Chagrin Valley Country Club

Table of Content

  1. Header
  2. Page
    1. Plan Highlights
    2. Eligibility & Qualifying Events
    3. Medical - Anthem - HSA and PPO three tiered
    4. Virtual Visits
    5. Dental - Plan 1 - Guardian
    6. Dental - Plan 2 - Guardian
    7. Vision - Guardian
    8. Basic Life and AD&D - Guardian
    9. Short Term Disability (STD) - Guardian
    10. Enrollment Form
    11. Contact Us
  3. EAP Program Guardian
  4. Footer

Plan Highlights

Medical: Staying with Aetna

Dental: Provided through Guardian with 100%/100%/60% in network coverage.

Vision: Provided through Guardian who utilizes a large network of providers.

Short Term Disability (STD): Provided through Guardian

Life and AD&D: Provided though Guardian

Do you plan to enroll an eligible dependent(s)?

If so, make sure to have their social security numbers and birthdates available. You cannot enroll your dependent(s) without this information.

Have you recently been married/divorced or had a baby?

If so, remember to add or remove any dependent(s) and/or update your beneficiary designation.

Did any of your covered children reach their 26th birthday this year?

If so, they may no longer be eligible for benefits, unless they meet specific criteria.

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


EMPLOYEE ELIGIBILITY

You are eligible to participate if you are full-time and work a minimum of 30 hours per week. Your coverage will be effective 90 days from your date of hire.


***Reminder:

You have up to 30 after your benefit effective date to make your elections. If you wait until the 31st day, you will need to wait until Open enrollment or a qualifying event.


DEPENDENT ELIGIBILITY

You may also enroll eligible dependents for benefits coverage. A ‘dependent’ is defined as the legal spouse and/or ‘dependent child(ren)’ of the plan participant or the spouse. 


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.


What is a Qualifying Life 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


Medical - Anthem - HSA and PPO three tiered

PPO 3k SBC

PPO 3k SBC

HSA 3500 SBC

HSA 3500 SBC

Virtual Visits

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?​

  1. ​If it is your first time using Virtual visits, download the Sydney App or go to anthem.com ​
  2. 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. ​
  3. 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.​

HOW DO I GET ACCESS?​

Learn more about Virtual Visits and access direct links by downloading the Sydney app on your phone.​

​

Dental - Plan 1 - Guardian

Dental Benefit Summary

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Dental Benefit Summary

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Value Plan:

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

IN NETWORK:

BENEFIT PERIOD: 2 years until 10/24

DEDUCTIBLE:

  • Single Deductible - $50
  • Family Deductible - $150

*Deductible applies when receiving Basic or Major services (Waived for Preventive Services)

CLASS I: - Covered at 100% (deductible waived)

Diagnostic and Preventive Services - Exams, cleanings, fluoride, space maintainers, sealants, x-rays.

CLASS II: - Covered at 100% (deductible waived)

Basic Services - Fillings, anesthesia, oral surgery, extractions

CLASS III: - Covered at 60% (deductible applies)

Major Services - Fixed bridgework, dentures, crowns, implants, endodontics (not root canals), periodontal services (gums), and orthodontia for children under age 19

ANNUAL MAXIMUM:

Calendar Year Maximum (Allowed per Benefit Period) - $1,000 per covered individual

EMPLOYEE CONTRIBUTION - PER PAY:

Employee - $4.11

Employee+Spouse - $8.65

Employee+Child(ren) - $10.37

Family - $14.91

Vision - Guardian

Vision Benefit Summary

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Vision Benefit Summary

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Under this plan, 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 from an out-of-network provider, you will be required to pay that provider at the time of service and submit a claim form for reimbursement.


IN NETWORK:


Vision Exam (with dilation as necessary) - $10

Retinal Imaging - Up to $39


COVERED SERVICES – LENSES / FRAMES

Single Lenses - $25

Bifocals - $25

Trifocals - $25

Progressive - $50

Frames - Up to $130, then 20%


COVERED SERVICES - CONTACT LENSES

Contact Lenses - Up to $130

Contact Lens Evaluation Fitting - Include in allowance


BENEFIT FREQUENCY

Exams - Once every calendar year

Lenses or Contact Lenses - Once every calendar year

Frames - Once every calendar year


EMPLOYEE CONTRIBUTION - PER PAY:

Employee - $0.00

Employee+Spouse - $0.00

Employee+Child(ren) - $0.00

Family - $0.00

Basic Life and AD&D - Guardian

Life and AD&D Benefit Summary

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Life and AD&D Benefit Summary

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Your Voluntary Life Benefit

  • Premiums: Covered by your employer if you meet eligibility requirements
  • Employee Benefit: Up to $10,000
  • Portability:  Allows you to take coverage with you if you terminate employment
  • Conversion: Allows you to continue your coverage after your group plan has 
  • Waiver of Premium: for employees disabled prior to age 60, premium waived to age 65, if conditions are met

*Please refer to attached Benefit Summary for more complete plan details and exclusions*

Short Term Disability (STD) - Guardian

Disability insurance covers a part of your income, so you can pay your bills if you're injured or sick and can't work. 

Accidents happen, and you can't always anticipate if or when you'll become sick or injured. That's why it's important to have a disability policy that helps you pay your bills in the event of being unable to collect your normal paycheck.

Your Short-Term Disability Benefit: 

  • Coverage Amount: Choose weekly benefit amount from $100 - $1,050 
  • Maximum Payment Period: 13 weeks
  • Accident Benefit Begin: Day 1
  • Illness Benefits Begin: Day 8

*Please see attached Benefit Summary for more complete plan details*

Short Term Disablity Benefit Summary

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Short Term Disablity Benefit Summary

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Contact Us

Client Contacts

JC

Jeff Criscione

jcriscione@cvcclub.com

(440) 248-4310

Account Team Contacts

ContactImage

Kevin Lurie

Producer / Sales Consultant

kevin.lurie@nfp.com

216-410-6751

EAP Program Guardian

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