21/22 OPEN ENROLLMENT - Open Enrollment Dates: February 1 to February 8, 2021
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OPEN ENROLLMENT
21/22
Open Enrollment Dates:
February 1 to February 8, 2021
W H AT ’ S N E W
21/22
Lower copays on the $4,000/$8,000 Deductible PPO Plan
• 0% no increase for children and family tiers
New Rally Wellbeing incentives up to $330
Introducing My Health Novel and Hinge Health
A new dental partner – Delta Dental!
• A dental election is REQUIRED if you want dental insurance coverage
for yourself and your family in the new plan year!
Enhanced frame allowance on the EyeMed Vision Plans
Up to guarantee issue with Aflac Voluntary Benefits
Welcome to ICUBA’s 19th Annual Open Enrollment
Celebrating 19 Years of Service to Private Florida Education Employees
3
Enrolling in your benefits in Workday!
During your Open Enrollment period you are free to update your benefits
for the April 1, 2021 to March 31, 2022 Plan Year.
Your OE elections will remain in effect until the next plan year, as
stipulated by Section 125 Internal Revenue Code.
You may only change your elections during the plan year within 30-days of
a qualified life event.
View, save or print your enrollment confirmation once complete!
4
Enrolling in your benefits in Workday!
1. Login to Workday using your TRACKS username and password.
2. The Open Enrollment event will show in your inbox at the top right corner.
5
Dependent Verification
Dependents that are “not eligible” on the ICUBA plan should be
removed during Open Enrollment (coverage will terminate March 31, 2021)
“I certify all dependents for which I elected coverage are eligible for coverage.
I understand that if there is any misrepresentation in the information I have
provided, the ICUBA Plan may end my ineligible dependent’s coverage and
may seek any other legal remedies available. I also understand that if any of my
enrolled dependents obtain a health care benefit of which we are not entitled to
receive, knowingly or unknowingly, I can be liable for the full amount of the
health care benefit or payment made and for reasonable attorney’s fees and
costs, including the cost of investigation. I further agree to notify the ICUBA
Health Plan within 30 days of any changes in dependent status and make
appropriate updates to my coverages as applicable.”
6
Who is an eligible dependent?
Your legally recognized spouse
Your natural child
Your legally adopted child
Your stepchild
A child required to be covered pursuant to a Qualified Medical Child Support
Order (QMCSO)
A child with proof of legal guardianship who resides with you
A foster child
A child is a dependent until the end of the calendar year in which the age of 26 is attained or is over 26
years of age and is continuously incapable of self-support because of a Disability.
7
ICUBAbenefits.org Single Sign-On!
Additional connections also available based
on ICUBA plan offerings for dental, vision
and spending accounts
8
ICUBA’s “Medical” Plan
Your medical election bundles BCBS medical, OptumRx prescription drugs,
Aetna behavioral health into one “Medical” Plan
Bonus features of the medical plan include SurgeryPlus, Rally, Hinge Health,
My Health Novel, and AbleTo
ICUBA’s Whole Person Approach triggers specialized outreach to members
with specific health challenges from trained health advisors, registered
nurses or pharmacists offering support, education and advocacy to help
manage your condition
9
Deductible only
$0 Access: No Deductible: applied to
major services:
• Total Care Primary Care visits • Advanced Imaging (MRI, CT scan, • Durable medical equipment
(Primary Care, Internist, PET scan) • Hearing aids
Pediatrician) • Chiropractic services • Home health care
• Bone mineral density tests • Common illnesses • Hospital delivery expenses for
• Colonoscopies • Convenient Care Clinic (Minute maternity
• EAP services for ALL employees Clinic) • Hospital expenses
• ICUBAcares assistance • Emergency Room • Hospital or out-patient surgery
• Immunizations (including COVID19) • Emergency transportation (unless through SurgeryPlus)
• In-network annual wellness exams • Maternity visits • In-patient mental health/substance
• Mammograms • Outpatient Mental abuse treatments
• Medically necessary COVID19 Health/Substance abuse • Inpatient rehabilitation
treatment and testing* • PCP office visits • Outpatient facility charges
• Medically necessary labs • Physicals • Private duty nursing
performed at Quest Diagnostics • Prescription drugs • Prosthetic appliances
• Medically necessary preventive • Specialist visits • Skilled nursing rehab
services • Therapy (Occupational, Physical, • TMJ
• SurgeryPlus non-emergent Speech) • Ultrasound (except breast
surgeries • Teladoc ultrasound)
• Ultrasounds of the breast • Urgent Care • X-ray
* All confirmed COVID-19 cases requiring medically necessary medical treatment during the national public health emergency declaration will be covered at 100% by the ICUBA medical plans including in and out of network hospitalization, follow up doctor visits, and other medical care
10BCBS My Health Toolkit Mobile App
11Free visits @ Total Care Providers Need Help from BCBS?
