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MedicalBenefits GuideEffective January 2025 - December 2025

Getting StartedMaking benefit selectionsOpen EnrollmentOpen Enrollment begins on November 1st and ends on November 22nd.Open enrollment will be passive, meaning if you do not want to make anychanges, your medical coverages will carry forward.Your medical benefits will be effective starting January 1, 2025.Who can I add to my coverage?Note: You the employee must be enrolled in the coverage you wish toenroll a dependent into.Legally Married SpouseBiological ChildrenStepchildrenAdopted ChildrenChildren in your custody for adoptionChildren under your legal guardianshipPermanently disabled children over the age restrictionsMid Year Changes | Qualifying Life EventsYou may only enroll in benefits when you are first eligible or make changesto your benefits during open enrollment. However, you can makechanges/enroll during the plan year if you experience a qualifying lifeevent:MarriageDivorceNew Baby/AdoptionDeath of DependentYour Dependent’s Open Enrollment You/Dependent lose other coverageYou/Dependent gain other coverageYou/Dependent lose Medicaid coverageYou/Dependent gain Medicaid/Medicare CoverageSee Full Event List HereIf you have a qualifying life event, you must submit yourchanges within 30 days of the event (60 days forMedicare or Medicaid events), or you must wait untilannual open enrollment to make any benefit changes.These events should be entered online through yourenrollment platform. You may also be required toprovide proof of the event to HR.Nancy LandryHuman Resources Manager978-355-4668 ext. 8505nlandry@qrsd.orgLooking for More?Check out these additionalresources to take a deeper dive! Video LibraryPodcast Vault Glossary of TermsFinancial AcademyQuestions about your benefits or claims? Contact Benemax now!800-528-1530 l benemax.service@onedigital.com

Medical insuranceThe information shown in this presentation is an illustrative summary only. The underlying plan contract or document governs all aspects of the plan. Final rates are dependent on actual enrollment, insurance carrier or plan rules, plan selection, and eligibility criteria. Please refer to the plan document, contract,and other notices contained in this document, applications, and other corresponding communications for additional information.The Benemax Health Plan integrates a fully insured component from Blue Cross BlueShield (BCBS) of Massachusetts with a self-funded component underwritten by youremployer, into a single, seamless benefit package.Mental HealthMaven MaternityTelehealth24 Hour Nurse HotlineMedication Look-up ToolaHealthyMe RewardsFlu VaccineFitness ReimbursementWeightloss ReimbursementE-KitHMO Blue New EnglandIn-network careBCBS Base PlanEmployee’s ResponsibilityQRSD ResponsibilityDeductible (DED)$4,000 per person$8,000 per family$0 per person$0 per family$4,000 per person$8,000 per familyPreventive CarePrimary Care VisitSpecialist VisitCovered in Full$20 Copay$35 CopayCovered in Full$20 Copay$20 CopayCovered in FullN/A$15 CopayUrgent CareEmergency RoomInpatient Hospital CareOutpatient Day Surgery$35 Copay$150 CopayDeductibleDeductible$20 Copay$75 Copay$250 Copay$150 Copay$15 Copay$75 CopayDED, less $250 CopayDED, less $150 CopayPrescription DrugsRetail (30 Days) | Mail Order (90 Days)Generic drugsPreferred brand drugsNon-preferred brand drugs$15 Copay | $30 Copay$30 Copay | $60 Copay$50 Copay | $150 Copay$15 Copay | $30 Copay$30 Copay | $60 Copay$50 Copay | $150 CopayN/AYour cost for coverageEmployee onlyEmployee + FamilyPer paycheck (Bi-Weekly)$150.93$354.67Questions about your benefits or claims? Contact Benemax now!800-528-1530 l benemax.service@onedigital.comHMO SummarySBC

