WELCOME


ELIGIBILITY

Current Benefit Period: January 2023 - December 2023


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


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'

MEDICAL / RX

Blue Cross Blue Shield / Blue Care Network


PLAN MENU


  1. PPO HSA
  2. PPO
  3. HMO


Common Terms & Resources


PPO

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.


HSA

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.


HMO

An HMO gives you access to doctors and hospitals within the HMO network. But unlike PPO plans, care under an HMO plan is covered only if you see a provider within that HMO’s network.

You must select a Primary Care physician (PCP) who will determine the care/treatment you need. In order to see other doctors, such as a specialist, you must obtain a referral from your PCP.


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.


Deductible

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.


Coinsurance

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 ...

What is a HMO?

Health Maintenance Organization

What is a HMO?

Health Maintenance Organizatio ...

HSA

Health Equity

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.

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

SPEND, SAVE AND INVEST IN YOUR HEALTHCARE

HSA Your Way Webinar

SPEND, SAVE AND INVEST IN YOUR ...

DENTAL

Blue Cross Blue Shield

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.


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 be not be covered under your plan, which is referred to as an exclusion. 

How Does Dental Insurance Work?

How Does Dental Insurance Work?

VISION

VSP

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.


DID YOU KNOW?

  • Eye exams can help detect serious eye and general health conditions sooner: high blood pressure, diabetes, heart disease, high cholesterol
  • Babies should receive their first professional eye exam at 6 months
  • 80% of learning in the first 12 years comes through the eyes





How Does Vision Insurance Work?

How Does Vision Insurance Work?

FSA

BASIC

Health Care FSA

A FSA is an employer-sponsored savings account that allows you to set aside pre-tax contributions that can be used – tax free – for qualified medical expenses ranging from deductibles, medical and prescription copays, dental & vision expenses, and more. In addition, you can use your Health FSA to pay not only for your healthcare expenses, but also for the expenses of your spouse and dependent(s).

  • With a Health Care FSA or Limited Purpose FSA, you can spend up to the full amount of your annual election as soon as your account has been set up.
  • After your initial contribution election, you ordinarily cannot change your election during the plan year. Your elected contribution amount can only be changed if your employer’s FSA plan permits you to change your election because of a qualifying life event.


Limited Purpose FSA

  • If you open or contribute to a Health Saving Account (HSA), you may only enroll in a Limited Purpose FSA.
  • If you enroll in a HDHP (High Deductible Health Plan) and elect a Health FSA, you will automatically be enrolled in the Limited Purpose FSA.


Dependent Care FSA allows you to pay for eligible dependent care* expenses with tax-free dollars so that you and your spouse can work or attend school full-time.

  • A limited purpose FSA will reimburse you for dental and vision expenses, but you cannot claim the same expense on both the FSA and HSA Accounts.
  • Unlike the Health Care FSA, funds in a Dependent Care FSA are only available once they have been deposited into your account and you cannot use the funds ahead of time.
  • You may set aside up to $5,000 annually in pre-tax dollars, or $2,500 if you are married and file taxes separately from your spouse.
  • If you participate in a Dependent Care FSA, you cannot apply the same expenses for a dependent care tax credit when you file your income taxes.


Qualified Dependent Care ‘Persons’ - A dependent under the age of 13:

  • that has the same principal residence as you for more than half the year;
  • that is your child or step-child (by birth or adoption), or eligible foster child; and,
  • that does not provide more than half of his or her own support for the year.
  • A spouse or dependent who is physically or mentally unable to care for himself or herself and lived with you for more than half the year.


FSA’s operate with the “Use-or-Lose” Rule, meaning “unused” FSA funds do not roll over from year to year. It is very important that participants carefully plan for and decide how much to contribute at the beginning of the plan year.

If you overfund your FSA and don’t use the amount deposited in your account by the last day of the plan year, you’ll lose the funds. However, an employer*, at its option, is permitted to amend its plan document, and provide either a ‘Grace Period’ or ‘FSA Rollover’ to plan participants. An FSA cannot have both a ‘Grace Period’ and ‘FSA Rollover’. It can have one or the other or neither, at the employer’s discretion. See your plan documents for how your plan operates.


Flexible Spending Account (FSA) Overview

Flexible Spending Account (FSA) Overview

Limited Purpose FSA Overview

Limited Purpose FSA Overview

Dependent Care FSA Overview

Dependent Care FSA Overview

LIFE

Unum


Basic Life/AD&D

At no cost to you, we provide a benefit on your behalf 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.


Life and AD&D Insurance Overview

Life and AD&D Insurance Overview

DISABILITY

Unum

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.



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 the elimination period.

Short Term Disability Overview

Short Term Disability Overview

Long Term Disability Overview

Long Term Disability Overview

LEARNING

RESOURCE CENTER

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)