At ALW Welding, we are proud of our accomplishments and especially proud of our people. The health of you and your family are important to us and we are excited to offer group benefits starting July 1st, 2024 Starting this year and every year going forward, we will hold an open enrollment in June Elections you make during open enrollment will remain in effect throughout the plan year, from July 1st, 2024, through June 30th, 2025, with the exception of qualified life status changes. You will be eligible to enroll in our benefits the 91st day of full-time employment. The benefit offerings are outlined here, so please take some time to review.
What we offer
Health
Medical coverage is offered through BlueCross BlueShield of North Carolina.
Dental
Dental coverage is offered through Mutual of Omaha and is a voluntary coverage.
Vision
Vision coverage is offered through Mutual of Omaha and is a voluntary coverage.
A $15,000 Life Insurance Benefit is offered to all eligible employees at no cost to you. Additional Voluntary Life is available.
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 Joni Faulkner on any of the following.
WHEN ITS TIME TO ENROLL
NEED HELP FILING A CLAIM
NEW ID CARDS
QUESTIONS OR CONCERNS
Contact Info For Flatlands
Joni Faulkner +252-275-8082
Joni@FlatlandsJessup.com 1420 E. Arlington Blvd. Suite A Greenville, NC 27858
Rem Morgan +252-275-8082
Rem@FlatlandsJessup.com 1420 E. Arlington Blvd. Suite A Greenville, NC 27858
Life Insurance
Jessup:
BlueCrossBlueShieldofNC Health Insurance
Bi-Weekly Cost
As a full-time employee with ALW Welding, you are offered health insurance through Blue Cross and Blue Shield of NC. 50% of the employee’s premium is paid for by ALW Welding Our health insurance plan runs from July 1st through June 30th every year. The plans’ cost and coverage highlights can be found below.
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 the in-network PCP you want
BlueCross BlueShield Contact Info:
1 877 258 3334
www BlueCrossNC com or login to BlueConnectNC com PO Box 35, Durham, NC 27702
The BCBS Summary of Benefits offers comprehensive detail about your plans benefits
See Age Banded Chart
Employee + Spouse = See Age Banded Chart attached.
Employee + Child(ren) = See Age Banded Chart attached
Family = See Age Banded Chart attached.
1 / 2
3 / 4
PleasevisityourBCBSSummaryofBenefitsfor additionalplaninformationandoutofnetworkbenefits
Ifyouhaveadditionalquestions,pleasefeelfreetocall JoniFaulkner252-275-8082Ext 4007
Individual Deductible Family Deductible Individual Out-of-Pocket Max Family Out-of-Pocket Max Preventive Care Primary Care Specialist Urgent Care Emergency Room Virtual
Hospital
In-Network
Tier
Tier
Tier
$5,000 $10,000 $9,100 $18,200 Covered 100% $45 Copay $135 Copay $135 Copay $750 Copay $10 Copay 30% after deductible $15 / $35 $45 / $90 25% or $90 min, up to $200 max
Visits (Teladoc)
In/Out Patient
Drugs:
5
Your Plan
Employee Only $ Weekly Deduction
Health Insurance
Age Banded Rate Grid
Below you will find the monthly age banded rate grid for the medical plan Your cost will be determined based upon your age and any dependents you plan to add You as the employee are responsible to pay 50% of the premium listed beside your current age below The balance is covered by ALW Welding You have the ability to add your spouse and or your children 100% of the costs for dependents is on you as the employee If you elect to cover your family, the max you will add for dependents is taking the age of the oldest 4 in your family and adding them together along with the employee premium. Listed below are examples of how to calculate your monthly and weekly costs. The premiums will be payroll deducted on a pre-tax weekly basis.
