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281-712-2038Lauren@thebcsg.comBENEFITINFORMATIONGUIDE 2023Beneficios para una vida mejor.Presented by The StevensonGroupCompany Name
WELCOME TO YOUR BENEFITS ENROLLMENTThe health and welfare of our employees and their families are of the utmost importance. That is why we are proud to offer a comprehensive, flexible and competitive benefits program designed to meet the unique needs of you and your family, while promoting your physical, financial and emotional health.The Benefits Information Guide has been designed as a resource to help you understand your benefit options for 2022 and make the enrollment elections that are right for you. Be sure to finalize your benefit decisions by the enrollment deadline to receive coverage for the year.
Effective Date of CoverageBenefit Contacts Phone Number Website or Email AddressMEDICAL833-726-2123https://providerlookup.healthsmart.com/SearchProviders.aspxDENTAL800-786-5433https://www.sunlife.com/us/Resources/Tools/Find+a+dentist/VISION800-786-5433 https://www.vsp.com/eye-doctorLIFE INSURANCE800-786-5433https://login.sunlifeconnect.com/commonlogin/HSA ADMINISTRATOR800-357-6246 myaccount.hsabank.comINSURANCE BROKER832-604-3153 Trey@thebcsg.comACCOUNT MANAGER281-712-2038 Lauren@thebcsg.comSummary of Benefits & CoverageThe Health section of this guide provides an overview of your medical plan options. you can find detailed information about each plan in the corresponding Summary of Benefits & Coverage (SBC). SBCs summarize important information about your health coverage options in a standard format to help you compare costs and feautres across plans. SBCs are available in paper copy by emailing HR.The Stevenson Group/ Trey KleffnerThe Stevenson Group/ Lauren StevensonSUNLIFEHSA BankProviderSANA BENEFITSSUNLIFESUNLIFEReach out to the appropriate contact listed below to view your benefits, take advantage of additional resources and learn more about your specific plans.To enroll throught Ease, log in to Ease and follow the instructions to complete your enrollment. You can enroll from any computer with internet access or on your phone, 24 hours a day, seven days a week.For new employees, your effective date of coverage will be 1st of the month following your waiting period. Any changes made outside of open enrollment must have a Qualifying Life Event (QLE).How to EnrollContactsHUMAN RESOURCES
Notes High Deductible Plan - HSA compatible Copay Plus PlanMEDICAL PLAN OPTIONSTelehealth / Virtual Visits 100% after deductible $0 copayDESIGN (in-network)Network HealthsmartDeductible (ind / fam) $2000/ $4000Coinsurance 20%20% coinsurance after deductible (No cost if Sana Partner is used)$4000/ $8000MEDICAL (in-network)$4000 / $8000Physician Office Visits 100% after deductible $25 copay$55.00ER Facility / Physician 100% after deductible $200 copay + ded/ 20%Outpatient Surgery 100% after deductible20% coinsurance after deductible SANA BENEFITSInpatient Care 100% after deductible20% coinsurance after deductible Complex Imaging 100% after deductible20% coinsurance after deductible (No cost if Sana Partner is used)Urgent Care Center 100% after deductible20% coinsurance after deductible (No cost if Sana Partner is used)Specialist Office Visits 100% after deductible $50 copayLab / X-Ray at OV 100% after deductibleOut-of-Pocket Max (ind/fam)NOTESPlan Type Open AccessPHARMACY BENEFITS (in-network 30 day supply)Tier 1 100% after deductible $10.00Tier 2Tier 3Tier 4100% after deductible$55.00100% after deductible100% after deductible$30.00H40 PLAN P20 PLANHealthsmart$4000 / $80000%
COVERAGE LEVELTOTAL COST PER MONTHCOMPANY PAYS PER MONTHEMPLOYEE PAYS PER MONTHEMPLOYEE PAYS BI-WEEKLYEmployee Only $395.70 $299.06 $96.64 $44.60Employee Spouse $796.90 $550.30 $246.60 $113.82Employee Child(ren) $696.61 $481.00 $215.61 $99.51Employee Family $1,131.25 $781.36 $349.89 $161.49COVERAGE LEVELTOTAL COST PER MONTHCOMPANY PAYS PER MONTHEMPLOYEE PAYS PER MONTHEMPLOYEE PAYS BI-WEEKLYEmployee Only $492.20 $370.13 $122.07 $56.34Employee Spouse $1,009.09 $691.79 $317.30 $146.45Employee Child(ren) $879.88 $603.17 $276.71 $127.71Employee Family $1,439.82 $987.20 $452.62 $208.90MEDICAL RATE SHEETSANA BENEFITS H40 MEDICAL PLANSANA BENEFITS P20 MEDICAL PLAN
PreventativeOral Evaluations, Fluroide Treatments, Sealants, X-raysBasicSimple Extractions, Oral Surgery, General Anesthesia, Space Maintainers, Palliative TreatmentMajorInlays/ Onlays, Crowns, Dentures, Bridges, Periodontics, EndodonticsCovered under MajorLaser Vision Correction 15% discount off regular priceNetwork Sun Life Dental NetworkDentalEndodontics PeriodonticsVisionBENEFIT NOTESNecessary ContactsElective Contacts Contact allowance replaces frame & lense allowanceBENEFIT NOTESHealthy teeth and gums are important to your overall wellness. That is why it is important to have regular dental checkups and maintain good oral hygiene.SERVICESDeductible (ind / fam)DESIGNDESIGN Vision PlanHaving vision coverage allows you to save money on eligible eye care expenses, such as periodic eye exams, eyeglasses and contact lenses for you and your covered depdendents.Lenses (Every 12 months)Calendar Year MaximumReferral Exam (Every 12 months)MAC PLAN (No Ortho)$50 individual / $150 family$1,200 None100%80%50%Covered under MajorCovered in full for members with specific conditionsElective Contacts (Every 12 months)Necessary ContactsSERVICESNetwork VSP$15 Copay$25 Copay$130 Allowance + 20% discount over allowance $130 Allowance $25 CopayFrames (Every 24 months)Find a dentist tool:https://www.sunlife.com/us/Resources/Tools/Find+a+dentist/Find a vision provider tool: https://www.vsp.com/eye-doctor