Medically necessary services:
Family Practice
Internal Medicine
Pediatrician • Help with claim questions
Total Care Providers are always FREE • Concierge assistance for billing
• Assistance finding a BDTC
Provider
• Lifestyle coaching
• Chronic condition coaching
1-866-377-5102,
Option 2
(or the Customer Service Number on
the back of your ID card)
1220/21
20/21
No increase
for children
and family
tiers!
20/21
_____
Copays
Reduced!ICUBA Prescription Drug Plan
90-Day saves $$$!
Up to 30-day Up to 90-day Up to 90-day
Tier
(Retail Only) (Retail) (Mail Order)
Preferred Generics at NSU Pharmacy $0 $0 N/A
Preferred Generics $5 $10 $10
Non-Preferred Generics $10 $20 $20
Preferred Brands $40 $80 $80
Non-Preferred Brands $75 $150 $150
OptumRx Specialty Pharmacy * $75 N/A N/A
* Specialty medications are limited to a 30-day supply. Copay Assistance Cards are acceptable to Preferred Specialty products.
• The Optum prescription plan is included with your election in an ICUBA Medical Plan.
• In-Network Rx copays will be applied toward an individual maximum out-of-pocket of
$2,000/single and $4,000/family.
• With a prescription from your provider, you can receive FREE prescribed diabetic supplies
including meters, lancing devices, lancets, test strips, control solution, needles, and syringes.
Other items include prescribed aspirin for adults, prescribed generic folic
acid, and generic prenatal vitamins for pregnancy.
16$0 Preventive Drugs for Chronic Conditions!
ICUBA is offering $0 Preventive Medications for Chronic Conditions!
The OptumRx pharmacy benefit plan includes special coverage for generic
preventive medications. These medications help protect against or manage a
medical conditions including:
preventing blood clots and reducing the risk of a stroke
preventing heart disease and reducing high blood pressure
preventing osteoporosis
These generic drugs found on OptumRx’s preventative drug list are now a
$0 copay to you!
17ICUBAcares Pharmacist Advocate Team
Serve as a liaison between your doctor, the pharmacy and the
insurance company — taking the burden off of you!
Answer questions on a medication you are taking or considering — providing
useful information on side effects and drug interactions.
Discuss preferred and non-preferred tier options to save you money.
Assist with obtaining prior authorization from your doctor.
Help you better understand and manage your health conditions such as asthma
and/or diabetes.
1-866-377-5102, Option 4 | M-F 9AM-5PM
Real Pharmacists, Real Advocates, Real Solutions
18Take care of your mental health!
You may experience increased stress during this pandemic.
Fear and anxiety can be overwhelming and cause strong emotions.
Coping with stress in a healthy way will make you, the people you care about,
and your community stronger.
During times of increased social distancing, people can still maintain social
connections and care for their mental health.
Speak with a licensed clinician to manage a diagnosed behavioral health
condition over the phone, televideo or in the office.
1-877-398-5816
Option 1: Employee Assistance Program | Option 2: Behavioral Health
19ICUBA Behavioral Health
(For display purposes: In-Network benefits only)
Preferred PPO Other Plans
Employee Pays Employee Pays
Deductibles and Out of Pocket Maximum Amounts are COMBINED with your BCBS Medical Plan Benefits.
