Sample Inc.

Table of Content

  1. Header
  2. Welcome
  3. Eligibility & Enrollment
    1. Eligibility
    2. Enrollment
  4. Medical & Rx
    1. Medical/Rx Plans Overview
    2. Rx Information
    3. Providers & Networks
    4. Virtual Visits
    5. Carrier Resources & Education
  5. Accounts
    1. Health Savings Account (HSA)
    2. Flexible Spending Accounts (FSA)
    3. Dependent Care Reimbursement Account (DCRA)
  6. Dental
    1. Dental Plans Overview
    2. Providers & Networks
    3. Carrier Resources & Education
  7. Vision
    1. Network & Resources
  8. Financial Protection
    1. Life/AD&D
    2. Disability
    3. Voluntary Benefits
  9. Personal Support & Assistance
    1. Employee Assistance Plan (EAP)
    2. Travel Assistance
    3. Hearing Discount
    4. Will Prep & ID Theft
  10. Wellbeing
  11. 401k
  12. Additional Educational Videos
  13. Have Questions?
  14. Footer

Eligibility & Enrollment

Medical & Rx

BCBSM & BCN

UHC Medical | Group # 1524647 | 866-801-4409 | www.uhc.com

United Health Care (UHC) will continue to be your medical and prescription carrier. You have the choice between three plans for the 2024-25 plan year. The three plan options include two PPO plans and an EPO plan. View the Providers & Networks for more information on how these plans networks differ from each other as well as the links below to locate participating providers.

If you are already enrolled in one of the Clear Rate UHC medical plans today and have not already done so, please be sure to register through the UHC member portal where you can access important information pertaining to your medical plans with UHC including participating providers, cost estimates for services, explanation of benefits/claims, and your accumulation amounts for deductibles and out-of-pocket costs. If you are not currently covered, you will be able to register in the UHC portal as of your effective date of coverage. Information on how to register can be found here.

2024-25 Medical/Rx Updates and Changes:

PPO HSA 2000 Plan: Small increase to contributions 

EPO HSA 2000 Plan: Small increase to contributions 

CORE PPO HSA 1500 Plan: Moving from $1,500 to $1,600 Deductible

  • Please note all plans run on a calendar year deductible and out-of-pocket maximum.

Accounts

Health Equity

(866) 346-5800 | memberservices@healthequity.com | www.healthequity.com


You have the opportunity to contribute to a variety of savings and/or spending accounts on a pre-tax basis which lowers your taxable income. View the information below for important details and guidelines for the various accounts offered by SAMPLEINC.

Dental

Delta Dental

Group # G000BY98 | 800-927-9197 Press 1


Clear Rate's dental plans provide comprehensive coverage to help you and your family maintain good dental health. The dental plans include both in and out of network benefits. Although your cost sharing is the same in and out of network, if you do go out of network it is likely that you will experience balance billing


When traveling out of the United States you also have access to the Passport Dental program giving you access to a worldwide network of dentists. English-speaking operators are available to help you access care. Mutual of Omaha Dental coverage outside of the United States is the same as Mutual of Omaha Dental coverage within the United States.

If you are already enrolled in one of the Clear Rate's Mutual of Omaha Dental plans today and have not already done so, please be sure to register through the Mutual of Omaha Dental member portal where you can access important information pertaining to your dental plan with Mutual of Omaha Dental including participating providers, coverage information, and explanation of benefits/claims. If you are not currently covered, you will be able to register in the Mutual of Omaha Dental portal as of your effective date of coverage.

Mutual of Omaha Member Portal

Log-In/Register Here!

Mutual of Omaha Member Portal

Log-In/Register Here!

Vision

Mutual of Omaha

Mutual of Omaha Vision | Group # G000BY98 | 800-769-7159

Clear Rate offers vision coverage through Mutual of Omaha to help pay for eye exams, prescription glasses and contact lenses. Mutual of Omaha also provides discounts for Hearing Care and Lasik.


If you are already enrolled in one of the Clear Rate's Mutual of Omaha vision plan today and have not already done so, please be sure to register through the Mutual of Omaha member portal where you can access important information pertaining to your vision plan including participating providers, coverage information, and explanation of benefits/claims. If you are not currently covered, you will be able to register in the MOO portal as of your effective date of coverage.


Your vision network with Mutual of Omaha is the EyeMed network. You may use the eye care professional of your choice. However, when you visit a participating in-network provider, you receive higher levels of coverage. If you choose to receive services out-of-network, you may be required to pay that provider at time of service and will need to submit a claim to Mutual of Omaha for the applicable reimbursement based on the out-of-network reimbursement schedule.

Mutual of Omaha Member Portal

Log In/Register

Mutual of Omaha Member Portal

Log In/Register

Financial Protection

Clear Rate understands the importance to you and your family to have strong financial protection. We provide all employees Basic Life/AD&D and Disability coverage at no cost to you. In addition to these benefits, we offer a variety of insurance you can choose from on a voluntary, employee paid basis so you can select what is best for your family. All of these coverages are provided to protect your income and out of pocket expenses.

Personal Support & Assistance

Mutual of Omaha also provides all employees and their families access to personal services and assistance resources at no cost. Here you will find information on our Employee Assistance Program, Hearing Discount, Travel Assistance, Will Prep, and ID Theft Assistance which all are designed to give you peace of mind and support when you need it the most!

Mutual of Omaha offers its members a Hearing Discount Program, see below to learn more.


Mutual of Omaha offers its members Will Preparation Services as well as Identity Theft Assistance.

Create your will at www.willprepservices.com and use code MutualWills to register.


Wellbeing

In today's fast-paced and interconnected world, where stress and mental health issues are on the rise, effective well-being plays a crucial role. At Sample, Inc., we recognize that a healthy, content workforce is not only more productive but also fosters a positive culture. We strive for a supportive and inclusive environment where we encourage and support improvement of physical, mental, emotional, and social well-being. Whether within a corporate setting, a community, or on a personal level, well-being focuses on fostering awareness, empathy, and support to create a healthier and more balanced workplace and environment for all. Prioritizing employee wellness and wellbeing is not just a policy but a reflection of our commitment to both the individual and collective success of team.


To access the wellbeing newsletter, which includes resources, tips, recipes, and more, please select the button below.



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401k

Fidelity Investments

Employees are eligible to contribute starting the 1st of the month following 60 days of employment.


SAMPLEINC matches up to 5% of your contributions!! FREE MONEY!!!


Fully vested after 2 years of employment



New Hires must complete the 401k enrollment at using the button below.


If you do not complete the enrollment process, you will be “auto enrolled” at a 3% deferral contribution rate and your funds will be deposited in the default investment account.

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Additional Educational Videos

Have Questions?

As you consider your benefit options, please be sure to review all available information. If you need further assistance, please reach out to Human Resources.



This is a high-level guide of certain benefits your employer offers. The information in this benefits guide is intended as a general outline of the benefits available under the following welfare benefit programs offered by your employer and should not be considered legal, investment or other benefits advice. Benefits described are subject to change, amendment, or termination without notice to, or the agreement of, any employee/participant. All protected health information is confidential, pursuant to the Health Insurance Portability and Accountability Act of 1996. If you have any questions about your benefits guide, contact Human Resources. If you (and/or your dependents) have Medicare or will become eligible for Medicare in the next 12 months, a Federal law gives you more choices about your prescription drug coverage.