Coverage Period:
Aug 1, 2022 to July 31, 2023

Group Number:
905467

Plan Number:
V1012

Customer Service:
800-638-2130

Provider Locator:
800-839-3242

Website:
UnitedHealthcare.com

Vision Care Flyer
Certificate of Coverage
Summary of Benefits

Which Eyewear is Best for Me
Vision Wellness

Get the App!

Get your health info, wherever you go

When you’re out and about, the UnitedHealthcare app puts your health at your fingertips. Download it today to get instant access to your health plan details.

Find care

• Find network care options for doctors, clinics and hospitals in your area.
• Talk to a doctor by video 24/7.
• See reviews and ratings for doctors.

Manage your health plan details

• Generate and share digital health plan ID cards.
• View claims and account balances.
• Manage prescription drugs and refills.

Stay on top of costs

• Estimate the costs of common procedures.
• View your copay, annual deductible and out-of-pocket expenses.
• View your Health Reimbursement Account, Flexible Spending Account or Health Savings Account, if applicable.

Viewing Your Account Settings.

Coverage Period:
Aug 1, 2022 to July 31, 2023

Contact:
800-859-2144
Monday-Friday
7:00 a.m. to 8:00 p.m. (Central Time)

Fax:
866-231-0214
eMail:
[email protected]

Website:
Further.com

An HSA is a personal savings account that can help you build a nest egg for future healthcare expenses. When you need healthcare in the future you can use the account to pay for qualified healthcare expenses, even once you have retired. You do not pay taxes on your contributions, earnings or withdrawals, if you use the account for qualified expenses. Any unused money in your account at the end of the year remains yours to use on eligible medical expenses in the future.

HSA Summary
Essential Guide
Contribution Form
Authorization for Direct Deposit

Eligible Expenses
Health Savings Account Calculator
Learning Site

Further’s mobile app moves with you

Life is about living – not putting life on pause. The Further mobile app is in your pocket ready for the moment you need it.

Coverage Period:
Aug 1, 2022 to July 31, 2023

Contact:
888-722-1850

Claims may be faxed to:
866-329-3539

Website:
ProBenefits.com

The Flexible Spending Account Plan through ProBenefits allows employee contributions up to $5,000 to an employee’s dependent care account and $1,500 to an employee’s medical spending account for each plan year, August through July.

Enrollment Guide – FSA Overview
Enrollment Form
Claim Form

Download our mobile app

Our app makes it easy to submit claims, check balances and more.

Coverage Period:
Aug 1, 2022 to July 31, 2023

Group Number:
905467

Plan Number:
P7345/U90

Contact:
800-445-9090

Website:
UnitedHealthcare.com

For more information on United Healthcare’s (UHC) Medical or Dental Plans, select “Medical” or “Dental” links in the upper left hand corner or go directly to https://www.myuhc.com/.  These websites are where you can view your healthcare costs and status of payments.

Certificate of Coverage
Plan Summary

Coverage Period:
Aug 1, 2022 to July 31, 2023

Policy Number:
306438

Claims Service:
888-299-2070
8 a.m. and 8 p.m. ET

Email the completed forms to:
[email protected]

Website:
UnitedHealthcare.com

All full-time employees are provided with a short-term disability (STD) and a long-term disability (LTD) policy through United Healthcare. These policies are provided on a non-contributory basis, which means that Highmark Companies, LLC pays 100% of the cost for employees.

Welcome Brochure
Certificate of Coverage

Welcome Brochure
Summary of Benefits
Certificate of Coverage

Claim Form

Note: Notify HR if you are submitting a claim form. HR will complete pages 1-5 and submit directly to UHC. Employee will complete pages 6-14 and submit directly to UHC.

Coverage Period:
Aug 1, 2022 to July 31, 2023

Policy Number:
306438

Contact:
888‐299‐2070
8 a.m. and 8 p.m. ET

Website:
UnitedHealthcare.com

We offer Basic Life and AD&D Insurance as a part of our basic package through United Healthcare and we provide this coverage at no cost to you.

Welcome Brochure
Plan Description
Certificate of Coverage
Claim Form – AR, CO, KS, MD, NC, ND, NV, NY
Claim Form – All other states
Beneficiary Designation Change Form

Plan Description
Enrollment Form
Evidence of Insurability Form
Evidence of Insurability Guide
Evidence of Insurability Signing Instructions

Note: The insurance claim forms for supplemental life insurance are the same as the ones listed for Basic Life above.

Contact:
888-700-0808
Fax: 206-938-5987

Email:
[email protected]

Website:
NWPSBenefits.com

You may contribute up to 100% of your eligible compensation up to $20,500 per year (subject to IRS limits). Highmark Companies, LLC will match 100% of your contributions up to 3% of eligible compensation, plus 50% on the next 2%. If you contribute 5% of your eligible compensation, you will receive the maximum match of 4% of eligible compensation.

Eligibility Requirements
Safe Harbor Contribution Notice
Qualified Default Investment Notice
Participant Fee Disclosure
“Updated” Enrollment Booklet
Summary Plan Description

Initial Enrollment Form – For new enrollees to sign up for the 401(k) plan.
Beneficiary Designation Form – For new enrollees or existing participants to designate or change beneficiaries.
Deferral Election Change Form
Rollover Contribution Form – For when a participant chooses to roll money INTO the Plan.
Loan Application Request Form – To request a loan from the Plan.
Special Tax Notice for 401(k) Plans – Must be reviewed when requesting distributions from the Plan.

