Annual Enrollment
December 3-12th
CoastMgtBenefits.com
2020 Enrollment
What’s Inside
This guide highlights your benefits. Official plan and insurance
documents govern your rights and benefits under each plan.
For more details about your benefits, including covered
expenses, exclusions, and limitations, please refer to the
individual Summary Plan Description (SPD), plan document,
or certificate of coverage for each plan, which can be found
in our company’s designated office. If any discrepancy exists
between this guide and the official documents, the official
documents will prevail.
Coast Property Management
provides participants and their
eligible dependents a vital program
of benefits designed to keep you
healthy, protect your financial
security, and help you balance your
life at work and home.
Open enrollment is the time for you
to review the coverage that will be
offered by the company beginning
January 1st, 2020 and elect the
benefits that will best meet the
needs of you and your family during
the coming year.
• LBG Advisors Overview
• Medical Plan Highlights
• TPA (Administrator) Overview –
Maestro Health
• Provider/Facility Networks (AMPS)
• Health plan App (HealthJoy)
• Other coverages (dental, vision etc.)
• Next steps
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LBG Advisors Overview
Our Role
• Design, negotiate & implement all
programs
• Provide on-going education and
support to Coast employees moving
forward
• We are an extension of your HR
Department
Key Facts:
• Member Firm of Benefits Partners
(large national brokerage)
• Located in the Pacific Northwest
• Key support:• Jason Jakobsen- Senior Consultant
• Matt Christensen- Senior
Consultant
• Kris Kirkpatrick- Claims Support
• 877-485-2120
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Annual Open EnrollmentDecember 3rd- 12th
DECEMBER DECEMBER
3 12
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Changing Your Benefits
General Information:
Certain Qualified Life Events (QLEs) may enable you to change your benefit elections at a time other than during
open enrollment. You can change your benefit elections during the year if you experience a qualified life event. QLEs
include the list below:
Marriage
Divorce, annulment, or legal separation
Birth of your child
Death of your spouse or dependent child
Adoption of/placement for adoption of your child
Termination or commencement of your
spouse’s employment
Change of employment status by you or your spouse, or
another dependent
A significant change in your or your spouse’s health
coverage due to your spouse’s employment
Qualification by the Plan Administrator of a Medical
Child Support Order
Entitlement to Medicare or Medicaid
Dependent satisfies or ceases to satisfy
eligibility requirements
Commencement of or return from an unpaid
leave of absence
A change in the place of residence of you, your spouse,
or your dependent
Your dependent satisfies or ceases to satisfy eligibility
requirements
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Who’s Eligible to Enroll
Active, full-time employees scheduled to work at least 30 hours per week
Eligible dependents include:
• Legally married spouse
• Registered domestic partner (must complete an affidavit of Domestic partnership)
• Children up to age 26, regardless of marital, dependent or student status
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Making Election in Sync-HR
All Employees Must Login to Sync-HR and select an option:
1. Keep existing benefits in place
2. Change Benefits (add/delete)
3. Decline coverage
Administered by Maestro Health
Network: PHCS / AMPS
RX: Envision RX Options
Medical & RX Plan
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Medical Plan Tips
Tip #1: Tell provider you are in-network
with:
• PHCS/MultiPlan Network
• AMPS Prime Network
Tip #2:
• Ask provider to send all invoices to
Maestro Health, contact information
on your benefits card
Tip #3:
• If provider doesn’t know Maestro
health, simply remind them Maestro
Health is the plan claims and billing
administrator. They are not the
insurance company
• You can always call Maestro Health
customer service line to verify benefit
coverage company
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How Your Medical & RX Plan Works
Coast Property Management
Medical Network Prescription Benefit Manager
Medical Administrator
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Envision – Pharmacy Benefits Manager
Details are included on the health benefits website under the “Prescriptions” tab, at:
coastmgtbenefits.com
General Info:Envision RX Options is the pharmacy benefit manager on your plan.Envision RX Options develops the formulary and can answer questions related to RX coverage.
