Welcome, Kinetic Advantage Employees
Welcome, Kinetic Advantage Employees
Our Employee Benefits And Wellness Program
Table Of Contents
To make your life easier, click on the topics below to go directly to that information:
Annual Notices: Under federal law, we are required to provide or have available specific benefit notices for your review. All annual notices are available on our benefit administration platform or from Human Resources. If you would like to review the Annual Notices now, please CLICK HERE.
Disclaimer: This benefit guide provides highlights of the benefits available. Please request a copy of the plan certificate for additional coverage details, limitations, exclusions and restrictions. If any conflict shall arise between this document and the plan certificate, the plan certificate will govern in all cases.
OPEN ENROLLMENT AND NEW HIRE VIDEO
Welcome to our employee benefits program. We have designed a personalized video for you and your family to better understand all of the benefits offered to you.
At the same time, you’ll have an opportunity to meet the team from AHW that will be working with you. In addition to the video, we have designed the following benefit highlights to be user-friendly.
You can click on any topic you’re interested in vs having to scroll through the entire booklet.
ELIGIBILITY
Eligibility
Eligibility Definitions
Employee:
A full-time employee who is scheduled to work at least 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 until the day 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.
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
November 14 – 23
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.
November 14 – 23
We are using an online benefit administration system to capture your benefit elections. Our online enrollment systems is with Paylocity. 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:
MEDICAL BENEFITS
Medical Plan Options
Choose the Plan that is Best for You and Your Family
Our medical plan administrator is Imagine360. Imagine360 will be administering our built-in Price Protection Program which gives you the choice to utilize any doctor or hospital with no network penalties. The Price Protection Program will provide additional resources, such as:
- Care Navigation Services to help you find local doctors, hospitals and clinics
- Benefit Information and support with chronic diseases
- Savings for you and your family with Price Protection and billing support
- Online and mobile app resources to check claims, find a provider, access your ID card and more
- Telemedicine for unlimited, virtual emergency medical doctors.
Also, you will have a traditional provider network option available with Imagine360 and the Cigna Network.
Choosing a Doctor or Hospital
Price Protection
Price Protection option allows you to utilize any doctor or hospital without the worry if they are in-network or not.
Cigna Network
Cigna Network option will utilize the Cigna national network of providers. If you use an out-of-network provider your financial responsibility for the deductible, coinsurance and out-of-pocket maximum will be higher.
Price Protection
Price Protection option allows you to utilize any doctor or hospital without the worry if they are in-network or not.
Cigna Network
Cigna Network option will utilize the Cigna national network of providers. If you use an out-of-network provider your financial responsibility for the deductible, coinsurance and out-of-pocket maximum will be higher.
Also, we are very pleased to continue our wellness program. Our program is designed to give you choices, so it fits your lifestyle and includes your family. The health coaching team from American Health & Wellness will continue to provide support with weight management, nutrition, wellbeing, exercise and more.
Also, we are very pleased to continue our wellness program. Our program is designed to give you choices, so it fits your lifestyle and includes your family. The health coaching team from American Health & Wellness will continue to provide support with weight management, nutrition, wellbeing, exercise and more.
