www.elitebenefitsgroup.comELITEBENEFITSGROUPENHANCE - EDUCATE - ENGAGE - ENROLL - EMPOWER
Fleur De Lis Worldwide is committed toacomprehensiveemployeebenefitprogram that helps our employees stay 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 personal circumstances. 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-POCKETMAXIMUMA limit on the amount of money you have to pay for covered health care 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
Memorial Hermann 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 https://healthplan.memorialhermann.org/find-a-doctor?network=Select+HMO or by calling 855-645-8448.www.elitebenefitsgroup.comSelect 500 HMOIN NETWORKOUT OF NETWORKParticipant90% 10%N/AN/ACaCaalelelndnddararYYeaear DeeDeductible (CYD)IndividualFamily$500$1,500N/AN/AMaximum mOuOt of PocoockeketIndividualFamily$1,500$4,500N/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$2 / $15 / $40$0.00$0.00$0.00PlanHospitalIn-Patient ServicesOut-Patient ServicesEmergency Room$0.00MEDICAL INSURANCE$15 Copay/visit. Deductible does not apply$30 Copay/visit. Deductible does not apply$50 Copay/visit. Deductible does not apply Covered at 100%10%/ Visit. Deductible applies first.10%/ Visit. Deductible applies first .$400 Copay then 10%/Visit. Deductible does not apply.
DENTALDental 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.The benefit year maximum for this plan is $2,000 per person.Class A, B and C services apply toward the benefit year maximum.Plan detailsThis 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.www.elitebenefitsgroup.comCLASS TYPE 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.The co-insurance for this plan is:INSURANCE(Network: UNUM) $2,000, 100%80% 50%Class AClass BClass CPreventive ServiceBasic ServiceMajor Service100%80%50%
Covered Procedures & Waiting PeriodsRoutine exams and cleanings (twice every 12 months) One additional cleaning per 12 months if member is in second or third trimester of pregnancy4X-raysBitewing X-rays (up to four films; once every 12 months)Full mouth/panoramic x-rays(once every five years)Children’s services(up to age 14) Fluoride treatment (once every 12 months) Sealants (once every 36 months) Space maintainers (up to age 14; once every 24 months)Adjunctive pre-diagnostic oral cancer screening (for age 40 or older; once every 12 months).Simple restorative services(fillings)Simple extractionsEmergency treatmentRepair of crown, denture or bridgeOral surgery (extractions and impacted teeth) Anesthesia (subject to review; covered with complex oral surgery)Periodontics (gum treatments)Endodontics (root canals)Inlays and OnlaysCrownsBridgesDenturesEndosteal implants (in lieu of an approved three-unit bridge)Preventive services (Class A): No waiting periodBasic services (Class B): No waiting periodMajor services (Class C): 12 - month waiting periodEmployee Contributions (Bi-Weekly)EmployeeEmployee and SpouseEmployee and Child (ren)Employee and Family$0.00$0.00$0.00$0.00www.elitebenefitsgroup.com
Dental insurance offers an optional vision rider to help 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-NETWORKS OUT 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)Materials$10$25Up to $35See belowSingle visionBifocalTrifocalLenticularProgressivePolycarbonate lenses (for children to age 19)Covered by co-payCovered by co-payCovered by co-payCovered by co-pay$80 allowance$70 allowanceUp to $25Up to $40Up to $50Up to $50Up to $40N/Achoose any frame avaiable at provider locations$120 allowanceUp to $50ElectiveMedically NecessaryUp to $120 allowanceUp to $210 allowanceUp to $100 allowanceUp to $210 allowanceVISIONNetwork: First LookEmployee Contributions (Bi-Weekly)EmployeeEmployee and SpouseEmployee and Child (ren)Employee and Family$0.00$0.00$0.00$0.00
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 billingTo learn more about voluntary benefits, contact us at 713-575-3722Underwritten 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 treatmentDental insurance Helps pay for dental procedures, like routine cleanings, crowns and root canalsDisability 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\HHRIFleur De Lis Worldwide\RXKDYHDFFHVVWRWKHIROORZLQJ EHQHILWVIRUWKH3ODQ<HDUSeptember24±August15. Core Plan Benefits offered:Memorial Hermann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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 GROUPMEDICALMemorial HermannDENTAL / VISION713-575-3722CONTACT INFORMATIONwww.elitebenefitsgroup.comwww.colonialLifedental.com 888-400-9304colonialLifedental.comCOLONIAL LIFEColonial Life Policies800-325-4368www.coloniallife.comhttps://healthplan.memorialhermann.org/find-a-doctor?network=Select+HMO 855-645-8448