IS OUR PRIORITY
OUR MISSION
At Edge Dental Solutions & Stone Laboratories, we are proud of our accomplishments and especially proud of our people. Your health and the health of your family are important to us. Each year, we hold an open enrollment in December. Elections you make during open enrollment will remain in effect throughout the plan year, from January 1st through December 31st of the following year, with the exception of qualified life status changes. To be eligible, employee's must be full-time and have been with the company at least 60 days. Please find the enclosed benefit offerings and take some time to review.
FLATLANDS JESSUP INSURANCE GROUP
Our benefit offerings are managed by Flatlands Jessup and they are here to serve you throughout the year if you have any questions at all. Please reach out to Kristy Harrell on any of the following. WHEN ITS
TIME TO ENROLL
Critical Illness Vision Hospital Indemnity
Health Dental Accident
What we offer
Employee Benefit Offerings Contact Info For Flatlands Jessup : +252-527-6100 Kristy@FlatlandsJessup.com 2120 N.
St, Kinston www.FlatlandsJessup.com
Queen
NEED HELP FILING A CLAIM NEW ID CARDS QUESTIONS OR CONCERNS
Health Insurance
BlueCrossBlueShieldofNC PlanOption1:SilverPlanPPO
Bi-Weekly Cost
As a full-time employee with our company you are eligible to enroll in one of our group ' s health insurance options through BCBS of NC The plan's cost and coverage highlights can be found in the right column which lists your bi-weekly costs for coverage,
BlueConnectNC.com is your go-to source for information about your health plan Look up innetwork doctors, get cost estimates, check claims, progress towards deductibles and more
Preventive Care This health plan covers a broad range of preventive services at no charge to you when using an in-network provider.
Who's In-Network? In-network providers save you money, so be sure to find doctors, specialists, urgent care facilities and hospitals that are in your plan's network For more info, visit the website: BlueCrossNC com/SearchDoctors
How Drug Benefits Work. Getting prescription drugs is simple Learn how a standard plan works for pharmacy and prescription drug coverage at: BlueCrossNC com/RxBenefits
Primary Care Provider (PCP). You can visit your PCP for most medical procedures and services and when you do, you could save money Once your plan is active, log in to BlueConnectNC com and choose your in-network PCP to waive your first three (3) copays
Ifyouhaveadditionalquestions,pleasefeelfreetocall KristyHarrellat252-527-6100
PleasevisityourBCBSSummaryofBenefitsfor additionalplaninformationandoutofnetworkbenefits
Employee + Spouse = $274 60 Employee + Children = $241.65 Family = $516 25 Plan Rates $54.92 Bi-Weekly Deduction Employee Only To find an In-Network provider visit www.BlueCrossNC.com/find-adoctor-or-facility or call 877.258.3334 for a list of participating providers. BlueCross BlueShield Contact Info: 1 877 258 3334 www BlueCrossNC com or login to BlueConnectNC com PO Box 35, Durham, NC 27702 Deductible Out-of-Pocket Max Co-Insurance Telahealth Co-Pay Primary Care Co-Pay Specialist/Urgent Care Co-Pay Prescription Tier: Tier 1/2/3/4 Tier 5 $2,500 Ind / $5,000 Fam $9,100 / $18,200 40%/60% $10 $30 $150 Prescription Cost $15/$35/$45/$90 $200
Health Insurance
BlueCrossBlueShieldofNC PlanOption2:BronzePlanPPO
Bi-Weekly Cost
As a full-time employee with our company you are eligible to enroll in one of our group ' s health insurance options through BCBS of NC The plan's cost and coverage highlights can be found in the right column which lists your bi-weekly costs for coverage,
BlueConnectNC.com is your go-to source for information about your health plan Look up innetwork doctors, get cost estimates, check claims, progress towards deductibles and more
Preventive Care This health plan covers a broad range of preventive services at no charge to you when using an in-network provider.