MEDICAL PLAN OPTIONS
Your employer offers 2 medical options:
Plans: (Scroll sideways to see all plans)
| Network Benefits 1/1/2023 - 12/31/2023 | High Deductible Health Plan $3,000 Your Responsibility | Copay Plan $1,500 Your Responsibility |
|---|---|---|
| Network Benefits 1/1/2023 - 12/31/2023 | High Deductible Health Plan $3,000 Your Responsibility | Copay Plan $1,500 Your Responsibility |
| Annual Deductible (embedded) Individual | $3,000 | $1,500 |
| Annual Deductible (embedded) Family | $6,000 | $3,000 |
| Out-of-Pocket Maximum (including deductible, copays & coinsurance) - Individual | $3,000 | $3,500 |
| Out-of-Pocket Maximum (including deductible, copays & coinsurance) - Family | $6,000 | $7,000 |
| Coinsurance In Network | 0% | 20% |
| Office Visit Copays - Primary (PCP) | Subject to Deductible | $25 per visit |
| Office Visit Copays - Specialist | Subject to Deductible | $45 per visit |
| Prescription Drugs Copays: Retail/Mail Order Supply: 30/90 day - Tier 1: generic | Subject to Deductible - All Tiers | $10/$30 |
| Prescription Drugs Copays: Retail/Mail Order Supply: 30/90 day - Tier 2: brand | Subject to Deductible - All Tiers | $30/$90 |
| Prescription Drugs Copays: Retail/Mail Order Supply: 30/90 day - Tier 3: formulary | Subject to Deductible - All Tiers | $50/$150 |
| Prescription Drugs Copays: Retail/Mail Order Supply: 30/90 day - Tier 4: specialty | Subject to Deductible - All Tiers | 25% up to $250 maximum |
| Medicare Part D Creditable Status | Creditable | Creditable |
| Preventive Care (Routine Exams, Colonoscopies, Immunizations, Well Baby Care & Mammograms) | Covered at 100% | Covered at 100% |
| Emergency Room (Charges outside of the facility could be billed separately) | Subject to Deductible, then 0% for true emergency (50% for non-true emergency) | $300 Copay per visit; then 20% after Deductible for a true emergency (50% for non-true emergency) |
| Urgent Care (Charges outside of the facility could be billed separately) | Subject to Deductible | $60 Copay per visit; the 20% coinsurance (deductible waived) |
| Inpatient Hospital | Subject to Deductible | Deductible; then 20% |
| Outpatient Surgery | Subject to Deductible | Deductible; then 20% |
| Network Benefits 1/1/2023 - 12/31/2023 | High Deductible Health Plan $3,000 Your Responsibility | Copay Plan $1,500 Your Responsibility |
|---|---|---|
| Network Benefits 1/1/2023 - 12/31/2023 | High Deductible Health Plan $3,000 Your Responsibility | Copay Plan $1,500 Your Responsibility |
| Annual Deductible (embedded) Individual | $3,000 | $1,500 |
| Annual Deductible (embedded) Family | $6,000 | $3,000 |
| Out-of-Pocket Maximum (including deductible, copays & coinsurance) - Individual | $3,000 | $3,500 |
| Out-of-Pocket Maximum (including deductible, copays & coinsurance) - Family | $6,000 | $7,000 |
| Coinsurance In Network | 0% | 20% |
| Office Visit Copays - Primary (PCP) | Subject to Deductible | $25 per visit |
| Office Visit Copays - Specialist | Subject to Deductible | $45 per visit |
| Prescription Drugs Copays: Retail/Mail Order Supply: 30/90 day - Tier 1: generic | Subject to Deductible - All Tiers | $10/$30 |
| Prescription Drugs Copays: Retail/Mail Order Supply: 30/90 day - Tier 2: brand | Subject to Deductible - All Tiers | $30/$90 |
| Prescription Drugs Copays: Retail/Mail Order Supply: 30/90 day - Tier 3: formulary | Subject to Deductible - All Tiers | $50/$150 |
| Prescription Drugs Copays: Retail/Mail Order Supply: 30/90 day - Tier 4: specialty | Subject to Deductible - All Tiers | 25% up to $250 maximum |
| Medicare Part D Creditable Status | Creditable | Creditable |
| Preventive Care (Routine Exams, Colonoscopies, Immunizations, Well Baby Care & Mammograms) | Covered at 100% | Covered at 100% |
| Emergency Room (Charges outside of the facility could be billed separately) | Subject to Deductible, then 0% for true emergency (50% for non-true emergency) | $300 Copay per visit; then 20% after Deductible for a true emergency (50% for non-true emergency) |
| Urgent Care (Charges outside of the facility could be billed separately) | Subject to Deductible | $60 Copay per visit; the 20% coinsurance (deductible waived) |
| Inpatient Hospital | Subject to Deductible | Deductible; then 20% |
| Outpatient Surgery | Subject to Deductible | Deductible; then 20% |
Cigna
Out-of-Network Benefits
Plans: (Scroll sideways to see all plans)
| Network Benefits 1/1/2023 - 12/31/2023 | High Deductible Health Plan Your Responsibility | Copy Plan Your Responsibility |
|---|---|---|
| Out-of-Network Benefits | High Deductible Health Plan Your Responsibility | Copay Plan Your Responsibility |
| ANNUAL DEDUCTIBLE (Single/Family) | $5,200/$10,400 | $3,000/$6,000 |
| OUT-OF-POCKET MAX (Single/Family) | $6,000/$12,000 | $7,000/$14,000 |
| COINSURANCE | 20% | 50% |
| Network Benefits 1/1/2023 - 12/31/2023 | High Deductible Health Plan Your Responsibility | Copy Plan Your Responsibility |
|---|---|---|
| Out-of-Network Benefits | High Deductible Health Plan Your Responsibility | Copay Plan Your Responsibility |
| ANNUAL DEDUCTIBLE (Single/Family) | $5,200/$10,400 | $3,000/$6,000 |
| OUT-OF-POCKET MAX (Single/Family) | $6,000/$12,000 | $7,000/$14,000 |
| COINSURANCE | 20% | 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!
