6H Management LLC

Table of Content

  1. Header
  2. Menu
    1. ENROLLMENT
    2. PLAN ELIGIBILITY
    3. QUALIFYING LIFE EVENTS
    4. MEDICAL
    5. Medical Plan Options
    6. Summary of Benefits
    7. VIRTUAL VISITS
    8. PHARMACY
    9. Drug Card
    10. HEALTH ADVOCATE SOLUTIONS
    11. HEALTH SAVINGS ACCOUNT (HSA)
    12. DENTAL
    13. Dental Plan Options
    14. VISION
    15. Vision Plan
    16. LIFE AND AD&D
    17. Voluntary Life and AD&D Summary
    18. DISABILITY
    19. VOLUNTARY BENEFITS
    20. FINANCIAL WELLNESS
    21. EMPLOYEE ASSISTANCE PROGRAM (EAP)
    22. UNDERSTAND YOUR BENEFITS
    23. BENEFITS FOR PART-TIME EMPLOYEES
    24. Carrier Contacts
    25. WELCOME
    26. WELCOME
    27. Contact Us
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ENROLLMENT


Using your desktop or mobile, you have access to our online benefits enrollment platform 24/7. In your Paycom portal you can:

  • View and select benefits for yourself and dependents
  • View per-pay-period amounts
  • Submit qualifying events
  • Add and edit beneficiaries and dependents


Download the Paycom Mobile App from Google Play or the App Store to get started or click on the link below to head to your enrollment portal!


*IMPORTANT: The Benefit choices you make during your initial enrollment or annual open enrollment remain in effect for the entire plan year unless you experience a qualifying life event.*




Paycom logo

PLAN ELIGIBILITY


EMPLOYEE ELIGIBILITY

You are eligible to participate if you are full-time and work a minimum of 25 hours per week (108 hours per month). Your coverage will be effective 1st of the month following 60 days from your date of hire.


DEPENDENT ELIGIBILITY

You may also enroll eligible dependents for benefits coverage. A ‘dependent’ is defined as the legal spouse and/or domestic partner and ‘dependent child(ren)’ of the plan participant or the spouse. 


The term ‘child’ refers to any of the following:

  • A natural (biological) child;
  • A stepchild;
  • A legally adopted child;
  • A foster child;
  • A child for whom legal guardianship has been awarded to the participant or the participant’s spouse/domestic partner; or
  • Disabled dependents may be eligible if requirements set by the plan are met.

QUALIFYING LIFE EVENTS


Your premiums for medical, dental, vision insurance are deducted through a Cafeteria Plan established under Section 125 of the Internal Revenue Code (IRC) on a pre-tax basis. Under Section 125, changes to an employee's pre-tax benefits can be made ONLY during the Open Enrollment period unless the employee or qualified dependents experience a qualifying event and the request to make a change is made within 30 days of the qualifying event.


Under certain circumstances, employees may be allowed to make changes to benefit elections during the plan year, if the event affects the employee, spouse, or dependent’s coverage eligibility. Any requested changes must be consistent with and on account of the qualifying event.


Examples Of Qualifying Events:

  • Legal marital status (for example, marriage, divorce, legal separation, annulment);
  • Number of eligible dependents (for example, birth, death, adoption, placement for adoption);
  • Work schedule (for example, full-time, part-time);
  • You, your spouse, or other covered dependent become enrolled in Part A, Part B, or Part D of Medicare
  • Death of a spouse or child;
  • Change in your child’s eligibility for benefits (reaching the age limit);
  • Becoming eligible for Medicaid; or
  • Your coverage or the coverage of your Spouse or other eligible dependent under a Medicaid plan or state Children’s Health Insurance Program (“CHIP”) is terminated as a result of loss of eligibility and you request coverage under this Plan no later than 60 days after the date the Medicaid or CHIP coverage terminates; or
  • You, your spouse or other eligible dependent become eligible for a premium assistance subsidy in this Plan under a Medicaid plan or state CHIP (including any waiver or demonstration project) and you request coverage under this Plan no later than 60 days after the date you are determined to be eligible for such assistance.


IMPORTANT: If you experience any of these qualifying life events during the year, be sure to reach out to your HR Department within 30 days to make changes to your benefit elections. If you miss that special enrollment window, you will have to wait until the next open enrollment period to make a change.

QLE

QLE

Medical Plan Options


You have 3 medical plans to choose from. Compare the options in the chart below:

MP

Summary of Benefits


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

Base HDHP SBC

Mid Copay Plan SBC

Buy-Up Copay Plan SBC

PHARMACY

Prescription Drug Benefits

Overview

Prescription Drug Benefits

Overview





Prescription drugs are a vital part of your health care coverage. The Pharmacy Benefit Manager for the New Waterloo health plans is Express ScriptsYou can access more information about your pharmacy coverage by visiting www.express-scripts.com. If you run into any trouble with your pharmacy benefits, you can reach out to the RxBenefits Member Services Team at 800-334-8134.


A drug list is a list of drugs that are covered under your prescription drug benefit. How much you pay out of pocket is determined by whether your drug is on the list and at what coverage level, or tier. A generic drug is often at the lower tier. See if your drug is covered by reviewing your formulary drug list using the link below! 


How do I get started with home delivery?

Getting started is easy. We just need your prescription.


For new prescriptions:

Ask your doctor to e-prescribe a 3-month supply to Express Scripts Home Delivery.


For current prescriptions:

After you register or log into your account, you can switch your eligible medications to delivery.


Once we have your prescription, we’ll take care of the rest. We’ll check to make sure your prescription is safe and effective before mailing it to you. If we have any questions, we’ll contact your doctor.


