A : Click here for default coverage that you will receive if you don’t make an election before the applicable deadline.
Q : What if I’m hired late in the year?
A : Depending on your date of hire, your current benefits may or may not carry over to the following year and you may need to enroll for your new hire benefits and the next year’s benefits immediately afterward. Be on the lookout for emails indicating action you need to take at the appropriate times.
Q : I use tobacco products; how will that affect the rates I pay for my health plan coverage?
A : During the enrollment process, you'll be asked to certify whether you have used tobacco products within the last six months. Tobacco users will not be eligible to receive a separate Tobacco-Free Health Credit of $18.46 per paycheck for their health plan coverage and higher rates apply for supplemental life insurance.
Q : What if I am not a tobacco user enrolling for health plan coverage?
A : If you certify during the enrollment process that you have not used tobacco products within the last six months, you'll receive a separate Tobacco-Free Health Credit of $18.46 per paycheck for your health plan coverage. However, if you are a new hire and you do not actively complete your enrollment via MyHR during your enrollment period, you will default into the Orange health plan, Employee-only coverage level, and you will not receive the Tobacco-Free Health Credit.
Q : I am not a tobacco user, but my spouse/domestic partner is a tobacco user. Will I still qualify for the tobacco-free credit?
A : If you are not a tobacco user, you will enroll as a non-tobacco user and receive the credit, even if you cover your spouse/domestic partner.
Q : What happens if I waive health plan coverage?
A : If you have health coverage through another source (such as through your spouse's/domestic partner's employer), you can waive health plan coverage.
If you choose to waive health plan coverage, you must still make an election to waive coverag within eight days of your hire date for new hires, or you will be automatically enrolled in the Orange plan with Health Savings Account at the Employee-only coverage level and you will pay the non-discounted rate.
Q : When will I receive new insurance ID cards?
A : If you enroll in the health plan for the first time, you will receive a combined medical/prescription ID card from Anthem Blue Cross and Blue Shield in the mail within 30 days from the date your Benefit Elections Summary information is available in MyHR. While prescription benefits under the health plan are administered by CVS Caremark, you will only need to use your Anthem ID card for both medical and pharmacy benefits. You will not receive a separate ID card from CVS Caremark.
If you need to visit your doctor or use your pharmacy benefits before you receive your new ID card, you can print temporary ID card. To print your temporary ID card, first contact Anthem at 1-855-285-4212 to request your ID number. Then, using your ID number, visit Anthem.com to sign up and follow the steps to download a temporary ID card. Once logged in, click on the link to Your ID Card located on the home page.
To print your CVS Caremark temporary ID card, visit My Caremark at caremark.com to sign up for an online account and follow the steps to access your temporary ID card.
If you enroll in the Green or Orange plan and are eligible for an HSA, you will receive a Anthem debit card in the mail. To access your HSA funds:
- You can use your debit card to pay for eligible expenses such as prescriptions, deductibles and coinsurance as long as you have funds available in your account.
- Through Anthem's website anthem.com, you also can pay for your eligible out-of-pocket expenses directly from your online account. Contact Anthem at 1-855-285-4212 with any additional questions.
Q : What is Assurant's group number with Anthem?
A : The Anthem Blue Cross and Blue Shield group number is 003330108 and is listed on your ID card.
Q : What is Anthem Blue Cross and Blue Shield's customer service phone number for Assurant Health Plan participants?
A : The customer service phone number is 1-855-285-4212.
Q : Do I need a Dental ID card?
A : You don’t need an ID card with the MetLife Dental Plan. If you’d like to print one, you may do so on the MetLife website.
A : To compare costs for procedures, access this tool directly from Anthem’s website going forward. From the home page, click on “Care & Cost Finder.” Quality and prices for health care can be different depending on where you go and aren’t necessarily related to the quality of care you can expect to receive. The Care & Cost Finder can help you:
- Find and compare network doctors, medical services and prescription drugs in your area based on the price you’ll pay and quality of care other patients have received.
- Review personalized cost estimates that take into account your health plan and whether you’ve already met your deductible.
Your privacy is always protected. Assurant never has access to your individual information or activities on the Care & Cost Finder. When you know more about quality and price, you can make better purchasing decisions. Learn more at anthem.com.
Q : What is LiveHealth Online?
A : LiveHealth Online provides certain professional services online 24/7 for generally less money than the average doctor visit or trip to the emergency room. LiveHealth Online connects Assurant employees outside of work to board certified network doctors via live two-way video from your personal computer, tablet or mobile device. If you are enrolled in an Assurant health plan, any costs associated with your online visit will be applied toward your deductible and coinsurance. If you are not enrolled in an Assurant health plan, you can still utilize LiveHealth Online, but you will be responsible for the entire fee for the services provided. LiveHealth Online is made available to all Assurant employees and their dependents as a convenience. Questions should be addressed to LiveHealth Online directly at 1-855-603-7985.
To learn more, visit LiveHealthOnline.com.
A : This is the amount you must pay each year for covered health care and prescription drugs before the plan begins to share eligible health care costs with you. The exception is for eligible preventive care and preventive prescriptions, which are covered before you meet your deductible. The deductible varies depending on the plan you elect, and who you cover.
See The Assurant Health Plan for more information.
Q : What is the out-of-pocket maximum?
A : This is the most you will pay out of your pocket in a given calendar year for your deductible and coinsurance. When you reach the out-of-pocket maximum, the plan begins paying 100% for eligible covered expenses for the rest of the year.
