Red Lobster Active Health Exchange - Frequently Asked Questions (FAQs)
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Red Lobster Active Health Exchange Frequently Asked Questions (FAQs)
FAQs Quick Start Menu
If you have a specific question, see if it’s in the list below and click on the link to be taken directly
to the answer you’re looking for. Otherwise, feel free to browse and scan the FAQs at your own pace.
THE AON ACTIVE HEALTH EXCHANGE™ ............................................................................................... 1
1. W HAT IS AN EXCHANGE? ....................................................................................................................... 1
2. IS AON’S EXCHANGE SPONSORED BY THE GOVERNMENT? ....................................................................... 1
3. W HAT DO I NEED TO KNOW ABOUT HEALTH CARE REFORM?..................................................................... 1
4. W HAT ARE THE BENEFITS OF THE EXCHANGE? ....................................................................................... 1
5. W HERE CAN I GET MORE INFORMATION? ................................................................................................ 2
OPEN ENROLLMENT .................................................................................................................................. 2
6. W HEN IS OPEN ENROLLMENT? .............................................................................................................. 2
7. W HAT WILL I NEED TO DO? .................................................................................................................... 2
8. W HO’S ELIGIBLE FOR BENEFITS? ........................................................................................................... 3
MY OPTIONS ................................................................................................................................................ 3
9. W HAT ARE MY OPTIONS FOR MEDICAL COVERAGE? ................................................................................. 3
10. AM I REQUIRED TO DESIGNATE A PRIMARY CARE PHYSICIAN? ............................................................... 4
11. IS ONE COVERAGE LEVEL BETTER THAN ANOTHER? ............................................................................. 4
12. W HAT’S THE DIFFERENCE BETWEEN A TRADITIONAL PPO AND A HIGH-DEDUCTIBLE PPO? .................... 4
13. CAN EACH FAMILY MEMBER CHOOSE A DIFFERENT MEDICAL COVERAGE LEVEL
OR INSURANCE CARRIER? ................................................................................................................. 4
14. W HICH MEDICAL INSURANCE CARRIERS WILL I BE ABLE TO CHOOSE FROM? .......................................... 5
15. W ILL I BE ABLE TO USE THE SAME PROVIDERS AS I DO TODAY? ............................................................ 5
16. HOW SHOULD I CHOOSE A MEDICAL INSURANCE CARRIER IF MY DEPENDENTS AND I LIVE
IN DIFFERENT STATES? ..................................................................................................................... 5
17. HOW DO I DECIDE WHICH MEDICAL OPTION IS RIGHT FOR ME? .............................................................. 6
18. W ILL PRE-EXISTING CONDITIONS BE COVERED? .................................................................................. 6
19. W HAT’S INCLUDED IN THE PREVENTIVE CARE THAT’S COVERED AT 100% BY ALL MEDICAL PLANS? ........ 6
20. HOW WILL MY PRESCRIPTION DRUGS BE COVERED? ............................................................................ 6
21. HOW ARE PRESCRIPTION DRUGS CATEGORIZED INTO “TIERS?”............................................................. 7
22. W HAT IS “PRIOR REVIEW” AND WHEN IS IT REQUIRED? ......................................................................... 7
23. W HAT ARE MY OPTIONS FOR DENTAL COVERAGE?............................................................................... 8
24. AM I REQUIRED TO DESIGNATE A PRIMARY CARE DENTIST? .................................................................. 8
25. W HICH DENTAL INSURANCE CARRIERS WILL I BE ABLE TO CHOOSE FROM? ............................................ 8
26. W HAT DO I NEED TO KNOW ABOUT DENTAL NETWORKS? ...................................................................... 8
27. W HY IS THE PLATINUM DENTAL COVERAGE LEVEL LESS EXPENSIVE THAN OTHER OPTIONS? .................. 9
28. W HAT ARE MY OPTIONS FOR VISION COVERAGE? ................................................................................ 9
29. W HICH VISION INSURANCE CARRIERS WILL I BE ABLE TO CHOOSE FROM? ............................................. 9
30. W HAT DO I NEED TO KNOW ABOUT VISION NETWORKS? ....................................................................... 9
PAYING FOR COVERAGE ........................................................................................................................ 10
31. W HEN WILL I FIND OUT ACTUAL COSTS? ........................................................................................... 10
32. DO I GET TO KEEP THE RED LOBSTER CREDIT IF I DON’T ENROLL IN COVERAGE? ................................ 10
