Fixed Indemnity Benefits for Field Associates

Transcription

1 Fixed Indemnity Benefits for Field Associates Highlights: Benefit Options FAQ s Missed Premium Additional Programs Important Notices WELCOME TO THE EMPLOYBRIDGE FIELD ASSOCIATES INDEMNITY BENEFITS PLAN. As a Field Associate, you are eligible to enroll in the EmployBridge Insurance Plan underwritten by Nationwide Life Insurance Company. The fixed indemnity program pays a set dollar amount for non-preventive medical services you may need such as doctor s office or emergency room visits if you get sick and do pay in addition to other coverage you may have. THESE BENEFITS DO NOT MEET THE AFFORDABLE CARE ACT (ACA) REQUIREMENTS. There are two ways to enroll: 1) ONLINE at or 2) CALL the Enrollment Center at (877) As a new Field Associate, you have 90 days from your date of hire in which to elect benefits. All benefits are Voluntary and paid for 100% by the Field Associate. THIS PRODUCT IS (A) NOT A SUBSTITUTE FOR MINIMUM ESSENTIAL HEALTH COVERAGE UNDER THE AFFORDABLE CARE ACT (ACA); (B) DOES NOT QUALIFY AS MINIMUM ESSENTIAL COVERAGE UNDER THE ACA; AND (C) DOES NOT QUALIFY TO AVOID THE INDIVIDUAL MANDATED TAX PENALTY.

2 Coverage Options FIXED INDEMNITY BENEFITS (underwritten by Nationwide Life Insurance Company) PLAN 1 PLAN 2 Hospital Admission Plan Pays $1,000 per confinement Plan Pays $1,000 per confinement Daily In-Hospital Indemnity (500 day lifetime max) - Intensive Care - Mental Illness - Substance Abuse - In-patient Skilled Nursing Facility Surgical Indemnity Benefit - Daily Inpatient Surgical - Inpatient Benefit Maximum - Daily Outpatient Surgical - Daily Outpatient Minor - Outpatient Benefit Maximum Plan Pays $100 per day Plan Pays $200 per day Plan Pays $50 per day Plan Pays $50 per day Plan Pays $50 per day Plan Pays $1,000 per day 1 day per person per year Plan Pays $500 per day Play Pays $100 per day 1 day per person per year Plan Pays $500 per day Plan Pays $1,000 per day Plan Pays $250 per day Plan Pays $250 per day Plan Pays $250 per day Plan Pays $2,000 per day 1 day per person per year Plan Pays $1,000 per day Play Pays $200 per day 1 day per person per year Anesthesia Plan Pays 30% of Surgical Benefit Plan Pays 30% of Surgical Benefit Doctor s Office Benefit Outpatient Diagnostic X-Ray Outpatient Diagnostic Laboratory Plan Pays $60 per day, 6 days per person per year Plan Pays $100 per testing day, Plan Pays $50 per testing day, Plan Pays $75 per day, 6 days per person per year Plan Pays $100 per testing day, Plan Pays $50 per testing day, Preventive Care Plan Pays $50 per day, Plan Pays $50 per day, Accident Expense Benefit Plan Pays $300 max per accident Plan Pays $300 max per accident *First Health Network Doctors and Hospitals Doctors and Hospitals *Discount Prescription Drug Program Included Included *Discount Health Savings Program: Teladoc, Medical Bill Saver, Counseling, Nurseline, Chiropractic/ Vision/Hearing discounts Included Included Voluntary Rates Weekly Weekly Field Associate Only $15.67 $24.59 Field Associate + Spouse $26.31 $43.22 Field Associate + Child(ren) $26.47 $42.40 Field Associate + Family $37.19 $61.18 *These benefits are not underwritten by Nationwide Life Insurance Company. The Discount Prescription Drug Program and Discount Health Savings Program are administered by New Benefits, Ltd. Nationwide Insurance and the Nationwide framemark are service marks of Nationwide Mutual Insurance Company.

