www.elitebenefitsgroup.comELITEBENEFITSGROUPENHANCE - EDUCATE - ENGAGE - ENROLL - EMPOWER
Vision insurance helps pay for eye exams and materials, such as glasses and contact lenses. This coverage can help you maintain healthy vision and overall wellness, as well as provide valuable financial protection for you, your spouse and dependent children.www.elitebenefitsgroup.comVISION BENEFITSIN-NETWORKSOUT OF NETWORK ALLOWANCECO-PAYSSTANDARD PLASTIC LENSES (once per 12 months)FRAMES (once per 24 months)CONTACT LENSES (once per 12 months) (Includes fit, follow-up and materials) in lieu of eyeglass lenses and framesExam $10Up to $30Single visionBifocalTrifocalLenticularProgressivePolycarbonate lenses (for children to age 19)$15$15$15$40$15$15Up to $25Up to $40Up to $60Up to $100Up to $40N/AChoose any frame available at provider locations$130 allowance$65 AllowanceElectiveMedically Necessary$130 allowance (15% off balance over $130)$0$104 allowance$200 allowanceVISION(Humana Network)Employee Contributions (Bi-Weekly)EmployeeEmployee and SpouseEmployee and Child (ren)Employee and Family$1.21$3.65$3.40$6.05
Voluntary Benefits 101What are voluntary benefits?Sometimes called “supplemental insurance,” voluntary benefits are policies you buy to add to the health and life insurance your employer may already provide. These benefits can help you pay for things your other insurance won’t, such as lost wages, out-of-pocket expenses and household bills.Advantages*Flexibility Use claim payments however you like – pay deductibles, co-payments and other expenses not covered by your health or life insurancePortability Take coverage with you if you leave your job or retireStability Maintain coverage whether or not you’re employedConvenience Pay premiums using your choice of payroll deduction, bank dra or direct billingColonialLife.comProducts have exclusions and limitations that may aect benefits payable. Products vary by state and may not be available in all states. Underwritten by Colonial Life & Accident Insurance Company, Columbia, SC ©2017 Colonial Life & Accident Insurance Company. All rights reserved. Colonial Life is a registered trademark and marketing brand of Colonial Life & Accident Insurance Company.Policies Accident insurance Helps cover out-of-pocket expenses in the event of a covered accidentCancer and critical illness insurance Helps with the high cost of cancer or critical illness diagnosis and treatmentDisability insurance Helps replace part of your regular income if you are unable to work because of a covered injury or illnessHospital confinement indemnity insurance Helps pay for covered hospital-related expenses, such as outpatient surgery and diagnostic proceduresLife insurance Protects the people who depend on you by helping cover final expenses and loss of income*Advantages may not apply to all products. See your Colonial Life benefits counselor forcomplete details.
%(1(),76(/,*,%,/,7< $VDQHPSOR\HHRICarrera Home Services Inc.\RXKDYHDFFHVVWRWKHIROORZLQJ EHQHILWVIRUWKH3ODQ<HDUFebruary24±January315 Core Plan Benefits offered:United HealthcareVision/ Dental- HumanaSupplemental Benefits through Colonial Life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`TLU[:[H[\Z +LH[OPU[OL-HTPS` +LWLUKLU[*OPSK9LHJOLZ3PTP[PUN(NL +P]VYJL(UU\STLU[ -43(9LSH[LK3LH]L 3LNHS:LWHYH[PVU4HYYPHNL :WV\ZL3VZZVM6[OLY*V]LYHNL ,UYVSSTLU[PU4HYRL[WSHJL*V]LYHNL<RXPXVWPDNHFKDQJHVWR\RXUEHQHILWFRYHUDJHZLWKLQGD\VRIDQHOLJLEOH FKDQJHLQVWDWXVOLIHHYHQW:+$7+$33(16,),'21¶7(152//" ,I\RXGRQRWHQUROOLQWKHEHQHILWVSURJUDP\RXZLOODXWRPDWLFDOO\UHFHLYH³GHIDXOW´ FRYHUDJHZKLFKLV1R&RYHUDJH,IODWHURQ\RXGHFLGHWRHQUROOLQEHQHILWV\RXPD\EHVXEMHFWWREHQHILWZDLWLQJ SHULRGVUHTXLUHHYLGHQFHRILQVXUDELOLW\DQGRUEHUHTXLUHGWRZDLWXQWLOWKHQH[W $QQXDO(QUROOPHQWwww.elitebenefitsgroup.com
The information in this Enrollment Guide is intended for illustrative purposes and informational purposes only. The information contained herein was taken from various summary plan descriptions, certificates of coverage and benefit information. Every effort was taken to accurately report your benefits however discrepancies and errors are always possible. It is not intended to alter or expand rights or liabilities set forth in the official plan documents or contracts. It is not an offer to contract nor are there any express or implied guarantees. In case of a discrepancy between this information and the actual plan documents, the actual plan documents will prevail. If you have any questions about this summary, please contact Human Resources or Elite Benefits GroupELITE BENEFITS GROUPMEDICALUnited Healthcarewww.myUHC.com1-877-797-8812DENTAL / VISION713-575-3722sara@elitebenefitsgroup.comCONTACT INFORMATIONwww.elitebenefitsgroup.comHUMAN RESOURCESCleo Rinehart cleo@tts.us.comHumana800-233-4013www.humana.com
