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Benefit Guide
Plan Administrator
T & O Refrigeration
170 Walter Way
Fayetteville, Georgia 30214
770-461-5217
Benefit Eligibility
All benefits are offered ala carte. I n order to be eligible to
participate in the benefits offered, you must maintain all of the
following:
Our benefits
give you
something to
smile about!
Plus, this enrollment guide contains most everything you need to know to get
you through the plan year. An electronic copy of it is also available with all
of the forms, benefit summaries and hotlinks to make accessing your important
benefit information easy!
You can also request (free) copies of important plan information, employee
notices, Plan Summary Documents (and much more) by making a written
request to the Plan Administrator (see Contacts).
Employees
W2 employees employed 90
days (eligible as of the first
day following the
probationary period)
A resident alien or citizen
Reside in the continental US,
and
Work 30 or more hours per
week,
Dependents
Legal spouse, or
Legal dependent
children up to age 19
for all benefits and to
age 26 for certain
health benefits. Some
children may qualify
for extended eligibility
due to disability or
impairment.
Make your decisions wisely they can affect you for the entire
plan year! Use our Counselors at the Resource Center for help .
Contact Info
Many plan benefits are based on a calendar year (not plan year) - check plan info carefully.
Plan Administrator
BCBS
Base Life & AD&D
We provide you with up to
Guardian
Accident Benefit
$15,000
Resource Center
Guardian
Supplemental Life
Employee up to
Spouse up to
$100,000
$50,000
Child/ren up to
$10,000
T & O Refrigeration
770-716-3200
Guardian
www.resourceseven.com
Employee
$10,000
$2,500
Guardian
Employee Assistance Program (EAP)
T & O Refrigeration
Pre-Tax Plan
Plan Contacts
InfiniSource. 800-300-3838
My Ideal Doc
Telemedicine Benefits
Offers members
Guardian
Vision Benefits
Guardian
Dental Benefits
Guardian. 800-541-7846
www.infinisource.com
800-441-2273
www.bcbsga.com
www.guardiananytime.com
Rates shown
Dental*
Vison
TeleMed Accident
Child
$59.62
Are weekly
EE
$6.57
$3.28
$2.31
$5.30
Spouse
$34.52
Rate tables
EE+SP
$15.32
$12.03
$2.31
$8.96
EE+CH
$15.11
$11.82
$2.31
$9.33
other benefits
Family
$23.85
$20.57
$2.31
$12.99
3 |Printed 2/12/15
Table of Contents
Find your topic and the corresponding page.
Viewing this electronically? Double click the page #.
4 |Printed 2/12/15
Complete
What?
Login to our portal at
https://resourceseven.easyap
psonline.com
Dependent
Eligibility Cert Form
Health Plan Eligibility
Health Reimbursement
Account Claim Form
Newly Eligible?
To protect your rights, we are required to obtain your
acknowledgement to decline or enroll in any benefits
available to you within 30 days of your eligibility date.
A newly benefit eligible employee or dependent may
also be given special guarantee issue privileges for
benefits that would otherwise require approval based
on health status. In these instances, often, electing the
lowest level of coverage may secure your ability to
increase coverage in the future, should the need arise.
This form.
Use to update a
beneficiary(s) any
time.
Employees electing
health plan coverage
for a dependent
spouse and/or child.
Yes.
Complete (timely) to
request
reimbursement for a
covered health claim.
Yes.
To authorize anyone
to help you or another
family member with
claims issues.
Be turned down,
Have to wait until open enrollment,
Have a delay or reduction in benefits for a time.
Questions?
For more details about eligibility, look to the plans
Insurance Certificates, Summary Plan Descriptions,
benefit summaries or visit www.irs.gov for Publication
969.
Qualifying Life
Event(s)
Birth, adoption or
gain of legal
guardianship
Dependent Death
Documentation
Example(s)
Birth Certificate, the
Hospital Certificate may
be used or Adoption or
Legal Guardianship
Papers.
Death Certificate.
Dependent
Loss of Eligibility
Dependent
Qualified Minor
Support Order
(QMSO)
We will comply
appropriately with any
court order received.