2
Employee Assistance Program (EAP) - Up to 6 short-term professional counseling sessions per
episode per year. Talk with a licensed clinician regarding stress, relationship issues, grief, etc. $0 $0
Outpatient 20% coinsurance $25 copay
Professional Counseling Sessions - Talk with a licensed clinician regarding anxiety, ADHD,
20% coinsurance $25 copay
depression, mood disorders, trauma, etc.
Psychiatric Medication Evaluation 20% coinsurance $25 copay
2
Applied Behavioral Analysis Therapy - Behavioral health services related to Autism Spectrum
20% coinsurance $25 copay
Disorder (ASD) diagnosis.
2
Partial Hospitalization (PHP) - Physician and nursing services, group, individual, family or multi-
20% coinsurance $25 copay
family group and other services.
Outpatient Detoxification - Monitor withdrawal from alcohol or another substance of abuse. 20% coinsurance $25 copay
Intensive Outpatient Sessions (IOP) - Planned and structured programs may include group,
20% coinsurance $25 copay
individual, family and other services.
AbleTo - Meet with a therapist and coach via web-based videoconferencing or by phone for an 8-
week program for select conditions including cancer recovery, heart problems, diabetes, $0 $0
depression, pain management, caregiver status, grief/loss and more.
2
Inpatient 20% after deductible 20% after deductible
2
Mental Health Hospital Admission 20% after deductible 20% after deductible
2
Substance Abuse Hospital Admission 20% after deductible 20% after deductible
2
Residential - Focus on evaluating to learn effective ways to cope with the symptoms and impact
20% after deductible 20% after deductible
of the illness.
2
Inpatient Detoxification - 24 hour treatment in a residential or hospital setting for patients who
20% after deductible 20% after deductible
are abusing alcohol or other addictive drugs.
1. Out-of-network services are covered at a reduced benefit. The Preferred PPO Plan and Premier Copay Plan will cover all services at 40% after the deductible is satisfied; the
$4,000/$8,000 Plan will cover all services at 50% after the deductible is satisfied. The EAP Plan and AbleTo benefits are not available out-of-network. 20
2. Services require prior-authorization.FREE AbleTo sessions for condition management
Through AbleTo, you’ll work with
two specialists, twice a week,
for eight weeks
Health Life
• Infertility support • Depression/anxiety
• Breast and prostate • Postpartum
cancer recovery depression
• Heart issues • Caregiver status
• Diabetes (child, elder, autism)
• Digestive heath • Grief and loss
• Pain management • Military transition
• Respiratory problems
• Substance abuse
Call to get set up today
1-877-398-5816
21Spending Accounts
Spending Account Details
If interested in
Flexible Spending
Accounts –
REQUIRES AN
ACTIVE ELECTION
EACH YEAR
23Employee Assistance Program Available to all employees and members living in your household 1-877-398-5816 Option 1: Employee Assistance Program
Employee Assistance Program
Emotional Life Legal Financial
Speak with a licensed Obtain referrals for Gain expert council Consult with a financial
clinician regarding life services needed by you regarding a wide array of specialist regarding
events to obtain an or your dependents and legal needs. budgeting, retirement
objective expert point save you time. Access online legal planning, college
of view over the phone, Access to retail, documents. planning, taxes and much
televideo or in the office. entertainment, travel and Request ID theft more.
6 sessions per issue per fitness discounts. prevention and
year for each member of resolution support.
your household.
1-877-398-5816
Option 1: Employee Assistance Program 25
25ICUBA Medical Plan Member Extras!
• Teladoc
• SurgeryPlus
• Rally Incentives
• My Health Novel
• Hinge HealthHave you registered for Teladoc?
When can I use Teladoc? Get the care you need Doctor Requirements
• When you need care now. Teladoc doctors can treat Teladoc is simply a new way
• If you’re considering the many medical conditions, to access qualified doctors.
ER or urgent care for a including: All Teladoc doctors:
non-emergency issue. • Cold & Flu symptoms • Are practicing PCPs,
• On vacation, on a business • Allergies pediatricians, and family
trip, or away from home. • Bronchitis medicine physicians.
