2020 2021 Benefits Book Wyfi Pages 1 50 Fliphtml5

Leo Migdal

-Nov 19, 2025, 6:18 AM

2020 2021 benefits book wyfi pages 1 50 fliphtml5

Doyle Johnson’s Auto Repair 651 W. Collins Dr. Casper, WY 82601 (307) 265-5062 Benefits Effective 11/1/20-10/31/21 PRESENTED BY 400 E. 1st St. Suite 214 Casper, WY 82601 (307) 473-3000 Contact Information Customer Service: Medical 888-292-0272 Customer Service: Dental, Vision & Basic Life Vision Network: Dental Network: 800-459-9401 VSP You can go to any dentist www.guardiananytime.com Account Manager Servicing Agent Amber McCormick E-Mail: [email...

Plan Summary Description DOYLE JOHNSON’S AUTO REPAIR *************************************************************** DEDUCTIBLE: Individual $3,500 Family 2X COINSURANCE: 70/30 COINSURANCE OUT-OF-POCKET: Individual $7,150 Family 2X MAXIMUM LIFETIME BENEFIT: Unlimited OFFICE VISIST: Co-Pay $40 Primary $60 Specialist $75 Urgent... Summary of Benefits and Coverage: What this Plan Covers & What You Pay For Covered Services Coverage Period: 11/01/2020-10/31/2021 DOYLE JOHNSON'S MUFFLER SHOP INC: Plan Option Plan 1 Coverage for: Individual/Family Plan Type: Indemnity... The SBC shows you how you and the plan would share the cost for covered health care services. NOTE: Information about the cost of this plan (called the premium) will be provided separately. This is only a summary. For more information about your coverage, or to get a copy of the complete terms of coverage, visit us at http://www.NGBSselffunded.com or call 1- 888-306-0905.

For general definitions of common terms, such as allowed amount, balance billing, coinsurance, copayment, deductible, provider, or other underlined terms see the Glossary. You can view the Glossary at https://www.healthcare.gov/sbc-glossary or call 1-888-306-0905 to request a copy. Important Questions Answers Why this Matters: $3,500 person/$7,000 family. Generally, you must pay all of the costs from providers up to the deductible amount What is the overall before this plan begins to pay. If you have other family members on the plan, each deductible? family member must meet their own individual deductible until the total amount of deductible expenses paid by all family members meets the overall family deductible.

Are there services covered Yes. Preventive care and primary care services are covered before you meet your deductible. This plan covers some items and services even if you haven't yet met the before you meet your deductible amount. But a copayment or coinsurance may apply. For example, this plan covers certain preventive services without cost-sharing and before you meet deductible? your deductible.

See a list of covered preventive services at https://www.healthcare.gov/coverage/preventive-care-benefits/ Are there other deductibles No. for specific services? You must pay all of the costs for these services up to the specific deductible amount before this plan begins to pay for these services. What is the out-of-pocket $7,150 person/$14,300 family. limit for this plan? The out-of-pocket limit is the most you could pay in a year for covered services.

If you have other family members in this plan, they have to meet their own What is not included in the Premiums, balance-billed charges, penalty for not obtaining out-of-pocket limits until the overall family... Preauthorization and health care this plan doesn't cover. out-of-pocket limit? Even though you pay these expenses, they don't count toward the out-of-pocket limit. Will you pay less if you use Not applicable. This plan does not use a provider network.

You can receive covered services from a network provider? any provider. Do you need a referral to No. You can see the specialist you choose without a referral. see a specialist? 1 of 6

All copayment and coinsurance costs shown in this chart are after your deductible has been met, if a deductible applies. Common Services You May Need What You Will Pay Limitations, Exceptions & Other Important Information Medical Event Copayment is not subject to any Deductible. Copay applies Primary care visit to treat an $40 copay/visit, then covered at 100% to exam charge only. Does not include office surgery. injury or illness If you visit a health $60 copay/visit, then covered at 100% Copay applies to exam charge only. See Plan Document for care provider's office Specialist visit No charge.

Deductible does not apply. other services. or clinic As required under the ACA, cost sharing does not apply to Preventive care/screening/ identified clinical preventive services. Any other preventive immunization medicine services covered under your plan are subject to deductible and coinsurance. You may have to pay for Diagnostic test (x-ray, blood 30% coinsurance services that aren't preventive. Ask your provider if the work) services needed are preventive.

Then check what your plan will pay for. If you have a test Inpatient services are subject to deductible and coinsurance. Imaging (CT/PET scans, 30% coinsurance Deductible and coinsurance are waived on the first $500 of MRIs) $20 copay retail/$60 copay mail order outpatient services; the remaining covered charges are subject to the applicable deductible... If you need drugs to Generic drugs $50 copay retail/$150 copay mail order treat your illness or Preauthorization is required. If not received, a penalty will be condition applied. More information about prescription Preferred brand drugs When the retail store offers a lower price for generic, pay only drug coverage is the lower price.