Divorce or
Annulment
Employee change
in employment
status that affects
eligibility
Judgment or Court
Order
Loss or Gain of
eligibility for medical
programs funded by
state or federal
assistance
Marriage
Spouse change in
employment and
loses coverage
Spouse change in
employment and
gains coverage
Marriage Certificate or
Affidavit of Marriage.
HIPAA Certificate of
Credible Coverage from
your Spouses (Qualified)
Group Health Plan.
Proof of Enrollment under
your Spouses (Qualified)
Group Health Plan.
of Membership Benefits
Dental
Vision
Min Value
of Benefits
$360
$210
Per person
Per person
EAP
24/7 counseling
Concierge services for personal needs
Free face to face counseling services
Travel assistance
Will preparation
$114-1500
Per Visit
Per person
Our
Resource
Center
1 Stop Shop
Private Exchange (24/7/365)
Professional benefits guidance
Open enrollment decision support
Claims assistance
Benefits & financial education
$500 ++
Per Year
Per Person/
Incident
Per Year
Priceless
You don't have to pay anything out of pocket to get your kids
immunized, except perhaps a copay for an office visit if the
immunizations are billed separately. Routine vaccines for adults
are also covered. As well as, the CDC recommends
vaccination for everyone 6 months and older during the flu
season.
15-45%
Pre-Tax
$75-5,000
Critical
Illness
Benefits
Up to $2500
HRA
TeleMed
With the HA, you'll get a report with steps you can take to
improve your health. Your personal health information won't
have an impact on your benefits coverage. But, with some
plans you can earn points for taking a health assessment. These
points can be redeemed for cash prizes! And, with a few plans,
you can actually pay a lower rate for taking an HA.
Membership Discounts
With your health plan membership, you may have free access
to discounted services and programs typically not covered
under your benefit plan. You are also able to nominate service
providers in your area that you would like to see included in the
discount program.
The following is a list of discounts, services, and programs
commonly available:
Before Logging In
You need basic information about
yourself and your dependents:
Social Security Number
Date of Birth
Address Info
User Tips
Refresh your screen often or keep
moving. The system times-out to
protect your privacy after 14 minutes
of inactivity.
Any enrollment, declination or
change
requires
an
acknowledgement and e-signature.
Please note, the portal is unable to
manage all of the rules associated
with eligibility.
To prevent payroll deduction issues
or the need for corrections, please
ensure you request only those
benefits that you or your dependents
are eligible for when navigating
through the enrollment pages in the
portal.
Returning Users
Go to
Go to
https://resourceseven.easyappsonline.com
https://resourceseven.easyappsonline.com
Need Help?
Please visit our help desk at:
www.easyappsonline.com/employe
ehelp.asp
8 |Printed 2/12/15
Pre-Tax Highlights
Pre-tax plans convert taxable dollars into tax free dollars.
Taxes and healthcare are a huge cost to you.
Saving money is good. Saving tax money is even better.
Pre-tax plans save you money.
The IRS Section 125 refers to these plans as Premium Only
Plans, Cafeteria Plans or as Flexible Spending
Accounts (FSA).
Any of these pre-tax plans allow premiums to be pretaxed for health, dental, vision and most accident
benefits.
Savings account pre-tax plans, if available, allow you to
contribute to them to pay for certain out of pocket
eligible expenses with the tax free dollars available in your
account.
W2 Pay (Income)
$31,000
$31,000
Pre-Tax Elections
N/A
($ 2,400)
Taxable Income
$31,000
$27,600
($ 6,000)
($ 5,520)
($ 2,400)
--
Take-Home Pay
$21,600
$22,080
Pre-Tax Savings
(Results)
N/A
(Bad)
$480*
(Good)
9 |Printed 2/12/15
stay healthy,
be happy,
live long and be wise.
Healthy people are happier, live longer, are more confident and productive.
As an added benefit, healthy people spend less on health plan insurance
premiums, out of pocket (health related) expenses and are less likely to
become disabled.
To participate in our
health plan this year:
Complete the
Health Assessment:
1.
2.
3.
4.
5.
6.
7.
To learn more,
please visit -https://www.bcbsga.healthand-wellness.