Silver 5000 Plan
0-14 15 16 17 18 19 20 21 22 23 24 $301 50 $328.30 $338 55 $348.80 $359 83 $370.87 $382 30 $394.12 $394 12 $394.12 $394 12 25 26 27 28 29 30 31 32 33 34 35 $395 70 $403.58 $413 04 $428.41 $441 02 $447.33 $456 79 $466.24 $472 16 $478.46 $481 61 36 37 38 39 40 41 42 43 44 45 46 $484 77 $487.92 $491 07 $497.38 $503 69 $513.14 $522 21 $534.82 $550 59 $569.11 $591 18 47 48 49 50 51 52 53 54 55 56 57 $616 01 $644.39 $672 37 $703.90 $735 03 $769.32 $804 00 $841.45 $878 89 $919.48 $960 47 58 59 60 61 62 63 64+ $1,004 22
64
Lee Wood (Employee) - 34 years old Marina Wood (Spouse) - 32 years old Child 1 - 10 years old Child 2 - 9 years old Child 3 - 6 years old Child 4 - 5 years old Premium Calculation Example(s) $ 478.46 $ 466.24 $ 301.50 $ 301.50 $ 301.50 $No Charge $ 1,609.97 Monthly $ 371.53 per week John Wood (Employee) - 25 years old $ 395.70 Employee Cost $ 197.85
$1,025.89 $1,069
$1,107.48 $1,132 31 $1,163.44 $1,182 36
Family Coverage Premium Employee Cost $ 239.23 Employee Only Coverage Premium $ 197.85 Monthly $ 45.66 per week Ifyouhaveadditionalquestionsonhowto calculateyouoryourdependentspremium, pleasefeelfreetocallJoniFaulkner252275-8082Ext 4007
Allergies
Cough, Cold & Flu
Diarrhea
Ear problems
Fever
Headaches Insect Bites
Sinus problems
Nausea & Vomiting
Sore throat
Urinary problems And more!
Teladocisanindependentcompanythatissolelyresponsibleforthetelehealthservicesitisproviding
orBlueShieldproductsorservices
Loss
Visit teladoc com and register an account Download the Teledoc mobile app
Anxiety
Addictions
Depression Grief &
Relationship Issues And more! Behavioral Services Health Services
Telehealthservicesarenot
Teladocissubjecttostateregulations Teladocdoes
Teladocdoesnotguaranteepatientswillreceiveaprescription Healthcareprofessionalsusingthe
basedonprofessionaljudgment acaseisinappropriatefortelehealthorformisuseofservices
TeladocdoesnotofferBlueCross
Teladocinteractiveconsultationsareavailable24hoursaday,7daysaweek Telehealthservicesare subjecttothetermsandconditionsofthemembershealthplan includingbenefits limitationsandexclusions
asubstituteforemergencycare Teladocdoesnotreplaceyourprimarycaredoctorandisnotaninsuranceproduct
notprescribeDEA-controlledsubstancesandmaynotprescribenontherapeuticdrugsandcertainotherdrugswhichmaybeharmful becauseoftheirpotentialforabuse
platformhavetherighttodenycareif
Dental Insurance
What's available to me?
Getting Started
Go to MutualofOmaha.com/dental 1. Click on the "Member Portal Link" and select the "Register Now" button. You will enter your Member ID number (located on your Member ID card) or the last 4 digits of your SSN, and follow the instructions to create your user name and password.
2. With access to your online portal you can view benefits, eligibility and claims. You can also search in network or out of network providers. If you visit an out-of-network provider, you can download a claim form from the home page.
Dental insurance helps pay for all, or a portion, of the costs associated with dental care, from routine cleanings to root canals. Our dental insurance is through Mutual of Omaha and you may elect to purchase coverage if you're an active, full-time employee. To learn how to make full use of your plan, please start by following the steps below to set up your log-in at Mutual of Omaha. 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 36 months. Sealants and space maintainers are also covered at 100%.
Basic Care
$50 Deductible with 80% Coinsurance
$50 Deductible with 50% Coinsurance
For additional information and plan details, please visit the Mutual of Omaha Summary of Benefits.
