Apex Dermatology & Skin Center

Table of Content

  1. Header
  2. Your 2024 Apex Dermatology & Skin Center Benefits
    1. To Our Employees:
    2. Eligibility & Qualifying Events
    3. How to Enroll
    4. Medical
    5. Summary of Benefits and Coverage (SBC)
    6. Prescriptions
    7. Virtual Visits
    8. FSA
    9. HSA
    10. Dental
    11. Vision
    12. Basic Life and Voluntary Life
    13. Disability
    14. Hospital Indemnity, Accident and Critical Illness Insurance
    15. Employee Contributions
    16. Understanding your Benefits
    17. Carrier Contacts
  3. Employee Assistance Plan (EAP)
    1. Guardian EAP
    2. MetLife EAP
    3. Ease@Work EAP
  4. Compliance Notices
  5. Total Rewards
    1. Company Time off and Holidays
    2. 401(k) Retirement & Profit Sharing
    3. FMLA
  6. Questions?
  7. Footer

Your 2024 Apex Dermatology & Skin Center Benefits

To Our Employees: 


Once again this year, we conducted a thorough review of options available to us and we think we’ve come up with the best possible package. But the process doesn’t stop here—we need you to take an active role in understanding and selecting your benefit options. A strong grasp of the plans available to you will best allow both you and this organization to get the most bang for our buck.  


To help you gain that strong understanding, please read this kit carefully and consult with HR with any questions. 


Thank you for all that you do for us!


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


QUALIFYING EVENTS

You can, however, modify your elections under certain circumstances, called "Qualifying Events".


Ready to Enroll?

Complete your enrollment form and hand it into Human Resources.

What is a Qualifying Life Event?

What is a Qualifying Life Event?


When Does My Coverage Start?


If you are a New Hire, you are eligible to participate if you are [full-time and work a minimum of 30 hours per week. Your coverage will be effective 1st of the month following 30 days from your date of hire.]


Open enrollment, your coverage is effective [9/1/2023]

What is a Qualifying Event?


  • Marriage
  • Divorce
  • Birth/Adoption of a child
  • Death of a spouse or other enrolled dependent
  • Change in spouse’s benefits or employment status
  • A dependent becomes eligible for Medicare or Medical

Who are my legal dependents?


  • Your legal spouse or domestic partner
  • Your children (up to age 26) including natural children, stepchildren, legally adopted children, children placed for adoption, children for whom you serve as legal guardian
  • Disabled dependent child(ren) of any age

Action Required:

All enrollment forms (Benefit Admin submissions) must be submitted by [end of day on August 14th].


This is an ACTIVE enrollment.

This means that you must log in to EaseCentral to enroll yourself and your dependents for benefits. All employees will complete the enrollment form for your OE elections. [You must take action no later than [August 14th] and submit the form to [[HR contact] [[Enroll via your benefit admin platform]. After this deadline you must wait until the next open enrollment period or experience a qualifying event.


  1. If you are not making changes, your current coverage and network will carry over to the new plan year.
  2. If you are making changes, you must [complete the Enrollment Form] [login to_____]
  3. If you are enrolling in a benefit you weren't enrolled in last year, you must also complete the necessary information.


REMINDER: if you wish to participate in a Flexible Spending Account and/or Health Savings Account in 2024, you MUST make an active election each year. Prior elections do not carry over.

Medical

Medical Mutual of Ohio

kin Center offers a medical plan through [Carrier].


A PPO option offers the freedom to see any provider when you need care. When you use providers from within the PPO network, you receive benefits at the discounted network cost. Most expenses, such as office visits, emergency room and prescription drugs are covered by a copay. Other expenses are subject to a deductible and coinsurance. The HDHP is similar to the PPO Plan in that you have the option to choose any provider when you need care. However, in exchange for a lower per-paycheck cost, you must satisfy a higher deductible that applies to almost all health care expenses, including those for prescription drugs. ​ All expenses are your responsibility until the deductible is reached, with the exception of preventive care, which is covered at 100% when you visit a physician in the network. Once the deductible is met, you are responsible for coinsurance for medical expenses and a copay for prescription drug expenses.


