2W E L C O M E T O Y O U R 2 0 2 3 - 2 0 2 4 B E N E F I T S !Your health and the health of your family is as important to us as it is to you. That’s why we have carefully considered the available benefit options and selected the plans that we feel offer first-rate benefits at a good value. During this enrollment period, please carefully review each of your options so that you can choose the plans that will best meet your needs. If you have any questions regarding your benefits, please contact us in Human Resources or reach out to our OneDigital Employee Advocate.T A B L E O F C O N T E N T S3. Important Contacts4. Enrollment & Eligibility 5. Common Terms6. Medical Insurance7. Save on Specialty Rx8. Make The Most Of Your Medical Plan9. Carrier Resources 11. Supplemental Insurance12. Dental Insurance13. Vision Insurance14. Finding In-Network Providers15. Life Insurance16. Disability Insurance17. Help When You Need It18. How to Enroll19. Notices & Enrollment
Y O U R B E N E F I T S T E A MMEDICALUMR | Group # PendingCall # on ID card | www.umr.comPRESCRIPTION (RX) PROGRAMSmithRx(844) 454-5201 | https://smithrx.comEmail: connect@smithrx.comSUPPLEMENTALGuardian | Group #529787(800) 541-7846 | www.guardiananytime.comDENTAL Guardian | Group #529787(800) 541-7846 | www.guardiananytime.comVISIONGuardian | Group #529787(877) 814-8970 | www.guardiananytime.comLIFEUnited Healthcare | Group #308006(866) 414-1959 | www.myuhc.comDISABILITYUnited Healthcare | Group #308006(866) 414-1959 | www.myuhc.comMEMBER ASSISTANCE PROGRAM United Healthcare(877) 660-3806 | www.liveandworkwell.comAccess Code: FP3EAP I M P O R T A N T C O N T A C T SReturn to Table of ContentsC A R R I E R C O N T A C T SObsidian Entertainment Tina Parker, Director of Human Resources (949) 379-3300 ext. 3399 | tparker@obsidian.netONEDIGITAL HEALTH & BENEFITSEmployee Advocate: Shannon Ball(800) 264-9918 ext. 57626 | shannon.ball@onedigital.com3
Your dependents can be enrolled on the plan with you if they meet one of the following requirements: • Legal Spouse or qualified domestic partner• Dependent Children (under the age of 26)• Children of your spouse or domestic partner • Dependent children of any age who are incapable of self-sustaining employment because of mental or physical handicap, and who receive from you or your spouse all of their support and maintenance, and who were continuously enrolled on the current medical plan before the age of 26.You can enroll on the plans included in this guide if you are an employee who is consistently working 30 hours or more per week. As a new hire, your benefits will be effective the 1stof the month following your date of hire if you are a permanent employee, or 1stof the month following 60 days of full-time employment if you are a temporary employee.E M P L O Y E E E L I G I B I L I T YF A M I L Y E L I G I B I L I T YW H E N C A N I M A K E C H A N G E S ?H O W M U C H W I L L I T C O S T ?Mid-year, you can make changes if one of these occur:Marriage, Birth of a child, Adoption, Involuntary loss of coverage from a qualified group plan, Divorce, Legal separation, Death of spouse or dependent child.Open Enrollment happens once a year and allows you to freely make changes to your plans and who is enrolled. Your company’s annual Open Enrollment takes place in July for an effective date of August 1st. You will pay for your portion of the benefit cost through payroll deductions. The deduction amounts are subject to change at any time as deemed appropriate. Any revisions and changes will be provided in writing with a minimum of 30 days prior to the implementation of the change in contributions.E N R O L L M E N T & E L I G I B I L I T YReturn to Table of ContentsD E P E N D E N T A G E L I M I T A T I O N SYour dependent children will no longer be eligible to be enrolled on your plan beyond these age limits:MEDICAL: Until age 26DENTAL: Until age 26VISION: Until age 26CHILD VOLUNTARY LIFE: Until age 264
