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Chamber Employee Benefit Program Prepared by:
Chamber Employee Benefit Program
Prepared by:
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• Introduction Letter .....................................................................................................................................................3
Exclusive Pricing For Chamber Members
• Dental Insurance Benefits ....................................................................................................................................4-6
• Vision Insurance Benefits .........................................................................................................................................7
• Telemedicine.................................................................................................................................................................8
• Mobile Rx App ..............................................................................................................................................................9
Other Programs Available Through Fringe Benefit Analysts
• Medical Benefit Program ................................................................................................................................10-11
• LSS Medicare .............................................................................................................................................................. 12
• Contact Info ................................................................................................................................................................ 13
Table of Contents
Let us help you with a custom-designed benefits package that will save you time and money.
This guide is intended to provide you a brief overview of insurance benefit options.Please refer to the plan documents provided by the carrier(s) for information regarding coverage, limitations and exclusions.
If there is a difference between this guide and the plan documents, the plan documents will prevail.
Cache Chamber of Commerce
Dear friends and members of the Cache Chamber of Commerce,
The Cache Chamber of Commerce prides itself on being more than just a meeting place for businesses. It is an opportunity for members to grow their businesses. The Chamber offers activities, committees, and programs that open the door of opportunity and enable businesses of all sizes to prosper.
Our commitment is to find new and ongoing ways to improve business operations. In keeping with this commitment, the Chamber, in cooperation with Fringe Benefit Analysts, is excited to offer this program to help businesses tackle the daunting task of providing and managing a successful and cost effective employee benefit program. FBA has been a loyal and active member of the Chamber for more than a decade and is excited to partner with Chamber members to bring innovative solutions to the challenges that many businesses face with their employee benefits.
With the State of Utah unemployment rate at an all-time low, it is becoming more and more difficult to attract and retain talented employees. This program provides Chamber members the opportunity to create a comprehensive benefits plan designed to contain costs, ensure Affordable Care Act compliance and develop greater employee satisfaction.
This booklet contains exclusive products as part of your membership in the Cache Chamber of Commerce. We hope you will take advantage of these valuable benefits.
Thank you for your loyalty and membership that makes programs like this possible.
Sincerely,
Sandy EmilePresident & CEO, Cache Chamber of Commerce
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This guide is intended to provide you a brief overview of insurance benefit options.Please refer to the plan documents provided by the carrier(s) for information regarding coverage, limitations and exclusions.
If there is a difference between this guide and the plan documents, the plan documents will prevail.
Summit Co-pay
Dental Insurance Benefits
Benefits In-Network Out-of-Network
Single Deductible None None
Family Deductible None None
Annual Maximum (per person per calendar year) Unlimited
Lifetime Orthodontic Maximum Unlimited N/A
Preventive Services (Class 1)Oral examinations, cleanings, x-rays, fluoride, etc.
100%See Co-pay Schedule
See Schedule
Basic Services (Class 2)Restorations, fillings, simple extractions, emergency pain, etc.
See Co-pay Schedule See Schedule
Major Services (Class 3)Extractions, oral surgery, endodontics (root canal therapy), periodontics
(treatment of gum tissue), crowns, dentures, bridges, implants, and other
prosthetic services
See Co-pay Schedule See Co-pay Schedule
Orthodontics Discount Only None
Waiting Period None
Minimum Participation (Group is 2+) 75% of eligible100% Groups 2-4
20%100% Groups 2-4
Contributory* Rates: Voluntary Rates:Employee: $16.59 Employee: $18.24Employee + 1: $32.02 Employee + 1: $35.22Family: $58.13 Family: $63.94*Minimum 50% of Employee Only Rate
Custom Options All Plans
Exams/Cleanings 2 in 12 not 1 in 6 PPO Only
Increase Max from $1000 to $1500Increase Max from $1000 to $2000Add Annual Max CarryoverAdd $1500 Dependent Ortho (10+ elig.)Add $1000 Dependent Ortho (10+ elig.)Move Perio from Major to BasicMove Endo from Major to BasicComposites on all teeth - no molar downgradeAdd Implant Coverage (Major)
Increase
2%
7%11%
2%8%5%4%3%4%2%
Dental Benefits Program
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This guide is intended to provide you a brief overview of insurance benefit options.Please refer to the plan documents provided by the carrier(s) for information regarding coverage, limitations and exclusions.
If there is a difference between this guide and the plan documents, the plan documents will prevail.
