Table of Content
- Header
-
Page
- Welcome
- Employee Medical
- Employee Virtual Visits
- Employee Vision
- Employee Dental
- Employee HSA
- Employee Voluntary Worksite Benefits
- Manager Medical
- Manager Virtual Visits
- Manager Vision
- Manager Dental
- Manager Basic Life
- Manager Supplemental Life
- Manager Disability
- Manager Voluntary Worksite Benefits
- Manager HSA
- Contact Us
- Additional Resources
- UNDERSTANDING YOUR BENEFITS
- Footer
Welcome
Plan Year
March 1,2023– February 29,2024
EMPLOYEES
MEDICAL/RX: Anthem will remain the carrier for Medical & Prescription Drugs effective March 1, 2023.
Plan Highlights:
- Anthem utilizes the Blue Access PPO network for services.
Ancillary Benefits: Guardian will continue to provide Dental and Vision; we will be adding voluntary accident insurance as well.
MANAGERS
MEDICAL/RX: Anthem will remain the carrier for Medical & Prescription Drugs effective March 1, 2023.
Plan Highlights:
- Anthem utilizes the Blue Access PPO network for services.
Ancillary Benefits: Guardian will continue to provide STD, LTD, Dental, Vision, Basic Life and Vol Life coverage. We will be adding a new voluntary Accident coverage for employees to opt into as of 3/1 with Guardian.
Employee Medical
Medical Mutual
IN-NETWORK
MMO Plan 1
- Single Deductible: $5,000
- Family Deductible: $10,000
Coinsurance: 100%
- Single Out-of-Pocket Maximum: $6,900
- Family Out-of-Pocket Maximum: $13,000
Membership Co-Payments
- Primary Care Office Visit (PCP): 100% after deductible
- Preventative services: 100% no deductible
- Specialist Office Visit: 100% after deductible
- Urgent Care Facility: 100% after deductible
- Emergency Room Visit: 100% after deductible
Employee Contributions: Monthly
- Single: $0
- Employee + Spouse: $0
- Employee + Child(ren): $0
- Family: $0
- Spousal Surcharge*: $190.00
Employee Contributions: Bi-weekly
- Single: $0
- Employee + Spouse: $0
- Employee + Child(ren): $0
- Family: $0
- Spousal Surcharge*: $190.00
Employee Virtual Visits
Virtual Doctors Visit
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. There will be a copay (unless the deductible is satisfied then it is covered at 100% for the HSA Plan only) 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
Employee 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
Exam Once every 12 months
Lens: Once very 12 months
Frame: Once every 24 Months
Exam Cop-Pay: $10
Lens Co-Pay: $25
Bifocal: $25
Trifocal: $25
Lenticular: $25
Progressive (standard): $55
Frames Allowance: up to $130, then 20% off
Contact Lenses: up to $130
Contact Lense Fitting: copay up to $50
Employee Dental
Guardian You have the freedom to select the dentist of your choice; however, when you visit a participating PPO or Premier dentist, you will have lower out-of-pocket costs, no balance billing, and claims will be submitted by your dentist on your behalf. Out of network dentists may bill you for the difference between the contracted rate and the dentist’s fee. Reimbursement is based on the usual, reasonable & customary rate. In addition, insurance claim payments for out of network dentists are paid directly to the member and the member must pay the provider.
Deductible
Single: $50
Family: $150
Calendar Year Maximum: $1,000
Preventative: 100%
Basic: 80%
Major: 50%
Child Ortho: 50%
Ortho Lifetime Maximum: $1,000
Deductible Waived For: Preventative & Ortho
Employee HSA
\Health Savings AccountThe Health Savings Account (HSA) allow you to set aside pre-tax dollars to pay for eligible expenses. By contributing to a HSA you reduce your taxable income, so you pay less in taxes — which saves you money.
- To be eligible for an HSA, you must be enrolled in a High Deductible Health Plan (HDHP).