COMMON TERMSThroughout this Benefits Guide, you may come upon a few terms that you don’t recognize or fully understand. Refer back to this page as needed to define common benefits terminology you come across. PPO PLANWith a Preferred Provider Organization (PPO) plan you have greater flexibility and choice to use both in-network and out-of-network physicians. However, you are encouraged to receive services from the in-network doctors, specialists or facilities. By doing so, you obtain a higher level of benefit than if services were rendered from an out-of-network provider.PREMIUMA premium is the total cost for your medical insurance. You and your company share this cost. You pay your portion through payroll deductions.DEDUCTIBLEA deductible is the amount you must pay before the medical plan begins sharing the cost of services. You pay this full amount, if required by your plan, before the plan pays benefits.• Embedded Deductible: A policy with a deductible for each person covered. Benefits kick in for a family member when they meet their individual deductible and for the whole family when at least two members do so. Embedded policies tend to have higher premiums to accommodate lower deductible options.COPAYA fixed amount (for example, $10) you pay for covered health care services to providers who contract with your health insurance or plan. In-network copayments usually are less than out-of-network copayments.COINSURANCEYour share of the costs of a covered health care service, calculated as a percent of the allowed amount for the service. You pay coinsurance plus any deductibles you owe.OUT-OF-POCKET MAXIMUMThe annual out-of-pocket maximum protects you from major medical expenses. This is the most you would pay, including your deductible and copay, for eligible expenses during the year. Once you reach the out-of-pocket maximum, the plan pays 100% of the usual, customary and reasonable charges for covered services.EVIDENCE OF INSURABILITY (EOI)Evidence of Insurability (EOI) is a record of a person's past and current health events. It's used by insurance companies to verify whether a person meets the definition of good health. You may have to submit this form to a carrier before you are able to elect certain amounts of coverage for voluntary plans.SBC & UNIFORM GLOSSARYYour employer is required to provide you with an easy-to-understand summary about the health plan benefits available to you, aka Summary of Benefits and Coverage (SBC) and a Uniform Glossary that outlines insurance definitions.• SUMMARY OF BENEFITS & COVERAGE (SBCs) are available free of charge. Please reach out to Human Resources to obtain copies of the medical plans that are offered to you during your plan year.• The UNIFORM GLOSSARY is a glossary of insurance definitions in standard, consumer-friendly terms. You may find this helpful as you are evaluating your options. To access the glossary visit: www.healthcare.gov/glossary.Return to Table of ContentsLEARN MOREClick HERE to watch a video on the Language of Insurance 5
UMR PPOIN-NETWORK BENEFITSUHC Select Plus NetworkMedical Deductible (Single/Family)NoneOut-of-Pocket Maximum (Single/Family)$2,000 / $4,000EmbeddedOffice Visits (PCP/Specialist)$10 Copay / $10 CopayVirtual Visit (PCP)$0 copayUrgent Care$35 CopayLaboratory/X-Ray0%Inpatient Care (Includes Maternity)0%Outpatient Surgery0%Emergency Room (Waived if Admitted)$75 CopayRX DeductibleNoneRX Copays (Tier 1/Tier 2/Tier 3)$10 Copay / $30 Copay / $50 CopayM E D I C A L I N S U R A N C EY O U R C O S T F O R C O V E R A G EThe co-insurance percentages listed are the amounts that you must pay for the service. For a more complete listing of what is covered, including out-of-network benefits, please consult the detailed benefit summary from the insurance carrier.COST PER PAYCHECK(24 per year)UMR PPOEmployee Only$0.00Employee + Spouse$124.23 Employee + Child(ren)$101.64 Employee + Family$327.50 Return to Table of Contents6
S A V E O N S P E C I A L T Y R X SMITHRX CAN HELP LOWER YOUR SPECIALTY DRUG COSTSReturn to Table of Contents7If you are taking certain specialty medications, the SmithRx team may reach out to help identify alternate sources for your high-cost specialty and branded medications to be covered at little to no cost for you. The SmithRx team helps you navigate the process, doing much of the heavy lifting. Here’s how it works:• You will work with a dedicated SmithRx specialist through this process. • To continue utilizing your same medication, it is important that you engage with the SmithRx team if they reach out and provide any requested information. • Fill out the required paperwork and return it as soon as possible to expedite the process and prevent delays in accessing your medications (at a lower cost). If you have any questions or concerns, please reach out to your OneDigital Employee Advocate or the SmithRx’s team. For member specific assistance call (844) 512-3030, or access the member portal at www.mysmithrx.com. SmithRx Contact Info:Phone: (844)-454-5201Email: connect@smithrx.com