COVERAGE LEVEL EMPLOYEE PAYS PER MONTH EMPLOYEE PAYS BI-WEEKLYEmployee Only $22.94 $10.59Employee Spouse $46.86 $21.63Employee Child(ren) $57.06 $26.34Employee Family $82.22 $37.95COVERAGE LEVEL EMPLOYEE PAYS PER MONTH EMPLOYEE PAYS BI-WEEKLYEmployee Only $6.99 $3.23Employee Spouse $13.26 $6.12Employee Child(ren) $15.58 $7.19Employee Family $21.90 $10.11ANCILLARY RATE SHEETVISION PLANMAC DENTAL PLAN
BASIC LIFEBASIC LIFE & AD&DTHE COMPANY PAYS 100% OF THIS BENEFITEligible EmployeesFull-time employees working in the United States who work a minimum of 30 hours per week.Class DescriptionAll Eligible EmployeesWaiting Period60 days of employmentBenefit AmountFlat $25,000Benefit AmountFlat $25,000Maximum Benefit$25,000 AD&DEligible EmployeesFull-time employees working in the United States who work a minimum of 30 hours per week.Class DescriptionAll Eligible EmployeesMaximum Benefit$20,000 Compulsory Coverage $25,000
Benefit Reduction Benefits reduced by 33% at age 70Spouse Age Spouse rates are based on employee ageVOLUNTARY LIFE BENEFITBenefit Amount $10,000 incrementsSpouse Maximum Benefit $250,000 EMPLOYEE VOLUNTARY LIFE & AD&DMaximum Benefit $500,000 or 5 times annual earnings, whichever is lessGuaranteed Issue Amount lesser of current amount or $100,000Rate Basis Per $1,000 of volumeClass Description All Eligible EmployeesWaiting Period 30 days of employmentEligible EmployeesFull-time employees working in the United States who work a minimum of 30 hours per week.SPOUSE VOLUNTARY LIFE & AD&DRate Basis Per $1,000 of volumeSpouse Benefit Amount $5,000 incrementsSpouse Guaranteed Issue Amount $50,000 Maximum % of Employee Coverage 50%Maximum % of Employee Coverage 50%Unmarried dependent children from birth to age 25Child EligibilityFull Child Benefit BeginsChild Benefit AmountN/ANotes Employee must elect VTL AD&D to elect Spouse VTL/AD&D$1,000, $5,000, or 10,000CHILD VOLUNTARY LIFE & AD&DSpouse Termination Age$10,000 Up to the maximum benefitBirth Child Maximum BenefitChild Guaranteed Issue AmountNotes Employee must elect VTL AD&D to elect Child VTL AD&DRates (per $1,000) $0.208Voluntary Life Equation: (Age banded rate) X (amount requested/ 1,000) = Monthly cost Bi-weekly rate: (Monthly Cost X 12) / 26 EX: 40 yr. old employee electing 50,000 VTL: ( $0.272 X 50) = $13.60 Monthly costBi-weekly rate: ($13.60 X 12) / 26 = $6.28
10,000 $2.080CHILD RATES COST PER MONTH 1,000 $0.2085,000 $1.04075-79 $15.56080-84 $15.56085 & over $15.56060-64 $1.364Under age 2020-24$0.081$0.10865-69 $2.31970-74 $4.06645-49 $0.27250-54 $0.72455-59 $0.95430-34 $0.10835-39 $0.13540-44 $0.217Under age 20 $0.05320-24 $0.08125-29 $0.08180-84 $19.79185 & over $19.791SPOUSE RATES COST PER MONTH65-69 $3.24770-74 $6.08775-79 $19.79150-54 $0.73655-59 $1.36460-64 $2.01935-39 $0.19040-44 $0.27245-49 $0.40825-29 $0.13530-34 $0.163VOLUNTARY LIFE RATESEMPLOYEE RATES COST PER MONTH
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10It’s easy to invite providers to Sana.Adding ProvidersFor the best experience, do this at least a month prior to your appointment.1. Sign in to your Sana account and search for a provider.2. If your provider is already in our system, give them a call to let them know you’ve switched to Sana Benefits. If they don’t recognize our name, let them know we lease the HealthSmart Physician and Ancillary Only network. Your provider is welcome to contact Sana directly at sanabenefits.com/chat, (833) 726-2123, or hello@sanabenefits.com for more information or assistance.3. If your provider isn’t in our search, select the option to invite a provider and complete our easy form. Sana will contact the provider to invite them to Sana, and we’ll email you once you’re all set.Over 90% of providers who we contact agree to accept Sana.What happens if a provider refuses to take Sana?You can still see them! Pay out-of-pocket, and use your itemized superbill to submit a claim to Sana after your visit. Our team reviews each claim within three business days after it’s submitted. Once your claim is approved and processed, Sana will quickly send you a reimbursement for the portion you’re owed.What happens if I need to schedule an elective procedure?For elective procedures, some facilities may require an agreement or contract with Sana. We’re happy to take care of this if and when it happens. AddingProviders
12ER VisitsIf it’s an emergency, go to the ER. Emergencies include severe life-threatening conditions like chest pain, broken bones, or major cuts and burns. How ER Visits WorkProvide the hospital with your Sana Benets information. If your ER visit is during Sana business hours, the hospital can contact Sana Member Support at sanabenets.com/chat or call (833) 726-2123 to verify benets. Members of PPO Plus Plans may need to pay a $200 copay at the time of the visit, while members of PPO Plus HSA plans may need to pay 100% at the time of the visit, depending on whether or not the deductible is met. Copays are waived if the patient is admitted to the hospital. The ER can send Sana claims directly to the claims address listed on your Sana Member ID card. Hospitals are obligated to accept patients even if they don’t recognize or already take your insurance. We’ll settle the claim for you after you receive care.There will inevitably be times when you are sick or have an emergency and need to see someone ASAP. We got you.Urgent CareIf your condition requires an in-person examination and you can’t get an appointment with your primary care physician, chances are you need to get yourself to urgent care. Non-life-threatening conditions that shouldn’t wait until the next day like sprains, allergic reactions, or minor cuts are appropriate for urgent care.How Urgent Care Visits Work1. Sign in to your Sana account and click Find a Doctor to search for an Urgent Care facility near you, or search for the facility you want to visit.2. Have your Sana ID card ready, and provide them with your benets information. 