Covers up to a 30-day supply (retail available at prescription); 31-90 day supply (mail order prescription). www.myCigna.com When a generic is available, pay the difference between the Non-preferred brand drugs $75 copay retail/$225 copay mail order Brand and Generic contracted rate. Covers up to a 30-day supply (retail prescription); 31-90 day supply (mail order prescription). When a generic is available, pay the difference between the Brand and Generic contracted rate. Covers up to a 30-day supply (retail prescription); 31-90 day supply (mail order prescription). 2 of 6

PUTTING YOU F RST 2020 Team Member Benefit Guide Contact 844-216-9320 or [email protected] for information about enrollment, effective dates, and any benefit questions. Para una guía en Español: 844-216-9320 o [email protected]Welcome Have a Smartphone? Benefit Effective This Benefit Guide is equipped with mobile- Hire Date Range Date friendly barcodes. These barcodes are more commonly referred to as “Quick Response” or 10/4 - 11/3/19 1/1/2020 QR codes. Scanning these codes will take you to 11/4 - 12/4/19 2/1/2020 a new place on your phone, allowing you to see new content. They might show you a website, 12/5 - 1/2/20 3/1/2020 video, or article.

They can take you anywhere, 1/3 - 2/2/20 4/1/2020 you just have to scan them first. 2/3 - 3/3/20 5/1/2020 So How do I Scan Them? 3/4 - 4/3/20 6/1/2020 First, you’ll need one of the many free QR Reader apps available for smartphones or 4/4 - 5/3/20 7/1/2020 tablets. Your phone may also be able to read 5/4 - 6/3/20 8/1/2020 them from within its camera app. After the download, just open the app and follow the 6/4 - 7/4/20 9/1/2020 directions to scan the QR 7/5 - 8/3/20 10/1/2020 code. The app will read it and immediately take you 8/4 - 9/3/20 11/1/2020 to that code’s content.

9/4 - 10/3/20 12/1/2020 Try it now on our 10/4 - 11/3/20 1/1/2021 benefits video library! 11/4 - 12/4/20 2/1/2021 Scan the QR code to access quick informational videos 12/5 - 1/1/21 3/1/2021 about our benefits plans. Your enrollment window opens 2 to 4 weeks before your Benefits Effective Date. Your benefit premiums will process on the first paycheck of your month of eligibility. Additional premiums will be recouped retroactively to the coverage effective date in no less than two Crystal Russell, Sales Support pay periods – so it pays to enroll early! North East, MD Since our theme this year is Putting YOU First, we have featured our Team Members and their families throughout the book!

See if your picture made it, or you might spot a coworker’s submission! Photos are identified by the Team Member who submitted them. Featured on the cover is a submission from Laura Torres, a Credit Assistant at Houston, TX Windows. 1 1Maricar Capulong, IT Engineer I Dallas, TX Table of Contents LEARN YOUR WEALTH 3 What’s New for 2019 Wealth Protection 4 Preparing to Enroll 31 Short-Term Disability 5 Benefits Eligibility 33 Long-Term Disability... Rewards range between $25 and $500, depending on the service. Use Benefits Value Advisor (BVA) to help you find an in-network provider participating in the Member Rewards program.

See p.18 for more information. MDLive Virtual healthcare is expanding to include behavioral health services. You can Behavioral schedule mental health services through MDLive at your convenience. Long and Health short-term treatment is available for such issues as depression and anxiety, grief and loss, eating disorders, addiction and more. See p. 15 for more information.

Virta Diabetes Introducing a voluntary program to help Type 2 diabetics covered in the medical Management plan to better manage and even reverse the disease! See p. 9 for more information. Hinge Health Introducing a non-surgical approach to chronic musculosketal and joint pain. This Musculosketel voluntary program will be rolled out to medical plan members on a limited basis in Solutions the first quarter of 2020. Be on the lookout for more information in the new year!

2020 2021 Benefits Book Wyfi Pages 1 50 Fliphtml5

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Doyle Johnson’s Auto Repair 651 W. Collins Dr. Casper, WY

Plan Summary Description DOYLE JOHNSON’S AUTO REPAIR *************************************************************** DEDUCTIBLE: Individual

For General Definitions Of Common Terms, Such As Allowed Amount,

Are There Services Covered Yes. Preventive Care And Primary Care

See A List Of Covered Preventive Services At Https://www.healthcare.gov/coverage/preventive-care-benefits/ Are