable Status (Creditable means the Rx plan is as good as Medicare Part D) | Creditable | Creditable | Not Creditable |
| Preventive Care (Routine Exams, Colonoscopies, Immunizations, Well Baby Care & Mammograms) | Covered at 100% | Covered at 100% | Covered at 100% |
| Emergency Room (Charges outside of the facility could be billed separately) | $250 copay, then 20% | Deductible, then 20% | N/A |
| Urgent Care (Charges outside of the facility could be billed separately) | $50 copay per visit | Deductible, then 20% | N/A |
| Inpatient Hospital | Deductible; then 20% | Deductible; then 20% | N/A |
| Outpatient Surgery | Deductible; then 20% | Deductible; then 20% | N/A |
| Out-of-Network Benefits - Deductible (Single/Family) | $5,000/$15,000 | $6,000/$12,000 | N/A |
| Out-of-Network Benefits - Out-of-Pocket (Single/Family) | $8,000/$24,000 | $12,000/$24,000 | N/A |
| Out-of-Network Benefits - Coinsurance (Single/Family) | 40% | 40% | N/A |
Employee Payroll Contributions
Premium contributions will be deducted from your paycheck on a pre-tax basis. General Hotels has 26 pay cycles, however, our benefit deductions are only taken 24 times a year. Twice a year, enjoy two paychecks without benefit deductions. Below shows your payroll deductions based on 24 pays.
Employee Contributions
Plans: (Scroll sideways to see all 3 plans)
| Description | Traditional PPO Plan | High Deductible Health Plan | Preventive Only Plan |
|---|---|---|---|
| Employee Only | $157.50 | $87.50 | $15.00 |
| Employee + 1 | $333.00 | $189.00 | $30.00 |
| Employee + Family | $594.00 | $336.00 | $15 per person |
| Description | Traditional PPO Plan | High Deductible Health Plan | Preventive Only Plan |
|---|---|---|---|
| Employee Only | $157.50 | $87.50 | $15.00 |
| Employee + 1 | $333.00 | $189.00 | $30.00 |
| Employee + Family | $594.00 | $336.00 | $15 per person |
Medical Resources Support & Mobile App
You have questions about your benefits
Need help with a claim
Need to find a provider
TELEMEDICINE AND VIRTUAL MENTAL HEALTH WITH FIRST STOP HEALTH
Plan Information
Which plan is right for you?
| High Deductible Health Plan | Traditional Plan | Preventive Only Plan |
|---|---|---|
| High Deductible Health Plan | Traditional Plan | Preventive Only Plan |
| Lower Payroll Deductions | Higher Payroll Deductions | Lowest Payroll Deductions |
| Deductible Applies First | Copays Apply First | Copays for office visits and prescriptions |
| 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 | N/A |
| 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. | Coverage excludes inpatient hospital Services and catastrophic events. Please carefully evaluate your care needs. |
| Catastrophic Coverage | Catastrophic Coverage | Limited Office Visits and Prescriptions (not catastrophic coverage) |
| Telemedicine Unlimited | Telemedicine Unlimited | Telemedicine Unlimited |
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
An urgent care facility is an extension of your primary care physician. A hospital emergency room should be used for health conditions that require a high level of care. Research your plan’s network to know what facilities are in the network.
HEALTH SAVINGS ACCOUNT (HSA)
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.
PHARMACY BENEFITS
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.
Find A Pharmacy And View The Formulary List
www.optumrx.com
https://professionals.optumrx.com/resources/formulary-resources/select-formulary.html
Potential Savings With Generic Medications
To get the most from your benefits, ask your doctor if a generic* medication is right for you. Generics normally cost less than brand medications, and the Food and Drug Administration (FDA) requires them to be just as safe and effective
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).
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!
Confidentiality
To protect your privacy and protected health information, American Health & Wellness Group (AHW) administers our wellness program. All health coaches are HIPAA (Health Insurance Portability and Accountability Act) certified. This means the information you share with your health coach is private and secure.
Nicotine Cessation
If you are a current nicotine user and ready to quit, there are options available to help.
Take Charge
Taking charge of your health starts with getting your annual, preventive exam to know your biometric numbers. Your weight, cholesterol, blood pressure and blood glucose numbers are key indicators of health. Your health coach will help you review your physician results and help create a lifestyle plan if you need to improve your numbers.