3. If the facility doesn’t recognize Sana, let them know “Sana PPO Plus plans are all-access with no provider restrictions.”4. If your visit is during Sana business hours, they can verify benets by contacting Member Support at sanabenets.com/chat or (833) 726-2123.5. If the facility is unable to verify benets at the time of your visit, please know that you can still get urgent care. You’ll just need to pay out-of-pocket, ask for an itemized bill, and submit a claim to Sana after your visit for reimbursement. Urgent Care Copays• Members on PPO Plus plans: $25• Members on PPO Plus HSA plans pay 100% until the deductible is met• Check out our Sana Care options on page 14 for free or discounted Urgent Care. Emergency medical issues will not be denied and Sana will always work with the provider after services are provided. We won’t deny claims for covered services, so members shouldn’t worry about being stuck with the bill if they need to pay upfront or out-of-pocket.
18Show your Sana membership card at any participating pharmacy to get your prescription lled — or get it delivered straight to your door! Pharmacy Benet ManagersOur best-in-class Pharmacy Benet Managers (PBM) are accepted at over 65,000 retail pharmacies nationwide. Check your membership card to conrm which PBM is assigned to your plan, and sign in to your Sana account to view additional information on your PBM in your Document Center. Create an account with your PBM to:• View your claims history• Find a pharmacy• Price a drug• Search drugs & alternatives• Sign up for mail-order RxMail-Order RxGet more for your money without leaving the house by switching to your PBM’s mail-order Rx service. Rather than paying full price at your pharmacy, get a 90 day supply of your prescription delivered straight to your door for the cost of a 60 day supply. That’s a 33% savings.Your PBM will help you transfer your medications from your current pharmacy to mail-order.PharmacyBenets
PlushCare Virtual doctor visitsLabcorp Routine labs and testingGreen Imaging Imaging and radiology servicesClassPass Fitness and wellness oeringsVida Personalized health coachingGinger Emotional health support and counselingSWORD Health Virtual physical care & pain management2nd.MD Second opinions and treatment plansConnect DME Durable Medical Equipment (DME) deliveryCarrum Health Top surgical care at world-class hospitalsBlueberry Pediatrics 24/7 virtual pediatric careMaven On-demand maternity careDispatchHealth Urgent care at homeSana Care Provider ListQuestions? Reach out to us at hello@sanabenets.com or (833) 726-2123 Sana Care Field GuideSana Care Field GuideSana Care Provider ListGet proactive about your health. Get the care you need when you need it. Take advantage of our world-class Sana Care oerings — available exclusively to Sana members.Sana Care empowers you to take controlof your health and wellness
Common PlushCare VisitsQuestions? Reach out to us at hello@sanabenets.com or (833) 726-2123Cost & EligibilityPPO Plus members: FreeGetting StartedPrimary care appointments from the comfort of home.Go to plushcare.com and create an accountClick “Check Your Copay”Search for Sana Benets and enter your member IDBook an appointment1234Get personalized, high-quality care from topU.S. medical doctors all from the ease of your smartphone or computer. We’ve got you covered with accessible, aordable appointments from our best-in-class telehealth partner. Appointments are available through the PlushCare app, web, and by phone. General Medical• Sinus infection• Urinary tract infection• Cold & u• Bronchitis• Pink eye• Sore throat & strep• Ear issues• Upset stomach• Skin rashPrescription Rells• Asthma• High blood pressure• High cholesterol• Pre-diabetes & diabetes• Erectile dysfunction• Thyroid disease• Arthritis• Birth control• Mental healthLabs & Testing• STD testing• Allergy testing• Hormone testing• PrEP• Diabetes• Cholesterol• Dietary Assessment• Blood analysis• Thyroid testingSana Care Field GuideSana Care for Virtual Doctor Visits•PPO Plus HSA members with company plansstarting in 2021: Free•PPO Plus HSA members with company plans starting on or after January 1, 2022:•– $99 per visit until the deductible is met–Free after deductible
Questions? Reach out to us at hello@sanabenets.com or (833) 726-2123PPO Plus members get free lab work through LabcorpCost & EligibilityPPO Plus HSA members get free lab work through Labcorp once the deductible is met••How It WorksGet tested with convenient labs taken at your doctor's oce or a local service center. If your sample is taken at your doctor’s oce:Sana is proud to partner with Labcorp, a nationwide network of more than 1,700 patient service centers, for convenient specimen collection and testing.Most Sana plans qualify for free labs through Labcorp. This includes tests collected by your doctor and sent to Labcorp, as well as tests taken at a Labcorp patient service center. Ensure your doctor knows you want your labs sent to Labcorp.If you’re on a PPO Plus plan you won’t be billed. If you’re on a PPO Plus HSA plan, you’ll be billed for all labs taken prior to your deductible.12If you’d like to make an appointment at a Labcorp location:Go toLabcorp.comand click onLabs & Appointmentsfor easy scheduling.Bring your ID, insurance card, credit or HSA card, and a doctor’s test order to your appointment.Optional: Download the Labcorp app to receive a notication when it’s your turn to come into the oce.If you’re on a PPO Plus plan, the representative will conrm your $0 fee. If you’re on a PPO Plus HSA plan, the representative will conrm your fee and ask for a one-time payment. 1234Sana Care Field GuideSana Care for Lab Testing