- 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
- Enrolled in spouses plan that is a PPO (this exclusion does not apply to certain other types of insurance such as dental, vision)
You may contribute as follows:
$3,850 for a single contract
$7,750 for a two person or family
Employee Voluntary Worksite Benefits
Accident Insurance
A serious injury can cost you a lot of money – not only in medical bills but in things like income from lost work hours. Some injuries are minor, but others are debilitating and require significant medical care. If you get hurt, accident insurance pays you money that you can use to cover personal expenses, bills, and out-of-pocket medical costs.
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.
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:
If you have a covered injury, accident insurance can help you pay for things like:
- Laceration – schedule up to $400
- ER Room – Accident: $175
- ospital Confinement: $225/day up to 1 yr.
- Hospital ICU: $2,000
- Intensive Care &Rehabilitation Unit Care
- Diagnostic Exams: see schedule
- Ambulance: $150
- Surgery: Schedule up to $1,250
Accidents that occur off the job are covered under this program. The benefit is paid directly to the member. You decide how to spend this benefit. You can also purchase this benefit for your spouse and dependent children.
- This policy includes an accidental death benefit:
- Employee $25,000
- Spouse $12,500
- Child $5,000
- Child Organized Sport – Benefit is paid if the covered accident occurred while your covered child is participating in an organized sport that is governed by an organization and requires formal registration to participate.
- 20% increase to child benefits
Manager Medical
Medical Mutual
IN-NETWORK
MMO Plan 1
- Single Deductible: $5,000
- Family Deductible: $10,000
Coinsurance: 100%
- Single Out-of-Pocket Maximum: $6,900
- Family Out-of-Pocket Maximum: $13,000
Membership Co-Payments
- Primary Care Office Visit (PCP): 100% after deductible
- Preventative services: 100% no deductible
- Specialist Office Visit: 100% after deductible
- Urgent Care Facility: 100% after deductible
- Emergency Room Visit: 100% after deductible
Employee Contributions: Monthly
- Single: $0
- Employee + Spouse: $0
- Employee + Child(ren): $0
- Family: $0
- Spousal Surcharge*: $190.00
Employee Contributions: Bi-weekly
- Single: $0
- Employee + Spouse: $0
- Employee + Child(ren): $0
- Family: $0
- Spousal Surcharge*: $190.00
Manager Virtual Visits
Virtual Doctors Visit
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. There will be a copay (unless the deductible is satisfied then it is covered at 100% for the HSA Plan only) 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
Manager 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
Exam Once every 12 months
Lens: Once very 12 months
Frame: Once every 24 Months
Exam Cop-Pay: $10
Lens Co-Pay: $25
Bifocal: $25
Trifocal: $25
Lenticular: $25
Progressive (standard): $55
Frames Allowance: up to $130, then 20% off
Contact Lenses: up to $130
Contact Lense Fitting: copay up to $50
Manager Dental
Guardian You have the freedom to select the dentist of your choice; however, when you visit a participating PPO or Premier dentist, you will have lower out-of-pocket costs, no balance billing, and claims will be submitted by your dentist on your behalf. Out of network dentists may bill you for the difference between the contracted rate and the dentist’s fee. Reimbursement is based on the usual, reasonable & customary rate. In addition, insurance claim payments for out of network dentists are paid directly to the member and the member must pay the provider.
Deductible
Single: $50
Family: $150
Calendar Year Maximum: $1,000
Preventative: 100%
Basic: 80%
Major: 50%
Child Ortho: 50%
Ortho Lifetime Maximum: $1,000
Deductible Waived For: Preventative & Ortho
Manager Basic Life
Coverage Amount:
- 100% of salary up to $250,000
- Spouse eligible for $5,000
- Children eligible for $2,000
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
Portability If your employment ends or you retire, you may be eligible to continue your term insurance at group rates.
Conversion When coverage ends under the plan, you can convert to an individual permanent life policy without evidence of insurability.
Manager Supplemental Life
Cost of Coverage: Premiums are based on age-rated tables and paid by the employee every pay period through a payroll deduction. These premiums are post-tax and benefits payable are tax-free.
Coverage Options
- Employee Coverage
1, 2 or 3x salary up to $250,000
- Spouse Coverage
50% of EE
- Dependent Coverage
50% of EE up to $10,000
Do I have to take a health exam to get coverage?
