Employee Benefits Guide
2024
Clear Connection
Table of Contents Medical Insurance.............................................................................4 Dental Insurance................................................................................5 Vision Insurance..................................................................................6
Clear Connection Monthly Contributions.........................7 Important Phone Numbers........................................................8
Introduction WELCOME TO CLEAR CONNECTION! Our company offers medical, dental and vision coverage to employees and their dependents.
WHAT WILL MY BENEFITS COST? Medical- Clear Connection pays 50% of the Employee Only cost for the Base medical plan until you have satisfied one year of service. At one year of
2
service, Clear Connection pays 80% of the Employee Only cost for the Base medical plan. Coverage for dental, vision and any plans where you choose to cover your eligible family members can be elected at your cost. Rates can be found in our online enrollment system. The rates and contributions for coverage are evaluated and adjusted every plan year.
Enrollment HOW DO I ENROLL IN BENEFITS?
HOW DO I MAKE CHANGES TO MY BENEFITS?
You are eligible for company paid benefits on the 1st of the month following 90 days of full-time employment. Please make your elections in the self-service portal: https://pcspay.myisolved.com.
During the Plan Year, you can make changes to your enrollment when you experience a qualifying life event. Life events include loss of other group coverage, marriage, divorce, legal separation, domestic partnership status change, birth or adoption of a child, change in child’s dependent status, death of spouse, child or other qualified dependent, change in residence due to an employment transfer or change in spouse’s or domestic partner’s insurance or employment status.
Once you finish your enrollment, you should expect to receive ID cards at your home or mailing address within 15-20 days.
WHO CAN I ENROLL? You may cover these eligible dependents on your plans: ■
■
■
Your spouse or registered domestic partner
Please contact HR representative to make the change within 30-days of the date of the event & provide documentation of the status change.
Your child(ren) up to age 26 regardless of student or marital status Your disabled child(ren), regardless of age, if incapable of self sustaining employment, and if the handicap began before the limiting age
3
Medical Insurance PPO The Preferred Provider Organization (PPO) plan allows you to direct your own care. You are not limited to the physicians within the network and you may self-refer to specialists. If you receive care from a physician who is a member of the PPO network, a greater percentage of the coinsurance cost will be paid by the insurance plan. You may also obtain services using a non-network provider; however, you may be responsible for the difference between the covered amount and the actual charges and you may be responsible for filing claims.
BANNER AETNA PPO
BANNER AETNA PPO
$4,000 Base Plan In-Network / Out of Network
$1,000 Buy Up Plan In-Network / Out of Network
Aetna Broad
Aetna Broad
Deductible - Individual
$4,000 / $8,000
$1,000 / $2,000
Deductible - Family
$8,000 / $24,000
$2,000 / $6,000
OOPM - Individual
$7,500 / $23,000
$5,000 / $12,000
OOPM - Family
$15,000 / $69,000
$10,000 / $36,000
30% / 50%
20% / 50%
PCP
$40 co-pay / 50% after deductible
$25 co-pay / 50% after deductible
Specialist
$80 co-pay / 50% after deductible
$75 co-pay / 50% after deductible
Diagnostic X-Ray
30% after deductible / 50% after deductible
No Charge / 50% after deductible
Diagnostic Lab
30% after deductible / 50% after deductible
No Charge / 50% after deductible
Inpatient Hospital
30% after deductible / 50% after deductible
20% after deductible / 50% after deductible
Outpatient Surgery
30% after deductible / 50% after deductible
20% after deductible / 50% after deductible
Emergency Room
$300 co-pay + 30% after deductible
$300 co-pay + 20% after deductible
Urgent Care
$100 co-pay / 50% after deductible
$75 co-pay / 50% after deductible
30-days, see mail order for other options
30 days, see mail order for other options
Member Copay Tier 1
$3 or $10 co-pay
$3 or $10 co-pay
Member Copay Tier 2
$50 co-pay
$45 co-pay
Member Copay Tier 3
$80 co-pay
$75 co-pay
Member Copay Tier 4
20% up to $250
20% up to $250
2x co-pay
2x co-pay
Network Deductible/Out-of-pocket
Benefits
Co-insurance
RX
Rx Supply Limit
Mail Order
4
Dental Insurance DPPO With the Preferred Provider Organization (PPO) dental plan, you may visit a PPO dentist and benefit from the negotiated rate or visit a non-network dentist. When you utilize a PPO dentist, your out-of pocket expenses will be less. You may also obtain services using a non-network dentist; however, you will be responsible for the difference between the covered amount and the actual charges and you may be responsible for filing claims.
