Your Enrollment
You are ultimately responsible for enrolling within the designated timeframe. Generally, any elections you make as a new hire will remain in effect through Dec. 31st of the current year. New Hires should enroll within 15 days from their date of hire. When your enrollment period ends, you may only make a change to your benefit elections during the year if you experience a qualified life event and report it through MyHR within 30 calendar days of a life event.
Open Enrollment is your annual opportunity to review all the benefits Assurant offers, think about your coverage over the last year, and update your selections to best support you and your family’s needs in the year ahead.
For detailed information, please visit How to Enroll.
Open Enrollment is your annual opportunity to review all the benefits Assurant offers, think about your coverage over the last year, and update your selections to best support you and your family’s needs in the year ahead.
For detailed information, please visit How to Enroll.
Your Responsibility
You are ultimately responsible for understanding how the plan works and your financial responsibility for all services. The Plan will not provide any reimbursement for non-covered services. You may be responsible for the total amount billed by your provider/laboratory for non-covered services, regardless of whether such services are performed by a network provider/laboratory or out-of-network provider/laboratory. You’re ultimately responsible for ensuring that the admission, services, and expenses have been pre-certified (if required) and network providers are using network laboratories/sites for your testing and treatment. You may also want to know the provider’s charges to calculate your out-of-pocket responsibility. Although member services can assist you with this information, the final maximum allowed amount for your claim will be based on the actual claim and coding submitted by the provider.
Understanding the below terms will help you make informed choices and maximize your Assurant benefits.Beneficiary
The person or people you choose to receive the money or benefits from your life insurance, health savings account, retirement plan, etc. in the event of your death, ensuring they go to the people who matter most to you.
Coinsurance
This is the percentage of the cost that you pay for covered health care and prescription drugs after you've met the deductible. Under the Purple plan, coinsurance would only apply to services that are subject to the deductible.
The percentage of costs for a covered service that you pay out of your pocket after you meet the deductible. Coinsurance varies by plan, but if you are enrolled in the Blue and Green Plans, you will pay 20% and Assurant will pay the remaining 80%. If you are enrolled in the Orange Plan, you will pay 10% and Assurant will pay the remaining 90%. If you are enrolled in the Purple Plan, you will pay 15% and Assurant will pay the remaining 85%.
| Under the PURPLE Plan option, you pay: In-network - 15% Out-of-network - N/A | Under the BLUE Plan option, you pay: In-network - 20% Out-of-network - 40% | Under the GREEN Plan option, you pay: In-network - 20% Out-of-network - 40% | Under the ORANGE Plan option, you pay: In-network - 10% Out-of-network - 30% |
Copay (copayment)
A set amount you pay out of your pocket for a covered health service. The Purple Plan includes copays.
| Purple (In-Network Only) | |
|---|---|
| Primary Care Physician (PCP) | $25 Copayment |
| Mental Health (outpatient/professional office visit) | $25 Copayment |
| Livehealth Online (including mental health visits) | $25 Copayment |
| Specialist | $45 Copayment |
| Urgent Care | $45 Copayment |
| Emergency Room | $300 Copayment |
Coverage Level
You can choose coverage for Employee-only, Employee & Spouse/Domestic Partner, Employee & Children, or Employee & Family.
Deductible
The amount you pay out of your pocket before the plan starts sharing expenses with you.
- Under the Purple Plan, the deductible applies only to certain services. It does not apply to preventive care, primary and specialist visits, emergency room and urgent care visits, or prescriptions.
- Under the Purple, Blue, and Green Plans, benefits subject to the deductible begin only after the entire family deductible is met.
- Embedded Deductible – In family plans with an embedded deductible, such as the Orange Plan, if someone in the family reaches the Individual deductible before the Family deductible is met, benefits for just that family member will begin.
| Purple | Blue | Green | Orange |
|---|---|---|---|
In-network deductible (individual/family)
Out-of-network deductible - N/A | In-network deductible (individual/family)
Out-of-network deductible (individual/family) | In-network deductible (individual/family)
Out-of-network deductible (individual/family) | In-network deductible (individual/family)
Out-of-network deductible (individual/family) |
Preventive care, prescription drugs, and benefits that are subject to a copay are not subject to the deductible. For all other services:
The individual deductible must be met before benefits begin for the individual.
The entire family deductible must be met before benefits begin for any covered family member. Any combination of you and/or one or more of your dependents can incur expenses to meet the family deductible. | Preventive care, and preventive prescriptions are not subject to the deductible. For all other services:
The individual deductible must be met before benefits begin for the individual.