10 |Printed 2/12/15
Option 1
BCBSGA OAP5 3.5K/0 6.6K B
Health Plan
Summary of Benefits & Coverage
Additional
Health Plan Eligibility
Requirements
Medical Deductible
Individual
Family
After the Deductible,
The Plan Pays (Co-Insurance %)
Out of
Pocket Max
100%
Individual
Family
$6,600
$13,200
Misc Info
Primary Care Office Visit
Specialist Office Visit
RX Deductible Per Person
Prescriptions by Tier
Urgent Care
Emergency Room
Health coaching
Member discounts
Telemedicine Benefits
Fungal Infection
Gout
Headache
Heartburn
High Blood Pressure
Infections
Insect Bites
Joint Aches
Migraines
Nausea
Pink Eye
Rashes & Hives
Runny Nose
Sinus Conditions
Sore Throat
Stomach Virus
Urinary Tract Infections
Vomiting
12 |Printed 2/12/15
Levaquin
Lisinopril
Macrobid
Prednisone
Z-Pak
Benefits of TeleMed
Option 1
BCBS OAP5 3.5K/0 6.6KB
In Network hospital or facility claims applied to the deductible and
co-insurance only. Does NOT include copays.
First $1000 of the calendar year deductible per member
(to a max of 3 per family).
Our HRA makes using our health plan for big stuff more affordable.
13 |Printed 2/12/15
Frequency Limitations
Be familiar with frequency limitations
most commonly found in dental, vision
and/or prescription plans.
Common
examples
of
benefit
provisions that have frequency
limitations include:
Dental
Cleanings
X-Rays
Materials
Vision
Exams
Lenses
Frames
Rx
Dosage
Pills
Guardian
Value Plan
Guardian
NAP Plan
Double Click to
Open Here
Double Click to
Open Here
OPEN ACCCESS
POS
DentalGuard
Preferred (PPO)
Primary Dentist
Referral Required
DentalGuard
Preferred (PPO)
Deductible
CALENDAR YEAR
CALENDAR YEAR
$50
$50
$150
$150
NONPREVENTATIVE
ONLY
NONPREVENTATIVE
ONLY
$1,500++
$1,500++
100%
100%
100%
80%
60%
50%
50% to
$1500 Lifetime Max
50% to
$1500 Lifetime Max
Individual
Family
Pre-Treatment Estimate
A pre-treatment estimate is a written
estimate of your share of the cost and
how much the plan will pay for a
dental treatment plan.
Request your dental provider to submit
(on your behalf) a pre-treatment
estimate to the dental plan for any
dental services that are likely to
exceed $250.
Getting a pre-treatment estimate
allows you to budget for out of pocket
dental expenses in advance.
Your dentist may also be able to
present alternative treatment options
that will lower your share of the bill,
while still meeting your basic dental
care needs.
Got a DHMO?
A DHMO (dental health maintenance
organization) is a discount plan that
offers unlimited dental benefits.
However, theres a tradeoff a fairly
restrictive provider network.
A DHMO also requires you to elect a
Primary Care Dentist.
A DHMO plans only cover services
performed by your Primary Care
Dentist or by a referred network
specialist.
You can change your primary care
dentist by calling the dental plan.
Deductible Applies to
Max Annual
Benefit/Member
Type I
Preventative
Type II Basic
Type III Major
Type IV Child Only
Ortho
The mouth is the gateway to the body keep it healthy! Remember, good
oral health is critical for good overall health.
People who access affordable preventative dental benefits regularly are less
likely to need expensive, invasive procedures in the future.
Keep Smiling
with Our Dental Plan Tips
Rollover benefits are included!
Your plan includes no cost preventative benefits.
Certain health conditions may qualify for more preventative
benefits.
Network providers make your dental benefit dollars go farther.
Preventative benefits dont count towards the annual max
benefit.
Your dental plan has a missing tooth exclusion limitation.
Cleanings are covered once each 6 months. (Not any sooner!)
A late entrant penalty applies if you decline the coverage
initially.
In Network
Guardian Vision
Plan Highlights
Vision Plan Benefits
Not viewing the doc electronically?
Refer to printed materials
Provider Network
Plan Name & Link
Preventative
Exam Co-Pay
Material Co-Pay
(Lens or Frames)
Elective Contact Lens
Allowance Per Year
Benefit Frequency
Exam
Lens
Frames
$10
$20
$120
12 MONTHS
12 MONTHS
24 MONTHS
Start by SHOPPING!!!
