Benefits Effective 1/1/2026
2026 Benefits Overview
NEW! Delta Dental will be your new Dental carrier!
Anthem: will continue as your Medical carrier.
- Sydney Health App will continue to be offered through Anthem.
VSP: will continue as your Vision carrier.
EBC: will continue to administer the Healthcare and Dependent Care Flexible Spending Account
Prescription Advocacy through ImpaxRX
Eligibility and Qualifying Event Changes
Employees are eligible to elect or waive coverage when hired. Coverage, if elected, begins on the first day of the month after employee's date of hire.
EMPLOYEE ELIGIBILITY: If you do not enroll during the Open Enrollment period, you must wait until the next Open Enrollment period unless you experience a Qualifying Life Event. If you experience a Qualifying Life Event (i.e., birth or adoption of a child, marriage, divorce, loss of other coverage, etc.) you must enroll within 30 days of the Qualifying Event.
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
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Life Events
Life Events
Medical
Anthem will remain as your Medical benefit provider.
- PPO 300 (0-5 years)
- PPO 200 (5-10 years)
- PPO 100 (10+ years or more)
You may go to any doctor/provider however, those who are in the Anthem network will be most cost effective. Employees who seek care outside of Anthems network will be responsible for higher costs.
Preventive Services Covered at 100%
All routine preventive services are covered 100% as long as the claim is submitted as routine or preventive and falls within the approved list of preventive services. Remind your physician that you are visiting for the purpose of a wellness visit and to submit your visit as preventive in nature.
What is considered a preventive service?
- Routine exams
- Pelvic exams, pap tests, mammograms
- Colorectal cancer screenings
- Vaccines & Immunizations
- Contraceptives (specific list applies)
- Diabetes screenings
**Please refer to attached Summary of Benefits and Coverage (SBC) for more complete plan details**
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Understanding an EOB
Understanding an EOB
Medical Benefits Summary - 0-5 Years
Medical Benefits Summary - 5-10 Years
Medical Benefits Summary - 10+ Years
Medicare
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Sydney Health App with Anthem
Telemedicine with Anthems Sydney Health App
Visit with a doctor 24/7!
You can visit with a doctor virtually for a variety of healthcare needs. You'll be connected with a board-certified doctor through video visits or virtual chat visits for little or no cost, depending on your plan.
Where Can I Download Anthem’s Sydney App?
- The app is available for both Apple and Android phones.
- Download the free Sydney Health app for your device.
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Sydney Health App
Sydney Health App
Using the Sydney Health App you can find a doctor, view your claims, manage your benefits, view ID cards and so much more online or on your mobile device!
- Find A Doctor and Check Your Costs
- Search for doctors, dentists, hospitals, labs, and other health professionals in your plan. You can search by name, location, and type of care and then check costs before you go to find what is best for you.
- View Your Claims
- Check medical, dental, and vision claims with one click. That means you can spend more time focused on your health and less on managing your healthcare benefits.
- See All Your Health Coverage Benefits
- The Sydney app shows you essential information briefly. Whether that is an overview of your plan, health reminders, or suggestions for wellness programs. You also can find your deductible, copay, and share of costs.
- View And Use Your Anthem Digital ID Card
- You will always have your most current Anthem ID card handy. And you can use it just like a paper one when you visit the doctor or dentist, pay for care, and more.
- Stay Connected to Healthy Living
- Anthem’s Sydney app makes it easier to put your wellness first. Sync your devices to your fitness tracker, monitor your nutrition, and set custom reminders to help you reach your goals.
- Check Your Health Records
- The My Health Records feature on the Sydney app gives you mobile access to your health data, including health history and electronic medical records, all in one place. Availability is based on your plan.
Prescription
TIER 1 (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.
TIER 2 | Low copay: This category includes non-preferred and low-cost generic drugs.
TIER 3 | 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 have a higher copay.
TIER 4 | Highest copay: In this category are nonpreferred brand name drugs for which there is either a generic alternative or a more cost-effective preferred brand including most specialty medications. These drugs have the highest copay. Make sure to check for mail-order discounts that may be available.
