MESA COUNTY GOVERNMENT - 2021 BENEFITS GUIDE
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MESA COUNTY GOVERNMENT
2021 BENEFITS GUIDE
1
2
TABLE OF CONTENTS
4 New for 2021
5 Enrollment Guidelines
6 Benefit Contacts
7 Glossary of Terms
8 Premiums
9 Medical Benefits
10 myamberiben.com
11 Ameriben’s Enhanced Customer Service
12 VSP Exam Benefit
13 Virtual Visits
14 CHP Hotline-Precertification Requirements
15 Triad EAP
16 CHP Resources
17 UNUM
18 Travel Benefit
19 GoodRx
20 Dental Benefits Summary
21 VSP Vision Benefits
22 Vision Benefits Summary
23 VSP Eyecare and Hearing Aids
24 Flexible Spending Account
28 Life & AD&D Insurance
30 Voluntary Life & AD&D Insurance
32 Long-Term Disability
33 Additional Voluntary Benefits
35 Retirement Benefits
36 Important Notices
37 Notice of Privacy Practices
41 Marketplace Exchange Notice
43 Children’s Health Insurance Program
47 Medicare Part D Notice
474
This Benefits Guide is an overview of the benefits provided by Mesa County Government. It is not a Summary
Plan Description or Certificate of Insurance. If a question arises about the nature and extent of your benefits
under the plans and policies, or if there is a conflict between the informal language of this Benefits Guide
and the contracts, the Summary Plan Description and Certificates of Insurance will govern. Please note that
the benefits in your Benefits Guide are subject to change at any time. The Benefits Guide does not represent
a contractual obligation on the part of Mesa County Government.
This Benefits Guide is an overview of the benefits provided by Mesa County Government. It is
not a Summary Plan Description or Certificate of Insurance. If a question arises about the
nature and extent of your benefits under the plans and policies, or if there is a conflict between
the informal language of this Benefits Guide and the contracts, the Summary Plan Description
and Certificates of Insurance will govern. Please note that the benefits in your Benefits Guide
are subject to change at any time. The Benefits Guide does not represent a contractual
obligation on part of (CLIENT NAME).
3
New for 2021!
NEW MEDICAL PLAN TPA
For the 2021 plan year Mesa County Government has elected to change third
party administrators to Ameriben Health. The PPO Networks and the plan
design option remains the same. You will continue to access the CHP
Partners Hotline for provider searches, CHP Concierge, University of Utah
Health Care Connect program, and virtual visits through University of Utah.
NEW VISION EXAM BENEFIT THROUGH VSP
The routine vision exam is moving from the medical plan to VSP effective
1/1/2021. This benefit will be for members enrolled in the 2021 medical plan
but not enrolled in the 2021 voluntary VSP plan. Please see page 12 for more
details.
4
ENROLLMENT GUIDELINES
Welcome to the 2021 Benefits Guide for Mesa County Government. This Guide provides a quick
overview of the benefits program and helps to remove confusion that sometimes surrounds Employee
benefits. The benefits program was structured to provide comprehensive coverage for you and your
family. Benefit programs provide a financial safety net in the event of unexpected and potentially
catastrophic events.
ELIGIBILITY QUALIFYING LIFE EVENTS
You are eligible to enroll in the medical benefits Generally, you can only change your benefit
program if you are a full-time employee working elections during the annual Open Enrollment
20 or more hours per week, or a temporary, non- period. However, you may make changes during
seasonal employee working at least 30 hours per the plan year if you have a qualifying event.
week. Medical, Dental, Vision, FSA, Basic
Lie/AD&D and LTD benefits for newly hired Qualifying events include:
employees will take effect the first day of the
month following 30 days of qualified • Marriage
employment. Voluntary life is effective the first of • Divorce
the month following 30 days of application if • Birth
dated prior to that date. Otherwise, it’s the first • Adoption
of the month following the date of signature (if • Death
signed within 30 days of eligibility). For benefits • Loss of Coverage
other than medical, Active at Work Provisions
apply, including Dependent Non-Confinement. When you have a qualifying event, you have 31
days to complete and return a new
Your legal spouse and your married or unmarried enrollment/change form for health, dental,
dependent children are eligible for medical and/or vision coverage. You may be asked to
coverage if less than 26 years of age. Your provide proof of the change and/or proof of
unmarried dependent children are eligible for eligibility. (You have 60 days to complete and
dental and/or vision benefits if less than 26 years return a new enrollment/change form after
of age. Disabled children over age 26 may be coverage under Medicaid or CHIP terminates.)
eligible to continue benefits after approval of
necessary applications. Available Benefits:
• Medical/Clinic
OPEN ENROLLMENT • Flexible Spending Account (FSA)
Open enrollment for health, dental and vision is • Dental
once a year and benefit elections will take effect • Vision
January 1st. Participants may add or drop • 401(a) Defined Contribution
coverage or make changes to their coverage at • 457(b) Deferred Compensation
this time. Late entrants (employees or • Basic Life/Accidental Death & Dismemberment
dependents who apply for coverage more than (AD&D)
31 days after the date of individual eligibility) are • Supplemental Life Insurance
also provided an opportunity to enroll for • Basic Voluntary Dependent Life Insurance
coverage during the plan’s open enrollment. The • Long-Term Disability (LTD)
elections you make stay in effect the entire plan • Accident/Critical Illness/Hospital
year, unless a qualifying life event occurs. Indemnity/Legal/Identity Theft
• Sick Leave
• Vacation
• Employee Assistance Program (EAP)
• Social Security (FICA)
5
BENEFIT CONTACTS
Ameriben Medical (855) 401-8698
www.myameriben.com
CHP Partners Hotline Contact CHP Partners Hotline for (877) 535-2295
assistance in determining the chp@gihosp.org
appropriate facility or provider for
Tier 1 services. Certain types of
services may be paid at the Tier 1
Network benefit level when
performed at another Anthem
ASO Network facility.
CHP Concierge Questions about CHP, CHP (970) 644-4000
Medical Clinic providers, hours
and locations
University of Utah Health Care Customer Service (801) 587-7219
Connect Program https://healthcare.Utah.edu/telehealth/
virtual-visits/
Virtual Visits University of Utah Virtual Visit Set-Up (844) 424-2172
Delta Dental Dental www.customer_service@ddpco.com
Group #12141 (800) 610-0201
VSP Vision (800) 877-7195
www.vsp.com
Rocky Mountain Reserve Flexible Spending Account (888) 722-1223
www.rockymountainreserve.com
UNUM Life/AD&D Insurance, Voluntary (800) 421-0344
Life, & Long-Term Disability www.unum.com
Mesa County Government Brenda Moore (970) 244-1695
HR Director Brenda.Moore@mesacounty.us
Shelley Vehik 970) 244-1847
Senior Benefits Administrator Shelley.Vehik@mesacounty.us
Novo Benefits Tre’ Bradley (970) 773-9145
Associate Account Manager tbradley@novobenefits.com
Novo Benefits Sharon Bacon (402) 802-9089
Account Coordinator sbacon@novobenefits.com
6
GLOSSARY OF TERMS
The following terms will help you better understand your benefits.