Q : How do the deductible and out-of-pocket maximum work under the health plan?
A : Each year, you must meet your deductible by paying a set dollar amount (depending on the health plan and coverage level you are enrolled in) before the plan will begin to pay for eligible expenses. Assurant provides a standard contribution into your Health Reimbursement Account (HRA) or Health Savings Account (HSA) each year to help you and your family meet your deductible.
The Family Deductible and Family Out-of-pocket Maximum applies if you elect Family coverage, which means coverage for yourself and any of your eligible dependents (i.e. Employee & Spouse/Domestic Partner, Employee & Child(ren), or Employee & Family).
- If you elect Family coverage under the Blue or Green plan, there is no individual deductible. This means that the entire family deductible must be met before benefits begin for any covered family member (except for eligible preventive care services and preventive prescription drugs).
- If you elect Family coverage under the Orange plan, each family member has an individual deductible amount equal to the deductible for Employee-only coverage. Once a family member satisfies the individual deductible, the Plan will begin to pay coinsurance for that family member's eligible non-preventive expenses. The family member does not need to wait for the entire family deductible to be satisfied.
- Under the Blue, Green and Orange plan, once the family’s combined expenses reach the family deductible, the plan will begin to pay coinsurance for all covered family members’ eligible non-preventive expenses for the remainder of the calendar year.
If you elect Family coverage under the Blue, Green or Orange plan, eligible expenses for all covered family members can be combined to meet the family annual in-network Out-of-pocket Maximum. However, under the Orange and Green plan, an individual enrolled in Family coverage may also meet the individual in-network Out-of-pocket Maximum and covered eligible expenses for that individual will be paid at 100%.
Remember that the deductible does not apply to eligible preventive care services and preventive prescription drugs.
There are separate in- and out-of-network deductibles for all three plan options. If you are using providers outside of the Anthem Blue Cross and Blue Shield network, you’ll pay more for coverage, and be subject to a separate higher deductible. For all plan, there are separate deductible and out-of-pocket maximums for your in-network and out-of-network care. They do not cross-apply.
Q : What is coinsurance?
A : After your deductible is satisfied, you are responsible for paying a percentage of the costs for eligible expenses you have incurred; this is called coinsurance. If you enroll in the Blue or Green plan and use an in-network provider, you will pay 20% of the negotiated rate between Anthem and the provider. If you decide to use an out-of-network provider, you will pay 40% of the charges, plus any amounts the provider charges that Anthem determines to be over the Reasonable & Customary (R&C) amount.
If you enroll in the Orange plan option and you use an in-network provider, you will pay 10% of the negotiated rate between Anthem Blue Cross and Blue Shield and the provider. If you decide to use an out-of-network provider, you will pay 30% of the charges, plus any amounts the provider charges that Anthem determines to be over the Reasonable & Customary (R&C) amount up to the out-of-network deductible.
Q : Are the contribution rates different for part-time employees?
A : The health plan and dental plan contribution rates for part-time employees are higher than those for full-time employees. The standard contribution to the HSA or HRA is the same for all benefits-eligible employees. See the Rates tab for details.
Q : How can I estimate my expected out-of-pocket costs for network health care in my area?
A : Anthem Blue Cross and Blue Shield offers a Care & Cost Finder tool, accessible from Anthem.com to compare network doctors and medical services in your area based on the price you’ll pay and quality of care other patients have received. To check on costs for drugs, you can continue using the "Check Drug Cost & Coverage" tool on Caremark.com.
A : The Anthem Blue Cross and Blue Shield member website, Anthem.com, enables you to search for in-network providers in your area and does not require you to log in. The Anthem network for Assurant is based upon where you live, not where your doctor is located. Go to anthem.com and do not sign in. Select "Find a Doctor/Find Care" at the top of the Home Page. Search as a Guest and then select, Medical for type of care, enter your state, select Under Medical (Employer-Sponsored) for type of plan, then follow these steps to select the plan/network or just click on the network links below:
- If you live in the state of Florida, choose the NetworkBlue (Select Network).
- If you live in the state of Georgia, choose the Blue Open Access POS (Select Network).
- If you live in the greater Kansas City service area, choose the Preferred-Care Blue (KC) (Select Network).
- If you live in the state of Wisconsin, choose the Blue Preferred POS (Select Network).
- All other employees should choose National PPO (BlueCard PPO).
- Click Continue.
- Enter the City or Zip Code in which to search.
- Choose the type of provider you want (e.g., a doctor, hospital, lab) and location.
- Click Search.
* The greater Kansas City service area includes doctors and hospitals in 30 Missouri and two Kansas counties: Missouri: Andrew, Atchison, Bates, Benton, Buchanan, Caldwell, Carroll, Cass, Clay, Clinton, Daviess, Dekalb, Gentry, Grundy, Harrison, Henry, Holt, Jackson, Johnson, Lafayette, Livingston, Mercer, Nodaway, Pettis, Platte, Ray, Saline, St. Clair, Vernon, and Worth; Kansas: Johnson and Wyandotte.
Q : How do I find a network doctor if I don't have access to a computer?
A : You can call Anthem Blue Cross and Blue Shield member services at 1-855-285-4212 for assistance. Also, some Assurant locations have computer kiosks you can use.
Q : What are the provisions for emergency care when received out-of-network?
