BENEFITS GUIDE
2023
January 1st, 2023 - December 31st, 2023
Our employees are our greatest resource. That's why Georgia Greater Concrete is continuing to provide you with health plans, wellness enhancements, and benefits that make sense for you and your family, your busy lifestyle, and your wallet.
Please take the time to carefully review the information, carrier changes and all the benefits offered to you, to ensure you get the best value based on your needs. We hope the benefits offered will inspire you and your dependents to take charge of your health and continue making wellness a priority.
OPEN ENROLLMENT
Open Enrollment is your opportunity to add, cancel, or make changes to your benefits. This year, open enrollment will be Thursday, December 7th, 2023 – Wednesday, December 14th, 2023.
Once you elect your benefits, the elections remain in effect for the plan year, January 1st December 31st, 2023 . You may only change coverage due to an IRS qualified “life event” and must do so within 30 days of the event. A qualifying event is a significant change in a person’s life that creates the need to add, cancel, increase, or change coverage. We encourage you to review all your benefits and make selections wisely.
This year we will be using Employee Navigator to make our benefits elections. You must elect or decline coverage through Employee Navigator.
ELIGIBILITY
New hires are eligible for benefits first of the month following 60 days of employment. You may enroll yourself and eligible dependents for coverage. You must enroll yourself in benefits in order to enroll your dependents. Eligible dependents include your spouse, dependent children, legally adopted children and stepchildren. Spouses and dependent children are eligible for: Medical, Dental, Vision, Voluntary Life.
Dependent children are eligible for the group health plan until their 26th birthday regardless of whether they are a full-time student.
QUALIFYING EVENTS
Once you have made your elections, you are NOT eligible to change or drop coverage until the next Open Enrollment period unless you have a qualifying event. If you experience a qualifying life event, contact the Human Resources Department within 30 days of your qualifying event. If you fail to do so, you will have to wait until the next open enrollment period to make any changes to your coverage. Qualifying life events include, but are not limited to:
• Marriage
• Divorce
• Birth or adoption
• Employment changes from Part-time to Full time
• Change in dependent status (i.e. Dependent child reaches age 26 limit)
WELCOME!
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How to Enroll using Employer Navigator
Step 1: Log In
Go to www employeenavigator com and click Login
• Returning users: Log in with the username and password you created when you registered. If you have forgotten your password, click Reset a forgotten password.
• First time users: Click on your Registration Link in the email sent to you by your admin or Register as a new user. Create an account, and create your own username and password
• Your company identifier is: GGAC
Step 2: Welcome!
After you login, click Let’s Begin to complete your enrollment and additional required tasks if applicable
Step 3: Start
Enrollments
After clicking Start Enrollment, you’ll need to complete some personal & dependent information before moving to your benefit elections.
TIP
Have dependent details handy. To enroll a dependent in coverage you will need their date of birth and Social Security number.
Step 4: Benefit Elections
To enroll dependents in a benefit, click the checkbox next to the dependent’s name under Who am I enrolling?
Below your dependents you can view your available plans and the cost per pay To elect a benefit, click Select Plan underneath the plan cost
Click Save & Continue at the bottom of each screen to save your elections.
If you do not want a benefit, click Don’t want this benefit? at the bottom of the screen and select a reason from the drop down menu.
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Step 5: Forms
If you have elected benefits that require a beneficiary designation, Primary Care Physician, or completion of an Evidence of Insurability form, you will be prompted to add in those details
Step 6: Review & Confirm Elections
Review the benefits you selected on the enrollment summary page to make sure they are correct then click Sign & Agree to complete your enrollment . You can either print a summary of your elections for your records or login at any point during the year to view your summary online.
TIP
If you miss a step you’ll see Enrollment Not Complete in the progress bar with the incomplete steps highlighted. Click on any incomplete steps to complete them.
Step 7: You’re Finished
You are finished You can go back to your homepage to view your elections and you can make changes until the enrollment window closes.
You can login to review your benefits 24/7!