Contact Info: Envision Help-Desk: (800) 361-4542
Envision BIN – 009893Envision PCN – ROIRX
Plan Numbers: WCST – Base Plan
WCSTBUY – Buy Up PlanWCSTHSA – HSA/HDHP Plan
Maestro Health
Medical Administrator- Maestro Health
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TPA: Maestro Health
Maestro Health :Third Party
Administrator
• Process & pay medical claims
• Provide customer service to
employees and providers
• Assist with plan design questions,
what is covered, etc.
• Pre-certify procedures
Maestro Health Customer Service
• Telephone: 800-228-1803
• Email: [email protected]
• Live Chat:
mybenefits.maestrohealth.com
• Hours: 5am-5pm PT
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TPA: Maestro Health
Maestro Health :Employee Portal
• Go to
mybenefits.maestrohealth.com
• Click on Register located under
“new members”
• Select your membership type:
Employee or Dependent*
• Complete the registration
information
• Click on Submit
*Note: Due to HIPAA regulation, Employees cannot have access to personal health information on any dependents ages 18 or older. These dependents must register separately and then authorize the employee to access their information
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TPA: Maestro Health
Maestro Health :Employee Portal
• Check your EOBs
• Check how much the plan has paid
YTD
• Check recent claims
• In –network vs Out of network
Controlling Healthcare Costs
Physicians Network- PHCS,
Facility, Diagnostic, Out of Network Claims- AMPS
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AMPS- Out of Network Cost Containment Service
General Info:Your Health Plan has partnered with Advanced Medical Pricing Solutions (AMPS),
to combat rising healthcare costs for Facility, and OUT OF NETWORK CLAIMS.
FACILITY & OUT OF NETWORK CLAIMS
AMPS handles the negotiations between your
plan and providers / facilities and works with
Maestro to pay a fair price to providers and
facilities that you use for your healthcare.
AMPS will assist plan participants with any balance billing type issues with out of network
claims.
Further details are included on the health benefits website under the AMPS tab, at:
coastmgtbenefits.com
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Medical Plan: PHCS/AMPS
Physician Network: PHCS/Multiplan
• Primary network for physicians and
ancillary
• https://www.multiplan.com/webcent
er/portal/ProviderSearch?SiteId=845
24
• PHCS
• AMPS Prime network backs PHCS up
Facility, Diagnostics, Lab, Out of
Network
• AMPS negotiates the best pricing for
the plan on any claim not through
PHCS/Prime
• Make sure to pay your patient
responsibility
• If you get a bill for more than your
patient responsibility: Call AMPS
immediately.
• More info on AMPS is located at
www.CoastMgtBenefits.com
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Medical Plan: AMPS
Any claim not through PHCS Network
will be handled by AMPS
This means you can go to any provider
you want and know that the plan will
pay a fair price
AMPS will also make sure that the
billing of your claim is reviewed for
errors!
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Medical Plan: AMPS
Facility Billing is out of control
AMPS negotiates a fair price for your
claim
Learn more at: coastmgtbenefits.com
under the AMPS tab
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Medical Plan: AMPS: KEY INFO
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Medical Plan: AMPS- ADVOCACY
AMPS Patient Advocates will be
notified and reach out with a Welcome
Letter to remind you that we’re here
for you in case of any balance billing.
An experienced Patient Advocate can:• Answer balance billing questions
• Explain the dispute process
• Send you a Balance Bill Kit
• Handle provider communications
Remember: 85-90% of the time there
isn’t an issue with balance billing
Remember To:
Medical Plan App: HealthJoy
https://healthjoy.com/features/
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Medical Plan App: HealthJoy
One App for all healthcare needs
• Consult with an online doctor
• Live healthcare concierges
• Quality and cost conscious healthcare
guidance
• Find Lower-cost medication
• Check bills for errors
• Schedule appointments
Mission Control for Your Employee Benefits
• Virtual healthcare assistance
• Centralized benefits access
• On-demand LIVE help
• Save time & money
• 24/7/365
• More information: coastmgtbenefits.com
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HealthJoy Set Up Steps
1. You’ll receive a welcome message in two ways possibly: email and text messages to
your smartphone (when supplied by your company). To activate, click the web link in
either message from your smartphone. The link will take you to an activation screen
where you can create an account.