Things to Remember:
Our deductibles and the annual maximum operate on a calendar year and reset January 1st of every year. When you select a dentist within the Mutually Preferred dental network, your cost may be lower. To find a dentist within the Mutually Preferred Dental network, visit MutualofOmaha.com/dental-insurance.
DentalInsurance $6.51 Employee Only Cost Weekly Employee + Spouse = $13 75 Employee + Child/Children = $16.81 Family Premium = $25.28 Dental Insurance is a voluntary coverage
Major Care
Mutual of Omaha Contact Info:
1.800.927.9197 www.MutualofOmaha.com/dental
Vision Insurance
What'savailabletome?
You have so many reasons to keep your eyes healthy. Ongoing vision care will help you maintain the best possible eye - and overall - health and well-being. Our Vision insurance is a voluntary coverage you may elect to enroll in if you're an active, full-time employee. This plan provides choice, flexibility and savings through Mutual of Omaha Vision Powered by EyeMed.
Getting Started
Go to MutualofOmaha.com/vision 1. Click on "View my vision benefits" 2. Click the "Create an account" button - enter your name, DOB, member ID number or the last four digits of your SSN and follow the instructions to select your username and password. 3.
With access to your online portal you can view benefits, eligibility and claims. You can also search in network or out of network providers. If you visit an out-of-network provider, you will have to pay for services out-of-pocket and submit a claim form located in the "Forms"section for reimbursement.
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 $25 copay.
Frames: covered up to $130 every 24 months; 20% off amount over the allowance For additional information and plan details, please visit the Mutual of Omaha Summary of Benefits.
Lens enhancements: Standard progressive lenses covered once every 12 months with an additional $65 copay.
Things to Remember:
Find a Provider
Once you've created an account and signed in, click "Provider locator." From here, you can search by ZIP code or "use my location" to find a provider near you.
If you need additional information regarding the EyeMed Insight network or your overall vision benefits, please call 1 833 279 4358
VisionInsurance
$1.32 Employee Only Cost Weekly Employee + Spouse = $2.98 Employee + Child/Children = $3 22 Family Premium = $5 26
Mutual of Omaha Contact Info:
1.833.279-4358 www MutualOfOmaha com/vision
Vision Insurance is a voluntary coverage
your annual salary) and you can elect up to $100,000 without submitting any medical questions. Any amount over $100,000 requires Evidence of Insurability (unless currently enrolled). You can also elect up to $250,000 on your Spouse and $10,000 on your children. For your spouse, you can elect up to $25,000 without submitting medical questions and $10,000 on your children without submitting medical questions. If you wish to elect over the $100,000 for yourself or $25,000 for your spouse, you can submit EOI online at www mutualofomaha com/eoi Please note, if you wish to elect coverage on your dependents, you must elect coverage of equal or greater value on yourself.
Frequently Asked Questions
What is Guarantee Issue?
The Best For Your Family
The amount of insurance applied without answering any health questions (or which does not require evidence of insurability) Coverage amounts over the Guarantee Issue amount will require evidence of insurability
What is Evidence of Insurability?
Evidence of insurability or proof of good health - may be required if you are a late entrant and/or you request any additional coverage above your guarantee issue amount
Can I take this insurance with me if I change jobs/am no longer a member of this group?
In the event this insurance ends due to a change in your employment/membership status with the group, or for certain other reasons, you or your insured spouse may have the right to continue this insurance under the Potability or Conversion provision, subject to certain conditions.
For additional information and plan details, please visit the United of Omaha
Company Summary of
Also, please feel free to contact your Flatlands Jessup representative.
Insurance
Mutual of Omaha Contact Info for Life: 1.800.775.8805 Submitgrplife@mutualofomaha com 3300 Mutual of Omaha Plaza | Omaha, NE 68175
Life
Benefits.
Glossary of Health Coverage & Medical Terms
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 Thehealthinsuranceorplanpaystherestoftheallowedamount
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