Death Benefit Request Form – Used by the beneficiary of a deceased Participant.
Death Benefit Request Notice

Distribution Request Form – For when a participant is requesting distribution (taxable or rollover to another plan).
Distribution Request Notice

Financial Hardship and Withdrawal Request Form – For when a participant requests a withdrawal from the Plan due to financial hardship.
Financial Hardship Request Notice

Coverage Period:
Aug 1, 2022 to July 31, 2023

Contact:
Care24: 888-887-4114
Optum: 877-660-3806

Website:
UnitedHealthcare.com

You may be faced with health, personal, family or work-related challenges. You have the added benefit of having two employee assistance programs offered by United Healthcare. These two resources can help you sort things out. These services offer information and resources that can help you and your family identify and resolve problems affecting emotional and physical health. Care24 and Optum are staffed by teams of friendly, registered nurses and master’s-level counselors who can assist individuals with a wide range of problems — at no cost to you.

Care 24 Overview
Optum EAP

Highmark Companies, LLC WRAP SPD

HIPAA Notice
Women’s Health and Cancer Rights Act Enrollment Notice
Newborns’ and Mothers’ Health Protection Act Disclosure
Patient Protection Notice
HIPAA Special Enrollment Notice
Premium Assistance Under Medicaid and CHIP Notice
Genetic Information Nondiscrimination Act (GINA) Disclosures
USERRA Notice
Notice of COBRA Continuation Coverage Rights
Medicare Part D Coverage Notice
Health Insurance Marketplace Notice

Common Health Insurance Terms

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Network: A clinic, hospital, doctor, lab, health care practitioner, or pharmacy.

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Insurer or carrier: The insurance company providing coverage to the policy holder.

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Policyholder: The individual or business (“group”) that has entered a contractual relationship with the insurance company.

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Insured: The person with the health insurance coverage. For individual health insurance, you may be both the policy holder and the insured.

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Premium: The amount of money charged by an insurance company for coverage. The cost of premiums may be determined by several factors, including age, geographic area, number of dependents and tobacco consumption. Policy holders pay these rates annually or in smaller payments over the course of the year, and the amount may change over time. When insurance premiums are not paid, the policy is typically considered void, and companies will not honor claims against it. Self-employed persons may deduct the cost of their individual health insurance premiums from their taxes.

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Copayment (Copays): A fixed amount you pay for a covered health care service, usually when you get the service. The amount can vary by the type of covered health care service.

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Preauthorization:  A decision by your health insurer or plan that a health care service, treatment plan, prescription drug or durable medical equipment (DME) is medically necessary. Your health insurance or plan may require preauthorization for certain services before you receive them, except in an emergency.

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Preventive Care: Medical tests and checkups, immunizations, and counseling services used to prevent chronic illness from occurring.

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Diagnostic Care: Care you receive to help diagnose symptoms or risk factors you already have.

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Primary Care Provider (PCP): Routine health care, including screenings, check-ups and patient counseling to prevent or discover illness, disease or other health problems.

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Referral: A written order from your primary care provider for you to see a specialist or get certain health care services.

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Specialist: A physician specialist focuses on a specific area of medicine or a group of patients to diagnose, manage, prevent or treat certain types of symptoms and conditions. A non-physician specialist is a provider who has special training in a specific area of health care.

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Deductible: The amount you owe for health care services each year before the insurance company begins to pay. For example, if your annual deductible is $1,000, your plan won’t pay anything until you’ve met your $1,000 deductible for covered health care services that are subject to the deductible. The deductible may not apply to all services, such as preventive care services.

Deductibles are useful for keeping the cost of insurance low. The amount varies by plan, with lower deductibles generally associated with higher premiums. They are standard on most types of health coverage.

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Coinsurance: Your share of the costs of a covered health care service calculated as a percent (for example, 20 percent) of the allowed amount for the service. You pay coinsurance plus any deductibles you still owe for a covered health service.

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Out-of-Pocket Maximum: The most you will be required to pay for your health care during a year, excluding the monthly premium. It protects you from very high medical expenses. After you reach the annual out-of-pocket maximum, your health insurance or plan begins to pay 100 percent of the allowed amount for covered health care services or items for the rest of the year. Copays, deductibles, and coinsurance count towards the out-of-pocket maximum.

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Formulary: A list of prescription drugs covered by the plan. Also called a drug list.

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In-Network: A group of doctors, clinics, hospitals, and other healthcare providers that have an agreement with your medical plan provider. You pay a negotiated rate for services when you use in-network providers.

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Out-of-Network: Care received from a doctor, hospital or other provider that is not part of the plan agreement. You’ll pay more when you use out-of-network providers since they don’t have a negotiated rate with your plan provider. You may also be billed the difference between what the out-of-network provider charges for services and what the plan provider pays for those services.

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High Deductible Health Plan (HDHP): This is a type of medical plan that requires the member to reach a deductible prior to having services covered by coinsurance. All expenses paid by the member count toward the deductible and out-of-pocket maximum.

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Prescription Drug List (PDL): Every plan with a pharmacy benefit contains a Prescription Drug List (PDL), also known as a formulary. The PDL lists the plan-approved drugs that your insurance will help pay for as well as how cost sharing works in each tier of drugs.

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Prior Authorization: A requirement from your health plan that some medications have additional coverage requirements which require approval from the health plan before you receive the medication.

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Guaranteed Issue: The amount of coverage that you can receive without having to answer health questions (Evidence of Insurability). The guaranteed issue applies to the voluntary life plan.

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Evidence of Insurability: Evidence of Insurability (EOI) is an application with medical questions that you complete in order to be considered for certain types of insurance coverage. Evidence of Insurability applies to the voluntary life and buy-up long-term disability plans.