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Welcome to your Virtual Benefits Hub
Benefits Are Effective January 1, 2025 - December 31, 2025
Annual enrollment is your opportunity to learn about the 2025 Benefits, review your current coverage, and choose the best options for you and your family. Please review this virtual benefit guide and attend our upcoming education session to learn more about our 2025 benefits offerings.
This annual enrollment will be a passive open enrollment, which means if you don't make or change your Ancillary elections for the upcoming 2025 Benefits, you will automatically be enrolled in the same or similar plan to what you currently have.
Open Enrollment is the one time of year when you can update your elections without experiencing a Qualifying Life Event (QLE). The elections that you make will remain in place until the next open enrollment period unless you notify HR within 30 days of your QLE to be eligible to make new elections.
The Benefit choices you make during your initial enrollment or annual open enrollment remain in effect for the entire year.
QUALIFYING EVENTS
You can, however, modify your elections under certain circumstances, called "Qualifying Events".
Ready to Enroll?
Complete your enrollment form and hand it in to Human Resources.
When Does My Coverage Start?
If you are a New Hire, you are eligible to participate if you are full-time and work a minimum of 30 hours per week. Your coverage will be effective 1st of the month following your date of hire.
Open enrollment:
Your coverage for benefits is effective 1/1/2025
What is a Qualifying 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
Who are my legal dependents?
children placed for adoption, children for whom you serve as legal guardian
Jade-Sterling Steel offers three medical plans through Medical Mutual.
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.
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 | Low copay: This category includes non-preferred and low-cost generic drugs
TIER 3 | 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 have a higher copay.
TIER 4 | 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 including most specialty medications. These drugs have the highest copay. Make sure to check for mail-order discounts that may be available.
Helpful Rx Cost Savings Tools & Tips:
MAIL ORDER - Many drugs are available in a 90-day supply, rather than the 30-day retail supply. Typically, you will pay less if you choose to get a mail-order 90-day supply.
GOOD Rx - There are many tools online that you can use to save on prescription costs. One is GoodRx.com, an online Rx database that allows you to find what pharmacy is the cheapest for your specific prescription. Additionally, you may be able to find a coupon that will greatly reduce your cost. It is important to remember that many of the coupons can only be used outside of your plan (which will not count towards your maximums).
ASK YOUR DOCTOR – Make sure to ask if there are cost-saving alternatives to the prescription they are providing. Many times, there are generic or different manufacturers that will save you money at the pharmacy.
Below is a high-level overview of your plan options and in-network benefit information:
You can view more details of these plans by accessing the medical benefit summaries provided under the Medical & Prescription section above.
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.
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 covered children may also use Virtual Visits when a parent or legal guardian is present for the visit.
Examples of Non-Emergency Conditions:
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 MedMutual App on your phone.
My Health Plan: Access your MMO information 24/7.
A secure website specifically for Medical Mutual members, My Health Plan makes it easy and convenient to manage your plan and your health online.
MedMutual Mobile App
With the Mobile App, you can get access to vital information when you are away from a computer. You can Track Claims and Spending Information, Estimate Costs, Find a Provider, and Access your ID Card. Download the app on the Apple Store or Google Play.
Chronic Management Program
If you suffer from one of the conditions below, this program may be right for you:
Call (800) 590-2583 to learn more or enroll in the Chronic Management Program.
Dental Benefits through MetLife, with two plan options, 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.
NETWORK: PDP Plus
How do I find an In-Network Provider? Use the helpful link below!
Did You Know?
Pre-treatment Estimate
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.
Looking for more details about how items are covered? Click on the link below to view the formal plan summary.
Below is a high-level overview of your plan options and in-network benefit information:
You can view more details of these plans by accessing the benefit summaries provided above.
Jade-Sterling Steel offers vision coverage through MetLife 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?
Eyes can give doctors a clear picture of overall wellness. That’s why vision care—and vision benefits—can help employees stay healthy. A comprehensive eye exam can detect early signs of serious health problems, such as:
To find out if your provider is in-network, please visit the website below.