Pinnacle Essentials PPO - Mid
Dental Insurance Benefits
Benefits In-Network Out-of-Network
Single Deductible $50 (waived for preventive)
Family Deductible $150 (waived for preventive)
Annual Maximum (per person per calendar year) $1,000
Lifetime Orthodontic Maximum Unlimited N/A
Preventive Services (Class 1)Oral examinations, cleanings, x-rays, fluoride, etc.
100% 80%
Basic Services (Class 2)Restorations, fillings, simple extractions, emergency pain, etc.
80% AD 70% AD
Major Services (Class 3)Extractions, oral surgery, endodontics (root canal therapy), periodontics (treatment of gum tissue), crowns, dentures, bridges, and other prosthetic services
50% AD 50% AD
Orthodontics Discount Only None
Waiting Period Varies**
Minimum Participation (Group is 2+) 75% of eligible100% Groups 2-4
20%100% Groups 2-4
AD = After Deductible**12 Month waiting period for Major Services, waived with prior comparable coverage for voluntary and contributory
Contributory* Rates: Voluntary Rates:Employee: $20.01 Employee: $22.01Employee + 1: $38.41 Employee + 1: $42.26Family: $77.20 Family: $84.93*Minimum 50% of Employee Only Rate
How to Calculate Custom Options
To calculate the price of adding custom options, simply add all of the selected options together and multiply each tier of the chosen plan by: 1+ (total % price increase)
Example:To increase the annual maximum to $1500 (7%) and add implant coverage (2%) on the Contributory Pinnacle Essentials PPO Mid:(7% + 2% = 9% total increase), multiply rates by 1.09:EE Only: $20.01 x 1.09 + $21.81EE+ 1: $38.41 x 1.09 = $41.87Family: $77.20 x 1.09 = $84.15
Dental Benefits Program
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This guide is intended to provide you a brief overview of insurance benefit options.Please refer to the plan documents provided by the carrier(s) for information regarding coverage, limitations and exclusions.
If there is a difference between this guide and the plan documents, the plan documents will prevail.
Pinnacle Essentials PPO - High
Find a provider www.usdentistdirect.com
• Click on "Provider Search" at the top• On the "Select your Network" drop down menu, click on
"Pinnacle Provider Network (PPO Network)" or "Summit Network" for Co-Pay Plan
• The "City" and "State" or "Zip Code" are required• Click on "Search"
Benefits In-Network Out-of-Network
Single Deductible $50 (waived for preventive)
Family Deductible $150 (waived for preventive)
Annual Maximum (per person per calendar year) $1,000
Lifetime Orthodontic Maximum Unlimited N/A
Preventive Services (Class 1)Oral examinations, cleanings, x-rays, fluoride, etc.
100% 100%
Basic Services (Class 2)Restorations, fillings, simple extractions, emergency pain, etc.
80% AD 80% AD
Major Services (Class 3)Extractions, oral surgery, endodontics (root canal therapy), periodontics (treatment of gum tissue), crowns, dentures, bridges, and other prosthetic services
50% AD 50% AD
Orthodontics Discount Only None
Waiting Period None**
Minimum Participation (Group is 2+) 75% of eligible100% Groups 2-4
20%100% Groups 2-4
AD = After Deductible**Contributory: No Waiting Period Voluntary: 12 Month waiting period for Major Services, waived with prior comparable
Contributory* Rates: Voluntary Rates:Employee: $22.30 Employee: $22.44Employee + 1: $42.80 Employee + 1: $43.08Family: $85.36 Family: $86.46*Minimum 50% of Employee Only Rate
Dental Insurance Benefits
Dental Benefits Program
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This guide is intended to provide you a brief overview of insurance benefit options.Please refer to the plan documents provided by the carrier(s) for information regarding coverage, limitations and exclusions.
If there is a difference between this guide and the plan documents, the plan documents will prevail.