Choose The Plan That Is Best For You And Your Family
We will continue to offer two medical plans to provide choice for you and your family. This year, you will have another choice relative to the doctor and hospital you utilize and your payroll contribution.
Choose A Doctor Or Hospital
Option 1:
Imagine360’s 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 provider advocate with One Call for All at 1-800-716-2852.
Option 2:
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.
Payroll Contribution
The Price Protection Program option will be less out of your paycheck. If you meet the Wellness Program goals, you will continue with lower payroll contributions, too!
PRICE PROTECTION PROGRAM
Employee Bi-Weekly Payroll Contributions
| Description | High Deductible Health Plan $3,000 | High Deductible Health Plan $1,500 | ||||||||
|---|---|---|---|---|---|---|---|---|---|---|
| Description | High Deductible Health Plan $5,000 | Copay Plan $1,500 | ||||||||
| With 2 Wellness Credits | With 1 Wellness Credit | No Wellness Credit | With 2 Wellness Credits | With 1 Wellness Credit | No Wellness Credit | |||||
| Employee Only | $89.69 | $94.69 | $99.69 | $129.77 | $134.77 | $139.77 | ||||
| Employee + Spouse | $231.25 | $236.25 | $241.25 | $308.87 | $313.87 | $318.87 | ||||
| Employee + Child(ren) | $206.48 | $211.48 | $216.48 | $283.13 | $288.13 | $293.13 | ||||
| Employee + Family | $322.10 | $327.10 | $332.10 | $437.57 | $442.57 | $447.57 | ||||
Plans: (Scroll sideways to see all plans)
| Description | High Deductible Health Plan $3,000 | High Deductible Health Plan $1,500 | ||||||||
|---|---|---|---|---|---|---|---|---|---|---|
| Description | High Deductible Health Plan $5,000 | Copay Plan $1,500 | ||||||||
| With 2 Wellness Credits | With 1 Wellness Credit | No Wellness Credit | With 2 Wellness Credits | With 1 Wellness Credit | No Wellness Credit | |||||
| Employee Only | $89.69 | $94.69 | $99.69 | $129.77 | $134.77 | $139.77 | ||||
| Employee + Spouse | $231.25 | $236.25 | $241.25 | $308.87 | $313.87 | $318.87 | ||||
| Employee + Child(ren) | $206.48 | $211.48 | $216.48 | $283.13 | $288.13 | $293.13 | ||||
| Employee + Family | $322.10 | $327.10 | $332.10 | $437.57 | $442.57 | $447.57 | ||||
Cigna
Employee Bi-Weekly Payroll Contribution
Plans: (Scroll sideways to see all plans)
| Description | High Deductible Health Plan $3,000 | High Deductible Health Plan $1,500 | ||||||||
|---|---|---|---|---|---|---|---|---|---|---|
| Description | High Deductible Health Plan $5,000 | Copay Plan $1,500 | ||||||||
| With 2 Wellness Credits | With 1 Wellness Credit | No Wellness Credit | With 2 Wellness Credits | With 1 Wellness Credit | No Wellness Credit | |||||
| Employee Only | $116.10 | $121.10 | $126.10 | $150.76 | $155.76 | $160.76 | ||||
| Employee + Spouse | $261.93 | $266.93 | $271.93 | $349.84 | $354.84 | $359.84 | ||||
| Employee + Child(ren) | $233.87 | $238.87 | $243.87 | $320.69 | $325.69 | $330.69 | ||||
| Employee + Family | $364.83 | $369.83 | $374.83 | $495.61 | $500.61 | $505.61 | ||||
| Description | High Deductible Health Plan $3,000 | High Deductible Health Plan $1,500 | ||||||||
|---|---|---|---|---|---|---|---|---|---|---|
| Description | High Deductible Health Plan $5,000 | Copay Plan $1,500 | ||||||||
| With 2 Wellness Credits | With 1 Wellness Credit | No Wellness Credit | With 2 Wellness Credits | With 1 Wellness Credit | No Wellness Credit | |||||
| Employee Only | $116.10 | $121.10 | $126.10 | $150.76 | $155.76 | $160.76 | ||||
| Employee + Spouse | $261.93 | $266.93 | $271.93 | $349.84 | $354.84 | $359.84 | ||||
| Employee + Child(ren) | $233.87 | $238.87 | $243.87 | $320.69 | $325.69 | $330.69 | ||||
| Employee + Family | $364.83 | $369.83 | $374.83 | $495.61 | $500.61 | $505.61 | ||||
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 | $3,050 | |
| Dependent Care Spending Account | $5,000 | |
BPC Benefits Debit Card
Rollover Feature
Our FSA plan has a $610 rollover feature. This allows up to $610 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 $3,050 maximum. Rollover dollars are limited to up to $610 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.