2. You’ll be taken to a web page asking you to create an 8 character password.
3. After you create a password, we’ll ask you to add family members. Adding family
members is free, and we encourage you to invite all members of your immediate
family that are over 18 years old. They will get access to all the same services including
access to free healthcare Concierges and online doctors.
4. The final step is to download, install and log into the HealthJoy app. The app is
available for Android, iPhone, and iPad and requires an Internet connection. Just click
the download button at the end of the setup process and will be taken to our app
within your smartphone’s app store.
After you download the HealthJoy app, all you need to do is log in to the app with the
email address where you received your invitation and the password you created. JOY,
your virtual healthcare assistant, will welcome you to the app. You can start using the app
within seconds.
Benefits
Medical & RX Plan Information
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Healthcare Definitions
No Network – Coverage extends to any licensed provider in the
United States. Our plans are designed to give you the freedom to
use the healthcare provider of your choice.
Preventive Care Services – These are services that are generally
linked to routine wellness exams and screenings. Non-preventive
services are those that are considered treatment or diagnosis for
an illness, injury, or other medical condition. Preventive care is
covered at 100% in-network.
Annual Deductible – The amount of money you must first pay
out of pocket before your plan begins paying for services covered
by coinsurance is your Annual Deductible. After you meet your
deductible, the plan pays for a percentage of eligible expenses
(coinsurance) until you meet your out-of-pocket maximum.
Copayments and Coinsurance – A copayment
(or copay) is the fixed dollar amount you pay at the time of
service. In some cases, you may be responsible for coinsurance
after the copay is made. Coinsurance is the percentage of
covered expenses shared by you and the plan. In some cases,
coinsurance is paid after you meet a deductible.
For example, the Basic Plan pays 85% of the covered charge after
your Annual Deductible (if applicable). You are responsible for
paying the remaining 15% coinsurance and any of the deductible
that may apply to the claim.
Maximum Out of Pocket Amount – Your plan provides a stated
maximum annual cost for you and your covered dependents. It
includes amounts your pay for your deductible, coinsurance,
pharmacy and co-payments. Once you reach this limit, your plan
covers 100% of your eligible claims expenses for the rest of the
year.
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Healthcare Definitions continued
Summary Plan Description (SPD) – The SPD is an important
document that defines the terms and care offered by the medical
plan. The booklet describes who is eligible and when coverage
terminates. It offers definitions for important terminology found
within the contract to help you better understand the coverage
afforded by the plan design. The Summary Plan Description also
provides a list of specifically excluded services, procedures and
conditions as well as describing your rights to appeal decisions that
you disagree with.
Health Plans are legally obligated by The Employee Retirement
Income Security Act (ERISA) to provide participants SPDs for each
benefit plan offered by the health plan.
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Medical Plan Comparison (PPO vs. HSA)
In Network Benefit Comparison (see SBC’s posted at
CoastMgtBenefits.com for more details and out-of-
network benefits)PPO-500 PPO-1000 H.S.A.