Co-pay: A Copay is the portion of the Covered Expense that is your responsibility, as shown in the Medical
Schedule of Benefits. A Copay is applied for each occurrence of such covered medical service and is not
applied toward satisfaction of the Deductible.
Deductible: A Deductible is the total amount of eligible expenses as shown in the Medical Schedule of
Benefits, which must be Incurred by you during any Calendar Year before Covered Expenses are payable
under the Plan.
Coinsurance: Coinsurance is the percentage of eligible expenses the Plan and the Covered Person are
required to pay.
Out-of-Pocket Maximum (OOPM): An Out-of-Pocket Maximum is the maximum amount you and/or all of
your family members will pay for eligible expenses Incurred during a Calendar Year before the percentage
payable under the Plan increases to 100%.
PPO (Preferred Provider Organization): This type of plan utilizes network and non-network benefits.
In-Network: The Plan offers a broad network of providers and provides the highest level of benefits when
Covered Persons utilize “in-network” providers. These networks will be indicated on your Plan
identification card.
Out-of-Network: Any non-contracted providers. The services from these providers are subject to balance
billing, meaning members can be billed for the difference between the insurance carrier's fee schedule
and the billed charges.
7
PREMIUMS
Employee Contributions
Effective January 1, 2021
MEDICAL EMPLOYEE COUNTY % CONTRIBUTION TOTAL
Single $43.00 $672.69 94% $715.69
Employee + Spouse $342.00 $1084.47 76% $1426.47
Employee + Child(ren) $228.00 $913.18 80% $1141.18
Family $374.29 $1408.06 79% $1782.35
DENTAL EMPLOYEE COUNTY % CONTRIBUTION TOTAL
Single $32.53 $0.00 0% $32.53
Employee + Spouse $68.30 $0.00 0% $68.30
Employee + Child(ren) $55.29 $0.00 0% $55.29
Family $97.58 $0.00 0% $97.58
VISION EMPLOYEE COUNTY % CONTRIBUTION TOTAL
Single $9.57 $0.00 0% $9.57
Employee + 1 $16.99 $0.00 0% $16.99
Family $27.40 $0.00 0% $27.40
Premium Paid by Employee
VOLUNTARY SUPPLEMENTAL TERM LIFE
Visit your enrollment portal at Mesa Wave to see your age banded rates.
8
MEDICAL BENEFITS
Mesa County Government offers medical benefits through Ameriben. This medical plan balances
affordability with the freedom to go outside the network. You may choose a participating or a non-
participating provider. Participating providers have agreed to provide services at a discounted fee.
For out-of-network care, you are responsible for charges above the in-network allowance for the
same services, in addition to the deductible and coinsurance. To find a participating provider, please
call the CHP Partners Hotline at 1-877-535-2295.
PPO Medical Plan
Medical Benefits Tier 1 Tier 2 Tier 3
Community Hospital & Community
Hospital Owned Facilities; Anthem BlueCross BlueShield
Network Non-Contracted Providers
Canyon View Surgery Center; Contracted Providers
University of Utah Health Center
Deductible
$1,250 Single / $2,500 Family $1,250 Single/ $2,500 Family $5,000 Single/ $10,000 Family
Out-of-Pocket Maximum
$5,000 Single/ $10,000 Family $6,850 Single/ $13,700 Family No Maximum
Preventive Care per
Covered 100%, DW Covered 100%, DW Not Covered
Schedule of Benefits
Office Visit $10 copay for office visit. $60 copay for office visit. All
$40 copay for office visit. All other
All other services subject to other services 50%, deductible
services subject to deductible + 20%
deductible + 20% waived
Virtual Visits $0 Copay
Not Available Not Available
University of Utah Only
Specialist Office visit
$45 copay for office visit. $45 copay for office visit. $60 copay for office visit.
All other services subject to All other services subject to deductible All other services 50%,
deductible then 20% then 20% deductible waived
Outpatient Hospital 20% AD 50% AD 50% AD
Inpatient Hospital 20% AD 50% AD 50% AD
Emergency Room $150 Copay per visit for facility and
physician services, then 20% after
Same as in-network Same as in-network
deductible for all other services.
Copay waived if admitted
Pharmacy Deductible $150 Deductible Per Person $150 Deductible Per Person Not Applicable
Retail – 30 day supply
Preventive RX Formulary 100% DW at Canyon View Subject to copay and deductible
Generic Lesser of $20 copay or 20%, AD Lesser of $20 copay or 20%, AD Not Covered
Formulary Lesser of $45 copay or 30%, AD Lesser of $45 copay or 30%, AD Not covered
Non-Formulary Lesser of $60 copay or 40%, AD Lesser of $60 copay or 40% AD Not covered
Specialty only through ESI Lesser of 25% to a maximum of $500 Lesser of 25% to a maximum of $500 Not covered
Pharmacy Management per prescription, AD per prescription, AD
Mail Order – 90 day supply
Generic Lesser of $60 copay or 3 x 20% AD Lesser of $60 copay or 3 x 20%, AD Not covered
Preferred Lesser of $135 copay or 3 x 30% AD Lesser of $135 copay or 3 x 30% AD Not covered
Non-Preferred Lesser of $180 copay or 3 x 40% AD Lesser of $180 copay or 3 x 40% AD Not covered
*Includes Deductible, Copays, & Rx AD – After Deductible DW – Deductible Waived
*The above benefits are meant for illustrative purposes only and are only a brief look at your benefits. See your Plan Document for details on
benefits, network utilization, limitations and exclusions. In the event of a discrepancy the Plan Document will prevail. The Plan Document is
available via your Mesa Wave Portal. Printed documents are available upon request.
9
Introducing MyAmeriBen.com!
MyAmeriBen is a tool designed to provide you quick and easy access to
claims status, benefits, eligibility information, customer care, and much more.
Information you can access:
Live Chat Features Live online help to answer any questions 7:00 am – 6:00 pm MT
Benefits & Claims Check benefit information, eligibility, and claim status 24/7
Important Links Access other plan vendors such as HSA, PPO, and PBM
ID Cards Electronic ID cards can be accessed and even emailed directly to
providers
Health Risk Complete the HRA to create a personalized wellness plan based
Assessment on your medical and lifestyle information
Translator Multiple languages can be utilized
... and muchmore!