Utilizing In-Network providers will allow for the highest level of coverage. In-Network providers agree to accept [Carrier] contract rate as the final charge and the member is not balanced billed.

Medical Summary

What is a PPO?

What is a PPO?

What is an HDHP with HSA?

What is an HDHP with HSA?

Summary of Benefits and Coverage (SBC)


Looking for more details about how items are covered? Please refer to the formal Summary of Benefits and Coverage (SBC) below.

Prescriptions

TRADITIONAL DRUGS


TIER 1 (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.


TIER 2  | 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.


TIER 3  |  Highest 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.

SPECIALTY DRUGS


TIER 4  | Lowest Specialty Drug copay: Tier 4 specialty drugs are generally more effective and less expensive than nonpreferred specialty drugs in tier 5.


WHERE CAN I FIND 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.

RX Summary

Managing Prescription Costs

Managing Prescription Costs

Prescription Overview

Prescription Overview

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.


WHEN CAN I USE A VIRTUAL VISIT?  ​

When you have a non-emergency condition and:​

  • your doctor is not available;​
  • you become ill while traveling; ​
  • When you are considering visiting a hospital emergency room for a non-emergency health condition. ​

*Your covered children may also use Virtual Visits when a parent or legal guardian is present for the visit.

​

Examples of Non-Emergency Conditions:​

  • Bladder infection​
  • Seasonal flu​
  • Sinus​
  • Sore throat​
  • Stomach
  • Rash​
  • Bronchitis​
  • Diarrhea​
  • Fever​
  • Pink eye


HOW DOES IT WORK?​

The first time you use a Virtual Visits provider, you will need to set up an account with that Virtual Visits provider group. You will need to complete the patient registration process to gather medical history, pharmacy preference, primary care physician contact information, and insurance information.


Each time you have a virtual visit, you will be asked some brief medical questions, including questions about your current medical concern. If appropriate, you will then be connected using secure live audio and video technology to a doctor licensed to deliver care in the state you are in at the time of your visit. You and the doctor will discuss your medical issue, and, if appropriate, the doctor may write a prescription* for you.


Virtual Visits doctors use e-prescribing to submit prescriptions to the pharmacy of your choice. Costs for the virtual visit and prescription drugs are based on, and payable under, your medical and pharmacy benefit. They are not covered as part of your Virtual Visits benefit.

*Prescription services may not be available in all states.


HOW DO I GET ACCESS?​

Learn more about Virtual Visits and access direct links by downloading the Cleveland Clinic Express Care App on your phone.

FSA

Flexible Spending Accounts & Dependent Care

The Health Care and Dependent Care Flexible Spending Accounts (FSA) allow you to set aside pre-tax dollars to pay for eligible expenses. By contributing to one or both of the Flexible Spending Accounts you reduce your taxable income, so you pay less in taxes — which saves you money.


“USE IT” OR “LOSE IT”

“Unused” FSA funds do not roll over from year to year. If you don’t use the funds in your account by March 31, 2023, you’ll lose them.

Both the Health Care and Dependent Care FSA have a 75 day “grace period”. This means that you have until March 15, 2024 to incur your eligible expenses and until March 31, 2024 to submit your claims.


Contributions

The election you make during enrollment is your election for the entire plan year. You may change it only if you have a qualifying life event and the change request must be consistent with the event.


You may contribute as follows:

Health Care FSA

  • Up to $2,850 annually
  • All benefit eligible can participate unless you or your spouse are contributing to an HSA.
  • Reimbursements allowed for unreimbursed medical, prescription, dental, and vision expenses


Dependent Care FSA

  • Up to $5,000 annually
  • Limited to $2,500 if you are married and file separate tax returns


The Dependent Care FSA

Allows you to pay for eligible dependent care expenses with tax-free dollars so that you and your spouse can work or attend school Full-time.

Funds in a Dependent Care FSA are only available once they have been deposited into your account and you cannot use the funds ahead of time.

  • You may set aside up to $5,000 annually in pre-tax dollars, or $2,500 if you are married and file taxes separately from your spouse.
  • If you participate in a Dependent Care FSA, you cannot apply the same expenses for a dependent care tax credit when you file your income taxes.


