Table of Content
- Header
-
Page
- Welcome!
- Common Insurance Terms
- How To Enroll?
- Eligibility & Qualifying Events
- Medical
- HSA - Health Savings Account
- Virtual Visits - Telemedicine
- Mobile App - MedMutual
- Dental
- Vision
- Life and AD&D Insurance
- Voluntary Disability
- EAP - Employee Assistance Program
- Voluntary Accident Insurance
- Voluntary Critical Illness Insurance
- Voluntary Hospital Indemnity Insurance
- Voluntary Pet Insurance
- Contact Information
- Footer
How To Enroll?
All team members have access to our online benefits enrollment platform 24/7 where you have the ability to enroll, select or change your benefits online during the annual open enrollment period, new hire orientation, and for qualifying events.
- Accessible 24/7
- View all benefit plan options and your elections
- View important carrier forms and links
- Report a qualifying life event
- Make changes to beneficiary designations and more
ENROLLMENT INSTRUCTIONS:
- Log into your Self-Service Portal through Ahola
- Click on Benefit Enrollment
- Select or change your benefits, dependents, beneficiaries, etc.
- Make sure to sign your forms, save your elections, and print your confirmation statement
Medical
Medical Mutual utilizes the SuperMed Plus network in the State of Ohio and the Cigna network for services provided Out-of-State. Please refer to Medical Mutual’s plan documents for the in and out of network benefit levels, along with plan details.
HSA - Health Savings Account
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.
You may contribute as follows:
$3,850 for Employee Only
$7,750 for a two-person or family
$1,000 HSA "Catch-Up" Contributions (Age 55 or older)
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 that is a non-HDHP plan. i.e. enrolled in spouses plan that is a PPO 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 (including dependents).
- You cannot be eligible to be claimed as a dependent on someone else’s tax return.
- You have not received Tricare, Indian Health Services or Department of Veterans Affairs Medical benefits in the past 90 days.
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.
*A full list of qualified expenses can be found in IRS Publication 502 at www.irs.gov.
Dental
Your dental coverage is through Medical Mutual who utilizes the Dentemax Network. Network dentists agree to accept Medical Mutual’s contracted amount and may not balance bill. Non-network dentists may bill you for any difference in cost between the Medical Mutual allowed amount and the dentists’ fees.
COMMON TERMS
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.
DUAL COVERAGE
You might have benefits from more than one dental plan, which is called dual coverage. In this situation, the total amount paid by both plans can’t exceed 100% of your dental expenses. And in some cases, depending on the specifics of the plans, your coverage may not total 100%.
LIMITATIONS AND EXCLUSIONS
Dental plans are intended to cover part of your dental expenses, so coverage may not extend to your every dental need. A typical plan has limitations such as the number of times you can receive a cleaning each year. In addition, some procedures may not be covered under your plan, which is referred to as an exclusion.
Vision
You have many choices when it comes to using your benefits. As a Blue View Vision plan member, you have access to one of the nation’s largest vision networks. You may choose from many private practice doctors, local optical stores, and national retail stores including LensCrafters®, Target Optical® and most Pearle Vision® locations. For a complete listing, go to anthem.com/findadoctor. Select Vision for type of care, then select the Blue View Vision network.
Did you know your eyes can tell an eye care provider a lot about you?
In addition to eye disease, a routine eye exam can help detect signs of serious health conditions like diabetes and high cholesterol. This is important, since you won’t always notice the symptoms yourself and since some of these diseases cause early and irreversible damage.
Life and AD&D Insurance
Basic Life and AD&D Insurance - Company Paid Benefit, no cost to you!
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.
Benefit Details
- 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 and 75% of the original amount at age 75
Additional Provisions
- Accelerated Death Benefit: Benefits are available if there is less than 12 months life expectancy, up to 75% of Life Benefit
- Conversion: Application must be made within 30 days following termination
Voluntary Life and AD&D Insurance - Employee Paid Benefit
Employees have the option to purchase additional life insurance at affordable group rates through payroll deduction. This coverage is also available for your spouse and dependent children if you elect coverage. Conversion and Portability are included as long as an application is received within 30 days following termination. An Accelerated Death Benefit is available if less than 12 months life expectancy, (lesser of) $250,000 or 75% of the Life Benefit.