A : Emergency room and ambulance charges are subject to your plan's deductible and coinsurance. If you receive care in an emergency room in a true emergency, the in-network coinsurance will apply after the deductible, regardless of whether you use an in-network or out-of-network provider. If you receive care in an emergency room in a non-emergency situation your coinsurance will be 50% under all three health plan options. The 50% out-of-pocket expense you incur will not count toward your out-of-pocket maximum.
For the definition of an emergency condition and common examples, please see the Assurant Health & Welfare Benefit Plan Summary Plan Description (SPD).
Q : I don’t see my doctor or hospital listed in the Anthem Blue Cross and Blue Shield network. What should I do?
A : Anthem’s network includes thousands of physicians and hospitals; unfortunately, not every provider will be in the network. Keep in mind that you always have a choice in the doctor or hospital you use. If you are unable to confirm your provider's participation in the Anthem Blue Cross and Blue Shield network, call Anthem Blue Cross and Blue Shield at 1-855-285-4212.
Q : What if my doctor is out-of-network?
A : If your doctors don't participate in the Anthem Blue Cross and Blue Shield network and you don't want to change providers, you still have coverage available to you. If you are enrolled in the Blue or Green plan and decide to use an out-of-network provider, you will pay 40% of the charges, plus any amounts the provider charges that Anthem determines to be over the Reasonable & Customary (R&C) amount up to a separate out-of-network deductible. If you are enrolled in the Orange plan and decide to use an out-of-network provider, you will pay 30% of the charges, plus any amounts the provider charges that Anthem determines to be over the Reasonable & Customary (R&C) amount up to a separate out-of-network deductible. You have separate deductible and out-of-pocket maximums for your in-network and out-of-network utilization.
A : In general, preventive care focuses on disease prevention and health maintenance. It includes the early diagnosis of disease, the discovery and identification of people at risk for development of specific problems, counseling, and other necessary intervention to avert a health problem. Screening tests, health education and immunization programs are common examples of preventive care.
Whether you elect coverage under the Blue, Green or Orange plan, you are eligible for the same preventive services.
Q : How do I make sure that my preventive medical service claim is paid as a preventive service under the health plan?
A : When you receive preventive medical services from an in-network provider, your provider should not bill you for these services. Sometimes, however, your doctor's office may incorrectly code your claim as non-preventive.
At the time of your preventive care visit, it's a good idea to remind the doctor's office staff to code the preventive care you receive as preventive services. If you are billed incorrectly for this visit, you should call your provider's office to ask them to re-code your claim as preventive care services and resubmit it to Anthem Blue Cross and Blue Shield. The doctor's office is responsible for any claim code corrections. Anthem Blue Cross and Blue Shield is not permitted to change these codes.
Visits to your doctor for treatment of a specific illness or condition are not considered preventive care and will not be covered at 100% through the health plan, even if received from an in-network provider.
Q : Do I need to satisfy my deductible before coverage for in-network preventive care begins?
A : No. Eligible in-network preventive services are covered at 100%. You do not have to satisfy your deductible before taking advantage of these benefits.
Q : How will the health plan pay benefits if I receive preventive medical services from an out-of-network provider?
A : If you choose to visit an out-of-network provider, the preventive visit will be subject to the separate out-of-network deductible and coinsurance. In addition, out-of-network doctors may charge more than Reasonable and Customary (R&C) charges, and you will be responsible for any charges that are above the R&C amount.
Q : How are preventive medications covered under the health plan?
A : Preventive medications are not subject to the deductible. Eligible generic preventive medications will continue to be covered at no cost to you, and eligible brand preventive medications will continue to be covered before you meet your deductible. View the Resources page for a list of eligible preventive medications.
Q : How does Assurant develop its preventive services and medications lists?
A : In developing the preventive services list, Assurant is using the available information provided by the Department of Health and Human Services under Health Care Reform, continuously updating as the law requires.
For preventive drugs, the Internal Revenue Service has not determined which classes of medications it considers preventive. Major insurance carriers and Pharmacy Benefit Managers such as CVS Caremark have stepped in to fill this void by developing their own lists.
Assurant’s Preventive Drug List includes medications that CVS Caremark consider preventive.
A : When you enroll in the Blue plan, it is comes with an HRA – you do not need to enroll separately for the HRA. An HRA is an IRS-sanctioned arrangement that allows an employer to reimburse for medical and prescription expenses incurred by participating employees. HRAs reimburse only those items (coinsurance and deductibles) that are not covered by an employer's the Health Plan. Reimbursements are tax-free.
Q : How is an HRA funded?
A : The HRA includes the standard contribution from Assurant to help pay for your deductible and coinsurance. At the start of each plan year, if you are enrolled in the Blue plan, your HRA will be credited with $200 for Employee-only coverage or $400 for Family coverage. Family coverage includes Employee and Spouse/Domestic Partner and/or any number of children.
Only Assurant is allowed to contribute to your HRA.
Q : How does the HRA pay for medical expenses?
A : As you incur eligible expenses, Anthem Blue Cross and Blue Shield automatically will apply the balance in your HRA to help meet your deductible or coinsurance until your account is exhausted. Any remaining balance not used during the calendar year is rolled over for use in the next calendar year.
Remember, preventive services and medications that are paid at 100% do not reduce your HRA balance.
Q : How does the HRA pay for my prescriptions?
A : When you purchase prescriptions at a participating pharmacy or through the CVS Caremark Mail-Order Service, your prescription costs automatically will be deducted from the available funds in your HRA at the point of service. This means that if you have enough funds in your HRA to cover your prescription costs, you will not have to pay anything out-of-pocket at the pharmacy. Generally, these amounts will be applied against your HRA balance on the same day.
