Welcome

Plan Highlights


MEDICAL/RX: Medical Mutual will continue to be the carrier for Medical and Prescription Drugs effective May 1, 2023

Plan Network: Medical Mutual utilizes the SuperMed PPO Network and the Cigna PPO Network for away from home care

Plan Summary: - HSA 5000 – $5,000 single / $10,000 family In-network deductible


VISION: Guardian will continue to be the carrier for Vision insurance and is 100% employer paid

Plan Network: Guardian utilizes the VSP Choice Network

Plan Summary: $10 exam copay / $25 single lens copay


BASIC LIFE AND AD&D: Guardian will continue to be the carrier for Life and AD&D Insurance and is 100% employer paid


SHORT TERM DISABILITY: Guardian will continue to be the carrier for Short Term Disability Insurance and is 100% employer paid

Medical - HSA 5000

Medical Mutual

IN NETWORK - SuperMed PPO / Cigna PPO (away from home care)


DEDUCTIBLE:

  • Single Deductible - $5,000
  • Family Deductible - $10,000


COINSURANCE (applies after deductible is met): 100%

COINSURANCE MAX SINGLE: $0

COINSURANCE MAX FAMILY: $0



MEMBER COPAYMENT(S):

  • Preventative Exam - 100% no deductible
  • Primary Care (PCP) - Office Visit - 100% after deductible
  • Specialist - Office Visit - 100% after deductible
  • Urgent Care Facility - 100% after deductible
  • Emergency Room Visit - 100% after deductible


OUT-OF-POCKET (OOP) MAXIMUM:

  • Single Out of Pocket Maximum - $6,900
  • Family Out of Pocket Maximum - $13,800


NON-SMOKER EMPLOYEE CONTRIBUTION - PER PAY (52 pays):

  • Employee - $22.43
  • Employee+Spouse - $129.58
  • Employee+Child(ren) - $93.87
  • Family - $201.01


NON-SMOKER EMPLOYEE CONTRIBUTION - PER PAY (26 pays):

  • Employee - $44.87
  • Employee+Spouse - $259.16
  • Employee+Child(ren) - $187.73
  • Family - $402.03


*Smoking Surcharge will apply for Tobacco users.

HSA 5000 SBC - Summary of Benefits and Coverage

Medical Mutual

HSA 5000 SBC - Summary of Benefits and Coverage

Medical Mutual

Tobacco Attestation Form

-REQUIRED-

Tobacco Attestation Form

-REQUIRED-

Find a Provider Flyer

Find a Provider Flyer

MedMutual Mobile App

Medical Mutual

MedMutual Mobile App

Medical Mutual

HSA - Health Savings Account

Make the most of your HSA

Make the most of your HSA

ENROLLED IN AN HSA ELIGIBLE HEALTH PLAN?


Take charge of your health care spending with a Health Savings Account (HSA). Contributions to an HSA are tax-free, and no matter what, the money in the account is yours!


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


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.


2023 | HSA FUNDING LIMITS

Each year, the IRS places a limit on the maximum amount that can be contributed to HSA accounts.


HSA Contribution Limits

Employee: $3,850

Two Person/Family: $7,750


HSA “Catch-Up” Contributions

Age 55 or older: $1,000 a year


HSA ELIGIBILITY REQUIREMENTS

To have an HSA and make contributions to the account, you must meet several basic qualifications.

  • 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. (There may be additional special circumstances, check with your tax preparer).

*A full list of qualified expenses can be found in IRS Publication 502 at www.irs.gov.

Prescription Drugs/Rx

Medical Mutual

Save Money With Generic (Tier 1) Drugs

Ask your doctor if it’s appropriate to use a generic drug rather than a brand. Generic drugs are less expensive, and according to the FDA, they contain the same active ingredients and are identical in dose, form and administrative method as a brand name.


HSA 5000

Retail 30 Day Supply

Rx Deductible - Medical Deductible Applies

TIER 1 - $15

TIER 2 - $45

TIER 3 - $75

TIER 4 - $275 (30 day supply only)


Mail Order 90 Day Supply

Rx Deductible - Medical Deductible Applies

TIER 1 - $45

TIER 2 - $135

TIER 3 - $225

TIER 4 - N/A


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.


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 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).


