Nature Environmental & Marine Services LV FRPPLWWHG WR D FRPSUHKHQVLYH HPSOR\HH EHQHILW SURJUDP WKDWKHOpV RXU HPSOR\HHV VWD\ KHDOWK\ IHHO VHFXUH DQG PDLQWDLQDZRUNOLIHEDODQFH7KHEHQHILWV SURJUDP ZDV GHVLJQHGWRSURYLGH\RXZLWK D FRPSHWLWLYHOHYHO RI VWDQGDUG FRYHUDJH ZKLOH DOORZLQJ \RX WKH IOH[LELOLW\ WR FKRRVH EHQHILWV WKDW UHIOHFW \RXU QHHGV DQG SHUVRQDO FLUFXPVWDQFHV,QDGGLWLRQWRUHFHLYLQJFRYHUDJHIRUKHDOWKLQVXUDQFH\RX KDYHWKHRSSRUWXQLW\WR FKRRVHRWKHUFRYHUDJHWKDWEHVWPHHWV\RXUQHHGVwww.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)E3500i80LX21BIN NETWORKOUT OF NETWORKE3500i80LX21B80% 2%N/AN/A$3,500$7,000N/AN/A$8,150$16,300N/AN/AEmployee Contribution (per pay period)Employee only Employee and Spouse Employee and Child (ren) Employee and FamilyN/A $45.09$202.13$420.69PlanParticipantCalendar 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$262.03MEDICAL 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 2E1500i100LX21BIN NETWORKOUT OF NETWORKE1500i100LX21B100% %N/AN/A$1,500$3,000N/AN/A$4,000$8,000N/AN/AEmployee Contribution (per pay period)Employee only Employee and Spouse Employee and Child (ren) Employee and FamilyN/A $91.31$293.19$574.15PlanParticipantCalendar 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$370.19MEDICAL INSURANCE $25 Copay$75 Copay$50 Copay Covered at 100%0% Coinsurance 0% Coinsurance 0% 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 3E01575LX21BIN NETWORKOUT OF NETWORKE01575LX21B100% %N/AN/A$0.00$0.00N/AN/A$4,000$8,000N/AN/AEmployee Contribution (per pay period)Employee only Employee and Spouse Employee and Child (ren) Employee and FamilyN/A $162.54$433.50$810.62PlanParticipantCalendar 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$536.86MEDICAL INSURANCE $15 Copay$15 Copay$75 Copay Covered at 100%No ChargeNo ChargeNo ChargeN/A N/AN/AN/AN/AN/AN/A$5 / $30 / $65 / $150
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 4 (HSA) HEVV600021BIN NETWORKOUT OF NETWORK HEVV600021B100% %N/AN/A$6,000$12,000N/AN/A$6,000$12,000N/AN/AEmployee Contribution (per pay period)Employee only Employee and Spouse Employee and Child (ren) Employee and FamilyN/A $26.76$166.02$359.85PlanParticipantCalendar 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$219.15MEDICAL INSURANCE Deductible & CoinsuranceDeductible & Coinsurance Deductible & CoinsuranceCovered at 100%Deductible & CoinsuranceDeductible & CoinsuranceDeductible & CoinsuranceN/A N/AN/AN/AN/AN/AN/ADeductible & Coinsurance
DENTALwww.elitebenefitsgroup.comCLASS TYPE OF SERVICE INSURANCE 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:INSURANCEUnlimited 100%80% 50%Class AClass BClass CPreventive ServiceBasic ServiceMajor Service100%80%50%
Covered Procedures& waiting periods•Emergency care for pain relief•Amalgam fillings (1 per tooth every 2 years, composite for anterior/front teeth)•Oral surgery (tooth extractions including impacted teeth)•Stainless steel crowns•Harmful habit appliances for children (1 per lifetime, through age 14)•Periodontics (scaling/root planing and surgery 1 per quadrant every 3 years)•Endodontics (root canals 1 per tooth per lifetime and 1 re-treatment)•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.)*Orthodontia services-child orthodontia - Covers children through age 18. Plan pays 50percent (no deductible) of the covered orthodontia services, up to: $1,000 lifetime orthodontiamaximum.Preventive services (Class A): 100% No DeductibleBasic services (Class B): 80% after DeductibleMajor services (Class C): 50% after DeductibleEmployee Contributions (Bi-Weekly)EmployeeEmployee and SpouseEmployee and Child (ren)Employee and Family$8.05$24.15$35.90$52.58www.elitebenefitsgroup.com• 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)
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 12 months)CONTACT LENSES (once per 12 months) (Includes fit, follow-up and materials) in lieu of eyeglass lenses and framesExam (once per 12 months)$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 avaiable at provider locations$130 allowance$65 AllowanceElectiveMedically NecessaryUp to $130 allowance$0Up to $104 allowanceUp to $200 allowanceVISIONEmployee Contributions (Bi-Weekly)EmployeeEmployee and SpouseEmployee and Child (ren)Employee and Family$1.65$4.95$4.62$8.20
BENEFITS & ELIGIBILITYAs an employee of Nature Environmental & Marine Services, you have access to the following benefits for the Plan Year February 1, 2024 – January31, 2025.Core Plan Benefits offered:United Healthcare=PZPVU+LU[HS7SHU :\WWSLTLU[HS)LULMP[Z[OYV\NO*VSVUPHS3PML• )PY[O(KVW[PVU• *OHUNLPU0UZ\YHUJL*V]LYHNL(KKYLZZ,TWSV`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]LYHNLWHO IS ELIGIBLE AND WHENAll active full-time Employees, who work at least 30 hours per week. Employee benefits are effective the first of the month following 60 days of active employment.ELIGIBLE DEPENDENTSYou may enroll your eligible dependents in coverage. They include:-Legal Spouse.-Children up to age 26, regardless of student status or marital status, includingnatural children, stepchildren, and legally adopted children (including children livingwith you before the adoption is final) who are your dependents or for whom you arerequired to provide health care coverage under a Qualified Medical Child SupportOrder.CHANGING YOUR COVERAGE DURING THE YEARIf you need to change your coverage throughout the year, you may only do so if you experience an eligible change in status/life event, such as:You must make changes to your benefit coverage within 30 days of an eligible change in status/life event.WHAT HAPPENS IF I DON’T ENROLL?If you do not enroll in the benefits program, you will automatically receive “default” coverage, which is:No Coverage.If later on you decide to enroll in benefits, you may be subject to benefit waiting periods, require evidence of insurability, and/or be required to wait until the next Annual Enrollment.www.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 GroupMEDICAL / PRESCRIPTIONSCOLONIAL LIFEELITE BENEFITS GROUPUnited Healthcarewww.myUHC.com or call 1-877-797-8812DENTAL / VISIONColonial Life Policieswww.colonialLife.com 800.325.4368713.575.3722CONTACT INFORMATIONwww.elitebenefitsgroup.comHUMAN RESOURCEShr@natureenviro.comHumanawww.humana.com/finder/medical 1.800.233.4013