Who's In-Network? In-network providers save you money, so be sure to find doctors, specialists, urgent care facilities and hospitals that are in your plan's network For more info, visit the website: BlueCrossNC com/SearchDoctors
How Drug Benefits Work. Getting prescription drugs is simple Learn how a standard plan works for pharmacy and prescription drug coverage at: BlueCrossNC com/RxBenefits
Primary Care Provider (PCP). You can visit your PCP for most medical procedures and services and when you do, you could save money Once your plan is active, log in to BlueConnectNC com and choose your in-network PCP to waive your first three (3) copays
PleasevisityourBCBSSummaryofBenefitsfor additionalplaninformationandoutofnetworkbenefits
Ifyouhaveadditionalquestions,pleasefeelfreetocall KristyHarrellat252-527-6100
Employee + Spouse = $159 33 Employee + Children = $136.86 Family = $324 06 Plan Rates $9.58 Bi-Weekly Deduction Employee Only To find an In-Network provider visit www.BlueCrossNC.com/find-adoctor-or-facility or call 877.258.3334 for a list of participating providers. BlueCross BlueShield Contact Info: 1 877 258 3334 www BlueCrossNC com or login to BlueConnectNC com PO Box 35, Durham, NC 27702 Deductible Out-of-Pocket Max Co-Insurance Telahealth Co-Pay Primary Care Co-Pay Specialist/Urgent Care Co-Pay Rx Deductible: Prescription Tier: Tier 1/2/3/4 Tier 5 $6,000 Ind / $12,000 Fam $9,100 / $18,200 40%/60% $10 $95 $190 $400 $15/$35/$45/$90 $200
Dental Insurance
What'savailabletome?
Dentalinsurancehelpspayforall,oraportion,ofthecostsassociatedwithdentalcare,fromroutine cleaningstorootcanals.OurdentalinsuranceisthroughSunLifeandyoumayelecttopurchase coverageifyou'reanactive,full-timeemployee.
Plan Highlights:
$1,000 Annual Maximum
Preventive Care is covered 100%
Routine exams and cleanings are covered twice per year Bitewing X-rays are covered once per calendar year Full mouth X-rays are covered every 60 months.
Basic Care
$50 Deductible per covered member up to $150 with 80% Coinsurance For additional information and plan
Major Care
$50 Deductible per covered member up to $150 with 50% Coinsurance
Things to Remember:
Just annual preventive care alone can help prevent other health issues such as heart disease and diabetes. Many plans cover preventive services at or near 100% to make it easy for you to use your dental benefits.
Visit www.sunlife.com/findadentist. Follow the prompts to find a dentist in your area who participates in the PPO network. You do not need to select a dentist in advance. The PPO network for your plan is the Sun Life Focus Dental Network® with 125,000+ unique dentists.
DentalInsurance $12.81 Employee Only Cost Bi-Weekly Employee + Spouse $25.66 Employee + Child/Children $36 24 Family Premium $49.09
Keepyoursmilesweet
Benefits.
details, please visit the Summary of
What'savailabletome?
Youcanhelpprotectyoureyesightbyvisitinganeyedoctor regularly.Visioninsuranceincludesanannualcomprehensive eyeexamwithaneyecaredoctor.Takingcareofyoureyes todaycanleadtoabetterqualityoflifelater.
Plan Highlights:
Every 12 months, one exam is covered in full after a $10 copay.
Prescription glasses: 1 pair of lenses are covered every 12 months with a $10 copay.
Frames: covered up to $130 every 24 months; 20% off amount over the allowance.
Lens enhancements: Standard, premium, and custom progressive are covered at additional copays that vary.
Things to Remember:
For online purchases visit www.eyeconic.com. Once you have linked your benefits you will be able to see how your coverage will be applied to different options that you are reviewing. Eyeconic features a virtual try-on tool so you can see how the glasses will look on you before you make your purchase.
There are three ways to find an in-network doctor:
1. Visit vsp.com and select the Signature network.
2. Call VSP at 800-877-7195.
Elective contacts: Covered up to $130 every 12 months with a $60 copay that includes fitting and evaluation. For additional information and plan details, please visit the Carrier Summary of Benefits.
3. Download our mobile app, Benefit Tools, and search for a doctor near you.
VisionInsurance $ 5.18 Employee Only Cost Semi-Monthly Employee + Spouse $ 9.97 Employee + Child/Children $ 10.98 Family Premium $ 15.96 Our vision insurance is a voluntary coverage Vision Insurance Seewhatyoucansave
Supplement Coverage
We offer each full time employee the opportunity to enroll in Supplemental Benefits through SunLife. These benefits are paid for by the employee on a bi-weekly payroll cycle.
These benefits offer cash reimbursements based on certain medical events such as Accidents, Cancer, Hospitalization, etc.
Supplemental Options are listed below:
Options Include:
Accident
Two Robust Options to choose from
Critical Illness
Guaranteed Issue up to $20,000
Hospital Indemnity
Two Plans to choose from that cover confinement, extended stay, and ICU
For additional information and plan details, please visit the Colonial Summary of Benefits.
