LJ Star
Table of Content
- Header
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Your 2026 LJ Star Benefits
- To Our Employees:
- Eligibility & Qualifying Events
- How to Enroll
- Medical
- Medical Plan Design
- Summary of Benefits and Coverage (SBC)
- Prescriptions
- Prescription Plan Design
- Sydney Health App
- Anthem Resources
- Dental
- Vision
- Basic Life
- Disability
- Employee Contributions
- Contributions 2
- Understanding your Benefits
- Carrier Contacts
- Compliance Notices
- Questions?
- Footer
Open Enrollment: December 10 - December 17
Plan Year: January 1, 2026 - December 31, 2026
This Virtual Benefits Hub was designed to be an interactive, centralized resource for you and your dependents to visit both during
open enrollment and throughout the year.
This page will serve as your go-to resource for benefits-related questions. You’ll be able to access enrollment information,
important benefit documents and different tools to help you understand your benefit offerings.
Your 2026 LJ Star Benefits
Overview of benefits:
Medical: New Carrier! Medical coverage will be administered through Anthem effective January 1, 2026
Dental: Anthem
Vision: Anthem
Basic Life/AD&D: The Standard
Short- and Long-Term Disability: The Standard
To help you gain that strong understanding, please read this site carefully and consult with HR with any questions.
Thank you for all that you do for us!
Eligibility & Qualifying Events
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".
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What is a Qualifying Life Event?
What is a Qualifying Life Event?
When Does My Coverage Start?
Please see HR for waiting period details.
During open enrollment, your medical coverage is effective 1/1/2026
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
How to Enroll
All employees must complete an enrollment form to enroll or waive benefits. For open enrollment, please turn the form into HR no later than Wednesday, December 17th.
Medical
LJ Star offers three medical plans 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 Plan Design
Medical Summary
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.
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 Plan Design
Prescription Summary
Sydney Health App
Download Anthem's Sydney Health App
The Sydney Health app is a free Anthem Blue Cross Blue Shield app that gives you fast and convenient access to your health insurance information right on your phone. It’s like having a personal health assistant in the palm of your hand.
What Can You Do With Anthem’s Sydney App?
Find A Doctor and Check Your Costs
Search for doctors, hospitals, labs, and other health professionals in your plan. You can search by name, location, and type of care. You can even filter by gender or languages spoken and then check costs before you go to find what’s best for you.
View Your Claims
Check medical claims with one click. That means you can spend more time focused on your health and less on managing your healthcare benefits.
See All Your Health Coverage Benefits
The Sydney app shows you essential information at a glance. Whether that’s an overview of your plan, health reminders, or suggestions for wellness programs. You also can find your deductible, copay, and share of costs.
View And Use Your Anthem Digital ID Card
You’ll always have your most current Anthem ID card handy. You can use it just like a paper one when you visit the doctor, pay for care, and more.
Use The Chat To Find Answers to Your Questions
Just type your questions in the app and receive the answers you’re looking for. Plus, Anthem’s Sydney app can suggest resources to help you understand your benefits, improve your health, and save money.
Anthem Resources
Smart Shopper
SmartShopper makes it easy to compare cost information about common health procedures. You can even earn cash* rewards when you choose a health care provider known for high-quality outcomes.
SmartShopper is easy to use:
- When your health care provider suggests a test or procedure, visit smartshopper.com or call the SmartShopper Personal Assistant Team at 1-844-328-1582.
- Choose where you would like to have your test or procedure. All of the SmartShopper options are in your plan’s network.
- After Anthem pays your claim, SmartShopper will mail you a reward check. Your check should arrive in about six weeks.
Wellbeing
The Wellbeing Solutions program connects you with easy-to-use digital health and wellness tools that can help you stay your best. When you complete any of the activities sponsored by your employer, you’ll earn rewards to put toward electronic gift cards for select retailers. You choose the activities you’d like to complete to receive the maximum of $200.
Please see attached flyer for a list of approved activities!
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.
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Dental Insurance Overview Video
Dental Insurance Overview Video
Dental Summary
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.
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Vision Insurance Overview
Vision Insurance Overview
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 $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.
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Life/AD&D
Life/AD&D
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 weekly amount.
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. Your coverage pays 60% of your income up to a $6,000 monthly amount.
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
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.
Medical Employee Contributions
Dental Employee Contributions
Vision Employee Contributions
Carrier Contacts
Carrier Contacts
Compliance Notices
Federal regulations require employers to provide certain notifications and disclosures to all eligible employees.
Questions?
LJ Star Contacts
Suzanne Horrigan
shorrigan@ljstar.com
(330) 405-3040
NFP Contacts
Joel Richman
Producer / Sales Consultant
joel.richman@nfp.com
216-225-9885
Samantha Geffert
Account Manager
samantha.geffert@nfp.com
216-260-2401