33. W HAT WILL I HAVE TO PAY WHEN I NEED MEDICAL CARE? .................................................................. 10
34. W HAT’S A DEDUCTIBLE AND HOW DOES IT WORK? ............................................................................. 10
35. W HAT’S AN OUT-OF-POCKET MAXIMUM AND HOW DOES IT WORK? ...................................................... 11
36. W HAT’S A HEALTH SAVINGS ACCOUNT (HSA)? ................................................................................ 11
Salaried ii37. HOW IS AN HSA DIFFERENT FROM A HEALTH CARE FLEXIBLE SPENDING ACCOUNT
(HEALTH CARE FSA)?.................................................................................................................... 12
38. CAN I ENROLL IN BOTH AN HSA AND A HEALTH CARE FSA? .............................................................. 12
39. W HY WOULD I WANT TO USE BOTH AN HSA AND A LIMITED PURPOSE HEALTH CARE FSA? ................. 13
40. W HY WOULD I WANT TO USE AN HSA? ............................................................................................. 13
41. CAN I USE MY SPOUSE’S HEALTH CARE FSA FOR MEDICAL EXPENSES IF I’M CONTRIBUTING
TO AN HSA? ................................................................................................................................. 13
42. CAN I KEEP MY CURRENT HSA?....................................................................................................... 13
43. W ILL MY HSA ADMINISTRATOR CHANGE? ......................................................................................... 13
Aon Active Health Exchange and Your Spending Account are trademarks of Hewitt Associates LLC.
Salaried iiiThe Aon Active Health Exchange™
1. What is an exchange?
An exchange is a new way for you to get medical, dental, and vision coverage. It is an online
insurance marketplace where buyers like you can shop for coverage from multiple health insurance
carriers who are competing for your business. An exchange merges the best of both worlds: group
rates with more individual choice and price competitiveness that comes from free-market
competition.
The Aon Active Health Exchange is America’s first national large employer multi-insurance carrier
exchange. Its website is easy to navigate and, just like other online stores, you’ll be able to see all
your options and sort by the features that are most important to you. By the time you complete your
enrollment, you should feel confident that you’ve selected the right coverage options at a price you
can afford.
To learn more about Aon’s private exchange, watch this short video.
2. Is Aon’s exchange sponsored by the government?
No. The Aon Active Health Exchange is a private exchange. It is unrelated to the government-run
state and federal health insurance exchanges, or marketplaces. It does, however, provide benefits
consistent with the law and guarantees coverage, regardless of pre-existing conditions.
3. What do I need to know about health care reform?
The “health care reform” law, also known as the Affordable Care Act (ACA), went into effect in
March 2010. The goal of the law is to make health insurance available to everyone, regardless of
medical history or ability to pay.
As part of the health care reform law, most Americans were required to have health insurance
generally as of January 1, 2014. This is called the “individual mandate.” If you don’t have coverage,
you’ll pay a penalty (details available at www.healthcare.gov).
4. What are the benefits of the exchange?
The medical, dental, and vision benefits offered through the exchange offer you:
Lots of choices. Traditionally, you got to choose from the health plans offered by your
company. Through the exchange, you’ll be able to choose from several coverage levels, a
variety of insurance carriers, and a range of costs.
Competitive pricing. The insurance carriers are competing for your business. So it’s in their
best interests to offer their best prices. Plus, Red Lobster will provide a credit to use toward the
cost of your coverage.
You also have help when you need it. There are great tools and resources to help you every step of
the way. See question #5 for details about tools and resources.
Return to FAQs Quick Start Menu
Salaried 15. Where can I get more information?
There are lots of resources available to help before, during, and after you enroll, including:
Before you enroll—Go to the Make It Yours website at redlobster.makeityoursource.com to
learn how the exchange works. You can watch videos and find information about your coverage
options. You can also visit insurance carrier microsites now or contact the insurance carriers
directly with specific questions. The insurance carriers’ contact information is available on the
Make It Yours website.
When you enroll—During Open Enrollment, November 10 to November 26, 2014, log on to My
Total Rewards on DiSH by clicking on My Total Rewards. There, you can compare your
options, use helpful tools (for example, to get a personalized medical plan suggestion), and
enroll. When you log on to My Total Rewards during Open Enrollment, that’s also where you’ll
be able to see the credit amount from Red Lobster and prices by option.