Calendar Year Deductible (CYD) $500 (EE)/ $1500
(FAM)
$1,000 (EE)/
$3,000 (FAM)
$1,400 (EE)/
$2,800 (FAM)
Out-of-Pocket Maximum (Includes Medical Copays, Pharmacy
copays, deductible and coinsurance)$2500 (EE)/$7500
(FAM)
$5,000 (EE)/
$12,700(FAM)
$5,000 (EE)/
$12,700(FAM)
Preventive Services
(Office Visit/Lab/X-ray/Childhood Immunizations) Covered at 100% Covered at
100%
Covered at 100%
Physician Visits:
Primary/Specialist/Chrio $25 co-pay $30 co-pay Deductible/ Then
20%
Urgent Care: $55 co-pay per visit $60 co-pay per
visit
Deductible/ Then
20%
ER Services $200 co-pay $250 co-pay Deductible/ Then
20%
Rx Retail (Generic/Pref/Non-Pref/Specialty)
Mail order 2x amount listed $5/$25/$50/20% to
$150
$5/$25/$50/20
% to $150
Deductible/ Then
5/25/50/20% to
150
Facility Fee (e.g. Hospital Room) 20% Co-Ins 20% Co-Ins Deductible/ Then
20%
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Prescription Benefit Summary
Prescription Drugs 30 day supply retail
(PPO 500/1000 Plans)
30 day supply retail (HSA Plan)
Tier 1 Generic $5 co-pay
(x 2 for 90 day mail)
After deductible is satisfied
$5 co-pay
(x 2 for 90 day mail)
Tier 2 Preferred $25 co-pay
(x 2 for 90 day mail)
After deductible is satisfied
$25 co-pay
(x 2 for 90 day mail)
Tier 3 Non-Preferred $50 co-pay
(x 2 for 90 day mail)
After deductible is satisfied
$50 co-pay
(x 2 for 90 day mail)
Tier 4 Specialty 20% co-insurance to $150 After deductible is satisfied
20% co-insurance to $150
*Out of network reimbursed at 50% of network rate after co-pay
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Did U know?
Urgent Care vs Emergency Care
Urgent Care ($55/60) vs.
ER ($200/$250)
Look-up Urgent Care in
directory before you need.
Use MeMD for Telehealth
Through HealthJoy App!
URGENT CARE EMERGENCY CARE
Ear infection Severe chest pain
Back pain Heavy bleeding
Sprains and strains Poisoning
Most minor cuts &
fractures
Major trauma
Colds & other minor
respiratory problems
Loss of consciousness
Health Savings Accounts
HSA Accounts
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HSA Account
A Health Savings Account (HSA):
• Set aside a portion of your paycheck—before taxes—into an account
• Rolls from year to year• It is your account – even if you leave Coast• Help you pay for qualified medical expenses for you
and your dependents!• It can also help you plan for future medical expenses• Reduces Taxable Income (w2 decrease through
payroll / tax form if direct contribution)*• Funds may be invested in mutual funds yielding tax
free earnings* (details to be provided by new H.S.A. administrator – min balance $2,000)
• Can use funds for dependent expenses even if they are not your health plan
* LBG Advisors are not tax advisors. Please consult your tax advisor for details.
Administrator- IntegraFlex/NueSynergy
HSA Administration
• Participant Customer Service Phone:
(855) 345-9151
• Participant Account Questions Email:
• Claims Fax: (855) 673-6711
• Claims Submission Email:
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HSA Account: Details
You are not eligible to contribute to H.S.A if:
• If you are claimed as a dependent on someone else’s taxes
• You are covered by any other health insurance policies that are not considered High-Deductible Health Plans (HDHPs)
• You are currently on Medicare (previous H.S.A. funds can pay Medicare premiums A/B)
• If you participate in an unlimited FSA or HRA through your employer or your spouse’s employer, (Limited or Dependent FSA is allowed with H.S.A)
• You and your spouse can each have an HSA if you both have high deductible coverage. If you have family HDHP coverage (Min deductible $1350 individual or $2700 family), the maximum contribution is split equally unless you and your spouse agree on a different division.
The list later in this PowerPoint shows common examples of qualified medical expenses. Complete lists of eligible and non-eligible expenses can be found in IRS Publication 502, which can be ordered from the IRS by calling 1-800-TAX-FORM (1- 800-829-3676) or by visiting www.irs.gov.
