Horizon Education Centers
Table of Content
- Header
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Page
- What's New for 2022?
- Benefits Overview
- Eligibility and Qualifying Life Changes
- Medical
- Virtual Visits
- Medical Mutual: My Health Plan
- Medical Mutual Programs & Discounts
- Dental
- Vision
- Voluntary Life
- Accident, Critical Illness, Hospital Indemnity
- Additional Resources
- Contact Us
- Footer
Benefits Effective 10/1/2022
What's New for 2022?
NEW Dental Carrier - Guardian will be your new Dental carrier 10/1/22-9/30/23
NEW Vision Carrier - Guardian will be your new Vision carrier 10/1/22-9/30/23
NEW Accident, Critical Illness & Hospital Indemnity carrier - Trustmark will be your new carrier for these benefits 11/1/22-9/30/23
Benefits Overview
Effective October 1, 2022 Horizon’s Education Centers will offer the following benefit package.
Medical: Medical Mutual will continue as your Medical carrier with no changes to benefit offerings.
- Cle-Care HMO plan 70% with $5,000/$10,000 deductible.
- PPO plan 80% with $1,000/$2,000 deductible.
Dental: Guardian will be your NEW Dental carrier.
Vision: Guardian will be your NEW Vision carrier.
Voluntary Life: Guardian will continue as your Voluntary Life benefit carrier.
Accident, Critical Illness & Hospital Indemnity: Trustmark will be your NEW Accident, Critical Illness and Hospital Indemnity benefit carrier.
*Please see attached 2023 Benefit Guide for enrollment forms*
Eligibility and Qualifying Life Changes
Full-Time Employees
*You are eligible for medical benefits if you are full-time working a minimum of 30 hours per week.
*You are eligible for voluntary benefits if you are working a minimum of 20 hours per week.
*Employees are eligible for benefits the first of the month following 90 days from date of hire.
EMPLOYEE ELIGIBILITY: If you do not enroll during the Open Enrollment period, you must wait until the next Open Enrollment period unless you experience a Qualifying Life Event. If you experience a Qualifying Life Event (i.e., birth or adoption of a child, marriage, divorce, loss of other coverage, etc.) you must enroll within 30 days of the 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.
- Your Legal Spouse
- Your Dependent Children: Children are eligible for medical, dental and vision up to the last day of the calendar year the child turns 26. Child life insurance is effective until the last day of the month the child turns 26.
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 Medicaid
If you have a Qualifying Life Event and want to request a mid-year change, you must notify Human Resources and complete your election changes within 30 days following the event. Be prepared to provide documentation to support the Qualifying Life Event.
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What is a Qualifying Life Event?
What is a Qualifying Life Event?
Medical
Medical Mutual will continue as your medical carrier.
You can choose the provider of your choice. However, when you visit an In-Network provider, you receive higher benefits. Employees who seek care from an out of network provider will be responsible for higher costs.
CLECare HMO Plan
In Network Deductible: Cost you pay to providers before the plan begins to pay.
- Single: $5,000
- Family: $10,000
Coinsurance (applies after deductible is met): 70%
Copayments:
- Preventative Exam: 100% no deductible
- Primary Care (PCP) - Office Visit: $40 copay
- Virtual Visit: $40 copay
- Specialist - Office Visit: $80 copay
- Urgent Care Facility: $40 copay
- Emergency Room Visit: $250 copay, then 70% coinsurance
PRESCRIPTION DRUG COVERAGE:
Save Money With Generic (Tier 1) Drugs
Ask your doctor if it’s appropriate to use a generic drug rather than a brand. Generic drugs are less expensive, and according to the FDA, they contain the same active ingredients and are identical in dose, form and administrative method as a brand name.
PPO Plan
The 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.
In Network Deductible:
- Single: $1,000
- Family: $2,000
COINSURANCE (applies after deductible is met): 80%
Copayments:
- Preventative Exam: 100% no deductible
- Primary Care (PCP) - Office Visit: $25 copay
- Virtual Visit: $25 copay
- Specialist - Office Visit: $50 copay
- Urgent Care Facility: $50 copay
- Emergency Room Visit: $250 copay, then 80% coinsurance
*Please refer to attached Summary of Benefits and Coverage (SBC) for more plan details and exclusions*
Virtual Visits
Available to you through MyClevelandClinic.
Speak to a doctor from your mobile device or computer. When you use a provider in our virtual visit network, you have benefit coverage for certain non-emergency medical conditions. Costs must be paid 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.
HOW DOES IT WORK?
- The first time you use a Virtual Visits provider, you will need to set up an account with that provider group. You will need to complete the patient registration process to gather medical history, pharmacy preference, primary care physician information, and insurance information.
- Each time you have a virtual visit, you will be asked brief medical questions about your current medical concern. If appropriate, you will then be connected using secure live audio and video technology to a doctor. You and your 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.
HOW DO I GET ACCESS?
Learn more about Virtual Visits and access direct links to provider sites using the link below.
Medical Mutual: My Health Plan
Utilize your Medical Mutual Member Portal
How to create an account:
- You will need your Medical Mutual identification number or Social Security number and your date of birth
- Create a username and password
- Agree to terms and conditions
- For additional help creating an account call (800) 294-7583
Manage you plan and your health online:
- Check your deductible
- Review your Explanation of Benefits
- Find In Network Providers
- View ID cards
- My Care Compare – Compare costs for services
- Access Prescription Drug Coverage information
- Access to variety of programs, discounts, money saving tools
Medical Mutual Programs & Discounts
Chronic Condition Management Program:
This program offers digital and telephonic options that are customized to meet your needs and help you achieve your personal health goals
- Asthma
- Heart Failure
- Coronary Artery Disease
- COPD
- Diabetes
- Hypertension
Maternity Program:
Offers digital education and support.
- Access to trained maternity health coaches
- Provides knowledge, advice, and comfort during pregnancy
No additional cost for Chronic Condition Management & Maternity programs. Call 1-800-590-2583 to learn more or enroll
Medical Mutual Tobacco Quitline Program:
- One on one coaching
- Personalized plan & educational materials
- May qualify for nicotine patches or gum at no cost
- Learn more by calling 1-866-845-7702
24-Hour Nurse Line:
- Health question, minor injury or medical question – get answers 24/7 from a clinical expert
- No charge to members
- Call 1-888-912-0636
Fitness Discounts:
- Discounted gym memberships at more than 10,000 fitness clubs through Medical Mutual partner, GlobalFit.
Weight Watchers Program:
- Save up to 50% off regular cost of WW membership
- Digital & Studio programs to help achieve health goals
Other Discounts:
We’ve partnered with vendors to offer discounts on a variety of unique health products and services including baby items, fitness club fees, hearing aids and other health products. You can find more details on My Health Plan.
- AmericanFitness.net: full selection of top brand exercise equipment to help you reach your fitness goals.
- Beltone™ Hearing Aids: full line of innovative hearing products that fit your lifestyle.
- Safe Beginnings®: large selection of items to help you keep your baby safe in your home.
- YogaAccessories.com: High-quality yoga, meditation, spiritual, wellness and holistic living supplies.