EMPLOYEE NAVIGATOR
ENROLLMENT GUIDE
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MEDICAL Georgia Greater Concrete Benefit Guide | 5 Medical benefits are available through Allied. Allied is your medical carrier. Aetna is your network. IN-NETWORK Base HMO Mid HMO Premium PPO Coinsurance (Allied pays) 70% 100% 100% Calendar Year Deductible Individual/Family $3,000 / $6,000 $0 / $0 $0 / $0 Out-of-Pocket Maximum Individual/Family $6,500 / $13,000 $6,000 / $12,000 $6,000 / $12,000 Preventive Care $0 $0 $0 HealthJoy $0 $0 $0 Office Visit Copays
Care Physician $40 copay $25 copay $25
Specialist $55 copay $65 copay $65 copay
scans, MRIs) Ded + 30%
Room
Services
Services
Prescription Drugs Tier 1 / Tier 2 / Tier 3 / Tier 4 $15/$35/$55/35% to max of $750 $15/$35/$55/35% to max of $750 $15/$35/$55/35% to max of $750 OUT-OF-NETWORK Coinsurance (Allied pays) 70% Calendar Year Deductible Individual/Family $5,000 / $10,000 Out-of-Pocket Maximum Individual/Family $18,000 / $36,000 COST PER PAYCHECK (26) Employee Only $0.00 $25.70 $62.32 Employee Spouse $159.98 $219.33 $267.54 Employee + Child(ren) $139.49 $205.74 $237.10 Family $263.71 $341.75 $409.64 N/A N/A Above is a snapshot of the plan benefits. For a more comprehensive review, please refer to the Summary of Benefits produced by the insurance carrier. In the event of a conflict with the insurance carrier, the contract takes precedent. A nicotine surcharge of $150 per month will be added to employees who have used nicotine or nicotine products in the last 12 months.
Primary
copay
Imaging (CT/PET
$500 copay $500 copay Emergency
Copay $500 copay $500 copay $500 copay Urgent Care $100 copay $50 copay $50 copay Inpatient Hospital &
Ded + 30% $500 copay $500 copay Outpatient Hospital &
Ded + 30% $500 copay $500 copay
Allied is your medical carrier. Member support: 1-866-455-8727 7:30am 7:00PM CT Contact your Advisor: o For answers about your plan and benefits o Billing assistance o To confirm precertification for an upcoming procedure Your member portal: o Register at alliedbenefit.com/Members o Verify coverage o Request a copy of your ID card o Check claims status o Pull up your customized Personal Health Record (PHR) Georgia Greater Concrete has partnered with Allied to bring you valuable benefits. IMPORTANT INFORMATION TO KNOW CONTACTING ALLIED Your network access is through Aetna. o Alliedbenefit.com/ProviderNetworks & select “Aetna PPO.” o Enter your location ZIP, city, county, or state and click “Search.” o Look up providers by typing into the general search bar or select from the categories shown. How to Access Your Benefits through Allied Georgia Greater Concrete Benefit Guide | 6
A DOCTOR Your ID card details the benefits offered through Georgia Greater Concrete. It is being mailed to your home with accompanying instructions. Provide your new ID Card to ALL of your providers after June 1st.
support: 1 866 455 8727 7:30am 7:00PM CT YOUR MEDICAL ID CARD Your pharmacy provider is SmithRX. Your pharmacy information is printed on your new medical ID Card.
support: 1 844 385 7612 To submit a mail in order, login to: mysmithrx.com YOUR PHARMACY BENEFIT
FINDING
Member
Member
ADDITIONAL RESOURCES Georgia Greater Concrete Benefit Guide | 7 Employees enrolled in medical will also have access to the following benefits. HealthJoy : On - Demand Benefits Guidance Employees and dependents enrolled in medical coverage will also be enrolled in HealthJoy. ► Online Medical Consultations (Telemedicine) ► Provider Recommendations ► Facility Recommendations ► Answer Benefits Questions ► Appointment Booking ► Health Cost Estimation ► RX Savings Review ► Medical Bill Review ► Dental and Vision Assistance • KisX Card assist in scheduling planned surgeries and diagnostics at prenegotiated prices with top providers. • GlobalFit discounted gym memberships nationwide. Your GlobalFit ID is P1295. • SmartMatch offers Medicare eligible employees alternative coverage options.
