OE2024 – Offer Of Coverage


 

(For current employees who are enrolled in, or have previously been offered enrollment in, the medical plan)

 

 

Eligibility.  We offer this coverage as indicated below:

·         Full time employees (40 or more hours per week)

·         Part-time employees.  To be eligible as a part-time employee, you must work at least 30 hours per week, and you must complete 600 hours of service before you become eligible.

·         Dependent children until age 26

·         Spouse

 

Coverage options. We are pleased to offer the benefits listed below:

Plan Name

Employee-only

Employee + spouse

Employee + children

Employee + family

HMO 610

$35 PER PAY PERIOD

$819.77

$734.64

$1,224.36

HMO 620

$0.00

$729.41

$653.59

$1,089.37

 

Dental. We offer dental coverage as indicated below:

Plan 274: Orthodontics (Adult and children)

 

Life Insurance. We offer employee life insurance in the following amounts:

·         Two and a half times (2.5) salary

 

*Maximum of $350,000. All principal amounts of life insurance for each eligible employee have an equal corresponding amount of accident death and dismemberment coverage.

 

We also offer dependent life insurance in the following amounts:

·         $2,000

·         $8,000 – Additional amount that can be selected for $4.44 per month (paid by the employee

 

Long Term Disability Coverage. We are pleased to offer long-term disability coverage.

Long Term Disability Elimination Period:  90 days

 

Coverage Effective Date. For new employees, you must complete the probationary period. For new employees, coverage will become effective the first of the month following the probationary period.

Enrollment Procedures.

Important information was emailed about our coverage.

 

If you wish to enroll, you should submit your enrollment as instructed no later than December 04, 2023.  If you complete your enrollment by that date, your coverage will become effective on January 01, 2024.  By enrolling in the plan, you authorize us to withhold your required contributions from your paychecks while your coverage is in effect.

 

If you decide not to enroll at this time, you should know that you will not have another chance to enroll until January 1 of next year or upon the occurrence of a “special enrollment event” as described in the Special Enrollment Rights Notice. Please sign below to acknowledge that you have received this offer of coverage.

 

SB476 Acknowledgement

I understand that I am enrolling in a health care plan, which requires that health care services must be provided by participating providers. Failure to use a participating provider will result in reduced coverage or no coverage for services that I receive, and I will be fully responsible for any and all costs not covered by Blue Cross and Blue Shield of Georgia/Blue Cross Blue Shield Healthcare Plan of Georgia (BCBSGA) (as applicable).

I have received a complete listing of participating providers. I understand that the participation status of any provider may change from time to time. It is my responsibility to verify that my health care provider is participating with BCBSGA/BCBSHP prior to receiving services. I may verify participation status via BCBSGA's Web site, www.anthem.com which is updated at least every 30 days. I may also verify status by contacting the customer service number listed on my member ID card.

As required by the State of Georgia regulations, the following is a summary of the financial arrangements with the health care providers who are participating in the BCBSGA/BCBSHP network:

1. Hospital providers are paid according to a contract which includes inpatient per diems, case rates, and discounted fee for service arrangements depending on specific services provided.

2. Physicians are paid discounted fee for service in accordance with a specific fee schedule, which has been provided to them as contracted.

3.Laboratory services are provided through a capitated per member per month flat fee.

4.Other ancillary