Welcome
January 1, 2023 – December 31, 2023
EFFECTIVE January 1, 2023 Overview of Benefit Changes:
Medical/RX: Provided through Anthem with no plan changes.
Plan 1: HSA Plan $3,500/$7,000 deductible with 100% coinsurance
Plan 2: PPO Plan $3,000/$6,000 deductible with 80% coinsurance
Plan 3: PPO Plan $1,500/$3,000 deductible with 80% coinsurance
Dental: Provided through MetLife with no plan changes.
Plan 1: $50/$150 deductible, 100%/100%/60% In-Network
Plan 2: $50/$150 deductible, 100%/80%/50% In-Network
Vision: Provided through MetLife with no plan changes.
VSP Choice will be the network. Same network as Guardian.
Basic Life: Provided through MetLife with no plan changes.
Provided to you at no cost. 100% Employer paid benefit.
Short-Term Disability: Provided through MetLife with no plan changes.
Provided to you at no cost. 100% Employer paid benefit.
Voluntary Long-Term Disability: Provided through MetLife with no plan changes. Available for employees.
Voluntary Life: Provided through MetLife with no plan changes.
Available for employees, spouses, and dependents.
Qualifying Life Events
If you have a Qualifying Life Event and want to request a mid-year change, you must notify Human Resources and complete your election changes within 30 days following the event. Be prepared to provide documentation to support the Qualifying Life Event.
Common life events include; Marriage, Divorce, New Dependent, Loss/gain of available coverage by you or any of your dependents.
How to Enroll
ENROLLMENT INSTRUCTIONS
1.Review the information in this guide and benefit plan summaries.
2.You must complete your enrollment through Paylocity, Click on the Icon Below.
3.After logging into the Paylocity portal, click on the “Web Pay” tab and select “Web Benefits”.
4.Click on “Manage My Benefits” within the Benefits panel.
5.Within the “Action Needed” section, click the “Start” button to begin selecting your benefits.
6.Review the benefits you have selected and hit “Submit”.
7.You will not be allowed to make changes after the open enrollment window closes and you submit your enrollment, unless you experience a qualifying life event.
Medical Benefits
Plan 1- HSA $3,500
Deductible
Single: $3,500
Family: $7,000
Out of Pocket Max
Single: $4,000
Family: $8,000
Preventive Service: Covered at 100% No Deductible
Primary Care: 100% After Deductible
Specialist Visits: 100% After Deductible
OP Lab, X-Ray, MRI, Cat Scan:100% After Deductible
Hospital IP, OP, Surgery:100% After Deductible
Urgent Care:100% After Deductible
ER Visits:100% After Deductible
Plan 2- PPO $3,000
Deductible
Single: $3,000
Family: $6,000
Out of Pocket Max
Single: $6,000
Family: $12,000
Preventive Service: Covered at 100% No Deductible
Primary Care: $35 Copay
Specialist Visits: $70 Copay
OP Lab, X-Ray, MRI, Cat Scan: 80% After Deductible
Hospital IP, OP, Surgery: 80% After Deductible
Urgent Care:$75 Copay
ER Visits: $250 Copay
Plan 3- PPO $1,500
Deductible
Single: $1,500
Family: $3,000
Out of Pocket Max
Single: $4,000
Family: $8,000
Preventive Service: Covered at 100% No Deductible
Primary Care: $30 Copay
Specialist Visits: $50 Copay
OP Lab, X-Ray, MRI, Cat Scan: 80% After Deductible
Hospital IP, OP, Surgery: 80% After Deductible
Urgent Care:$75 Copay
ER Visits: $250 Copay
Click on the Anthem Icon to see the website
Flexible Spending Accounts
DEPENDENT CARE FSA
The Dependent Care FSA allows you to pay for eligible dependent care expenses with tax-free dollars so that you and your spouse can work or attend school FT. Funds in a Dependent Care FSA are only available once they have been deposited into your account and you cannot use the funds ahead of time.
-You may set aside up to $5,000 annually in pre-tax dollars, or $2,500 if you are married and file taxes separately from your spouse.
