Table of Content
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Overview of Health Benefits
- Welcome to your Great Lakes Power Products Benefits Page
- How to Enroll
- Eligibility & Qualifying Events
- Medical
- Prescriptions
- Virtual Visits
- FSA
- HRA
- HSA
- Dental
- Vision
- Basic Life and Voluntary Life
- Disability
- Accident and Critical Illness Insurance
- Employee Contributions
- Understanding your Benefits
- Additional Resources
- Company Time off and Holidays
- 401(k) Retirement & Profit Sharing
- Carrier Contacts
- Contact Us
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Medical
Dakota Software offers 4 plan options through Excellus BCBS.
You have the option to choose between a PPO and 3 HDHP HSA plans. 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 Medical Mutual's contract rate as the final charge and the member is not balanced billed.
Medical Summary
Prescriptions
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.
On a maintenance medication, you take each month?
Use home delivery from Express Scripts PharmacySM or Wegmans Pharmacy. Your Rx is delivered to your door about eight days after your Rx is received. Delivery is free!
- By Phone: 1-855-315-5220
- Online: Express-Scripts.com
The differences in prescription drug costs are summarized here:
RX Summary
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 and access direct links by downloading the MD Live App on your phone or my click on ExcellusBCBS.com/member