Carrera Home Services Inc. & Bespoke Countertops iscommitted to a comprehensive employeebenefitprogram that helpsouremployeesstay healthy, feel secure andmaintain a work/life balance.The benefits program was designed to provide you with a competitive level of standard coverage while allowing you the flexibility to choose benefits that reflect your needs and personalcircumstances. In addition to receiving coverage for health insurance, you have the opportunity to choose other coverage that best meets your needs.www.elitebenefitsgroup.com
1. DEDUCTIBLEThe amount you must pay before your insurance company starts to pay for covered services each year.3. COPAYMENTSA fixed amount you pay for coveredservices such as doctor visit or diagnostic test.5. COVEREDSERVICESMedical services included in your insurance plan, such as doctor visits, hospital stays and diagnostic tests.7. OUT-OF-NETWORKA doctor or medical facility that is not contracted with your insurance company. Using out-of-network providers can result in you paying a higher portion of the medical bills or possibly the entire bill.2. COINSURANCEThe percentage of a medical expense you are responsible for paying. This usually kicks in after you have met your deductible.4. OUT-OF-POCKETMAXIMUMThe most you have to pay for covered services in a plan year.6. IN-NETWORKThe doctors, hospitals and other medical facilities and suppliers that contract with your insurance company to provide medical services.8. PROVIDERThe person or facility providing services to you, including doctors, hospitals and pharmacies.www.elitebenefitsgroup.comYOU SHOULD KNOW8TERMS
United Healthcare is our medical carrier. Below is a brief summary of the medical plan. Using In-Network facilities and physicians will result in significant cost savings to the member. Network facilities and physicians can be found at myuhc.com or call 1-877-797-8812. Please refer to the United Healthcare Summary of Benefits for a more comprehensive listing of services and additional information. www.elitebenefitsgroup.comPlan 1 (Base Plan)E3000i70LX21BIN NETWORKOUT OF NETWORKE3000i70LX21B70% 3%N/AN/A$3,000$6,000N/AN/A$8,150$16,300N/AN/AEmployee Contribution (Bi-Weekly)Employee only Employee and Spouse Employee and Child (ren) Employee and FamilyN/A $37.35$196.09$417.03PlanParticipantCalendar Year Deductible (CYD) IndividualFamilyMaximum our of Pocket IndividualFamilyOffice VisitPrimary Care Visits (non-surgical) Specialist Visit (non-surgical) Urgent Care VisitPreventive Care HospitalIn-Patient Services Out-Patient Services Emergency Room Retail Prescription* Preferred Generic$256.65MEDICAL INSURANCE $25 Copay$75 Copay$50 Copay Covered at 100%30% Coinsurance 30% Coinsurance 30% Coinsurance N/A N/AN/AN/AN/AN/AN/A$10 / $35 / $75 / $250
United Healthcare is our medical carrier. Below is a brief summary of the medical plan. Using In-Network facilities and physicians will result in significant cost savings to the member. Network facilities and physicians can be found at myuhc.com or call 1-877-797-8812. Please refer to the United Healthcare Summary of Benefits for a more comprehensive listing of services and additional information. www.elitebenefitsgroup.comPlan 2E1000i80LX22BIN NETWORKOUT OF NETWORKE1000i80LX22B80% 2%N/AN/A$1,000$2,000N/AN/A$3,000$6,000N/AN/AEmployee Contribution (Bi-Weekly)Employee only Employee and Spouse Employee and Child (ren) Employee and FamilyN/A $86.46$292.85$580.08PlanParticipantCalendar Year Deductible (CYD) IndividualFamilyMaximum our of Pocket IndividualFamilyOffice VisitPrimary Care Visits (non-surgical) Specialist Visit (non-surgical) Urgent Care VisitPreventive Care HospitalIn-Patient Services Out-Patient Services Emergency Room Retail Prescription* Preferred Generic$371.57MEDICAL INSURANCE $25 Copay$75 Copay$50 Copay Covered at 100%20% Coinsurance 20% Coinsurance 20% Coinsurance N/A N/AN/AN/AN/AN/AN/A$10 / $35 / $75 / $250
United Healthcare is our medical carrier. Below is a brief summary of the medical plan. Using In-Network facilities and physicians will result in significant cost savings to the member. Network facilities and physicians can be found at myuhc.com or call 1-877-797-8812. Please refer to the United Healthcare Summary of Benefits for a more comprehensive listing of services and additional information. www.elitebenefitsgroup.comPlan 3E250i80LX21BIN NETWORKOUT OF NETWORKE250i80LX21B80% 2%N/AN/A$250$500N/AN/A$4,000$8,000N/AN/AEmployee Contribution (Bi-Weekly)Employee only Employee and Spouse Employee and Child (ren) Employee and FamilyN/A $91.59$302.94$597.10PlanParticipantCalendar Year Deductible (CYD) IndividualFamilyMaximum our of Pocket IndividualFamilyOffice VisitPrimary Care Visits (non-surgical) Specialist Visit (non-surgical) Urgent Care VisitPreventive Care HospitalIn-Patient Services Out-Patient Services Emergency Room Retail Prescription* Preferred Generic$383.57MEDICAL INSURANCE $25 Copay$75 Copay$50 Copay Covered at 100%20% Coinsurance 20% Coinsurance 20% Coinsurance N/A N/AN/AN/AN/AN/AN/A$10 / $35 / $75 / $250
