Mr. Rooter Plumbing

Table of Content

  1. Header
  2. Your 2023 Mr. Rooter Plumbing 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. HSA
    9. Dental
    10. Vision
    11. Voluntary Life
    12. Accident Insurance
    13. Employee Contributions
    14. Understanding your Benefits
    15. Carrier Contacts
  3. Compliance Notices
  4. Total Rewards
    1. Company Time off and Holidays
    2. 401(k) Retirement & Profit Sharing
  5. Questions?
  6. Footer

Your 2023 Mr. Rooter Plumbing 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. Your coverage will be effective on your 91st day of employement.


Open enrollment, your coverage is effective [9/1/2023]

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 with Ease

Action Required:

All Benefit Admin submissions must be submitted by end of day on August 14th.


This is an ACTIVE enrollment.

This means that you must log in to EaseCentral to enroll yourself and your dependents for benefits. All employees will complete the enrollment form for your OE elections. You must take action no later than [August 14th] and Enroll via your benefit admin platform. After this deadline, you must wait until the next open enrollment period or experience a qualifying event.


  1. If you are not making changes, your current coverage and network will carry over to the new plan year.
  2. If you are making changes, you must log in to Ease.
  3. If you are enrolling in a benefit you weren't enrolled in last year, you must also complete the necessary information.


REMINDER: if you wish to participate in a Flexible Spending Account and/or Health Savings Account in 2024, you MUST make an active election each year. Prior elections do not carry over.

Medical

Medical Mutual of Ohio


Mr. Rooter Plumbing offers a medical plan through Medical Mutual of Ohio.


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 of Ohio contract rate as the final charge and the member is not balanced billed.

Medical Summary

What is a PPO?

What is a PPO?

What is an HDHP with HSA?

What is an HDHP with HSA?

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.

HSA SBC

HSA SBC

PPO SBC

PPO SBC

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.

RX Summary

Managing Prescription Costs

Managing Prescription Costs

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 in order to save on prescription costs. One being 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 (will not count towards your maximums).


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 Cleveland Clinic Express Care App on your phone.

HSA

Health Savings Account (HSA) Overview

Health Savings Account (HSA) Overview

Health Savings Account

A Health Savings Account (HSA) is a tax-free savings account that is owned by you, it is 100% vested from day one, and lets 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.


To be eligible for an HSA, you must be enrolled in a High Deductible Health Plan (HDHP).


UNDERSTANDING YOUR HSA

  • Pre-tax contributions are deducted through payroll and deposited into your HSA account
  • You can use your HSA available funds to pay for qualified medical expenses tax-free
  • HSA funds can be used for non-eligible expenses but will be subject to regular income taxes and a 20% excise tax penalty
  • Unused funds remain in your account for future use and roll over each calendar year
  • HSAs remain with you even if you change health plans or companies. If you open an HSA and later become ineligible to make contributions, you can still use your remaining funds
  • You can change your HSA contribution at any time during the plan year for any reason.


You may contribute as follows:

$3,850 for Employee Only

$7,750 for a two-person or family


MAINTAINING RECORDS

To protect yourself in the event that you are audited by the IRS, keep records of all HSA documentation and itemized receipts for at least as long as your income tax return is considered open (subject to an audit), or as long as you maintain the account, whichever is longer.

HSA funds may be used for non-eligible expenses, but will be subject to regular income taxes and a 20% excise tax penalty.

Dental


Dental Benefits through MetLife 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: [Carrier Network]


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

  • In-Network providers can also be found by calling [Phone Number] or 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


[Client Name] offers vision coverage through Lincoln 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

Voluntary 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.


Voluntary - Employee Paid Life

Coverage is also available for your spouse and/or child dependents, but only after you've elected coverage for yourself. 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.Review the full benefit summary below for additional details.


Employee: $10,000 increments up to 5x your annual salary, to a maximum of $500,000 ($200,000 GI)

Spouse: $5,000 increments up to $250,000 or 100% of what you elect for yourself ($50,000 GI)

Children: $10,000 Benefit, one premium covers all of your eligible children


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.


*Guaranteed Issue (GI) and Evidence of Insurability (EOI)

When you are first eligible (at hire) for Voluntary Life and AD&D, you may purchase up to the Guaranteed Issue (GI) for yourself and your spouse without providing proof of good health (EOI). [Annually, you are able to increase elections up $50,000 not to exceed the GI without proof of EOI. ]


Any amount elected over the GI will require EOI. If you elect optional life coverage, and are required to complete an EOI, it is your responsibility to complete the EOI and send to the provider (address will be listed on your form). In addition, your spouse will need to provide EOI to be eligible for coverage amounts over GI, or if coverage is requested at a later date.

Accident Insurance

Accident

A serious injury can cost you a lot of money – not only in medical bills but in things like income from lost work hours. Some injuries are minor, but others are debilitating and require significant medical care. If you get hurt, accident insurance pays you money that you can use to cover personal expenses, bills, and out-of-pocket medical costs.


Accident Insurance can pay a set benefit amount based on the type of injury you have and the type of treatment you need. It covers accidents that occur on and off the job. And it includes a range of incidents, from common injuries to more serious events.


Who Gets Paid? You get paid! 

  • When you are paid a benefit from Accident Insurance, your health insurance company pays your doctor or hospital, but your Guardian Accident insurance pays you. 
  • You can use the money however you want.


Examples of what's covered

  • Accidental Death - Employee $25,000, Spouse $12,000 and Child $5,000
  • Ambulance - $150
  • Concussions - $75
  • Hospital Admission - $1,000
What is Accident Coverage?

What is Accident 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.


After-Tax Contributions


If you choose to purchase Supplemental Life insurance and Optional AD&D insurance benefits for yourself or your dependents, your contributions will be taken out of your pay on an after-tax basis. You will be able to see the costs for these benefits in the enrollment system when you log in.

Medical Employee Contributions

Dental Employee Contributions

Vision Employee Contributions

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 [Add Dates] plan year. If you have any questions or concerns please contact your HR Department.

Total Rewards

Company Time off and Holidays

Paid Time Off (PTO)

PTO is available to eligible employees to provide opportunities for rest, relaxation, personal pursuits, sick days, and time off to care for family members.


  • Regular full-time employees begin accruing PTO on their date of hire.
  • Part-time regular employees are entitled to PTO on a pro-rated basis and begin accruing PTO on their date of hire.


Please remember that all PTO should be scheduled at least 2 weeks in advance or per supervisor’s request. For more information on PTO, refer to [add HRIS system] or the Employee Handbook.


Company Paid Benefits

Company Paid Holidays

  • Monday, January 3 - New Year's Day (Observed)
  • Monday, January 17 - Martin Luther King, Jr. Day
  • Monday, May 30 - Memorial Day
  • Monday, July 4 - Independence Day
  • Monday, September 5 - Labor Day
  • Thursday, November 24 - Thanksgiving Day
  • Friday, November 25 - Day after Thanksgiving
  • Friday, December 23 - Christmas Eve (Observed)
  • Monday, December 26 - Christmas Day (Observed)