• For short-term prescription • Urinary tract infection • Average 15 years
refills. • Respiratory infection experience.
• Teladoc does not replace • Sinus problems • Are US board certified and
your primary care • And more! licensed in your state.
physician. It is a • Are credentialed every
convenient and affordable three years, meeting
option for quality care. $5 Copay! NCQA standards.
27Your SurgeryPlus Benefits
Surgeons of Excellence Financial Incentive
You have access to the elite S+ Surgeons of Your DEDUCTIBLE and COINSURANCE are
Excellence Network. The surgeons are: WAIVED, so your procedure is at NO COST to
Licensed you; and travel benefits are INCLUDED, if
Board certified applicable.
Fellowship trained
Screened for malpractice, sanctions & Call your Care Advocate for more information
criminal records (855) 200 – 2119
Covered Surgical Procedures Full-Service Concierge
• Knee • Spine You have access to a dedicated care advocate
• Hip • General Surgery throughout your healthcare journey to locate
• Shoulder • Gastroenterology the best provider, schedule appointments,
• Foot & Ankle • GYN coordinate record transfer and schedule
• Wrist & Elbow • Bariatric follow-up as necessary!
• Cardiac
• ENT 282021-2022 Rally Wellbeing Incentives!
Activity to Complete Incentives
Complete health survey Gatekeeper plus 400 Coins & ICUBA Private Sweepstakes
Missions ICUBA Private Sweepstakes & Unlimited Coins
Rally Virtual City Challenges $5 per quarter – achieve a challenge milestone (up to $20 per year)
+ the chance to win a $50 Amazon Gift Card every 14-days
Onsite Campus Event $10 Gift Card (10 events, $100 maximum)
Biometric Screening - Physician $40 Gift Card
Results Form
Annual Wellness Exam $60 Gift Card
Preventive Screening: Colorectal $50 Gift Card (first claim processed)
Exam, Mammogram or PSA
Qualified Medication Change through $50 Gift Card
ICUBAcares Pharmacist Advocates
Clinical Rewards 500 Coins per quarter (2,000 Coins per year)
& Annual Rally Private Sweepstakes
Teladoc Registration 400 Coins
Tobacco Attestation 400 Coins
Flu Shot Attestation 400 Coins
Eye Exam Attestation 400 Coins
Dental Exam Attestation 400 Coins
My Health Novel* $10 Gift Card (completion of MHN assessment)
Incentive Total $330 (and Unlimited Coins) 29Keep moving with Rally Virtual City Challenges
ICUBA is continuing $50 Amazon Giveaway every 14-days!
New! Rally City Challenge incentive $5/quarter (up to $20/year)
Coming soon: ICUBA Private Challenges for 2021-2022
• Once per quarter
• ICUBA wide challenge
• Competing against fellow ICUBA members
A compatible fitness tracking device must be used to track
activity and sync your progress with Rally to qualify.
30Know your numbers with the Physician Results Form
Employees and spouses enrolled in the ICUBA Medical Plan can visit your individual portal
at My.QuestForHealth.com and download the Physician Results Form.
The Physician Results Form contains a bar code specific to the employee or spouse and
cannot be shared – it is unique to you!
*Pro Tip: If you have an established relationship with your physician, request your blood work ahead of your
annual wellness exam to save time and check this off your list with one visit. (Screenings will include total
cholesterol, HDL/LDL, triglycerides, blood sugar, blood pressure, and A1c.)
Remember to take the form with you to your annual physical. It is important both you and
your doctor sign the Quest Physician Results Form; then your doctor’s office can fax it to
the number found on the form.
You are encouraged to request a copy for your records, and if necessary, upload/fax the form
to your Quest portal.
Members should allow at least 30 days after the form is uploaded/faxed to see credit in Rally.
Remember, the final deadline for submission to Quest is no later than March 31.