cM A K I N G T H E M O S T O F Y O U R M E D I C A L I N S U R A N C EW H E R E T O S E E K C A R EYou can benefit from significant savings using an urgent care or virtual care facility versus a hospital Emergency Room (ER) without sacrificing quality of care. Please consult the previous pages of this booklet or plan documents for urgent care and emergency room costs and benefits.U S I N G Y O U R I N - N E T W O R K P R E V E N T I V E C A R E B E N E F I T SPreventive care visits can help detect unhealthy habits before they become a risk and potentially save your life. Our health plans offer an annual in-network well check at no cost to you. When you get these services from doctors in your plan’s network, you don’t have to pay anything out of your own pocket.Get more out of your well checks by preparing yourself:• Make a list of health concerns.• Make a list of medications you are taking.• If you are seeing a new doctor, get copies of your medical records and your family medical history.• Review your health plan in advance to be sure you understand your coverage.• Call your doctor in advance to see which tests and screenings are usually run. You can request that your doctor not perform tests not covered by your health plan.U R G E N T C A R EE M E R G E N C Y R O O MV I R T U A L C A R EFor injuries and illnesses that aren’t life threatening but need fast care. • Sprains• Strains• Minor broken bone• Mild asthma attacks• Minor infections• Small cuts• Minor burns• Urinary tract infections• Pelvic infectionsFor serious and/or life-threatening conditions.• Heavy bleeding• Trouble breathing• Severe head injury• Chest pain or pressure• Sudden or severe pain• Coughing or vomiting blood• Sudden dizziness, weakness, or changes in vision• Severe or persistent vomiting or diarrhea• Changes in mental status, such as confusion• Loss of consciousness• Major burns• Spinal injuriesFor minor conditions and convenience. Get care from the comfort of your own home or on the road. • Flu• Minor rashes• Tooth pain• Pink eye• Allergies• Cold & fever• Sore throat• Skin infections• Headache• DiarrheaReturn to Table of ContentsLEARN MOREClick HERE to learn more about the differences between Urgent vs ER8
VIRTUAL CAREVirtual care through Teladoc combines in-office quality with in-home privacy and convenience. See and talk to a doctor from your mobile device or computer without an appointment! Most visits take about 10-15 minutes and doctors can write a prescription, if needed, that you can pick up at your local pharmacy. This service is part of your health benefits offered through Aetna.HOW MUCH DOES IT COST?• $0 CopayUHC TELEHEALTH | GETTING STARTED• Web: www.Teladoc.com• Phone: (800) Teladoc (835-2362)9Return to Table of ContentsCARRIER MOBILE APPS & ONLINE PORTALSYou can access your medical, dental and vision member ID cards and enrollment details any time, anywhere through your carrier mobile app or carrier website. You can also use these resources to view claims, find providers, and more! MEDICAL:• Visit www.umr.com• Download the UMR Claims & Benefits mobile app DENTAL & VISION:• Visit www.guardiananytime.com• Download the Guardian Providers & ID Card mobile appC A R R I E R R E S O U R C E S
10Return to Table of ContentsU N D E R S T A N D I N G Y O U R U M R I D C A R DHave you ever wondered what all that stuff on your IDcard really means? Here’s a sample of what you mightsee. Each plan is different.Member ID: The number assigned specifically to you to track all of your benefits andclaims information.Dependents: A list of the family members who are covered under your plan.Group Number: The number assigned to identifyyour group health plan.Rx Information: Your prescriptiondrugplan. Pharmacists usethis to process yourclaims.Your Network: Your medical provider network, alsoreferred to as your preferred provider organization (PPO).Going to doctors, clinics and hospitals in your networkwill save you money.More on the BackLook for important contact information, including the customer service phone number to call for answers to claimsor benefit questions. You can also go to umr.com to check your benefits, claims status, accumulators and eligibility.Medical Service Numbers:Call this number only when you need medical services and your plan requires prior authorization for those services.Coverage:Your in-network (In-Net) and out-of-network (Out of Net) medical individual and family deductibles (Ded) and out-of-pocket maximums (OOPM) information.Pharmacy Number: Call this number when you have questions about pharmacy benefits.