Q : Do I keep my HRA if I waive coverage, terminate employment, or switch to the Green or Orange plan?
A : No. The HRA is not transferable. This account only is available if you are enrolled in the Blue Plan. You cannot transfer your HRA to an individual account like you can with the Health Savings Account (HSA).
Q : What happens to my account balance if I leave Assurant?
A : If you leave Assurant, you may continue to use any remaining balance under COBRA if you choose to continue your health plan coverage after you leave.
Q : May I still participate in the Health Care Flexible Spending Account (FSA) with an HRA?
A : Yes. If you enroll in the Blue Plan or if you waive Health Plan coverage, you can participate in what's called a "General Purpose" FSA. A General Purpose FSA is one that covers most eligible out-of-pocket health care expenses including medical, prescription, dental and vision expenses.
A : If you enroll in the Green or Orange plan, which are high-deductible health plans, an HSA will be set up for you automatically, and the company contribution will be deposited directly into your HSA. You also will have the option to contribute to the Health Savings Account (HSA) through payroll deductions. The HSA can help pay for your qualified out-of-pocket health care expenses during the year. Since unused balances roll over from one year to the next, it also is a great way to save for future health care expenses. If you are not eligible to have an HSA because you are enrolled in Medicare or other health plan coverage that is not a high deductible health lan, contact HR Services. The company contribution will be paid to you in cash as taxable income.
Q : How can I contribute to an HSA?
A : You can elect to have funds deducted from your paycheck to be deposited into your HSA. The contribution should be in your HSA within two to three business days after payday.
- There are two ways that you can make contributions to the account. The simplest way is to have your contributions deducted on a pre-tax basis through payroll deductions. You can make this election upon enrollment in the Green or Orange plan, or you can go into MyHR at any time during the year to make your election. Alternatively, you may make contributions via check(s)/electronic funds transfer (EFT).
- If you contribute to an HSA by check or EFT, you can claim your contribution as a deduction when you file your income taxes. Assurant will not take deductions for HSAs held at institutions other than Anthem.
- If the contributions you make through payroll deductions are less than the maximum allowable annual contribution, you may choose to send in additional contributions by check to make up the difference at some point during the year.
A : Assurant will deposit $200 for Employee-only coverage and $400 for Family coverage into the HSA two business days after your first paycheck of the year or the paycheck that follows your initial enrollment period.
Q : How do I access the funds in my HSA?
A : There are two ways to access your funds to pay for your qualified health care expenses. You can access your HSA funds through a debit card or you can set up online payments.
- You will receive a new debit card from Anthem along with important account information.
- You can pay for your qualified expenses through the online bill pay system at anthem.com.
Q : Can I change my contribution amount or stop payroll deductions for my HSA?
A : Yes. You can start, stop, or change your HSA contribution amount at any time, for any reason. Your changes will be implemented as soon as it is practicable. To make changes to your HSA contributions, visit MyHR through Connect.
Q : May I still participate in the Health Care Flexible Spending Account (FSA) with an HSA?
A : Yes, If you enroll in the Green or Orange plan, you can participate in what's called a "Limited Purpose" FSA - one that only covers dental, LASIK surgery and vision hardware expenses. Out-of-pocket medical and prescription drug expenses are not eligible for reimbursement through the Limited Purpose FSA. These expenses can be paid from your Health Savings Account.
Q : What happens to my account balance if I leave Assurant?
A : The Health Savings Account (HSA) is portable (you can take it with you) after termination or retirement from Assurant. You will become responsible for all fees associated with your HSA after leaving Assurant.
Q : If I switch from the Blue plan to the Green or the Orange, will any funds remaining in my HRA transfer to my HSA next year?
A : Once you stop participating in the Blue plan, any funds remaining in the HRA will be forfeited unless you have claims to be submitted that were incurred while you or your dependents were covered under the Blue Plan option — they will not transfer to your HSA.
Q : If I switch from the Green or the Orange plan to the Blue plan, will any funds remaining in my HSA transfer to my HRA next year?
A : Once you stop participating in a Green or Orange plan, you keep any funds remaining in your HSA and become responsible for paying any maintenance fees associated with the account. The funds will not transfer to your HRA; however you may continue to use the money in your HSA to pay for your eligible out-of-pocket health care expenses. You will no longer be able to contribute to your HSA while not enrolled in a qualified high deductible health plan such as the Green or Orange plan.
Q : Where can I check my HSA balance?
A : You can easily view your balance on Anthem's member website Anthem.com.
Q : How do I know what expenses are eligible for reimbursement from my HSA?
A : For a list of expenses that are eligible for reimbursement through your HSA, you can refer to the Assurant Health and Welfare Benefit Plan Summary Plan Description, or visit irs.gov and click on Forms and Publications, Publication 502. The penalty for using your Health Savings Account funds for non-qualified medical or prescription expenses is a 20% excise tax (income tax penalty).
Q : Can I use my HSA to pay for expenses before the money is in my account?
A : You only can use your HSA when you have money available in the account. You cannot draw against future deposits. If you need to pay for your health care expenses and you don't have enough money in your HSA, you can pay with a personal credit card or a personal check, then reimburse yourself later for these expenses, once funds are available.
Q : I am turning 65 next year and will be eligible for Medicare. Am I still eligible for an HSA?