Questions? Reach out to us at hello@sanabenets.com or (833) 726-2123Get free or discounted imaging services through our partner, Green Imaging. "I was concerned about using a facility outsideof the hospital, but Green Imaging wasvery quick to get my CT scheduled with great communication. Thank you!" — Erika G."Chelsea had the patience to work towardshelping me all the way. I really appreciatehow she helped me sort out the intricacies of this process." — Juan Y.What patients are sayingDepending on your plan, you can get free or discounted imaging services through our partner, Green Imaging. Green Imaging has hundreds of locations across the United States where they oer comprehensive imaging and radiology services, including CT, MRI, Mammogram, Ultrasound, PET, Echogram, interventional pain management, and more.Sana Care Field GuideSana Care for Imaging ServicesFree for members of Sana PPO Plus plansCost & EligibilityFree after the deductible is met for members of Sana PPO Plus HSA plans with a substantial discount on imaging services••How It Works12345Text Green Imaging at 713-524-9190.Send a photo of your member ID, your name, zip code, and a photo of your doctor's order for the imaging service.Green Imaging will reach out to you via text to get you an appointment close to your home at a time that works best for you.Green Imaging will text you the order form and your voucher, both of which you’ll need to show at your appointment to receive your free or discounted services.Members of PPO Plus HSA plans will pay their discounted rate directly to Green Imaging prior to the appointment. Members of PPO Plus plans receive services for free. In both cases, the imaging facility will not collect money at the time of service.
Questions? Reach out to us at hello@sanabenets.com or (833) 726-2123Cost & Eligibility10 free credits per month for all Sana subscribers and spousesTo Create a New AccountFitness, wellness, and self care have never been easier.Go toclasspass.com/corporate/sanabenetsSelect "Get Started Today"Select the "$0 Monthly" plan or one of theother discount oers exclusive to SanaEnter the name and email tied to your Sana accountEnter your credit card info and Sana Subscriber ID (to enroll a spouse, add an "S" to the end of your ID)Respond to the email prompting you to set up your passwordDownload the ClassPass app or log in at ClassPass.com1234567Take virtual tness classes and access thousands of gyms, tness studios, and wellness centers — available anywhere in the U.S. or through the app.Sana Care Field GuideSana Care for Fitness & WellnessTo Update a Current AccountGo toclasspass.com/corporate/sanabenetsSelect "Update Your Existing Account"Fill out the form to request your plan changeCheck your inbox for updates or a conrmation1234• Yoga• Meditation• Pilates• HIIT• Cycling• Barre• Dance• Gym TimeOerings vary by location. Check ClassPass to see what’s available in your area.• Live Virtual Classes• Massage• Acupuncture• Facials• Cryotherapy• Sauna• Nail Care• Hair Care
Questions? Reach out to us at hello@sanabenets.com or (833) 726-2123Cost & EligibilityFree for all Sana members over 18Getting StartedFrom weight loss to therapy — Vida has you covered on your whole health journey. Go to vida.com/sana to download the appChoose your coachPersonalize your plan123Get virtual access to health coaches with proven success in helping people manage chronic conditions, behavioral health, and lifestyle. Whether you want to focus on nutrition, weight loss, mental health, or simply building healthy habits one day at a time, your coach will develop a personal plan and guide you every step of the way.Sana Care Field GuideSana Care for Virtual Health CoachingPersonalize Your Wellness Track• Weight Loss• Eating Better• Exercise• Stress Management• Sleep Health• COPD Management• Resilience• Anxiety• Diabetes Prevention• Diabetes Management• Healthy Blood Pressure• Healthy Cholesterol• Asthma Management• Depression• Quit SmokingGo toclasspass.com/corporate/sanabenetsSelect "Update Your Existing Account"Fill out the form to request your plan changeCheck your inbox for updates or a conrmation
Questions? Reach out to us at hello@sanabenets.com or (833) 726-2123Cost & EligibilityHow to Access GingerQuality mental health care from the convenience of your smartphone.Download the Ginger emotional support appIn the app, tap “Get Started,” and enter your email address registered with SanaFollow the instructions sent to your inbox andyou’re all set!123Speak to an emotional health coach, therapist, or psychiatrist from the comfort of your home. Plus access self-guided content clinically proven to reduce symptoms of stress, anxiety, and depression.Sana Care Field GuideSana Care for Emotional SupportHow Dependents Access GingerDownload the Ginger emotional support appIn the app, tap “Verify with Name, DOB, ZIP,” then tap “I’m a dependent.” Enter the info for your Sana subscriber and your email addressFollow the instructions sent to your inbox andyou’re all set!1234PPO Plus members: Free•PPO Plus HSA members with company plans starting on or before December 31, 2021: Free•PPO Plus HSA members with company plans starting on or after January 1, 2022: Free after meetingthe deductible. –Text-based in-app coaching content: Free–Therapy evaluation: $149 –Therapy follow-up: $119 –Psychiatry evaluation: $249 –Psychiatry follow-up: $179 •