DENTAL BENEFIT SUMMARY
(Scroll sideways to see all options)
| Benefit Summary | In-Network High Plan | In-Network Low Plan | |||
|---|---|---|---|---|---|
| Benefit Summary | In Network | Out of Network | |||
| Preventive Expenses | > Exams and cleanings (once/6 months) > X-rays (full mouth once/36 months) > Fluoride treatment to age 19 (once every year) > Sealants to age 16 (once/36 months) | Covered at 100%, no deductible | Covered at 100%, no deductible | ||
| Basic Expenses | > Fillings > Repair/maintenance of crowns, bridges & dentures > Simple Extractions | Covered at 80% | Covered at 50% | ||
| Major Expenses | > Anesthesia > Bridges & dentures > Inlays, onlays and veneers > Periodontal surgery > Periodontal Maintenance (once every 6 months) > Endodontic services (root canals) > Scaling and root planning (per quadrant) > Single crowns > Surgical Extractions | Covered at 50% | Covered at 20% | ||
| Deductible | Single Family | $25 $75 | $100 $300 | ||
| Calendar Year Maximum | Includes Maximum Rollover with a rollover account limit of $1,000 Maximum is combined in-network and out-of-network maximum of $1,000 with an additional $1,000 of benefit for in-network | $2,000 | $1,000 | ||
| Orthodontia | Dependent Children Only | $1,000 Lifetime Maximum Covered at 50% | |||
| 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 High Plan | In-Network Low Plan | |||
|---|---|---|---|---|---|
| Benefit Summary | In Network | Out of Network | |||
| Preventive Expenses | > Exams and cleanings (once/6 months) > X-rays (full mouth once/36 months) > Fluoride treatment to age 19 (once every year) > Sealants to age 16 (once/36 months) | Covered at 100%, no deductible | Covered at 100%, no deductible | ||
| Basic Expenses | > Fillings > Repair/maintenance of crowns, bridges & dentures > Simple Extractions | Covered at 80% | Covered at 50% | ||
| Major Expenses | > Anesthesia > Bridges & dentures > Inlays, onlays and veneers > Periodontal surgery > Periodontal Maintenance (once every 6 months) > Endodontic services (root canals) > Scaling and root planning (per quadrant) > Single crowns > Surgical Extractions | Covered at 50% | Covered at 20% | ||
| Deductible | Single Family | $25 $75 | $100 $300 | ||
| Calendar Year Maximum | Includes Maximum Rollover with a rollover account limit of $1,000 Maximum is combined in-network and out-of-network maximum of $1,000 with an additional $1,000 of benefit for in-network | $2,000 | $1,000 | ||
| Orthodontia | Dependent Children Only | $1,000 Lifetime Maximum Covered at 50% | |||
| 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 Contribution
| Dental Care | |
|---|---|
| Dental Care | |
| Employee Only | $13.10 |
| Employee + 1 | $26.85 |
| Employee + Family | $51.16 |
| Dental Care | |
|---|---|
| Dental Care | |
| Employee Only | $13.10 |
| Employee + 1 | $26.85 |
| Employee + Family | $51.16 |
VISION BENEFIT SUMMARY IN-NETWORK
(Scroll sideways to see all options)
| High Plan | |||
|---|---|---|---|
| Benefit Summary | |||
| Copay | Benefit Frequency | ||
| Eye Exam | $10 copay | Every calendar year | |
| Lenses | $25 for single vision, bifocal, trifocal, lenticular | Every calendar year | |
| Contact Lenses (in lieu of eyeglass lenses and/or frames) | $25 copay if medically necessary $150 max (copay waive), if elective | Every calendar year | |
| Frames | $150 retail maximum + 20% off balance | Every two calendar years | |
| 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 | |||
|---|---|---|---|
| Benefit Summary | |||
| Copay | Benefit Frequency | ||
| Eye Exam | $10 copay | Every calendar year | |
| Lenses | $25 for single vision, bifocal, trifocal, lenticular | Every calendar year | |
| Contact Lenses (in lieu of eyeglass lenses and/or frames) | $25 copay if medically necessary $150 max (copay waive), if elective | Every calendar year | |
| Frames | $150 retail maximum + 20% off balance | Every two calendar years | |
| 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 Contribution
| Vision High Plan | |
|---|---|
| Vision Care | |
| Employee Only | $4.36 |
| Employee + 1 | $8.16 |
| Employee + Family | $12.41 |
| Vision High Plan | |
|---|---|
| Vision Care | |
| Employee Only | $4.36 |
| Employee + 1 | $8.16 |
| Employee + Family | $12.41 |
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 | $15,000 |
| Insurance Carrier | Guardian |
| Age Reduction Rule | Benefit reduces 35% at age 65; and at age 50% at age 75 |
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.