DENTAL Georgia Greater Concrete Benefit Guide | 8 Dental benefits are available through MetLife. To find dental providers visit www.metlife.com/dental VISION MetLife offers easy access to thousands of conveniently located vision care providers including optometrists, ophthalmologists, opticians, Visionworks, Costco Optical, Walmart and Sam’s Club. To locate in network eye care doctors or locations visit: www.metlife.com/vision Exam $10 Frequency 12 /12 / 12 Frames $150 allowance Lenses Single $15 Bifocal $15 Trifocal $15 Contact Lenses (in lieu of frames) $150 allowance Employee Only $2.98 Employee Spouse $5.97 Employee + Child(ren) $6.39 Family $10.21 Your Network is PDP Plus Annual Deductible (Waived for Preventative) Individual / Family $50 / $100 Yearly Maximum Benefit per Person $2,000 Preventative Services (Oral Exams, Cleanings, X-rays) 100% Basic Services (Fillings, Emergency Palliative Treatment etc. 80% Major Services (Crowns, Endodontics, Periodontics, etc.) 50% Orthodontia Services 50% Orthodontia Maximum $1,500 Out-of-Network UCR 90th COST PER PAYCHECK (26) Employee Only $4.62 Employee Spouse $23.08 Employee + Child(ren) $27.69 Family $32.31
offered at NO COST
you: Georgia
Concrete Benefit Guide | 9
Life Insurance and AD&D – All full time employees are provided through MetLife, $50,000 of Basic Life and Accidental Death &
benefit. Long-Term Disability – Through MetLife all full time employees are offered long term disability. Benefit Amount: 60% of monthly earnings up to a maximum of $5,000 for a covered accidents or sicknesses. Waiting Period: 90 days Benefit Period: up to Social Security Normal Retirement Age (SSNRA) Employee Assistance Program – All fulltime employees have access to experienced counselors provided through LifeWorks. 5 phone or video consultations with licensed counselors for you and your eligible household members, per issue, per calendar Licensed counselors can talk to you about anything going on in your life such as family, work, financial. legal services, identify theft recovery, health and or everyday life. Phone: 1-888-319-7819 to speak with a counselor or schedule an appointment, 24/7/365. Web: metlifeap.lifeworks.com User Name: metlifeeap Password: eap Mobile App: User Name: metlifeeap Password: eap
Benefits
to
Greater
Basic
Dismemberment
Additional Benefits:
Voluntary Short-Term Disability Through MetLife all full time employees have the option to purchase short term disability.
Benefit Amount: 60% of weekly salary up to a maximum of $1,000 for non work related accidents or sicknesses.
Waiting Period: Benefits begin on day 15
Benefit Period: up to 11 weeks
Voluntary Life Insurance and AD&D – Employees are offered the option to purchase additional life insurance through MetLife. Rates will vary based on age and the benefit you select. All rates can be found in your Employee Navigator portal.
Plan Highlights
Employee:
Increments of $10,000 up to a maximum of $500,000 subject to medical eligibility. At your initial enrollment, you are eligible for up to a $100,000 with no medical questions asked.
Spouse:
Child(ren):
Increments of $5,000 up to a maximum of $100,000 (not to exceed 50% of employee’s amount). Subject to medical eligibility. At your initial enrollment, your spouse is eligible for up to a $25,000 with no medical questions ask.
Up to a maximum of $10,000. Coverage begins at 15 days.
Guide | 10
Georgia Greater Concrete Benefit
Claims Questions? Darlene Moorman 770.635.0439 dmoorman@sspins.com BE SURE TO HAVE THE FOLLOWING INFORMATION WHEN CALLING: Subscriber ID # Date of Service Name of Patient Name of Doctor, Facility or Hospital Copy of Bill or Explanation of Benefits (EOB) Benefit Questions? Marie Volk 770.635.0451 mvolk@sspins.com Trevor Holder 678.742.3827 tholder@sspins.com Your Employee Support Contacts KEY CONTACTS & RESOURCES Questions on your benefits or need assistance with Claims, contact Sterling Seacrest Pritchard: Georgia Greater Concrete Benefit Guide | 11
LEGAL NOTICES
THIS GUIDE This brochure summarizes the health care and income protection benefits that are available to Georgia Greater Concrete and their eligible dependents. Official plan documents, policies, and certificates of insurance contain the details, conditions, maximum benefit levels and restrictions on benefits . These documents govern your benefits program. If there is any conflict, the official documents prevail. These documents are available upon request through your Human Resources department. Information provided in this brochure is not a guarantee of benefits.
