Table of Content
- Header
-
Page
- Welcome
- How to Enroll with ADP
- Medical Benefits
- Prescriptions
- Virtual Visits
- Health Saving Account
- Dental Benefits
- Vision Benefits
- Employee Contributions
- Life Benefits
- Disability Benefits
- Accident Benefits
- 401k
- PIRHL - Company Resources
- Armadillo Home Warranty
- Pet Insurance
- Contact Us
- Footer
How to Enroll with ADP
ENROLLMENT INSTRUCTIONS
1. Review the information in this guide and benefit plan summaries.
2. You must complete and sign an enrollment form, even if you are waiving coverage.
3.You will not be allowed to make changes after the open enrollment window closes, unless you experience a qualifying life event.
IMPORTANT
You must notify HR and change elections within 30 days of the event.
Medical Benefits
Medical Summary
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 | Low copay: This category includes non-preferred and low-cost generic drugs
TIER 3 | 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 have a higher copay.
TIER 4 | 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 including most specialty medications. These drugs have the highest copay. Make sure to check for mail-order discounts that may be available.
Helpful Rx Cost Savings Tools & Tips:
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 to save on prescription costs. One is 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 (which will not count towards your maximums).
ASK YOUR DOCTOR – Make sure to ask if there are cost-saving alternatives to the prescription they are providing. Many times, there are generic or different manufacturers that will save you money at the pharmacy.
RX Summary
Virtual Visits
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 Sydney Health App on your phone.
:
Health Saving Account
-To be eligible to open and contribute to an HSA, you must have coverage under a qualified High Deductible Health Plan (HDHP).
-Participants cannot be covered by any other health insurance plan (this exclusion does not apply to certain other types of insurance, such as dental, vision, disability or long-term care coverage).
-Participants cannot participate in a Healthcare FSA or spouse/domestic partner’s Healthcare FSA or Health Reimbursement Account (HRA).
-Participants cannot be enrolled in Medicare or Medicaid.
-You cannot be eligible to be claimed as a dependent on someone else’s tax return.
-You have not received Department of Veterans Affairs Medical benefits in the past 90 days, unless the Veteran has a disability rating.
Dental Benefits
PPO Dental Plan
Deductible
Single: $50
Family: $150
Preventive Care: 100%
Basic Care: 80%
Major Care: 50%
Dental Summary
Vision Benefits
VSP Vision Plan
Vision Exam: $10 copay (every 12 months)
Lenses: $0 copay (every 12 months)
Frames: 80% of amount over $150 (every 24 months)
Vision Benefit Summary
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
Life Benefits
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.
PIRHL provides Basic Life Coverage for all full-time employees in the amount of 100% of your annual salary, to a maximum of $50,000
Click on the Guardian plan for all rates.
Disability Benefits
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.
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.
To see you plan detail click on the plan documents below:
Accident Benefits
Accident Insurance
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.
Click on the link below to see your plan details:
401k
For more information click on the Peoples Bank Icon below:
PIRHL - Company Resources
Click the links below for quick access to PIRHL'S:
- Benefits Overview
- Holiday Schedule
- PTO Policy
- FMLA Policy & Parental Leave Policy
Armadillo Home Warranty
Appliance Only
Max Annual Coverage: $7,500
Deductible: $100
Monthly Price $27.31
Appliances
Dishwasher: $2,000
Oven: $2,000
Range: $2,000
Exhaust: $2,000
Refrigerator: $2,000
Microwave: $2,000
Washer: $2,000
Dryer: $2,000
Garbage Disposal: $2,000
Trash Compactor: $2,000
BASE
Max Annual Coverage: $7,500
Deductible: $100
Monthly Price: $38.26
Appliances
Dishwasher: $2,000
Oven: $2,000
Range: $2,000
Exhaust: $2,000
Refrigerator: $2,000
Microwave: $2,000
Washer: $2,000
Dryer: $2,000
Garbage Disposal: $2,000
Trash Compactor: $2,000
Other:
Central Humidifier: $1,000
Garage Door Openers: $1,000
Ceiling Fans: $1,000
Plumbing and Electric
Plumbing Issues: $3,000
Water Heater: $2,000
Electrical Issues: $3,000
COMPREHENSIVE
Max Annual Coverage: $7,500
Deductible: $150
Monthly Price $55.30
Appliances
Dishwasher: $2,000
Oven: $2,000
Range: $2,000
Exhaust: $2,000
Refrigerator: $2,000
Microwave: $2,000
Washer: $2,000
Dryer: $2,000
Garbage Disposal: $2,000
Trash Compactor: $2,000
Other
Central Humidifier: $1,000
Garage Door Openers: $1,000
Ceiling Fans: $1,000
Plumbing and Electric
Plumbing Issues: $3,000
Water Heater: $2,000
Electrical Issues: $3,000
HVAC
Heating System: $3,000
Cooling System: $3,000
LUXURY:
Max Annual Coverage: $25,000
Deductible: $200
Monthly Price: $108.85
Appliances
Dishwasher: $7,500
Oven: $7,500
Range: $7,500
Exhaust: $7,500
Refrigerator: $7,500
Microwave: $7,500
Washer: $7,500
Dryer: $7,500
Garbage Disposal: $7,500
Trash Compactor: $7,500
Other
Central Humidifier: $7,500
Garage Door Openers: $7,500
Ceiling Fans: $7,500
Plumbing and Electric
Plumbing Issues: $7,500
Water Heater: $7,500
Electrical Issues: $7,500
HVAC
Heating System: $7,500
Cooling System: $7,500
Pet Insurance
Your Pet Insurance Benefit
PIRHL LLC is excited to offer pet insurance for your dog or cat at a 5% discount!
What is Pet Insurance?
Pet Insurance us health insurance for dogs and cats. Get reimbursed for costly veterinary bills and focus more on the health of your pets and less on how you're going to pay for it. Plans feature comprehensive coverage for accidents, illnesses and injuries including cancer coverage.
How it works:
- Enroll in Pet Insurance
- Pay your Vet
- Submit a Claim with your vet bill
- Get reimbursed for elidable expenses
Contact us at 866-774-1113 or help@petpartners.com
Contact Us
Client Contacts
Chanin Sparks
csparks@pirhl.com
(216) 378-9690
Account Team Contacts
Naomi Butze
Account Executive
naomi.butze@nfp.com
216-816-0026