32Stay informed with Clinical Rewards Hypertension
Congestive Heart Failure
Coronary Artery Disease
Hyperlipidemia
COPD
Diabetes
Asthma
Quarterly Annual
• Coaching Interaction • A1c Test
• Telehealth Registration • Annual Wellness Exam
• Cost Estimate Completion • Eye Exam - Attestation
• Activate My Health Planner • Flu Shot - Attestation
• Complete Clinical Missions • Health Survey
• Condition Education • Lipid Panel
• Liver Enzymes
• Microalbumin Test
• Dental Exam
33Introducing My Health Novel
1. Take a one-minute assessment When you qualify and sign up, you’ll get
2. Receive recommended programs access to health coaching, nutrition
and resources for which you qualify guidance, digital tools, group support
Assessment completion & engagement and more to keep you on track.
will earn your Rally incentive!
Whether you’re interested in starting Enjoy access to programs and
new healthy habits or maintaining your specialists who can help you answer
weight, My Health Novel matches you questions and support you on your
with the best nutrition, physical activity health journey – all at no cost to
and weight management tools, qualified participants
programs and apps available.
34Matching based on data and preferences
Pre-populated data
(12-month lookback biometrics)
+
Self-reported data
+
Member preference
=
Drives match logic
3536
Welcome to Delta Dental! 2021 Open Enrollment A dental election is REQUIRED if you want dental insurance coverage for yourself and your family in the new plan year!
Delta Dental PPO™
Delta Dental
Click to editPPO – We've
Master titlegot you covered
style
The Delta Dental Difference®
• Visit a PPO dentist to
save the most.
• You can visit any
licensed dentist.
• You won’t be charged
more than your
expected share of Delta Dental PPO Delta Dental Premier® Non–Delta Dental
the bill.Your
ClickPPO coverage
to edit Master title style
BASE PLAN
Delta Dental PPO –
BASE PLAN
$75 per person, PPO
providers
Deductible
$100 per person, Premier &
Per calendar year
Non-Contracted providers
Waived for D&P
Annual maximum
Per calendar year $1,500 per person
Orthodontic
Lifetime maximum $1,500 per personYour
ClickPPO coverage
to edit Master title style
BASE PLAN
Delta Dental PPO – BASE PLAN
In-Network Premier &
PPO Non-Delta
Employee Pays
Diagnostic and
preventive care 0% 50%
(exams, cleanings,
x-rays, sealants)
Basic services
(Fillings, simple 20% 30%
extractions, root
(after deductible) (after deductible)
canals, gum
treatment)
Major services 70% 80%
(Crowns, oral surgery,
(after deductible) (after deductible)
bridges, dentures)Your
ClickPPO coverage
to edit Master title style
BASE PLAN
Delta Dental PPO –
BASE PLAN
Employee Pays
Comprehensive
50%
orthodontics – CHILD ONLY
Comprehensive
Not covered
orthodontics (Adult)
Lifetime Maximum $1,500Your
ClickPPO coverage
to edit Master title style
BUY-UP PLAN
Delta Dental PPO –
BUY-UP PLAN
$50 per person
Deductible
$150 per family
Per calendar year
Waived for D&P
Annual maximum
Per calendar year $2,000 per person
Orthodontic
Lifetime maximum $2,000 per personYour
ClickPPO coverage
to edit Master title style
BUY-UP PLAN
Delta Dental PPO – BUY-UP PLAN
In-Network Premier &
PPO Non-Delta
Employee Pays
Diagnostic and
preventive care 0% 20%
(exams, cleanings,
x-rays, sealants)
Basic services
(Fillings, simple 20% 50%
extractions, root canals, (after deductible) (after deductible)
gum treatment)
Major services
(Crowns, implants, oral 50% 70%
surgery, bridges, (after deductible) (after deductible)
dentures)Your
ClickPPO coverage
to edit Master title style
BUY-UP PLAN
Delta Dental PPO –
BUY-UP PLAN
Employee Pays
Comprehensive
50%
orthodontics (child)
Comprehensive
50%
orthodontics (adult)
Lifetime Maximum $2,000Pre-treatment estimate Click to edit Master title style It’s easy to plan for dental expenses
Web and mobile resources
Sign
Clickup
tofor anMaster
edit online account
title style
Check your benefits information online – deltadentalins.com
• Check your plan details: eligibility, covered
services and level of benefits.