NEED HELP?
Customer Care Center is also available to help you, Monday-Friday, 7:00 AM to 6:00 PM MT 10Introducing
AmeriBen's Enhanced CustomerService!
Navigating the healthcare labyrinth
can be difficult. Allowus to guide your
membersthrough the healthcare
maze with confidence andcare.
YourMembersWill Appreciate the Additional Care They
Receive From AmeriBen Enhanced Customer Care
Benefits of Enhanced CustomerService Optional ServicesAvailable
Youremployeesworkhardforyou.Allowustotakegoodcareof AmeriBenConsumerSupport
themwithourEnhancedCustomerServiceoption.Weprovide TheConsumerSupportteamwill assist memberswithfinding high-
assistance withschedulingdoctorvisits, coordinatingwithother quality, low-costoptionsforprocedureslike MRIs,CTscans,total knee
programssuchaspharmacyorHSAbenefits,andmuchmore. replacements,total hipreplacements,andmore!Additionalfees may
Oneofthemostutilizedservicesis assistance findingahigh- apply.
quality,low-cost providerin themember'sarea.Thisservicecan
beusedforprimarycarephysiciansaswell asspecialists. Behavioral/CaseManagement
Representativeswill alsotakethetimetodiscuss availablecare
AnAmeriBenregisterednursecasemanageris heretoprovidethe
resourcesdependingonsymptomsorneedsdiscussed.
support membersneedthroughout illness, life-changing injury, or
Services Comparison behavioralhealthcrisis.Additionalfeesmayapply.
11
CustomerCareRepresentativesAvailable 7:00am- 6:00pmMountainTimeVision Benefits for Members Insured in Our 2021 Medical
Plan and Not Enrolled in the 2021 Voluntary VSP Plan
Create an account on vsp.com to view your in-network coverage, find the VSP network doctor
who’s right for you, and discover savings with exclusive member extras. At your appointment,
just tell them you have VSP.
Maximize your coverage with bonus offers and additional savings that are exclusive to
Premier Program locations.
WellVision Exam $20 Copay Every 12 Months
Glasses & Sunglasses 20% savings on complete pair of prescription glasses and sunglasses,
including lens enhancements, from any VSP Provider with 12 months
from your last WellVison Exam.
Contacts 15% savings on a contact lens exam (fitting & evaluation)
Laser Vision Average 15% off the regular price or 5% off the promotional price –
only available from contracted facilities
Coverage with a retail chain may be different or not apply. Log in to vsp.com to check your benefits for eligibility
and to confirm in-network locations based on your plan type.
Plan Benefits are not available at Walmart, Sam’s Club, or Costco. VSP guarantees coverage from VSP network
providers only.
12VIRTUAL VISITS
Online Acute Care through University of Utah
Mesa County-insured have access to virtual visits! If you have a minor illness, but you can’t make it to
a doctor, you can utilize online acute care!
If you are feeling sick and don’t want to leave the comfort of your home, you can speak face-to-face
with a University of Utah provider. You don’t need an appointment, just a Wi-Fi internet connection on
your smartphone, tablet or computer.
• Available 9:00 a.m. - 8:00 p.m. 7 days a week.
• Call from anywhere in Colorado or Utah.
• Virtual Visits are covered with a $0 co-pay through your Mesa County insurance.
To start your visit, please call
(844) 424-2172
*Save this number in your phone!
Symptoms Suitable for Virtual Visits
• Allergies
• Cough, cold and flu
• Eye infections
• Sore throat (adult patients only)
• Minor muscle or joint pain
(adult patients only)
• Nausea, vomiting and diarrhea
• Sinus problems
• Skin issues
• Stomach and digestive issues
• Urinary track issues (adult patients only)
And many more!
Apple users will need to download the “UofU Health Virtual Care” app on the App Store
prior to starting their visit. There is no app requirement for Androidusers.
13
6CHP HOTLINE
What procedures/services does Community Hospital offer?
What about labs, x-rays, mammograms, MRIs?
What services does Community Hospital not provide?
Our team will help you navigate the health care system and provide answers to your health plan questions.
Call the toll free number below to speak directly with the CHP Partners Hotline team member. Calls or
emails received by 5 p.m. will be returned by 5 p.m. the following business day. To best serve you, calls and
emails can be made to the hotline 24 hours a day, seven days a week. If a team member is not available at
the time of the call, please leave a message. All calls and emails will be returned in a timely manner.
PRE-CERTIFICATION
Contact CHP Partners Hotline at 1-877-535-2295 for assistance in determining
the appropriate facility or provider for services. Certain types of services may
61% OF THE TIME
also be paid at the in-network Tier 1 benefit level when performed at a MEMBERS SELF-REFER
University of Utah facility. TO THE WRONG
SPECIALIST. CALL
Before you receive certain medical services or procedures, your health plan TODAY FOR HELP!
requires a doctor to confirm that these requested services are considered
medically necessary under your plan. This verification process is called "pre-
certification.“ Even if some services or therapies are performed in your
doctor's office, you may still need a pre-certification.
SERVICES REQUIRING PRE-CERTIFICATION
Inpatient Hospitalizations Oncology Care & Services Labor & Delivery
(chemotherapy, radiation therapy, etc.)
Colonoscopies other than at Grand Junction Out-Patient Surgeries other than Canyon View Surgery Center
Endoscopy and Gastroenterology Associates of & Community Hospital
Western Colorado.
Services Community Hospital does not currently provide; however, with approval through the CHP Hotline, these
services, if authorized by the third party administrator (TPA) as medically necessary and covered by the
employer’s health plan, would be paid at the higher level benefit/in-network/Tier 1 for facilities in the
employer’s selected provider network including University of Utah.
• Cardiac Catheterization
• Cardiothoracic Surgery
• Neonatal and Pediatric ICU
• Neurosurgery
*The above benefits are meant for illustrative purposes only and are only a brief look at your benefits. See your Certificate of Coverage or SBC for 14
details on benefits, network utilization, limitations and exclusions. In the event of a discrepancy the plan document will prevail. Plan Documents
are available via your Mesa Wave Portal. Printed documents are available upon request.LIFESTYLE MODIFICATION
Outpatient Behavioral Health
Our Behavioral Health Specialists can help you with:
• Personal relationship problems
• Anxiety and depression
• Drug and alcohol interventions
• Work stress
• And more!
Behavioral health services are available at no cost to you!
To schedule an appointment, please call (970) 242-9026.