3 DENTAL Deductible Optional Benefits Benefit Maximum Co-Insurance (underwritten by Ameritas) Type 1 - Preventive and Diagnostic (routine exam and cleanings, fluoride treatments, x-rays) Type 2 - Basic Treatment (extractions, fillings, endodontics, periodontics) Type 3 - Major Treatment (crowns and dentures) Orthodontia Voluntary Rates $20 per visit $1,000 per calendar year 100% of Usual & Customary Rate (no waiting period) 60% (3 month waiting period) 50% (12 month waiting period) Not covered Weekly Field Associate Only $5.76 Field Associate + Spouse $14.36 Field Associate + Child(ren) $9.92 Field Associate + Family $15.06 VISION Deductibles (underwritten by Ameritas) VSP Choice Network $10 Exam, $25 Eye Glass Lenses or Frames Out of Network Annual Eye Exam (1 in 12 months) Up to $45 Lenses (per pair) (1 in 12 months) - Single Vision - Bifocal - Trifocal - Lenticular Contacts (1 in 12 months) - Fit & Follow Up Exams - Elective - Medically Necessary 15% discount Up to $120 $10 Exam, $25 Eye Glass Lenses or Frames Up to $30 Up to $50 Up to $65 Up to $100 No benefit Up to $105 Up to $210 Frames (1 in 24 months) $120 Up to $70 Voluntary Rates Weekly Field Associate Only $2.07 Field Associate + Spouse $4.10 Field Associate + Child(ren) $3.82 Field Associate + Family $5.84 LIFE/ACCIDENTAL DEATH & DISMEMBERMENT INSURANCE PLAN Life/AD&D Insurance Dependent Life Insurance Voluntary Rates $20,000 (employee only, age reductions apply) $10,000 spouse $5,000 child (6 months to 26 years) $800 child (10 days to 6 months) Weekly Field Associate Only $2.05 Field Associate + Spouse $3.07 Field Associate + Child(ren) $3.07 Field Associate + Family $4.35 SHORT TERM DISABILITY (underwritten by Nationwide Life Insurance Company) This benefit is payable for non-occupational injuries and sickness only Benefit Amount Waiting Period Maximum Benefit Period Voluntary Rates $150 lump sum 14 days 26 weeks Weekly Field Associate Only $3.70 (underwritten by Nationwide Life Insurance Company)

4 Frequently Asked Questions WHEN CAN I ENROLL/CANCEL COVERAGE? As a Field Associate, you have 90 days from your date of hire in which to elect benefits. Outside of this new hire period, you will be able to elect benefits or make plan changes during the annual Open Enrollment period. You may cancel your coverage at any time. WHO IS ELIGIBLE TO ENROLL? Field Associates and their eligible dependents may enroll. An eligible dependent is a Field Associate s spouse and child(ren) from birth to age 26. Residents of New Hampshire are not eligible for the plan. HOW DOES THIS PLAN WORK? Benefits will run on a weekly cycle. Your benefits are active in any week where your pay check that week was deducted for the benefit. If you do not have a deduction you will need to make a Missed Premium payment. If you do not have a deduction and do not make a Missed Premium payment, you will not be covered for that period. IS THIS A QUALIFIED PLAN UNDER THE AFFORDABLE CARE ACT (ACA)? No, This product is (a) not a substitute for minimum essential health coverage under the ACA; (b) does not qualify as minimum essential coverage under the ACA; and (c) does not qualify to avoid the individual mandated tax penalty. WILL MY COVERAGE BE CANCELLED IF I DON T HAVE A DEDUCTION? If you do not have a payroll deduction and do not make a Missed Premium payment, your coverage will be terminated as of your last paid benefit period after the 4th consecutive missed deduction. HOW WILL MY SHARE OF THE COST OF COVERAGE BE PAID AND WHEN WILL IT BE EFFECTIVE? Your share of the cost of Company-sponsored health insurance coverage will be taken out of each paycheck. You will pay 100% of the insurance premiums. The effective date of coverage will depend on when a premium deduction was made from your paycheck. WILL I RECEIVE AN ID CARD? Yes, you will receive a packet including ID cards and information about each coverage you elect. Depending on which benefits are elected, you may receive up to two ID cards: - Red: Fixed Indemnity, Life/AD&D and Short-Term Disability - Blue: Discount Program These will be mailed to your home address. Please note, there is no ID card for the Dental and Vision benefits. If these benefits are elected, you will tell your provider that you have coverage through Ameritas and provide your Social Security number. WHICH INSURANCE COMPANY PAYS MY MEDICAL INSURANCE CLAIMS? Nationwide Life Insurance Company pays the Fixed Indemnity benefits, Life/AD&D and Short-Term Disability claims. Ameritas pays the Dental and Vision claims. HOW DO I SUBMIT A MEDICAL CLAIM? There are two ways to file a claim for benefits under this plan: Option 1 - Present your ID card to the provider at the time of service. If the provider will file the claim with the insurance company on your behalf, then you do not have to pay for the services in advance. The insurance carrier will pay that benefit to the provider. You would be responsible for paying the provider any billed amount that the insurance company does not pay them. Option 2 - Pay the full billed amount to the provider and submit a claim for reimbursement to the insurance carrier. When filing a claim for reimbursement, you need to provide the certificate or member number from your insurance booklet and original bill for service which includes the patient name, date of service, diagnosis code and itemized charges, along with a reimbursement form. Benefit will be payable to you. CAN I USE ANY DOCTOR OF HOSPITAL? Yes, you can go to any doctor for the fixed indemnity benefits as there are no network restrictions. However, you can maximize your savings by going to a provider in the First Health Network. Benefits are payable to any hospital that is accredited by JCAHO (Joint Commission on Accreditation of Healthcare Organizations) and meets the definition of a hospital. Most hospitals have received their accreditation. WHAT HAPPENS IF I ELECT NOT TO RECEIVE COVERAGE UNDER THE COMPANY S HEALTH INSURANCE PLAN OR WISH TO CANCEL MY ELECTION? If you are eligible to receive coverage under the Company s health insurance plan and elect not to receive coverage, you will not be allowed to enroll in the health insurance plan until either the next open enrollment date or at such time you notify the insurance carrier that you have experienced a qualifying event such as the loss of other coverage or the birth or adoption of a child. If there is a qualifying event, then you can change or elect coverage by notifying Member Services at (800) within 31 days of the event. You may cancel your coverage at any time. A failure to pay insurance premiums will also result in a cancellation of insurance coverage. WHOM CAN I CONTACT IF I HAVE QUESTIONS ABOUT MY BENEFITS? Contact Member Services, toll-free at (800) They are available Monday - Friday from 7 AM to 7 PM Central Time.

