Medical Documents
Magellan Prescription Drug Plan
Precision Formulary →Precision Plus Preventive List →
Precision Plus Exclusion List →
Prescription Drug Documents
Magellan Prescription Drug Plan
Precision Formulary →Precision Plus Preventive List →
Precision Plus Exclusion List →
HSA/FSA Documents
Health Savings Account
Benefit Summary →
HSA Investments →
HSA Customer ID Process →
Understanding the HDHP →
Flexible Spending Account
FSA Discovery Guide →
FSA Handout →
Accessing Your Account →
Recurring Dependent Care Request Form →
Dental Documents
Life & Disability Documents
Work/Life Documents
Discount Programs
Get access to exclusive LA Fitness Membership
pricing with Niagara.
Learn more →
Other discounts through various providers:
WorkingAdvantage Discounts
→
Company Code: 973455836
Enterprise/National Car Discount
→
AT&T Discount →
Verizon Discount →
Microsoft Discount
→
Hearing & Vision Discount →
Rocket Mortgage Discount
→
Rocket Homes Discount
→
Learning Care Group Daycare Services →
Family-Friendly Benefits Documents
Progyny Fertility
☊ Progyny Welcome Video
Member Guide
→
Benefit Overview Webinar →
What is
Patient Care Advocate? →
What is In
Vitro Fertilization? →
What
is Egg Freezing? →
Fertility
Network Specialist →
LGBTQ
and Family Building →
Benefit Overview Brochure →
Learn more about
your new Enhanced Fertility Benefits through Progyny →
401(k) Documents
COBRA, Compliance & Medicare
SOPs
401(k)
Electing your 401(k) Deferrals →Dental
How to find a Dentist →How to Print a Delta ID Card →
Leave of Absence
LOA Guide for Managers →LOA Guide for Team Members →
LOA Planning Tool
Medical
7 Reasons to Use Teladoc →How to Find an Aetna Doctor - HMO →
How to Find an Aetna Doctor - PPO →
Midyear Changes
How to Report a Qualifying Life Event →Supporting Documentation for your QLE →
Reporting a Voluntary Benefit Change →
Savings/Spending Accounts
How to Change Commuter FSA Elections →How to Change Commuter HSA Elections →
Tuition
Tuition Assistance Policy →Tuition Assistance →
Wellness
Hydrate Your Health FAQs →Workday
Beneficiary Change in Workday →How to Add a Dependent SSN in Workday →
Locating your Form 1095 →
How to Complete your New Hire Benefit Elections →
Medical Plan Details
-
Deductible
$1,750 (I) / $3,500 (F)
-
Out-of-Pocket Maximum
$5,000 (I) / $10,000 (F)
-
Company HSA Contribution
$500
-
Per-pay-period Premiums
Team Member Only:
Team Member + Spouse:
Team Member + Child(ren):
Family:
-
Deductible
$1,500 (I) / $3,000 (F)
-
Out-of-Pocket Maximum
$3,500 (I) / $7,000 (F)
-
Company HSA Contribution
N/A
-
Per-pay-period Premiums
Team Member Only:
Team Member + Spouse:
Team Member + Child(ren):
Family:
-
Preventive Care →
Plan pays 100%
-
Preventive Dermatology
Plan pays 100%
-
Preventive 3D Mammogram New!
Plan pays 100%
-
Preventive Breast Ultrasound New!
Plan pays 100%
-
Preventive Care →
Plan pays 100%
-
Preventive Dermatology
N/A
-
Preventive 3D Mammogram
N/A
-
Preventive Breast Ultrasound
N/A
-
Primary Care
20% after deductible
-
Specialist Visit
20% after deductible
-
Teladoc
Up to $47 per consult
-
Primary Care
$25 copay
-
Specialist Visit
$40 copay, deductible waived
-
Teladoc
$47 per consult
-
Preventive
Covered at 100%
-
Generic
$15 after deductible
-
Formulary/Brand
$30 after deductible
-
Non-Formulary Brand
$50 after deductible
-
Specialty
20% ($120 maximum)
-
Preventive
Covered at 100%
-
Generic
$15
-
Formulary/Brand
$30
-
Non-Formulary Brand
$50
-
Specialty
30% ($150 maximum)
-
Emergency Room
You pay 20% after deductible
-
Urgent Care
You pay 20% after deductible
-
Emergency Room
$150 copay after deductible (waived if admitted)
-
Urgent Care
$25 copay, deductible waived
Teladoc
Virtual visits with a real doctor.
Virtual visits with a real doctor
Teladoc gives you 24/7/365 access to U.S. board-certified doctors through the
convenience of phone or video consults in all 50 states.
It’s an affordable alternative to costly urgent care and emergency room visits
when you need care now. Teladoc lets you resolve your routine medical issues,
on-demand, from wherever you happen to be - and you can even get prescriptions
sent to your
local pharmacy when medically necessary.
Meet ALEX!
Your personal benefits counselor.
ALEX is an interactive decision support tool that acts as an
informative, virtual benefits counselor to help you learn more about Niagara’s
benefits!
ALEX uses information you provide to help you make choices tailored to your
needs and the needs of your family.
Am I Eligible for Medicare?
Medicare and You →
Apply for Medicare Online →
Medicare Coordination →
Medicare
is available to individuals age 65 and older. You can
start the application process 3 months before the month in
which you turn
65.
You’ll
be able
to keep his current providers,
as
long as they are participating in the Medicare program. Medical
providers, suppliers and groups must enroll in the Medicare program to
be eligible for payments for Medicare-approved services. To
find out if your provider is participating, call you provider directly. Your
provider will fall into one of three categories:
Participating providers accept Medicare and always take assignment. Taking assignment means that the provider accepts Medicare’s approved amount for health care services as full payment.