Rx Summary - 0-5 Years
Rx Summary - 5-10 Years
Rx Summary - 10+ Years
Prescription Advocacy through ImpaxRx
ImpaxRX is a prescription advocacy program that assists employees and their family members with the high cost of certain eligible medications. If the medications you or a family member are taking is identified as eligible under the Medication Under Management (MUM) program, an ImpaxRX advocate will reach out to you to confirm your enrollment in the program and obtain additional information needed to secure the medication at no cost.
Timely participation with ImpaxRX is required to receive these programs for your high-cost medications. Please respond if ImpaxRX contacts you! This will allow them to work on your behalf to obtain you medication at no cost.
There is no cost to you to participate in this program, and there will be no copayments for eligible medications approved by the program. Additionally, by using the program, the cost of these medications is lowered under the Lake County Health Plan which allows for savings to keep employee premium contributions to a minimum for all.
Please call ImpaxRX at 844-467-2979, option 1 with questions.
Dental
Delta Dental is your new dental provider!
Your dental network is the Delta PPO/Premier.
**Please refer to attached Benefit Summary for more complete plan details**
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Dental Insurance
Dental Insurance
Dental Benefits
Vision
VSP will remain as your Vision benefit provider.
Your vision network is VSP Signature.
You may go to any eye care provider. However, those who are in network will be more cost effective.
**Please refer to attached Benefit Summary for more complete plan details**
Vision Benefit Summary
Flexible Spending Account (FSA)
A Flexible Spending Account (FSA) allows you to pay for your families out of pocket medical and dependent care expenses with pretax income. You can elect to deposit a part of your before-tax income to a personal reimbursement account that you use to pay for qualified expenses incurred during the plan year. Amounts you put into your FSA plan are deducted before federal, state and social security taxes are withheld. Visit www.irs.gov/213d for a listing of services that qualify for FSA.
Your FSA provider: EBC
Maximum FSA Contribution: $3,400.00 with a $680.00 maximum carryover amount
Medical FSA (Health Care FSA)
What it’s for:
Used to pay for medical, dental, and vision expenses for you, your spouse, and your dependents.
Examples of what you can use it for:
- Doctor’s visits and copays
- Prescription medications
- Glasses or contact lenses
- Dental work (like fillings or braces)
- Over-the-counter medicines
If you are enrolled in a Health Savings Account (HSA) you are not eligible to enroll and contribute to a Flexible Spending Account (FSA).
Dependent Care FSA
What it’s for:
Used to pay for childcare or elder care expenses that allow you (and your spouse, if applicable) to work.
Examples of what you can use it for:
- Daycare, preschool, or after-school programs
- Summer day camps
- Care for a disabled spouse or adult dependent while you work
Note for Employees Switching from a FSA to a HSA: The Limited Purpose FSA Option
If you’re moving from a traditional Medical FSA to a Health Savings Account (HSA), there’s an important rule you should know: You can’t have both a regular Medical FSA and a HSA at the same time. The IRS doesn’t allow it because both accounts are designed to cover the same types of medical expenses with tax advantages.
However, there’s a special version of the FSA that works with an HSA - it’s called a Limited Purpose FSA.
- A Limited Purpose FSA is a special type of Flexible Spending Account that’s limited to dental and vision expenses so you can stay eligible to contribute to your HSA.
You can use a Limited Purpose FSA to pay for:
- Dental expenses (cleanings, fillings, orthodontia)
- Vision expenses (eye exams, glasses, contacts, LASIK)
The limit for Dependent Care Flexible Spending Accounts is $7,500.00 or $3,750.00 if married and filing taxes separately.
Carrier Contact Information
Medical Plan - Anthem
Medical Plan Customer Service: 1-800-331-1476
Website: www.anthem.com
Dental - Delta Dental
Customer Service:
Website: www.deltadental.com
Vision - VSP
Customer Service: 1-800-877-7195
Website: www.vsp.com
ImpaxRX
Customer Service: 844-467-2979, option 1
Website: www.impaxRX.com
The Way International Contact Information
Basil Makharita
basilmakharita@theway.org
(419) 753-1195
Heather Neault
heatherneault@theway.org
419-753-2523