• Look up claim statements for recent dental visits.
• View or print your ID card.
• Estimate the cost of your next procedure.
• Submit questions to Customer Service.Go mobile
Click to edit Master title style
Download the app to have all the information you need at your fingertips
What can you do with the app?
To find the app, visit the App Store or Google Play and
search for “Delta Dental.” Then download the Delta
Dental app by Delta Dental Plans Association.Clickato
Find edit Master
network dentisttitle style
• Go to deltadentalins.com.
• Look for the Find a Dentist tab.
• Search by name, address, landmark, city or ZIP code.
• Select your network plan.
• Click Search.
• Narrow your search by location, specialty, network and
language.
• Your search results will include a dentist’s Yelp rating,
address and phone number.Cost
ClickEstimator
to edit Master title style
Budget for dental expenses with personalized estimates
Personalized. Estimates are based on your
benefits, including maximums and deductibles.
Insightful. Compare the cost of the same
procedure at different dentists.
Economical. See how choosing an in-network
dentist can help you save.Value Added Service: Savings you can hear!
Click to edit Master title style
Access hearing aid and LASIK discounts
Now available to you and your dependents
Amplifon Hearing 62% average savings off retail
Health Care hearing aid pricing
40-50% off traditional LASIK
QualSight eye surgeryThanks for your time
WELCOME TO EYEMED Vision benefits for every set of eyes ICUBA 54
Value and wellness:
It’s all yours with EyeMed
Focus on value Focus on wellness
• Save an average of 71% off retail on • Help spot some serious eye and health
eyeglasses with an eye exam1 conditions sooner with a comprehensive
• Choose from more than 100K network eye exam
provider access points, including • Protect your eyes from digital eye
independent eye doctors and top optical strain, which is linked to blurred vision,
retailers dry eye and headaches
• Get members-only offers and everyday • Easily find an in-network eye doctor,
discounts, like 40% off a complete and manage claims and benefits with
additional pair of glasses3 online member tools
1 Based on weighted average of sample transactions; EyeMed Insight network/$10 exam co-pay/$10 materials
co-pay/$120 frame or contact lens allowance
2 EyeMed Insight network, All network data, October 2019
3 At participating in-network providers
55 Confidential Notice: This document contains privileged information and is for the sole use of the intended recipient(s).
Disclosure or distribution to and review or use by any unauthorized Luxottica EyeMed associate(s) and external parties is prohibited.Your vision benefits
at-a-glance
Base Plan
Eye exam every 12 months,
covered with $5 copay – PLUS…
$130 frame allowance $15 lens plus fixed $100 contact lens
pricing on options, allowance, with coverage
every 24 months
every 12 months for fit and follow-up
every 12 months
56 Confidential Notice: This document contains privileged information and is for the sole use of the intended recipient(s).
Disclosure or distribution to and review or use by any unauthorized Luxottica EyeMed associate(s) and external parties is prohibited.Your vision benefits
at-a-glance
Buy-Up Plan
Eye exam every 12 months,
covered with $5 copay – PLUS…
$160 frame allowance $15 lens plus fixed $130 contact lens
pricing on options, allowance, with coverage
every 12 months every 12 months for fit and follow-up
every 12 months
57 Confidential Notice: This document contains privileged information and is for the sole use of the intended recipient(s).
Disclosure or distribution to and review or use by any unauthorized Luxottica EyeMed associate(s) and external parties is prohibited.A few more benefit basics
Your frequency is based on: Date of Service
So, if you receive an exam today, you are eligible again 12
months from today’s date of service.
Contacts are in lieu of lenses only
That means you are entitled to a full pair of glasses (frame &
lenses) OR contacts and frames (you would then receive a 20%
discount on your lenses).
ContactsDirect.com will save you $$$
Save $20 off your contacts (and free shipping) beyond your
regular contact lens benefit! Just create an account at
contactsdirect.com and an extra $20 will be deducted at
checkout.
58 Confidential Notice: This document contains privileged information and is for the sole use of the intended recipient(s).