Things to Remember:
Some Options include a Health Screening benefit which is free money to claim for receivng certain annual screenings
Evidence of Insurability is required for some benefits if not chosen during your Initial Eligibility Period
SupplementyourBenefits& ProtectyourIncome
GlossaryofHealthCoverageandMedicalTerms
AllowedAmount-Maximumamountonwhichpaymentisbasedforcoveredhealthcareservices.Thismaybecalled“eligible expense, ”paymentallowanceor“negotiatedrate”Ifyourproviderchargesmorethantheallowedamount,youmayhavetopay thedifference (SeeBalanceBilling)
Appeal-Arequestforyourhealthinsurerorplantoreviewadecisionoragrievanceagain
BalanceBilling-Whenaproviderbillsyouforthedifferencebetweentheprovider’schargesandtheallowedamount For example,iftheprovider’schargeis$100andtheallowedamountis$70,theprovidermaybillyoufortheremaining$30.A preferredprovidermaynotbalancebillyouforcoveredservices
Co-insurance-Yourshareofthecostsofacoveredhealthcareservice,calculatedasapercent(forexample,20%)ofthe allowedamountfortheservice Youpayco-insuranceplusanydeductiblesyouowe Forexample,ifthehealthinsuranceor plan’sallowedamountforanofficevisitis$100andyou’vemetyourdeductible,yourco-insurancepaymentof20%wouldbe $20 Thehealthinsuranceorplanplaystherestoftheallowedamount
Co-payment-Afixedamount(forexample,$15)youpayforacoveredhealthcareservice,usuallywhenyoureceivetheservice Theamountcanvarybythetypeofcoveredhealthcareservice
Deductible-Theamountyouoweforhealthcareservicesbeforeyourhealthinsuranceorplanbeginstopay Forexample,if yourdeductibleis$1,000,yourplanwon’tpayanythinguntilyou’vemetyour$1,000deductibleforcoveredhealthcareservices subjecttodeductible Thedeductiblemaynotapplytoallservices
EmergencyMedicalCondition-Anillness,injury,symptomorconditionsoseriousthatareasonablepersonwouldseekcare rightawaytoavoidsevereharm
EmergencyRoomCare-Emergencyservicesyougetinanemergencyroom
HealthInsuranceAcontractthatrequiresyourhealthinsurertopaysomeorallofyourhealthcarecostsinexchangefora premium
Hospitalization-Careinahospitalthatrequiresadmissionasaninpatientandusuallyrequiresanovernightstay.Anovernight stayforobservationcouldbeanoutpatientcare
In-networkCo-insurance-Thepercent(forexample,20%)youpayoftheallowedamountforcoveredhealthcareservicesto providerswhocontractwithyourhealthinsuranceorplan In-networkco-insuranceusuallycostsyoulessthanout-of-network co-insurance
In-networkCo-payment-Afixedamount(forexample,$15)youpayforcoveredhealthcareservicestoproviderswhocontract withyourhealthinsuranceorplan In-networkco-paymentsusuallyarelessthanout-of-networkco-payments
Network-Thefacilities,providersandsuppliersyourhealthinsurerorplanhascontractedwithtoprovidehealthcareservices
Non-PreferredProvider-Aproviderwhodoesn’thaveacontractwithyourhealthinsurerorplantoprovideservicestoyou You’llpaymoretoseeanon-preferredprovider Checkyourpolicytoseeifyoucangotoallproviderswhohavecontractedwith yourhealthinsuranceorplan,ofifyourhealthinsuranceorplanhasa“tiered”networkandyoumustpayextratoseesome providers
Out-of-networkCo-payment-Afixedamount(forexample,$30)youpayforcoveredhealthcareservicesfromproviderswho donotcontractwithyourhealthinsuranceorplan Out-of-networkco-paymentsusuallyaremorethanin-networkco-payments
Out-of-PocketLimit-Themostyoupayduringapolicyperiod(usuallyayear)beforeyourhealthinsuranceorplanbeginsto pay100%oftheallowedamount Thislimitneverincludesyourpremium,balance-billedchargesorhealthcareyourhealth insuranceorplandoesn’tcover Somehealthinsuranceorplansdon’tcountallofyourco-payments,deductibles,co-insurance payments,out-of-networkpaymentsorotherexpensestowardsthislimit.
PhysicianServices-Healthcareservicesalicensedmedicalphysicianprovidesorcoordinates.
Pre-AuthorizationCertainproceduresorhospitalizationsmayrequirethattheproviderreceiveauthorizations Theprovideris typicallytheonetogothroughtheprocesswiththeinsurancecompanyandobtainpre-authorization
Pre-Determination-Ifyouarehavingamajorproceduredone,yourdoctorordentistcansubmitapre-determinationtothe insurancecompanysoyoucanknowinadvanceoftreatmenthowmuchofthebillyouwillberesponsiblefor
