Siler's Drive Thru 2022

Table of Content

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    1. WELCOME
    4. MEDICAL / RX
    5. HSA
    6. DENTAL
    7. VISION
    8. FSA
    9. LIFE
    11. LEARNING
    17. Contact Us
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Current Benefit Period: December 2022 - November 2023

The benefit choices you make during your initial enrollment or annual open enrollment remain in effect for the entire year.   Any changes you make will be effective as of 12/1/2022. You have until 12/15/2022 to submit your changes to HR.

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. Contact Human Resources if you have questions about qualifying events.

Common life events include; Marriage, Divorce, New Dependent, Loss/gain of available coverage by you or any of your dependents.

*A full list of qualifying events can be found in the ‘Required Notice - IRS Code Section 125'



helping you and your family reach and maintain good health is very important to Siler's Drive Thru. We are pleased to offer you the Humana HSA health plan.

Common Terms & Resources


You have the freedom to see any physician, located in any area; however, to receive the maximum benefits under the plan, physicians should be chosen from the network of participating providers. You may also use a doctor that is not in-network and receive reduced, out-of-network benefits. Primary care physicians do not need to be designated, and referrals are not needed to visit specialists.


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.

Preventive Services

Regardless of which plan you choose, preventive services are covered at 100% in-network and copays & deductibles do not apply.

There are 3 sets of free preventive services. Select the links below to see a list of covered services for each group:

Online Healthcare

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.

Find a Doctor

You pay less out of pocket if you receive care from an In-Network provider. In-Network providers can be found on your provider’s website under “Find a Doctor”. Log in to your account and choose the network based on the plan type you are choosing.


The amount of money you are responsible for paying each year before the plan begins to pay for covered services, with the exception of preventive care services, which are covered at 100% In-Network.


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 Maximum

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.

Common Pharmacy Tiers

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. 

Preferred Brand | 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 a higher copay.

Non-Preferred Brand  | Highest Brand copay: In this category are nonpreferred brand name drugs for which there is either a generic alternative or a more cost-effective preferred brand. These drugs have the highest copay. Make sure to check for mail order discounts that may be available.

Preferred Specialty  | Lowest specialty drug copay: Preferred specialty drugs are generally more effective and less expensive than non-preferred specialty drugs.

Non-Preferred Specialty | Highest specialty drug copay: These drugs have the highest copay for specialty drugs, usually because there may be a more cost-effective generic or preferred brand available.

Finding 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.

What is a PPO?

Preferred Provider Organization

What is a PPO?

Preferred Provider Organizatio ...

Prescription Drug Overview

Prescription Drug Overview

What is an HDHP?

The PPO HSA is a HDHP (High Deductible Health Plan) which allows employees to contribute to an HSA (Health Savings Accou ...

What is an HDHP?

The PPO HSA is a HDHP (High De ...

Humana HSA Summary of Benefits & Coverage

Humana HSA Summary of Benefits & Coverage

Humana Preventive Services

Humana Preventive Services


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.

2022 IRS Contribution Limits:

Single: $3,650

Two Person or Family: $7,300

Contribution limits include your individual contribution as well as any employer contributions. The combined total can not exceed the amount(s) mentioned above each calendar year.

You may choose the bank of your choice to open your HSA, but you must be enrolled in the HSA Humana plan option in order to be eligible.

What Is a Health Savings Account (HSA)?

What Is a Health Savings Account (HSA)?

Harness The Power of An HSA

Harness The Power of An HSA

HSA Your Way Webinar


HSA Your Way Webinar




Benefit Terms Explained

Benefit Terms Explained

What is Preventive Care?

What is Preventive Care?

How To Read An EOB (Explanation of Benefits)

How To Read An EOB (Explanation of Benefits)


Enrollment Materials

What forms do I need?

This section contains all the forms you may need to either enroll in a plan for the first time or make any changes to your existing coverage. Remember, any changes you make will take effect as of December 1, and you may not be able to make any other changes the remainder of the plan year unless you have a qualifying event.

Any completed forms would need to be submitted to your benefits administration in order for them to be processed, and remember, these forms must submitted prior to December 15! If you have any questions about what form you need, please reach out to one of the contacts on this page. We're happy to help!

Also included:

This section also contains important notices about your benefits! Please sign the "Annual Notices" acknowledgement and return to your employer.

Humana enrollment form

Humana enrollment form

Humana change form

Humana change form

Annual Benefit Notices

Annual Benefit Notices

Annual Notices acknowledgement

Annual Notices acknowledgement





What is Go365?

Go365 is a wellness program designed to help employees kick start their health and well-being. Employees take steps to engage in and adopt healthier behaviors and move up in Status level, earning Points and rewards for their progress. A combination of behavioral economics, individualized recommended activities, and an advanced incentive program help motivate members toward positive lifestyle change.

There are a few things members will need to do to get started with the Go365

program. This section outlines the registration process and moving out of Blue Status. It’s important to note that members who have Humana medical insurance will register for Go365 differently than those who do not.

How to register:

For members with Humana insurance:

Members who have Humana medical insurance

will follow the steps below. Once they create an account, they can use the same username and password on and the Go365 App to access Go365 moving forward.

1. Visit and “Get Started.”

2. Enter member ID number (or Social Security

number), date of birth and ZIP code.

3. Create a username, password and security prompt, and click “Next” to finish.

For members without Humana insurance:

There are two ways to register for members who DO NOT have

Humana medical insurance. Even if members register online,

encourage them to download the App for easy access on-the-go.


1. Visit

2. Click “Register now” from the homepage

3. Complete the registration form and select “Continue.”

4. Create a username and password and click “Submit.”

Contact Us

As you consider your benefit options, please be sure to review all available information: Employee Benefits Guide, Intranet, and other videos and flyers found on this webpage. If you don't understand your benefits or need any assistance, please contact the Human Resources Department.

Client Contacts


Denise Siler

(513) 378-2345