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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
IN NETWORK - SuperMed PPO / Cigna PPO (away from home care)
DEDUCTIBLE:
COINSURANCE (applies after deductible is met): 100%
COINSURANCE MAX SINGLE: $0
COINSURANCE MAX FAMILY: $0
MEMBER COPAYMENT(S):
OUT-OF-POCKET (OOP) MAXIMUM:
NON-SMOKER EMPLOYEE CONTRIBUTION - PER PAY (52 pays):
NON-SMOKER EMPLOYEE CONTRIBUTION - PER PAY (26 pays):
*Smoking Surcharge will apply for Tobacco users.
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
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.
*A full list of qualified expenses can be found in IRS Publication 502 at www.irs.gov.
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.
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 covered children may also use Virtual Visits when a parent or legal guardian is present for the visit.
Examples of Non-Emergency Conditions:
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
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
Guardian will continue to provide your Life and AD&D benefits with no plan changes. 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.
Your Basic Life Benefit:
Coverage Amount: 100% of salary up to $25,000
Accidental Death and Dismemberment (AD&D): Amount equal to your Life benefit
Benefit Reduction Schedule:
Your insurance will reduce to:
– 35% of the original amount at age 65
– 60% of the original amount at age 70
– 75% of the original amount at age 75
– 85% of the original amount at age 80
*See your Summary of Benefits for coverage amounts and plan details
BENEFICIARY(IES)
It’s very important to designate beneficiaries. Taking a few minutes to designate your beneficiaries now will help ensure that your assets will be distributed according to your direction.
A Beneficiary is the person you designate to receive your life insurance benefits in the event of your death. It is important that your beneficiary designation is clear so there is no question as to your intentions.
It is also important that you name a Primary and Contingent Beneficiary. A contingent beneficiary will receive the benefits of your life insurance if the primary beneficiary cannot. You can change beneficiaries at any time.
You should review your beneficiary elections on a regular basis to ensure they are updated as life changes. Even if you are single, your beneficiary can use your Life Insurance to pay off your debts, such as: credit cards, mortgages, and other expenses.
*You designate your beneficiary(ies) when enrolling for your benefits.
WHAT WILL MY BENEFICIARY RECEIVE?
In The Event That Death Occurs:
–Your Basic Life insurance is paid to your beneficiary.
–If death occurs from an accident: 100% of the AD&D benefit would be payable to your beneficiary(ies) in addition to your Basic Life insurance.
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.
Benefit Duration: The maximum number of weeks you can receive benefits while you are sick or disabled.
Coverage Amount
What's covered?
Definition of Earnings
Additional Plan Provisions
Benefit Payment Frequency
Cost Calculation
Waiver of Premium
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
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
Guardian
Guardian
Download and print the Enrollment Form and Tobacco Attestation Form and return to Brian Abraham
Brian Abraham
babraham@proquipinc.com
(330) 468-1850 x217