Questions? Reach out to us at hello@sanabenets.com or (833) 726-2123Cost & EligibilityGetting StartedOn-demand virtual physical care to treat back, joint, muscle pain, and more.Go to join.swordhealth.com/sanaEnter your info to registerMeet your PTGet your kitMove your way to better health12345SWORD oers the industry's rst end-to-end clinical musculoskeletal (MSK) pain management solution — designed with busy lifestyles in mind.Relieve pain by up to 70% from the comfort of home with a dedicated Physical Therapist (PT) and easy-to-use wearable technology.Sana Care Field GuideSana Care for Pain ManagementFree for members, spouses, and dependents 13+BackShoulder NeckAnkle Wrist PelvicHipElbowKneeWherever and whenever it hurts, SWORD can help.Your dedicated physical therapist designs an exercise program just for you.Complete your exercise sessions at home when it is convenient for you.SWORD will ship you a tablet and motion sensors to guide you and provide real-time feedback during your exercises.Your physical therapist is there to support you virtually and is available at any time.How it works1423
Questions? Reach out to us at hello@sanabenets.com or (833) 726-2123Cost & EligibilityFree for all Sana members on all plansHow It WorksGet medical certainty with fast, virtual second opinions from top specialists.Go to 2nd.md/sana, download the 2nd.MD app, or call (866) 841-2575 to activate your account and request a consultation.A dedicated Care Team nurse will reach out to learn about your condition, answer questions, obtain your records, and schedule your consultation with the best specialist for your needs.Within 3 to 5 days, you'll get an expert consultation via video or phone at a time that works for you. Your dedicated Care Team nurse will send you all follow-up notes and referrals from 2nd.MD.1234Sana is proud to partner with 2nd.MD — a revolutionary online resource providing direct access to the nation's leading medical specialists for second opinions — to give Sana members medical certainty from the comfort of home, all at no cost to you.Download the 2nd.MD app and register your free account to get access to the expert information you need, when you need it, and feel condent about your medical treatments.Schedule a consultation with 2nd.MD when you or an eligible dependent have questions about:82% of consultations lead to an improved treatment plan or a dierent diagnosis.•••••A new or existing diagnosisTreatment planPossible surgeryYour medicationsA chronic conditionWhat's better than getting complimentary virtual second opinions from the nation's top specialists? Members of Sana PPO Plus plans get up to a $500 deductible credit after completing their rst consultation through 2nd.MD. $500 Deductible CreditSana Care Field GuideSana Care for Second Opinions
Questions? Reach out to us at hello@sanabenets.com or (833) 726-2123Connect DME is available nationwide. They even do home visits for ttings.Joint braces such as knee, ankle, upper extremityRespiratory Supports such as CPAP, BI-PAP, and nebulizersTherapies such as DVT prevention, cold & heat therapy, CPM machinesBreast pumps oering all major brandsSupports such as knee-wheelers, crutches, and wheelchairsDiabetic supplies oering all major brands••••••Examples of medical equipment include:Note: Sana requires prior authorization approval for products over $1,000Sleep studies at home•Free for members of Sana PPO Plus plansIf you have a prescription for durable medical equipment, please email the following information to orders@connectdme.com and copy hello@sanabenets.com to get started.Cost & EligibilityFree after the deductible is met for members of Sana PPO Plus HSA plans with a substantial discount on equipment••How It WorksCopy of doctor’s prescription for DMECopy of Sana ID cardYour contact information•••Top of the line, customized medical equipment delivered right to your door.Email Connect DME if you have a specic brand or model you're interested in. Connect DME accepts those requests and works to secure that product.Connect DME takes requests!Sana Care Field GuideSana Care for Medical Equipment
Questions? Reach out to us at hello@sanabenets.com or (833) 726-2123Carrum Health makes it easier, more comfortable, and less expensive to get the top surgical care for over 100 procedures including hip, knee, shoulder, spine, heart, cancer care, and many more at world-class hospitals across the US.Sana Care for Complex ProceduresThe highest-quality surgical care at the top hospitals in the US is free for most members thanks to Carrum Health.Sana Care Field GuideSana Care Field GuideCost & EligibilityAvailable to all Sana members aged 18 and older•Free for PPO Plus members•For PPO Plus HSA members the maximum charge towards your deductible for Carrum services is $1400. Once $1400 is reached, the service is free.•Register for Carrum Health at info.carrumhealth.com/sanabenets1Answer a few qualifying questions and tell us which surgery your doctor has recommended2Connect with a Carrum Health care specialist, dedicated to helping you throughout your surgical journey3Use Carrum’s expert guidance to nd the facility and providers that are right for you4How It WorksSana is able to cover this unbelievable service, including all medical costs and travel expenses because sending members to top-notch hospitals is cost-eective for us and better for you. When you get the best procedure the rst time, we all win.You’re not dreaming. It’s that good.
