Benefits At-A-Glance

 

Benefits Offered	Eligible / Who Pays		Page #
MEDICAL INSURANCE, UnitedHealthcare		866-633-2446
High-Deductible (HDHP) Plan	Full-time employees (FT) / VOASELA & Employee paid SCA employees / Employee paid		2 –3
Traditional Copay Plan
Ochsner Copay Plan
PAYTIENT: This benefit gives you access to payroll deducted payment plan(s) for eligible expenses. 573-206-9147	Employees enrolled in a VOASELA medical plan / VOASELA pays administration cost & Employee pays the loan amount selected		4
PRE-TAX SAVINGS PLANS, Alt Bentley Yates		877-731-3532
Healthcare FSA	FT employees not enrolled in a HDHP medical plan / Employee paid		4
Dependent Care FSA	FT employees / Employee paid		4
Health Savings Account	FT employees enrolled in HDHP medical plan / Employee paid		4
DENTAL INSURANCE, Mutual of Omaha		800-927-9197
Dental Plan	FT employees / VOASELA & Employee paid SCA employees / Employee paid		5
VISION INSURANCE, Mutual of Omaha		833-279-4358
Vision Plan	FT employees / Employee paid SCA employees / Employee paid		5
ACCIDENTAL INJURY INSURANCE, Mutual of Omaha		800-775-8805
Accidental Injury Plan	FT employees / Employee paid		6
LIFE INSURANCE, Mutual of Omaha		800-877-5176
Basic Life and AD&D	FT and Part-time (PT) employees / VOASELA paid		6
Voluntary Life and AD&D	FT and PT employees / Employee paid		6
DISABILITY INSURANCE, Mutual of Omaha		800-877-5176
Short-term Disability Plan	FT employees / Employee paid		7
Long-term Disability Plan	FT employees / VOASELA paid		7
EMPLOYEE ASSISTANCE PLAN, Mutual of Omaha		800-316-2796
EAP Plan	All employees—FT, PT and SCA / VOASELA paid		7

 

When Coverage Is Effective

AD&D after 30 days of service. Coverage is effective 1st of the month following 30 days of service.

• PT employees are eligible to enroll in Voluntary Life and AD&D after 30 days of service. Coverage is effective 1st of the month follow- ing 30 days of service.
• Benefits paid 100% by VOASELA—Basic Life and AD&D and Long-term Disability—have a one year waiting period. Coverage is effec- tive 1st of the month following one year of active service.

 

1

 

Medical, UnitedHealthcare (UHC)

Following is a high-level overview of the coverage options available. For complete coverage details, please refer to the UHC Plan Summary.

 

	High-Deductible Plan (DBNJ)	Traditional Copay Plan (DBMP)	Ochsner Copay Plan (DBS7)
Cost—see rate card	Lowest cost plan	Highest cost plan	Middle cost plan
Network (1)	In-network providers are part of the UHC National Choice Plus network.	In-network providers are part of the UHC National Choice Plus network.	This is a tiered network plan. Some services cost less if you go to a Designated Network provider in the Ochsner Network. Regular Network providers are in the UHC National Choice Plus network.
Deductible (per calendar year)
Individual / Family	$4,000 / $8,000	$3,000 / $6,000	$4,000 / $8,000
Out-of-Pocket Maximum (per calendar year)
Individual / Family	$6,250 / $12,500	$6,000 / $12,000	$7,000 / $14,000
Covered Services
Routine Preventive Care	$0	$0	$0
Virtual Visits through UHC designated virtual provider	$49	$0	$0
Primary Care Office Visit	80% covered after deductible met	$30     ($0 under 19)	Designated Network: $20    ($0 under 19) Regular Network: $40
Specialist Office Visit		$60	Designated Network: $50 Regular Network: $75
Urgent Care Facility		$50	$75
Emergency Room		70% covered after deductible met	80% covered after deductible met
Inpatient Services			Designated Network: 80% covered after deductible met Regular Network: $500 copay and deductible then 60% covered
Outpatient Services			Designated Network: 80% covered after deductible met Regular Network: $250 copay and deductible then 60% covered
Advanced Imaging (MRI, CAT scan)		Designated Diagnostic: 70% covered after deductible met Regular Diagnostic: 60% covered after deductible met	80% covered after deductible met
Outpatient Lab Testing	Designated Diagnostic: 80% covered after deductible Regular Diagnostic: 60% cov- ered after deductible	Designated Diagnostic: $15 Regular Diagnostic: 50% covered after deductible met	$15
Outpatient X-Ray and other		$75	$75
Prescription Drugs (Tiers)
Tier 1 / Tier 2 / Tier 3	Once deductible is met, copays apply: $10/35/70	$250 drug deductible before copays apply: $10 / $35 / $70	$10 / $35 / $70

