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Benefits Guide
Plan Year: 9/1/2015 to 8/31/2016
Medical Plans Employees may choose between 3 plans based on individual needs & budget.
Plan choices are made on an annual basis.
Types of Coverage
8WX You Pay
EDGE 8XI You Pay
EDGE 5ZY You Pay
Physicians Office Services Primary Physician Office Visit
Specialist Office Visit
DED & Coinsurance
DED & Coinsurance
$25 Copayment
$50 Copayment
$30 Copayment
$60 Copayment
Preven ve Care Rou ne Exams, Immuniza ons, Mammograms & Colonoscopy
You Pay $0: Covered in Full as Per Federal Health Care Reform
Guidelines
You Pay $0: Covered in Full as Per Federal Health Care Reform Guide‐
lines
You Pay $0: Covered in Full as Per Federal Health Care Reform Guide‐
lines
Emergency Medical Care Urgent Care Center Services
Emergency Services‐Outpa ent
Ambulance Services (Emergency & Non‐Emerg.)
DED & Coinsurance
DED & Coinsurance
DED & Coinsurance
$80 Copayment
$300 Copayment
DED & Coinsurance
$100 Copayment
$175 Copayment
DED & Coinsurance
Rx Up to a 31 Day Supply
Tier 1 Tier 1 Specialty
Tier 2 Tier 2 Specialty
Tier 3 Tier 3 Specialty
Tier 4 Tier 4 Specialty
Mail Order Rx
DED & Coinsurance DED & Coinsurance DED & Coinsurance DED & Coinsurance DED & Coinsurance DED & Coinsurance
N/A N/A
DED & Coinsurance (Specialty Excluded)
$20 Copayment $20 Copayment $65 Copayment $100 Copayment $100 Copayment $300 Copayment $200 Copayment $500 Copayment
3X 31 Day Supply
(Specialty Excluded)
$10 Copayment $10 Copayment $35 Copayment $100 Copayment $60 Copayment $200 Copayment
N/A N/A
2.5X 31 Day Supply (Specialty Excluded)
Addi onal Core Benefits Hospital Inpa ent Stay
Surgery‐Outpa ent
Physician Fees for Medical and Surgical Services
Lab, X Ray and Major Diagnos cs‐Outpa ent (MRI, CT, PET, MRA, Nuclear Medicine)
Lab, X‐Ray & Diagnos cs– Outpa ent
(Lab Tes ng, X‐Ray and Other)
Scopic Procedures– Outpa ent Diag. & Ther.
DED & Coinsurance
DED & Coinsurance
DED & Coinsurance
DED & Coinsurance
DED & Coinsurance
DED & Coinsurance
DED & Coinsurance + $1000 per
Occurrence DED
DED & Coinsurance + $500 per Occurrence DED
DED & Coinsurance
DED & Coinsurance
100% Covered, DED does not apply
DED & Coinsurance
DED & Coinsurance + $500 per
Occurrence DED
DED & Coinsurance + $250 per Occurrence DED
DED & Coinsurance
DED & Coinsurance
100% Covered, DED does not apply
DED & Coinsurance
Financial Annual Deduc ble
(“DED”)
Plan Coinsurance
Maximum Out‐of‐Pocket
Maximum Policy Benefit
Network Individual = $4,400 Family = $8,800
30% A er Deduc ble
Individual = $6,600 Family = $13,200
Includes Copays, Deduct. & Coins.,& RX
Unlimited—No Maximum
Network Individual = $4,000 Family = $8,000
100% A er Deduc ble
Individual = $6,600 Family = $13,200
Includes Copays, Deduct. Coins.,& RX
Unlimited—No Maximum
Network Individual = $1,000 Family = $2,000
20% A er Deduc ble
Individual = $5,000 Family = $12,000
Includes Copays, Deduct. & Coins.,& RX
Unlimited—No Maximum
Non‐Network Benefits
This Plan Provides Network Level Benefits Only. You must use Network Providers unless there
is a “true” emergency..
This Plan Provides Network Level Benefits Only. You must use Net‐work Providers unless there is a
“true” emergency..
This Plan Provides Network Level Benefits Only. You must use Net‐work Providers unless there is a
“true” emergency..
DISCLAIMER: This is not a guarantee of coverage or benefits. You must refer to Insurance Carrier literature for guarantees. Certain limita ons and exclusions may apply to ALL of these programs that are not outlined in this Summary.
DISCLAIMER: This is not a guarantee of coverage or benefits. You must refer to Insurance Carrier literature for guarantees. Certain limita ons and exclusions may apply to ALL of these programs that are not outlined in this Summary.
Dental Plan
DISCLAIMER: This is not a guarantee of coverage or benefits. You must refer to Insurance Carrier literature for guarantees. Certain limita ons and exclusions may apply to ALL of these programs that are not outlined in this Summary.