Disclosure or distribution to and review or use by any unauthorized Luxottica EyeMed associate(s) and external parties is prohibited.Find your best fit
You’re on EyeMed’s Insight network,
so you’ve got choices — lots of them
More than 105,700 provider access points at 26,021 locations, including:
Plus, your local retailers:
Americas Best and EyeGlass World
Plus, online options:
59 Confidential Notice: This document contains privileged information and is for the sole use of the intended recipient(s).
Disclosure or distribution to and review or use by any unauthorized Luxottica EyeMed associate(s) and external parties is prohibited.How to find an eye doctor
Use the Provider Locator
at eyemed.com
Download and use the EyeMed Members App
(available in the App Store or Google Play)
Check the listing of the closest
eye doctors from your Welcome Kit (you’ll
get this after you enroll)
60 Confidential Notice: This document contains privileged information and is for the sole use of the intended recipient(s).
Disclosure or distribution to and review or use by any unauthorized Luxottica EyeMed associate(s) and external parties is prohibited.Enjoy more extras:
Member-only savings & discounts
40% off 15% off 20% off
additional pair of glasses standard LASIK prices or any remaining balance
5% off the promotional price over the frame allowance
15% off 20% off up to 40% off
any balance over the conventional any non-covered items, hearing exams and discounted,
contact lens allowance including non-prescription set pricing on hearing aids
sunglasses
At participating in-network providers. Some exclusions may apply. Log into Member Web for details.
61 Confidential Notice: This document contains privileged information and is for the sole use of the intended recipient(s).
Disclosure or distribution to and review or use by any unauthorized Luxottica EyeMed associate(s) and external parties is prohibited.Experience more with member tools
You’ll receive an in-home Welcome Kit detailing
your new vision benefits and the closest eye
doctors. And using your benefits couldn’t be
easier with access to convenient digital tools.
EyeMed Members App Member Web
• Benefits, eligibility and claims • See benefits and eligibility
at-a-glance status*
• Find an eye doctor and get • View Savings Dashboard
door-to-door directions • Estimate out-of-pocket costs
• Grab special offers before your visit to the eye
doctor
• Load and save prescriptions
• Download ID cards and EOBs
• Set exam and contact lens
reminders • Find an eye doctor
• Check claim status
• Pull up ID card and add to your
wallet (for iOS only) • Get special offers
*Due to HIPAA regulations, members will not be able to view dependents over the age of 18
62 Confidential Notice: This document contains privileged information and is for the sole use of the intended recipient(s).
Disclosure or distribution to and review or use by any unauthorized Luxottica EyeMed associate(s) and external parties is prohibited.There’s more to
love with EyeMed
Learn more at
eyemed.com/enroll
PPT-2009-M-656Voluntary Benefits Please note: Dental and Vision enrollment videos can be viewed separately!
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Income Protection Benefits
• Basic Life
• Basic AD&D (Accidental Death and Dismemberment)
• Voluntary Life
• Voluntary AD&D
• Spouse Life
• Child Life
• Short-term Disablility
• Long-term Disability
Age restrictions and enrollment limitations apply.
Open Enrollment is a good time to review/update your beneficiary.The image part with relationship ID rId2 was not found in the file.
When is Evidence of Insurability (EOI) required?
EOI is generally required when employees:
• Apply for group life coverage that exceeds the guaranteed issue
amount.
• Want to increase their current group life insurance benefit
amount.
• Late entrants enrolling in group life insurance coverage after
declining during the initial eligibility period. (Employees usually
must apply for coverage within 30 days of becoming eligible to
avoid EOI.)The image part with relationship ID rId2 was not found in the file.
Evidence of Insurability (EOI)
During Open Enrollment, you may have the opportunity to increase your life and
disability coverages.
• All increases or first-time elections in life and disability coverage require
Evidence of Insurability (EOI).
• The hyperlink for the Symetra EOI will be at the top of the enrollment review
and sign page in Workday.
• EOI must be completed and submitted to Symetra following the enrollment.
• Coverage will be active upon approval by the carrier.
• Provide the information to the best of your ability, Symetra will contact you
with questions.The image part with relationship ID rId2 was not found in the file.