Kinetic Advantage HSA Contribution
$500 Annually for Employee Only Medical Coverage. $1,000 Annually for Employee + Dependent Medical Coverage
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
Included With All Medical Plans
Our Pharmacy Benefit Manger (PBM) is SmithRx.
SmithRx has over 75,000 in-network retail pharmacies. For specific in-network pharmacy questions or to check whether your local pharmacy is in-network, please contact SmithRx’s dedicated Member Support team. SmithRx’s online Member Portal give you access to forms, pharmacy transactions and member support. When you register for an account, have your Imagine360 ID card handy.
Who is my mail-order service provider?
Contact Serve You DirectRx to set up your account.
· E-prescribe or Fax: Have your doctor electronically prescribe or fax your prescription to 1-866-494-0364. Faxed prescriptions may only be sent by a doctor’s office and must include patient information and diagnosis for timely processing.
· Phone: Your doctor can call in the prescription to 1-800-759-3203 with an IVR (interactive voice recognition) option.
· Prompt Delivery: Call Serve You DirectRx at 1-800-759-3203
· Call SmithRx Member Support if you need assistance.
Contact Information
Reach Out Anytime
Toll Free: (844) 454-5201
Website: www.mysmithrx.com/login and click “Create an Account”
Email: connect@smithrx.com
Where do I get my specialty medications?
Prescribed specialty medications covered by your plan benefits can be secured through SmithRx preferred specialty pharmacies, US BioServices and Senderra.
To utilize the specialty pharmacy, simply call SmithRx Member Support to check coverage and start any necessary authorization processes.
GoodRx
GoodRx gathers current prices and discounts to help you find the lowest cost pharmacy for your prescriptions. GoodRx is 100% free. No personal information required. Go to www.goodrx.com/how-goodrx-works to learn more.
Important Things To Know About Your Pharmacy Benefits
| Prior Authorization | Generic Drugs |
|---|---|
| Prior Authorization | Some drugs, and certain amounts of some drugs, require an approval before they are eligible to be covered under your medical plan. Even if a drug is listed or on a formulary, you should check your schedule of benefits to verify it is a covered benefit. |
| Generic Drugs | When a patent or exclusivity expires on a Food and Drug Administration (FDA)-approved drug, other companies can make the drug in a generic form. The FDA requires generic drugs have the same high quality, strength, purity and stability as brand-name drugs. On average, the cost of a generic drug is 80-85% lower than the brand -name equivalent. |
| Generic Drugs |
|---|
| Prior Authorization: Some drugs, and certain amounts of some drugs, require an approval before they are eligible to be covered under your medical plan. Even if a drug is listed or on a formulary, you should check your schedule of benefits to verify it is a covered benefit. |
| Generic Drugs: When a patent or exclusivity expires on a Food and Drug Administration (FDA)-approved drug, other companies can make the drug in a generic form. The FDA requires generic drugs have the same high quality, strength, purity and stability as brand-name drugs. On average, the cost of a generic drug is 80-85% lower than the brand -name equivalent. |
WELLNESS PROGRAMS & SERVICES
Wellness Disclaimer: Before beginning any health and wellness program, you should seek the advice of your physician or other qualified health provider with any questions that you may have regarding a medical condition or potential medical condition. Also, you should never disregard professional medical advice, or delay seeking medical advice or treatment. Any wellness program participant further understands that the recommendations made to you by the American Health & Wellness Health Coach is not intended to diagnose, treat, prescribe, cure or prevent any disease.