What if I have a question about my medication or want to talk to a pharmacist?


Our pharmacists are available around the clock, with no voicemails or callbacks, so you can have an unrushed conversation from the privacy of your own home, whenever you need it.

Simply contact Express Scripts® Pharmacy using the toll-free number on the back of your member ID card or call 800.282.2881.




Review your prescription costs for each plan in the chart below!

rx

HEALTH ADVOCATE SOLUTIONS

866-272-6009


Health Advocacy: 

Personal Health Advocates help you navigate through insurance and healthcare systems. Advocates can also locate doctors, specialists, hospitals, dentists, and pharmacies as well as research treatments, resolve claims, and provide medical explanations so you can make more informed decisions.

  • Untangle medical bills and insurance claims
  • Clarify benefits and answer questions about tests, treatments, and medication options
  • Coordinate care among multiple providers
  • Assist with eldercare and related healthcare issues
  • Arrange second opinions and transfer medical records


Medical Bill Saver: 

Individuals are responsible for more out-of-pocket medical and dental costs than ever before. Medical Bill Saver provides skilled negotiators who will attempt to negotiate discounts for you, no matter your benefit status. Negotiations can lead to a reduction in their out-of-pocket costs. Once an agreement is made, the provider signs off on payment terms and conditions. You will receive an easy-to-read personal Savings Results Statement, summarizing the outcome and payment terms.


NurseLine: 

You have a place to turn to for trusted advice and information when you need it most. Rest assured—highly trained registered nurses are on-call 24/7 to answer questions for non-urgent concerns. Nurses can offer self-care tips, direct you to the appropriate care for immediate attention or offer advice on how to ease common problems such as a sore shoulder. NurseLine can help with everything from fevers or flu symptoms to at-home remedies or side effects of medications.

Health Advocate Soutions

Overview

Health Advocate Soutions

Overview

Dental Plan Options


You have 2 dental plans to choose from. Compare the options in the chart below!

d

Vision Plan


A summary of your vision benefits is shown in the chart below!

v


Here are your options under the Voluntary life and AD&D Plan!

la

DISABILITY



Short-Term Disability (STD)

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. This voluntary 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.



Elimination Period - Benefits begin on the 15th day of an injury or illness (including pregnancy).

Benefit Duration - Payments may last up to11 weeks (You must be sick or disabled for the duration of the waiting period before you can receive a benefit payment).

Coverage Amount - Covers 60% of your weekly income, up to a maximum benefit of $1,000 per week.

Pre-Existing Condition Exclusion - This plan will look 3 months in advance of your effective date and will not pay a benefit for any conditions you saw the doctor or were treated for during those 3 months until you have been enrolled for 12 months.


Long-Term Disability (LTD)

This employer-paid coverage pays a monthly benefit if you have a covered illness or injury and you can't work for a few months - or even longer! You're generally considered disabled if you're unable to do important parts of your job - and your income suffers as a result.


Elimination Period - Benefits begin on the 91st day of an injury or illness.

Benefit Duration -

  • Salaried Employees - Payments may last up to Social Security Normal Retirement Age (SSNRA) (You must be sick or disabled for the duration of the waiting period before you can receive a benefit payment).
  • Hourly Employees - Payments may last the lesser of 5 years or to age 70.

Coverage Amount - Covers 60% of your monthly income, up to a maximum benefit of $6,000 per month.

Pre-Existing Condition Exclusion - This plan will look 3 months in advance of your effective date and will not pay a benefit for any conditions you saw the doctor or were treated for during those 3 months until you have been enrolled for 12 months.




Disability Insurance Overview

Disability Insurance Overview

FINANCIAL WELLNESS

Financial Wellness Services

Financial Wellness Services


800-704-1308


Financial Wellness can guide you through the major financial changes you face throughout life, from paying for college to buying a home to navigating the loss of a spouse. You can achieve financial wellness with live one-on-one coaching from accredited financial counselors and independent learning through online resources. 

  • Accredited or Certified Financial Counselors are accessible by phone to assess issues, discuss options, and help you determine the best course of action for their situation
  • Online Financial Wellness Center does the heavy lifting for research, providing a variety of vetted articles, videos, worksheets, checklists, and more to guide your financial wellness journey
  • Established learning tracks include resources for major life events, like getting married or having a child, and general financial goals, like developing a budget and eliminating student debt


HOW IT WORKS

  1. Members can access the service by phone Monday through Friday, 7:00 a.m. to 8:00 p.m. Central Time
  2. The member will be connected with a financial counselor who will provide objective guidance on the member's particular situation
  3. The service may also be accessed online

EMPLOYEE ASSISTANCE PROGRAM (EAP)


1-800-386-7055

Monday - Friday 9am - 8pm EST

24 hour crisis help available



Our comprehensive Employee Assistance Program; available through Uprise Health, provides you and your family members with confidential, personal and online/web-based support on a wide variety of important and relevant topics — such as stress management, dependent/elder care, nutrition, fitness, and legal and financial issues.


EAP consultative services include:

  • Online modules and coaching
  • Telephonic counseling - unlimited 24/7 consultations
  • Face-to-face counseling - up to 3 visits per employee/household member per issue per year
  • Bereavement
  • College planning resources


Work/Life assistance and resources:

  • 24/7 access to Work/Life Specialists
  • Child and elder care referrals
  • Employee discounts
  • Medical billing negotiation tools


Legal/financial assistance and resources:

  • Legal consultations - telephonic and face-to-face
  • Financial consultations
  • ID theft
  • Tax consultation
  • Online self-service legal documents