Employees:
• Control HSA disbursements (not a reimbursement program)
• Will receive a debit card for HSA funds or can use bill-pay feature online
• Will be responsible to save all receipts for tax audit purposes
• If you are disabled or reach age 65, you can receive non-medical distributions without penalty, but you must report the distribution as taxable income (similar to traditional 401k)
• $3.00 monthly admin fee built into total rate
Annual Funding Limits
• 2020 Limit $3,550 Individual
• 2020 Family Limit $7100
• If over 55, add $1,000 to limits above
There are certain restrictions that may prevent joining H.S.A. Plan
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HSA: Eligible Expenses- Keep your Receipts!
Acne treatment*AcupunctureAllergy & Sinus medication*Antacids*Antibiotic ointment*Anti-diarrheal*Antifungal foot cream*Anti-gas medication*Anti-itch cream/gel*Antiseptic* Asthma treatment*Bandages/gauzeBirthing classes or LamazeBlood pressure monitor Braces (knee, ankle, wrist)Breast pumpBurn cream*Chiropractic servicesCoinsurance Cold/hot packCold sore treatment*
Cold/cough medication*Compression stockingsContacts & solutionsCopaysCPAP machineCrutchesDeductiblesDental services Diabetic suppliesDiaper rash ointment*Digestive Aids*Drug addiction treatmentEar wax removal kits*Eye dropsFeminine Anti-Fungal/Anti-Itch*First Aid KitFlu shotsGroup therapyHearing aids & suppliesHemorrhoid medication*Hormone therapyHospital fees
HumidifiersImmunizations*Incontinence supplies Individual counselingInsect bite treatment*Lab workLactation ConsultantLactose intolerance pills*Laser eye surgeryLaxative*Lice treatment products*Massage therapyMedical records Motion sickness relief*Nasal stripsNaturopathic visitsOrthodontiaOrthotic insertsOxygen and equipmentPain relievers*Parasitic treatment*Physical exams
Physical therapy Pregnancy testPrenatal vitaminsPrescription drugsPrescription glassesReading glassesRespiratory TreatmentsSaline nasal spraySleep Aids & Sedatives*Sleep deprivation treatmentSmoking cessation products*Smoking cessation programs Speech therapyStool softener*ThermometerThroat lozenges*Vision careWalker Wart treatment*Wheelchair & repairX-rays
Things that are hygienic
or cosmetic in nature are
not eligible
Some Items that are
hygienic:
Toothbrushes
Toothpaste
Toiletries
Some items that are
cosmetic:
Veneers
Teeth whitening /
bleaching
Cosmetic Surgery
Delta Dental
Dental Plan
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Dental Plan: PPO Plans
General Info:In 2020 your dental plan will be renewing with Delta DentalSee coastmgtbenefits.com for details, disclaimers & disclosures.
Calendar Year Benefits In-Network Base-Plan In-Network Buy-Up
Deductible $50(EE) /$150 (FAM)
(Class II/III only)
$50(EE) /$150 (FAM)
(Class II/III only)
Preventive Care (Class I) 100%
(deductible does not apply)
100%
(deductible does not apply)
Basic Care (Class II) 80% 90%
Major Care (Class III) 50% 60%
Annual Maximum $2,000 / person $2,500 / person
Child Ortho n/a $1,000 lifetime
Vision Plan- VSP
Vision Plan
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VSP Vision Plan
General Info:In 2020 your vision plan will be with VSP
Large U.S. network of providers
Private practitioners and major retail centers
Eye exams, frames, lenses, and contacts
See coastmgtbenefits.com for details, disclaimers & disclosures.Co-Pay $10 Routine Exam / Frames
Eye Exam 1 routine exam per year
100% after $10 co-pay
Hardware (glasses) Frames Up to $150 every year
Lenses 100% Every year
Contacts Up to $150 every year
Visit 1 PCY
Network VSP (www.vsp.com)
Life, AD&D- Lincoln
Life, AD&D
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Basic Life and AD&D
Please see reference documents below- must be enrolled in medical plan to receive life
insurance benefit
Current Enrollees
• Flat $15,000 per employee
• Employee must be enrolled in medical coverage to receive this benefit
• Benefits terminate at retirement
• Non-portable
Customer Service Center: (800) 423.2765 Press
“Option One” for claims. Press “Option Two”
for administration and other questions.
