overview & editing instructions irenewal open enrollment meeting presentation template
TRANSCRIPT
O V E RV I E W & E D I T I N G I N S T R U C T I O N S
iRenewal Open Enrollment Meeting Presentation Template
Overview
This template was created to save you time in developing PowerPoint Presentations for your Enrollment meetings.
Please read the instructions on how to efficiently edit this template to fit your needs.
This is a template. Please save a copy of this template to a safe location and do not save over the template version. Always save your edits as a new document.
This template is broken up into sections. If you don’t need any slides from a section, you can delete the section and it’s slides by selecting the section header, right clicking and selecting “remove section and slides”.
Many of the slides in this template have items marked in parenthesis, these are items that need to be completed by you. – Example: (Group Name)
Group & Broker Info Section
Cover Slide – This will be your first slide in your PowerPoint Presentation (PPT) Add your Group’s Name Add the date of the presentation You can also add your group’s logo, by inserting an image.
Agency Slide Add Broker/Agency Logo Enter Broker/Agency Info
Medical Carrier/Plan Information
There is a section for each major medical carrier.
There is also a section for you to add any carriers not contained in this template.
For any carriers you don’t need, simply delete the section, by selecting the section header, right clicking and selecting “remove section and slides”.
Each carrier contains a carrier logo, a listing of their value add services as well as carrier contact information for members.
There is a slide for entering information about a carrier or plan. Delete the example wording already listed and type the new information in it’s place.
You also have the ability to enter specific plan benefit information. If you have more than one of any type of plan, you can duplicate that slide to enter additional plans.
Ancillary Lines Carrier/Plan Information
There is a section each for Dental, Vision, Life and Disability Carrier/Plan information.
For any lines of coverage you don’t need, simply delete the section, by selecting the section header, right clicking and selecting “remove section and slides”.
There is a slide for entering information about a carrier or plan. Delete the example wording already listed and type the new information in it’s place.
You also have the ability to enter specific plan benefit information. If you have more than one of any type of plan, you can duplicate that slide to enter additional plans.
Summary Information
This section contains slides for you to note costs, important information and to answer any questions.
There are some examples of information you may want to include but are not necessary.
Either delete or write over any information you do not wish to include in this section.
Other Carrier Information
At the end of this PPT we have included carrier logo’s and contact sheets for our ancillary lines carriers.
You can add these to the Ancillary Lines section as needed.
If you have the same carrier for more than one ancillary line, you can duplicate the appropriate slide and move one to each ancillary section as necessary.
A CoPower section is also available. This section also has slides for the Value Add services available to CoPower groups.
Finalize Your Presentation
Once you have all the plan and carrier information entered, finalize your presentation and remove unneeded slides.
The easiest way to remove slides is by going to the slide sorter view, highlighting a slide and right click, then select delete from the pop-up menu. (Don’t forget to remove the instruction section you just read!)
Once all unneeded slides are removed and your order is how you want it, save your PPT and you are done!
Presentation Best Practices
Speak clearly and breath normally.
Always have a beverage (water, coffee, etc.) nearby just in case during your presentation.
Practice your presentation so you are comfortable delivering the material.
Do not read each word on a slide. Use the presentation to supplement your speaking points.
Relax, remember, you are the professional!
( D AT E )
(Group Name)Benefits Enrollment
Presented by:
(Broker Name)
(Agency Name)
(Agency Address)
(Agency City, State, Zip)
(Broker Phone)
(Broker Email)
(Agency Logo) To add logo, delete all text in this box Click on the Picture icon “Insert Picture
from File” Locate the Agency Logo file on your
computer in the finder window and click the “Open” button
You may need to resize the logo to make sure it is not distorted
Health Insurance
Value Add Services
Member Management Tools24/7 Nurse HotlinesEAP ProgramDisease Management ProgramHealthy Lifestyles Coaching
Member Savings on… Fitness Discount Program Weight-loss Programs Hearing exams and devices Eye Care, Eyewear &
Accessories LASIK Eye surgery Massage Therapy Chiropractic & Acupuncture Dietetic Counseling
For Example Ded applies to OOP max For Example Self Injectables covered under OVFor Example Ped Dental benefit counts toward OOPFor Example Preventative Covered in full
Plan Highlights
Plan Benefits - HMO
(Plan Name/Network) Benefits
Single Annual DeductibleFamily Annual Deductible
Annual Out-of-Pocket Maximum
Family Annual Out-of-Pocket Maximum
Office Visit Copay
Coinsurance
In Patient Hospitalization
Generic Prescription Drugs Copay
Brand Name Prescription Drug Deductible
Brand Name Prescription Drug Copay
Pediatric Dental
Plan Benefits – PPO
(Plan Name/Network) In-Network Benefits Out-of-Network Benefits
Single Annual Deductible Family Annual Deductible
Annual Out-of-Pocket Maximum
Family Annual Out-of-Pocket Maximum
Office Visit Copay
Coinsurance
In Patient Hospitalization
Generic Prescription Drugs Copay
Brand Name Prescription Drug Deductible
Brand Name Prescription Drug Copay
Pediatric Dental
Plan Benefits –CDHP
(Plan Name/Network) In-Network Benefits Out-of-Network Benefits
Single Annual Deductible Family Annual Deductible
Annual Out-of-Pocket Maximum
Family Annual Out-of-Pocket Maximum
Office Visit Copay
Coinsurance
In Patient Hospitalization
Generic Prescription Drugs Copay
Brand Name Prescription Drug Deductible
Brand Name Prescription Drug Copay
Pediatric Dental
Medical Enrollment Form Completion
Complete the sections applicable in its entirety.