5 Missed Premium DOES YOUR INCOME VARY FROM PAYCHECK TO PAYCHECK? SOME PAYROLL PERIODS MAY NOT HAVE ENOUGH FUNDS TO COVER THE COST OF YOUR BENEFITS. You have 30 days to pay for the premiums that could not be deducted from your paycheck. If you do not pay the missed premiums within 30 days you will be unable to pay for them at a later date. If you have missed premium deductions and want to find out the balance due or have questions about making a payment, contact Member Services at (800) or go online to You can authorize us to charge a credit/debit card or draft your bank account anytime you have had a missed deduction from your paycheck. This authorization can be setup online at at any time or when you are enrolling. HOW DO I PAY MISSED PREMIUMS? To pay by credit/debit card or electronic check: Go to If this is your first time visiting the site, use the New User? box and sign in using your Social Security Number and date of birth. From there you will be prompted to verify your contact information (one time process) and setup a username and password. If you have already created a user account select the Returning User? box and enter your username and password. The Security Question tool can assist in instances where you cannot remember your username or password. Once logged in, click Billing and follow the instructions. To pay missed premiums by check or money order: Attach the payment to a missed premium form and write the group number, FV1244, on your payment. Make sure the check or money order is written for the total amount due and is made payable to Nationwide Life Insurance Company. Mail your payment along with the missed premium form to: Nationwide Life Insurance Company Anderson Mill Road, Suite 401 Austin, TX 78726