HEALTH INSURANCE PORTABILITY AND ACCOUNTABILITY ACT (HIPAA)
Georgia Greater Concrete, in accordance with HIPAA, protects your Protected Health Information (PHI) . We will only discuss your PHI with medical providers and third party administrators when necessary to administer the plan that provides you your medical, dental and vision benefits or as mandated by law A copy of the Notice of Privacy is available upon request through your Human Resources department.
WOMEN'S HEALTH ACT
If you have had or are going to have a mastectomy, you may be entitled to certain benefits under the Women's Health and Cancer Rights Act of 1998 (WHCRA) For individuals receiving mastectomy related benefits, coverage will be provided in a manner determined in consultation with the attending physician and the patient for:
• All stages of reconstruction of the breast on which the mastectomy was performed;
• Surgery and reconstruction of the other breast to produce a symmetrical appearance;
• Prostheses; and
• Treatment of physical complications of the mastectomy, including lymphedema. These benefits will be provided subject to the same deductibles and coinsurance applicable to other medical and surgical benefits provided under this plan If you have any questions about your coverage, please contact your Human Resources department.
SPECIAL ENROLLMENT NOTICES
If you decline enrollment in your employer's health plan for you or your dependents (including your spouse) because of other health insurance or group health plan coverage, you or your dependents may be able to enroll in your employer's plan without waiting for the next open enrollment period if you:
• Lose other health insurance or group health plan coverage You must request enrollment within 30 days after the loss of other coverage.
• Gain a new dependent as a result of marriage, birth, adoption or placement for adoption. You must request (medical plan OR health plan) enrollment within 30 days after the marriage, birth, adoption or placement for adoption
• Lose Medicaid, or Children's Health Insurance Program (CHIP) coverage because you are no longer eligible. You must request medical plan enrollment within 60 days after the loss of such coverage.
CONTINUATION REQUIRED BY FEDERAL LAW FOR YOU & YOUR DEPENDENTS (COBRA)
The continuation required by Federal Law does not apply to any benefits for loss of life, dismemberment or loss of income . Federal law enables you or your dependent to continue health insurance if coverage would cease due to a reduction of your work hours or your termination of employment (other than gross misconduct) Federal law also enables your dependents to continue health insurance if their coverage ceases due to your health, divorce, or legal separation, or with respect to a dependent child, failure to continue to qualify as a dependent. Continuation must be elected in accordance with the rules of your Employer's group health plan(s) and is subject to federal law, regulations and interpretations
MEDICAID AND THE CHILDREN'S HEALTH INSURANCE PROGRAM (CHIP)
The continuation required by Federal Law does not apply to any benefits for loss of life, dismemberment or loss of income . Federal law enables you or your dependent to continue health insurance if coverage would cease due to a reduction of your work hours or your termination of employment (other than gross misconduct) Federal law also enables your dependents to continue health insurance if their coverage ceases due to your health, divorce, or legal separation, or with respect to a dependent child, failure to continue to qualify as a dependent. Continuation must be elected in accordance with the rules of your Employer's group health plan(s) and is subject to federal law, regulations and interpretations
NEWBORNS' & MOTHERS' HEALTH PROTECTION ACT
Federal law prohibits the plan from limiting a mother's or newborn's length of hospital stay to less than 48 hours for a normal delivery or 96 hours for a Cesarean delivery or from requiring the provider to obtain pre authorization for a stay of 48 or 96 hours, as appropriate. However, federal law generally does not prohibit the attending provider, after consultation with the mother, from discharging the mother or her newborn earlier than 48 hours for normal delivery or 96 hours for Cesarean delivery
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THE INSURANCE AND RISK MANAGEMENT BROKERAGE YOU NEVER EXPECTED.