Medical insuranceThe information shown in this presentation is an illustrative summary only. The underlying plan contract or document governs all aspects of the plan. Final rates are dependent on actual enrollment, insurance carrier or plan rules, plan selection, and eligibility criteria. Please refer to the plan document, contract,and other notices contained in this document, applications, and other corresponding communications for additional information.The Benemax Health Plan integrates a fully insured component from Blue Cross BlueShield (BCBS) of Massachusetts with a self-funded component underwritten by youremployer, into a single, seamless benefit package.Mental HealthMaven MaternityTelehealth24 Hour Nurse HotlineMedication Look-up ToolaHealthyMe RewardsFlu VaccineFitness ReimbursementWeightloss ReimbursementE-KitHMO Blue New England $250In-network careBCBS Base PlanEmployee’s ResponsibilityQRSD ResponsibilityDeductible (DED)$4,000 per person$8,000 per family$250 per person$500 per family$3,750 per person$7,500 per familyPreventive CarePrimary Care VisitSpecialist VisitCovered in Full$20 Copay$35 CopayCovered in Full$20 Copay$35 CopayN/AUrgent CareEmergency RoomInpatient Hospital CareOutpatient Day Surgery$35 Copay$150 CopayDeductibleDeductible$35 Copay$150 CopayDeductibleDeductibleN/APrescription DrugsRetail (30 Days) | Mail Order (90 Days)Generic drugsPreferred brand drugsNon-preferred brand drugs$15 Copay | $30 Copay$30 Copay | $60 Copay$50 Copay | $150 Copay$15 Copay | $30 Copay$30 Copay | $60 Copay$50 Copay | $150 CopayN/AYour cost for coverageEmployee onlyEmployee + FamilyPer paycheck (Bi-Weekly)$125.28$294.37Questions about your benefits or claims? Contact Benemax now!800-528-1530 l benemax.service@onedigital.comHMO SummarySBC

Medical insuranceThe information shown in this presentation is an illustrative summary only. The underlying plan contract or document governs all aspects of the plan. Final rates are dependent on actual enrollment, insurance carrier or plan rules, plan selection, and eligibility criteria. Please refer to the plan document, contract,and other notices contained in this document, applications, and other corresponding communications for additional information.The Benemax Health Plan integrates a fully insured component from Blue Cross BlueShield (BCBS) of Massachusetts with a self-funded component underwritten by youremployer, into a single, seamless benefit package.Mental HealthMaven MaternityTelehealth24 Hour Nurse HotlineMedication Look-up ToolaHealthyMe RewardsFlu VaccineFitness ReimbursementWeightloss ReimbursementE-KitPreferred Blue PPO In-network careBCBS Base PlanEmployee’s ResponsibilityQRSD ResponsibilityDeductible (DED)$4,000 per person$8,000 per family$0 per person$0 per family$4,000 per person$8,000 per familyPreventive CarePrimary Care VisitSpecialist VisitCovered in Full$20 Copay$35 CopayCovered in Full$20 Copay$35 CopayN/AUrgent CareEmergency RoomInpatient Hospital CareOutpatient Day Surgery$35 Copay$150 CopayDeductibleDeductible$35 Copay$75 Copay$250 Copay$150 CopayN/A$75 CopayDED, less $250 CopayDED, less $150 CopayPrescription DrugsRetail (30 Days) | Mail Order (90 Days)Generic drugsPreferred brand drugsNon-preferred brand drugs$15 Copay | $30 Copay$30 Copay | $60 Copay$50 Copay | $150 Copay$15 Copay | $30 Copay$30 Copay | $60 Copay$50 Copay | $150 CopayN/AYour cost for coverageEmployee onlyEmployee + FamilyPer paycheck (Bi-Weekly)$220.83$518.95Questions about your benefits or claims? Contact Benemax now!800-528-1530 l benemax.service@onedigital.comPPO SummarySBC

You or a member of your family visits yourprovider (doctor/hospital) and shows boththeir medical carrier ID card and theirBenemax Card. Pay any applicable copaysat the time of service.Your provider will bill your medical carrier.Your medical carrier will process your claim,notify your provider, and send a ClaimsSummary to you and your provider.Benemax receives a report of your claimsfrom your medical carrier.Benemax reviews your claim and (ifapplicable) makes additional paymentson behalf of your employer.Benemax posts a Benemax Explanation ofBenefits (EOB) on your Claims Connectionportal. You are responsible to pay theamount due to your provider as shown.Who pays for what and when?Claims SubmissionThere is a weekly automatic claimsfeed from your medical carrier toBenemax. Members and providersmay also submit claims using anymethod below.Email:benemax.claims@onedigital.comFax: 508-242-6198Mail: Benemax , P.O. Box 950,Medfield, MA, 02052You should include an EOB orClaims Summary and a copy of theProvider Bill. Click here to accessClaims Connection. Provider LetterDo not make a payment to your provider until you have reviewed yourclaim responsibility amount on your Benemax Claims Connection portal.Learn More HereSample EOBIf your provider needs help understandinghow both layers of coverage work together,you can share with them this letter.CardsPresent your provider with both your medicalcarrier card AND your Benemax card. Be sureyour provider's office takes copies of BOTHcards. Ensure your provider knows Benemax isyour secondary payer.For any questions, contact:800-528-1530benemax.service@onedigital.comLearn WhyBenemax Information HubBenemax’s Information Hub offers online customer service and information. Submit a benefit questionReview educational videosAccess your Claims ConnectionCheck your claims statusDownload a Benemax Explanation of Benefits (EOB)Link to your medical carrier websiteHMO Summarymybenemax.comHMO Blue NE $250HMO Blue NE Understanding Your Medical Plan +Preferred Blue PPOPPO Summary