If you need additional assistance, customer service representatives are available through
online chat or the Red Lobster Benefits Center. You can call 1.855.596.7452 Monday through
Friday, from 8:00 a.m. to 8:00 p.m. ET, during Open Enrollment, to get answers to your
questions about the exchange and enrollment process. You can also call the insurance carriers
with specific questions about the plans they offer.
Throughout next year—For questions about your coverage, always start by contacting your
insurance carrier directly. They know their plans best and have the final authority on all claims,
billing disputes, etc. If you need help with more complex coverage issues, call the Red Lobster
Benefits Center at 1.855.596.7452 and ask to be connected with a health care advocate. For
more tips on making the most of your benefits, visit the Make It Yours website at
redlobster.makeityoursource.com.
Open Enrollment
6. When is Open Enrollment?
Open Enrollment for your 2015 benefits will take place from November 10 through November 26,
2014.
7. What will I need to do?
Between November 10 and November 26, 2014, you should enroll to make sure you get the
coverage you want next year! Not only could your needs have changed, but your options, prices,
and network of doctors could have changed too. It’s worth a look even if you choose exactly what
you have today.
If you don’t enroll, your current medical, dental, and vision coverage will continue at 2015 prices
unless it is no longer available to you.
To enroll, go to My Total Rewards on DiSH. Over the course of the enrollment process, you’ll need
to:
Enroll the eligible dependents you want to cover in 2015.
Choose the insurance carriers and coverage levels you want for your medical, dental, and
vision benefits.
Return to FAQs Quick Start Menu
Salaried 2You can get information about the enrollment process and available tools on the Make It Yours
website at redlobster.makeityoursource.com.
8. Who’s eligible for benefits?
Full-time employees are eligible for Red Lobster’s medical, dental, and vision benefits. Regular
part-time employees are eligible for Red Lobster’s dental and vision benefits.
Full-time means that you work between 30 and 40 standard hours per week.
Regular part-time employment means that you work fewer than 30 hours per week.
Eligible dependents include:
Your spouse or domestic partner (including common-law marriage where applicable by state
law, as well as a same-sex domestic partnership);
Your eligible children under age 26; and
Your eligible children of any age who became handicapped or totally disabled before age 26.
My Options
9. What are my options for medical coverage?
1
You have several coverage levels to choose from, including:
Bronze: A basic, high-deductible plan with a Health Savings Account (HSA) and prescription
drug coinsurance
Bronze Plus: A buy-up to the Bronze option—a high-deductible plan with a Health Savings
Account (HSA) and prescription drug coinsurance
Silver: A high-deductible plan with an HSA and prescription drug coinsurance
Gold: A PPO plan with prescription drug copays or coinsurance
Platinum: A PPO plan with prescription drug copays that covers in-network care and offers
limited benefits for out-of-network care (or, for some insurance carriers in CA, CO, DC, GA,
MD, OR, VA, and WA—an HMO plan with prescription drug copays that covers in-network care
only)
Each coverage level is available from multiple insurance carriers at different costs. When you
enroll, you’ll be able to compare benefits and features across your medical options. Watch this
short video to find out how coverage levels cover you in different ways.
Do you live in California? Your plans might be a little different, depending on the insurance carrier
you choose.
Return to FAQs Quick Start Menu
1
If you live outside the service areas of all the insurance carriers, an out-of-area plan through Aetna at the Silver or
Gold coverage level will be your only choice.
Salaried 310. Am I required to designate a primary care physician?
You must designate a primary care physician to coordinate your medical care if you:
Choose Kaiser Permanente as your insurance carrier;
Live in California and choose UnitedHealthcare as your insurance carrier; or
Live in California and choose Platinum as your coverage level and Health Net as your
insurance carrier.
11. Is one coverage level better than another?
No. Don’t let the names of the coverage levels fool you—one option isn’t better than another.
They’re designed to give you choice so that you can find the option that makes the most sense for
your situation. Remember to take your total costs into consideration, which includes what you pay
out of your paycheck (before-tax premiums) and what you pay out of your pocket (deductibles,
coinsurance, copays) when you get medical care.
For example, for medical coverage, the Gold and Platinum coverage levels will cost you more each
paycheck, but less when you receive care. These medical coverage levels have copays for some
services and lower deductibles, coinsurance, and out-of-pocket maximums compared to the
Bronze, Bronze Plus, and Silver coverage levels.