Your Health Coaching Team
American Health & Wellness health coaches are graduates of accredited colleges with bachelor degrees in nursing, kinesiology, exercise science and have a collection of certifications amongst them, i.e., Certified Integrative Nutritional Health Coach; Lifestyle Health Coaching; Wellcoaches® Health & Wellness Coach; ACSM Certified Exercise Physiologist; Certified Health Coach through Health Coaching Institute and Certified Stress Management Coach (CSMC).
What Is Health Coaching?
Your Health Coach will provide wellness education on a variety of subjects via seminars, videos, social media, group coaching circles and challenges. The information should empower and inspire you to make choices that improve your physical, mental and emotional wellbeing!
Your Health Coach cares about you and is here to help you maximize your personal strengths. Support will be provided to create action steps to help you achieve your health goals. Motivation, positivity and wellbeing will be the focus for health improvement and maintenance
Seminars / Videos
Monthly seminars are engaging, inspiring and relevant and FUN! Seminars will be available for viewing either virtually or recorded. If you miss a seminar you can contact your health coach for the recorded version.
Challenges
Several times a year, we will be offering challenges using the MoveSpring app. We will be focused on activity, nutrition, positive support and fun. Best of all, there will be prizes! Your spouse is welcome to join!
Group Coaching
Group coaching circles are a safe place to connect with others who have the same goal in mind as you. Facilitated by your Health Coach, group coaching has proven results in providing momentum to help you manage and meet your goals. The meetings are held 16 times a month at different times and days for your convenience. Your health coach will text you the link to join.
Text Reminders From Your Health Coach
Your American Health & Wellness Health Coach will text you reminders of upcoming seminars, challenges & group coaching circles. Add AHW Texts to your contacts: (765) 256-6400.
Social Media Community
With our closed Facebook group, you will want to stay informed and connected. And, have a safe place to share your successes! The coaches post weekly interesting articles, recipes, and relevant news about your company’s wellness program! Don’t hesitate to share your wellness journey with us!
Wellness Credits will reduce your Medical Premium Payroll Deductions
We are excited about our wellness program! By engaging now, we will provide you with a wellness premium credit to reduce your medical premium payroll contribution. You can continue to keep the credit when you participate in our wellness program and complete the criteria shown below. Best of health and wellness to you!
Wellness Credit #1
Wellness Physical Exam
Visit your physician for a wellness physical exam AND submit the results form to your AHW health coach by 10/31/2023 to earn your credit for 1/1/2024 – 12/31/2024
Wellness Credit #2
Monthly Wellness Activities
From 1/1/23—10/31/2023, complete at least 9 monthly wellness activities to earn your wellness credit for 1/1/2024 – 12/31/2024.
Wellness activities include:
Seminars, Group Coaching Circles and Challenges
New Hires
We are glad you have joined our team. If you enroll in the medical plan, you will automatically receive the wellness credits applied to your medical premium upon your effective date.
To keep your wellness credits for 2024, you will need to complete the criteria in the New Hire grid.
| New Hire Grid | ||||
|---|---|---|---|---|
| New Hires | Hired Before 8/1/2023 | Hired After 8/1/2023 | ||
| Wellness Credit #1 Wellness Physical Exam | Turn in your exam results by 10/31/2023 | Automatically eligible | ||
| Wellness Credit #2 Activity | Participate in one wellness activity every month through 10/31/2023 | Automatically eligible | ||
| Result | Your medical premiums will be reduced in 2024 | |||
Confidentiality
To protect your privacy and protected health information, American Health & Wellness (AHW) administers our wellness program. All health coaches are HIPAA (Health Insurance Portability and Accountability Act) certified. This means the information you share with your health coach is private and secure.