Symetra Value Add Programs
Travel Assistance Identity Theft Protection Beneficiary Companion
24/7 availability Steps to help prevent identity Help managing a loved one’s
200+ countries/territories theft final affairs
100 miles+ from home Support if your ID is stolen Key services
Less than 90 days Key services Beneficiary Companion
Key services Assistance completing ID guidebook
Help finding physicians, theft affidavit 24/7 access to
dentists and medical Help replacing cash, debit Beneficiary Assistance
facilities and membership cards Coordinators
Medication and Access to emergency Help if a deceased’s
eyeglasses replacement cash identity is stolen
Access to emergency Translation services
cash
Call anytime, from anywhere: 1-877-823-5807
Travel Assistance is offered by Europ Assistance and Identity Theft Protection and Beneficiary Companion are offered through Generali Global Assistance. Benefits may not be available in all states. Europ
Assistance and Generali Global Assistance are not affiliated with any of the subsidiaries under Symetra Life Insurance Company.Nationwide Pet Insurance
Through the partnership with ICUBA, all employees are eligible for preferred
Pet Insurance pricing through Nationwide.
Employees have the option to choose, on a direct bill basis with Nationwide,
the level of coverage that fits your needs ranging from 50%-90%
reimbursement on vet bills and more.*
• Save with preferred pricing
• Use any vet, anywhere
• Get cash back on vet bills
Get a fast, no-obligation quote at http://benefits.petinsurance.com/icuba. For
exotic pets or avian coverage, please call 877-738-7874.
* Some exclusions may apply. Certain coverages may be subject to pre-existing exclusion
69Critical Illness
Coverage includes: Pays a lump sum cash benefit to you
Cancer (Invasive, Non-Invasive, and Skin) Pays in addition to other insurance
Heart Attack Guaranteed Issue
• Up to $30,000 coverage for employee
Sudden Cardiac Arrest
• Up to $15,000 coverage for spouse
Coronary Artery Bypass (spouse election cannot exceed 50% of the employee election)
Major Organ Transplant Children automatically covered to age 26
Bone Marrow Transplant Portable if changing jobs or retiring
Kidney Failure Bonus: $50 annual wellness/health
screening benefit*
Stroke * Qualifying routine tests include one of the tests performed each year: COVID-19 screening, annual physical
exam, ultrasound, colonoscopy, mammogram, Pap Smear, and more.
Every employee is eligible to enroll in the CI plan regardless of health and all covered illnesses in the policy will be covered as long as the
diagnosis is after their policy effective date. Those who have been diagnosed with a covered illness prior to enrolling in Critical Illness will
collect a recurrence benefit for non-Cancer illnesses as long as the separation time is 6+ months and Cancer requires complete remission and
12 months treatment free.
70Hospital Indemnity
Hospital admission or Two levels of coverage
confinement due to an accident or High Low
illness (including maternity) Admission $1,000 $500
Pays a lump sum cash benefit to Confinement $100 $100
you Intensive Care $100 $100
Pays in addition to other
insurance
Portable if changing jobs or Example for Pregnancy/Delivery
retiring High Low
No medical questions asked Admission $1,000 $500
Confinement (3 days) $300 $300
Total Payment to You! $1,300 $800
71Accident
An accident plan can be there in you time of need
to help cover unplanned expenses like:
Ride in an ambulance
Emergency Room visits
Trip to the Urgent care
Bone fracture
Second and third degree burns
Lacerations
And more!
Bonus: $50 annual health/wellness screening
benefit*
* Qualifying routine tests include one of the tests performed each year: COVID-19 screening, annual
physical exam, ultrasound, colonoscopy, mammogram, Pap Smear, and more. 72How do I file a claim with Aflac?
To file a claim online visit: www.AflacGroupInsurance.com
Select Customer Service > File a Claim
(Please note: Specific documentation, such as itemized bills, is required when submitting claims to Aflac.
Specifics for your claim are listed in the website.)
73We hope you found this presentation informative and
we look forward to a successful 19th year of
Better Benefits Through Collaboration!
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