Richter & Associates

Table of Content

  1. Header
  2. Page
    1. Welcome!
    2. Common Insurance Terms
    3. How To Enroll?
    4. Eligibility & Qualifying Events
    5. Medical
    6. HSA - Health Savings Account
    7. Virtual Visits - Telemedicine
    8. Mobile App - MedMutual
    9. Dental
    10. Vision
    11. Life and AD&D Insurance
    12. Voluntary Disability
    13. EAP - Employee Assistance Program
    14. Voluntary Accident Insurance
    15. Voluntary Critical Illness Insurance
    16. Voluntary Hospital Indemnity Insurance
    17. Voluntary Pet Insurance
    18. Contact Information
  3. Footer

Welcome!

Welcome to your 2023 Annual Open Enrollment 

Your Benefit Period is July 1, 2023 – June 30, 2024


For Full-Time Employees Only 

Richter Healthcare Consultants sponsors the Richter Healthcare Welfare Benefit Plan under plan number 501 and hereby provides notice of the plan changes which are effective on 7/1/2023. If you have any questions about these changes in benefits, please contact, Karen Drebo 216-285-0804

Medical/RX: Provided through Medical Mutual with no plan changes

IMPORTANT: As of 1/1/2023, Medical Mutual now uses the Cigna network for services Out-of-State (Ohio).

Plan 1 - PPO MOP 80 with $100/$200 deductible

Plan 2 - HSA $4,000/$8,000 deductible, then 100%

Plan 3 - PPO 2080 $1000/$2000 deductible, then 80%

Plan 4 - PPO $7,500/$15,000 deductible, then 100%


Dental: Provided through Medical Mutual (2 plans) with no plan changes

Plan 1 - Basic PPO $75/$225 ded; 100%/50%/50% w/ ortho

Plan 2 - Advantage PPO $75/$225 ded; 100%/100%/50% w/ ortho


Vision: Provided through Anthem BCBS (1 plan offering) utilizing expanded network Blue View Vision and EyeMed with no plan changes


Basic Life & ADD & Voluntary Life: Provider through Lincoln with no changes

 

STD & LTD Disability: Provided through Lincoln with no plan changes


Worksite: Provided through Lincoln with 3 offerings

Voluntary through payroll deductions and employee owned

Supplements medical plans as a cash benefit

3 Product Offerings for Critical Illness, Accident, and Hospital Indemnity


Pet InsuranceVoluntary benefit through Pet’s Best. Employee enrolls and pays premiums directly through Pet’s Best.


HSA Contributions: The maximum limit for 2023 increased to $3,850 single / $7,750 family.

Richter Healthcare Employee Benefits Meeting 6-12-23

Click here to watch!

Richter Healthcare Employee Benefits Meeting 6-12-23

Click here to watch!

Common Insurance Terms

A PREMIUM is the amount you pay for insurance, using pre-tax or post-tax dollars. 


A DEDUCTIBLE is the amount of money you are responsible for paying each year before the plan begins to pay for covered services. Your plans include two types of deductibles:

Embedded Deductible: One individual must meet the single deductible.  A combination of 2 or more members can meet a family deductible.


COINSURANCE This is your share of the expense of covered services after your deductible has been paid when the company plan is paying a percentage. The coinsurance rate is usually a percentage.


OUT-OF-POCKET (OOP) MAXIMUM is the most you pay per Plan Year for health care expenses and applies to deductibles, flat-dollar copays and coinsurance for all covered services – including cost-sharing amounts for prescription drugs. Once this limit is met, the plan will cover all in-network services at 100% until the end of the plan year.


OUT-OF-NETWORK charges are subject to reasonable and customary limitations, which means you are responsible for any charges that exceed the carrier’s contracted amount (often referred to as balance billing). In addition, charges will be paid at the non-network deductible and coinsurance. Call your insurance carrier or refer to your provider’s network directory to verify if the provider is in network – this includes all providers of care: radiologists, pathologist or any referrals from physicians. 


PPO HSA | In-Network & Out-of-Network Benefits

The HDHP is similar to the PPO Plan in that you have 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 and a copay for prescription drug expenses.


Enrolling in this plan allows you to contribute tax free dollars to a health savings account (HSA). Any dollars that you (and your employer) wish to contribute can be used towards any eligible medical, Rx, dental and vision expenses that you may incur while covered under the plan. See HSA section of this guide for additional details.


PPO | In-Network & Out-of-Network Benefits Available

The PPO option offers the freedom to see any provider when you need care. When you use providers from within the PPO network, you receive benefits at the discounted network cost. Most expenses, such as office visits, emergency room and prescription drugs are covered by a copay. Other expenses are subject to a deductible and coinsurance.


Preventive Services | Covered at 100% NO COST SHARE

All plans recognize routine preventive services at 100%, no coinsurance, no deductible as long as the claim is submitted as “routine or preventive” and the services performed falls within the approves list of preventive services. For a complete and updated listing, please go online and search uspstf-a-and-b recommendations or visit https://www.uspreventiveservicestaskforce.org.