A : No. If you are covered under any other plan that is not a high deductible health plan such as Medicare or Tricare, you are not eligible to contribute or receive employer contributions to an HSA. However, you can still use the funds in your HSA to pay for your qualified health care expenses. You should contact HR Services for details on tax consequences relating to an HSA when you have other coverage.
Q : Are my dependents eligible for an HSA?
A : You only can use the HSA for medical expenses for qualified tax dependents as defined by the IRS.
If you cover a dependent who does not qualify as a tax dependent (such as an adult child or a domestic partner), you cannot use your HSA to pay for his or her expenses. These dependents may set up their own HSA and may contribute up to the maximum amount allowable by IRS for family coverage. To set up an account, your dependent can call Anthem BlueCross BlueShield customer service at 1-855-285-4212.
Q : What is the Customer Identification Process (CIP) and who should I contact if I have issues?
A : The CIP is a federally required identification process used to confirm an individual's eligibility for a Health Savings Account.
You may fail the CIP because your personal information, (i.e., SSN, date of birth, name or address) submitted by Assurant to Anthem may not reflect the most current information on file for you (e.g., you recently moved).
If you are eligible for an HSA, but you failed the CIP, it is important to respond directly to Anthem and provide the necessary documentation as soon as feasible to ensure that an HSA can be opened for you.
Q : Who do I contact if I need a new HSA card?
A : Contact Anthem member services at 1-855-285-4212. If your card is lost or stolen, you must contact Anthem immediately.
Q : I have another Health Savings Account and would like to merge my accounts together. What is the process?
A : Contact Anthem member services at 1-855-285-4212.
A : If you're enrolling in an Assurant health plan for the first time, you will receive a combined medical/prescription ID card from Anthem Blue Cross and Blue Shield in the mail within 30 days from the date your Benefit Elections Summary information is available in MyHR. While prescription benefits under the health plan are administered by CVS Caremark, you will only need to use your Anthem ID card for both medical and pharmacy benefits. You will not receive a separate ID card from CVS Caremark.
If you need to visit your doctor or use your pharmacy benefits before you receive your new ID card, you can print a temporary ID card. To print your temporary ID card, first contact Anthem at 1-855-285-4212 to request your ID number. Then, using your ID number, visit Anthem.com to sign up and follow the steps to download a temporary ID card. Once logged in, click on the link to Your ID Card located on the home page.
medical/prescription ID card from Anthem.
Q : Which medications are considered preventive?
A : For the list of medications that are considered preventive by the health plan, see the Resources page. For exact terms, conditions, limitations and exclusions please refer to the Assurant Health & Welfare Benefit Plan Summary Plan Description (SPD).
Certain new drugs including compound prescription medications costing $300 or more will require prior authorization from CVS Caremark to confirm medical necessity and ensure only the most clinically appropriate medications are covered. You still will be able to receive the medications you need, as long as CVS Caremark confirms their medical necessity before you buy them.
Caremark reviews their formulary quarterly. Certain formulary medications may be excluded from coverage from time to time and impacted family members will be notified.
Q : Must I first meet my deductible before the plan will begin to pay 50% of my prescription drug costs?
A : For non-preventive prescriptions, you will first need to meet your deductible before the Plan will begin to pay benefits, regardless of which Plan option you choose.
The deductible does not apply to preventive drugs and Assurant provides 100% coverage for generic preventive medications.
Q : What is Dispense As Written (DAW)?
A : When a prescribed brand name drug has a generic equivalent, you will receive the generic equivalent unless your physician specifies Dispense as Written or DAW on the prescription. If the physician does not specify DAW and you elect to receive the brand name drug, you will pay your share of the cost plus the difference in price between the brand name and the generic drug.
Q : Each of the health plan reimburses non-preventive prescription drugs at 50%, up to the maximum per prescription. What does "up to the maximum per prescription" mean?
A : For example, the maximum amount that you will have to pay (after the deductible, if applicable) for a 30-day supply of a non-preventive, preferred brand prescription medication is $75. If a 30-day supply of this medication costs $200, you will pay $75 (50%of $100, capped at $75) and the plan pays $125.
Q : What is the maximum I will pay in prescriptions in any plan year?
A : The out-of-pocket maximum for your health plan option (Blue, Green or Orange) is for your medical and prescription drug costs combined. Once you reach your out-of-pocket maximum, the plan pays 100% for your eligible prescriptions and other covered medical expenses for the balance of the calendar year.
Q : Are there any prescriptions that are not covered?
A : Information regarding prescription drug exclusions and limitations can be found in the Assurant Health & Welfare Benefit Plan Summary Plan Description. For the list of medications that will require prior authorization to be dispensed, review the list of Medications Requiring Prior Authorization on the Resources page.
Q : How do I pay for my prescriptions with my HSA?
A : There are two convenient ways you can pay for your prescription costs using your HSA:
1. You can use your HSA debit card at the point of service, or when filling out the mail-order form.
2. You can pay using personal funds (via cash, check or a personal credit card) and then , if you choose, you may reimburse yourself using funds from your HSA. To reimburse yourself, you may use the convenient online bill pay system to transfer funds from your HSA directly into your personal bank account.
Q : How do I order prescriptions using the Mail-Order service?
A : To use the CVS Caremark Mail Order service you will need to complete a Mail-Service Order Form and send it to CVS Caremark at the address specified on the form, along with your original prescription(s) and the appropriate payment for each prescription. The mail order form is available here.