Questions? Reach out to us at hello@sanabenets.com or (833) 726-2123Cost & EligibilitySana members with an enrolled dependent under the age of 21 are eligible for a free Blueberry membership and medical kit. Current states: AL, AZ, CA, CO, FL, GA, IL, KY, MI, MN, NJ, NY, OK, PA, UT, TN, TX, and WI PPO Plus members: Free•PPO Plus HSA members with company plans starting in 2021: Free•PPO Plus HSA members with company plans starting on or after January 1, 2022: Free after meeting the deductible•Getting StartedOn-demand 24/7 virtual pediatric care, plus a medical toolkit to help diagnose your child’s conditions quickly.Go to blueberrypediatrics.com/sanaEnter YOUR info to registerEnter your Sana membership IDEnter your address to receive the kit1234Provide your children with quality care from the comfort of home 365 days per year with on-demand telemedicine available through phone, video call, or text.Receive a free medical kit after completing enrollment that contains an otoscope, thermometer, and pulse oximeter to help you and your virtual doctor diagnose conditions quickly and eectively!Sana Care Field GuideSana Care for Virtual Pediatric CareDoctors typically respond within minutes — 365 days a yearPediatrician advice on potty training, breastfeeding, food safety, and sleeping through the night is just a text awaySpanish-speaking doctors availableMore convenient than ER or Urgent CareFollow-ups with every family within 24 hours, as well as hourly care if neededComprehensive visits — Get to know your doctor, while they get to know you and your family.HighlightsColdsFeversCoughsNauseaHeadachesRashesAllergiesHivesCellulitisSunburnsEar InfectionsPink EyeServices Include:Runny NoseBreastfeedingGeneral QsCuts & ScrapesAbdominal PainDiarrheaStings & BitesVomitingSinus InfectionsStrepUTIs…and more!
Questions? Reach out to us at hello@sanabenets.com or (833) 726-2123Cost & EligibilityFree for Members, Spouses, & Dependents 18+ who are pregnant or within 6 months postpartum.Getting StartedHigh-quality maternity care throughout every stage of the new parent journey.Go to mavenclinic.com/maven-maternity-signupSet up your account and verify your coverageDownload the app123Maven oers virtual, around-the-clock unlimited access to quality care for new and expecting parents. Maven practitioners span 20+ specialties, including mental health, OB-GYN, pediatrics, sleep coaching, lactation support, nutrition, and more.Sana Care Field GuideSana Care for Maternity CareSo much of the information that we discussed were things we didn’t know, so now we feel reassured and ready!"Amazing!!! Super informative and helpful, we feel so much more prepared and condent now to make informed decisions. Thank you!! :)”This is a great start. I feel really secure preparing for the birth of my baby with this type of support."Sana Members Love Maven
Questions? Reach out to us at hello@sanabenets.com or (833) 726-2123Free for all members of Sana PPO Plus plansCost & Eligibility$250 per visit for all members on PPO Plus HSA plans until the deductible is met, then free••How It WorksWe're bringing back the house call for urgent care in select areas.Call (469) 397-0485 or visit DispatchHealth.com1Provide patient information over the phone2DispatchHealth will determine the eligibility of the condition3Receive an ETA, typically within a few hours4The medical team will assess the patient, diagnose, and treat as appropriate5Currently available in limited areas, but constantly expandingGo to dispatchhealth.com/locations to see if your zip code is coveredAvailable 7 days a week from 8 AM–10 PM including holidays and weekendsLocations & AvailabilitySana is proud to partner with DispatchHealth to bring members fast quality house calls for a variety of medical conditions at little or no cost to you. DispatchHealth specializes in treating everything Urgent Care can treat, and more, all in the comfort and safety of your own home! In fact, they can perform 70% of the services at the ER, but much faster and without the drive or waiting room.Receive a copy of the visit summary, any test results, and any written prescriptions6DispatchHealth will send a copy of the same info to the patient’s primary care physician, and to other care team members with the patient's permission7DispatchHealth will keep credit card info on le and charge members of PPO Plus HSA plans directly8Sana Care Field GuideSana Care for Urgent Care at Home
