JJ CBus Holdings
Table of Content
- Header
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Overview of Health Benefits
- Welcome to your 2023 Benefits
- How to Enroll
- Eligibility & Qualifying Events
- Medical PPO 3020-2000RX
- Prescriptions
- Virtual Visits
- Dental
- Vision
- Voluntary Life
- Employee Contributions
- Understanding your Benefits
- Additional Resources
- Carrier Contacts
- Contact Us
- Footer
Open Enrollment runs Monday, August 1st - August 17th
Benefits Are Effective September 1, 2023
Overview of Health Benefits
Welcome to your 2023 Benefits
To Our Employees:
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 are taken care of.
Once again this year, we conducted a thorough review of 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 this organization to get the most bang for our buck.
To help you gain that strong understanding, please read this kit carefully and consult us with any questions.
Thank you for all that you do for us!
How to Enroll
Action Required:
This is an PASSIVE enrollment.
This means that you must complete an Enrollment Form to enroll yourself and your dependents for benefits. Once you enroll, you will not be able to make any changes throughout the year unless you experience a qualifying event in order to:
- Waive any benefits
- Change or drop the coverage of your current 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 on 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 PPO 3020-2000RX
IN NETWORK
DEDUCTIBLE:
- Single Deductible - $2,000
- Family Deductible - $4,000
COINSURANCE (applies after deductible is met): 80%
SINGLE OUT OF POCKET MAX: $5,000
FAMILY OUT OF POCKET MAX: $10,000
MEMBER COPAYMENT(S):
- Preventative Exam - 100% no deductible
- Primary Care (PCP) - Office Visit - $30
- Specialist - Office Visit - $60
- OP Lab & X-ray - Deductible then 20%
- MRI/Cat Scan - Deductible then 20%
- Hospital IP, OP Surgery: Deductible then 20%
- Urgent Care Facility - $75 copay
- Emergency Room Visit - $350, then 20%
Video Preview
Qualifying Life Events
Video Overview
Qualifying Life Events
Video Overview
Video Preview
Preferred Provider Organization (PPO) Overview
Video Overview
Preferred Provider Organization (PPO) Overview
Video Overview
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.
Prescription Chart
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
Dental
Dental Benefits through Principal 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
Video Preview
Dental Insurance Overview Video
Dental Insurance Overview Video
Vision
Vision Benefit Summary
JJ CBus Holdings offers vision coverage through Principal 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.
Understanding your Benefits
Video Preview
What is Preventive Care?
What is Preventive Care?
Video Preview
Benefit Terms Explained
Benefit Terms Explained
Video Preview
How to Read An Explanation of Benefits (EOB)
How to Read An Explanation of Benefits (EOB)
Video Preview
What is Balance Billing?
What is Balance Billing?
Video Preview
What is a Qualifying Event?
What is a Qualifying Event?
Video Preview
Primary Care vs. Urgent Care vs. ER
Primary Care vs. Urgent Care vs. ER
Contact Us
As you consider your benefit options, please be sure to review all available information. If you don't understand your benefits or need any assistance, please contact Human Resources.