Table of Content
- Header
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Your 2024 Pulsar Benefits
- To Our Employees:
- How to Enroll
- Eligibility & Qualifying Events
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Medical & Prescription
- Medical Summary
- Summary of Benefits and Coverage (SBC)
- Prescriptions
- Virtual Visits
- Anthem Resources
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Spending Accounts
- Health Savings Account (HSA)
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Dental
- Dental Summary
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Vision
- Vision Summary
- Employee Contributions
- Well-being Hub
- Compliance Notices
- Understanding your Benefits
- Carrier Contacts
- Contact Us
- Footer
Your 2024 Pulsar Benefits
To Our Employees:
Once again this year, we conducted a thorough review of the options available to us and we think we’ve come up with the best possible package. But the process doesn’t stop here—we need you to take an active role in understanding and selecting your benefit options. A strong grasp of the plans available to you will best allow both you and this organization to get the most bang for our buck.
Highlights of the 2024 benefit plans include:
- Changes to the Medical plan design for the HSA $3,000 / $6,000 deductible to a $3,250 / $6,500 deductible.
- No Changes to the dental & vision carrier and plan design.
To help you gain that strong understanding, please read this virtual benefits guide carefully and consult HR with any questions.
Thank you for all that you do for us!
All team members have access to our Virtual benefits platform 24/7 where you can view your benefits online during the annual open enrollment period, new hire orientation, and anytime throughour the year.
- Accessible 24/7
- View all benefit plan options
- View important carrier forms and links
Ready to enroll? Download and Complete the enrollment forms below.
Helpful Tips To Consider Before You Enroll
Do you plan to enroll an eligible dependent(s)?
- If so, make sure to have their social security numbers and birthdates available. You cannot enroll your dependent(s) without this information.
Have you recently been married/divorced or had a baby?
- If so, remember to add or remove any dependent(s) and/or update your beneficiary designation.
Did any of your covered children reach their age limit for this year?
- If so, they may no longer be eligible for benefits, unless they meet specific criteria
REMINDER: if you wish to participate in a Health Savings Account in 2024, you MUST make an active election each year. Prior elections do not carry over.
The Benefit choices you make during your initial enrollment or annual open enrollment remain in effect for the entire year.
QUALIFYING EVENTS
You can, however, modify your elections under certain circumstances, called "Qualifying Events".
Ready to Enroll?
Complete your enrollment form and hand it in to Human Resources.
When Does My Coverage Start?
If you are a New Hire, please see HR for your benefit elgible date
Open enrollment, your coverage is effective 5/1/2024
What is a Qualifying Event?
Marriage
Divorce
Birth/Adoption of a child
Death of a spouse or other enrolled dependent
Change in spouse’s benefits or employment status
A dependent becomes eligible for Medicare or Medical
Who are my legal dependents?
- Your legal spouse or domestic partner
- Your children (up to age 26) including natural children, stepchildren, legally adopted children,
children placed for adoption, children for whom you serve as legal guardian
- Disabled dependent child(ren) of any age
Medical & Prescription
Pulsar offers a medical plan through Anthem.
The HDHP gives you the option to choose any provider when you need care. However, in exchange for a lower per-paycheck cost, you must satisfy a higher deductible that applies to almost all health care expenses, including those for prescription drugs. All expenses are your responsibility until the deductible is reached, with the exception of preventive care, which is covered at 100% when you visit a physician in the network. Once the deductible is met, you are responsible for coinsurance for medical expenses for prescription drug expenses.
Utilizing In-Network providers will allow for the highest level of coverage. In-Network providers agree to accept Anthem's contract rate as the final charge and the member is not balanced billed.
Medical Summary
Summary of Benefits and Coverage (SBC)
Looking for more details about how items are covered? Please refer to the formal Summary of Benefits and Coverage (SBC) below.
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
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 [Virtual Visit App Name] App on your phone.
Anthem Resources
Anthem member portal: Access your Anthem information 24/7.
A secure website specifically for Anthem members, the Anthem member portal makes it easy and convenient to manage your plan and your health online.
- Search for In-Network doctors, hospitals, and facilities. For example, a less expensive MRI location
- View your EOB (Explanation of benefits)
- View plan documents
- and so much more!!
Sydney Health Mobile App
With the Mobile App, you can get access to vital information when you are away from a computer. You can Track Claims and Spending Information, Estimate Costs, Find a Provider, and Access your ID Card. Download the app on the Apple Store or Google Play.
Healthy Lifestyles
When you sign up for Healthy Lifestyles, you’ll take a private Well-Being Assessment. Based on the results of your assessment, you’ll be able to spot areas to focus on that will become the basis of your well-being plan. Your well-being plan uses the personal goals you set to keep you motivated, and it changes over time as you make progress toward them.