Non-participating providers accept Medicare but do not agree to take assignment in all cases (they may on a case-by-case basis). This means that while non-participating providers have signed up to accept Medicare insurance, they do not accept Medicare’s approved amount for health care services as full payment.
Opt-out providers do not accept Medicare at all and have signed an agreement to be excluded from the Medicare program. This means they can charge whatever they want for services but must follow certain rules to do so.
After
confirming you provider’s status, you should start the application process and set
up your account with the Centers
for Medicare & Medicaid Services (CMS).
Once
you’re
ready to apply, you’ll need the
following information on hand, before you
begin
the online application process:
Date and Place of Birth If they were born outside the United States or its territories:
• Name of birth country at the time of their birth (it may have a different name now)
• Permanent Resident Card number (if they are not a U.S citizen)
Current Health Insurance
• Employment start and end dates for their current employer who provides them health insurance coverage through a Group Health Plan
• Start and end dates for the Group Health Insurance provided by their current employer
First you will need to create a my Social Security account if you don’t have one already at: https://www.ssa.gov/myaccount/ (This will allow you to check on your application and access your personal information).
Once
you have your account established, go
to: https://www.ssa.gov/benefits/medicare/ to
actually apply.
Once there, scroll down to
select the blue button “Apply for Medicare
Only" button
Apply and complete the
application (which normally takes 10 to 30 minutes).
Select “Submit Now”
to send your application electronically.
Print/Save your receipt /
confirmation page and application number.
(You
can always go back to your my Social Security account to check status with this
info)
After
enrollment, you will be
mailed a letter with the determination and how to proceed. The representatives
at
CMS will take you
through
the whole process from that point forward.
When can I apply?
You
can start the application process 3 months before the month you turn 65. This includes
the month you turn age 65 and ends three months after that birthday. Avoid enrolling
late, as it will make you subject to penalties (part-b-late-enrollment-penalty & part-a-late-enrollment-penalty).
Will I be able to keep my current providers?
You may be able to keep your current providers as long as they too are participating in the Medicare program. Medical providers, suppliers and groups must enroll in the Medicare program to be eligible for payments for Medicare-approved services. A suggested way to start-off would be by reaching out to each of your providers to ask them to confirm if they are enrolled. You may come to discover they will fall in to one of 3 categories of providers:
Participating providers accept Medicare and always take assignment. Taking assignment means that the provider accepts Medicare’s approved amount for health care services as full payment.
Non-participating providers accept Medicare but do not agree to take assignment in all cases (they may on a case-by-case basis). This means that while non-participating providers have signed up to accept Medicare insurance, they do not accept Medicare’s approved amount for health care services as full payment.
Opt-out providers do not accept Medicare at all and have signed an agreement to be excluded from the Medicare program. This means they can charge whatever they want for services but must follow certain rules to do so.
Once you've gone through the application process and the Centers for Medicare & Medicaid Services finalize your application / account, and it comes time to choose a plan and other options, CMS will be able to verify if the providers are participating or if you may have to search for new ones.
Where
can I find more detailed information about applying and how Medicare
works?
Please consider downloading and reading the useful digital guides provided (below?) before applying for Medicare.
How do I get started once I am eligible and ready to apply?
One you are ready to apply, you'll need the following information on hand, before you begin the online application process:
Date and Place of Birth If they were born outside the United States or its territories:
• Name of birth country at the time of their birth (it may have a different name now)
• Permanent Resident Card number (if they are not a U.S citizen)
Current Health Insurance
• Employment start and end dates for their current employer who provides them health insurance coverage through a Group Health Plan
• Start and end dates for the Group Health Insurance provided by their current employer
First
you'll have to create a my Social Security account if you dont have one
already at: https://www.ssa.gov/myaccount/ (this
will be the way you can check on your application and personal info and data, later as
well)
Then you'll need to go to: https://www.ssa.gov/benefits/medicare/ to
actually apply.
Once
there, scroll down to select the blue button “Apply for Medicare
Only" button
Apply and complete the application (which
normally takes 10 to 30 minutes).
Select “Submit Now” to send your
application electronically.
Print/Save your receipt / confirmation page and
application number.
(you can always go back to your my Social Security
account to check status with this info)
You'll eventually be mailed a letter with the determination and how to proceed. The reps at CMS will take you through the whole process from that point forward.
Aetna Preventive Services & Prescription Drugs
Preventive Services are covered at 100% as long as you seek services from an in-network
provider and your service is billed as routine/preventive. Both must be true for Aetna to
process the claim at 100%.
When you make an appointment, be clear that you’re seeking preventive services. Talk
with your physician during your appointment to ensure you are billed correctly. If they bill
with an existing or new diagnosis, you will be charged for an office visit.
If you receive a bill for any portion of your preventive exam or labs, contact the
Piper Jordan Claims Advocacy team for help!
| Medical Services covered at 100%
(follows US Preventive Task Force) |
Generic Prescriptions covered at $0 Copay
(Magellan Rx Preventive Rx List) |
|---|---|
| Routine Annual Physical | Low dose statin medications (cholesterol) |
| Well Woman Exams | Blood Pressure medications |
| Well Child Exams | Tobacco Cessation medications |
| Colon Screening | Oral contraceptives |
| Breast Screening (including 3D mammogram & breast ultrasound) | Antiasthmatics (asthma treatment) |
| Prostate Screening | Anticoagulants |
| Labs (cholesterol, blood sugar, etc. | Antihyperglycemics (diabetic medications) |
| Preventive Dermatology | Antivirals |
_BROCHURE_99 CENT STORES.jpg){kind=spacer}