Our dedicated team is here to assist
you with finding the best plan for you,
your family and your company!
Annual Deductible
Calendar or plan year
Traditional
Health Plans
HDHPs
(H.S.A. Eligible)
Preventative care is
covered at 100%. Plus, you
can receive medical care
from in-network doctors and
hospitals and get
prescription coverage using
significant member
discounts!
Co-Insurance %
Co-Pays
Free Preventative
Covered at 100% - Waive Deductible
16 |Printed 2/12/15
Traditional
Co-Pay Plans
QHDHPs
(HSA Eligible)
Price (Premium)
Theres pros and cons to every plan. Its important to pick the right plan for
you. When it makes sense, keep as much $ in your pocket as possible try to
buy the right amount of insurance not too little and not too much.
Is a promise to pay
whether you use it or not.
Annual Deductible
(Can be calendar
or plan year)
In the end, you add the premium to the total you spend (or could
spend) to determine your true cost for the plan.
Opt 1
Opt 2
Opt 3
_______
_______
_______
_______
_______
_______
_______
_______
_______
_______
_______
_______
17 |Printed 2/12/15
Preventative
Benefits
Premiums &
Renewal Increases
Traditionally higher
premiums and renewal
increases.
Important Information
The plans provide documents including Summaries of Benefits &
Coverage, Insurance Certificates.
As well as, Summary Plan
Descriptions (also known as SPDs) outline, in detail, plan provisions
such as benefit eligibility, limitations and exclusions and your rights and
responsibilities as a plan participant.
These documents are provided &/or made available within 60 days of
the effective date of coverage to participants. Copies are available,
at no charge, by requesting a copy, in writing, from your Plan
Administrator.
Embedded:
A per person deductible applies. Any per person deductible incurred
applies to the maximum family deductible.
The SBC is designed to help you better understand and evaluate your
health insurance choices and includes:
T & O Refrigeration
170 Walter Way
Fayetteville, Georgia 30214
770-461-5217
Life Benefits
BASE
LIFE
SUPPLEMENTAL
LIFE
Double Click to
Open Plan Info
Double Click to
Open Plan/Rate
Info
N/A
Children
N/A
Up to $100K
100% of EE to
$50k
50% of EE to
$10k
Accidental Death
&
Dismemberment
Benefits
Included
Included
Living Benefits
Included
Included
Yes
Yes
Included
Included
Benefits may be
continued if you
leave the Co?
Waiver
of Premium
You:
Your age
Rates are
determined by
amount of
coverage plus:
N/A- Your
Employer Pays
for this
Coverage
Your Spouse:
Your age
Your Children:
One rate covers
all children!
19 |Printed 2/12/15
EAP
Benefit
Highlights
Substance abuse
Emotional distress
Financial needs
To learn more, contact the EAP plan or visit our EAP plans
member home page:
EAP plan member home web page.
Username Matters
Password- wlm70101
20 |Printed 2/12/15
Total
U.S.
U.S.: Private
Employer
U.S.: Public
Employer
$4,939
$5,222
$6,157
Planning Ahead
Reality isdeath is a real fact of life and
disability can be.
Both carry harsh consequences if not
planned for properly.
In fact, most
Americans admit they:
Wouldnt be able to meet expenses if
they couldnt work for a period of
time; and
Dont have enough life insurance.
Accident Benefits
Accidents happen to all kinds of people every day.
Accident benefits are ideal for those who have an active lifestyle or kids
who play sports.
Accident benefits are designed to provide cash benefits by reimbursing
an insured throughout different stages of care, regardless of the severity of
the injury.
Benefit Highlights
Accident
Plan Benefits
Accident Benefits
Double Click to Open the Plan
Summary
Wellness Incentive
Benefits are for
Benefits Begin
Other Perks
Ask Yourself
What are my biggest assets?
Do I have adequate insurance to
protect my biggest assets?
Have I planned properly?
Accidents happen.
When they do they dont have to wreck your life.
21 |Printed 2/12/15
Kicking Cancer
Getting diagnosed with cancer
changes your life but, it doesnt have
to end it!
Staying positive, living healthy and
being financially able to fight the
disease can make all the difference in
the outcome.
Learn about your condition.