- Track your progress
- Food tracker
- Exercise tracker
- Medication tracker
- Stress tracker
- Be More Social
- Quit Smoking
Anthem Smart Shopper
With SmartShopper, you can shop online or call a SmartShopper Personal Assistant who can help you understand your options and can schedule your appointment.
- Shop for a provider by calling (866) 488-5441 or go to www.smartshopper.com
- Recieve medical care at one of the Smart Shopper options
- Earn Rewards: once your claim is paid you will receive a reward check within six weeks.
Engagement 200
Engagement Package 200 rewards employees up to $200 for taking part in a wide variety of condition management, preventive care, and wellness activities that offer employees options to best meet their goals.
Spending Accounts
You have the opportunity to contribute to a variety of savings and/or spending accounts on a pre-tax basis which lowers your taxable income. View the information below for important details and guidelines for the various accounts offered by (Client Name).
A Health Savings Account (HSA) is a tax-free savings account that is owned by you, it is 100% vested from day one, and lets 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.
To be eligible for an HSA, you must be enrolled in a High Deductible Health Plan (HDHP).
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.
MAINTAINING RECORDS
To protect yourself in the event that you are audited by the IRS, keep records of all HSA documentation and itemized receipts for at least as long as your income tax return is considered open (subject to an audit), or as long as you maintain the account, whichever is longer.
HSA funds may be used for non-eligible expenses but will be subject to regular income taxes and a 20% excise tax penalty.
HSA Contribution Limits
Dental
Dental Benefits through Guardian provides comprehensive coverage to help you and your family maintain good dental health. Your coverage will be greater 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.
NETWORK: Dental Guard Preferred
How do I find an In-Network Provider? Use the helpful link below!
- In-Network providers can also be found by visiting your provider’s website below where you can search by location, provider/facility name, or search by specialty.
Did You Know?
- 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.
Pre-treatment Estimate
- 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.
PREVENTION FIRST!
Your dental health is an important part of your overall health. Make sure you take advantage of your preventive dental visits.
Preventive care services are covered at 100% if you visit an In-Network provider. They are also not subject to the annual deductible.
Looking for more details about how items are covered? Click on the link below to view the formal plan summary.
Dental Summary
Below is a high-level overview of your plan options and in-network benefit information:
You can view more details of these plans by accessing the benefit summaries provided below.
Dental Summary
Vision
Pulsar offers vision coverage through Guardian to help pay for eye exams, prescription glasses and contact lenses. You receive a higher level of benefits when you see a provider in network, however, out-of-network coverage is provided but may only be handled as reimbursements in some situations. Please note: Members may choose between prescription glasses (lenses and frame) and contact lenses, not both.
Did You Know?
Eyes can give doctors a clear picture of overall wellness. That’s why vision care—and vision benefits—can help employees stay healthy. A comprehensive eye exam can detect early signs of serious health problems, such as:
- Diabetes
- Heart disease
- High blood pressure
- High cholesterol
- Glaucoma and cataracts
To find out if your provider is in-network, please visit the website below.
Vision Summary
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
Well-being Hub
In today's fast-paced and interconnected world, where stress and mental health issues are on the rise, effective well-being plays a crucial role. At Sample, Inc., we recognize that a healthy, content workforce is not only more productive but also fosters a positive culture. We strive for a supportive and inclusive environment where we encourage and support the improvement of physical, mental, emotional, and social well-being. Whether within a corporate setting, a community, or on a personal level, well-being focuses on fostering awareness, empathy, and support to create a healthier and more balanced workplace and environment for all. Prioritizing employee wellness and wellbeing is not just a policy but a reflection of our commitment to both the individual and collective success of the team.
To access the wellbeing newsletter, which includes resources, tips, recipes, and more, please select the button below.
Contact Us
As you consider your benefit options, please be sure to review all available information. If you need further assistance, please reach out to Human Resources.
This is a high-level guide to certain benefits your employer offers. The information in this benefits guide is intended as a general outline of the benefits available under the following welfare benefit programs offered by your employer and should not be considered legal, investment, or other benefits advice. Benefits described are subject to change, amendment, or termination without notice to, or the agreement of, any employee/participant. All protected health information is confidential, pursuant to the Health Insurance Portability and Accountability Act of 1996. If you have any questions about your benefits guide, contact Human Resources. If you (and/or your dependents) have Medicare or will become eligible for Medicare in the next 12 months, Federal law gives you more choices about your prescription drug coverage.
Account Team Contacts
EJ
Elena Joyce
Account Manager
elena.joyce@nfp.com
216-264-2707
Lisa Holocker
Account Executive
lisa.holocker@nfp.com
216-264-2719