Table of Content
- Header
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Overview of Health Benefits
- Welcome to your 2024 iDesign Benefits
- How to Enroll
- Eligibility & Qualifying Events
- Medical
- Prescriptions
- Virtual Visits
- HSA
- Dental
- Vision
- Basic Life
- Disability
- Accident and Critical Illness Insurance
- Employee Contributions
- Guardian Resources
- Understanding your Benefits
- Additional Resources
- Carrier Contacts
- Contact Us
- Footer
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.
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. 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
Dental
Dental Benefits through Guardian 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.
A comparison of the options is ->
Dental Summary
Vision
iDesign 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?
- 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.
Vision Benefit Summary
Basic Life
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 $50,000 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
You may elect Supplemental Life Insurance without electing Accidental Life and Dismemberment. To elect Accidental Death & Dismemberment you MUST elect Supplemental Life Insurance. Your Supplemental Life and Accidental Death & Dismemberment election MUST be for the same amount if electing both types of coverages. If you choose to enroll in employee coverage, this will be in addition to your employer-provided Basic Life coverage. Coverage is also available for your spouse and/or child dependents. It is required that you elect coverage for yourself in order to be eligible for coverage on your dependents.
Employee: $25,000 increments up to $150,000, to a maximum of $150,000 ($150,000 GI)
Spouse: $10,000 or $50,000 ($50,000 GI)
Children:$10,000 ($10,000 GI)
Who's Your Beneficiary?
It is also important that you name a Primary and Contingent Beneficiary. A contingent beneficiary will receive the benefits of your life insurance if the primary beneficiary cannot. You can change beneficiaries at any time.
*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).
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 the form to Guardian (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.
Disability
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.
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
- Benefit begins after 90 day elimination period if you remain disabled
- Benefit equal to 60% of pay – benefit is taxable income
- Pre-existing condition limitations apply for first 12 months
Accident and Critical Illness Insurance
Accident Insurance
Accident Insurance through Guardian can pay you money for covered accidental injuries and their treatment. Accident Insurance can pay a benefit amount based on the type of injury you have and the type of treatment you need. It covers accidents that occur on and off the job. And it includes a range of incidents, from common injuries to more serious events.
- Coverage is limited to accidents incurred while off-job only
- All participants must have medical coverage
- •No medical underwriting is required
Examples of what's covered
- Accidental Death - Employee $25,000, Spouse $12,000 and Child $5,000
- Ambulance - $150
- Concussions - $75
- Hospital Admission - $1,000
Critical Illness Insurance
Critical Illness Insurance can pay money directly to you when you are diagnosed with certain serious illnesses. Pre-existing condition will have a 6 month look back; 6 months exclusion period.
What's covered?
- Critical Illness such as heart attack, stroke and end-stage kidney failure
- Cancer conditions, such as breast cancer and skin cancer
- Progressive disease such as Alzheimer's Multiple Sclerosis and Parkinson's disease
Wellness Benefit
When you enroll in Accident or Critical Illness Insurance you can earn $50 just by getting an annual physical or covered preventive test.