Q : What is the difference between the three tiers of prescription drug coverage?
A : All three health plans include three tiers of prescription coverage: generic, preferred and non-preferred, based on what drugs you need.
By using generic or preferred medicines, you can help make sure you get better value based on your plan and individual needs. Visit caremark.com and click on the Covered Drug List (Formulary) under the Plan and Benefits tab to review your preferred drug list. There you will find a Performance Drug List for non-specialty medications, and an Advanced Control Specialty Formulary for specialty medications. Here are definitions of each of the three tiers:
Tier 1: Generic - generic drugs must have the same active ingredients as the original brand name drug.These are listed on the CVS formulary/covered drug list in lower case italics.
Tier 2: Preferred brand - brand name drugs listed on the CVS formulary/covered drug list.
Tier 3: Non-preferred brand - brand name drugs not listed on the CVS formulary/covered drug list.
A : A prior authorization is a process used to determine the medical necessity, appropriateness and efficiency of certain health care services, or to assess the safety and effectiveness of certain medications. Services that may require prior authorization may be surgical services, items of durable medical equipment, drugs, etc. It is sometimes referred to as pre-authorization or pre-certification. To see some examples of services that may require prior authorization, review the Assurant Health & Welfare Benefit Plans Summary Plan Description (SPD).
Q : What is my role in obtaining prior authorization for medical services?
A : All covered services and medications requiring prior authorization may be handled by your treating or referring physician, whether he or she is in-network or out-of-network. Ultimately, it is your responsibility to ensure prior authorization has been completed and approved with Anthem Blue Cross and Blue Shield and CVS Caremark, whenever prior authorization is required, before receiving care. If a medical service subject to prior authorization is not approved, coverage may be denied. Once medical information is received, a denied claim can be reopened and re-evaluated. Any services or hospitalization days found not to be medically necessary will not be covered. The phone numbers to call for prior authorization are located on the back of your ID card.
Q : What is covered under the vision plan?
A : Anthem has chosen to partner with EyeMed Vision Care to provide quality eye care services. EyeMed offers more choices and better quality in eyewear and eye care. The vision plan (Anthem’s Blue View Vision Insight Plan) gives you benefits for eye exams, prescription glasses and contacts. Click here for additional information.
Q : Can I enroll in the vision plan if I waive coverage in the health plan?
A : Yes, you can elect vision coverage even if you waive health plan coverage.
Q: If I am enrolled in both the vision and health plans, will I receive a separate ID card for each coverage?
A : You will only receive one Anthem ID card, no matter if you are enrolled in both the vision and health plans or just one. Dependent(s) will receive their own ID card with their name on it and the coverage you selected for them, but the card will have the same ID number as yours.
Q : How do I find a provider under the Blue View Vision Insight Plan?
A : You’ll save money by visiting in-network providers. To find a network provider near you, visit Anthem.com. You don’t have to sign in.
- Select “Find a Doctor/Find Care” from the home page.
- Select “Guest” to browse the network directory.
- Select “Vision” as the type of care you’re searching for.
- Select the State you wish to search in.
- Select “Vision” as the type of plan.
- Select the “Blue View Vision Insight”’ as the plan/network.
Q : If I don’t enroll in the vision plan, do I still have access to the preventive vision exam under the health plan?
A : Yes, a preventive vision exam is covered at 100% under the health plan and the deductible will not apply if you use an Anthem in-network provider. You can find a list of participating vision providers on anthem.com or call Anthem at 1-855-285-4212 for assistance.
Q : What are the eye care discounts I am eligible to receive as a health plan participant?
A : For new frames, lenses or contacts, Anthem members have access to discounts through thousands of providers nationwide including Target, LensCrafters and 1-800-CONTACTS. Just log in at anthem.com, and under the “Care” tab at the top of the home page, select Discounts, then use the “Refine Results” tab to select “Vision, Hearing & Dental".
- You can also visit eyewearspecialoffers.com to search for participating eyewear providers near you.
- Provide your Anthem ID card at the time you receive services to receive the discount.
For Lasik Surgery, you can receive discounts through the Premier Lasik Network and TruVision.
- Visit https://www.lasikplus.com/promotion or call 1-866-921-2125 to learn more about available discounts and participating providers.
- For more information on TruVision discounts and participating providers, visit truvision.com or call 1-877-575-2020.
- Identify yourself as an Anthem Blue Cross and Blue Shield member and provide your Social Security Number when you make your appointment.
Assurant employees also have access to discounts on eye exams and eyewear through MetLife's VisionAccess Program. For more information or to find a participating provider, visit www.metlife.com/mybenefits or call 1-888-GET-MET8. Provide your program code, MET2020, when making an appointment or receiving services or materials.
Q. What are Pregnancy Leave benefits?
A. If you go out on Short-Term Disability due to pregnancy, you can receive up to eight weeks of pay at 100% under the Short-Term Disability benefit (typically six weeks for the birth of a child, though up to eight weeks may be approved based on medical necessity).
Q. Who is eligible for Pregnancy Leave benefits?
A. Enhanced Pregnancy Leave benefits are provided under Assurant’s Short-Term Disability (STD) plan. You must be employed by Assurant for at least 90 calendar days and be a benefits-eligible employee for STD coverage to be effective. Your coverage is effective on the 91st day. If you go out on leave prior to the 91st day, you will not be eligible for any benefits under the STD plan.
You’re automatically enrolled for STD coverage when you’re eligible. If you’re not actively at work on the day STD would otherwise be effective, coverage will not take effect until you return to active work.
