A.J. RAHN GREENHOUSES

Table of Content

  1. Header
  2. Page
    1. WELCOME
    2. OVERVIEW
    3. ENROLLMENT
    4. MEDICAL/RX
    5. DENTAL
    6. VISION
    7. LIFE & DISABILITY
    8. FSA
    9. HSA
    10. WELLNESS HUB
    11. UNDERSTANDING YOUR BENEFITS
    12. Additional Resources
    13. Contact Us
  3. Footer

WELCOME

Helping you and your family reach and maintain good health is very important to A.J. Rahn Greenhouse. A.J. Rahn is pleased to offer a selection of benefits designed with your health and financial wellbeing in mind. We review our benefit programs each year to ensure we consider the best combination of benefit coverage, network access and affordability for employees.


Eligibility

Regular employees working at least 30 hours per week are eligible to participate in benefits offered byA.J. Rahn. When you enroll in the benefits program, you may also cover your eligible benefits. Dependents include your legal spouse, child(ren) up to age 26 (regardless of student status, marital status, residence, or financial dependence on you), and an unmarried child incapable of self-support.



ENROLLMENT

How To Enroll In Benefits

Action Required:


All elections must be submitted by January 30, 2023]. The benefits you elect during open enrollment will be effective from 01/01/2023 - 12/31/2023



The Benefit choices you make during your initial enrollment or annual open enrollment remain in effect for the entire year.


You can, however, modify your elections under certain circumstances, called "Qualifying Events" These are events such as marriage, divorce, birth or adoption of a child, loss of eligibility under another plan. If you experience a qualifying event, you may make changes to your benefits within 30 days of the event or 60 days if the event is due to birth or adoption of a child.


Contact Human Resources if you have questions about qualifying events.

MEDICAL/RX

Humana

PPO

You have the freedom to see any physician, located in any area; however, to receive the maximum benefits under the plan, physicians should be chosen from the network of participating providers. You may also use a doctor that is not in-network and receive reduced, out-of-network benefits. Primary care physicians do not need to be designated, and referrals are not needed to visit specialists.


Preventive Services

Regardless of which plan you choose, preventive services are covered at 100% in-network and copays & deductibles do not apply.


There are 3 sets of free preventive services. See below for see a list of covered services for each group:

  • For all adults
  • For women
  • For children



Online Healthcare

A virtual visit lets you see and talk to a doctor from your mobile device or computer. When you use one of the provider groups in our virtual visit network, you have benefit coverage for certain non-emergency medical conditions. Costs must be paid by you at the time of the virtual visit and will apply toward your deductible and out-of-pocket maximum.


Find a Doctor

You pay less out of pocket if you receive care from an In-Network provider. In-Network providers can be found on your provider’s website under “Find a Doctor”. Log in to your account and choose the network based on the plan type you are choosing.


Deductible

The amount of money you are responsible for paying each year before the plan begins to pay for covered services, with the exception of preventive care services, which are covered at 100% In-Network.


Coinsurance

Your share of the expense of covered services after your deductible has been paid when the company plan is paying a percentage. The coinsurance rate is usually a percentage.


Out-of-Pocket Maximum

The most you pay per Plan Year for health care expenses and applies to deductibles, flat-dollar copays and coinsurance for all covered services – including cost-sharing amounts for prescription drugs. Once this limit is met, the plan will cover all in-network services at 100% until the end of the plan year.


Common Pharmacy Tiers


Generic | Lowest copay: Most drugs in this category are generic drugs. Members pay the lowest copay for generics, making these drugs the most cost-effective option for treatment. 

Preferred Brand | Higher copay: This category includes preferred, brand name drugs that don't yet have a generic equivalent. These drugs are more expensive than generics, and a higher copay.

Non-Preferred Brand  | Highest Brand copay: In this category are nonpreferred brand name drugs for which there is either a generic alternative or a more cost-effective preferred brand. These drugs have the highest copay. Make sure to check for mail order discounts that may be available.

