LJ Star

Table of Content

  1. Header
  2. Your 2024 LJ Star Benefits
    1. To Our Employees:
    2. Eligibility & Qualifying Events
    3. How to Enroll
    4. Medical
    5. Summary of Benefits and Coverage (SBC)
    6. Prescriptions
    7. Virtual Visits
    8. Dental
    9. Vision
    10. Basic Life
    11. Disability
    12. Employee Contributions
    13. Understanding your Benefits
    14. Carrier Contacts
  3. Compliance Notices
  4. Questions?
  5. Footer

Your 2024 LJ Star Benefits

To Our Employees: 


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 with HR with any questions. 


Thank you for all that you do for us!


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 into Human Resources.

What is a Qualifying Life Event?

What is a Qualifying Life Event?


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. Please see HR for waiting period details.


During open enrollment, your coverage is effective 10/1/24.

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?


  • Your legal spouse or domestic partner
  • Your children (up to age 26) including natural children, stepchildren, legally adopted children, children placed for adoption, children for whom you serve as legal guardian
  • Disabled dependent child(ren) of any age

All employees must complete an enrollment form to enroll or waive benefits. For open enrollment, please turn the form into HR no later than Monday, September 16, 2024.

Medical

LJ Star offers a medical plan through Anthem.


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.


Utilizing In-Network providers will allow for the highest level of coverage. In-Network providers agree to accept Anthem's contract rate as the final charge and the member is not balanced billed.

Medical Summary

What is a PPO?

What is a PPO?

Engagement $200

Engagement $200

Smart Shopper

Smart Shopper

Summary of Benefits and Coverage (SBC)


Looking for more details about how items are covered? Please refer to the formal Summary of Benefits and Coverage (SBC) below.

PPO 18 $4000 Buy Down

PPO 18 $4000 Buy Down

PPO 14 $2500 Base

PPO 14 $2500 Base

PPO 5 $1000 Buy Up

PPO 5 $1000 Buy Up

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.

Additional Prescription Resources:

  1. EnsureRx – discount program for select generic prescriptions. Discounts are applied automatically at the pharmacy counter.  Members have access to this today.

  1. Cost Relief – This is a manufacturer copay assistance program for certain specialty drugs. Members would have to Opt In/ Sign up for the program. They are not automatically enrolled.  Any amount paid by manufacturer copay assistance will not count toward deductible and out of pocket maximums. Once enrolled, we work with drug manufacturers to sign up for their copay assistance program. In most cases, this will mean a $0 copay for those on PPO plan. Members under a HSA plan would still need to satisfy their deductible first before being eligible for the $0 copay.  Members can call 877-638-4008 to enroll and it takes approximately 60 days to set up. I found all 5 drugs listed above on the Cost Relief drug list.

RX Summary

Managing Prescription Costs

Managing Prescription Costs

Prescription Overview

Prescription Overview

EnsureRx

EnsureRx

Cost Relief Drug List

Cost Relief Drug List

Rx Choice Network

Rx Choice Network

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 Anthem Sydney App on your phone.

Dental


Dental Benefits through Anthem 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: Anthem BCBS Dental Complete


How do I find an In-Network Provider? Use the helpful link below!

  • In-Network providers can also be found by visiting your provider’s website below where you can search by location, provider/facility name, or search by specialty.


Did You Know? 

  • You have the freedom to select the dentist of your choice; however, 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.


Pre-treatment Estimate

  • If your dental care is extensive and you want to plan ahead for the cost, you can ask your dentist to submit a pre-treatment estimate. While it is not a guarantee of payment, a pre-treatment estimate can help you predict your out-of-pocket costs.


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.

Dental Summary

Dental Insurance Overview Video

Dental Insurance Overview Video

Vision


LJ Star offers vision coverage through Anthem 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:

  • Diabetes
  • Heart disease
  • High blood pressure
  • High cholesterol
  • Glaucoma and cataracts


To find out if your provider is in-network, please visit the website below.



Vision Benefit Summary

Vision Insurance Overview

Vision Insurance Overview

Basic Life

Life/AD&D

Life/AD&D


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 $25,000 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.


Who's Your Beneficiary?

Naming a beneficiary is a crucial part of electing life insurance. Also, don't forget to update your primary or secondary beneficiary if you experience a life event, such as a divorce or birth of a child.


Resource Advisor

This value-added support program gives you and your family access to work/life resources, at no additional cost to you, including face-to-face visits with a counselor or online visits via LifeWorks Employee Assistance Program; identity monitoring and identity theft victim recovery, legal and financial consultations; toll-free, 24/7 phone counseling from anywhere in the United States; and unlimited access to LifeWorks. To access LifeWorks, call 1-888-319-7819 or search "LifeWorks" on iTunes App store or Google Play. Login with user name metlifeeap and password eap.

Disability

Overview of Short Term & Long Term 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 up to a $1,000 maximum in your benefits summary.


STD Benefit Features

  • Benefit begins 15th day Accident/15th day Illness for up to 24 weeks
  • Benefit equal to 60% of pay – benefit is not taxable income as it is paid post tax.
  • Pre-existing condition limitations apply for first 12 months


Long Term Disability

Insurance through Anthem 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 180 day elimination period if remain disabled
  • Benefit equal to 60% of pay – benefit is not taxable income as it is paid post tax
  • Pre-existing condition limitations apply for first 12 months
What is LTD Coverage?

What is LTD Coverage?

What is STD Coverage?

What is STD Coverage?

Employee Contributions

Pre-Tax Contributions


You share in the cost of your Medical, Dental and Vision Benefits. Your employee contributions for these benefits are taken out of your pay on a pre-tax basis as set forth below. In addition, if you elect to contribute to a flexible spending account or a health savings account, those contributions will be taken out of your pay on a pre-tax basis based on your election.



What is Preventive Care?

What is Preventive Care?

Benefit Terms Explained

Benefit Terms Explained

How to Read An Explanation of Benefits (EOB)

How to Read An Explanation of Benefits (EOB)

What is Balance Billing?

What is Balance Billing?

What is a Qualifying Event?

What is a Qualifying Event?

Primary Care vs. Urgent Care vs. ER

Primary Care vs. Urgent Care vs. ER

Compliance Notices

Federal regulations require employers to provide certain notifications and disclosures to all eligible employees. The compliance packet linked is dedicated to those disclosures for your 2024-2025 plan year. If you have any questions or concerns, please contact your HR Department.

Questions?

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.

Client Contacts

KC

Kristalyn Crom

kcrom@tankcomponents.com

(330) 405-3040

SH

Suzanne Horrigan

shorrigan@ljstar.com

(330) 405-3040

Account Team Contacts