By complementing your medical plan, supplemental insurance plans can help fill in some of the gaps that your primary medical coverage may not cover. The following plans are available for you and your dependents. For full plan details and cost, please review the benefit summary from the insurance carrier.G U A R D I A N – A C C I D E N T I N S U R A N C EAccident insurance can help you pay for the out-of-pocket costs you may experience after an accident and pay regardless of any other insurance you have. • A limited benefit policy (not health insurance)• Spend it on what you need – medical expenses, groceries, utilities• Benefits for common injuries like fractures, dislocations, and concussions• Benefits for physician visits, emergency room visits, ambulance service, and hospital care.• $100 wellness benefit is available to you, your spouse, and your child(ren).G U A R D I A N – C R I T I C A L I L L N E S S I N S U R A N C EBeing diagnosed with a critical illness can be devastating, both personally and financially. Breathe easier knowing critical illness insurance can help you pay your out-of-pocket expenses and allow you to focus on your health.You can elect up to $20,000 for yourself, 50% of your elected benefit for your spouse, and 25% of your elected benefit for your child(ren). Additionally, a $100 wellness benefit is available to you, your spouse, and your child(ren).G U A R D I A N – H O S P I T A L I N D E M N I T Y I N S U R A N C EHospital indemnity insurance pays a daily benefit if you have a covered stay in a hospital, critical care unit or rehab facility. The benefit amount is determined by the type of facility and the number of days you stay. A few examples of how this coverage could be used are:• Medical expenses, like deductibles and copays• Travel, food and lodging expenses for family• Childcare• Everyday expenses like utilities and groceries11S U P P L E M E N T A L I N S U R A N C EReturn to Table of Contents
Y O U R C O S T F O R C O V E R A G EGUARDIANDPPOIN-NETWORK BENEFITSNetwork NameDental Guard Alliance Dental Guard PreferredDeductible (Single/Family)$0 $50/150Maximum Calendar Benefit$1,500 $1,500PREVENTIVE SERVICESOral Exam0% 0%X-Rays0% 0%BASIC SERVICESResin-Based Fillings20% 20%*Root Canal20% 20%*Deep Cleaning20% 20%*Single Extraction20% 20%*Impaction20% 20%*MAJOR SERVICESComplete Denture40% 50%*Partial Denture40% 50%*Crowns40% 50%*Implants40% 50%*ORTHODONTICSOrthodontia Coverage50% Child & Adult 50% Child & Adult OUT-OF-NETWORK FEE SCHEDULEFee Schedule Fee ScheduleCOST PER PAYCHECK (24 per year)Guardian DPPO Employee Only$5.33Employee + 1$10.19Employee + 2 or more$17.72D E N T A L I N S U R A N C EReturn to Table of Contents*Benefits with an asterisk (*) require that the deductible be met before the plan begins to pay.12The co-insurance percentages listed are the amounts that you must pay for the service. For a more complete listing of what is covered, including out-of-network benefits, please consult the detailed benefit summary from the insurance carrier.
Y O U R C O S T F O R C O V E R A G EGUARDIANVISIONIN-NETWORK BENEFITSNetwork NameVSP ChoiceBENEFIT FREQUENCIESExamination12 monthsLenses12 monthsFrames24 monthsVISION EXAMExamination$25 copayLENSES & FRAMESSingle Vision Lenses$0Bifocal Lenses$0Trifocal Lenses$0 FramesUp to $150*CONTACTSElectiveUp to $150*COST PER PAYCHECK(24 per year)GUARDIAN VISIONEmployee Only$1.31Employee + 1 $2.75Employee + 2 or more$5.48V I S I O N I N S U R A N C EReturn to Table of Contents*For In-Network, insurance provider reimburses up to this amount13For a more complete listing of what is covered, including out-of-network benefits, please consult the detailed benefit summary from the insurance carrier.