Q. What happens if I have complications and I can’t return to work after the Pregnancy Leave period ends?
A. If you are unable to return to work following your Pregnancy Leave period (typically six weeks for the birth of a child, though up to eight weeks may be approved based on medical necessity), additional Short-Term Disability benefits may be available to you at a lower benefit percentage, based on your medical condition. You will need to contact your case manager to discuss next steps and will also need to work with your treating provider to ensure that appropriate medical information is sent to your case manager. Your case manager will need ongoing medical proof that you continue to be unable to perform the duties of your job due to your own medical condition, beyond the 8-week pregnancy leave.
Q. May I use PTO while I’m on Pregnancy Leave?
A. You may use your available PTO to get paid during the Short-Term Disability plan’s one-week qualifying period.
Q. Does my Pregnancy Leave run at the same time as another type of leave?
A. If you are eligible for FMLA, any Pregnancy Leave and STD Leave will be taken concurrently with FMLA leave.
Q. How do I request Pregnancy Leave?
A. To request Pregnancy Leave, contact Lincoln Financial, Assurant’s disability and leave administrator, by phone at 1-800-213-1939 or online at MyLincolnPortal.com.
Q. What are Paid Parental Leave benefits?
A. If you are new parent, whether due to birth, adoption or surrogacy, you are eligible to take four weeks of 100% Paid Parental Leave to bond with your new child.
Q. Who is eligible for Paid Parental Leave benefits?
A. Paid Parental Leave benefits are provided to all benefits-eligible employees who become new parents due to birth, adoption or surrogacy after at least 90 calendar days of employment with Assurant. For Paid Parental Leave, an eligible parent is defined as an employee:
- Who gives birth to a child
- Whose spouse or partner has given birth to a child
- Who adopts a child who is under the age of 18. Paid Parental leave benefits are not available in circumstances in which a child is not newly matched for adoption (e.g., when a stepparent is adopting a partner's child)
- Who has a child placed in their home in cases of surrogacy, when the employee is the intended parent
The date of the birth, adoption or surrogacy must occur after the 90th day of employment. If the date of the event is prior to the 91st day, you will not be eligible for any benefits under the Paid Parental Leave benefit.
Q. Are foster parents eligible for Paid Parental Leave benefits?
A. No. Due to the nature and potential frequent transitions of foster parenting, foster parents are not eligible for Paid Parental Leave benefits. Foster parents can apply for Family and Medical Leave (FMLA) to care for a child after placement for foster care, but they are not eligible for Paid Parental Leave benefits and would need to use vacation, personal, or accrued compensatory time to be paid during an FMLA Leave.
Q. Do I have to take my Paid Parental Leave all at once?
A. You can take the time off in four consecutive weeks, or split the time and use it in two, 2-week increments. If taken in 2-week increments, any unused time from the 1st period cannot roll over to the 2nd period, and any time remaining after the 2nd period will be forfeited.
Q. When can I take my Paid Parental Leave?
A. You can take the time off within the six-month period that starts on the day your child is born or placed with you through adoption or surrogacy. You must start your leave within this six-month period. No increments of leave will be approved that begins after the six-month period ends. This means that if you begin your leave on the last day of the six-month period, you must take it in full, you cannot begin a 2nd increment after the six-month period has ended.
Employees may use Paid Parental Leave benefits once every rolling 12-month window.
Q. If both parents work for Assurant, can we both take Paid Parental Leave?
A. Yes, as long as the leave is taken within six-months from the date of the birth or placement of the child.
Q. Does the birth, adoption, or surrogacy of multiples (e.g., twins, triplets) increase the length of Paid Parental Leave granted for that event?
Q: Can I cash out my Paid Parental Leave benefit if I don’t wish to use it?
A. No. Paid Parental Leave benefits cannot be cashed out.
Q. Does my Paid Parental Leave run at the same time as another type of leave?
A. Yes. If you are eligible for FMLA or state parental leave, your Paid Parental Leave will run concurrently with those leaves.
Q. How do I request Paid Parental Leave?
A. To request Paid Parental Leave, contact Lincoln Financial, Assurant’s disability and leave administrator, by phone at 1-800-213-1939 or online at MyLincolnPortal.com.
Q. What are Adoption Assistance benefits?
A. Assurant provides financial assistance of up to $6,000 per adopted child for qualifying adoptions. Eligible employees may be reimbursed for eligible out-of-pocket costs up to the maximum.
Q. Who is eligible for Parental Adoption Assistance benefits?
A. Adoption Assistance benefits are provided to all benefits-eligible employees who become new parents due to adoption after at least 90 calendar days of employment with Assurant.
Benefits will be provided to employees who adopt a child or children who are under the age of 18. Adoption Assistance benefits are not available in circumstances in which a child is not newly matched for adoption (e.g., when a stepparent is adopting a partner's child).
Q. I adopted my step-child. Am I eligible for the adoption benefit?
A. No. Benefits are not available in circumstances in which a child is not newly matched for adoption.
Q. My spouse/partner and I both work for Assurant. Are we both eligible to receive the Adoption Assistance benefit?
A. No. The Adoption Assistance benefit provides up to $6,000 per child, and only one Assurant employee can submit expenses per child adopted.