The Bronze, Bronze Plus, and Silver coverage levels come with lower paycheck costs (before-tax
premiums) and higher deductibles, coinsurance, and out-of-pocket maximums. If you don’t need a
lot of medical care, you’ll spend less overall because you’re not paying premiums for coverage you
don’t need.
12. What’s the difference between a traditional PPO and a high-deductible PPO?
A PPO is a type of medical plan that uses a network of physicians, hospitals, and other health care
providers that have agreed to provide care at negotiated prices. You can also go to out-of-network
providers, but you’ll pay more.
When you enroll in a traditional PPO, like a Gold plan, you have to meet a low deductible before the
plan starts paying a percentage of the costs. For example, the Gold plan deductible is $600 for
Employee Only coverage and $1,200 for Family coverage. In exchange for a lower deductible, you
will pay more each paycheck.
A high-deductible PPO plan operates the same, but as the name suggests, you have a higher
deductible before your coverage kicks in. For example, the deductible in the Silver plan is $1,500
for Employee Only coverage and $3,000 for Family coverage. You’ll pay the full cost of office visits
and prescription drugs until you meet the deductible. But to balance the cost of the high deductible,
you will pay less each paycheck. Once you meet your deductible, you get the protection of a
traditional PPO and pay a percentage of your ongoing expenses, up to the out-of-pocket maximum.
See question #34 for more details about the deductible. Note: If you have money in a Health
Savings Account (HSA), you can use the money in your HSA to pay for qualified expenses.
13. Can each family member choose a different medical coverage level or insurance
carrier?
No. All family members must be enrolled in the same plan.
Return to FAQs Quick Start Menu
Salaried 414. Which medical insurance carriers will I be able to choose from?
Most of the largest insurance carriers are participating in the exchange. Keep in mind that carriers
may vary by region. And any state that is a part of your carrier's name refers to where the carrier
operates from (i.e., which state has primary jurisdiction over the laws, rules, and regulations the
carrier follows)—it generally isn't a reference to the network. For example, Florida Blue offers
coverage nationally. That means Florida Blue is the plan available to you and has providers
nationally, regardless of which state you live in.
For medical, the insurance carriers offering coverage include Aetna, Dean / Prevea360, Florida
Blue, Health Net, Kaiser Permanente, and UnitedHealthcare. Your specific options are based on
where you live. You’ll be able to see the options available to you when you enroll.
Watch this short video for things you should consider when choosing a medical insurance carrier.
The carriers have designed special microsites to give you a preview of their services, networks, and
more. You should check out the microsites now to get a closer look at the carriers you’re
considering. You can get to the carrier microsites through the Make It Yours website at
redlobster.makeityoursource.com. Once you’re enrolled in coverage, you’ll be able to register
and log on to the carrier’s main website for personalized information.
15. Will I be able to use the same providers as I do today?
It depends. Each insurance carrier has its own network of preferred providers. If you want to keep
seeing your current doctors, select an insurance carrier that includes your preferred providers (e.g.,
doctors, specialists, hospitals) in its network. Even if you can keep your current insurance carrier
through the exchange, the provider network could be different and can change from year to year, so
always check the provider directories before making a decision.
To see whether your doctor is in network:
Before enrollment, check out the insurance carrier microsites. Follow the instructions on the
microsites to make sure you are searching for providers in the exchange network.
During enrollment, check the networks of each insurance carrier you’re considering on My Total
Rewards.
16. How should I choose a medical insurance carrier if my dependents and I live in
different states?
In this situation, you may want to consider one of the national insurance carriers that offer national
provider networks, so that your dependents have access to in-network providers in most locations.
To search for providers:
Before enrollment, check out the insurance carrier microsites listed on the Make It Yours
website under Learn Your Options > Medical > Insurance Carriers. Follow the instructions on
the microsites to make sure you are searching for providers in the exchange network.
During enrollment, check the networks of each insurance carrier you’re considering on My Total
Rewards.
If you have any questions during Open Enrollment, you can call the Red Lobster Benefits Center at
1.855.596.7452. Customer service representatives are available Monday through Friday, from
8:00 a.m. to 8:00 p.m. ET. The insurance carriers can also answer specific questions about their
provider networks.
Return to FAQs Quick Start Menu
Salaried 5Keep in mind that any state that is a part of your carrier's name refers to where the carrier operates
from (i.e., which state has primary jurisdiction over the laws, rules, and regulations the carrier
follows)—it generally isn't a reference to the network. For example, Florida Blue offers coverage
nationally. That means Florida Blue is the plan available to you and has providers nationally,
regardless of which state you live in.