Available to participants who see a CHP Medical
Clinic Provider.
EAP Services
Triad EAP is a prepaid, confidential service offered by Mesa County. This
benefit is available to all Mesa County employees and extends to the
employee’s spouse and dependents under the age of 26. Five EAP
short-term, solution based counseling sessions are available at no cost
to you! This benefit includes legal and financial counseling.
Crisis counseling is available 24-hours a day, seven days a week.
Triad works with highly trained and qualified professionals who are experts in the fields such as
wellbeing, family matters, relationships, debt management, consumer rights, and much more.
For information regarding your benefits or to see a list of counselors, log in to www.triadeap.com.
Username: mesa / Password: county, or call (970) 242-9536 (local) or 877-679-1100 (toll free).
Nutritional Education Services
Nutritional education is available at no cost to you!
Our dieticians can assist you with:
• Weight loss
• Medical nutrition therapy
• And more!
To schedule an appointment, please call 263-2664.
*A referral from a CHP Medical Clinic Provider is required.
15
8C H P Resources
Your CHP Resources
Utilize these resources to enhance wellness and navigate the healthcare system.
Navigation
Contact your CHP Coordinator by calling (970) 644-4000 or emailing chp@gjhosp.org.
Your CHP Coordinator can help you with the following:
• Find a primary care provider
• Assist with the new patient process
• Find in-network health care services and facilities
• Specialist referrals/questions
• Narrow network exception process (CHP Hotline)
• Miscellaneous benefit questions
Health Coaching
Health coaching is a FREE personal approach to enhance wellness.
Through a series of interactions, your health coach will help you
determine health priorities, develop strategies and create a plan
of action for:
• Nutrition and exercise evaluation/education
• Chronic disease management
You can receive up to 12 free coaching visits a year!
Can’t leave work? Crunched for time?
We offer telephonic health coaching appointments! Danielle Wells, RN, CHWC
Health Coach
(970) 263-2639
dwells@gjhosp.org
10
16Employee Assistance Program
Help, when you need it most
With your Employee Assistance Program and
Work/Life Balance services, confidential assistance
is as close as your phone or computer.
Employee Assistance Program (EAP)
Your EAP is designed to help you lead a happier and more productive life at home and at
Always by your side work. Call for confidential access to a Licensed Professional Counselor* who can help you.
• Expert support 24/7
• Convenient website A Licensed Professional Counselor can help you with:
• Short-term help • Stress, depression, anxiety • Family and parenting problems
• Referrals for additional care • Relationship issues, divorce • Anger, grief and loss
• Monthly webinars • Job stress, work conflicts • And more
• Medical Bill SaverTM
—helps you save on medical bills
Work/Life Balance
You can also reach out to a specialist for help with balancing work and life issues. Just
Who is covered? call and one of our Work/Life Specialists can answer your questions and help you find
Unum’s EAP services resources in your community.
are available to all
Ask our Work/Life Specialists about:
eligible employees, their spouses
• Child care • Financial services, debt management, credit report issues
or domestic partners, dependent
children, parents and parents-in-law. • Elder care • Even reducing your medical/dental bills!
• Legal questions • And more
• Identity theft
Help is easy to access:
Online/phone support: Unlimited, confidential, 24/7.
In-person: You can get up to 3 visits available at no additional cost to you with a
Licensed Professional Counselor. Your counselor may refer you to resources in your
community for ongoing support.
Employee Assistance Program —Work/Life Balance
Toll-free 24/7 access: Turn to us, when
1-800-854-1446 (multi-lingual) you don’t know
www.unum.com/lifebalance where to turn.
* The counselors must abide by federal regulations regarding duty to warn of harm to self or others. In Services are not valid after coverage terminates. Please contact your Unum representative for details.
these instances, the consultant may be mandated to report a situation to the appropriate authority. Insurance products are underwritten by the subsidiaries of Unum Group.
Unum’s Employee Assistance Program and Work/Life Balance services, provided by HealthAdvocate, unum.com
are available with select Unum insurance offerings. Terms and availability of service are subject to © 2018 Unum Group. All rights reserved. Unum is a registered trademark and marketing brand of
change. Service provider does not provide legal advice; please consult your attorney for guidance. Unum Group and its insuring subsidiaries.
EN-2055 (5-18) FOR EMPLOYEES
17TRAVEL BENEFIT
• Call Anthem for pre-authorization of services/treatment by calling
800-542-9402
• Travel Reimbursement related to travel to University of Utah for
medical care.
• Annual maximum benefit is $1,000
• Eligible expenses are transportation, parking fees and tolls,
payable to the standard mileage rate per the IRS;
• Lodging up to $150 per night
• Inform Human Resources you are using this benefit when
your claim form is completed
Retain travel receipts along with
your Anthem Claim Form to HR:
Attn: Brenda Moore or Shelley Vehik
shelley.vehik@mesacounty.us
brenda.moore@mesacounty.us
*This is a separate benefit from the Transplant Travel benefits provide under the Anthem benefits
explained in your Certificate of Insurance.
The above benefits are meant for illustrative purposes only and are only a brief look at your benefits. See your Certificate of Coverage for
details on benefits, network utilization, limitations and exclusions. In the event of a discrepancy the plan document will prevail.
Plan Documents are available via your Mesa Wave Portal. Printed documents are available upon request. 18GoodRx – THE FREE Rx SAVINGS SOLUTION
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19Delta Dental PPO plus Premier
MESA COUNTY – Group # 12141
MAXIMUM BENEFIT $2,000 per member, per calendar year
Calendar Year Maximum
CALENDAR YEAR DEDUCTIBLE Individual Deductible – $50.00 Combination of in and out-of-network
Applies to Basic and Major Services Family Deductible – $100.00 Combination of in and out-of-network
PPO PREMIER NON-PAR
COVERED SERVICES BENEFIT INFORMATION (subject to Delta Dental guidelines)
Dentist Dentist Dentist
DIAGNOSTIC AND PREVENTIVE SERVICES
Twice each in a calendar year. Two additional cleanings may be covered
Oral Exams and Cleanings
for those with a documented EBD condition.
Once per tooth in a 36-month period for unrestored permanent
Sealants
molars, through age 14
Bitewing X-Rays Once in a calendar year
100% 100% 100%
Full Mouth X-Rays Once in a 60-month period
Fluoride Twice in a calendar year, through age 15
One per quadrant, per lifetime to maintain space for eruption of
Space Maintainers
permanent posterior teeth, through age 13
BASIC SERVICES
Fillings (Composite or Amalgam) Once per tooth in a 12-month period
Simple Extractions
80% 80% 80%
Oral Surgery
Endodontics
MAJOR SERVICES
Periodontics
Crowns Once per tooth in a 60-month period. Not a benefit under age 12.