Go to: www.guardiananytime.com• Select “Find a Provider” at the top of the screen• Select “PPO: DentalGuard Preferred” as your network• Enter your location and dentist name (optional)• Click “Search”• A list of in-network providers will populate the screenGo to: www.umr.com• Click “Find a Provider” on the homepage• Type in “Select Plus” into the network search bar, then select “UnitedHealthcare Select Plus Network (English)”• Click “Search”• Scroll down and click “View Providers”• You will be re-routed to UHC’s online directory. Enter your zip code• Select the type of Healthcare Category you are looking for. If you’re looking for a specific doctor, click “People”• Follow the prompts and answer the questions pertaining to your search• A list of in-network providers will populate the screenM E D I C A L – U M R ( U H C S E L E C T P L U S N E T W O R K )D E N T A L - G U A R D I A NV I S I O N - G U A R D I A NGo to: www.guardiananytime.com• Select “Find a Provider” at the top of the screen• Then select “Find a vision provider”• Under ”Select your Vision Network” select “VSP”• You may search by Location, Office, or Doctor• Click “Search”• A list of in-network providers will populate the screen14F I N D I N G I N - N E T W O R K P R O V I D E R SYour insurance plan contracts with a number of doctors, specialists, hospitals, labs, pharmacies, etc. These providers make up your network. By selecting a provider within your network, you can secure your low costing health services while maintaining high quality of care. See below for instructions on finding an in-network provider near you:Return to Table of ContentsLEARN MOREClick HERE to learn more about the cost saving benefits of staying in-network!
G R O U P T E R M L I F E & A D & D – U N I T E D H E A L T H C A R EYour employer provides you with life and accidental death and dismemberment (AD&D) insurance coverage at no cost!• Coverage Amount: $50,000• Age Reductions: Age 65: 35%; Age 70: 55%; Age 75: 70%; Age 80: 80%Don’t forget to designate a beneficiary for your Life and AD&D benefits when enrolling!V O L U N T A R Y L I F E & A D & D – U N I T E D H E A L T H C A R EYou can purchase additional life and AD&D insurance for you and your dependents. This plan is optional and paid 100% by you through payroll deductions if you choose to sign up.The basic summary of Voluntary Life and AD&D benefits are included here. Please view the carrier’s full plan summary document for a detailed description of what is or is not covered, along with rates.An Evidence of Insurability (EOI) may be required if you elect coverage over the Guarantee Issue amount or if you enroll after your initial eligibility period. 15L I F E I N S U R A N C EReturn to Table of ContentsUNITED HEALTHCAREVOLUNTARY LIFE & AD&DEMPLOYEEBENEFITSBenefit (Min/Max) $10,000 / $500,000Benefit Increments $10,000Guarantee Issue $140,000SPOUSEBenefit (Min/Max) $5,000 / $125,000Benefit Increments $5,000Guarantee Issue $25,000CHILD(REN)Child Benefit (Infant)$10,000Child Benefit (Child) $10,000AGE REDUCTIONSAge Reduction at 6535%Age Reduction at 7050%
C A L I F O R N I A S T A T E D I S A B I L I T YAs an employee in California, you are offered state disability. You pay for this benefit through state taxes that are automatically taken from your paychecks.California State Disability (CASDI) pays 60-70% of your weekly gross income to a maximum of $1,620. You have a waiting period of 7 days and the maximum benefit duration is 52 weeks. For more information, visit www.edd.ca.gov/disability. E M P L O Y E R P A I D S H O R T - T E R M D I S A B I L I T Y – U N I T E D H E A L T H C A R ELong term disability insurance will start paying out at the end of your short term disability coverage period. This benefit to offered to you at no cost!Please view the carrier’s full plan summary document for a detailed description of what is or is not covered. This benefit is 100% employer-paid!UNITED HEALTHCARELONG TERM DISABILITYMONTHLY BENEFITPercentage of Salary60%Maximum Monthly Benefit$12,500PLAN DETAILSDefinition of Disability2 YearsElimination Period90 DaysMaximum Benefit PeriodSocial Security Normal Retirement Age (SSNRA)Pre-Existing Limitations3/12**Disabilities that occur during the first 12 months of coverage due to pre-existing condition during the 3 months prior to coverage are excluded.16D I S A B I L I T Y I N S U R A N C EReturn to Table of ContentsE M P L O Y E R P A I D L O N G - T E R M D I S A B I L I T Y – U N I T E D H E A L T H C A R EShort Term Disability is available to employees. This benefit to offered to you at no cost!Please view the carrier’s full plan summary document for a detailed description of what is or is not covered.This benefit is 100% employer-paid!UNITED HEALTHCARESHORT TERM DISABILITYWEEKLY BENEFITPercentage of Salary20%Maximum Weekly Benefit$1,000PLAN DETAILSWaiting Period (Accident/Sickness)8 days/8 daysMaximum Benefit Period12 WeeksPre-Existing LimitationsNone