Do not fill out any ancillary sections if the ancillary plans are not being offered with your medical carrier.
Below are commonly missed fields which are required and may hold up your group’s approval.
Complete SSN for each member of your family Complete address Pick your plan/network Complete date of hire mm/dd/yy HMO members – indicate PCP assignment Complete a waiver for you or any family member
not enrolling Sign and date application for enrolling in coverage. Signature date needs to be before effective date
On the Phone: On the Web:
Member Services/Claims
HMO 877-702-3862
PPO 877-802-3862
Pharmacy Info:
800-238-6279
Carrier Website:
http://www.aetna.com/
Find a Provider:http://www.aetna.com/docfind/
Contact Info
Health Insurance
Value Add Services
Member Management Tools
LiveHealth Online24/7 Nurse HotlineBlueCardWellness
Smoking Cessation programs
Stress Management
Savings Gym Memberships Holistic Care Eye Care Weight Management Hearing exams, devices,
audio gear Allergy Control LifeMart Membership
For Example Ded applies to OOP max For Example Self Injectables covered under OVFor Example Ped Dental benefit counts toward OOPFor Example Preventative Covered in full
Plan Highlights
Plan Benefits - HMO
(Plan Name/Network) Benefits
Single Annual DeductibleFamily Annual Deductible
Annual Out-of-Pocket Maximum
Family Annual Out-of-Pocket Maximum
Office Visit Copay
Coinsurance
In Patient Hospitalization
Generic Prescription Drugs Copay
Brand Name Prescription Drug Deductible
Brand Name Prescription Drug Copay
Pediatric Dental
Plan Benefits – PPO
(Plan Name/Network) In-Network Benefits Out-of-Network Benefits
Single Annual Deductible Family Annual Deductible
Annual Out-of-Pocket Maximum
Family Annual Out-of-Pocket Maximum
Office Visit Copay
Coinsurance
In Patient Hospitalization
Generic Prescription Drugs Copay
Brand Name Prescription Drug Deductible
Brand Name Prescription Drug Copay
Pediatric Dental
Plan Benefits –CDHP
(Plan Name/Network) In-Network Benefits Out-of-Network Benefits
Single Annual Deductible Family Annual Deductible
Annual Out-of-Pocket Maximum
Family Annual Out-of-Pocket Maximum
Office Visit Copay
Coinsurance
In Patient Hospitalization
Generic Prescription Drugs Copay
Brand Name Prescription Drug Deductible
Brand Name Prescription Drug Copay
Pediatric Dental
Medical Enrollment Form Completion
Complete the sections applicable in its entirety.
Do not fill out any ancillary sections if the ancillary plans are not being offered with your medical carrier.
Below are commonly missed fields which are required and may hold up your group’s approval.
Complete SSN for each member of your family Complete address Pick your plan/network Complete date of hire mm/dd/yy HMO members – indicate PCP assignment Complete a waiver for you or any family member
not enrolling Sign and date application for enrolling in
coverage.
On the Phone: On the Web:
Member Services/Claims
800-627-8797
Pharmacy Info:
866-297-1013
Carrier Website:http://www.anthem.com/ca
Find a Provider:https://www.anthem.com/health-insurance/provider-directory/searchcriteria?qs
Contact Info
Health Insurance
Value Add Services
Carrier Member Perks 24/7 Nurse Hotline Member management
tools Wellness programs Savings on a variety of
personal health items and healthy living programs
** Every carrier varies on the amount and program discounted. Please contact your enrolled carrier for additional information.