50% 50% 50% Implants Once per tooth in a 60-month period. Not a benefit under age 16.
Once in a 60-month period, only when existing prosthesis cannot be made
Dentures, Bridges
serviceable. Fixed bridges or removable partials are not a benefit under age
16.
ORTHODONTICS $2,000 lifetime maximum
50% 50% 50% For covered children to age 19
You are enrolled in a Delta Dental PPO plus Premier plan. You and your family members may visit any licensed dentist, but will enjoy the greatest out-of-
pocket savings if you see a Delta Dental PPO dentist. There are three levels of dentists to choose from.
PPO Dentist - Payment is based on the PPO dentist's allowable fee, or the actual fee charged, whichever is less.
Premier Dentist - Payment is based on the Premier Maximum Plan Allowance (MPA), or the fee actually charged, whichever is less.
Non-Participating Dentist - Payment is based on the non-participating Maximum Plan Allowance. Members are responsible for the difference between
the non-participating MPA and the full fee charged by the dentist. You will receive the best benefit by choosing a PPO dentist.
Open Enrollment applies. Members may add coverage once per year.
This is a brief description of services covered under your dental plan. Please refer to the Employee Benefit Booklet for full plan details. If differences
exist between this summary and the Employee Benefit Booklet, the Employee Benefit Booklet will govern.
20A L O O K AT YO U R
VSP VISION COVE R AGE
S E E H E A LT H Y A N D L I V E H A P P Y
WITH H E L P FROM MESA C O U N T Y
G O V E R N M E N T A N D VSP.
Enroll in VSP® Vision Care to get personalized care from a
VSP network doctor at low out-of-pocket costs.
VALUE A N D SAVINGS YOU LOVE. U s i n g your benefit is easy!
Save on eyewear and eye care when you see a VSP network Create an account on v s p . c o m
doctor. Plus, take advantage of Exclusive Member Extras to view your in-network
for additional savings. coverage, find the VSP network
P R O V I D E R C H O I C E S Y O U WANT. doctor who’s right for you, and
With an average of five VSP network doctors within six discover savings with exclusive
miles of you, it’s easy to find a nearby in-network doctor member extras. At your
or retail chain. Plus, maximize your coverage with bonus appointment, just tellthem you
offers and additional savings that are exclusive to Premier have VSP.
Program locations.
Prefer to s h o p online? Use your vision benefits on
Eyeconic®—the VSP preferred online retailer.
QUALITY VISION C A R E YOU NEED.
You’ll get great care from a VSP network doctor, including
a WellVision Exam®—a comprehensive exam designed to
detect eye and health conditions.
G E T Y O U R P E R F E C T PA I R
EXTRA $20 + UP
TO 40%
TO SPEND ON SAVINGS ON L E N S
F E AT U R E D FRAME BRANDS* ENHANCEMENTS
S E E MORE BRANDS AT V S P . C O M / OFF E R S .
Contact us: 8 0 0 . 877. 7195 or
vsp.com
2122
VSP DISCOUNTS: EYE CARE & HEARING AIDS
VSP Diabetic Eyecare Plus ®
Available to Covered Persons who have been diagnosed with type 1 or type 2
diabetes and specific ophthalmological conditions .The Program is intended
to be a supplement to Covered Persons group medical plan. Providers will
first submit a claim to Covered Persons group medical insurance plan, and
then to VSP. Any amounts not paid by the medical plan will be considered for
payment by VSP. Examples of symptoms which may result in a Covered
Person seeking services under DEP Plus may include, but are not limited to:
blurry vision, trouble focusing, transient loss of vision, “floating” spots.
Examples of conditions which may require management under DEP Plus may
include, but are not limited to: diabetic retinopathy, rubeosis, and diabetic
macular edema.
TruHearing® is making hearing aids affordable by providing exclusive savings to all VSP® Vision Care members.
You can save up to $2,400 on a pair of hearing aids with TruHearing pricing. What’s more, your dependents
and even extended family members are eligible, too.
In addition to great pricing, TruHearing provides : Plus, with TruHearing you’ll get:
• Three provider visits for fitting, adjustments, and • Access to a national network of more than 4,500
cleanings licensed hearing aid professionals
• 45-day money back guarantee • Straightforward, nationally fixed pricing on a
• Three-year manufacturer’s warranty for repairs and selection of more than 90 digital hearing aids in
one-time loss and damage 400 styles
• 48 free batteries per hearing aid • Deep discounts on replacement batteries shipped
directly to your door
Best of all, if you already have a hearing aid benefit from your health plan or employer, you can combine it
with this program to maximize the benefit and reduce your out-of-pocket expense.
How it works
Call TruHearing. Call 877.396.7194. You and your family members must mention VSP.
Schedule exam. TruHearing will answer your questions and schedule a hearing exam with a local provider.
Attend appointment. The provider will make a recommendation, order the hearing aids through TruHearing
and fit them for you.
Learn more about this VSP Exclusive Member Extra at vsp.truhearing.com or, call 877.396.7194
with questions.
23Flexible Spending Account EnrollmentGuide
A health Flexible Spending Account (FSA) allows individuals to use pre-tax dollars to pay
for medical expenses not covered by insurance. A dependent care FSA, also known as a
Dependent Care Assistance Plan (DCAP) allows individuals to use pre-tax dollars for
W h a t is an FSA? daycare or dependent care expenses. The dependent care FSA (DCAP) cannot be used to
pay for medical expenses. Individuals elect to contribute a portion of their paychecks to
either a health FSA or dependent care FSA and save 25% to 40% in taxes.
Know the Rules:
Health (medical) FSA Health FSA and Dependent Care FSA Dependent Care FSA
Participants may claim and be paid out Contributions are subject to the IRS “use- Participants may only be paid what they
their entire annual election at any time. it-or-lose-it” rule. However, for the health have contributed at any point in time.
FSA, your employer has adopted a provision
Every expense must be substantiated. allowing up to a $500 carry over of Participants must be ready to provide
Participants must be able to provide unclaimed monies. Unclaimed monies not receipts for dependent care expenses.
receipts, statements or bills for all carried over are forfeited at the end of the
expenses if substantiation is requested. plan year.
Dependent care expenses reimbursed by
Documents must include the date, amount
and description of the expense or service. Elections cannot be changed during the the dependent care FSA may not be used
plan year, unless the participant has a to claim the day care credit.
change of status. IRS Regulations define a
Only eligible expenses can be reimbursed. change of status.