Why create a Sun Life account?Below are the different ways you can use your Sun Life account. It’s the easiest way to submit your claim!Upload claim documents directly to your account—making it the fastest way to get your information to us.View your claim status, payment information, and other important information about your claim in one spot. Report your return to work date as well as time if you need to take an intermittent leave.Apply for Evidence of Insurability. Our site leads you step by step through the process. Access Employee Assistance Program (EAP) resources, benefits information and more. It’s mobile friendly, so you can do everything right from your smartphone or tablet! Have Dental with us? You can find your most recent dental visit history, view and print your personalized dental ID card, and search for an in-network dental provider.Register for an account today at www.sunlife.com/createaccountFor more information or to register by phone, call 800-247-6875, Monday through Friday from 8 a.m. to 8 p.m. ET.Group insurance policies are underwritten by Sun Life Assurance Company of Canada (Wellesley Hills, MA) in all states, except New York. In New York, group insurance policies are underwritten by Sun Life and Health Insurance Company (U.S.) (Lansing, MI). © 2022 Sun Life Assurance Company of Canada, Wellesley Hills, MA 02481. All rights reserved. Sun Life and the globe symbol are trademarks of Sun Life Assurance Company of Canada. Visit us at www.sunlife.com/us. WFL-10712-f (01/22)
BENEFIT TOOLSLet Sun Life help you discover the true benefit of benefits – anytime, anywhere.With the Benefit Tools app, you can easily view your dental and vision coverage, find a dentist, access your electronic dental ID card, and more. Use this app to quickly access:My Benefits: An overview of dental and vision plan detailsDental ID Card: Your electronic dental ID cardNEW! iPhone users of Benefit Tools can now add their Dental ID card to their Apple WalletFind a Dentist: Uses your location to find a dentist nearbyFind an Eye Doctor: Uses your location to find an eye doctor nearbyIndividual dental plans: To learn about the products we sell in your areaAvailable for iPhone and Android devices. Download now:© 2020 Sun Life Assurance Company of Canada, Wellesley Hills, MA 02481. All rights reserved. Sun Life and the globe symbol are trademarks of Sun Life Assurance Company of Canada. Visit us at www.sunlife.com/us. GGFL-6292aThe Benefit Tools app is available for iPad and Android Tablets. For more information, please visit www.sunlife.com/mobileapps Add Dental ID Card to Apple Wallet Find a Dentist/Find an Eye Doctor
HealthInsurancePortabilityAndAccountabilityAct(HIPAA)InAccordancewithHIPAA,weprotectyourProtectedHealthInformaon(PHI).WewillonlydiscussyourPHIwithmedicalprovidersandthirdpartyadministratorswhennec essarytoadministertheplanthatprovidesyourmedicalanddentalbenefitsorasmandatedbylaw.HIPAAPrivacyNoceUpdateHIPAArequiresustonofyyouthataPrivacyNoceisavailablefromtheHumanResourcesDepartment.Torequesta copyofthisPrivacyNoceorforaddionalinformaon,pleasecontactyourHumanResourcesDepartment.ConnuaonRequiredByFederalLawForYouandYourDependentsFederallawenablesyouoryourdependenttoconnuehealthinsuranceifcoveragewouldceaseduetoareduconofyourworkhoursoryourterminaonofemployment(otherthangrossmisconduct).Federallawalsoenablesyourdependent(s)toconnuehealthinsuranceiftheirhealthinsuranceceasesduetoyourdeath,divorce,legalseparaon,orwithrespecttodependentchildren,failuretoconnuetoqualifyasadependent.Connuaonmustbeelectedinaccordancewiththerulesofyouremployer’sgrouphealthplan(s)andissubjecttofederallaw,regulaonsandinterpretaons.Foraddionalinformaon,contacttheHumanResourcesDepartment.StateConnuaonForYouAndYourDependentsYouareeligibleforstateconnuaoncoverageifyouhavebeenconnuouslycoveredunderthegroupcoverageforatleastthreeconsecuvemonthspriortotheterminaonofemployment,andifthelossofcoverageisnotduetoterminaonofemploymentforcause.Connuaonofcoverageunderthegrouphealthplanwillconnueforamaximumofsixmonths.Thepremiumwillbe102%ofthefullemployerpremium.Attheendofthesixmonths,nootherconnuaonoponswillbeavailable.Thestateconnuaoncoveragewillbeeffecveonthedayaerterminaonofthegroupcoverage.Youwillbegivencreditformesasfiedtowardpre‐exisngcondions,waingperiodsandanychargesthatwereappliedtoyourcurrentdeducblesandcoinsuranceamounts.Likewiseallamountsappliedtolifememaximumswillbetransferredtothestateconnuaoncoverage.MEDICAIDAndTheChildren’sHealthInsuranceProgram(CHIP)Ifyouareeligibleforhealthcoveragefromyouremployer,butareunabletoaffordthepremiums,somestateshavepremiumassistanceprogramsthatcanhelppayforcoverage.ThesestatesusefundsfromtheirMedicaidorCHIPprogramstohelppeoplewhoareeligibleforemployersponsoredhealthcoverage,butneedassistanceinpayingtheirhealthpremiums.IfyouoryourdependentsarealreadyenrolledinMedicaidorCHIPandyouliveinastatelisted,youcancontactthemtofindoutifpremiumassistanceisavailable.Onceitisdeterminedthatyouoryourdependentsareeligibleforpremiumassistance,youremployer’shealthplanisrequiredtopermityouandyourdependentstoenrollintheplan–aslongasyouandyourdependentsareeligiblebutnotalreadyenrolledintheemployer’splan.Thisiscalleda“specialenrollment”opportunity,andyoumustrequestcoveragewithin60daysofbeingdeterminedeligibleforpremiumassistance.TEXASwww.gethipptexas.com800‐440‐0493THEWOMEN’SHEALTHANDCANCERRIGHTSACTTheWomen’sHealthandCancerRi ghtsActrequiresgrouphealthplansthatprovidecoverageformastectomytoprovidecoverageforcertainreconstruc‐veservices.Thislawalsorequiresthatwriennoceoftheavailabilityofthecoveragebedeliveredtoallplanparcipantsuponenrollmentandannuallythereaer.Thislanguageservestofulfillthatrequirementforthisyear.Theseservicesincluded:Reconstruconofthebreastuponwhichthemastectomyhasbeenperformed,surgery/reconstruconoftheotherbreasttoproduceasymmetricalappearance,prosthesis,andtreatmentforphysicalcomplicaonsduringallstagesofmastectomy,includinglymphedemas.Inaddiontheplanmaynotinterferewithaparcipantsrightsundertheplantoavoidtheserequirementsorofferinducementstothehealthcareproviderorassesspenalesagainsttheprovider,inanaempttointerferewiththerequirementsofthelaw.Howevertheplanmayapplydeducbles,coinsuranceandcopaysconsistentwithothercoverageprovidedbytheplan.Newborn’sandMother’sHealthProteconActFederallaw(Newborn’sandMother’sHealthProteconActof1996)prohibitstheplanfromlimingamother’sornewborn’slengthofstaytolessthan48hoursforanormaldeliveryor96hoursforacesareandeliveryorfromrequiringtheprovidertoobtainpre‐authorizaonforastayof48hoursor96hoursasappropriate.Howeverfederallawgenerallydoesnotprohibittheaendingprovider,aerconsultaonwiththemother,fromdischargingthemotherorhernewbornearlierthan48hoursfornormaldeliveryor96hoursforcesareandelivery.MentalHealthParityActAccordingtotheMentalHealthParityActof1996,thelifememaximumandannualmaximumdollarlimitsformentalhealthbenefitsunderthegroupplanareequaltothelifememaximumandannualmaximumdollarlimitsformedicalandsurgicalbenefitsunderthisplan.However,thementalhealthbenefitsmaybelimitedtoamaximumnumberoftreatmentdaysperyearorseriesperlifeme.ERISATheEmployeeRerementIncomeActof1974(ERISA)isafederallawthatsetsminimumstandardsforrerementandhealthbenefitplansinprivateindustry.ERISAdoesnotrequireanyemployertoestablishaplan.Itonlyrequiresthatthosethatestablishplansmustmeetcertainminimumstandards.ERISAcoversrerement,healthandotherwelfarebenefitplans.Amongotherthings,ERISAprovidesthatthoseindividualswhomanageplansandotherfiduciariesmustmeetcertainminimumstandardsofconduct. Thelawalsocontainsdetailedprovisionsforreporngtothegovernmentanddisclosuretotheparcipants.Therearealsoprovisionsaimedatassuringthatplanfundsareprotectedandthatparcipantswhoqualifyreceivetheirbenefits.AfullexplanaonofERISAandyourrightsisbeyondthescopeofthisdocument.Ifyouwanttoknowmore,pleasegotothissite:hp://RequirementsofMedicalLeaveActof1993(FMLA)TheFamilyandMedicalLeaveActof1993entlesaneligibleemployeetojob‐protected,unpaidleaveuponthebirthoradoponofachildoftheemployee,orone’splacementwiththeemployeeforfostercare,orwhentheemployee’sspouse,son,daughter,orparenthasaserioushealthcondionandrequirescarefromtheemployee.Thelawalsogivesemployeesjob‐protectedunpaidleavefortheemployee’sownseriousillness.Formoreinformaongotowww.dol.gov/topic/benefits‐leave/fmla.htmGenecInformaonNondiscriminaonActof2008TheGenecInformaonandNondiscriminaonActof2008generallyprohibitsgrouphealthplansfromusinggenecinformaonofplanparci‐pantstodiscriminateinprovidingcoverageofbenefits.QualifiedMedicalChildSupportOrderAqualifiedmedicalchildsupportorderisacourtorderusedtoenforceahealthplanparcipanttoprovidechildsupporthealthbenefits.Itrequiresahealthplantoincludeachildascoveredunderahealthplanevenifthechild(ren)ortheparcipantdonotmeetthecondionsofthehealthplan.Theorderauthorizeswithholdingtheparcipant’sshareofthecostforcoveragefromtheirpay.TheymaynotdropcoverageforthechildwithoutproofthattheQMSCOisnolongerineffect.Formoreinformaongotowww.dol.gov/ebsa/publicaons/QMCSO.htmlNocesRegardingYourBenefitsAndCertainRights