Preferred Specialty  | Lowest specialty drug copay: Preferred specialty drugs are generally more effective and less expensive than non-preferred specialty drugs.

Non-Preferred Specialty | Highest specialty drug copay: These drugs have the highest copay for specialty drugs, usually because there may be a more cost-effective generic or preferred brand available.


Finding a Drug List

Typically, a full listing of covered drugs is found on your provider’s website. A drug list, also called a formulary, is a list of generic and brand-name drugs covered by a health plan. Although a drug may be on the drug list, it might not be covered under every plan. Review the plan materials for details on specific benefits. You can use drug lists to see if a medication is covered by your health insurance plan. You can also find out if the medication is available as a generic, needs prior authorization, has quantity limits and more.



Preferred Provider Organization (PPO) Overview

Preferred Provider Organization (PPO) Overview

Prescription Drug Benefits Overview

Prescription Drug Benefits Overview

Humana Medical Summary of Benefits & Coverage

Humana Medical Summary of Benefits & Coverage

VISION

Humana

DID YOU KNOW?

  • Eye exams can help detect serious eye and general health conditions sooner: high blood pressure, diabetes, heart disease, high cholesterol
  • Babies should receive their first professional eye exam at 6 months
  • 80% of learning in the first 12 years comes through the eyes


A.J. Rahn offers vision coverage through Humana to help pay for eye exams, prescription glasses and contact lenses. You receive a higher level of benefits when you see a provider in the Humana Network.


To find out if your provider is in-network, please visit the Humana website below.



Vision Insurance Overview

Vision Insurance Overview

Humana Vision Benefit Summary

Humana Vision Benefit Summary

WELLNESS HUB

What is Go365?


Go365 is a wellness program designed to help employees kick start their health and well-being. Employees take steps to engage in and adopt healthier behaviors and move up in Status level, earning Points and rewards for their progress. A combination of behavioral economics, individualized recommended activities, and an advanced incentive program help motivate members toward positive lifestyle change.


There are a few things members will need to do to get started with the Go365

program. This section outlines the registration process and moving out of Blue Status. It’s important to note that members who have Humana medical insurance will register for Go365 differently than those who do not.


How to register:


For members with Humana insurance:

Members who have Humana medical insurance

will follow the steps below. Once they create an account, they can use the same username and password on Go365.com and the Go365 App to access Go365 moving forward.

1. Visit Humana.com/register and “Get Started.”

2. Enter member ID number (or Social Security

number), date of birth and ZIP code.

3. Create a username, password and security prompt, and click “Next” to finish.


For members without Humana insurance:

There are two ways to register for members who DO NOT have

Humana medical insurance. Even if members register online,

encourage them to download the App for easy access on-the-go.

Via Go365.com

1. Visit Go365.com

2. Click “Register now” from the homepage

3. Complete the registration form and select “Continue.”

  • 4. Create a username and password and click “Submit.”[CL
Go365

Go365

UNDERSTANDING YOUR BENEFITS

What is Preventive Care?

What is Preventive Care?

Benefit Terms Explained

Benefit Terms Explained

How to Read An Explanation of Benefits (EOB)

How to Read An Explanation of Benefits (EOB)

What is Balance Billing?

What is Balance Billing?

What is a Qualifying Event?

What is a Qualifying Event?

Primary Care vs. Urgent Care vs. ER

Primary Care vs. Urgent Care vs. ER

Contact Us

As you consider your benefit options, please be sure to review all available information: Employee Benefits Guide, Intranet, and other videos and flyers found on this webpage. If you don''t understand your benefits or need any assistance, please contact:




Client Contacts

DR

Deborah Rahn

debbie.ajrahn@gmail.com

(513) 253-8279

Account Team Contacts

ContactImage

Tammy Roberts

Account Executive

tammy.roberts@nfp.com

(513) 725-2312