Seek care from the best practioners
avaialble in treating your disease. Stick
to your guns rely on people who care
about your health.
Seek natural foods and activities to
compliment medical treatment.
Andif youre lucky enough to have
never had the diagnosis, try to help
your body keep it that way!
Healthy living is simpleeat fresh
vegetables and fruits. Lean meats and
good fats.
Benefit Highlights
Tax free cash benefits are paid directly to you upon the diagnosis of a
(covered) critical illness or occurrence of cancer.
Critical
Illness Plan Benefits
Not viewing the doc electronically?
Refer to printed materials
Reoccurence Benefits
Wellness Incentives
Stay active.
And, most of all, keep a positive
attitude knowing that yourattitude
is a little thing that makes a big
diference.
Rates Change
Included.
$100 each year for employee only for simply getting a wellness or
preventative exam even if the
wellness or preventative exam is
free!
You:
Your age
Your Spouse:
Your spouses age
Your Children:
One flat rate covers all children!
23 |Printed 2/12/15
Issue
After taking
determine:
the
steps
above,
if
you
24 |Printed 2/12/15
Your Dependents:
Continuation
Portability
The ability to
convert group life
insurance to
individually owned
life coverage
(typically converted
to a form of
permanent life).
The ability to
continue Health &
Welfare benefits at
the same cost and
coverage offered
to active
employees.
Questions?
To obtain information about your COBRA rights, please contact our
COBRA Administrator, Aetna, 866-472-0897. To obtain information
about portability or conversion, please contact the Plan Administrator
Preventative Benefits
problem.
higher risk
6. Colorectal Cancer screening for adults over 50
7. Depression screening for adults
8. Diabetes (Type 2) screening for adults with high blood
pressure
9. Diet counseling for adults at higher risk for chronic
disease
10. HIV screening for everyone ages 15 to 65 & other ages
at increased risk
26 |Printed 2/12/15
11. Immunization
vaccines
for
adults--doses,
Meningococcal
Herpes Zoster
Pneumococcal
Human Papillomavirus
Tetanus, Diphtheria, Pertussis
Influenza (Flu Shot)
Varicella
12. Obesity screening & counseling for all adults
13. Sexually
Transmitted
Infection
(STI)
prevention
Inactivated Poliovirus
Influenza (Flu Shot)
Pneumococcal
Rotavirus
Varicella
28 |Printed 2/12/15
Need minor or
basic care?
Be a Savvy Shopper
Some pharmacies or drug manufacturers offer
coupons or savings card, free antibiotics &/or
100s of low cost prescriptions for a 30 or 90 day
supply! And, not all charge the same price shop around. If your Rx is covered at the
lowest co-pay (if you have a co-pay plan),
make sure the pharmacy charges the lower of
the actual cost of the medication or copay.
Plus, you can search for coupons that can
save your lots of money!
Self-Care
Walk In
Clinics*
$$
Wait to See
Your
Doctor*
Urgent
Care*
$$$
$$$$
Risk to life,
limb or vision?
Emergency Room
Call 911
$$$$$
Where
Who
When
You Can
Use telemedicine
benefits or your
health plans nurse
line to save yourself
time and money.
Use an outpatient
imaging center
rather than a
hospital for imaging
services.
Make sure lab
services are sent to
your in network
preferred lab
service provider.
Finally, use our resources to help you make sure you pick the benefits
and plans that make the most sense for you and your family. Request
a prior authorization for a recommended service or procedure.
http://www.iom.edu/weightofthenation
Research has shown that as peoples weight increase so
does their risk for developing some of the most deadly
health conditions.
Do it Naturally
Even if you have a health condition, look for ways to solve
your health problems naturally.
Avoid prescription cocktails when possible. Make sure the
side effects dont outweigh the symptom(s) youre looking
to cure.
Get Connected
There are lots of free resources to help you get healthy,
educated or obtain assistance.
Commonly used resources include your benefits plans
and our Resource Center. Others include:
Use the new Food Guide Pyramid. It shows you how much
of which foods you should eat every day.
Good eating habits, include:
Notices
PRIVACY OF THE
IMPORTANT TO US.
INFORMATION
WE
MAINTAIN
IS
6. Our
Document Disclosure
Your
wellbeing
relies on...
good health
good
education
reliable
resources
plans for
financial
security