(Scroll sideways to see all options)
| Benefits | All Full-Time Employees (Guardian) | Salaried Employees (MetLife) |
|---|---|---|
| Benefits | All Full-Time Employees (Guardian) | Salaried Employees (MetLife) |
| Guaranteed Coverage Amount and Benefit Maximums | Employee: $120,000, <65 years old; $50,000, 65-69 years old; $10,000, 70+ years old $10,000 minimum to $500,000 maximum ($10,000 increments) Spouse: $50,000, <65 years old; $10,000, 65-69 years old; $0, 70+ years old $5,000 minimum to $100,000 maximum not to exceed 50% of employee’s amount ($5,000 increments) Child: $10,000 (infant birth to 14 days $1,000) $2,500 minimum to $10,000 maximum Not to exceed 100% of employee’s amount (same rate and coverage for all children) | Employee: $200,000 $10,000 minimum to $500,000 maximum ($10,000 increments) Spouse: Not Applicable $5,000 minimum to $100,000 maximum not to exceed 50% of employee’s amount ($5,000 increments) Child: Not Applicable $2,500 minimum to $10,000 maximum Not to exceed 100% of employee’s amount (same rate and coverage for all children) |
| Insurance Carrier | Guardian | MetLife |
| Grief Counseling | www.ibhworklife.com User name: WorkLife; password: 70101 | www.metlifegc.lifeworks.com User name: metlifeassist; password: support |
| Will Preparation Services | Assistance Preparing a Will 1-800-386-7055 | Assistance Preparing a Will 1-800-821-6400 |
| Travel Assistance | Emergency Services when Traveling 1-410-453-6330 Travel Aid ID: 329111 | Emergency Services when Traveling http://webcorp.axa-assitance.com Login: axa; Password: travelassist |
| Portability | Included, see HR for details | Included, see HR for details |
| Age Reduction Rule | Benefit reduces 40% at age 75; 65% at age 80; 73% at age 85 and 80% at age 90 | None |
| 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. | 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 | All Full-Time Employees (Guardian) | Salaried Employees (MetLife) |
|---|---|---|
| Benefits | All Full-Time Employees (Guardian) | Salaried Employees (MetLife) |
| Guaranteed Coverage Amount and Benefit Maximums | Employee: $120,000, <65 years old; $50,000, 65-69 years old; $10,000, 70+ years old $10,000 minimum to $500,000 maximum ($10,000 increments) Spouse: $50,000, <65 years old; $10,000, 65-69 years old; $0, 70+ years old $5,000 minimum to $100,000 maximum not to exceed 50% of employee’s amount ($5,000 increments) Child: $10,000 (infant birth to 14 days $1,000) $2,500 minimum to $10,000 maximum Not to exceed 100% of employee’s amount (same rate and coverage for all children) | Employee: $200,000 $10,000 minimum to $500,000 maximum ($10,000 increments) Spouse: Not Applicable $5,000 minimum to $100,000 maximum not to exceed 50% of employee’s amount ($5,000 increments) Child: Not Applicable $2,500 minimum to $10,000 maximum Not to exceed 100% of employee’s amount (same rate and coverage for all children) |
| Insurance Carrier | Guardian | MetLife |
| Grief Counseling | www.ibhworklife.com User name: WorkLife; password: 70101 | www.metlifegc.lifeworks.com User name: metlifeassist; password: support |
| Will Preparation Services | Assistance Preparing a Will 1-800-386-7055 | Assistance Preparing a Will 1-800-821-6400 |
| Travel Assistance | Emergency Services when Traveling 1-410-453-6330 Travel Aid ID: 329111 | Emergency Services when Traveling http://webcorp.axa-assitance.com Login: axa; Password: travelassist |
| Portability | Included, see HR for details | Included, see HR for details |
| Age Reduction Rule | Benefit reduces 40% at age 75; 65% at age 80; 73% at age 85 and 80% at age 90 | None |
| 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. | 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.