Nicotine Cessation
If you are a current nicotine user and ready to quit, there are options available to help.
Take Charge
Taking charge of your health starts with getting your annual, preventive exam to know your biometric numbers. Your weight, cholesterol, blood pressure and blood glucose numbers are key indicators of health. Your health coach will help you review your physician results and help create a lifestyle plan if you need to improve your numbers.
DENTAL BENEFIT SUMMARY
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| 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 (2 in 12 months) > X-rays (bitewings, in one visit, once in 12 months) > X-rays (full mouth once per 60 months) > Fluoride Treatments up to age 19, (2 in 12 months) > Sealants up to age 16 (one per tooth per 36 months) > Space Maintainers up to age 16 (initial appliance only) | Covered at 100% | Covered at 100% | ||
| Basic Expenses | > Fillings > General Anesthesia > Perio Surgery > Periodontal Maintenance (once every 3 months) > Repairs & Maintenance of Crowns/Bridges/Dentures > Scaling & Root Planing (per quadrant) > Root Canal | Covered at 100% | Covered at 80% | ||
| Major Expenses | > Bridges & Dentures > Inlays, Onlays & Veneers > Simple Extractions > Single Crowns > Surgical Extractions | Covered at 60% | Covered at 50% | ||
| Orthodontia | Dependent Children Only; Lifetime Maximum $1,500 per Child | Covered at 25% | Covered at 25% | ||
| Deductible: Single Family | --------------------------------> | $50 $150 | $50 $150 | ||
| Calendar Year Maximum | Maximums for preventive, basic and major procedures are combined. Some of your unused annual benefit maximum can be carried over to the next year. To qualify, you must have had a dental service performed within the calendar year and used less than the maximum threshold of $800. If the qualification is met, the threshold is carried over to next year’s maximum benefit. The plan’s annual maximum plus maximum rollover cannot exceed $3,500 in total. | $2,000 | $2,000 | ||
| Out-Of-Network | Employees using out-of-network providers may be responsible for the difference between the discounted PPO fees and the out-of-network dentist’s regular fees for the services performed. | ||||
| Benefit Summary | In-Network High Plan | In-Network Low Plan | |||
|---|---|---|---|---|---|
| Benefit Summary | In-Network High Plan | In-Network Low Plan | |||
| Preventive Expenses | > Exams and cleanings (2 in 12 months) > X-rays (bitewings, in one visit, once in 12 months) > X-rays (full mouth once per 60 months) > Fluoride Treatments up to age 19, (2 in 12 months) > Sealants up to age 16 (one per tooth per 36 months) > Space Maintainers up to age 16 (initial appliance only) | Covered at 100% | Covered at 100% | ||
| Basic Expenses | > Fillings > General Anesthesia > Perio Surgery > Periodontal Maintenance (once every 3 months) > Repairs & Maintenance of Crowns/Bridges/Dentures > Scaling & Root Planing (per quadrant) > Root Canal | Covered at 100% | Covered at 80% | ||
| Major Expenses | > Bridges & Dentures > Inlays, Onlays & Veneers > Simple Extractions > Single Crowns > Surgical Extractions | Covered at 60% | Covered at 50% | ||
| Orthodontia | Dependent Children Only; Lifetime Maximum $1,500 per Child | Covered at 25% | Covered at 25% | ||
| Deductible: Single Family | --------------------------------> | $50 $150 | $50 $150 | ||
| Calendar Year Maximum | Maximums for preventive, basic and major procedures are combined. Some of your unused annual benefit maximum can be carried over to the next year. To qualify, you must have had a dental service performed within the calendar year and used less than the maximum threshold of $800. If the qualification is met, the threshold is carried over to next year’s maximum benefit. The plan’s annual maximum plus maximum rollover cannot exceed $3,500 in total. | $2,000 | $2,000 | ||