• Additional California Choice Savings• Savings on hearing
exams and hearing devices
• Dental Discount Plan• Discounts on EyeMed
Vision Care• Cal Perks – Access to
employee discounts on tickets, membership and more.
For Example Ded applies to OOP max For Example Self Injectables covered under OVFor Example Ped Dental benefit counts toward OOPFor Example Preventative Covered in full
Plan Highlights
Plan Benefits - HMO
(Plan Name/Network) Benefits
Single Annual DeductibleFamily Annual Deductible
Annual Out-of-Pocket Maximum
Family Annual Out-of-Pocket Maximum
Office Visit Copay
Coinsurance
In Patient Hospitalization
Generic Prescription Drugs Copay
Brand Name Prescription Drug Deductible
Brand Name Prescription Drug Copay
Pediatric Dental
Plan Benefits – PPO
(Plan Name/Network) In-Network Benefits Out-of-Network Benefits
Single Annual Deductible Family Annual Deductible
Annual Out-of-Pocket Maximum
Family Annual Out-of-Pocket Maximum
Office Visit Copay
Coinsurance
In Patient Hospitalization
Generic Prescription Drugs Copay
Brand Name Prescription Drug Deductible
Brand Name Prescription Drug Copay
Pediatric Dental
Plan Benefits –CDHP
(Plan Name/Network) In-Network Benefits Out-of-Network Benefits
Single Annual Deductible Family Annual Deductible
Annual Out-of-Pocket Maximum
Family Annual Out-of-Pocket Maximum
Office Visit Copay
Coinsurance
In Patient Hospitalization
Generic Prescription Drugs Copay
Brand Name Prescription Drug Deductible
Brand Name Prescription Drug Copay
Pediatric Dental
Medical Enrollment Form Completion
Complete the sections applicable in its entirety.
Do not fill out any ancillary sections if the ancillary plans are not being offered with your medical carrier.
Below are commonly missed fields which are required and may hold up your group’s approval.
Complete SSN for each member of your family Complete address Pick your plan/network Complete date of hire mm/dd/yy HMO members – indicate PCP assignment Complete a waiver for you or any family member
not enrolling Sign and date application for enrolling in
coverage.
Medical Carriers Ancillary Carriers
Aetna: 888-702-3862
Anthem: 866-524-5659
Health Net: 800-361-3366
Kaiser: 800-464-4000
SHARP: 800-359-2002
Western Health Advantage:888-563-2250
Ameritas: 877-203-0036
FDH: 800-558-8003
Smile Saver: 800-333-9561
EyeMed: 866-939-3633
Landmark: 800-638-4557
Contact Info
www.calchoice.com
Health Insurance
Value Add Services
Member Management Tools
24/7 Nurse HotlineWellness
Smoking Cessation programs
Stress Management
Savings Gym Memberships Holistic Care Eye Care Weight Management Hearing exams, devices,
audio gear Allergy Control LifeMart Membership
Member perks offered by Anthem Blue Cross
For Example Ded applies to OOP max For Example Self Injectables covered under OVFor Example Ped Dental benefit counts toward OOPFor Example Preventative Covered in full
Plan Highlights
Plan Benefits - HMO
(Plan Name/Network) Benefits
Single Annual DeductibleFamily Annual Deductible
Annual Out-of-Pocket Maximum
Family Annual Out-of-Pocket Maximum
Office Visit Copay
Coinsurance
In Patient Hospitalization
Generic Prescription Drugs Copay
Brand Name Prescription Drug Deductible
Brand Name Prescription Drug Copay
Pediatric Dental
Plan Benefits – PPO
(Plan Name/Network) In-Network Benefits Out-of-Network Benefits
Single Annual Deductible Family Annual Deductible
Annual Out-of-Pocket Maximum
Family Annual Out-of-Pocket Maximum
Office Visit Copay
Coinsurance
In Patient Hospitalization
Generic Prescription Drugs Copay
Brand Name Prescription Drug Deductible
Brand Name Prescription Drug Copay
Pediatric Dental
Plan Benefits –CDHP
(Plan Name/Network) In-Network Benefits Out-of-Network Benefits
Single Annual Deductible Family Annual Deductible
Annual Out-of-Pocket Maximum
Family Annual Out-of-Pocket Maximum
Office Visit Copay
Coinsurance
In Patient Hospitalization
Generic Prescription Drugs Copay
Brand Name Prescription Drug Deductible
Brand Name Prescription Drug Copay
Pediatric Dental
Medical Enrollment Form Completion
Complete the sections applicable in its entirety.
Do not fill out any ancillary sections if the ancillary plans are not being offered with your medical carrier.