BEAM Dental PPO Network
DPPO
Network
Benefits
In-Network
Out-of-Network
Calendar Year Maximum
$1,500
Same as In-Network
Individual Deductible
$50
$50
Family Deductible
$150
$150
Waived for Preventive
Yes
-
Class I - Preventive
100%
100%
Class II - Basic
80%
80%
Class III - Major
50%
50%
Class IV - Orthodontia
Not Covered
Not Covered
Dental Reimbursement Sch.
Negotiated Rate
90th percentile of UCR*
* UCR is the usual customary and reasonable amount as determined by dentists charges in a similar geographic region. You may be responsible for any balance billing from a non-contracted provider for amounts between UCR and actual charges.
5
Vision Insurance The vision plan provides coverage for vision care services including examinations, lenses and frames through a broad network of contracted optical providers. You will receive richer benefits if you utilize a contracted, in-network provider.
Superior Vision Plan Versant Health Network
VPPO Network benefits shown. Please refer to plan summary for non-contracted provider reimbursement schedule
Benefits
6
Exams Frequency
12 months
Lenses Frequency
12 months
Frames Frequency
12 months
Contacts Frequency
12 months
Exam Copay
$10
Materials Copay
$15
Contacts Allowance
Up to $100 in-lieu of frames/lenses
Frame Allowance
Up to $100
Clear Connection Monthly Contributions Aetna 1000 Medical
DENTAL PLAN
Employee monthly contributions less than or equal to 12 months of service with Clear Connection:
Employee
$41.67
Employee + Spouse
$87.96
Employee
$342.03
Employee + Children
$93.64
Employee + Spouse
$1,141.55
Family
$151.72
Employee + Children
$1,018.54
Family
$1,756.67
Employee monthly contributions more than 12 months of service with Clear Connection:
VISION PLAN
Employee
$7.62
Employee + Spouse
$16.39
Employee
$209.84
Employee + Children
$12.34
Employee + Spouse
$1,009.36
Family
$22.48
Employee + Children
$886.35
Family
$1,624.48
Aetna 4000 Medical Employee monthly contributions less than or equal to 12 months of service with Clear Connection:
Employee
$220.32
Employee + Spouse
$830.24
Employee + Children
$736.40
Family
$1,299.48
Employee monthly contributions more than 12 months of service with Clear Connection:
Employee
$88.13
Employee + Spouse
$698.05
Employee + Children
$604.21
Family
$1,167.29
7
Important Phone Numbers Banner Aetna
Superior Vision
Group Number: TBD Customer Service: Please refer to the number on the back of your ID card
Group Number: 27202 Customer Service: 800-507-3800
banneraetna.com/en/individuals-families
superiorvision.com
BEAM Dental
Online Enrollment & Benefit Information
Group Number: AZ0054 Customer Service: 800-648-1179
pcspay.myisolved.com
app.beambenefits.com/dentists
About this booklet This booklet highlights important features of Clear Connection’s benefits for its benefit eligible employees. While efforts have been made to ensure the accuracy of the information presented, in the event of any discrepancies your actual coverage and benefits will be determined by the legal plan documents and the contracts that govern these plans.
Capital Financial 14614 N. Kierland Blvd., Suite N230, Scottsdale, AZ 85254 Office / 480.347.0926 Fax / 480.360.6417