Shannon Ballshannon.ball@onedigital.comPhone: (800) 264-9918 ext. 57626Insurance is confusing. We love to help. You have someone dedicated to assist you with the following:• YOUR ENROLLMENT: As a new hire, during open enrollment and if you have a mid-year qualifying event• ACCESSING CARE: Locating in-network medical, dental and vision providers, hospitals and urgent care facilities near you and how to receive treatment by a specialist through the referral and authorization process• UNDERSTANDING YOUR BENEFITS: Helping you understand the benefits available to you and how to use your insurance plans• DETERMINING YOUR COSTS: Explaining the cost of service for in-network providers• CLAIMS RESOLUTION: Effectively resolving claims disputes and confirming your claims were processed correctly by your carrierSometimes life is stressful. When situations seem too tough to get through on your own, you have a lifeline for help. You and your household members can access confidential, professional assistance from an Member Assistance Program (MAP). Every session is 100% confidential and can provide you with assistance for issues such as: • Marital conflicts• Mental health management• Substance abuse• Financial/legal concerns• And much more!Your MAP includes 3 face-to-face visits per 12 months per issue and unlimited calls. GET STARTED TODAY!• Phone: (877) 660-3806 • Web: www.liveandworkwell.comAccess Code: FP3EAP H E L P W H E N Y O U N E E D ITReturn to Table of ContentsLEARN MOREClick HERE to learn more about the support that your MAP can offer17
Return to Table of ContentsOur online enrollment platform is ADP! Quickly and conveniently make your enrollments online through a computer or with the convenience of a smart phone. No app required, just follow the directions below. 1ELECTING BENEFICIARIES• While enrolling, Please be sure to indicate which dependents should be covered in Step 2, if applicable. If you need to update or add dependent, you may click the Manage Dependents link in Step 2.LOG INTO THE ADP BENEFITS PORTAL• Access the ADP Associate Self Service Web site at: www.workforcenow.adp.com• Click User Login• Enter your User ID and Password• Click Sign In• If this is your first-time logging in, click Sign Up. You will need your company’s registration code to set up your account for the first time. The code can be obtained from HR. Follow the prompts to set up your account.• Note: If you have previously changed your password and do not remember your password. Please click the “Forgot your User ID/Password” function.SUBMIT YOUR ELECTIONS After you log in, if you are in an eligible enrollment period, like a New Hire Enrollment or Open Enrollment period, a pop-up will appear when you first log in. To make your elections, click Start This Enrollment.• Once you start the enrollment process, read the welcome letter and answer any questions if applicable. Click Continue when done. • The left side of the screen will indicate the different plan types that are available to enroll in. When you are viewing the selected plan type, all enrollment options will be displayed on the screen.• You may choose to click Select Plan for the desired enrollment or Waive This Benefit. If you chose to waive a benefit, you may be required to select a waive reason. • When you choose to enroll in a plan, you may review your costs on a Per Pay Period, Monthly or Annual basis by selecting the desired view in the calculator drop-down.REVIEW• Click Continue to Preview. Review your enrollment, costs and covered individuals. Then click Save and Continue to Next Benefit to continue making your desired selections.• Once all benefit plan elections have been completed, Please review your information for accuracy and then click SUBMIT.23418H O W T O E N R O L L
N O T I C E S & E N R O L L M E N TReturn to Table of ContentsPlease review the required employee notices detailing your rights and options by clicking the link below. You can also request a paper copy of any of these notices at any time. EMPLOYEE NOTICESDOWNLOAD NOTICES HEREAre you ready to make your benefit elections? Click the link below to log into your enrollment system and begin your enrollment.READY TO ENROLL? ENROLL NOW19The rates and benefit plan information shown in this guide are illustrative only. To the extent the rates or the benefit plan informationsummarized herein differs from the underlying plan details specified in the insurance documents and/or plan document(s) that governthe terms and c onditions of the plans described in this guide, the underlying insurance and/or plan documents will govern in all cases.The insurance carrier will determine the actual rates based upon the final member enrollment, plan selection, funding, type, andeligibility criteria. Until that time, and the carrier's final communication, the rates will be subject to change.
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