How the Plan Works

You must incur your eligible expenses during the plan year — January 1 to December 31. An expense is considered to be incurred when the service is performed, not when you are billed or pay for the service. You do, however, have until March 31st annually to file your claims. Any funds after March 31 unclaimed will be forfeited.

What is an FSA?

What is an FSA?

What is a Dependent Care FSA?

What is a Dependent Care FSA?

HSA

Health Savings Account (HSA) Overview

Health Savings Account (HSA) Overview

Health Savings Account

A Health Savings Account (HSA) is a tax-free savings account that is owned by you, it is 100% vested from day one, and lets you build up savings for future needs. The funds may be used to pay for qualifying healthcare expenses not covered by insurance or any other plan for yourself, your spouse, or tax dependents. You decide how much you would like to contribute, when and how to spend the money on eligible expenses, and how to invest the balance.


To be eligible for an HSA, you must be enrolled in a High Deductible Health Plan (HDHP).


UNDERSTANDING YOUR HSA

  • Pre-tax contributions are deducted through payroll and deposited into your HSA account
  • You can use your HSA available funds to pay for qualified medical expenses tax-free
  • HSA funds can be used for non-eligible expenses but will be subject to regular income taxes and a 20% excise tax penalty
  • Unused funds remain in your account for future use and roll over each calendar year
  • HSAs remain with you even if you change health plans or companies. If you open an HSA and later become ineligible to make contributions, you can still use your remaining funds
  • You can change your HSA contribution at any time during the plan year for any reason.


You may contribute as follows:

$3,850 for Employee Only

$7,750 for a two-person or family


[Client Name] contributes the following to the employee's HSA:

$720 annually for Employee Only

$1,800 annually for two-person, or family


MAINTAINING RECORDS

To protect yourself in the event that you are audited by the IRS, keep records of all HSA documentation and itemized receipts for at least as long as your income tax return is considered open (subject to an audit), or as long as you maintain the account, whichever is longer.

HSA funds may be used for non-eligible expenses, but will be subject to regular income taxes and a 20% excise tax penalty.

Dental


Dental Benefits through MetLife provide comprehensive coverage to help you and your family maintain good dental health. Your coverage will be greater when you visit a participating in-network dentist, you will have lower out-of-pocket costs, no balance billing, and claims will be submitted by your dentist on your behalf.


NETWORK: [Carrier Network]


How do I find an In-Network Provider? Use the helpful link below!

  • In-Network providers can also be found by calling [Phone Number] or by visiting your provider’s website below where you can search by location, provider/facility name, or search by specialty.


Did You Know? 

  • You have the freedom to select the dentist of your choice; however, when you visit a participating in-network dentist, you will have lower out-of-pocket costs, no balance billing, and claims will be submitted by your dentist on your behalf.


Pre-treatment Estimate

  • If your dental care is extensive and you want to plan ahead for the cost, you can ask your dentist to submit a pre-treatment estimate. While it is not a guarantee of payment, a pre-treatment estimate can help you predict your out-of-pocket costs.


PREVENTION FIRST!

Your dental health is an important part of your overall health. Make sure you take advantage of your preventive dental visits.

Preventive care services are covered at 100% if you visit an In-Network provider. They are also not subject to the annual deductible.


Looking for more details about how items are covered? Click on the link below to view the formal plan summary.

Dental Summary

Dental Insurance Overview Video

Dental Insurance Overview Video

Vision


[Client Name] offers vision coverage through Lincoln to help pay for eye exams, prescription glasses and contact lenses. You receive a higher level of benefits when you see a provider in network, however, out-of-network coverage is provided but may only be handled as reimbursements in some situations. Please note: Members may choose between prescription glasses (lenses and frame) and contact lenses, not both.


Did You Know?

Eyes can give doctors a clear picture of overall wellness. That’s why vision care—and vision benefits—can help employees stay healthy. A comprehensive eye exam can detect early signs of serious health problems, such as:

  • Diabetes
  • Heart disease
  • High blood pressure
  • High cholesterol
  • Glaucoma and cataracts


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