Boehm, Kurtz, Lowry

Table of Content

  1. Header
  2. Page
    1. WELCOME
    2. OPEN ENROLLMENT IS HERE
    3. ELIGIBILITY
    4. MEDICAL / RX
    5. HSA
    6. DENTAL
    7. VISION
    8. FSA
    9. LIFE
    10. DISABILITY
    11. LEARNING
    12. RESOURCES
    13. PLAN DETAILS
    14. EMPLOYEE ASSISTANCE PROGRAM
    15. WELLNESS HUB
    16. ADDITIONAL BENEFITS
    17. Contact Us
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ELIGIBILITY

Current Benefit Period: January 2023 - December 2023


The benefit choices you make during your initial enrollment or annual open enrollment remain in effect for the entire year.   Any changes you make will be effective as of 01/01/2023. You have until 01/30/2023 to submit your changes to HR.


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.


Common life events include; Marriage, Divorce, New Dependent, Loss/gain of available coverage by you or any of your dependents.

*A full list of qualifying events can be found in the ‘Required Notice - IRS Code Section 125'

MEDICAL / RX

Medical Mutual of Ohio

If you would like to make changes to your current coverage, this must be done at open enrollment, unless you have a qualifying event during the plan year. The Summary of benefits & Coverage outline the benefits available, and the attached videos can also help you decide which plan is the best fit for you and your family.


Common Terms & Resources


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. Select the links below to see a list of covered services for each group:



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.


What is a PPO?

Preferred Provider Organization

What is a PPO?

Preferred Provider Organizatio ...

Prescription Drug Overview

Prescription Drug Overview

Medical Summary of Benefits & Coverage

Medical Summary of Benefits & Coverage

LEARNING

RESOURCE CENTER

Benefit Terms Explained

Benefit Terms Explained

What is Preventive Care?

What is Preventive Care?

How To Read An EOB (Explanation of Benefits)

How To Read An EOB (Explanation of Benefits)

RESOURCES

Enrollment Materials

What forms do I need?


This section contains all the forms you may need to either enroll in a plan for the first time or make any changes to your existing coverage. Remember, any changes you make will take effect as of January 1, and you may not be able to make any other changes the remainder of the plan year unless you have a qualifying event.


Any completed forms would need to be submitted to your benefits administration in order for them to be processed, and remember, these forms must submitted prior to January 30! If you have any questions about what form you need, please reach out to one of the contacts on this page. We're happy to help!


Please also read and review the attached Employer Annual Notices packet and ERISA Rights Statement. Please sign and return the Annual Notices Signature page.

Annual Notices Packet

Annual Notices Packet

ERISA Rights

ERISA Rights

Annual Notices Signature

Annual Notices Signature

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 the Human Resources Department.

Client Contacts

KW

Kim Walton

kwalton@bkllawfirm.com

(513) 421-2255

Account Team Contacts

ContactImage

Tammy Roberts

Account Executive

tammy.roberts@nfp.com

(513) 725-2312