(Scroll sideways to see all options)
| Details | Short Term Disability | Long Term Disability - Salaried Employees | Long Term Disability - Hourly Employees |
|---|---|---|---|
| Details | Short Term Disability | Long Term Disability - Salaried Employees | Long Term Disability - Hourly Employees |
| Benefit | 60% of your pre-disability base salary to a maximum weekly benefit of $1,500 | 60% of your pre-disability base salary to a maximum monthly benefit of $5,000 | 60% of your pre-disability base salary to a maximum monthly benefit of $6,000 |
| Waiting (Elimination) Period | Benefits begin after 14 days for accident and illness | Benefits begin after 90 days | Benefits begin after 90 days |
| Pre-existing Conditions Limitation | Any condition/symptom for which you, for three months prior to the coverage in this plan, consulted with a physician, received treatment, or took prescribed drugs. Coverage exclusion for the pre-existing condition applies for the first 12 months of coverage | Any condition/symptom for which you, for three months prior to the coverage in this plan, consulted with a physician, received treatment, or took prescribed drugs. Coverage exclusion for the pre-existing condition applies for the first 12 months of coverage. | Any condition/symptom for which you, for three months prior to the coverage in this plan, consulted with a physician, received treatment, or took prescribed drugs. Coverage exclusion for the pre-existing condition applies for the first 12 months of coverage. |
| Contribution | 100% Employee Paid | 100% Employee Paid | 100% Employee Paid |
| Benefit Duration | 11 weeks after elimination period | Normal Social Security Retirement Age | Two Years; Coverage ends at age 70 |
| Insurance Carrier | Guardian | Guardian | One America |
| Benefits Based On | Your own occupation | Your own occupation for the first 36 months; any occupation thereafter | Your own occupation |
ADDITIONAL BENEFITS
Critical Illness Insurance
Employees can purchase additional coverage for covered conditions and receive a lump sum payment. Payments are for first and second diagnosis of any qualified Critical Illnesses listed under the plan’s covered conditions. Benefits are paid directly to the insured and can be used under their discretion for medical or household expenses.
| Benefits | Details |
|---|---|
| Benefits | Details |
| Guaranteed Coverage Amount | Employee: $30,000 (choose lump sum increments of $15,000 to a maximum of $30,000) Spouse: $15,000 (limit to 50% of employee benefit) Child: $15,000 (limit to 50% of employee benefit) |
| Covered Conditions | Cancer (invasive, carcinoma, skin) Vascular (heart attack, stroke), Kidney and Other Organ Failure, ALS, Coma, Parkinson’s Disease, Burns, Alzheimer’s Disease, Multiple Sclerosis, Childhood Conditions (see plan highlights on Employee Navigator for a complete list and benefits) |
| Wellness Benefit | Provides a per year benefit for completing certain routine wellness screenings such as mammography, colonoscopy, pap smear, PSA. Benefits paid even if medical insurance is paying 100% of the cost: Employee: $50 Spouse: $50 Child: $50 |
| Insurance Carrier | Guardian |
| Pre-existing Condition Limitation | 3 month look back period, 12 month exclusion period |
| Portability | Allows the employee to take the coverage with them if employment has ended (application timeline applies, see Human Resources) |
| Age Reduction Rule | Benefit reduces by 50% at age 70 |
| Evidence of Insurability | Evidence of Insurability is required for employees that do not elect the benefit when initially eligible. |
Critical Illness policies have exclusions and limitations that may impact the eligibility for or entitlement to benefits under each covered condition. The certificate of coverage provides full details. This policy will not pay for diagnosis of a listed critical illness that is made before the covered person’s Critical Illness insurance effective date with the carrier.
Accident Insurance
Accident Insurance is available to our employees and eligible dependents. The coverage is for on and off 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: $25,000 Spouse: $12,500 Child: $5,000 |
| Covered Accidents/Expenses | Accidental Dismemberment, Air Ambulance expenses, Ambulance expenses, Blood, Accidental Burns, Child Organized Sports, Concussions, Dislocations, Fractures, Hospital ICU Admission, Lacerations, (see plan highlights on Employee Navigator for a complete list and benefits) |
| Examples of Payments | Air Ambulance: $1,000 Hospital Admission/Hospital ICU Admission: $1,000/$2,000 Fracture: Up to $5,500 |
| 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 24 Pays | ||
| Employee | $5.80 | |
| Employee + Spouse | $8.93 | |
| Employee + Child(ren) | $8.99 | |
| Employee + Family | $12.11 | |
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 30 days per insured per benefit year |
| Treatments Covered | Sickness and injury |
| 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 | Not applicable (see plan summary for limitations and exclusions on treatment for maternity) |
| 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
| Payroll Contributions Bi-Weekly | ||
|---|---|---|
| Payroll Contributions 24 Pays | ||
| Employee | $7.22 | |
| Employee + Spouse | $13.34 | |
| Employee + Child(ren) | $11.53 | |
| Employee + Family | $17.65 | |
Pet Insurance
GHC offers Pet Health Insurance! Pets are part of the family too, with ASPCA Pet Health Insurance you can customize each pet’s plan that is right for you and your fur baby. The program provides a 10% discount which can be combined with the 10% multiple pet discount for a maximum savings of 20%. This benefit will be direct bill, where you pay directly to ASPCA Pet Health Insurance in the frequency that you choose.
