HEALTH INSURANCE
-Company Contribution
-Claims
-Pre-certification
-Prior Approval
-Prescription
Coverage (Including Mail-Order Drug Plan)
-Qualified Dependents
-Explanation of Benefits
(EOB)
WELLNESS
CAFETERIA (FLEX) PLAN
SHORT TERM DISABILITY
401K REPLACEMENT PIN#
PROCEDURE
ADDRESS
CHANGES - DEPENDENT STATUS CHANGES
ONLINE BENEFIT INFORMATION
· Company
Contribution
Beginning in January 2003, the company contribution for health
insurance will be 75% of the premium cost. An employee can earn an
additional 5% contribution, or 80% total, by participating in the
wellness screening the previous calendar year. If you have family
coverage both you and your spouse must participate to qualify for
the additional 5%.
TOP
· Claims
Prescriptions, doctor bills, etc., for the year 2001 must be
submitted prior to March 31, 2002. You have 3 months after the
year-end to submit 2001 claims. Eligible expenses incurred during
October, November and December which are applied toward this year’s
deductible will also be applied toward next year’s deductible.
Co-insurance and maximum out-of- pocket expenses do not carry
forward. The co-pay for office visits DOES NOT apply toward
deductible or co-insurance.
TOP
· Pre-certification
Planned inpatient admissions must be reported to Wellmark
Administrators (800-344-5822) prior to the actual admission.
Emergency admissions must be reported within 24 hours following
the date of admission. Failure to call will result in reduced
benefits. Most hospitals will do this for you, but you are
responsible for any penalty for failure to pre-certify.
TOP
· Prior
Approval
Certain services require prior approval from Wellmark
Administrators before the service is provided. Failure to obtain a
prior approval will result in reduced benefits. Some services
requiring prior approval include hospice services, home health
care, private duty nursing, home infusion therapy, and organ
transplants. A complete list of these services, and applicable
penalties, are listed in the benefit summary of the Group Health
Benefit Booklet.
TOP
· Prescription
Coverage (Including Mail-Order
Drug Plan)
Ø Pay the full cost
of the prescription drug and submit the receipt to Wellmark
Administrators for reimbursement.
Ø Prescriptions are
first subject to the calendar year deductible.
Ø After calendar
year deductible is satisfied, prescriptions are covered at 80%.
TOP
· Qualified
Dependents
Ø Unmarried
children under age 19
Ø Unmarried
children 19 but under the age of 25 if a full-time student in an
accredited institution and taking the proper number of credits to
qualify as a full-time student.
TOP
· Explanation
of Benefits (EOB)
Due to the new Privacy Laws, beginning January 2002, employers
will no longer have access to any employee EOB’s. This means
you will need to take a major role in reviewing your own
EOB’s. Please review every EOB you receive from the Group Health
Plan for any type of error. If you discover a mistake or
have questions, contact Frank Heinen in the Brooklyn Office
immediately.
TOP
· Cobra
On page 13 of your Health Benefit Booklet you will find the
criteria for COBRA. It is your responsibility to notify Frank
Heinen or Diane Kilmer within sixty (60) days if you become
divorced or legally separated, or a dependent child ceases to be
an eligible dependent as defined by this Plan.
TOP
WELLNESS
· Beginning in
January 2003, the company contribution for health insurance will
be 75% of the premium cost – single or family.
· You can earn an
additional 5% contribution, or 80% total, by participating in
the wellness screening.
· If you
participate in Wellness during 2002, you will be eligible to
receive an 80% company contribution during 2003.
· If your spouse
is covered under Manatts Group Health Plan, both you and your
spouse must participate in Wellness to qualify for the
additional 5%.
TOP
CAFETERIA (FLEX) PLAN
· All
unreimbursed medical claims and dependent care claims (when
applicable) for the year 2001 must be submitted to Bev Vaverka
within 60 days from the end of the year or prior to February 28,
2002.
· Flex claim
forms are available from your local office. Complete the claim
form and attach an eligible receipt. Cash receipts, cash
register tapes, cancelled checks or credit card receipts are NOT
eligible receipts.
· Flex checks are
written on the 15th of each month. You must have your
claims submitted to Bev at least 3 business days prior to the 15th.
TOP
SHORT TERM DISABILITY
· Effective January
1, 2002, the short- term disability benefit amount will be raised
to $250.00 per week for a disability due to illness or injury
incurred off the job.
TOP
401K REPLACEMENT PIN#
PROCEDURE
· A request for a
PIN# replacement must be done via telephone.
· Dial the 800
phone number (1-800-258-2715).
· Enter your social
security number.
· Enter your PIN#.
· Listen to the
instructions on what to do if you do not know your PIN#.
· A request will be
made for you to enter a couple of numbers.
· A new PIN# will
be sent to your home address within 2 working days.
· You will not be
able to access your account until you receive your PIN#.
TOP
ADDRESS
CHANGES – DEPENDENT STATUS CHANGES
· Contact Diane
Kilmer with any address or dependent status changes. It is very
important to keep our files correct for all mail
correspondence, processing of forms, and claim information.
TOP
ONLINE BENEFIT
INFORMATION
· If you have
access to the World Wide Web, you can view all the benefit
information and SPD's online at http://www.manatts.com.
To access these documents you must sign into the corporate
intranet. If you do not have a valid username and/or
password, contact Nate Hopwood in Brooklyn to get set up.
Nate’s email address is nateh@manatts.com or call him in
Brooklyn at 641-522-9206 ext 276.
TOP
|