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Welcome To Your
Virtual Benefits Hub
Plan Year : [Date]
This Virtual Benefits Hub was designed to be an interactive, centralized resource for you and your dependents to visit both during
open enrollment and throughout the year.
This page will serve as your go-to resource for benefits-related questions. You’ll be able to access enrollment information,
important benefit documents and different tools to help you understand your benefit offerings.
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.
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?
Who are my legal dependents?
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.
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.
[Client Name] 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.
Looking for more details about how items are covered? Please refer to the formal Summary of Benefits and Coverage (SBC) below.
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.
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 covered children may also use Virtual Visits when a parent or legal guardian is present for the visit.
Examples of Non-Emergency Conditions:
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.
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
Dependent Care FSA
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.
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.
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
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.
[Name of Vendor] will administer HRA that will offset a portion of the employee deductible as follows:
For Employee-Only Coverage
For Employee plus Spouse, Employee plus Child(ren), and Family.
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!
Did You Know?
Pre-treatment Estimate
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.
[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:
To find out if your provider is in-network, please visit the website below.
Life insurance is an important part of your financial security. Life insurance helps protect your family from financial risk and sudden loss of income in the event of your death. Accidental Death & Dismemberment (AD&D) insurance is equal to your Life benefit in the event of your death being a result of an accident and may also pay benefits for certain injuries sustained.
Basic - Employer Paid $75,000 Benefit
A sudden accident or death can leave you or your loved ones in a vulnerable position. Employees have the opportunity to enroll in Term Life and Accidental Death & Dismemberment insurance which will supplement lost income in the event of an accident or death. If you choose to enroll in employee coverage, this will be in addition to your employer-provided Basic Life coverage.
Voluntary - Employee Paid Life
Coverage is also available for your spouse and/or child dependents, but only after you've elected coverage for yourself. A sudden accident or death can leave you or your loved ones in a vulnerable position. Employees have the opportunity to enroll in Term Life and Accidental Death & Dismemberment insurance which will supplement lost income in the event of an accident or death. If you choose to enroll in employee coverage, this will be in addition to your employer provided Basic Life coverage.Review the full benefit summary below for additional details.
Employee: $10,000 increments up to 5x your annual salary, to a maximum of $500,000 ($200,000 GI)
Spouse: $5,000 increments up to $250,000 or 100% of what you elect for yourself ($50,000 GI)
Children: $10,000 Benefit, one premium covers all of your eligible children
Who's Your Beneficiary?
Naming a beneficiary is a crucial part of electing life insurance. Also, don't forget to update your primary or secondary beneficiary if you experience a life event, such as a divorce or birth of a child.
*Guaranteed Issue (GI) and Evidence of Insurability (EOI)
When you are first eligible (at hire) for Voluntary Life and AD&D, you may purchase up to the Guaranteed Issue (GI) for yourself and your spouse without providing proof of good health (EOI). [Annually, you are able to increase elections up $50,000 not to exceed the GI without proof of EOI. ]
Any amount elected over the GI will require EOI. If you elect optional life coverage, and are required to complete an EOI, it is your responsibility to complete the EOI and send to the provider (address will be listed on your form). In addition, your spouse will need to provide EOI to be eligible for coverage amounts over GI, or if coverage is requested at a later date.
Short Term Disability
Everyday illnesses or injuries can interfere with your ability to work. Even a few weeks away from work can make it difficult to manage household costs. Short Term Disability coverage provides financial protection for you by paying a portion of your income, so you can focus on getting better and worry less about keeping up with your bills. Your coverage pays 60% of your income up to a specific maximum in your benefit summary.
STD Benefit Features
Long Term Disability
Insurance through Unum can pay you a weekly benefit if you have a covered disability that keeps you from working. Long Term Disability insurance can replace part of your income while you recover.
LTD Benefit Features