Cost of Coverage
Premiums are based on age-related tables and paid by the employee every pay period through a payroll deduction. These premiums are post-tax and benefits payable are tax-free. The age-related tables and premiums are programmed into the Ahola online enrollment system.
Coverage Options
Employee
- Choose in $10,000 increments up to the lesser of 5x annual salary or $300,000 (up to age 70)
- If newly hired, you must enroll for Voluntary Life within 30 days for up to $100,000 on a Guarantee Issue basis. Any amounts in excess of $100,000 will require medical evidence of insurability (EOI)
- Existing employees may elect up to $10,000 or $20,000 without evidence of insurability as long as not previously declined or enrollment withdrawn, and Guarantee Issue has not been exceeded
Spouse
- Newly hired spouses can elect in increments of $5,000, not to exceed $150,000
- Spouse may not exceed 50% of the employee’s elected amount
- Premiums for spouse will be based on employee’s age
- Existing employee’s spouse may elect up to $10,000 without evidence of insurability as long as not previously declined or enrollment withdrawn
Children
- Can elect in flat amount of $250 from 15 days to 6 months and a flat $10,000 from 6 months to age 19 (or age 25 if fulltime student)
- Age limit – birth to age 14 days – NOT COVERED
- Note: the premium rate is a flat rate that applies to all eligible children in the family
Plan Provisions
Benefit Reduction Schedule - Your insurance will reduce to: 50% of the original amount at age 70 and 75% of the original amount at age 75
Conversion: Application must be made within 30 days following termination.
Designation of Beneficiary: You must add/update your beneficiary in EASE with any changes in beneficiary designations. You may designate different beneficiaries for your Basic Life/AD&D and Voluntary Life.
*Guaranteed Issue (GI) and Evidence of Insurability (EOI)
When you are first eligible (at hire) for Voluntary Life and AD&D, you may purchase up to the Guaranteed Issue (GI) for yourself and your spouse without providing proof of good health (EOI). Annually, you are able to increase elections up to $10,000 or $20,000 without proof of good heath.
Any amount elected over the GI will require EOI. If you elect optional life coverage, and are required to complete an EOI, it is your responsibility to complete the EOI and send to the provider (address will be listed on your form). In addition, your spouse will need to provide EOI to be eligible for coverage amounts over GI, or if coverage is requested at a later date.
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.
Voluntary Disability
VOLUNTARY 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.
Cost of Coverage: Voluntary Benefit - Employee is responsible for 100% of the cost
Elimination Period: Benefits begin on the 1st day of an accident or 8th day of an illness
This is the number of days that must pass between your first day of a covered disability and the day you can begin to receive your disability benefits.
Benefit Duration: 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.
The maximum number of weeks you can receive benefits while you are sick or disabled.
Coverage Amount: Cannot exceed 60% of your salary *see your Certificate of Coverage for details.
What's Covered: A variety of conditions and injuries. Typical claims would include pregnancy, injuries, joint, back and digestive disorders.
Benefit Payment Frequency: Weekly benefit may be reduced or offset by other sources of income.
Cost Calculation: Composite Rate per $10 of Benefit
Waiver of Premium: If you're disabled and receiving benefit payments, you cost may be waived until you return to work.
Pre-Existing Condition Limitation: You have a pre-existing condition if you have received: medical treatment, consultation, care or services including diagnostic measures for the condition, or took prescribed drugs or medicines for it in the 3 months just prior to your effective date of coverage; and the disability begins in the first 12 months after your effective date of coverage.
Certain exclusions and any pre-existing condition limitations may apply. Please refer to the Provider’s detailed benefit summary for details.
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.
Cost of Coverage: Voluntary Benefit - Employee is responsible for 100% of the cost
Elimination Period: Your elimination period is 90 days (if elected, this will be the benefit duration of Short-Term Disability)
This is the number of days that must pass between your first day of a covered disability and the day you can begin to receive your disability benefits.
Benefit Duration: Payments will last for as long as you are disabled, or until you reach Retirement Age (age 65), whichever is sooner. You must be sick or disabled for the duration of the elimination period before you can receive a benefit payment.
The maximum number of weeks you can receive benefits while you are sick or disabled.