There are flexible coverages which is unique to each pet and budget! Choosing from the Complete Coverage plan that covers accidents and illness or the Accident Only plan for accident only coverage. You may also add optional preventative care at an additional cost. There is no waiting period for wellness, which begins on the effective date and a 14-day waiting period for accident and illness. Lastly, there is no waiting period at the beginning of a renewal year.
All pets 8 weeks and up are eligible with no upper age limits. There are no breed-specific or condition-specific exclusions.
With this plan pre-existing conditions are not covered. Employees can sign up at any time throughout the year. Visit www.aspcapetinsurance.com/GHC Priority code is EB22GHC.
With the ASPCA Pet Health Insurance program, you can choose the care you want when your pet is hurt or sick and take comfort in knowing they have coverage.
Simple to Use
Just pay your vet bill, submit claims, and get reimbursed for covered expenses! You’re free to visit any licensed vet, specialist, or emergency clinic you want, and you can choose to receive reimbursement by direct deposit or mail.
Customizable Options
Annual Limit – from $3,000 to unlimited.
Reimbursement Percentage – 90%, 80% or 70% of your covered vet bill.
Deductible – select $100, $250, or $500. You’ll only need to satisfy it once per 12-month policy period.
Add Preventive Care Coverage – Get reimbursed scheduled amounts for things that protect your pet from getting sick, like vaccines, dental cleanings, and screenings for a little more per month.
Select Accident-Only Coverage – If you’re just looking to have some cushion when your pet gets hurt, you can choose coverage that only includes care for accidents.
Employee Assistance Program (EAP)
This is provided to you at NO COST and is confidential. We care about you and your family’s total health management. For that reason, we are providing you access to an Employee Assistance Program at no cost to you. The service provides guidance for personal issues that you might be facing and information about other concerns that affect your life, whether it is a life event or on a day-to-day basis. The EAP, provided by Guardian, is in addition to the Virtual Mental Health services provided by First Stop Health.
Help for what matters most
WorkLifeMatters Employee Assistance Program offers services to help promote well-being and enhance the quality of life for you and your family. Support and guidance is available online for assistance with family and personal issues at ibhworklife.com and by phone at 1-800-386-7055.
WorkLifeMatters can offer help with:
Health
Family
Financial
WorkLifeMatters
Employee Assistance Program
Connect to a counselor for free support services
The Guardian Life Insurance Company of America
New York, NY
guardianlife.com
Email:
Phone: 1-800-386-7055
Available 24 hours a day, 7 days a week*
Web: ibhworklife.com
Username: WorkLife
Password: 70101
Support and guidance for you online or by phone
- You have unlimited access to support and helpful resources on our website, and you can consult with a professional counselor via telephone
- Face-to-face counseling sessions with an Uprise Health network provider – and up to three sessions are free of charge as part of WorkLifeMatters.
- Free initial 30-minute consultation with an attorney, with a 25% discount on attorney services thereafter.
- Unlimited telephonic support for financial problems or planning needs, and referral for face-to-face for more complex issues are provided for a fee.
Connect to a counselor for free support services:
1-800-386-7055 (Available 24 hours a day, 7 days a week*)
Visit ibhworklife.com (User name: WorkLife Password: 70101)
[Future written communications may be in English only.]
*Office hours: Monday-Friday 6am-5pm PST. Live answer exchange available after hours. WorkLifeMatters Program services are provided by Uprise Health, and its contractors. Guardian does not provide any part of WorkLifeMatters program services. Guardian is not responsible or liable for care or advice given by any provider or resource under the program. This information is for illustrative purposes only. It is not a contract. Only the Administration Agreement can provide the actual terms, services, limitations and exclusions. Guardian and Uprise Health reserve the right to discontinue the WorkLifeMatters program at any time without notice. Legal services provided through WorkLifeMatters will not be provided in connection with or preparation for any action against Guardian, Uprise Health or your employer. WorkLifeMatters Program services is not an insurance benefit and may not be available in all states. Uprise Health, Niguel, CA. File #2021-127686 (10/23) Pub 3525 GUARDIAN® and the GUARDIAN G® logo are registered service marks of The Guardian Life Insurance Company of America® and are used with express permission.
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.