17. How do I decide which medical option is right for me?
You’ll have access to a number of resources to help you make smart decisions. You should start by
visiting the Make It Yours website at redlobster.makeityoursource.com to access videos, details
about your options, a Reference Guide with comparison charts, and more.
When you enroll, you’ll be able to see the credit amount from Red Lobster and your price options
on My Total Rewards on DiSH. You’ll also be able to access tools that can give you a personalized
suggestion, help compare the details of your options, and more.
If you need additional help, customer service representatives at the Red Lobster Benefits Center
will also be available Monday through Friday, from 8:00 a.m. to 8:00 p.m. ET, during Open
Enrollment, to answer questions about the exchange and enrollment process. Just call
1.855.596.7452. You can also call the insurance carriers with specific questions about the plans
they offer.
18. Will pre-existing conditions be covered?
Yes. When you enroll in medical coverage through the exchange, coverage is guaranteed,
regardless of whether you and/or your eligible dependents have pre-existing conditions.
19. What’s included in the preventive care that’s covered at 100% by all medical plans?
The U.S. Preventive Services Task Force recommendations are used to determine which services
are considered preventive services. The following outpatient preventive care services are 100%
paid by the plan when you see an in-network provider, without needing to meet the deductible.
Limitations vary by carrier, so check with your insurance carrier if you have any questions.
Annual physical exam Colorectal screening
Pediatric exam Prostate screening
Well-woman exam (includes Pap) Digital rectal exam
Mammogram Immunizations (child)
Bone density screening Immunizations (adult)
Cancer screenings Influenza vaccination (adult)
Cardiovascular screenings
20. How will my prescription drugs be covered?
Through the exchange, your prescription drug coverage is provided through your medical insurance
carrier’s pharmacy benefit manager—which could be a separate prescription drug company. Each
pharmacy benefit manager has its own rules about how prescription drugs are covered. That’s why
you need to do your homework to determine how your medications will be covered before choosing
an insurance carrier.
Return to FAQs Quick Start Menu
Salaried 6If you or a family member regularly takes medication, it is strongly recommended that you
call the medical insurance carrier before you enroll to better understand how your particular
prescription drug(s) will be covered. Do not assume that your generic or brand name medication will
be covered the same way by each carrier. See the Reference Guide posted on the Make It Yours
website at redlobster.makeityoursource.com for a cheat sheet of questions to ask.
Your coverage also depends on your coverage level:
If you enroll in the Bronze, Bronze Plus, or Silver coverage level, you’ll pay 100% of the cost of
prescription drugs until you meet the deductible. After you meet the deductible, you’ll pay 20%
coinsurance until you reach the out-of-pocket maximum, and then you’ll pay nothing. (See
question #34 for more details about the deductible.) Note: If you have money in a Health
Savings Account (HSA), you can use the money in your HSA to pay for qualified expenses.
If you enroll in a Gold or Platinum coverage level, you’ll pay a flat fee for prescription drugs until
you reach the out-of-pocket maximum, and then you’ll pay nothing. In the Gold plan though,
that’s only true for Tier 1 prescription drugs—you’ll pay coinsurance for Tier 2 and 3
prescription drugs until you reach the out-of-pocket maximum, and then you’ll pay nothing. Call
the insurance carrier or visit their microsite (posted on the Make It Yours website) for a listing of
medications in each tier.
21. How are prescription drugs categorized into “tiers?”
In 2015, prescription drugs are categorized into “tiers” by type of drug. These tiers are a standard
way to determine the pricing of like drugs across all of the carriers’ plans. Here’s a general
description of each tier:
Tier 1: The lowest priced options; most generic drugs, and a few branded drug options
Tier 2: Medium priced options; branded drugs in the formulary, plus some higher priced
generics
Tier 3: Higher priced options; branded drugs that are not in the formulary, plus some higher
priced generics
Tier 4: Brand name drugs with generics
Tier 5: 100% covered preventive drugs
22. What is “prior review” and when is it required?
Before getting certain types of care, you or your doctor may be required to run it by your insurance
carrier first. Getting “prior review” (also referred to as prior authorization or precertification) allows
the carrier to make sure you’re eligible for the services, ensure you’re getting care that makes
sense for your condition, and confirm how the bill is going to be paid.