Dental Plan
DISCLAIMER: This is not a guarantee of coverage or benefits. You must refer to Insurance Carrier literature for guarantees. Certain limita ons and exclusions may apply to ALL of these programs that are not outlined in this Summary.
Vision Plan
Only available to Members enrolled in Medical Plan
Employee Assistance Plan ‐ Care 24
Only available to Members enrolled in Medical Plan
Employee Assistance Plan ‐ Care 24
ATTENTION ALL EMPLOYEES! PSYCHAMERICA/BIG BEAR COUNSELING
provides you with an opportunity by making AFLAC® available!
CONSIDER THE POSSIBILITIES …
What if you get sick or hurt? What if you can’t earn your income? How will you pay your bills during your recovery? What if it is your spouse or child?! Most of us have seen others go through this; some of us have experienced it ourselves…
Will you use some of your savings? Will you sell some of your assets?
Will you try to borrow money?
It doesn’t have to be that way!!! AFLAC® benefits protect your family and household against the negative financial impact of getting sick or hurt! AFLAC® pays you CA$H to help with your household expenses during such a time! No mat-ter how good your health insurance is, they will never send you extra $ to pay your bills!!! AFLAC® pays on top of and in spite of any other insurance you have!
Learn how to protect yourself, your family, and your livelihood…
AFLAC = FINANCIAL SAFETY NET
Aflac provides a financial safety net to assist you with these expenses. Aflac works with or without health insur‐ance and pays over and on top of other types of insurance! AFLAC® benefits protect your family and household against the nega ve financial impact of ge ng sick or hurt! AFLAC® pays you CA$H to help with your household
expenses.
All Aflac plans pay cash to you, not providers, so you can use the money for your priority! We pay most claims within 4 days! Now offering 1 day claim with direct deposit!!! Your rates will never change and you will never be cancelled! It is yours forever, even if you leave your current employer! Plans Available: Short‐Term Disability Aflac pays you 60% of your income should you be out of work due to illness or injury Cash benefit for each day you’re disabled Enrollment is guaranteed regardless of health history Accident Plan Pays benefits to those enrolled for unforeseen accidents on or off the job Benefits include amounts for various injuries as well as travel expenses, physical therapy, ambulance Includes Accidental life insurance and a $60 annual wellness benefits Hospitaliza on Plan Pays benefits to those enrolled for admissions to the hospital and outpa ent surgical benefits Benefits paid each day confined to hospital Benefits for major and invasive diagnos c exams Cancer Plan Cancer can be one of the most devasta ng illnesses financially. This plan provides financial benefits to the
insured. Upon diagnosis, ini al benefit is $4000 Addi onal cash benefits for nearly every part of the treatment regimen, including hospital confinement, radia‐
on, chemotherapy, experimental treatment, stem cell transplants, a ercare, travel expenses, etc. $75 annual wellness benefit Cri cal Care Plan Covers health incidents including Heart A ack, Stroke, Coronary, Artery Bypass Surgery, End‐Stage Renal Fail‐
ure, Major Human Organ Transplant, Major Third‐Degree Burns, Coma, Paralysis Ini al benefit is $5000 Addi onal benefits for hospital confinement and con nuing care with a bonus ICU policy built in
You have the personal service of your agent – Ali Smith (407)921‐0962
Broker/Agent‐Your Consumer Advocate
Steve March Stephen Holleran
Phone: (407) 480‐3456 Email: [email protected] [email protected]
Medical / Dental / Vision
For Customer Service—See your ID card Medical: See number on ID Card
Www.myuhc.com Dental
Www.myuhcdental.com Vision
Www.myuhcvision.com
©2015, Powered By IPRG
Online Benefit Management and Enrollment
Enroll, view and manage your plan online. All related documents and pricing is available on this site.
Access claim forms, detailed summaries, carrier websites, contact informa on using this portal. Look for registra on email to enroll
IPRG Helpdesk: 407‐480‐3456 or [email protected]
Helpful Contact Informa on
Bi‐Weekly Employee Cost (26 Pay Periods)
Dental FIN08
Dental F7332
Vision V1006 Enrollment Level 8WX Edge 8XI Edge 5ZY
Single = $ 85.26 $ 131.37 $ 171.95 $ 10.59 $ 16.64 $ 3.06
Single & Spouse = $ 255.79 $ 348.01 $ 429.17 $ 21.18 $ 33.29 $ 5.81
Single & Kid(s) = $ 230.21 $ 315.51 $ 390.58 $ 21.37 $ 33.60 $ 6.78
Family = $ 400.73 $ 532.15 $ 647.80 $ 32.94 $ 51.78 $ 9.56
Medical
Insurance Plan Cost and Contact Informa on
Eligibility & Enrollment Guidelines
Wai ng Period for Newly Eligible Employees Employees who qualify, will have to wait
90 days before your insurance becomes effec ve
Open Enrollment Open Enrollment is held every year during the month of August and
Changes are effec ve September 1st