Below are commonly missed fields which are required and may hold up your group’s approval.
Complete SSN for each member of your family Complete address Pick your plan/network Complete date of hire mm/dd/yy HMO members – indicate PCP assignment Complete a waiver for you or any family member
not enrolling Sign and date application for enrolling in
coverage.
On the Phone: On the Web:
Anthem Member Services/Claims
800-627-8797
Pharmacy Info:
866-297-1013
Delta Dental of California
888-335-8227
VSP
800-877-7195
Carrier Website:
http://www.calcpa.com
Find a Provider:https://www.anthem.com/health-insurance/provider-directory/searchcriteria?qs
Contact Info
Health Insurance
For Example Ded applies to OOP max For Example Self Injectables covered under OVFor Example Ped Dental benefit counts toward OOPFor Example Preventative Covered in full
Plan Highlights
Plan Benefits - HMO
(Plan Name/Network) Benefits
Single Annual DeductibleFamily Annual Deductible
Annual Out-of-Pocket Maximum
Family Annual Out-of-Pocket Maximum
Office Visit Copay
Coinsurance
In Patient Hospitalization
Generic Prescription Drugs Copay
Brand Name Prescription Drug Deductible
Brand Name Prescription Drug Copay
Pediatric Dental
Plan Benefits – PPO
(Plan Name/Network) In-Network Benefits Out-of-Network Benefits
Single Annual Deductible Family Annual Deductible
Annual Out-of-Pocket Maximum
Family Annual Out-of-Pocket Maximum
Office Visit Copay
Coinsurance
In Patient Hospitalization
Generic Prescription Drugs Copay
Brand Name Prescription Drug Deductible
Brand Name Prescription Drug Copay
Pediatric Dental
Plan Benefits –CDHP
(Plan Name/Network) In-Network Benefits Out-of-Network Benefits
Single Annual Deductible Family Annual Deductible
Annual Out-of-Pocket Maximum
Family Annual Out-of-Pocket Maximum
Office Visit Copay
Coinsurance
In Patient Hospitalization
Generic Prescription Drugs Copay
Brand Name Prescription Drug Deductible
Brand Name Prescription Drug Copay
Pediatric Dental
Medical Enrollment Form Completion
Complete the sections applicable in its entirety.
Do not fill out any ancillary sections if the ancillary plans are not being offered with your medical carrier.
Below are commonly missed fields which are required and may hold up your group’s approval.
Complete SSN for each member of your family Complete address Pick your plan/network Pick your Pediatric Dental Plan Complete date of hire mm/dd/yy HMO members – indicate PCP assignment Complete a waiver for you or any family member
not enrolling Sign and date application for enrolling in coverage.
On the Phone: On the Web:
Blue Shield of California
800-325-5166
Chinese Community Health Plan
888-775-7888
Health Net
888-926-5122 or 800-522-0088
Kaiser Permanente
800-464-4000
Sharp Health Plan
800-359-2002
Western Health Advantage
888-563-2250
http://www.blueshieldca.com/
http://www.cchphmo.com/
http://www.healthnet.com/
http://www.kp.org/
http://www.sharphealthplan.com/
http://www.westernhealth.com/
Contact Info
Health Insurance
Value Add Services
Member Management Tools
Decision Power: Health & Wellness Program
Smoking Cessation Programs
Health Net Mobile App24/7 Nurse Hotline
Savings Gym Memberships Holistic Care Eye Exams, Glasses,
Frames and Contacts Hearing Exams and
Devices Weight Management
Programs Vitamins, Minerals and
Herbal Supplements
For Example Ded applies to OOP max For Example Self Injectables covered under OVFor Example Ped Dental benefit counts toward OOPFor Example Preventative Covered in full
Plan Highlights
Plan Benefits - HMO
(Plan Name/Network) Benefits
Single Annual DeductibleFamily Annual Deductible
Annual Out-of-Pocket Maximum
Family Annual Out-of-Pocket Maximum
Office Visit Copay
Coinsurance
In Patient Hospitalization
Generic Prescription Drugs Copay
Brand Name Prescription Drug Deductible
Brand Name Prescription Drug Copay
Pediatric Dental
Plan Benefits – PPO
(Plan Name/Network) In-Network Benefits Out-of-Network Benefits
Single Annual Deductible Family Annual Deductible
Annual Out-of-Pocket Maximum
Family Annual Out-of-Pocket Maximum
Office Visit Copay
Coinsurance
In Patient Hospitalization
Generic Prescription Drugs Copay
Brand Name Prescription Drug Deductible
Brand Name Prescription Drug Copay
Pediatric Dental
Plan Benefits –CDHP
(Plan Name/Network) In-Network Benefits Out-of-Network Benefits
Single Annual Deductible Family Annual Deductible
Annual Out-of-Pocket Maximum
Family Annual Out-of-Pocket Maximum
Office Visit Copay
Coinsurance
In Patient Hospitalization
Generic Prescription Drugs Copay
Brand Name Prescription Drug Deductible
Brand Name Prescription Drug Copay
Pediatric Dental
Medical Enrollment Form Completion
Complete the sections applicable in its entirety.
