Employee Benefits Plan Year 6/1/2022 to 5/31/2023
Welcome
Helping you and your family reach and maintain good health is very important to Live Oak Gottesman, LLC. We are pleased to offer a selection of benefits designed with your health and financial wellbeing in mind. We review our benefit programs each year to ensure we consider the best combination of benefit coverage, network access and affordability for employees.
Eligibility
Regular employees working at least 30 hours per week are eligible to participate in benefits offered by Live Oak Gottesman, LLC. When you enroll in the benefits program, you may also cover your eligible dependents.
Enrollment
The Benefit choices you make during your initial enrollment or annual open enrollment remain in effect for the entire year.
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.
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 1st of the month following 60 days from your date of hire.
STEP 1
Enroll through Employee Navigator (see link below) by 5/16/22.
STEP 2
If you are enrolling in Sedera:
In addition to completing the election form or Employee Navigator enrollment, new Sedera members must complete their enrollment through the Sedera portal before the 19th of the month to ensure an effective date of the 1st of the following month. If you do not do this your enrollment may not be processed properly.
New Members:
Click the following link and enter the Employer code below.
Employer Verification Code: 6465
MEDICAL OPTION 1
Option 1 - Sedera (cost sharing) with MEC (Minimum Essential Coverage)
The Sedera combo plan has two parts: Sedera Cost Sharing and a Minimum Essential Coverage (MEC) plan which will cover your preventative care.
Cost Sharing Plan with Sedera
Sedera is a cost sharing community that will share the cost of the large events in life.* The Sedera plan doesn't have a network. Please reference the Sedera materials and view the video presentations below for details.
There is no ID for this plan and no network. You will present yourself as a cash payer and start a "Need" on the member portal if the total goes over your chosen IUA (Initial Unshareable Amount). See "Sedera Select + Presentation" link below.
Sedera Member Services:
If you need additional information or have addition questions about Sedera may contact Sedera at memberservices@sedera.com or 855-873-3372.
Telemedicine is included with your Sedera membership.
Teladoc gives you access 24 hours, 7 days a week to a U.S. board-certified doctor through the convenience of phone, video or mobile app visits.
GET THE CARE YOU NEED
Teladoc doctors can treat many medical conditions, including:
• Cold & flu symptoms
• Allergies
• Pink Eye
• Respiratory infection
• Sinus problems
• Skin problems
• And more!
Teladoc.com
1-800-Teladoc (835-2362)
*Pre-existing limitations apply.
See how to enroll above.
MEC (Minimum Essential Coverage) - Preventative Care through ASi
When you enroll in Sedera you are automatically enrolled in this plan.
You will receive an ID card for this plan.
This plan will cover your preventative care at 100% and also provides the framework for an HSA banking account. You do need to stay in network for your preventative care. All preventative care mandated by ACA is covered. You can see a complete list here.
PHCS network search instructions:
●Go to www.multiplan.com
●Click on Find a Provider in the upper right corner
●Click on the green Select Network button & choose PHCS
●Click the green Select Network box
●Choose PHCS in the pop-up box
●Select Preventive Services Only
MEDICAL OPTION 2
BCBS (Fully Insured)
The BCBS plans are fully insured medical plans and you have four options. Two of these options are PPO plans with in and out of network benefits. Two of these plans are HMO options. The HMO plans have no out of network benefits and require a member to choose a PCP (primary care physician) and get a referral to see a specialist.
See plan summaries below.
DENTAL
Sunlife's dental plan provides comprehensive coverage to help you and your family maintain good dental health. Providers are part of the Sunlife dental network, or you may see an out-of-network dentist of your choice. Be aware that if you go out-of network, your costs could be higher.
See Sunlife Dental Summary below.
VISION
Voluntary Vision through Sunlife
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
Live Oak Gottesman offers vision coverage through Sunlife using the VSP network to help pay for eye exams, prescription glasses and contact lenses. You receive a higher level of benefits when you see a provider in VSP's Network.
How do I use my vision benefit?
Once enrolled, simply tell your VSP doctor you’re a member and they will handle the rest. If you visit an in-network doctor for services and materials, you don’t need an ID card or have forms to complete.
How do I locate an in-network VSP doctor?
You will have access to the largest national network of private-practice eye care doctors in the industry through Vision Service Plan (VSP). There are three ways to find an in-network doctor:
1. Visit vsp.com and select the Choice network.
2. Call VSP at 800-877-7195.
3. Download our mobile app, Benefit Tools, and search
for a doctor near you.
What happens if I use an out-of-network doctor?
You will be required to pay the full amount to the doctor at time of service. You can then submit a claim for reimbursement, which is a lesser benefit when compared to visiting a VSP doctor.
LONG TERM DISABILITY
Long Term Diability Insurance through Sunlife can pay you a monthly benefit if you have a covered disability that keeps you from working. This employer paid benefit can replace part of your income while you recover.
Benefit Features
- Benefit begins after 90 day elimination period
- Benefit is equal to 60% of pay - benefit is taxable income
- Monthly maximum benefit is $6,000
See plan summary for additional details.
VOLUNTARY LIFE
All full time eligible employees have the option to purchase Voluntary Life through Sunlife. This coverage is available for the employee and their dependents.
At initial enrollment, 6/1/2022, all employees are eligible to elect up to $130,000 without EOI (evidence of insurability). See summary for additional details.
AFLAC
Employees have the option to choose from a variety of AFLAC products. See more details in Employee Navigator.