Coverage Amount: Covers up to 60% of your monthly income. *see your Certificate of Coverage for details
What's Covered: A variety of conditions and injuries. Typical claims would include cancer, back disorders, injuries and poison, cardiovascular, joint disorders.
Benefit Payment Frequency: Monthly benefit may be reduced or offset by other sources of income.
Cost Calculation: Age Rated Benefit
Waiver of Premium: If you're disabled and receiving benefit payments, you cost may be waived until you return to work.
Pre-Existing Condition Limitation: You have a pre-existing condition if you have received: medical treatment, consultation, care or services including diagnostic measures for the condition, or took prescribed drugs or medicines for it in the 3 months just prior to your effective date of coverage; and the disability begins in the first 12 months after your effective date of coverage.
Certain exclusions and any pre-existing condition limitations may apply. Please refer to the Provider’s detailed benefit summary for details.
EAP - Employee Assistance Program
Employees are automatically eligible for an Employee Assistance Program (EAP) and is provided at no cost through Lincoln.
EAP Overview
- Provided through the ComPsych EAP Program that provides consultation for relationship issues, stress, coping with change, grief and loss, family and marital issues, adjustment disorder, depression, anxiety, addiction and domestic violence
- In-Person sessions that includes up to 5 face-to-face sessions per issue. Per person, per issue, per year.
- Live, 24/7 access to ComPsych clinicians. All clinicians hold master level degrees with at least 3 years of experience
- Assists in locating childcare and elder care services.
- Includes referrals to a local attorney that provides a 30-minute consultation for free.
- On-staff accredited financial consultants who can assist with credit management, budget analysis, home buying, mortgage/refinancing, retirement planning, basic estate planning.
- Consumer and Convenience Research—provides consultation, research and referrals on consumer issues, home and appliance repair, pet services, transportation services, house/apartment sitting resources and purchasing large ticket items.
- Online resources such as, articles, streaming videos and interactive tools.
This is a confidential, voluntary and professional program and is intended to be a short term resource. This EAP is administered and provided by Carrier/Vendor Name and is available to you and your dependents at no additional cost.
ComPSYCH
Call: (888) 628-4824
Visit: www.guidanceresources.com
User ID: LFGsupport
Password: LFGsupport1
Voluntary Accident Insurance
Accident Insurance with Sickness & Hospital Confinement Rider
Accident Insurance can pay a set benefit amount based on the type of injury and the type of treatment. It covers accidents that occur on and off the job. An option benefit, Accident Hospital Daily Confinement Benefit, pays a daily amount if you’re in the hospital for a covered illness. It’s available to each family member who has Accident coverage. You can receive $200 per day.
Who Gets Paid?
You get paid. When you have a covered accident or injury, your health insurance company pays your doctor or hospital, but your accident insurance company pays you. The money is paid directly to you, and you decide how to spend it.
What’s Covered?
Not all accidents are “qualifying injuries.” The kinds of accidents that are covered can vary by plan but accident insurance plans typically cover things like:
- Nonsurgical Fractures
- Nonsurgical Dislocations
- Concussion
- Lacerations
- Burns
- Dental Crown/Extraction
- Accidental Death
If you have a covered injury, accident insurance can help you pay for things like:
- Accidental death: employee ($50,000), spouse ($20,000) and child ($10,000)
- Hospital Admissions (injury): $1,000
- Hospital confinements: $200/day
- ICU: $400/day
- Ambulance Transportation: $300
- ER initial care visit: $100
- Surgical repair under general anesthesia: $225
- Fracture-nonsurgical: $100 to $3,500
- Laceration: $35 to $400
What it Doesn’t Cover
Accident insurance will not typically cover things like check-ups or hospitalization due to illness. Accident insurance will not cover you for injuries suffered before you purchased the plan.
What is the Cost of Accident Insurance?
Refer to the Ahola self-service portal / benefit enrollment for premium cost.
$50 WELLNESS BENEFIT - Per Covered Individual
You receive a cash benefit every year you and any of your covered family members complete a single covered assessment test.
Voluntary Critical Illness Insurance
How would you pay your bills if you were suddenly diagnosed with cancer and couldn’t work? Critical illness insurance doesn't’ pay your medical bills. It pays you if you’re diagnosed with a covered illness. The benefit is paid directly to you and is your choice how to spend it.