Do not fill out any ancillary sections if the ancillary plans are not being offered with your medical carrier.
Below are commonly missed fields which are required and may hold up your group’s approval.
Complete SSN for each member of your family Complete address Pick your plan/network Complete date of hire mm/dd/yy HMO members – indicate PCP assignment Complete a waiver for you or any family member
not enrolling Sign and date application for enrolling in
coverage.
On the Phone: On the Web:
Member Services
(membership questions, claims and Rx)
800-3611-336
Carrier Website:
http://www.healthnet.com
Find a Provider:https://www.healthnet.com/portal/providerSearch.action
Contact Info
Health Insurance
Value Add Services
Member Management Tools
Workforce Health Program
Smoking Cessation Programs
24/7 Nurse Hotline
Savings Gym Membership Holistic Care Eye Exams, Glasses,
Frames and Contacts Weight Management
Programs Private Duty – Home
Support Services
For Example Ded applies to OOP max For Example Self Injectables covered under OVFor Example Ped Dental benefit counts toward OOPFor Example Preventative Covered in full
Plan Highlights
Plan Benefits - HMO
(Plan Name/Network) Benefits
Single Annual DeductibleFamily Annual Deductible
Annual Out-of-Pocket Maximum
Family Annual Out-of-Pocket Maximum
Office Visit Copay
Coinsurance
In Patient Hospitalization
Generic Prescription Drugs Copay
Brand Name Prescription Drug Deductible
Brand Name Prescription Drug Copay
Pediatric Dental
Plan Benefits – PPO
(Plan Name/Network) In-Network Benefits Out-of-Network Benefits
Single Annual Deductible Family Annual Deductible
Annual Out-of-Pocket Maximum
Family Annual Out-of-Pocket Maximum
Office Visit Copay
Coinsurance
In Patient Hospitalization
Generic Prescription Drugs Copay
Brand Name Prescription Drug Deductible
Brand Name Prescription Drug Copay
Pediatric Dental
Plan Benefits –CDHP
(Plan Name/Network) In-Network Benefits Out-of-Network Benefits
Single Annual Deductible Family Annual Deductible
Annual Out-of-Pocket Maximum
Family Annual Out-of-Pocket Maximum
Office Visit Copay
Coinsurance
In Patient Hospitalization
Generic Prescription Drugs Copay
Brand Name Prescription Drug Deductible
Brand Name Prescription Drug Copay
Pediatric Dental
Medical Enrollment Form Completion
Complete the sections applicable in its entirety.
Do not fill out any ancillary sections if the ancillary plans are not being offered with your medical carrier.
Below are commonly missed fields which are required and may hold up your group’s approval.
Complete SSN for each member of your family Complete address Pick your plan/network Complete date of hire mm/dd/yy HMO members – indicate PCP assignment Complete a waiver for you or any family member
not enrolling Sign and date application for enrolling in
coverage.
On the Phone: On the Web:
Member Services/Claims
800-464-4000
Pharmacy Info:
800-390-3510
Carrier Website:
http://www.kp.org
Find a Provider:https://healthy.kaiserpermanente.org/health/care/consumer/locate-our-services/doctors-and-locations
Contact Info
Health Insurance
Value Add Services
Member Management Tools
Smoking Cessation Programs
24/7 Nurse Hotline
Savings Gym Membership Dental Products Holistic Care Stress Management Weigh Management Wellness Products
Vitamins Nutritional Supplements Books DVDs Fitness Skin Care
For Example Ded applies to OOP max For Example Self Injectables covered under OVFor Example Ped Dental benefit counts toward OOPFor Example Preventative Covered in full
Plan Highlights
Plan Benefits - HMO
(Plan Name/Network) Benefits
Single Annual DeductibleFamily Annual Deductible
Annual Out-of-Pocket Maximum
Family Annual Out-of-Pocket Maximum
Office Visit Copay
Coinsurance
In Patient Hospitalization
Generic Prescription Drugs Copay
Brand Name Prescription Drug Deductible
Brand Name Prescription Drug Copay
Pediatric Dental
Plan Benefits – PPO
(Plan Name/Network) In-Network Benefits Out-of-Network Benefits
Single Annual Deductible Family Annual Deductible
Annual Out-of-Pocket Maximum
Family Annual Out-of-Pocket Maximum
Office Visit Copay
Coinsurance
In Patient Hospitalization
Generic Prescription Drugs Copay
Brand Name Prescription Drug Deductible
Brand Name Prescription Drug Copay
Pediatric Dental
Plan Benefits –CDHP
(Plan Name/Network) In-Network Benefits Out-of-Network Benefits
Single Annual Deductible Family Annual Deductible
Annual Out-of-Pocket Maximum
Family Annual Out-of-Pocket Maximum
Office Visit Copay
Coinsurance
In Patient Hospitalization
Generic Prescription Drugs Copay
Brand Name Prescription Drug Deductible
Brand Name Prescription Drug Copay
Pediatric Dental
Medical Enrollment Form Completion
Complete the sections applicable in its entirety.
