Common Terms & Resources
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.
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:
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.
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.
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.
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.
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.
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.
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.
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?
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. The amount of the coverage is $25,000.
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.
At no cost to you, Nadona provides you with Short Term and Long Term Disability Coverage
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.
Long Term Disability
Serious illnesses or accidents can interrupt your life, and your ability to work for months – even years. Long Term Disability provides financial protection for you by paying a portion of your income, so you have financial support to manage your disability and your household. Benefits begin after the elimination period.