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.
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.
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:
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.
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.
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.
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.
DID YOU KNOW?
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.
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.
1. Visit Go365.com
2. Click “Register now” from the homepage
3. Complete the registration form and select “Continue.”
Looking for the forms you need to make any changes? Look no further! Below is everything you would need to make changes to any current benefits, update elections for the plan year, or update any information, such as a beneficiary. Also included is your Annual Benefits Notices packet - this packet contains important information about the health plans provided by your employer.