-If you participate in a Dependent Care FSA, you cannot apply the same expenses for a dependent care tax credit when you file your income taxes. All claims must be submitted through the mobile app, fax or by clicking the Paylocity logo below.
Parking/Transit FSA
With a Parking/Transit FSA (Section 132 Plan), you can get reimbursed for parking expenses incurred at or near your work location or a location from which you continue your commute to work by carpool, van pool or mass transit. Out-of-pocket parking fees for parking meters, garages and lots qualify. Parking at or near your home is not an eligible expense.
Virtual Visits
WHEN CAN I USE Telemedicine?
When you have a minor illness or injury 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.
HOW DOES IT WORK?
The first time you use a Virtual Visit provider, you will need to set up an account with that Virtual Visit 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.
Dental Benefits
Plan 1 NAP UCR
Single:$50
Family:$150
Preventive Care: 100%
Basic Care: 80%
Major Care: 50%
Orthodontia : 50%
Plan 2 Value MAC
Single:$50
Family:$150
Preventive Care: 100%
Basic Care: 80%
Major Care: 50%
Orthodontia : 50%
Vision Benefits
Vision Plan
Exam: $10 copay ( every 12 months)
Lenses: $25 copay ( every 12 months)
Progressive Lenses: $55 copay
Frames: $130 retail allowance. plus 20% off remaining balance ( every 24 months)
Contacts: $130 allowance ( Every 12 months)
Contact Fittings: up to $60 copay
Voluntary Benefits
Employees have the opportunity to enroll in Voluntary Life insurance. If you choose to enroll in employee coverage, this will be in addition to your employer provided Basic Life coverage. Coverage is also available for your spouse and/or child dependents. It is typically required that you elect coverage for yourself in order to be eligible for coverage on your dependents.
Cost of Coverage
Premiums are based on age-rated tables and paid by the employee every pay period through a payroll deduction. These premiums are post-tax and benefits payable are tax-free.
Coverage Options
Employee Coverage
Choose in $10,000 increments up to the lesser of 5x your annual salary or $500,000
Spouse Coverage
Choose in $5,000 increments up to the lesser of 50% of the amount you elect for yourself or $150,000
Dependent Coverage*
Choose $1,000, $2,000, $4,000, $5,000, or $10,000
*15 days-6 months: $1,000
*terminates at age 26
Do I have to take a
health exam to get coverage?
If you and your dependents enroll in coverage at your initial eligibility date,
you may apply for up to the Guaranteed Issue amounts without medical questions.
Guaranteed Issue
Employee
$150,000
Spouse
$50,000
Dependent
$10,000
Basic Life/ AD&D
BASIC LIFE INSURANCE
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. 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.
Coverage Amount
Flat $50,000 Benefit
Accidental Death and Dismemberment (AD&D)
Amount equal to your Life benefit
Benefit Reduction Schedule
Your insurance will reduce to 50% of the original amount at age 70
LTD/STD
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.
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.
VOLUNTARY LONG-TERM DISABILITY (LTD)
Serious illnesses or accidents can come out of nowhere. They 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.
PLAN FEATURES
SHORT-TERM DISABILITY (STD)
Cost of Coverage
Employer Paid
Provided at no cost to you
VOLUNTARY LONG-TERM DISABILITY (LTD)
Voluntary Benefit
Employee is responsible for 100% of the cost
Certain exclusions and any pre-existing condition limitations may apply.
Please refer to the Provider’s detailed benefit summary for details.
401k
EFFECTIVE 11/26/2021
All eligible employees with no election on file will automatically be enrolled at 6%
All new hires will be automatically enrolled at 6% approximately 35 days after your hire date
You will be given at least 30-day notice in advance to opt-out if you choose
EFFECTIVE 1/1/2022
QACA Safe Harbor: Nexus will match 100% of the first 3% and 50% of the next 2%
Anyone hired before 1/1/2022 will be 100% vested in the QACA Match
Anyone hired on or after 1/1/2022 will have a 2-year cliff: 100% vested after 2 years of service
Contact Us
HR Contacts
Lisa Theis
HR Director
lisa.theis@nexusegroup.com
216-456-8562
Nicole Dashiell
HR Coordinator
nicole.dashiell@nexusegroup.com
216-225-1902