Vision Insurance Benefits
Find a provider www.standardoptical.net
• Click on “Search” next to Find a doctor• Click on drop down box with “Search Type” • Click on “Vision” • Click “Go” • Click on “Member ID”• Type your Member ID, and click “Go”
Exclusive Benefits for Chamber Members
Benefits Standard Optical Exclusive
In-Network Out-of-Network
Provider Network Basic Free Plan 10-120B 10-120B
Eye ExamCopay $10 $10 Co-pay $40 Allowance
LensesSingleBifocalTrifocal
$20$20$20
$10 Co-pay$10 Co-pay$10 Co-pay
$85 Allowance for lenses, options &
coatings
Lens OptionsProgressivePremium Progressive OptionsUltra Premium Progressive OptionsPolycarbonateHigh Index
$50 Co-pay$100 Co-pay
Up to 20% Discount$40 Co-pay$80 Co-pay
$50 Co-pay$100 Co-pay
Up to 20% Discount25% Discount25% Discount
FramesAllowance (based on retail pricing) $70 Allowance $120 Allowance $80 Allowance
ContactsAllowance $50 Allowance $120 Allowance $80 Allowance
Lasik $250 off per eye $250 off per eye Not covered
FrequencyExams, lenses, frames, contacts Every 12 Months Every 12 Months Every 12 Months
Basic Free Plan: 10-120B:Employee: FREE Employee: $6.32Employee + 1: $5.53 Employee + 1: $12.39Family: $9.42 Family: $21.11
Vision Benefits Program
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This guide is intended to provide you a brief overview of insurance benefit options.Please refer to the plan documents provided by the carrier(s) for information regarding coverage, limitations and exclusions.
If there is a difference between this guide and the plan documents, the plan documents will prevail.
Telemedicine Rates:Employee: $4.00 Employee + 1: $4.00Family: $4.00
Telemedicine Prgram
Teladoc does not replace the primary care physician. Teladoc does not guarantee that a prescription will be written. Teladoc operates subject to state regulation and may not be available in certain states. Teladoc does not prescribe DEA controlled substances, non-therapeutic drugs and certain other drugs which may be harmful because of their potential for abuse. Teladoc physicians reserve the right to deny care for potential misuse of services. 03292011
Visit us: www.Teladoc.com or Call us: 1-800-Teladoc (835-2362)
U.S. BOARD-CERTIFIED DOCTORS24/7/365 on-demand access to
Talk to a anytime.
Teladoc 24/7/365
When can you use Teladoc? Two words: Anytime. Anywhere. Call Teladoc:
• When you need care now.• If you’re considering the ER or
urgent care center for a non-emergency issue.
• On vacation, on a business trip, or away from home.
• For short-term prescription refills.
Teladoc your concerns
Our state-licensed doctors can resolve many of your medical issues including:
• Cold & flu symptoms• Bronchitis• Respiratory infection• Sinus problems• Allergies• Urinary tract infection• Ear infection• Pink eye
Teladoc for less
Teladoc consultations are only:
Why wait for the care you need?
Call Teladoc and feel better now!
$38Teladoc is happy to provide information about your consultation to your primary care physician.
Teladoc is a national network of U.S. board-certified doctors available on-demand 24/7/365 to diagnose, treat and prescribe medication, if necessary, for many of your medical issues. It's
quality care when you need it at a price you can afford.
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This guide is intended to provide you a brief overview of insurance benefit options.Please refer to the plan documents provided by the carrier(s) for information regarding coverage, limitations and exclusions.
If there is a difference between this guide and the plan documents, the plan documents will prevail.
OneRx is the first mobile solution that puts the tools to control prescription drug spend at the fingertips of both insured and uninsured employees.
THE FREE RX SAVINGS SOLUTION FOR ALL EMPLOYEES
Free Rx SavingsManage prescriptions Search for the lowest price Save money instantly
With OneRx...Know out-of-pocket costs in real timeEmployees save money by seeing their personalized out-of-pocket for a drug being prescribed, right at the point of care
Be alerted to insurance restrictions Increase adherence by knowing if step therapy or prior auth is required before you try to fill the script
Save InstantlyRedeem Rx coupons & discounts instantly See local pharmacy pricing
FREE. For you and your employees
SAVINGS. Employees save money by being in the know
NOW. No enrollment windows, no restrictions
Free Supplemental Benefit Avg individual can save $750+ per year with OneRx
No SurprisesAccess real time plan based info, when & where it’s needed
EMPOWER YOUR EMPLOYEES TO SAVE MORE TODAY
Learn more at onerx.com/employer | Request a demo at [email protected]
IN PARTNERSHIP WITH
Mobile Rx App
Rx Discount Program
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EMI Health has a unique approach to health insurance by combining employers with better risk into one large pool. This provides small employers the same advantages that large employers enjoy, resulting in better cost control and lower renewals. Employers can have better control over their health insurance budget, contributing to a happier and a more engaged workforce.