Do not fill out any ancillary sections if the ancillary plans are not being offered with your medical carrier.
Below are commonly missed fields which are required and may hold up your group’s approval.
Complete SSN for each member of your family Complete address Pick your plan/network Complete date of hire mm/dd/yy HMO members – indicate PCP assignment Complete a waiver for you or any family member
not enrolling Sign and date application for enrolling in
coverage.
On the Phone: On the Web:
Member Services:
800-359-2002
Carrier Website:http://www.sharphealthplan.com/
Find a Provider:https://www.sharphealthplan.com/index.php/find-a-doctor/
Contact Info
Health Insurance
Value Add Services
Member Management Tools
UnitedHealth WellnessFitness Reimbursement
ProgramSmoking Cessation24/7 Nurse HotlineMulticultural Solutions
Savings Biometric
Screenings/Coaching Cosmetic Dental Holistic Care Smoking Cessation Eye Exams, Glasses,
Contacts and Frames Weight Management Hearing Exams and
Devices
For Example Ded applies to OOP max For Example Self Injectables covered under OVFor Example Ped Dental benefit counts toward OOPFor Example Preventative Covered in full
Plan Highlights
Plan Benefits - HMO
(Plan Name/Network) Benefits
Single Annual DeductibleFamily Annual Deductible
Annual Out-of-Pocket Maximum
Family Annual Out-of-Pocket Maximum
Office Visit Copay
Coinsurance
In Patient Hospitalization
Generic Prescription Drugs Copay
Brand Name Prescription Drug Deductible
Brand Name Prescription Drug Copay
Pediatric Dental
Plan Benefits – PPO
(Plan Name/Network) In-Network Benefits Out-of-Network Benefits
Single Annual Deductible Family Annual Deductible
Annual Out-of-Pocket Maximum
Family Annual Out-of-Pocket Maximum
Office Visit Copay
Coinsurance
In Patient Hospitalization
Generic Prescription Drugs Copay
Brand Name Prescription Drug Deductible
Brand Name Prescription Drug Copay
Pediatric Dental
Plan Benefits –CDHP
(Plan Name/Network) In-Network Benefits Out-of-Network Benefits
Single Annual Deductible Family Annual Deductible
Annual Out-of-Pocket Maximum
Family Annual Out-of-Pocket Maximum
Office Visit Copay
Coinsurance
In Patient Hospitalization
Generic Prescription Drugs Copay
Brand Name Prescription Drug Deductible
Brand Name Prescription Drug Copay
Pediatric Dental
Medical Enrollment Form Completion
Complete the sections applicable in its entirety.
Do not fill out any ancillary sections if the ancillary plans are not being offered with your medical carrier.
Below are commonly missed fields which are required and may hold up your group’s approval.
Complete SSN for each member of your family Complete address Pick your plan/network Complete date of hire mm/dd/yy HMO members – indicate PCP assignment Complete a waiver for you or any family member
not enrolling Sign and date application for enrolling in
coverage.