Q. I went through the process, but the adoption fell through at the end. Can I submit my expenses?
A. No. The adoption must be finalized in order to be eligible for any reimbursement.
Q. How long do I have to request a reimbursement for adoption-related expenses?
A. You must submit your request for reimbursement within 90 days from the date the adoption is finalized.
Q. How do I request reimbursement under the Adoption Assistance benefit?
A. Submit your request for reimbursement under the Adoption Assistance benefit in MyHR. Your reimbursement will be paid to you through Assurant Payroll within one to two pay periods of receipt of your complete and approved request.
Q: What is back-up care?
A: Assurant has teamed up with Bright Horizons to provide back-up care for when you’re in a bind. You do not need to be enrolled in an Assurant health plan to take advantage of back-up care. We’ll subsidize up to seven days per year for care of your dependent children or dependent adults for which you provide assistance (such as a parent, in-law or grandparent) through Bright Horizons’ national network of qualified facilities and caregivers.
Q: What type of back-up care is available?
A: Care in high-quality centers for well children, screened in-home caregivers for well or mildly ill children, and in-home adult and elder care is available. Care recipients may include infants, toddlers, preschoolers, school-age children, teens, and adult and elderly family members.
Q: Who is considered an adult or elder relative?
A: Any adult or elder relative for whom you have care responsibilities is covered. This could be a parent, grandparent, spouse or domestic partner, in-law, adult child, etc.
Q: What is the age limit for care recipients?
A: For center care, age limits will vary by location. Most centers can serve children from six weeks to six years of age; some serve children through age 12. For in-home care, there is no age limit.
Q: Where is back-up care available?
A: The benefit gives you access to a nationwide network of high-quality, licensed child care centers, including hundreds of accredited Bright Horizons child care centers across the United States. Chances are high that there are options near your home and your work site. In addition, Bright Horizons has partnerships with 650 in-home care agencies that employ a total of nearly 200,000 experienced caregivers who travel up to 35 miles to provide care in your home or the home of your relative. Care options depend on the availability of these network providers in your area. While care is not guaranteed, Bright Horizons will make every effort to accommodate your reservation request.
Q: I do not see a local provider on the Bright Horizons Back-Up Care website. What should I do?
A: Call the Bright Horizons Contact Center at 1-877-BH-CARES (242-2737) to determine if there are contracted providers in your local area. The contact center has the most up-to-date information on our contracted network, and they will try to help you find options that will suit your care requirements.
Q: What constitutes a “use” when back-up care services are provided?
A: Each use of care for each child or adult is one use regardless of the hours used (or number of times in and out during that same day) up to a maximum of one day.
Q: How much does it cost?
A: Assurant will subsidize up to seven days per year of care. Back-up care is available at the following co-payment cost to an employee:
- Center-based child care: $15 per child per day or $25 per family per day.
- In-home child or adult/elder care: $6 per hour (a four-hour minimum is required for in-home care.)
Q: How do I pay for back-up care services?
A: Payment for back-up care services is through your personal credit card or EFT from your checking account and can be arranged through the Bright Horizons Back-Up Care program website.
Q: How are caregivers screened?
A: Only providers who meet Bright Horizons’ stringent standards are invited into the caregiver network. Providers are required to be in compliance with state licensing, meet accreditation standards and complete thorough background checks during the screening process.
Q: When should I register for Back-Up Care?
A: A one-time registration to the program is necessary, therefore you are highly encouraged to register at http://backup.brighthorizons.com prior to utilizing the program. Once registered, services may be arranged online or by calling Bright Horizons Back-Up Care at 1-877-BH-CARES (242-2737).
A : Some people have coverage under more than one group medical plan. Coordination of benefits provisions determine which plan is the primary carrier – the one that must pay benefits first. Please see the Assurant Health & Welfare Benefit Plans Summary Plan Description (SPD) for a summary of these rules.
Q : How is Durable Medical Equipment covered?
A : Durable Medical Equipment is subject to the deductible and coinsurance for the health plan you elect. If your provider recommends Durable Medical Equipment that will cost $5,000 or more to rent or purchase, you must first contact Anthem BlueCross BlueShield to pre-certify or the expense will not be covered by the health plan. For examples of covered Durable Medical Equipment, please see the Assurant Health & Welfare Benefit Plans Summary Plan Description (SPD).
Q : If a medical procedure is not a covered expense under the health plan, will the cost be applied toward my deductible and out-of-pocket maximum?
A : No, the cost of a medical procedure that is not covered under the plan does not count toward the deductible or the out-of-pocket maximum.
Q : If you go to the doctor for a routine preventive service and the doctor requires you to come back every quarter for an appointment and blood work, will these additional services be considered preventive?
A : No. If as a result of a routine preventive service, a medical condition is suspected or identified, any further exams and tests for the disease will be considered diagnostic and will be subject to deductible and coinsurance.
For more information on covered preventive services, please refer to the Resources page.
Q : If you are pregnant, do you have to pay the doctor's office visit each time you visit the OB/GYN?
A : It depends. Some providers use a global fee, where all the doctor office visits are charged at the time of delivery. However, other providers might bill per visit. It is important for you to check with your treating provider regarding how they bill for all services related to a pregnancy, (i.e., doctor visits, blood work, ultra sounds, etc.). Remember that you are responsible for your deductible and coinsurance. Contact Anthem Blue Cross and Blue Shield Member Services at 1-855-285-4212 for detailed information.
A : You can contact the Assurant Help Desk at 1-800-554-6386 if you experience any technical issues with MyAssurantBenefits.com or submit a service ticket via the MyIT link on Connect.