6 Additional Programs FIRST HEALTH NETWORK The First Health Network provides access to one of the nation s largest and most respected networks. By going to a First Health provider you can reduce your out of pocket expenses and stretch your benefit dollars. Access to more than 490,000 provider locations across all 50 states and the District of Columbia First Health logo on medical ID card for fast and easy recognition by the provider Re-priced claims will be assigned directly to the provider to simplify the claims process To find a provider online, visit Members retain the ability to choose any doctor they wish and have those claims assigned under the fixed indemnity plans. All fixed indemnity benefits will pay as specified in the benefit provisions of the policy regardless of the provider chosen. DISCOUNT HEALTH SAVINGS PROGRAM Your membership provides significant savings on the following services: Vision Hearing Chiropractic Vitamins & Diabetic Supplies In addition, members also receive access to the following: Teladoc Health Advocate Services (Medical Bill Saver TM, Medical Health Advisor, Nurseline TM ) Telephonic Counseling Services TELADOC Teladoc provides 24/7 access to a national network of U.S. board-certified doctors who can resolve many of your medical issues via telephone. Teladoc doctors can diagnose, treat and prescribe medication, when necessary, for medical issues including cold and flu symptoms, allergies, bronchitis, sinus problems, urinary tract infection, respiratory infection, pink eye, ear infection and more! HEALTH ADVOCATE SERVICES Medical Bill Saver - The Health Advocate Medical Bill Saver benefit can lower out-of-pocket costs on medical bills not covered by insurance. Advocates will work with healthcare providers and attempt to lower the balance on any uncovered medical or dental bill over $400. Medical Health Advisor - The services are organized around Personal Health Advocates, typically registered nurses, supported by a team of medical directors and administrative experts, who assist individuals in getting the most value from their healthcare benefits. One call to Medical Health Advisor and we ll help members resolve insurance claims and billing issues. Health Advocate does not replace health insurance, provide medical care or recommend treatment. DISCOUNT PRESCRIPTION PROGRAM The neighborhood pharmacy program assures members the lowest price on prescription drugs, saving 10% to 85% on most prescriptions. It s simple to use. The member simply presents the membership card to the pharmacist with the prescription. The pharmacist calculates the discount and the member pays the discounted price. No other forms required. Pharmacy locations may be obtained by contacting customer service at Pharmacy Discounts are Not Insurance and are Not Intended as a Substitute for Insurance. The discount is only available at participating pharmacies.

7 Important Notices The Nationwide program is not intended or recommended to replace any comprehensive program of insurance in which you currently participate, or intend to participate. This plan is not designed to replace or provide major medical or catastrophic coverage. This brochure is for summary purposes only. The insurance benefits for the medical indemnity plan are offered by Nationwide Life Insurance Company. Additional information will be provided upon enrollment in the Program. Plan exclusions and limitations apply. The fixed indemnity product is (a) not a substitute for minimum essential health coverage under the Affordable Care Act (ACA); and (b) does not qualify as minimum essential coverage under the ACA. DISCLOSURES The Discount Health Savings Program is plan is NOT insurance. The plan is not insurance coverage and does not meet the minimum creditable coverage requirements under the Affordable Care Act or Massachusetts M.G.L. c. 111M and 956 CMR This plan provides discounts at certain healthcare providers for medical services. This plan does not make payments directly to the providers of medical services. The plan member is obligated to pay for all healthcare services but will receive a discount from those healthcare providers who have contracted with the discount plan organization. This discount card program contains a 30 day cancellation period. The range of discounts for medical or ancillary services provided under the plan will vary depending on the type of provider and medical or ancillary service received. Member shall receive a full refund of membership fees, excluding registration fee, if membership is cancelled within the first 30 days after the effective date. AR and TN residents: A refund of all fees will be issued if membership is cancelled within the first 30 days. Discount Medical Plan Organization: New Benefits, Ltd., Attn: Compliance Department, PO Box Dallas, TX , Website to obtain participating providers: MyMemberPortal.com. The Discount Prescription Program is not considered Creditable Coverage under the Medicare Part D regulations. Medicare eligible individuals may have to pay higher costs if they delay enrolling in the Medicare Pharmacy plan. Teladoc is not available to Arkansas and Idaho residents Teladoc, Inc. All rights reserved. Teladoc and the Teladoc logo are registered trademarks of Teladoc, Inc. and may not be used without written permission. Teladoc does not replace the primary care physician. Teladoc does not guarantee that a prescription will be written. Teladoc operates subject to state regulation and may not be available in certain states. Teladoc does not prescribe DEA controlled substances, nontherapeutic drugs and certain other drugs which may be harmful because of their potential for abuse. Teladoc physicians reserve the right to deny care for potential misuse of services. Teladoc phone consultations are available 24 hours, 7 days a week while video consultations are available during the hours of 7am to 9pm, 7 days a week.

8 EmployBridge c/o Fringe Benefit Group Anderson Mill Road, Suite 401 Austin, TX Important Benefit Information Enclosed! NH0115 Enroll Today! Go to or call (877)