United Healthcare is our medical carrier. Below is a brief summary of the medical plan. Using In-Network facilities and physicians will result in significant cost savings to the member. Network facilities and physicians can be found at myuhc.com or call 1-877-797-8812. Please refer to the United Healthcare Summary of Benefits for a more comprehensive listing of services and additional information. www.elitebenefitsgroup.comPlan 4E040100i100LX24BIN NETWORKOUT OF NETWORKE040100i100LX24B100% %N/AN/A$0$0N/AN/A$6,000$12,000N/AN/AEmployee Contribution (Bi-Weekly)Employee only Employee and Spouse Employee and Child (ren) Employee and FamilyN/A $107.73$334.74$650.68PlanParticipantCalendar Year Deductible (CYD) IndividualFamilyMaximum our of Pocket IndividualFamilyOffice VisitPrimary Care Visits (non-surgical) Specialist Visit (non-surgical) Urgent Care VisitPreventive Care HospitalIn-Patient Services Out-Patient Services Emergency Room Retail Prescription* Preferred Generic$421.33MEDICAL INSURANCE $40 Copay$100 Copay$100 Copay Covered at 100%No Charge per admission after $1,500 Copay/VisitNo Charge, after $1,500 Copay/Visit $525 Copay/visit. Ded. does not applyN/A N/AN/AN/AN/AN/AN/A$5 / $20 / $50 / $100
DENTALwww.elitebenefitsgroup.comCLASSTYPE OF SERVICEINSURANCE PAYSNetworkOur national dental network offers more than 323,000 access points. Members may choose any dentist but may receive additional savings by choosing an in-network dentist. Plus, services not covered by this plan may also still be eligible for in-network savings. Out-of-network benefits are paid at the network negotiated rate.Dental insurance can help preserve your smile with easy-to-use coverage that promotes overall wellness.Benefits can help with a variety of dental costs, from routine cleanings to more advanced procedures. Coverage is available for you, your spouse and dependent children.Plan detailsThe benefit year maximum for this plan is unlimited per person.Class A, B and C services apply toward the benefit year maximum.This plan has a deductible of $50 per person.Families only pay the deductible for a maximum of three people. Applies only to class B and C services.The co-insurance for this plan is:INSURANCE(Humana Network) Unlimited 100%80% 50%Class AClass BClass CPreventive ServiceBasic ServiceMajor Service100%80%50%
Covered Procedures & Waiting Periods•Crowns (1 per tooth every 5 years)•Inlays/onlays (1 per tooth every 5 years)•Bridges (1 per tooth every 5 years)•Dentures (1 per tooth ever 5 years)•Denture relines/rebases (1 every 3 years, following 6 months of denture use)•Denture repair and adjustments (following 6 months of denture use)•Implant Related Services (crowns, bridges, and dentures each limited to 1per tooth every five years. Coverage limited to equivalent cost of a non-implantservice. Implant placement itself is not covered)•Periodontics-(Scaling/root planing and surgery 1 per quadrant every 3 years)•Endodontics-(root canals 1 per tooth per lifetime and 1 re-treatment)Preventive services (Class A): 100% No DeductibleMajor services (Class C): 50% after DeductibleEmployee Contributions (Bi-Weekly)EmployeeEmployee and SpouseEmployee and Child (ren)Employee and Family$6.42$19.28$31.98$46.34• Routine oral examinations (3 per year)• Bitewing x-rays (2 films under age 10, up to 4 films ages 10 and older)• Routine cleanings (3 per year)• Periodontal cleanings (4 per year)• Fluoride treatment (1 per year, through age 16)• Sealants (permanent molars, through age 16)• Space maintainers (primary teeth, through age 15)• Oral Cancer Screening (1 per year, ages 40 and older)Basic services (Class B): 80% after Deductible• Emergency care for pain relief• Amalgam fillings (1 per tooth every 2 years, composite for anterior/frontteeth)• Oral surgery (tooth extractions including impacted teeth)• Stainless steel crowns• Harmful habit appliances for children (1 per lifetime, through age 14)3 years)**Non-participating dentists can bill you for charges above the amount covered by your Humana Dental plan. To ensure you do not receive additional charges, visit a participating PPO Network dentist.