Medical expenses are defined by IRS
rules. Expenses generally include items Expenses must be incurred by a
and services for the diagnosis, cure, participant, spouse or eligible dependents
mitigation, treatment, or prevention of during the current plan year and while
disease, or for the purpose of affecting participating. Expenses are incurred when
any structure or function of the body. See the medical care is provided and not when
IRS Publication 502. the expense is billed, the bill is due or when
the bill ispaid.
All over-the-counter drugs areeligible
along with all menstrual care products. Every employer sets the deadline when
claims and documentation must be
submitted after the end of the plan year. It
Only “out-of-pocket” medical expenses is usually 60 or 90 days after the end of the
are eligible for reimbursement. Medical plan year.
expenses covered by insurance or any
other plan or program are not eligible for
reimbursement.
Expenses for personal use or
cosmetic surgery are not eligible for
Tax Savings Examples:
reimbursement. See IRS Publication 502.
Dave, a single taxpayer, earns $27,000/year and has eligible medical
Medical expenses reimbursed under the expenses of $1,200/year.
health (medical) FSA may not be used to Dave's annual savings realized by participating in the FSA is $327 .
claim a federal income tax deduction.
Michael and Sharon, working parents, earn a total of $48,000/year.
They have $5,000 in child care expenses and $1,000 per year in
eligible medical expenses.
Their annual savings realized by participating in the FSA is $1,637 .
Assumptions are based off of 15% Federal, 4.63% State, and 7.65% FICA tax
24
PO Box 631458 · Littleton, CO 80163 · (888) 722-1223 · fax (866) 557-0109 · https://www.RockyMountainReserve.comHealth Care Reform &
EligibleExpenses Over -the-Counter Items:
Over-the-Counter Medicine and Drugs do not require a
prescription to be eligible for reimbursement under the
plan.
Common Eligible Medical Expenses: Allergy medications
Antacids
Eyeglasses, eye exams, sunglasses Anti-diarrhea medicine
(prescription) Bug-bite medication
Over-the-counter drugs Cold medicine
Menstrual care products Cough drops and throat lozenges
Eye surgery Diaper rash ointments
Fertility enhancement Hemorrhoid medication
HMO expenses Incontinence supplies
Laxatives
Hearing aids, batteries, and exams
Hospital services Muscle/joint pain products/rubs
Immunizations, vaccines, flu shots Nicotine medications, gum,patch-es
Laboratory fees Pain relievers
LASIK eye surgery Sinus medications, nasal sprays, nasal strips
Medicines (prescribed) Sleep aids
Wart removal medication
Obstetric services
Optometrist
Orthodontia These are only examples and this list is not all-inclusive --
Prescription drugs it only provides some of the more common expenses.
Psychiatric care
Additional information is available in IRS Publication 502 and
Psychologist
Speech therapy on our website: https://www.rockymountainreserve.com
Stop smoking programs
Surgery/operations
Therapy Over-The-Counter Items:
Vasectomy
Wheelchair Band-aids/bandages
X-rays Cold/hot packs for injuries
Dual Purpose Expenses That Potentially Qualify: Condoms
Contact lens solutions
The expense must be for a specific medical reason Diabetic supplies
and be accompanied by a prescription. First aid kits
Medical alert bracelets/necklaces
Massage therapy Pregnancy test kits
Vitamins Thermometers
Supplements
Herbal supplements Dependent Care Eligible Expenses:
Natural medicines
Aromatherapy A dependent receiving care must be a child under
Weight-loss program the age of 13, or a tax dependent unable to provide
Health club dues for their own care, who resides with you. The care
must be necessary for you or your spouse to be
Ineligible Expenses: gainfully employed or to go to school. Care may be
provided by anyone other than your spouse or your
Cosmetic surgery children under the age of 19. Expenses for schooling,
Long term care kindergarten, over-night care, and nursing homes
Hair transplant/re-growth are not reimbursable. See IRS Publication 503.
Maternity clothes The maximum you can elect, in a calendar year, is
Nutritional supplements equal to the smallest of the following:
Personal use items: such as toiletries,cotton $5,000 – Married and filing federal taxes jointly or
swabs, toothbrush, toothpaste, facial care, a single parent
shampoo $2,500 – Married and filing separate federal tax
Teeth whitening return
Drunk drivingclasses The amount contributed year-to-date, is available
for reimbursement. 25Access to Your FSAMoney
Access with a Debit Card
Pay for Expenses w i t h a Deb it Card
Easy to use- the Benefits Card is a stored-value card that simplifies the process of paying for qualified expenses.
Restricted by merchant code (MCC) to healthcare-related merchants where MasterCard is accepted.
It pays directly at the point of sale - No waiting for reimbursement!
You can use it to pay for online mail-order prescriptions.
You must save all receipts and be prepared to provide receipts if they are requested.
Save All Receipts For Purchases M a d e W i t h The Benefit Card
Please r em em b er to keep receipts for all purchases made with th e Benefit Card. Per IRS regulations, Rocky M o u n tain Reserve
may request itemized receipts to verify th e eligibility of purchases made with th e card.
All receipts or other proofs of purchase must include the date of service, name of provider, dollar amount, and a description of
the purchased service or product.
Any receipt that does not contain the detailed information described above is not acceptable. Credit card receipts and
canceled checks are not acceptable.
If the requested receipt is lost or otherwise unavailable, most providers can provide a detailed statement documenting FSA eligible
purchases. An Explanation of Benefits (EOB) is sufficient documentation to substantiate a transaction. Additional documentation
will be requested UNLESS the transaction matches a co-payment, a previously approved repetitive expense, or was at a merchant
that has installed the inventory information approval system referenced above.
If a receipt is requested, Rocky Mountain Reserve will email a request within hours. Participants can mail, fax, email, upload
the receipt online, or take a picture and submit it through the mobile app.
N o Receipt Retailers
Some retailers have installed an inventory information approval system for most medical expenses and receipts will not be
requested. Below is a sample of some of the retailers who have installed the inventory information approval system:
1-800 Contacts Costco KingSoopers Safeway
Albertsons CVS Kroger Sam'sClub
City Market Drugstore.com Rite Aid Target
Submit Claims for Reimbursement
Submit Claims Through a Mobile Application
Take a picture of your receipt and submit it with your reimbursement request through the mobile application. You can also
look up your account balance and recent transactions. Claims submitted through the mobile application receive high
priority. To
download the mobile application: Search for “RM R Benefits”
Submit Claims Through a W e b Portal
Participants may file requests for reimbursement directly to Rocky Mountain Reserve through
https://www.rockymountainreserve.com . Claims submitted through the web portal receive high priority.