ASK YOUR DOCTOR - Make sure to ask if there are cost savings alternatives to the prescription they are providing. Many times there are generic or different manufacturers that will save you money at the pharmacy.

Prescription Drug/Rx Overview

Prescription Drug/Rx Overview

Virtual Visits - Telehealth

Medical Mutual

No crowded waiting rooms. No Driving. See a doctor when you need a doctor.


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. A $49 copay will apply (unless the deductible is satisfied then it is covered at 100%) and this 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​
  • Bronchitis​
  • Diarrhea​
  • Fever​
  • Pink eye
  • Rash​
  • Seasonal flu​
  • Sinus​
  • Sore throat​
  • Stomach


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 to provider sites by logging into your www.member.medmutual.com or by using the MedMutual app on your phone.​


​For questions regarding online health care, go to: clevelandclinic.org/eco

Virtual Visits | Cleveland Clinic

Virtual Visits | Cleveland Clinic

Telehealth Flyer

Medical Mutual

Telehealth Flyer

Medical Mutual

MedMutual Mobile App

Medical Mutual

MedMutual Mobile App

Medical Mutual

Vision

Guardian

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.


IN NETWORK - VSP Choice Network


Vision Exam - $10


COVERED SERVICES – LENSES / FRAMES

Single Lenses - $25

Bifocals - $25

Trifocals - $25

Lenticular - $25

Frames - $130 allowance, then 20% off


COVERED SERVICES - CONTACT LENSES

Contact Lenses: up to $130

Contact Lens Fitting: 15% off


BENEFIT FREQUENCY

Exams - Once every 12 Months

Lenses or Contact Lenses - Once every 12 Months

Frames - Once every 24 Months


EMPLOYEE CONTRIBUTION - PER PAY: $0 - Your Vision benefit is 100$ employer paid


Summary of Benefits

Guardian

Summary of Benefits

Guardian

Find a Provider

Guardian

Find a Provider

Guardian

STD - Short Term Disability

Guardian

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.


Plan Features:

Cost of Coverage: Employer Pays 100%

Elimination Period: This is the number of days that must pass between your first day of a covered disability & the day you can begin to receive your disability benefits.

  • Benefits begin on the 8th day of an accident and the 8th day of an illness (including pregnancy)

Benefit Duration: The maximum number of weeks you can receive benefits while you are sick or disabled.

  • Payments may last up to 13 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 salary up to $1000/week

What's covered?

  • A variety of conditions and injuries.
  • Typical claims would include pregnancy, injuries, joint, back and digestive disorders.

Definition of Earnings

  • Base Salary (excludes commissions and bonuses)


Additional Plan Provisions

Benefit Payment Frequency

  • Weekly benefit may be reduced or offset by other sources of income.

Cost Calculation

  • Age and amount chosen based

Waiver of Premium

  • If you're disabled and receiving benefit payments, you cost may be waived until you return to work.
STD Summary of Benefits

Guardian

STD Summary of Benefits

Guardian

STD Overview

STD Overview

EAP - Employee Assistance Program

Guardian

We all need a little support every now and then. Guardian’s Employee Assistance Program gives you and your family members access to confidential personal support, across everything from stress management and nutrition to handling legal or financial issues. The services available include consultations with experienced professionals, as well as access to resources and discounts designed to help you in a variety of different ways.


How it can help

  • Consultative services are available to provide direct support and assistance
  • Work/life assistance that can help you save money and balance commitments
  • Access legal and financial assistance and resources – including WillPrep Services


How to access

To access the WorkLifeMatters Employee Assistance Program, you’ll need a few personal details.

Visit: worklife.uprisehealth.com

Access Code: worklife


For more information or support, you can reach out by calling 800-386-7055. The team is available 24 hours a day, 7 days a week

EAP Summary of Benefits

Guardian

EAP Summary of Benefits

Guardian

EAP Overview

Guardian

EAP Overview

Guardian

ENROLL!

Download and print the Enrollment Form and Tobacco Attestation Form and return to Brian Abraham

Election Form with Vision

Election Form with Vision

Tobacco Attestation Form

-REQUIRED-

Tobacco Attestation Form

-REQUIRED-

Contact Us

Human Resource Department

Client Contacts

BA

Brian Abraham

babraham@proquipinc.com

(330) 468-1850 x217