During your wellness visit, proactively let your physician know the reason for the appointment is for a wellness visit and that your physician needs to submit and code the visit as routine, preventive in nature. If your visit is submitted with a diagnosis, the wellness visit will not be paid at 100%, but instead, will be subject to deductible and coinsurance.  Below are a few examples of services that can be recognized as preventive:

  • Routine Wellness Exams, including well baby & child routine exams
  • Cholesterol and lipid level screening
  • Pelvic exam, pap test and screening mammograms
  • Colorectal cancer screening, colonoscopies, sigmoidoscopies (age limit applies)
  • Vaccines & immunizations: Hepatitis A & B, Influenza, Pneumonia, Shingles
  • Contraceptives (specific list applies) & Diabetes screenings

How To Enroll?

**Action Required**


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:

  1. Log into your Self-Service Portal through Ahola
  2. Click on Benefit Enrollment
  3. Select or change your benefits, dependents, beneficiaries, etc.
  4. Make sure to sign your forms, save your elections, and print your confirmation statement

Eligibility & Qualifying Events

The Benefit choices you make during your initial enrollment or annual open enrollment remain in effect for the entire year.


EMPLOYEE ELIGIBILITY

You are eligible to participate if you are full-time and work a minimum of 30 hours per week. 

New hires are eligible for coverage on the first day of the month following 30 days of employment.

Eligible employees may make their benefit elections between June 12th and June 19th for a July 1, 2023 effective date. If you do not enroll during this Open Enrollment period, you must wait until the next Open Enrollment period unless you experience a Qualifying Life Event. 


DEPENDENT ELIGIBILITY

You may also enroll eligible dependents for benefits coverage. A ‘dependent’ is defined as the legal spouse and/or ‘dependent child(ren)’ of the plan participant or the spouse. 


You can, however, modify your elections under certain circumstances, called "Qualifying Events" These are events such as marriage, divorce, birth or adoption of a child, loss of eligibility under another plan. If you experience a qualifying event, you may make changes to your benefits within 30 days of the event or 60 days if the event is due to birth or adoption of a child.


What is a Qualifying Life 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 Medicaid


The term ‘child’ refers to any of the following:

  • A natural (biological) child
  • A stepchild
  • A legally adopted child
  • A foster child
  • A child for whom legal guardianship has been awarded to the participant or the participant’s spouse
  • Disabled dependents may be eligible if requirements set by the plan are met.


IMPORTANT

You cannot make changes to these elections during the year unless you experience a qualified family status change, which must be reported to Human Resources within 30 days of the event.

If you separate from employment, COBRA continuation of coverage may be available as applicable by law. COBRA Continuation details can be found in the notices section of this employee benefit guide.

What is a Qualifying Life Event (QLE)?

What is a Qualifying Life Event (QLE)?

HSA - Health Savings Account

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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. 


Health Savings Account (HSA) Overview

Health Savings Account (HSA) Overview

Virtual Visits - Telemedicine

Cleveland Clinic Express Care


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.


Plan 1 - MOP 80 and Plan 3 - 2080-1000: Office visit copay applies.

Plan 2 - HSA 4000: A $49 copay for Plan (unless the deductible is satisfied then it is covered at 100% for the HSA Plan only)

Plan 4 - PPO 7500-15000 requires the deductible to be met, then 100%


Payment is required at the time of the virtual visit


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 Express Care

Virtual Visits | Cleveland Clinic Express Care

Telemedicine Flyer

Telemedicine Flyer

Mobile App - MedMutual

Download the MedMutual Mobile App

Your Health Plan Benefits at Your Fingertips


Get access to the vital health insurance information you need wherever you are with the MedMutual mobile app. It makes it easy and convenient to manage your health insurance, whether you’re at home, at your doctor’s office or on the go.


Track Your Claims and Spending Information

Review your claims, including details about the total amount billed, what Medical Mutual paid and what you are responsible for paying. You can also view other spending information, like your deductible, out-of-pocket costs and explanation of benefits (EOB) statements.


Find a Provider

You can enter your location to find the nearest doctor, hospital or urgent care facility covered by your plan and get step-by-step directions. You can also view quality and patient ratings for providers.


Access Your ID Card

You always have your ID card with you with our mobile app. View the front and back of your card and call any of the phone numbers listed with just a tap. You can also email or fax your card to your provider.


Securely Log In Without Your Password

You can even use your device’s Facial Recognition or Touch ID feature for a simple, secure and convenient login. This means you don’t have to type in your username and password if these features are enabled.


To download or update the app, visit your device’s App Store (Apple) or Google Play (Android). Make sure your app is set to automatically update, so you don’t miss out on future upgrades and new features.

Mobile App Flyer

Mobile App Flyer

Life and AD&D Insurance

The Best Life Insurance for Seniors in 2019 | TermLife2Go


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.

Lincoln Member Login

Lincoln Member Login

Funeral Prep Flyer

Funeral Prep Flyer

LifeKeys Services Flyer

LifeKeys Services Flyer

TravelConnect Services Flyer

TravelConnect Services Flyer

Voluntary Disability

The Best Life Insurance for Seniors in 2019 | TermLife2Go


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.

Lincoln Member Login

Lincoln Member Login