| Out-Of-Network | Employees using out-of-network providers may be responsible for the difference between the discounted PPO fees and the out-of-network dentist’s regular fees for the services performed. | ||||
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 Care | |
|---|---|
| Dental Care | |
| Employee Only | $18.90 |
| Employee + Spouse | $38.68 |
| Employee + Child(ren) | $42.73 |
| Employee + Family | $66.93 |
| Dental Care | |
|---|---|
| Dental Care | |
| Employee Only | $18.90 |
| Employee + Spouse | $38.68 |
| Employee + Child(ren) | $42.73 |
| Employee + Family | $66.93 |
VISION BENEFIT SUMMARY IN-NETWORK
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| Benefit Summary In Network | |||
|---|---|---|---|
| Benefit Summary In Network | |||
| Allowances | Benefit Frequency | ||
| Eye Exam | $10 | Every calendar year | |
| Lenses: Single Vision, Bifocal, Trifocal & Lenticular (Waived for elective contact lenses) | $25 | Every calendar year | |
| Contact Lenses Elective Medically Necessary Evaluation & Fitting (in lieu of eyeglass lenses and/or frames) | Covered up to $130 Medically Necessary: Covered in full after $25 copay Fitting and Evaluation: up to $60 copay | Every calendar year | |
| Frames | Allowance $130; 20% off amount over allowance | Every two calendar years | |
| Network | VSP | FIND AN EYE DOCTOR www.vsp.com 1-800-877-7195 | |
| Out-of-Network Benefits | Out-of-network benefits are allowed, however, copays and maximums are less. Employees using out-of-network providers may be responsible for additional fees. | ||
| Benefit Summary In Network | |||
|---|---|---|---|
| Benefit Summary In Network | |||
| Allowances | Benefit Frequency | ||
| Eye Exam | $10 | Every calendar year | |
| Lenses: Single Vision, Bifocal, Trifocal & Lenticular (Waived for elective contact lenses) | $25 | Every calendar year | |
| Contact Lenses Elective Medically Necessary Evaluation & Fitting (in lieu of eyeglass lenses and/or frames) | Covered up to $130 Medically Necessary: Covered in full after $25 copay Fitting and Evaluation: up to $60 copay | Every calendar year | |
| Frames | Allowance $130; 20% off amount over allowance | Every two calendar years | |
| Network | VSP | FIND AN EYE DOCTOR www.vsp.com 1-800-877-7195 | |
| 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 | |
|---|---|
| Contribution | |
| Employee Only | $4.87 |
| Employee + Spouse | $8.21 |
| Employee + Child(ren) | $8.37 |
| Employee + Family | $13.24 |
| Vision High Plan | |
|---|---|
| Contribution | |
| Employee Only | $4.87 |
| Employee + Spouse | $8.21 |
| Employee + Child(ren) | $8.37 |
| Employee + Family | $13.24 |
No ID Card Needed
Your vision provider only needs your social security number and the Guardian Group ID #00576408 to confirm your eligibility.
LIFE INSURANCE BENEFITS
Basic Life & Accidental Death & Dismemberment (AD&D)
We provide basic life and accidental death and dismemberment insurance at no cost for our employees.
| Benefits | Details |
|---|---|
| Benefits | Details |
| Coverage Amount | 1x salary to a maximum of $300,000 |
| Guaranteed Coverage Amount | $225,000 (based on salary) |
| Insurance Carrier | Guardian |
| Age Reduction Rule | 35% reduction at age 65; 60% at age 70, 75% at age 75, 85% at age 80 |
Beneficiary Designation is the person you designate to receive your life insurance benefits in the event of your death. During your enrollment, you will be asked to provide a primary and contingent beneficiary.