1.     Out-of-network (OON): Separate OON deductibles and out-of-pocket maximums apply when you go out-of-network. There are no copays for OON ser-

vices. The coinsurance for OON services is 50% after the OON deductible is met. Emergency room services for OON providers will be charged as an in-                                                                                                                                                                                                                        2

network event, providing emergency services are required. For pharmacy OON, balance billing may apply in addition to in-network charges. See the plan’s

 

Medical, UnitedHealthcare (UHC)                                                                     

Connect to UHC

• Go to myuhc.com
• Choose Register under New Member?
• Enter your name, date of birth and social security number or member ID to setup your UHC account.

Get On-the-go Access

Once you setup your online account, go to the app store to download the UnitedHealthcare app. Use the app to find nearby care, video chat with a doctor 24/7, access your health plan ID card and more.

 
 

Search the Network

 

 

• Under “What plan are you looking for?” choose
  • Choice Plus for the High-Deductible Plan and Traditional Copay Plan

 

 

Care Cash—included with the Traditional Copay Plan and

the Ochsner Copay Plan

 

• Select Plus for the Ochsner Copay Plan

 

For lab testing and advanced imaging procedures, you can save money by using a Designated Diagnostic Provider. Look for these signs when you search diagnostic providers in the search instructions above.

 

Search Pharmacy

 

• Click Find a Network Pharmacy to search pharmacy locations. OR

• Click Advantage 3-Tier PDL under Find Your Medications to search the tier for your medication

Vital Medication Program: Medications that are part of this program for chronic conditions are available to members at a $0 cost share. See the Vital Medication Program flyer for details.

 

UHC Rewards: earn up to $300 for completing healthy actions With UHC Rewards, a variety of actions—including many things you may already be doing—lead to rewards.

Reach daily goals

• Track 5,000 steps or 15 active minutes a day
• Track 14 nights of sleep

Complete one-time reward activities

• Go paperless
• Get a biometric screening
• Take a health survey
• Connect a tracker

Get Started

• On myuhc.com, sign in or register
• Select UHC Rewards
• Activate and choose activities to start earning
• On the UHC app, sign in or register
• Select the Menu tab and choose UHC Rewards

 

This benefit provides you a preloaded debit card at no cost to you.

 

$200 for employee only coverage

 

$500 for employee + spouse, employee + child(ren) and family coverage.

 

Where can you use Care Cash?

 

 

How to order your card?

• Go to myuhc.com > Coverage and Benefits (must register your ac- count first).
• Scroll to Care Cash section and select Request Card button.

 

button.

 

• Follow prompts to verify your address and contact information and select Request Care Cash Card button.
• Make sure you receive a confirmation message.

 

 

Questions about Care Cash: call 1-888-201-4286

 

Employee Assistance Plan through UHC

3 free counseling sessions per incident per year conducted via

face-to-face or video

    Call 888-877-4114 to get started

 

Paytient

This benefit is available to anyone enrolled in one of the Company’s medical plans.

Turn every out-of-pocket medical, dental, vision, pharmacy or veterinary expense into an affordable pay- roll-deducted payment plan. You will have access to an interest-free line of credit up to $2,000. No credit checks are required to participate in this program. Use your Paytient card on eligible expenses for yourself or any of your dependents.

 

How Paytient Works Create your account Visit paytient.com to get started. Swipe Use your Paytient card to pay for eligible ex- penses. Click Click the notification that appears on your smartphone after your charge. Split Choose the payment plan that fits your budget and will be spread over your designated pay periods.

Where you can use Paytient:

At the doctor: Use your Paytient card to pay for medical services at doctors offices, urgent care locations or hospital facilities

At the pharmacy: Use your Paytient card to pay for any type of pre-

scription.