On the Phone: On the Web:
Member Services/Claims
877-844-4999
Pharmacy Info:
800-788-7871
Carrier Website:
PPO: www.myuhc.com
HMO: www.uhcwest.com
Find a Provider:
PPO: www.myuhc.com
HMO: www.uhcwest.com
Contact Info
Health Insurance
For Example Ded applies to OOP max For Example Self Injectables covered under OVFor Example Ped Dental benefit counts toward OOPFor Example Preventative Covered in full
Plan Highlights
Plan Benefits - HMO
(Plan Name/Network) Benefits
Single Annual DeductibleFamily Annual Deductible
Annual Out-of-Pocket Maximum
Family Annual Out-of-Pocket Maximum
Office Visit Copay
Coinsurance
In Patient Hospitalization
Generic Prescription Drugs Copay
Brand Name Prescription Drug Deductible
Brand Name Prescription Drug Copay
Pediatric Dental
Plan Benefits – PPO
(Plan Name/Network) In-Network Benefits Out-of-Network Benefits
Single Annual Deductible Family Annual Deductible
Annual Out-of-Pocket Maximum
Family Annual Out-of-Pocket Maximum
Office Visit Copay
Coinsurance
In Patient Hospitalization
Generic Prescription Drugs Copay
Brand Name Prescription Drug Deductible
Brand Name Prescription Drug Copay
Pediatric Dental
Plan Benefits –CDHP
(Plan Name/Network) In-Network Benefits Out-of-Network Benefits
Single Annual Deductible Family Annual Deductible
Annual Out-of-Pocket Maximum
Family Annual Out-of-Pocket Maximum
Office Visit Copay
Coinsurance
In Patient Hospitalization
Generic Prescription Drugs Copay
Brand Name Prescription Drug Deductible
Brand Name Prescription Drug Copay
Pediatric Dental
Medical Enrollment Form Completion
Complete the sections applicable in its entirety.
Do not fill out any ancillary sections if the ancillary plans are not being offered with your medical carrier.
Below are commonly missed fields which are required and may hold up your group’s approval.
Complete SSN for each member of your family Complete address Pick your plan/network Complete date of hire mm/dd/yy HMO members – indicate PCP assignment Complete a waiver for you or any family member
not enrolling Sign and date application for enrolling in
coverage.
Dental Insurance
Dental Carrier: (_______________)(________________)Plan Highlights
For example DP waiverFor example benefit roll over For example additional cleaning for pregnant womenFor example implants are covered, no missing tooth
clauseFor example endo/perio in basicFor example composite fillings covered
Plan Benefits - DHMO
(Plan Name/Network) Benefits
Calendar Year Deductible
Calendar Year Maximum
Diagnostic & Preventive Services (D0210)
Basic Restorative (D2104)
Periodontics (D4341)
Endodontics (D3310 and D3330)
Oral Surgery (D7140 and D7240)
Restorative (D2790 and D2750)
Prosthodontics (D5110 and D 5211)
Orthodontics (D8070 and D8090)
Plan Benefits - PPO
(Plan Name/Network) In-Network Benefits Out-of-Network Benefits
Reimbursement Basis
Calendar Year Max
Annual Deductible
Diagnostic & Preventive Services
Basic
Major
Endo/Perio/Oral Surgery
Orthodontia
Dental Enrollment Form Completion
Complete the sections applicable in its entirety.
These are some commonly missed fields which are required and may hold up your group’s approval.
Complete SSN for each member of your family Complete address Pick your plan Complete date of hire mm/dd/yy DHMO members – pick your PCP Complete a waiver for you or any family member
not enrolling Sign and date application for enrolling in
coverage.
Vision Insurance
Vision Carrier: (_______________)(________________)Plan Highlights
Plan Benefits
(Plan Name/Network) In-Network Benefits Out-of-Network Benefits
Annual Copayment
Eye Exam
Single-Vision Lenses
Bifocal Lenses
Trifocal Lenses
Frames
Contact Lenses
Eye Exam Frequency
Lenses Frequency
Frames Frequency
Contact Lenses (In lieu of Lenses and Frames
Vision Enrollment Form Completion
Complete the sections applicable in its entirety.
These are some commonly missed fields which are required and may hold up your group’s approval.
Complete SSN for each member of your family Complete address Pick your plan Complete date of hire mm/dd/yy Complete a waiver for you or any family member
not enrolling Sign and date application for enrolling in
coverage.
Life Insurance
Life Carrier: (_______________)(________________)Plan Highlights
Life Plan Benefits
(Plan Name) Benefits
Base Volume
Guarantee Issue Amount
Age Reduction Schedule
Buy Up Option
Dependent Coverage
Life Enrollment Form Completion
Complete the sections applicable in its entirety.
These are some commonly missed fields which are required and may hold up your group’s approval.
Complete SSN Complete address Complete date of hire mm/dd/yy Name your beneficiary If your benefit is salary amount, indicate annual
salary Sign and date application for enrolling in
coverage.
Disability Insurance
Disability Carrier: (_______________)(________________)Plan Highlights
Disability Plan Benefits
(Plan Name) Benefits
Elimination Period
Maximum Monthly Benefit
Maximum Coverage Period
Benefit Amount
Elimination Period
Life Enrollment Form Completion
Complete the sections applicable in its entirety.
