2022-2023 Benefit Presentation

Chief Entertainment Officer

Christin Scherb

Advantage Benefit Solutions

Omar Arif & Stephanie Mohr ClaimDOC

Allyson Cooper & Delana Wolf Next Level PRIME

Don Klein

Jeanne Toth

Khia Flores

Heather Flowers

Your HR Team

How Can HealthJoy Help You?

WHEN YOU ARE LEARNING ABOUT OUR BENEFITS

How Will You Use HealthJoy This Year?

How

Reference Based Pricing (RBP)

• Your health plan has partnered with ClaimDOC, a reference based pricing and member advocacy company, to deliver a successful RBP and open access program.

• ClaimDOC’s claim review and audit program determines the fair and reasonable costs for the medical services you receive.

• RBP defines a consistent reference point to price medical claims, with Medicare being the most common.

• RBP works to lower the high cost of healthcare for you and your health plan.

Open Access

More choice for you and your family

• You have the freedom to choose your healthcare providers, without restrictions or limitations from your plan.

•

• Your plan does not impose any “out-of-network” penalties or benefit reductions.

As long as the healthcare provider submits your medical claim, you are only responsible for your patient responsibility (copays, deductible and coinsurance) as it appears on the Explanation of Benefits (EOB) you receive from Assured Benefits Administrators.

ClaimDOC Member Advocates

Your new health plan provides you with member advocacy services through ClaimDOC. Your Member Advocates are here to help you navigate

new health plan and assist you with:

•

• Introducing

• Finding

•

Pave

Let Us Make the Introduction

Partnering with your healthcare providers

• In some cases, your healthcare providers may be unfamiliar with your new plan.

• Let us remove the unnecessary stress and make the introduction for you!

• As part of the Pave the Way program, a ClaimDOC Member Advocate will contact your provider BEFORE your first appointment, ensuring they have the necessary information to see you and submit your claims.

Nominate Your Healthcare Providers

Utilizing Your Health Plan

Present Your ID Card and Expect to Receive Care

• The front desk representative needs to review the ID card.

• The name of your health plan is Chesmar Group Health Plan.

• Benefits and eligibility can be verified by calling Assured Benefits Administrators.

• Claims may be submitted to Assured Benefit Administrators’ claims address or EDI Payor ID, located on the back of the ID card.

• If your provider has additional questions about your health plan, or doesn’t recognize your health plan, please have the representative call ClaimDOC.

Open Your Mail & Communicate

• Always compare your medical bills to the Explanation of Benefits (EOB) that you receive from Assured Benefits Administrators after your claims have been fully processed.

• Only pay the “Patient Responsibility” amount listed on the EOB.

• In some cases, a healthcare provider may attempt to balance bill you. This means they’ve received the fair and reasonable payment from you and your health plan but are seeking to collect additional amounts directly from you.

• Your health plan provides you with balance bill defense through ClaimDOC.

Protect Yourself From Paying More Than Due

What If I Receive a Balance Bill?

• Call ClaimDOC as soon as possible and be ready to submit a copy of the bill.

• Do not pay anything more than the patient responsibility amount on your Explanation of Benefits (EOB).

• ClaimDOC will send you an authorization requesting your signature so we may initiate your plan sponsored balance bill defense benefit.

• The ClaimDOC Balance Bill Specialists will contact the provider to understand their position and ensure your involvement is limited.

• Continue sending ClaimDOC any correspondence you receive related to the balance bill.

You are not responsible for paying the balance bill!

Overview

Founded on Access and Affordability

Health & Wellness Coaching

• Each individual will receive information on nutrition, exercise, dieting, behavior modifications, body image, and more!

• Individuals will learn healthy habits and how to manage long-term continued success.

• Program is personalized for each individual.

• Reduce risk of chronic health conditions and reverse diseases.

• Accountability services and education to adopt lifelong healthy habits.

Emotional Wellness Coach

• Access to counselors for short term, intermittent therapy.

• Referrals to our counseling team will be based on our medical team assessment.

• Available to children, adolescents, adults, couples, and families.

• Cognitive behavioral therapy.

• Mindfulness therapy.

• Relational therapy.

• Education on community resources to overcome barriers to care.

• Long term therapy needs will be referred to outside behavioral health providers.

All CLIA-waived labs (Rapid Strep, Flu, RSV, Mono, Covid, Urinalysis, trichomonas, urine pregnancy)

•Amylase

•CMP

•Lipid panel

•TSH

•Free T4

•Total T3

•HIV screen

•Hemoglobin A1c

•Microalbumin, Urine (w/creatinine)

•Vitamin D

•Hepatitis B Antibody Titer

•Hepatitis B Surface Antigen

•Uric Acid

•PSA

•Vitamin B12/Folate

•Testosterone, male

•Hepatitis C Ab

•Hepatitis panel

•Vitamin B12

•Lipase

•Folic Acid

•Magnesium

•Iron, total

•Estradiol

•FSH

•Thyroid Panel with TSH

•LH

•HCG Quantitative

•Liver Panel

•Sedimentation Rate

•CBC

•Urine Culture

•Throat Culture

•Wound Culture

***Labs not on the list above will need to be sent to an outside laboratory. Next Level utilizes Quest Laboratories. Labs sent to Quest will be treated as either a self pay cost to the employee/patient billed from Quest Laboratory to the employee/patient OR the employee/patient may submit their insurance information to Quest for processing.

• Chesmar Group

plan

PHCS

by

•

Claim Doc.

also

Level Prime

primary,

and

outpatient complex imaging, and KISx

Imaging

surgeries .