Submit Claims Manually
Participants may also file requests for reimbursement directly to RMR through fax, mail, or email.
Fax: 866.557.0109 E-mail: claims@rmrbenefits.com Mail: PO Box 631458 Littleton, CO 80163
26
Claims are paid by direct deposit or check.Online &MobileAccess
www.rockymountainreserve.com
To Create Your Online Account: W i t h Online Access You Can:
1 Go to
www.rockymountainreserve.com Viewbalance
2 Click on "Login/Register" in the top right- View transaction history
hand corner
Download statements
3 Submit claimsand upload
Click on "Employee Registration"
receipts
4 Username will be the name you use to log in for
the web portal and mobile application. View debit card receipt requests
5 The password must contain at least 3 of these: special
and uploadreceipts
character, number, upper or lower case letter
6 For Employee ID Use SS# or other assigned
Employee ID.
7 For Registration ID select “Card Number” which is your
Benefits MasterCard. If you do not have a card, your
Employer will give you an Employer ID.
Download the mobile application and gain real-time accessto your:
Flexible Spending Account (FSA)
Search "RMR Benefits" on the app store 27
PO Box 631458 · Littleton, CO 80163 · (888) 722-1223 · fax (866) 557-0109 · https://www.RockyMountainReserve.comLIFE INSURANCE
Mesa County provides eligible employees (at no cost to the employee) Basic Life/AD&D coverage. All
regular full-time employees scheduled to work at least 20 hours each week in active employment in the
U.S. will be enrolled in the group Life/AD&D plan.
Life Insurance Amount
$20,000
Reduction Schedule Benefits are reduced to 65% at age 65; to 40% of the original amount at age 70,
and to 25% of the original amount at age 75.
Accidental Death &
Dismemberment (AD&D) Loss: Amount of Additional Benefit Paid:
Life 100%
Loss must occur while One Limb 50%
insured and within 365 days Speech & Hearing 100%
after the accident is Speech or Hearing 50%
sustained Thumb & Index Finger of Same Hand 25%
Quadriplegia 100%
The total benefit paid for all Paraplegia 75%
losses due to the same Hemiplegia 50%
accident will not be more Sight of One Eye 50%
than 100%
If you are certified as terminally ill with a life expectancy of 12 months or less, you
Accelerated Benefit
may elect to receive a portion of your life insurance benefit up to 75% in advance.
Upon death, your beneficiary will receive the balance of your benefit.
Safe Driver Benefit (seatbelt & airbag)
Dependent Education Benefit
Child Care Benefit
Additional Benefits Disappearance & Exposure
Child Education
Repatriation
Portability
$5,000 Spouse (no age reduction)
Basic Employee-Paid
Child(ren) 14 days to 6 months - $1,000 / Age 19 or 26 if a full-time student -
Voluntary Dependent Life: $2,500
*The above benefits are meant for illustrative purposes only and are only a brief look at your benefits. See your plan
document for details on benefits, limitations and exclusions. In the event of a discrepancy the plan document will prevail.
Certificate of Insurance is available via your Mesa Wave Portal. Printed documents are available upon request
28Employer Paid Life/AD&D Insurance Continued...
Insured by Unum
Personalized financial counseling provides expert, objective financial counseling to
survivors and terminally ill employees at no cost. The financial consultants are
Life Planning Financial &
master level consultants that will not offer to sell any product or service. They will
Legal Resources
help develop strategies needed to protect resources, preserve current lifestyles,
and build future security.
If you become totally disabled for 6 months while insured, your life insurance will
Waiver of Premium continue without payment to age 70 if the disability began prior to age 65. If total
disability ends, you may exercise the conversion privilege.
If your insurance terminates because you are no longer employed full-time, your
insurance may be converted to an individual life insurance policy if you apply and
Conversion
include payment of the first premium within 31 days of termination.
Conversion does not require proof of medical insurability.
To complement your Group Life Insurance coverage, you and your immediate
family have access to Emergency Travel Assistance administered by Assist America.
Emergency Travel Assistance offers you and your dependents worldwide medical,
travel, concierge and legal and financial assistance services, 24 hours a day, 365
days a year.
If you have a medical emergency while you are more than 100 miles away from
home, you don’t have to face it alone. With one phone call you can be connected
to Assist America’s staff of medically trained, multilingual professionals who can
advise you in a medical emergency, 24x7. No matter where you are in the world,
they will help you access or receive:
Travel Assistance Benefits
Pre-qualified, English-speaking professionals working in hospitals, pharmacies, and
dental offices; Medical consultation, evaluation and referral; Hospital admission,
critical care monitoring, emergency medical evacuation, transportation to return
home or to a rehabilitation facility, lost prescription assistance, legal and
interpreter services, and more.
Assist America pays for 100% of the services it arranges for and provides.
Your spouse and dependent children up to age 19 are also covered.
This is just a summary of your benefits. Please refer to your certificate booklet for a complete plan description. If
the terms of this summary differ from the Certificate, the Certificate will govern.
29Voluntary Life and AD&D Insurance
Employee: Up to 5 times earnings in increments of $10,000. Not to exceed $400,000.
Spouse: Up to 100% of employee amount or $200,000, in increments of $5,000.
Coverage Amounts
(Term Life and AD&D) Children: $10,000 of coverage if eligible. Maximum death benefit for a child between the ages
of live birth and 6 months is $1,000.
Reduction Schedule
Benefits are reduced to 65% at age 70, and to 50% of the original amount at age 75
$200,000 for yourself and any amount of coverage up to $30,000 for your spouse.
Guarantee Issue Any Life insurance coverage over the Guarantee Issue amount(s) will be subject to
evidence of insurability.
Loss: Amount of Benefit Paid:
Accidental Death & Life 100%
Dismemberment (AD&D) Both Hands 100%
Both Feet 100%
Sight of Both Eyes 100%
The total benefit paid for all One Hand & Sight of One Eye 100%
losses due to the same One Foot & Sight of One Eye 100%
accident will not be more Speech & Hearing 100%
than 100%
Other losses may be covered.
Education Benefit: If you or your insured spouse die within 365 days of an accident,
an additional benefit is paid to your dependent child(ren). Your child(ren) must be a
Additional AD&D full-time student beyond grade 12.
Benefits Seat Belt/Air Bag Benefit: If you or your insured dependent(s) die in a car accident and
are wearing a properly fastened seat belt and/or are in a seat with an air bag, an
amount will be paid in addition to the AD&D benefit.
*The above benefits are meant for illustrative purposes only and are only a brief look at your benefits. See your plan
document for details on benefits, limitations and exclusions. In the event of a discrepancy the plan document will prevail.