The entire family deductible must be met before benefits begin for any covered family member. Any combination of you and/or one or more of your dependents can incur expenses to meet the family deductible. | Preventive care, and preventive prescriptions are not subject to the deductible. For all other services: The individual deductible must be met before benefits begin for the individual. The entire family deductible must be met before benefits begin for any covered family member. Any combination of you and/or one or more of your dependents can incur expenses to meet the family deductible. | Preventive care, and preventive prescriptions are not subject to the deductible. For all other services: The individual deductible must be met before benefits begin for the individual. Benefits begin for a family member once that family member satisfies the individual deductible. Benefits begin for the entire family once the entire family deductible is met. Any combination of you and/or one or more of your dependents can incur expenses to meet the family deductible. |
Dependent
You may enroll your eligible family members, including your spouse or domestic partner, children under age 26 (including stepchildren, legally adopted and foster children), and disabled children over age 26, in the Assurant benefits plans.
Evidence of Insurability
Evidence of Insurability or “proof of good health” may be required when enrolling in or changing your life insurance coverage.
Formulary
A list of prescription drugs covered by your health plan, organized into tiers with different costs.
GLP-1 Drugs
Medications that help lower blood sugar and support weight loss, often used to treat type 2 diabetes and, in some cases, for weight management.
Health Savings Account (HSA)
A personal savings account you can use to set aside pre-tax money to pay for eligible medical expenses now or in the future. If you enroll in the Green or Orange Plan, you can contribute to an HSA, and Assurant will also contribute to your account.
Imputed Income
If the value of a benefit you receive from Assurant exceeds $50,000 (such as Basic Life Insurance), the IRS considers the amount above $50,000 as taxable income.
In-Network
The health care administrators negotiate discounted rates for services with a network of doctors, dentists, specialists, hospitals, labs, facilities and pharmacies, which are typically lower than out-of-network providers and services. The Purple Plan only covers in-network services.
Out-of-Network
Doctors and other providers outside of the Plan’s network have not agreed to negotiated rates and your cost for care, deductible, coinsurance and annual out-of-pocket maximum will be higher.
Out-of-Pocket Maximum
The maximum amount you’ll pay for medical services in a calendar year before the Plan begins paying 100% of covered services.
- Embedded out-of-pocket maximum – In family plans with an embedded out-of-pocket maximum, including the Purple, Green and Orange Plans, the Family out-of-pocket maximum includes the Individual out-of-pocket maximum. If someone in the family reaches the Individual out-of-pocket maximum before the Family out-of-pocket maximum is met, covered benefits for just that family member will be paid at 100%.
| Purple | Blue | Green | Orange |
| The Blue Plan out-of-pocket maximums are (individual/family): In-network - $3,000/$6,000 Out-of-network - N/A | The Blue Plan out-of-pocket maximums are (individual/family): In-network - $3,450/$6,900 Out-of-network - $6,450/$12,900 | The Green Plan out-of-pocket maximums are (individual/family): In-network - $4,200/$8,400 Out-of-network - $7,200/$14,400 | The Orange Plan out-of-pocket maximums are (individual/family): In-network - $5,300/$10,600 Out-of-network - $9,200/$18,400 |
| Once the individual out-of-pocket maximum is reached by one family member, claims for that individual will be paid at 100%. Once the family’s combined expenses reach the family out-of-pocket maximum, claims will be paid at 100% for all covered family members’ eligible expenses for the remainder of the calendar year. | If you elect Family coverage under the Blue health plan, there is no individual out-of-pocket maximum. Claims will be paid at 100% by the Plan only when the family out-of-pocket maximum is met. Any combination of you and/or one or more of your dependents can incur expenses to meet the family out-of-pocket maximum. | Once the individual out-of-pocket maximum is reached by one family member, claims for that individual will be paid at 100%. Once the family’s combined expenses reach the family out-of-pocket maximum, claims will be paid at 100% for all covered family members’ eligible expenses for the remainder of the calendar year. | Once the individual out-of-pocket maximum is reached by one family member, claims for that individual will be paid at 100%. Once the family’s combined expenses reach the family out-of-pocket maximum, claims will be paid at 100% for all covered family members’ eligible expenses for the remainder of the calendar year. |
Per-Paycheck Contribution
This is the amount that is deducted from each of your paychecks for your benefits coverage. Under the Purple and Blue Plans, you pay a higher per paycheck contribution and a lower deductible as compared to the Green and Orange Plans. Under the Orange Plan, your per paycheck contribution is the lowest but with the highest deductible, as compared to the Purple, Blue and Green Plans.
Precertification
Certain medical services require precertification for you to receive benefits. To precertify, contact Anthem Blue Cross and Blue Shield at 1-855-285-4212. Note: If precertification is not required, it does not mean that a service will necessarily be covered. Please see the Summary Plan Description for a list of covered services and exclusions, and the Medical page to see the list of Services Requiring Precertification.
Premium
The amount deducted from your paycheck to pay for your benefits coverage.
Preventive Care
Preventive care generally includes annual physicals, check-ups, well child and well woman visits, and age-appropriate screenings and immunizations. Under the Assurant medical and dental plan options, there is no charge for preventive care when using in-network providers and it’s covered at 100%.
Resources