Who completes the process depends on where you get care:
When you stay in-network, your doctor usually completes the process on your behalf when it’s
required. But you should always confirm with your doctor to be sure they are handling it.
If you go out-of-network, you are usually responsible for completing the process. You may have
to work with your doctor or directly with your insurance carrier to fill out paperwork and receive
the appropriate approval before getting care.
Return to FAQs Quick Start Menu
Salaried 7When prior review is required and you don’t get preapproved, you could get stuck paying most or
all of the bill. For that reason, it’s always in your best interest to ask your doctor whether you need
to do anything in advance and confirm that services you need will be covered by your insurance
carrier.
23. What are my options for dental coverage?
You have several coverage levels to choose from, including:
Bronze: A basic PPO plan that covers in- and out-of-network care, but does not cover major or
orthodontic expenses
Silver: A buy-up to the basic PPO plan that covers in- and out-of-network care, including
coverage for major services and, for children up to age 19, orthodontic expenses
Gold: An enhanced PPO plan that covers in- and out-of-network care, including coverage for
major services and orthodontic expenses for children and adults
Platinum: A DHMO plan that covers in-network care only, including orthodontic expenses for
children and adults (not available in AK, ME, MT, ND, NH, SD, VT, WY, and some other limited
areas)
Each coverage level is available from different insurance carriers at different costs. When you
enroll, you’ll be able to compare benefits and features across your dental options.
24. Am I required to designate a primary care dentist?
You must designate a primary care dentist to coordinate your care if you elect the Platinum
coverage level (where available by carrier) and choose Delta Dental, MetLife, or UnitedHealthcare
as your insurance carrier.
25. Which dental insurance carriers will I be able to choose from?
You’ll be able to choose from Aetna, Delta Dental, MetLife, and UnitedHealthcare.
The carriers have designed special microsites to give you a preview of their services, networks, and
more. You should check out the microsites now to get a closer look at the carriers you’re
considering. You can get to the carrier microsites through the Make It Yours website at
redlobster.makeityoursource.com. Once you’re enrolled in coverage, you’ll be able to register
and log on to the carrier’s main website for personalized information.
26. What do I need to know about dental networks?
Just like the medical plans, each dental insurance carrier has its own provider networks that can
vary by the coverage level you choose. If it’s important that you continue using the same dentist,
you should check to see whether your dentist is in the network before you choose a carrier.
To see whether your dentist is in network:
Before enrollment, check out the insurance carrier microsites. Follow the instructions on the
microsites to make sure you are searching for providers in the exchange network.
During enrollment, check the networks of each insurance carrier you’re considering on My Total
Rewards.
Return to FAQs Quick Start Menu
Salaried 8If you are considering a Platinum dental plan:
It may cost less than some of the other options, but you must get care from a dentist who
participates in the insurance carrier’s Platinum network. The network could be considerably
smaller, so be sure to check the availability of local in-network dentists before you enroll.
The Platinum dental plan does not provide out-of-network benefits. So if you don’t use a
network dentist, you’ll pay for the full cost of services.
27. Why is the Platinum dental coverage level less expensive than other options?
Dentists who participate in the Platinum (DHMO) network are unique because they get paid a set
amount per member no matter how often services are used. That gives DHMO dentists an extra
reason to keep their patients healthy and control costs. In addition, individuals who enroll in a
DHMO are typically required to select a primary care dentist. Having one dentist coordinate your
care also helps to control costs. For these reasons, insurance carriers can often offer DHMOs at
lower prices than other options.
28. What are my options for vision coverage?
You have several coverage levels to choose from, including:
Bronze: Exam-only option that provides discounts for materials (e.g., lenses, frames, contacts)
Silver: A PPO plan that covers in- and out-of-network care
Gold: An enhanced PPO plan that covers in- and out-of-network care
Each coverage level is available from different insurance carriers at different costs. When you
enroll, you’ll be able to compare benefits and features across your vision options.
29. Which vision insurance carriers will I be able to choose from?
You’ll be able to choose from EyeMed, MetLife, UnitedHealthcare, and VSP.
The carriers have designed special microsites to give you a preview of their services, networks, and
more. You should check out the microsites now to get a closer look at the carriers you’re
considering. Once you’re enrolled in coverage, you’ll be able to register and log on to the carrier’s
main website for personalized information.
30. What do I need to know about vision networks?
Each vision insurance carrier has its own provider networks. If it’s important that you continue using
the same eye doctor, you should check to see whether your eye doctor is in the network before you
choose a carrier.
