iRenewal Open Enrollment Meeting Presentation Template

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 Program

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

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

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

Smoking Cessation Programs

24/7 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

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

Fitness Reimbursement Program

Smoking Cessation24/7 Nurse Hotline

Savings 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