What’s Covered?
Critical illness can vary widely from one another. Some may focus on a single specific diagnosis, while others may provide you with coverage for a range of possible diagnoses, such as:
- Cancer
- Heart Attack
- Loss of Sight
- Loss of Speech
- Major Organ Failure
- Renal (kidney) Failure
- Arterial/Vascular Disease
- Severe Burns
- Stroke
- Permanant Paralysis
- Traumatic Brain Injuries
COVERAGE OPTIONS
- Employee: can choose from $5,000 to $20,000 in increments of $5,000. Coverage is guaranteed up to $20,000.
- Spouse: can choose from $2,500 to $10,000 in increments of $2,500. Coverage is guaranteed up to $10,000.
- Children: with your coverage election, your dependent children automatically receive 50% of your coverage amount at no extra cost
What is the Cost of Critical Illness Insurance?
Refer to the Ahola self-service portal / benefit enrollment for premium cost.
Pre-Existing Condition Limitation: During the first 12 of coverage benefits will not be payable for a pre-existing condition. A " pre-existing" condition is one in which you or an insured dependent receive treatment during the 12 months prior to the effective date of coverage. Treatment means consultation, care, and services provided or prescribed by a Physician for which symptoms exist.
If you are a participant in a Critical Illness plan which this plan replaces and are diagnosed with a pre-existing condition, we will consider whether the condition was payable under the prior plan when determining if it will be payable under this plan.
A complete list of benefit exclusions is included in the policy. State variations apply. See plan summary for details.
$50 WELLNESS BENEFIT - Per Covered Individual
You receive a cash benefit every year you and any of your covered family members complete a single covered exam, screening or immunization.
Voluntary Hospital Indemnity Insurance
Hospital indemnity compliments your health insurance to help you pay for costs associated with a hospital stay. The funds can be used to help pay for the out-of-pocket expenses that your medical plan not may cover, such as deductible and coinsurance.
Coverage is available for:
- Employee
- Spouse
- Dependent Children
NOTE: Employee must purchase coverage for themselves in order to purchase spouse or child coverage
Who Gets Paid?
You get paid. When you have a covered inpatient admission, your health insurance company pays your doctor or hospital, but your accident insurance company pays you.
What’s Covered?
Hospital related expenses with plan highlights listed below:
Hospital Admissions: $1,000 per day for 1 day per calendar year
Hospital confinements: $200 per day for 15 days per calendar year starting on 2nd day of confinement
Hospital Intensive Care: $200 per day for 15 days per calendar year starting on the 1st day of confinement
Complications of Pregnancy: Included
Newborn Care: $100 per day for 2 days per calendar year
Portability
If you leave employment for any reason, worksite benefits can be converted to a direct-pay policy. The same benefits and premium rate will apply. Lincoln will send a notice to your home address following your termination from the group plan.
Pre-Existing condition limitation:
A preexisting condition means a covered condition for which treatment was received during the look-back period prior to the effective date of coverage. Treatment means consultation, care, and services provided or prescribed by a physician. It includes diagnostic measures and the prescription, refill, or taking of prescribed drugs or medicines for which symptoms exist.
- Look-back period: A preexisting exclusion applies to conditions for which the employee received treatment during a 12-month period prior to the employee’s effective date of coverage.
- Exclusionary period: A preexisting exclusion applies during the first 12 months of an employee’s coverage or increase in coverage. Once this period is satisfied, the exclusion no longer applies.
Voluntary Pet Insurance
Pet Insurance reimburses you for vet bills when your pet is sick or injured, to help take the financial worry out of vet visits.
- Fast claims processing and payment
- Optional direct deposit and direct vet pay options
- Use any veterinarian in the U.S. - including specialty and emergency clinics
- Exclusive employee discount on a BestBenefit plan*
- Optional coverage for routine care
- Access to a 24/7 pet helpline powered by WhiskerDocs
How to obtain a quote (it’s recommended to call the (888) number in order to run different options and ask questions):
Reference Code - RICHTER
Website - www.petsbest.com/richter.
Phone - (888) 984-8700
HOW PET INSURANCE WORKS