Voluntary Life & Accidental Death & Dismemberment (AD&D)
Employees can purchase additional life insurance at group rates. Rates are age banded based on $1,000 of covered benefit.
| Benefits | Details |
|---|---|
| Benefits | Details |
| Guaranteed Coverage Amount and Benefit Maximums | Employee: $100,000, under age 65; $50,000, age 65-69; $10,000, age 70+ $10,000 minimum to $300,000 maximum ($10,000 increments) Spouse: $25,000, under age 65; $10,000 age 65-69; $0, 70+ $5,000 minimum to $150,000 maximum, not to exceed 50% of the employee’s coverage ($5,000 increments) Rates based on employee’s age; Coverage ends at age 70 Child: $10,000 $1,000 increments to a maximum of $10,000 for covered children ages 14 days to 26 years old (if a full-time student), not to exceed 100% of the employee’s coverage. Same rate and coverage for all children Dependent children under 14 days old: $500 benefit. |
| Insurance Carrier | Guardian |
| Age Reduction Rule | 35% reduction at age 65; 60% at age 70, 75% at age 75, 85% at age 80 |
| Evidence of Insurability | Evidence of Insurability is required for employees that do not elect the benefit when initially eligible or for coverage amounts over the Guaranteed Issue amount. |
| Benefits | Details |
|---|---|
| Benefits | Details |
| Guaranteed Coverage Amount and Benefit Maximums | Employee: $100,000, under age 65; $50,000, age 65-69; $10,000, age 70+ $10,000 minimum to $300,000 maximum ($10,000 increments) Spouse: $25,000, under age 65; $10,000 age 65-69; $0, 70+ $5,000 minimum to $150,000 maximum, not to exceed 50% of the employee’s coverage ($5,000 increments) Rates based on employee’s age; Coverage ends at age 70 Child: $10,000 $1,000 increments to a maximum of $10,000 for covered children ages 14 days to 26 years old (if a full-time student), not to exceed 100% of the employee’s coverage. Same rate and coverage for all children Dependent children under 14 days old: $500 benefit. |
| Insurance Carrier | Guardian |
| Age Reduction Rule | 35% reduction at age 65; 60% at age 70, 75% at age 75, 85% at age 80 |
| Evidence of Insurability | Evidence of Insurability is required for employees that do not elect the benefit when initially eligible or for coverage amounts over the Guaranteed Issue amount. |
INCOME PROTECTION BENEFITS
Other than medical and life insurance, disability insurance is one of the most important benefits you can elect. If you are disabled and unable to work, short term and long term disability insurance can help replace lost income and make a difficult time a little easier. Disability benefits are available to full-time employees. PTO/vacation time may be required to meet the elimination period before benefits begin. 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 | Voluntary Short Term Disability | Long Term Disability |
| Benefit | 60% of your pre-disability base salary to a maximum weekly benefit of $2,500 | 60% of your pre-disability base salary to a maximum monthly benefit of $10,000 |
| Waiting (Elimination) Period | Benefits begin after 7 days for accident and illness | Benefits begin after 180 days |
| Benefit Duration | Up to 25 weeks after elimination period | Normal Social Security Retirement Age |
| Benefits Based On | N/A | Your own occupation for the first 24 months; any occupation thereafter |
| Pre-existing Conditions Limitation | Any condition/symptom for which you, for three months prior to the coverage in this plan, consulted with a physician, received treatment, or took prescribed drugs. Coverage exclusion for the pre-existing condition applies for the first 12 months of coverage. | Any condition/symptom for which you, for three months prior to the coverage in this plan, consulted with a physician, received treatment, or took prescribed drugs. Coverage exclusion for the pre-existing condition applies for the first 12 months of coverage. |
| Contribution | 100% Employee Paid | 100% Employer Paid |
| Insurance Carrier | Guardian | Guardian |
| Evidence of Insurability | Evidence of Insurability is required for employees that do not elect the benefit when initially eligible. | N/A |
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.
We all need a little support every now and then.
Guardian’s Employee Assistance Program gives you and your family members access to confidential personal support, across everything from stress management and nutrition to handling legal or financial issues. The services available include consultations with experienced professionals, as well as access to resources and discounts designed to help you in a variety of different ways.
Consultative services are available to provide direct support and assistance. Work / life assistance that can help you save money and balance commitments. Access legal and financial assistance and resources, including WillPrep Services.
For more information or support, you can reach out by phoning 1-800-386-7055. The team is available 24 hours a day, 7 days a week.
How to access
To access the WorkLifeMatters Employee Assistance Program, you’ll need a few personal details.
URL: www.ibhworklife.com
UserID: Matters
Password: wlm70101
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.