These are some commonly missed fields which are required and may hold up your group’s approval.
Complete SSN Complete address Complete date of hire mm/dd/yy Name your beneficiary If your benefit is salary amount, indicate annual
salary Sign and date application for enrolling in
coverage.
Costs
Your employer contributions:
Medical Dental Vision Life
Important Information
Paperwork must be received by:
Return forms to:
Have Questions? Call:
Questions?
Dental Insurance
Through
Value Add Services
•Discount Rx – up to 75% off on prescription drugs•Telecure – access to medical providers over the phone. •Wild at Work – savings on dining, theme parks, shopping and a host of other services
Vision Insurance
Through
Value Add Services
Savings 20% off Additional
Sunglasses and Glasses 15% off cost of contact
lens exam 15% off Laser Vision
Correction or 5% off the promotional price.
• Discount Rx – up to 75% off on prescription drugs
• Telecure – access to medical providers over the phone.
• Wild at Work – savings on dining, theme parks, shopping and a host of other services
Basic Life Insurance
Through
Value Add Services
Accidental Death and Dismemberment coverage
Work Life Balance EAPLife Planning Financial
and Legal ResourcesWorld Wide Emergency
Travel Assistance.
• Discount Rx – up to 75% off on prescription drugs
• Telecure – access to medical providers over the phone.
• Wild at Work – savings on dining, theme parks, shopping and a host of other services
Long Term Disability Insurance
Through
Value Add Services
Standard Waiver of Premium
Work Life Balance EAPWorld Wide Emergency
Travel Assistance.
• Discount Rx – up to 75% off on prescription drugs
• Telecure – access to medical providers over the phone.
• Wild at Work – savings on dining, theme parks, shopping and a host of other services
On the Phone: On the Web:
Delta Dental of California
888-335-8227
Delta Care USA
800-422-4234
MetLife
800-275-4638
Unum
866-679-3054
VSP
800-877-7195
http://www.deltadentalins.com/
http://www.deltadentalins.com/
http://www.metlife.com/
http://www.unum.com/
http://www.vsp.com/
Find a Provider:
http://copower.com/contact-us/finding-a-provider/
Contact Info
(Line of Coverage) Insurance
On the Phone: On the Web:
Member Services:
800-487-5553
Carrier Website:http://www.ameritasgroup.com/
Find a Provider:http://www.ameritasgroup.com/resources/419.asp
Contact Info
(Line of Coverage) Insurance
On the Phone: On the Web:
Member Services/Claims
877-433-6825
Ext 3
Carrier Website:
http://www.caldental.net
Find a Provider:http://www.caldental.net/CDNWebsite/FindDentist.do
Contact Info
(Line of Coverage) Insurance
On the Phone: On the Web:
Member Services:
800-275-4638
Claims:
Life: Option 2, then 4, then 1
Dental: Option 2 then 2
Disability: Option 2, then 3, then 1
Vision: Option 2 then 5
Carrier Website:
http://www.metlife.com/
Find a Provider:https://metlocator.metlife.com/metlocator/execute/Search
Contact Info
(Line of Coverage) Insurance
On the Phone: On the Web:
Member Services:
888-715-0760
Carrier Website:http://www.premierlife.com/
Contact Info
(Line of Coverage) Insurance
On the Phone: On the Web:
Member Services Dental and Vision:
800-247-4695
Member Services Life and Disability
800-245-1522
Carrier Website:
http://www.principal.com/
Find a Provider:
http://www.principal.com/partners/providers/providerdirectory.htm
Contact Info
(Line of Coverage) Insurance
On the Phone: On the Web:
Member Services:
800-351-7500
Claims:
800-351-7500 ext 4149
Carrier Website:http://www.reliancestandard.com/
Find a Provider:
http://ameritas-dental.prismisp.com/
Contact Info
(Line of Coverage) Insurance
On the Phone: On the Web:
Member Services:Disability: 800-303-9744
Life: 888-563-1124
Carrier Website:http://www.thehartford.com/
Contact Info
Health Insurance
Value Add Services
Member Management Tools
24/7 Nurse HotlineCalifornia State Parks –
Free Day Access to all CA State Parks
Savings Weight Management Baby Books DVDs Emergency Kits
On the Phone: On the Web:
Member Services/Claims
866-218-6009
Pharmacy Info:
800-325-1404
Carrier Website:www.seechangehealth.com
Find a Provider:http://www.cigna.com/hcpdirectory
Contact Info