Customer Service Center Hours of Operation:
Monday through Thursday, 7 a.m. – 7 p.m.
Central Time Friday, 7 a.m. – 5 p.m. Central
Time
Email us at: [email protected] for any claims
questions. [email protected] for
administration and other questions.
Email address to submit disability claims is:
Visit us at: Lincoln4Benefits.com for real-time
information and benefit administration.
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Employee Assistance Program
• Emotional/mental health
• Parenting/family issues
• Marital/relationship difficulties
• Workplace Issues
• Substance abuse
• Other – dependent care, legal issues, health problems
The EmployeeConnect Plus program
providers assistance with personal and
work- related concerns.
Call toll-free 888-628-4824 or 855-327-4463 (24 hrs/day), or visit us online at
www.GuidanceResources.com
(Register with Web ID "Lincoln" and select
Hoban as employer)
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Next Steps
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Next Steps
Login to Sync-HR to confirm, decline, or change benefits
If you select H.S.A. option, please setup an H.S.A. bank account
complete payroll deduction information (see H.S.A. tab on
website)
For more information please contact HR or LBG Advisors
Visit www.coastmgtbenefits.com
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Required Notices
• Notice of HIPAA Special Enrollment Rights
• Wellness Program Disclosure Notice of Alternative
Standard
• Medicare Part D Notice
• Children’s Health Insurance Program
(CHIP) Notice
• Grandfather Status
• Notice of Patient Protection Provisions
• COBRA Notice
• Medical Child Support Order Notice
• Women’s Health and Cancer Rights Act
• Summary of Benefits and Coverage
• Mental Health Parity and Addiction Equity Act
(MHPAEA) Notice
The U.S. government requires companies offering certain employee benefit plans to inform
covered participants and their dependents about laws/provisions that affect the
governance and/or coverage within those plans.
The company has full details available for you concerning the following laws/provisions
listed below:
Summaries of each can be found in the Your Required
Notices brochure. For complete information and more
detailed explanations about any of these notices,
contact Liza Spooner, Human Resources. Also, from time
to time, you may receive detailed explanations directly
from the company via letter or email.
These can be found on the trust web site at:
coastmgtbenefits.com
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Contact
Coast Property ManagementLynette Jacobson | V.P. Human Resources
PH: 425.339.3638
E: Lynette Jacobson [email protected]
Medical & Vision QuestionsCustomer Service (Claims/Pre-Cert) :
800.228.1803
Submit Claims to:
Maestro Health
P.O. Box 1178
Matthews, NC 28106https://mybenefits.maestrohealth.com/#/
Prescriptions – Envision RX Option
(800) 361-4542Dental- Delta Dental
Contact Info: 800-554-1907
Facility, Balance Bill, and Out of
Network Support
AMPS
(800) 425-9373
Basic Life & AD&D
(800) 423.2765
Lincoln4Benefits.com
Employee Assistance Program
Employee Connect Plus
888-628-4824
www.GuidanceResources.com
HSA Administration
IntegraFlex/Nue Synergy
(855) 345-9151
https://integra-flex.com/coastmgt
Vision
VSP-800-877-7195
www.vsp.com
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Your LBG Advisors Service Team
Dedicated Service
Claims Issues/Questions
Kris Kirkpatrick
877-485-2120 ext. 303 [email protected]
Benefit Consultants:
Matt Christensen
877-485-2120 ext. 309
Jason Jakobsen
877-485-2120 ext. 306
Thank You!
LBG Advisors, LLCLocal 425.778.2800 / TF: 877.485.2120
http://www.lbgadvisors.com
[email protected] or [email protected]
*All information in this Power Point is for illustrative purposes only.
Please consult full SPD’s for full details. This presentation is not a guarantee of coverage.