Table of Content
- Header
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Welcome
- Welcome to Your 2023 Eleanor Health Benefits
- How to Enroll
- Eligibility & Qualifying Events
- Medical
- Prescriptions
- Virtual Visits
- HSA
- FSA
- Dental
- Vision
- Basic Life and Voluntary Life
- Disability
- Supplemental Insurance
- Pet Insurance
- Additional Resources
- Understanding your Benefits
- Carrier Contacts
- Contact Us
- Footer
Welcome to Your 2023 Eleanor Health Benefits
To Our Team Members:
Our mission at Eleanor Health is to help people affected by addiction live amazing lives. We deliver whole-person, comprehensive care, and are passionate about transforming the quality, delivery, and accessibility of addiction & mental health treatment.
Our actions are rooted in respect for each member's values, culture, and life experiences, and our commitment to their well-being is unwavering and without judgment. We believe the only way to deliver on our commitment to helping others live amazing lives is for you to be able to live an amazing life yourself! To that end, we have developed a comprehensive benefit plan which supports you and your family members holistically. We have made a conscious decision to offer you benefits because we care about you and your families, and we want to do everything we can to make sure you stay healthy and happy at Eleanor Health.
Once again this year, we conducted a thorough review of the 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 Eleanor to get the most bang for our buck.
To help you gain that strong understanding, please read this kit carefully and consult with our HR department with any questions.
Thank you for all you do for Eleanor and our community members!
How to Enroll
Action Required:
All elections must be submitted by 5:00 pm est on June 2nd.
This is an ACTIVE enrollment.
This means that you must log in to ADP to enroll yourself and your dependents for benefits. All employees will use our benefits enrollment system to confirm or change benefit elections. You must take action no later than Friday, June 2nd. After this deadline you will have to wait until the next open enrollment period or experience a qualifying event in order to:
- Waive any benefits
- Change or drop the coverage of your current plan, including your dependents enrolled within that plan.
- Participate, if you did not enroll during open enrollment or within the first 30 days of becoming eligible
Eligibility & Qualifying Events
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 1st of the month following your date of hire.
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
Ready to Enroll?
Medical
Eleanor Health offers three plan options through BCBS of Massachusetts
- Plan 1 HSA - $4,000 Single / $8,000 Family deductible
- Plan 2 PPO - $3,000 Single / $6,000 Family deductible
- Plan 3 EPO - $2,000 Single / $4,000 Family deductible
You have the option to choose between two PPO plans and a high deductible health plan (HDHP) plan. 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 HSA 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 up to your annual out-of-pocket maximum.
Utilizing In-Network providers will allow for the highest level of coverage. In-Network providers agree to accept BCBS of Massachusetts' contract rate as the final charge and the member is not balanced billed.
Medical Summary
Medical Premium - Monthly
Prescriptions
Please note the differences in prescription drug costs on the right of this screen →
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.
WHERE CAN I FIND A DRUG LIST?
The full listing of covered drugs is found on the BCBS MA website with the link below. 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.
On a maintenance medication that you take each month?
BCBS MA uses home delivery from CVS Caremark. Your Rx is delivered to your door about eight days after your Rx is received. Delivery is free. With mail order, you get three months of maintenance medications for two copays - this is like getting one month free!
- Login to your My Blue member portal
On a specialty medication?
Rx Summary
Virtual Visits
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 by signing into your MYBLUE account at bluecrossma.com
HSA
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.
The maximum amount that can be contributed to your HSA account (both employer & your contribution):
$3,850 for Employee Only
$7,750 for a two-person or family
$1,000 catch up contribution for employees 55+
Eleanor Health contributes the following to the employee's HSA:
$25 per month for Employee Only
$50 per month for Employee plus Spouse; Employee plus child
$1,200 for Family coverage ($1,200 per month)
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.
FSA
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.
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 $3,050 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.
- 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 — Plan year ends December 31, 2023. An expense is considered to be incurred when the service is performed, not when you are billed or pay for the service.
Limited Purpose FSA
If you are enrolled in the HSA and are interested in enrolling in the FSA, you must enroll in a Limited Purpose FSA. Funds in a Limited Purpose FSA can only be used for expenses related to dental or vision care.
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.
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.
Dental Summary
Dental Premiums - Monthly
Vision
Eleanor Health offers vision coverage through MetLife 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?
- Eye exams can help detect serious eye and general health conditions sooner: high blood pressure, diabetes, heart disease, high cholesterol.
- Babies should receive their first professional eye exam at 6 months.
- 80% of learning in the first 12 years comes through the eyes.
To find out if your provider is in-network, please visit the website below.