If you and your dependents enroll in coverage at your initial eligibility date, you may apply for up to the Guaranteed Issue amounts without medical questions.
Guaranteed Issue
- Employee: $50,000 under 65
- Spouse: $10,000 under 65
- Dependent: $10,000
Cost Calculation: Age Rated Benefit (Spouse Life based on employee's age)
Benefit Reduction Schedule
Employee Coverage Will Reduce To:
– 65% of the original amount at age 70
– 50% of the original amount at age 75
Spouse Coverage Will Reduce By: The same amount and at the same time your coverage reduces.
Portability: If your employment ends or you retire, you may be eligible to continue your term insurance at group rates.
Conversion: When coverage ends under the plan, you can convert to an individual permanent life policy without evidence of insurability.
Manager Disability
Sugar Creek Pizza provides you with Basic & Voluntary Life/AD&D coverage as well as Short- and Long-Term Disability through Guardian.
Basic Life/AD&D
Employees working [30 or more] hours per week are eligible for [$XXX] coverage payable to your designated beneficiary in the event of your death. An additional accidental death & dismemberment benefit (AD&D) is payable to you in the event of a covered dismemberment or to your beneficiary if your death is the result of an accident.
Voluntary Life/AD&D
A sudden accident or death can leave you or your loved ones in a vulnerable position. Employees have the opportunity to enroll in Term Life and Accidental Death & Dismemberment insurance which will supplement lost income in the event of an accident or death. If you choose to enroll in employee coverage, this will be in addition to your employer provided Basic Life coverage.
Who''s Your Beneficiary? Naming a beneficiary is a crucial part of electing life insurance. Also, don''t forget to update your primary or secondary beneficiary if you experience a life event, such as a divorce or birth of a child.
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. Your coverage through [CARRIER] pays [XX%] of your income to a maximum of [$XXX] per week.
Long Term Disability
Serious illnesses or accidents can interrupt your life, and your ability to work for months – even years. Long Term Disability provides financial protection for you by paying a portion of your income, so you have financial support to manage your disability and your household. Benefits begin after a [XX] day elimination period are are equal to [XX%] of covered monthly earnings up to [$XXX] for full-time employees.
Please consult your Employee Benefits Guide and review the benefit summaries for additional details.
Manager Voluntary Worksite Benefits
Accident Insurance
A serious injury can cost you a lot of money – not only in medical bills but in things like income from lost work hours. Some injuries are minor, but others are debilitating and require significant medical care. If you get hurt, accident insurance pays you money that you can use to cover personal expenses, bills, and out-of-pocket medical costs.
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.
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:
If you have a covered injury, accident insurance can help you pay for things like:
- Laceration – schedule up to $400
- ER Room – Accident: $175
- ospital Confinement: $225/day up to 1 yr.
- Hospital ICU: $2,000
- Intensive Care &Rehabilitation Unit Care
- Diagnostic Exams: see schedule
- Ambulance: $150
- Surgery: Schedule up to $1,250
Accidents that occur off the job are covered under this program. The benefit is paid directly to the member. You decide how to spend this benefit. You can also purchase this benefit for your spouse and dependent children.
- This policy includes an accidental death benefit:
- Employee $25,000
- Spouse $12,500
- Child $5,000
- Child Organized Sport – Benefit is paid if the covered accident occurred while your covered child is participating in an organized sport that is governed by an organization and requires formal registration to participate.
- 20% increase to child benefits
Manager HSA
Health Savings AccountThe Health Savings Account (HSA) allow you to set aside pre-tax dollars to pay for eligible expenses. By contributing to a HSA you reduce your taxable income, so you pay less in taxes — which saves you money.
- To be eligible for an HSA, you must be enrolled in a High Deductible Health Plan (HDHP).
- 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
- Enrolled in spouses plan that is a PPO (this exclusion does not apply to certain other types of insurance such as dental, vision)
You may contribute as follows:
$3,850 for a single contract
$7,750 for a two person or family
Contact Us
Account Team Contacts
Kevin Lurie
Producer / Sales Consultant
kevin.lurie@nfp.com
216-410-6751