To see whether your eye doctor is in network:
Before enrollment, check out the insurance carrier microsites. Follow the instructions on the
microsites to make sure you are searching for providers in the exchange network.
During enrollment, check the networks of each insurance carrier you’re considering on My Total
Rewards.
Return to FAQs Quick Start Menu
Salaried 9Paying for Coverage
31. When will I find out actual costs?
During the Open Enrollment window, you’ll be able to see the credit amount from Red Lobster and
your price options when you enroll on My Total Rewards on DiSH.
32. Do I get to keep the Red Lobster credit if I don’t enroll in coverage?
No. The credit you get from Red Lobster is for the medical coverage you purchase through the
exchange. A cash refund is not available.
33. What will I have to pay when I need medical care?
Other than preventive care, which is paid 100%, how much you have to pay when you need
medical care primarily depends on your coverage level. Find coverage details for all coverage
levels in the Reference Guide on the Make It Yours website at redlobster.makeityoursource.com.
34. What’s a deductible and how does it work?
The deductible is what you pay out of your own pocket before your insurance carrier begins to pay
a share of your costs. If you have a deductible, you pay the full “negotiated” costs of all in-network
services until you meet your deductible. The “negotiated” costs are the payments providers
(doctors, hospitals, labs, etc.) have agreed to accept for a particular service from the insurance
carrier.
How the medical plan deductible works depends on your coverage level:
The Gold medical coverage level has a traditional deductible. Once a covered family
member meets the individual deductible, your insurance will begin paying benefits for that
family member. Charges for all covered family members will continue to count toward the family
deductible. Once the family deductible is met, your insurance will pay benefits for all covered
family members.
The Bronze, Bronze Plus, and Silver medical coverage levels have a “true family
deductible.” This means that the entire family deductible must be met before your insurance
will pay benefits for any covered family members. There is no “individual deductible” in these
coverage levels when you have family coverage.
To clarify, if you choose a Bronze, Bronze Plus, or Silver coverage level, the individual
deductible only applies if you have Employee Only coverage. If you choose Employee +
Spouse/Domestic Partner, Employee + Children, or Family coverage, though, you must satisfy
the family deductible before coinsurance will kick in, even if only one family member has
expenses.
The Platinum coverage level does not have an in-network deductible. Keep in mind,
though, that in exchange for no deductible, the Platinum coverage level is usually the most
expensive coverage level per paycheck. Be sure to use in-network providers, as in some cases,
the Platinum level does not cover out-of-network services. Check with your carrier before
getting care.
The annual deductible doesn’t include copays or amounts taken out of your paycheck for health
coverage.
Do you use out-of-network providers? Out-of-network charges do not count toward your
in-network annual deductible; they only count toward your out-of-network deductible.
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Salaried 1035. What’s an out-of-pocket maximum and how does it work?
The annual out-of-pocket maximum is the most you and your covered family members would have
to pay in a year for health care costs. What counts toward your out-of-pocket maximum depends on
your medical coverage level:
With the Bronze, Bronze Plus, and Silver coverage levels, all medical and prescription drug
amounts you pay will count toward the out-of-pocket maximum.
With the Gold coverage level, medical and prescription drug copays and amounts you pay as
coinsurance will count toward the out-of-pocket maximum.
With the Platinum coverage level, medical and prescription drug copays will count toward the
out-of-pocket maximum.
The annual out-of-pocket maximum doesn’t include amounts taken out of your paycheck for health
coverage or certain copays under the Gold and Platinum coverage levels.
Do you use out-of-network providers? Out-of-network charges do not count toward your in-network
annual out-of-pocket maximum; they only count towards your out-of-network out-of-pocket
maximum.
36. What’s a Health Savings Account (HSA)?
An HSA is a special bank account that you can use when you enroll in a Bronze, Bronze Plus, or
Silver coverage level. It allows you to set aside tax-free money to pay for qualified health care
expenses, like your medical, dental, and vision copays; deductibles; and coinsurance. Because
you’ll be responsible for 100% of your medical and prescription drug expenses until you meet your
deductible in the Bronze, Bronze Plus, or Silver coverage levels, an HSA is a great way to pay less
for those out-of-pocket expenses because you’re using tax-free money.
Just make sure you use money in your HSA only for qualified health care expenses. If you use
money in your HSA for unqualified expenses, you’ll pay income taxes on that money and an
additional 20% penalty tax if you’re under age 65. Keep careful records of your health care
expenses and withdrawals from your HSA, in case you ever need to provide proof that your
expenses were qualified.