Having good health and the energy to perform your job life outside ofwork, such as spending time with family, friends, or participating inactivities you enjoy. Think of physical wellbeing as nutrition, stayinghydrated, getting rest, avoiding illness through vaccines, preventivescreenings, and following doctors’ orders!The information shown in this presentation is an illustrative summary only. The underlying plan contract or document governs all aspects of the plan. Final rates are dependent on actual enrollment, insurance carrier or plan rules, plan selection, and eligibility criteria. Please refer to the plan document, contract,and other notices contained in this document, applications, and other corresponding communications for additional information.Mental health care is essential health care. Managing work, family, relationships, and finances can be tough. Total wellbeing: caring for all of youSupport for your health, finances, and life.There are five ingredients to wellbeing — each is just as important as the others:The recipe to living wellHealthy, supportive relationships with family, friends, and mostimportantly, yourself. Effectively managing feelings and emotions andpracticing healthy ways to manage stress and adapt to challenges.Social & EmotionalPhysicalThe ability to effectively understand and plan for day-to-day expenses,short-term, and long-term goals, like paying back student loans, savingfor a house, sending children to college, retirement, or caring for agingfamily members.FinancialConnection to your passion, the reason you get out of bed every day.PurposeFeeling connected to where you live, work and play through activitiessuch as volunteering and mentoring.Community Access quality care in the convenience of your own home, on your lunchbreak, or on the way to your child’s soccer game! Whether it's a nagging cough, middle-of-the-night fever, or a suspicious-looking mole or rash — telehealth through BCBS of MA is here when you needit. Connect with a board-certified physician 24 hours a day, 7 days a week.Your cost per visit depends on your medical plan:Telehealth: virtual health care that fits yourscheduleTelehealthMental health supportWellbeing CalendarThe BreakroomMental Health Hub

Balance billingWhen you use an out-of-network medical or dental provider, they may bill youthe difference between what they charge and the amount your insurance pays.Medical: balance billing is in addition to – and does not count towards – yourout-of-pocket maximum.CoinsuranceAfter you’ve met your deductible, you’re sometimes responsible for apercentage of the cost of the medical care, dental care, or prescriptionmedication you received. This percentage is coinsurance.CopayA flat fee you pay each time you receive a copay-eligible medical, dental, orvision service or prescription medication. DeductibleThe amount you’re responsible for paying in care expenses before the medicalor dental plan starts paying deductible-eligible expenses.In-networkIn-network care is always your lowest-cost option. Networks are groups ofmedical, dental, and vision providers, pharmacies, and facilities that agree todiscount the cost of their care or service.Out-of-pocket maximumThe most you’ll pay for covered in-network medical care in a year. This includesyour deductible, any coinsurance or copays, and prescription drugs. The out-of-pocket maximum does not include your premium (the amount youpay for coverage), non-covered expenses, or out-of-network care that’s beenbalance billed.Primary care physicianA primary care physician (PCP) is your main medical doctor – usually a generalpractitioner (GP), family doctor, internist, OB/GYN, or pediatrician (for children).Referral/pre-authorizationSome specialty medical providers and services require a referral from a primarydoctor. These may include - but are not limited to - cardiology, psychiatry,orthopedic surgeons, rheumatology, surgery, and imaging (CT or MRI).How to handlemedical bills (4:46)Helpful terms & resourcesWe've removed as much jargon as possible.But you’ll probably still encounter some terms as you enroll in and use your benefits, and we want you to be prepared!Annual NoticesWe’re required to tell you about certain rights and responsibilities you have asan employee of Quabbin Regional School District. You can request a paper copy at no charge from:Nancy LandryHuman Resources Manager978-355-4668 ext. 8505nlandry@qrsd.orgDownload now