Why Participate in ProGroup EMI Health Pool?Minimized RiskEasier to predict cost increases and decreases Lower administrative costsUnderwritten as a large groupProvides quarterly pool reportsSignificant cost and benefit design advantages in relation to ACA requirementsKeeps renewal rates at a minimumPossible premium reimbursement
Network OptionsAll Intermountain Hospitals and InstaCare facilitiesDavis Hospital and Medical CenterMcKay-Dee HospitalOgden ClinicTanner ClinicLarge comprehensive network of doctors and specialistsCIGNA network for out-of-state coverage
Value Added ProgramsIntegrated wellness program with on-site biometric screeningsFree Telemedicine with access 24/7/365 to a board certified doctor who can write
prescriptions over the phone for most conditionsOnline portals for employers and employees Free COBRA administration
Pooled product offered through EMI ProGroup Pool is an ERISA partially self-funded arrangement. This product is medically underwritten and rates are based upon the underwriting assessments of the employer group applying for coverage. Not all groups will receive the same rates. EMI reserves the right to decline to quote if the requirements to enter the EMI ProGroup Pool are not satisfied or if they are found to be uncompetitive in comparing the current rates of the group sponsor health insurance plan. Minimum sized employer group to be considered is 10 full-time employees.
This guide is intended to provide you a brief overview of insurance benefit options.Please refer to the plan documents provided by the carrier(s) for information regarding coverage, limitations and exclusions.
If there is a difference between this guide and the plan documents, the plan documents will prevail.
Medical Benefit Program
Medical Insurance Benefits
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This guide is intended to provide you a brief overview of insurance benefit options.Please refer to the plan documents provided by the carrier(s) for information regarding coverage, limitations and exclusions.
If there is a difference between this guide and the plan documents, the plan documents will prevail.
Medical Benefit Program
Medical Insurance Benefits
Aetna’s Funding Advantage plan is a great way for employers with five or more full-time employees to take advantage of the benefits of level-funding. Aetna’s new healthcare approach provides employer reporting, a large comprehensive network of doctors and facilities and the possibility of premium refunds!
Why Participate in Aetna Funding Advantage?Easier to predict cost increases and decreasesMedically underwritten to your company’s demographicsProvides reporting on company claimsSignificant cost and benefit design advantages in relation to ACA requirementsPossible premium reimbursement
Network OptionsMany Intermountain Hospitals and InstaCare facilitiesDavis Hospital and Medical Center McKay-Dee HospitalOgden Regional Medical Center Ogden ClinicTanner ClinicAetna’s large national network
Level-funding product offered through Aetna is an ERISA partially self-funded arrangement. This Product is medically underwritten and rates are based upon the underwriting assessment of the employer group applying for coverage. Not all groups will receive the same rates. Aetna reserves the right to decline to quote if the contract requirements are not satisfied or if they are found to be uncompetitive in comparing the current rates of the group sponsor health insurance plan. Minimum sized employer group to be considered is 10 full-time employees.
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This guide is intended to provide you a brief overview of insurance benefit options.Please refer to the plan documents provided by the carrier(s) for information regarding coverage, limitations and exclusions.
If there is a difference between this guide and the plan documents, the plan documents will prevail.
Medicare HelpMEDICARE HELP
Ready for Medicare? LSS Insurance Agency is here to help. Let us answer all your questions, assist you with enrollment as well as help guide you through your additional Medicare options. We know all the ins and outs of original Medicare, Medicare Supplements and Medigap plans, Medicare Advantage plans, and Prescription Drug plans. Not ready to retire just yet? We can help compare your employer coverage to Medicare and see which would best fit your needs. We’re here every step of the way. Even after your enrollment is complete we’re here to help with on-going needs such as answering network questions, finding a provider, assisting with claims and answering benefit questions. Please give us a call 435-752-9493 or come by the office 169 East 1600 North, North Logan – we’re here local for you.
Bob Larsen, Rusty Allen & Gary Smith
LSS Insurance Agency is affiliated with Fringe Benefits.
Medicare Benefit Program
Copyright © 2017 Encore Benefits. All rights reserved.
Simplifying the Complex
Fringe Benefit Analysts is here to help.
Contact an office near you for a no-obligation consultation.
Phone Website/Email
Fringe Benefit AnalystsLayton Office 801-546-6004
Fringe Benefit AnalystsLogan Office - LSS Insurance 435-232-1439
