Table of Content
- Header
-
Page
- WELCOME
- OPEN ENROLLMENT IS HERE
- ELIGIBILITY
- MEDICAL / RX
- HSA
- DENTAL
- VISION
- FSA
- LIFE
- DISABILITY
- LEARNING
- RESOURCES
- PLAN DETAILS
- EMPLOYEE ASSISTANCE PROGRAM
- WELLNESS HUB
- ADDITIONAL BENEFITS
- Contact Us
- Footer
ELIGIBILITY
The benefit choices you make during your initial enrollment or annual open enrollment remain in effect for the entire year. Any changes you make will be effective as of 12/1/2022. You have until 12/15/2022 to submit your changes to HR.
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. Contact Human Resources if you have questions about qualifying events.
Common life events include; Marriage, Divorce, New Dependent, Loss/gain of available coverage by you or any of your dependents.
*A full list of qualifying events can be found in the ‘Required Notice - IRS Code Section 125'
MEDICAL / RX
You have a choice between two medical plans. If you would like to change the plan you are currently in, this must be done at open enrollment, unless you have a qualifying event during the plan year. The Summary of Benefits & Coverage outline the benefits available, and the attached videos can also help you decide which plan is the best fit for you and your family.
- PPO HSA
- Simplicity PPO
Common Terms & Resources
PPO
You have the freedom to see any physician, located in any area; however, to receive the maximum benefits under the plan, physicians should be chosen from the network of participating providers. You may also use a doctor that is not in-network and receive reduced, out-of-network benefits. Primary care physicians do not need to be designated, and referrals are not needed to visit specialists.
HSA
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.
Enrolling in this plan allows you to contribute tax free dollars to a health savings account (HSA). Any dollars that you (and your employer) wish to contribute can be used towards any eligible medical, Rx, dental and vision expenses that you may incur while covered under the plan. See HSA section of this guide for additional details.
Preventive Services
Regardless of which plan you choose, preventive services are covered at 100% in-network and copays & deductibles do not apply.
There are 3 sets of free preventive services. Select the links below to see a list of covered services for each group:
Online Healthcare
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.
Find a Doctor
You pay less out of pocket if you receive care from an In-Network provider. In-Network providers can be found on your provider’s website under “Find a Doctor”. Log in to your account and choose the network based on the plan type you are choosing.
Deductible
The amount of money you are responsible for paying each year before the plan begins to pay for covered services, with the exception of preventive care services, which are covered at 100% In-Network.
Coinsurance
Your share of the expense of covered services after your deductible has been paid when the company plan is paying a percentage. The coinsurance rate is usually a percentage.
Out-of-Pocket Maximum
The most you pay per Plan Year for health care expenses and applies to deductibles, flat-dollar copays and coinsurance for all covered services – including cost-sharing amounts for prescription drugs. Once this limit is met, the plan will cover all in-network services at 100% until the end of the plan year.
Common Pharmacy Tiers
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.
Preferred Brand | 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.
Non-Preferred Brand | Highest Brand 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.
Preferred Specialty | Lowest specialty drug copay: Preferred specialty drugs are generally more effective and less expensive than non-preferred specialty drugs.
Non-Preferred Specialty | Highest specialty drug copay: These drugs have the highest copay for specialty drugs, usually because there may be a more cost-effective generic or preferred brand available.
Finding 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.
HSA
A Health Savings Account (HSA) is a tax-free savings account is owned by you, is 100% vested from day one, and let’s you build up savings for future needs. The funds may be used to pay for qualifying healthcare expenses not covered by insurance or any other plan for yourself, your spouse, or tax dependents. You decide how much you would like to contribute, when and how to spend the money on eligible expenses, and how to invest the balance.
2022 IRS Contribution Limits:
Single: $3,650
Two Person or Family: $7,300
Contribution limits include your individual contribution as well as any employer contributions. The combined total can not exceed the amount(s) mentioned above each calendar year.
You may choose the bank of your choice to open your HSA, but you must be enrolled in the HSA Humana plan option in order to be eligible.
DENTAL
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.
COMMON TERMS
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.
DUAL COVERAGE
You might have benefits from more than one dental plan, which is called dual coverage. In this situation, the total amount paid by both plans can’t exceed 100% of your dental expenses. And in some cases, depending on the specifics of the plans, your coverage may not total 100%.
LIMITATIONS AND EXCLUSIONS
Dental plans are intended to cover part of your dental expenses, so coverage may not extend to your every dental need. A typical plan has limitations such as the number of times you can receive a cleaning each year. In addition, some procedures may be not be covered under your plan, which is referred to as an exclusion.
VISION
Under this plan, you may use the eye care professional of your choice. However, when you visit a participating in-network provider, you receive higher levels of coverage. If you choose to receive services from an out-of-network provider, you will be required to pay that provider at the time of service and submit a claim form for reimbursement.
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
LIFE
Basic Life/AD&D
At no cost to you, we provide a benefit on your behalf payable to your designated beneficiary in the event of your death. An additional accidental death & dismemberment benefit (AD&D) is payable to you in the event of a covered dismemberment or to your beneficiary if your death is the result of an accident.
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.
LEARNING
RESOURCES
What forms do I need?
This section contains all the forms you may need to either enroll in a plan for the first time or make any changes to your existing coverage. Remember, any changes you make will take effect as of December 1, and you may not be able to make any other changes the remainder of the plan year unless you have a qualifying event.
Any completed forms would need to be submitted to your benefits administration in order for them to be processed, and remember, these forms must submitted prior to December 15! If you have any questions about what form you need, please reach out to one of the contacts on this page. We're happy to help!
Also included:
This section also contains important notices about your benefits, please choose the correct package based on your health plan. If you are not enrolled in the health plan, but do participate in the dental and or vision programs, please select either package. Please sign the "Annual Notices" acknowledgement and return to your employer.
WELLNESS HUB
What is Go365?
Go365 is a wellness program designed to help employees kick start their health and well-being. Employees take steps to engage in and adopt healthier behaviors and move up in Status level, earning Points and rewards for their progress. A combination of behavioral economics, individualized recommended activities, and an advanced incentive program help motivate members toward positive lifestyle change.
There are a few things members will need to do to get started with the Go365
program. This section outlines the registration process and moving out of Blue Status. It’s important to note that members who have Humana medical insurance will register for Go365 differently than those who do not.
How to register:
For members with Humana insurance:
Members who have Humana medical insurance
will follow the steps below. Once they create an account, they can use the same username and password on Go365.com and the Go365 App to access Go365 moving forward.
1. Visit Humana.com/register and “Get Started.”
2. Enter member ID number (or Social Security
number), date of birth and ZIP code.
3. Create a username, password and security prompt, and click “Next” to finish.
For members without Humana insurance:
There are two ways to register for members who DO NOT have
Humana medical insurance. Even if members register online,
encourage them to download the App for easy access on-the-go.
Via Go365.com
1. Visit Go365.com
2. Click “Register now” from the homepage
3. Complete the registration form and select “Continue.”
4. Create a username and password and click “Submit.”
Contact Us
As you consider your benefit options, please be sure to review all available information: Employee Benefits Guide, Intranet, and other videos and flyers found on this webpage. If you don't understand your benefits or need any assistance, please contact the Human Resources Department.
Client Contacts
Stacy Ginn
srginn4@gmail.com
(502) 741-7020