BENSELECT ONLINE ENROLLMENT CONT.:

• CANCER ASSIST

You may enroll online in Cancer Assist coverage.

• DISABILITY - EDUCATOR 1.0

You may enroll online in Educator 1.0 coverage.

• GROUP ACCIDENT

You may enroll online in Group Accident coverage.

• GROUP MEDICAL BRIDGE 7000

You may enroll online in Group Medical Bridge coverage.

• CRITICAL ILLNESS 6000

You may enroll online in Critical Illness 6000 coverage.

• TERM LIFE 5000

You may enroll online in Term Life 5000; however, employees wishing to purchase an individual policy for their spouse should speak with the Benefits Representative.

• UNIVERSAL LIFE WITH LONG-TERM CARE

You may enroll online in Universal Life with Long-Term Care coverage.

Click ‘Sign & Submit’ once you have decided which benefits to enroll in.

Review your coverage. If any items are ‘Pending’, you will need to decide whether to enroll or decline this benefit.

Click ‘Next’ to review and electronically sign the authorization for your benefit elections.

Review the confirmation, then if you are satisfied with your elections, enter your PIN and click ‘Sign Form’.

Click ‘Download & Print’ to print a copy of your elections, or download and save the document. Please do not forget this important step!

Click ‘Log Out’.

Lifetime Maximum Covered Services

Doctor's Visits (Outpatient or In-Office)

Primary Care Physician VisitsChiropractic, Spinal Manipulations (30 visit limit)

Specialist VisitsChiropractic, Spinal Manipulations (30 visit limit)

Shots - Allergy or Therapeutic InjectionsDoctor's Office, ER, or Outpatient Setting

Diagnostic Tests, Labs, and X-Rays

Specific conditions/diseases at doctor's office, ER, or Outpatient Setting

Preventive Care Visits

Emergency Room Visits

Hospital & Other Services (Pre-certification may be required)

Ambulance Services

Inpatient Hospital Services

Outpatient Hospital Services

Outpatient Diagnostic Test, Labs, and X-Rays

Outpatient Therapy Services - Occupational, Speech, Physical, Cardiac, Chemotherapy, Radiation, Infusion, & Respiratory

Louisa County Government & Schools 2023/24 Plan Year

*You have a mandatory generic drug program. However, if there is no generic equivalent for the drug, you may get the brand and pay only the applicable benefit level. If there is a generic equivalent available, you may opt to use the brand but you'll pay the applicable brand level plus the difference between the brand and generic allowable charge.

** This plan will waive the hospital Copayment if the member enrolls in the maternity management pre-natal program within the first trimester of pregnancy, has a dental cleaning during pregnancy and satisfactorily completes the program.