Certificate of Insurance is available via your Mesa Wave Portal. Printed documents are available upon request.
30Voluntary Life and AD&D Insurance Continued...
Insured by Unum
Each year you will be given the opportunity to change your Life and AD&D coverage, and may purchase additional life
insurance up to the guarantee issue amounts without evidence of insurability as long as you are already enrolled in the plan
(even at a minimum of $10,000).
If you waived coverage when you were first eligible and want to apply at a later date, all amounts are subject to evidence of
insurability – there is no guarantee issue available.
If you become terminally ill and are not expected to live beyond a certain time
period as stated in your certificate booklet, you may request up to 75% of your life
Accelerated Benefit insurance amount up to $250,000, without fees or present value adjustments. A
doctor must certify your condition in order to qualify for this benefit. Upon your
death, the remaining benefit will be paid to your designated beneficiary(ies).
Personalized financial counseling provides expert, objective financial counseling to survivors
and terminally ill employees at no cost. The financial consultants are master level
consultants that will not offer to sell any product or service. They will help develop
Life Planning Financial &
strategies needed to protect resources, preserve current lifestyles, and build future
Legal Resources security.
If you become disabled (as defined by your plan) and are no longer able to work, your
premium payments may be waived during the period of disability.
Waiver of Premium
If you retire, reduce your hours or leave your employer, you can take this coverage with
you according to the terms outlined in the contract. However, if you have a medical
condition which has a material effect on life expectancy, you will be ineligible to port your
Portability/Conversion coverage. You may also have the option to convert your Term life coverage to an individual
life insurance policy.
Life benefits will not be paid for deaths caused by suicide in the first twenty-four
months after your effective date of coverage.
Suicide Exclusion
This is just a summary of your benefits. Please refer to your certificate booklet for your complete plan description.
If the terms of this summary differ from the Certificate, the Certificate will govern.
31LONG-TERM DISABILITY INSURANCE
Monthly Benefit 60% of monthly earnings to a maximum benefit of $6,000, reduced by other income
Elimination Period Benefits will begin after 180 days of disability
Benefit Duration Your duration of benefits is based on your age when the disability occurs. Your LTD benefits are payable for
the period during which you continue to meet the definition of disability up to the Social Security Normal
Retirement Age. If your disability occurs on or after age 62, benefits would be paid for a reduced period of
time.
Disability Definition You are disabled when Unum determines that:
• you are limited from performing the material and substantial duties of your regular occupation due to
your sickness or injury; and
• you have a 20% or more loss in weekly earnings due to the same sickness or injury.
• After benefits have been paid for 24 months, you are disabled when Unum determines that due to the
same sickness or injury, you are unable to perform the duties of any gainful occupation for which you
are reasonably fitted by education, training or experience.
You must be under the regular care of a physician in order to be considered disabled.
Gainful Occupation Gainful occupation means an occupation that is or can be expected to provide you with an income within
12 months of your return to work that exceeds:
• 80% of your indexed monthly earnings, if you are working
• 60% of your indexed monthly earnings, if you are not working
Pre-Existing Conditions If you received treatment 3 months prior to your effective date under this plan and are disabled from that
condition within the first 12 months, that disability will be excluded.
Rehabilitation and Unum has a vocational Rehabilitation and Return to Work Assistance program available to assist you in
Return to Work returning to work. We will make the final determination of your eligibility for participation in the program
Assistance and will provide you with a written Rehabilitation and Return to Work Assistance plan developed
specifically for you. This program may include, but is not limited to the following benefits:
• coordination with your Employer to assist your return to work;
• adaptive equipment or job accommodations to allow you to work;
• vocational evaluation to determine how your disability may impact your employment options;
• job placement services;
• resume preparation;
• job seeking skills training; or
• education and retraining expenses for a new occupation.
If you are participating in a Rehabilitation and Return to Work Assistance program, we will also pay an
additional disability benefit of 10% of your gross disability payment to a maximum of $1,000 per month. In
addition, we will make monthly payments to you for 3 months following the date your disability ends, if we
determine you are no longer disabled while:
• you are participating in a Rehabilitation and Return to Work Assistance program; and
• you are not able to find employment.
Survivor Benefit If you die after receiving benefits for 180 or more consecutive days, your eligible survivors will receive a
lump sum benefit equal to three months of your gross disability payment.
This is just a summary of your benefit. Please refer to your certificate booklet for your complete plan description. If
the terms of this summary differ from your Certificate, the Certificate will govern.
32ADDITIONAL VOLUNTARY BENEFITS
Aflac Group Accident Insurance Introducing added protection for life’s unexpected moments.
If you’re like most people, you don’t budget for life’s
unexpected moments. But at some point, you may make an
unexpected trip to your local emergency room. And
that could add a set of unexpected bills into the mix.
That’s the benefit of the Aflac group Accident Advantage Plus
plan.
In the event of a covered accident, the plan pays cash
benefits fast to help with the costs associated with out-of-
pocket expenses and bills—expenses major medical may
not take care of, including:
• Ambulance rides.
• Wheelchairs, crutches, and other medical appliances.
• Emergency room visits.
• Surgery and anesthesia.
• Bandages, stitches, and casts.
Aflac Group Critical Illness Insurance You can win the battle against a critical illness, but can you
handle the added costs? A group critical illness plan helps
prepare you for the added costs of battling a specific critical
illness. The good news is that many people with a critical
illness survive these life-threatening battles. Unfortunately,
as the recovery process begins, people become aware of the
medical bills that have piled up. Your recovery doesn’t have
to be spoiled by medical bills. With this plan, our goal is to
help you and your family cope with and recover from the
financial stress of surviving a critical illness.
Aflac Hospital Indemnity Insurance The average cost of a hospital stay is $10,000-and the
average length of a stay is 4.8 days. Hospital indemnity
insurance can help reduce costs by paying you or a covered
dependent a benefit to help cover your deductible,
coinsurance and other out-of-pocket costs due to a covered
sickness or injury related hospitalization.
Legal Shield Legal Plan Imagine having access to top-rated legal professionals,
without worrying about high hourly costs.
• Protect your family
• Save money and time
• Enjoy peace of mind… for pennies a day!
Preventive Law – Unlimited phone calls, letters and phone
calls on your behalf, legal contract and document review, will
preparation and annual updates, access to legal forms.
Trial Defense – Defense of civil actions, pre-trial and trial
assistance, coverage increases each year for the first 5 years.
Family services, motor vehicle, IRS audit services, 25%
member discount for services not covered on this plan.
This benefit summary was provided by Mesa County and Novo Benefits is not responsible for any discrepancies. 33You can also read