You can decide whether to enroll in an HSA and how much (if any) money you want to save. And if
you don’t have a lot of health care expenses, your money can stay in your account and earn tax-
free interest. If you have questions about the use and appropriateness of an HSA as it applies to
your specific situation, you should consult a tax professional.
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Salaried 1137. How is an HSA different from a Health Care Flexible Spending Account (Health Care
FSA)?
HSA Health Care FSA
Do I need to be enrolled in a Yes, you must be enrolled in a No, but if you enroll in a
particular medical coverage Bronze, Bronze Plus, or Silver Bronze, Bronze Plus, or Silver
level to participate? coverage level coverage level and contribute
to an HSA, your Health Care
FSA must be limited to dental
and vision expenses, and
medical expenses after you
have met the medical plan
deductible
Can I contribute to my account Yes Yes
before taxes?
Do unused dollars roll over Yes Yes, up to $500
from year to year?
Does the money in the Yes No
account earn interest?
Can I use a debit card to pay Yes Yes
for expenses?
Can I use the account to pay Yes Yes
for vision or dental expenses? Please note: If you also have a
Health Care FSA, your FSA will
pay eligible dental and vision
expenses and your HSA will pay
eligible medical expenses. Once
the FSA funds are depleted, your
HSA will begin paying eligible
dental and vision expenses, as
well.
How much can I contribute to For 2015, the annual limits set by $2,500
the account per year? the IRS are $3,350 for Employee
Only coverage, and $6,650 for
Family coverage. If you’ll be
age 55 or older next year, you
can also contribute an additional
$1,000 catch-up contribution.
38. Can I enroll in both an HSA and a Health Care FSA?
Yes. If you enroll in the Bronze, Bronze Plus, or Silver coverage level, you can participate in both
an HSA and a limited purpose Health Care FSA. If you contribute to your HSA, your Health Care
FSA will be “limited purpose” and can only be used to pay eligible dental and vision expenses.
Once you meet the medical plan deductible, then it can be used towards eligible medical expenses.
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Salaried 1239. Why would I want to use both an HSA and a limited purpose Health Care FSA?
Both accounts allow you to pay for eligible expenses with tax-free dollars. The biggest difference
between the accounts is that your HSA balance rolls over from year to year, even if you change
medical plans, leave the company, or retire. With the Health Care FSA (whether limited purpose or
not), any unused balance exceeding $500 is forfeited at the end of the year.
It may not be advantageous to enroll in both, except in unique situations. For example, if you expect
to have higher expenses than your HSA balance can cover (based on the maximum you can
contribute each year), you may want to contribute to the limited purpose Health Care FSA also to
pay for those expenses with tax-free money, once the health plan deductible is reached.
40. Why would I want to use an HSA?
An HSA lets you set aside money to pay for qualified health care expenses, like your medical,
dental, and vision copays; deductibles; and coinsurance. You decide how much money you want to
save, and you can change it at any time.
The HSA has the following tax advantages:
Your contributions to an HSA are tax-free, meaning that they are deducted from your paycheck
before taxes are taken out.
Interest earnings on your HSA balance are not taxed.
You are not taxed on the HSA dollars when you use them to pay eligible expenses.
41. Can I use my spouse’s Health Care FSA for medical expenses if I’m contributing to
an HSA?
No. When you’re contributing to an HSA, you cannot use a Health Care FSA for medical expenses.
However, if your spouse's employer offers a Limited Use HC FSA, then post-deductible medical
expenses may be eligible.
42. Can I keep my current HSA?
Yes. If you currently have an HSA and you have money left over at year-end, the unspent funds will
remain in your HSA, earn tax-free interest, and be available for qualified health care expenses at
any time in the future.
In order to continue contributing to your HSA, you need to meet the following criteria:
You must enroll in a high-deductible medical plan at the Bronze, Bronze Plus, or Silver
coverage level;
You cannot be enrolled in Medicare or TRICARE;
You are not claimed as a dependent on someone else’s tax return;
You are not covered by any other health insurance plan, such as a spouse’s plan; and
You are not enrolled in a general purpose Health Care FSA, or you are enrolled only in a
limited purpose Health Care FSA.
43. Will my HSA administrator change?
HSAs will continue to be administered by Your Spending Account™ (YSA). That means you’ll
access your money the same way you do today.
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