• By choosing

•

Day One Help

We are available to help you from the day of your diagnosis and beyond. You can register for the program at any point in your cancer journey to gain access to our resources and support. Registration is available through our website or by phone.

Personalized Care

Once you are part of the program, a dedicated nurse will be with you every step of the way. This nurse will be available to answer any questions you might have as well as make sure you are receiving ideal treatment for your diagnosis.

National Resources

Through CancerCARE, you will have access to some of the best doctors, hospitals, and technology nationwide. We will work with your local oncologist to make sure all treatment options are considered, not just local ones.

Expert Medical Team

Our medical staff has decades of experience treating cancer and we pride ourselves on staying up-to-date with the latest cancer treatments and technology. Each medical staffer has unique cancer expertise and background.

Vision

Cards available on Provider

Low Plan (MAC) High Plan (UCR)

Calendar Year Maximum $1,500

$1,500

Deductible $50 Ind / $150 Fam $50 Ind / $150 Fam

PREVENTIVE: Oral Exams, Full mouth xrays, bitewing x-rays, Prophylaxis— cleanings, Topical Fluoride applications, sealants, space maintainers. 100%

PREVENTIVE: Oral Exams, Full mouth x-rays, bitewing x-rays, Prophylaxis—cleanings, Topical Fluoride applications, sealants, space maintainers. 100%

BASIC RESTORATIVE: Amalgam and composite fillings, oral surgery (simple extractions), emergency palliative treatment, general anesthesia

80% after deductible

BASIC RESTORATIVE: Amalgam and composite fillings, endodontics root canal, periodontal surgery, periodontal maintenance, oral surgery (simple extractions and surgical extractions), emergency palliative treatment, general anesthesia

80% after deductible

MAJOR RESTORATIVE:

Crowns/Inlays/onlays, prefabricated crowns, repairs, endodontics root canal, periodontal surgery, periodontal scaling & root planning, periodontal maintenance, oral surgery (surgical extractions), bridges, dentures, consultations, implant services.

50% after deductible

MAJOR RESTORATIVE:

Crowns/Inlays/onlays, prefabricated crowns, repairs, periodontal scaling & root planning, bridges, dentures, consultations, implant services.

50% after deductible

UCR Plans Dental Plans

How do I decide?

Chesmar Paid Coverages

Life Insurance/ AD&D Coverage

Chesmar Homes will continue to provide all eligible full-time employees with basic life insurance and accidental death and dismemberment (AD&D) benefit coverage at 1 times your salary up to $250,000.

The benefit will be paid to the designated beneficiary. The AD&D benefit will be paid in the event of death by accident or a loss of limb by accident while covered under the plan. Detailed information can be found in the Certificate of Coverage. Beneficiaries can be updated at any time.

Short Term Disability Coverage (STD)

Disability insurance ensures that you and your family are protected with income replacement benefits in the event of an accident or an illness.

Benefits begin after the 21st day for accident or 21st for an illness and a maximum benefit duration of 23 weeks.

The weekly benefit will not exceed 60% of the members weekly earnings, including commissions and excluding overtime pay and bonuses — up to a maximum of $1,500 per week.

Long Term Disability Coverage (LTD)

Long term disability insurance picks up where STD ends and pays you a percentage of your income when you are out of work over 180 days due to an accident or illness.

The benefit paid is 60% up to a maximum of $6,000 per month. Maximum benefit duration may vary based on type of disability.

Problems Legal

Abuse

Workplace

Injury?

Insurance Policy

Information: Texas Mutual Policy #00011193001

Insurance Policy Information: Texas Mutual Policy #00011193001

We understand that workplace injuries can happen in our business, and we are here to help.

We understand that workplace injuries can happen in our business, and we are here to help.

As soon as you are injured or made aware of a

As soon as you are injured or made aware of a

workplace injury immediately notify HR, even if your injury does not require medical assistance.

workplace injury immediately notify HR, even if your injury does not require medical assistance.

Do NOT use your personal health

Do NOT use your personal health

If the provider has insurance questions they can call 1-800-859-5995

If the provider has insurance questions they can call 1-800-859-5995

ESOP

As an owner, YOUR efforts impact YOUR stock value. The better the company performs, the better your ESOP statements look!

What is going to happen to the ESOP?



Because the company was wholly purchased by Sekisui House in July 2022, we will apply to terminate the ESOP in January 2023.





Everyone who has qualified to enter in 2022 will receive their final allocations and statements mid 2023.

Most of the value of your stock will be converted to ‘cash’.  At that time, most of the cash in your account will become available to roll into your qualified retirement account or your Chesmar 401k.  In 2024 the remaining balance of your ESOP account will be available to roll into your qualified retirement account or your Chesmar 401k.

 We will have meetings and educational sessions to explain the options available so that you can make the best financial choice for your own situation.

Hired on or before June 30, 2021 Completing at least 1,000 hours and 12 months with the Company

Student Debt Repayment Program

How the program works:

&

Chesmar believes employees

to learn and grow.

The educational program must

• Enhance the associate’s effectiveness and contribution.

• Be related to current or future role within Chesmar Group.

Criteria

· Full-time associates with at least six (6) months of service prior to application

· Must maintain full-time status while taking courses.

· This benefit may be considered income and subject to payroll taxes, depending on amount reimbursed.

Benefits How to Apply? Email Khia Flores for the full criteria and applications

This program is for the children of Chesmar Group employees, the children of contractors who spend at least 50% of their time working on Chesmar Homes, and local high schools that offer courses in building trades.

Up to $5,000 scholarships will be awarded each school year for post high school education or trade schools.

Current applications and program criteria can be located at the bottom of the Chesmarian.

Paid