www.elitebenefitsgroup.comELITEBENEFITSGROUPENHANCE - EDUCATE - ENGAGE - ENROLL - EMPOWER
Interland/Interfield LV FRPPLWWHG WR D FRPSUHKHQVLYH HPSOR\HH EHQHILW SURJUDP WKDWKHlpV 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 QHHGVDQGSHUVRQDOFLUFXPVWDQFHV,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 877-797-8812.www.elitebenefitsgroup.comPlan 1 E6000i80LX21BIN NETWORKOUT OF NETWORKParticipant80% 20%N/AN/ACaCaalelelndnddararYYeaear DeeDeductible (CYD)IndividualFamily$6,000$12,000N/AN/AMaximum mOuOt of PocoockeketIndividualFamily$8,150$16,300N/AN/AOffice VisisititPrimary Care Visits (non-surgical)Specialist Visit (non-surgical)Urgent Care VisitPreventive CareRetailPPrerescscription*Preferred Generic(PSOR\HH&RQWULEXWLRQ (Bi-WeeklyEmployee onlyEmployee and SpouseEmployee and Child (ren)Employee and Family$10 / $35 / $75 / $250$81.02$219.61$412.50PlanHospitalIn-Patient ServicesOut-Patient ServicesEmergency Room$272.48MEDICAL INSURANCE$25 Copay/visit. Deductible does not apply. $75 Copay/visit. Deductible does not apply.$50 Copay/visit. Deductible does not apply. No Charge. Deductible does not apply.20% Coinsurance 20% Coinsurance 20% Coinsurance
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 877-797-8812.www.elitebenefitsgroup.comPlan 2 E3000i80LX22BIN NETWORKOUT OF NETWORKParticipant80% 20%N/AN/ACaCaalelelndnddararYYeaear DeeDeductible (CYD)IndividualFamily$3,000$6,000N/AN/AMaximum mOuOt of PocoockeketIndividualFamily$6,500$13,000N/AN/AOffice VisisititPrimary Care Visits (non-surgical)Specialist Visit (non-surgical)Urgent Care VisitPreventive CareRetailPPrerescscription*Preferred Generic(PSOR\HH&RQWULEXWLRQ (Bi-WeeklyEmployee onlyEmployee and SpouseEmployee and Child (ren)Employee and Family$10 / $35 / $75 / $250$91.22$250.63$472.49PlanHospitalIn-Patient ServicesOut-Patient ServicesEmergency Room$311.44MEDICAL INSURANCE$25 Copay/visit. Deductible does not apply. $75 Copay/visit. Deductible does not apply.$50 Copay/visit. Deductible does not apply. No Charge. Deductible does not apply.20% Coinsurance 20% Coinsurance 20% Coinsurance
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 877-797-8812.www.elitebenefitsgroup.comPlan 3 E2000i100LX21BIN NETWORKOUT OF NETWORKParticipant100% 0%N/AN/ACaCaalelelndnddararYYeaear DeeDeductible (CYD)IndividualFamily$2,000$4,000N/AN/AMaximum mOuOt of PocoockeketIndividualFamily$4,000$8,000N/AN/AOffice VisisititPrimary Care Visits (non-surgical)Specialist Visit (non-surgical)Urgent Care VisitPreventive CareRetailPPrerescscription*Preferred Generic(PSOR\HH&RQWULEXWLRQ (Bi-WeeklyEmployee onlyEmployee and SpouseEmployee and Child (ren)Employee and Family$10 / $35 / $75 / $250$104.80$291.95$552.41PlanHospitalIn-Patient ServicesOut-Patient ServicesEmergency Room$363.33MEDICAL INSURANCE$25 Copay/visit. Deductible does not apply. $75 Copay/visit. Deductible does not apply.$50 Copay/visit. Deductible does not apply. No Charge. Deductible does not apply.0% Coinsurance 0% Coinsurance 0% 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: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$0.00$13.63$21.13$34.77• 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)Orthodontia servicesMembers may receive a discount on non-covered services ofup to 20%. Members may contact their participating provider to determine if any discounts are available on non-covered services.**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.
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 1 (once per 12 months)FRAMES 1 (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)$10$10$10$40$10$10Up to $25Up to $40Up to $60Up to $100Up to $40N/Achoose any frame avaiable at provider locations$150 allowance$80 AllowanceElectiveMedically NecessaryUp to $150 allowance$0$128 allowance$210 allowanceVISION(Humana Network)Employee Contributions (Bi-Weekly)EmployeeEmployee and SpouseEmployee and Child (ren)Employee and Family$0.00$3.66$3.30$7.28
Voluntary Benefits 101What are voluntary benefits?Sometimes called “supplemental insurance,”voluntary benefits arepolicies you buy to add to the healthand lifeinsuranceyour 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*FlexibilityUseclaimpaymentshoweveryoulike–paydeductibles, co-payments and other expenses not covered by your healthorlifeinsurancePortabilityTakecoveragewithyouifyouleaveyourjoborretireStabilityMaintaincoveragewhetherornotyou’reemployedConveniencePaypremiumsusingyourchoice ofpayrolldeduction, bankdraftor directbillingColonialLife.comProducts have exclusions and limitations that may affect benefits payable.Products varyby state and may not be availablein all states.PoliciesAccidentinsuranceHelpscoverout-of-pocketexpenses in the eventof a coveredaccidentCancer and critical illness insurance Helpswith the highcost of canceror critical illness diagnosis and treatmentDentalinsuranceHelpspayfordentalprocedures,likeroutine cleanings, crownsand root canalsDisability insuranceHelps replace part of your regular income if youare unable to work because of a covered injuryor illnessHospitalconfinementindemnityinsuranceHelps pay for covered hospital-related expenses, such as outpatient surgeryand diagnosticproceduresLifeinsuranceProtects the people who depend on you byhelpingcoverfinalexpensesandlossof income*Advantagesmay notapply to all products. SeeyourColonialLife benefits counselorforcompletedetails.Underwritten by Colonial Life &AccidentInsuranceCompany, Columbia, SC©2017 Colonial Life & Accident Insurance Company. All rights reserved. Colonial Life is a registered trademark and marketing brand of Colonial Life &Accident InsuranceCompany.Interfield/Interland is providing each employee with a benefit bank to use towards Voluntary Benefits of their choosing.
BENEFITS & ELIGIBILITYAs an employee of Interfield/Interland, you have access to the following benefits for the Plan Year May 1, 2024 – April30, 2025.Core Plan Benefits offered:Humana=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 90 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 Healthcaremyuhc.com1-877-797-8812DENTAL / VISIONColonial Life Policieswww.colonialLife.com 800-325-4368713-575-3722CONTACT INFORMATIONwww.elitebenefitsgroup.comHUMAN RESOURCESHumanaHumana.com1-800-233-4013Patricia Mata713-780-0909 Ext. 333INTERLANDINTERFIELDAmparo Miranda713-880-0516