GK's Custom Polishing, Inc

Table of Content

  1. Header
  2. Page
    1. What's New for 2022!
    2. Benefits Overview
    3. Medical - Aetna
    4. Prescriptions
    5. Virtual Visits - Teledoc
    6. Dental - Delta Dental
    7. Vision - Delta Dental
    8. How To Enroll?
    9. Additional Resources
    10. Contact Us
  3. Footer

What's New for 2022!

Medical coverage will be moving from Anthem to Aetna!

Benefits Overview

MEDICAL: Moving from Anthem to Aetna.

DENTAL: Provided through Delta Dental  with 100%/80%/50% in network coverage.

VISION: Provided through Delta Dental with one plan option that utilizes a large network of providers.

Medical - Aetna

DEDUCTIBLE:

  • Single Deductible - $500
  • Family Deductible - $1,000
  • COINSURANCE - 80% - (applies after deductible is met) & Out of Pocket Max (includes coinsurance and deductible)



PLAN PAYS:

  • Single Out of Pocket Maximum - $3,500
  • Family Out of Pocket Maximum - $7,000
  • Primary Care (PCP) - Office Visit - $30
  • Preventive Services - 100%
  • Specialist - Office Visit - $60
  • Urgent Care Facility - $75
  • Emergency Room Visit - $500


EMPLOYEE CONTRIBUTIONS (BI-WEEKLY)

Single: $125.17

EE+Spouse: $432.41

EE+Children: $380.00

Family: $585.69

Find a Doctor

Find a Doctor

Summary of Benefit Coverage

Summary of Benefit Coverage

MinuteClinic No Cost Benefit

MinuteClinic No Cost Benefit

Attain by Aetna

Earn a FREE Apple Watch

Attain by Aetna

Earn a FREE Apple Watch

Prescriptions

RETAIL - 30 DAY SUPPLY


TIER 1 - $30/$10

TIER 2 - $45

TIER 3 - $75

TIER 4 - 20% up to $250 (pref.)/40% up to $500 (non-pref.) (30 day only)

Virtual Visits - Teledoc

Access to quality care at your fingertips!


General Medical - Talk to a licensed doctor for non-emergency conditions 24/7

Mental Health - Talk to a therapist 7 days a week

Dermatology - Upload images of a skin issue online and get a custom treatment plan within 2 days

Teledoc Flyer

Teledoc Flyer

Dental - Delta Dental

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.


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 80% (deductible applies)

Basic Services - Fillings, crown repair, root canals, extractions and oral surgery, religns and repairs to prosthetic appliances. 


CLASS III: - Covered at 50% (deductible applies)

Major Services - Crowns, bridges, implants, dentures, and crowns over implants


ANNUAL MAXIMUM:

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


EMPLOYEE CONTRIBUTIONS (WEEKLY)

Employee: $12.99

Employee + 1: $28.29

Employee + 2 or more: $48.76

Find a Dentist

Find a Dentist

Vision - Delta Dental

GK's Custom Polishing offers vision benefits provided by Delta Dental. Services rendered by a participating  provider will be paid at a higher level. 


IN NETWORK:


Vision Exam - $10 copay


COVERED SERVICES – LENSES / FRAMES

Single Lenses - $25 copay

Bifocals - $25 copay

Trifocals - $25 copay

Lenticular - $25 copay

Frames - $130 copay


COVERED SERVICES

Elective Contact Lenses - $130 allowance

Necessary Contact Lenses - Covered in full after copay

Contact Lens Evaluation Fitting - Up to $60


BENEFIT FREQUENCY

Exams - Once every 12 Months

Lenses - Once every 12 Months

Frames - Once every 24 Months


EMPLOYEE CONTRIBUTIONS (PER PAY PERIOD)

Single: $2.54

EE+Spouse: $5.09

EE+Children: $5.42

Family: $8.65


* NOTES

  • The lens frequency limit applies to contact lenses OR lenses for eyeglasses. You cannot purchase both in 12 months—its one or the other.
  • If receiving Progressive lenses, contact Vision Benefits of America to verify the plan reimbursement prior to placing your final order. The in-network allowance for these expensive lenses typically covers only a portion of the total cost.  

How To Enroll?

Action Required

Contact Us

Human Resource Department

Client Contacts

KZ

Kristin Zehnder

kristin@gkspolishing.com

440-937-4457

Account Team Contacts

ContactImage

Naomi Butze

Account Manager

naomi.butze@nfp.com

(216) 816-0026