At the dentist: Use your Paytent card to pay for dental services with regular or specialty dentists—root canals, fillings...got you covered

At the eye doctor: Need new glasses or contacts? Ready to get LASIK? Paytient can help.

At the vet: Need help with your furry friends? Paytient has them cov- ered too. Use your Paytient card for everything from flea and tick med- ications to routine wellness exams.

Pre-Tax Savings Plans, Alt Bentley Yates

  

 

	Health Savings Account (HSA)	Healthcare Flexible Spending Account	Dependent Care Flexible Spending Account
Medical Plan Participation Requirements	You must be enolled in the High-Deductible Plan to contribute to the HSA. New participants must complete application for account setup.	You cannot be enrolled in a High-Deductible Plan to contribute to the Healthcare FSA.	none
2024 Benefit Year Annual IRS Limits	Individual coverage: up to $4,150 Family coverage: up to $8,300 Members 55+ can contribute an additional $1,000.	up to $3,050	$5,000 or $2,500 if married and filing separate taxes
Rollover for Unused Funds into the next benefit year	You can rollover any unused funds in your HSA.	You can rollover up to $610 of unused funds in your FSA..	no rollover allowed

4

 

 Dental, Mutual of Omaha

 

Network or Out-of-Network (1)
Deductible (per calendar year)
Individual / Family	$50 / $150
Benefit Maximum (per calendar year plan pays up to the benefit maximum)
Per Individual	$1,000
Covered Services, limitations and exclusions may apply see carrier summary for full details
Preventive Services	no charge
Basic Services (2) fillings, sealants	100% covered after deductible
Major Services (2) crowns, bridges, endodontics, periodon tics, dentures	60% covered after deductible
Orthodontia covers children up to age 19	50% covered up to a lifetime maximum of $1,250

Request a PRE-TREATMENT ESTIMATE for basic and major ser- vices before they are performed to estimate your out-of-pocket expenses. A pre-treatment estimate can show you any hidden costs not covered by your plan, so you can discuss other options with your dentist.

1. If you use an out-of-network provider, you will be responsible for any charges above the maximum allowed amount for in-network providers.

2. Pre-Treatment Estimate is recommended before services are done.

 

 

 

Vision, Mutual of Omaha

 

	Network
Exam with dilation as necessary, once every 12 months	$10
Lenses Copay once every 12 months	$20 for single vision / bifocal / trifocal / lenticular lenses
Lens Options	copays vary from $15–$200 for coatings and specialty lenses
Frames once every 24 months	up to $130 allowance; 20% off balance over $130
Contact Lenses, once every 12 months; in lieu of glasses	Exam and fitting: 10% off retail   Conventional lenses: up to $130 allowance; 15% off balance over $130 Disposable lenses: up to $130 allowance

5

This plan gives you the freedom to seek care from the provider of your choice. However, you will maximize your benefits and lower your out-of- pocket costs if you choose a provider

who participates in the network. The following is a high-level overview of the coverage available.

 

 

For details on additional discounts, limitations and exclusions see the full plan summary.

 

 

Out-of-network reimbursement s may apply for some services and products.

 

Accidental Injury, Mutual of Omaha

 

Accidental injury coverage provides a benefit when an enrolled person suffers a covered injury or undergoes a broad range of medical treatments or care resulting from a covered accident occurring off the job. The benefit will reimburse you based on the benefit plan’s covered schedule. Following is a summary of commonly covered benefits. See the carrier’s full plan summary for a full covered sched-

 

 

 

Covered Benefit Benefit Amount Ground ambulance / air ambulance $350 / $1,500 Emergency room visit / urgent care visit $300 / $225 Physician office visit $100 Hospitalization admission / daily confinement $1,500 / $300 per day Lacerations, depending on wound size $125—$250 Fractures, based on location and treatment $400—$9,000 X-ray / diagnostic exam $75 / $300   Accidental death $50,000 for employee only $25,000 for spouse $10,000 for child

HOW TO FILE A CLAIM

To start an accident claim or file an Express Benefit, call

800-775-8805

  

Life and AD&D, Mutual of Omaha

 

 

Life insurance provides your named beneficiary(ies) with a benefit after your death. Remember to keep your beneficiary information up-to-date.

Accidental death and dismemberment (AD&D) insurance

provides specified benefits to you in the event of a covered accidental bodily injury that directly causes dismemberment (i.e., the loss of a hand, foot or eye). In the event that your

death occurs due to a covered accident, both the life and the AD&D benefit would be payable.

Basic Life/AD&D is provided to you at NO COST after 12

months of active service.

 

Benefit Amount
Full-time Employees	1.5 X your annual earnings to a max of $200,000 Benefits reduce by 65% at age 65 and 50% at age 70 rounded to the next higher $1,000
Part-time Employees	$10,000 Benefits reduce by 65% at age 65 and 50% at age 70 rounded to the next higher $1,000

 

6

 

Voluntary Life/AD&D (Employee-paid)

If you determine you need more than the VOASELA paid basic coverage amount, you may purchase additional coverage for yourself and your

eligible family members. Rates for employee and spousal coverage are based on the employee’s age as of the start of the benefit year.

Benefits reduce by 65% at age 65 and 50% at age 70 rounded to the next higher $1,000.

 

Benefit Option		Guaranteed Issue (GI)
Employee	$10,000 increments minimum of $10,000 up to $500,000 (not to exceed 5 times annual earnings)	$170,000
Spouse	$5,000 increments minimum of $5,000 up to $100,000 (not to exceed 100% of employee’s coverage)	$50,000
Child(ren)	$10,000 per covered child	$10,000

Any amounts exceeding the GI will require you and/or your spouse (if applicable) to go through medical underwriting by completing the online Evidence of Insurability (EOI) form. See Human Resources for the link to the online EOI form. Coverage amounts requiring medical underwriting will not be effective until approved by the insurance carrier.

 

Currently enrolled employees: You may increase the employee voluntary life coverage amount by $10,000 without going through medical underwriting as long as the coverage amount does not exceed the GI. Any increase in spouse coverage amount will trigger medical underwriting.

 

New hires electing coverage for the first time: You do not have to go through medical underwriting if elected coverage amounts are below the GI.

 

Disability, Mutual of Omaha

 

Disability insurance provides benefits that replace part of your lost income when you become unable to work due to a covered injury or illness. Short term disability rates are based on employee’s age as of the start of the

benefit year. Benefit amount is based on employee’s annual earnings at the start of the benefit year.

 

 

Mutual Employee Assistance Program

 Life is full of challenges, and sometimes balancing them all can be

difficult. We are proud to provide a confidential program dedicated to supporting the emotional health and well-being of our employees and their families.

The EAP is provided at NO COST to you through Mutual of Omaha.

 

mutualofomaha.com/eap or 800-316-2796

Short-Term Disability, Employee paid Benefit 60% of weekly earnings Weekly Benefit Maximum up to $1,000 When Benefits Begin after 14th day of disability Maximum Benefit Duration up to 11 weeks   Pre Existing Condition Limitation If you have a disability event within the first 12 months of your coverage start date, the carrier will request documentation to verify a pre-existing condition did not exist within 3 months prior to the start of the benefit. Long-Term Disability, VOASELA paid Benefit Percentage 60% of monthly salary Monthly Benefit Maximum up to $5,000 When Benefits Begin after 90th day of disability Maximum Benefit Duration up to 5 years Medical Underwriting none required     Pre-existing Condition Limitation If you have a disability event within the first 12 months of your coverage start date, the carrier will request documentation to verify a pre-existing condition did not exist within 3 months prior to the start of the benefit.

The EAP can help with the following issues, among others:

 

Mental health Relationships or marital conflicts Child and eldercare

Substance abuse Grief and loss Legal or financial issues

 

EAP Benefits

• Assistance for you and your household members, 24/7/365 services available
• Up to 3 free counselling sessions per year (per household) conducted face-to-face or video
• National network of more than 10,000 licensed clinical providers

  

Valuable Extras

Mutual of Omaha also offers help with the following:

 

 

Identity theft Travel assistance	Hearing discounts Will prep
See informational product flyers for details about each benefit.

 

DISCLAIMER: The material in this benefits brochure is for informational purposes only and is neither an offer of coverage or medical or legal advice. It contains only a partial description of plan or program benefits and does not constitute a contract. Please refer to the Summary Plan Description (SPD) for complete plan details. In case of a conflict between your plan documents and this information, the carrier plan documents will always

govern.                                                                                                                                                                                                                         7