BASIC INSURANCE Q&A’S
Health insurance is a list of medical benefits that an insurance company agrees to cover when you meet certain requirements. You pay a premium each week for this coverage; it is automatically deducted from your paycheck with The Ōnin Group. When you use the insurance, we will pay part or all of the costs based on your specific insurance contract, called a policy.
Health insurance helps to protect you from the high costs of medical procedures. In the past, US citizens were required to have basic coverage either through their employer, a private insurer or the government. If you did not have health insurance, you would be fined each year. This has changed in most states around the country, and you will no longer be penalized. This means you won’t have to pay extra money for not having insurance. Insurance policies include some basic preventative benefits to help keep you healthy, and cover other conditions as well. The amount of coverage you have depends on the policy you pick.
A premium is the amount of money that is deducted from your paycheck each week to pay for your insurance plan. It is the fee you pay for the service, like your cable bill or Netflix. Basically, money is taken out of your check and we pay it to the insurance company for you.
A copay is what you pay when you go to the doctor’s office. The amount of this copay will vary based on the type of plan you choose. You will pay this each time you visit the doctor.
Coinsurance is the percentage of the bill you will have to pay when you go to the doctor. You will pay part and your insurance company will pay the rest. You will pay the coinsurance amount at the time of service or you will pay it when you receive it in the mail as a bill.
A deductible is the total amount you will have to pay for medical services before your insurance starts to help you pay for your medical expenses. Your deductible is based on the type of plan you choose. It is important that you pick a plan that has a deductible you can afford. Our Teammate Plan is a no deductible plan, so the insurance company will immediately begin to help pay for your services.
A no deductible plan means you do not have to pay any money toward your medical bills before your insurance begins to help you pay.
- Deductible Plan: Jane’s deductible insurance plan requires her to spend $2,000 on medical services before insurance will help her pay.
- No Deductible Plan: Joe’s no deductible plan immediately helps him pay to visit a specialist even though Joe has not spent any money (except his premium) for health insurance so far this year.
To find doctors near you that will accept your insurance, follow these steps:
- Visit www.multiplan.com
- Click “Find a Provider” in the top right
- Click “Select Network”
- Select “PHCS”
- Select “Limited Benefit Plan”
- Search for a provider for your desired zip code
- Visit www.dentemax.com
- Click “Find a Dentist” in the top center
- Enter desired zip code Vision Provider:
- Visit www.superiorvision.com
- Click “Members”
- Select “Find an eye care professional”
- Enter your location information
- Select the “Insurance Through Your Employer” option
- Select the “Superior National” network
- Choose your desired distance
- Select the “Find Providers” button
- If you choose the Teammate Plan, it is best to add up the copays for each service you expect to use. You will only pay your copay costs instead of a high deductible amount first. This means your insurance will automatically begin helping to pay for your covered expenses. This is great, because many plans require you to pay thousands of dollars before insurance will help you pay for your medical expenses. If you only plan to work with Ōnin for a limited amount of time, this insurance plan is a great option, because you can immediately receive financial help from the insurance company for your medical expenses. That said, for the remaining estimation, you do not have a maximum out-of-pocket amount with this plan, so there is no limit to the amount of money you can spend on healthcare.
- If you choose the Bronze Plan, multiply the cost of your premiums by 52 weeks, then add your out-of-pocket maximum. This is the highest total amount you would have to pay in a year for your health insurance. That will cover your premiums, copays, coinsurance and deductibles. You may not reach your maximum in the year, but that is the MOST you would have to pay. However, often people do not meet their deductible amount or maximum out-of-pocket within a year, which is important to remember when selecting plan. If you need more information about this plan’s costs, call the Advocate line 833-751-1096.
Yes, you have the ability to opt-out of the insurance. You must do this yourself; Ōnin’s staff cannot do this for you.
You will need to call the Enrollment Assistance line at 833-236-7463 or visit worxenroll.com/oningroup to opt-out of or choose a different insurance plan. If you do not opt-out or choose a different plan, you will be automatically enrolled in the Teammate only, Teammate Plan.
For the Teammate Plan, you do not have to pay any deductible. This is helpful for you because it means your insurance will automatically begin to help you pay for your healthcare bills that are covered by the plan. If think you may only work with Ōnin for a short period of time, this is a great option because you can immediately receive amazing prices on health services – including $5 prescriptions, free online or telephone unlimited visits with a doctor through our teledoctor program, and two $5 in-person visits with your doctor.
For the Bronze Plan, you must meet a deductible ($3,000 for a single person plan or $9,000 for a family plan) before insurance begins to help you pay your medical bills. This is a lot of money to spend before insurance begins to pay for your services, especially if you think you may only work with Ōnin for a short period of time, which is why we custom-built the Teammate Plan.
Deductibles works like this: When you go to the doctor, you will be charged for the service you received in addition to your copay. Although some preventative services are free, most of the time you will get a bill for your visit. Once you’ve met your deductible, meaning you’ve spent the deductible amount ($3,000 for a single person and $9,000 for a family plan in the Bronze Plan) on your medical costs, the insurance company starts to pay part of the bills. You will still pay your copay, plus your part of the bill, which is called coinsurance.
Your maximum out-of-pocket refers to the total amount of money you have to pay for services covered by your insurance plan in a year. There are a few exceptions though. The maximum out-of-pocket does not include your premiums, balance-billed charges, healthcare costs not covered by the plan, or penalties for not pre-authorizing your service.
For instance, if your maximum out-of-pocket is $6,500 for a single person plan or $13,200 for a family plan, like in the Bronze Plan, you won’t have to pay for any more money on in-network services for the rest of the year, but you will still have your premiums deducted from your paycheck.
We offer plans for you, you and your spouse, you and your children, or you and your family (spouse and children). Who is covered by your policy will depend on the type of plan you pick. If you choose an individual plan, you will be the only person covered by the insurance and additional benefits, like the Vision Plan, teledoctor services and the Employee Assistance Plan. However, if you choose other coverage, this can include your legal spouse, and children for which you are legally responsible who are under the age of 26, who live with you or who attend school.
You will start paying your premium (the amount of money taken out of your paycheck each week) the first pay period after you have reached your 30 days of working with Ōnin. At this point, you can begin using your insurance policy and you will receive an insurance card in the mail. If you do not sign up for the insurance plan of your choice or opt-out, you will be automatically enrolled in the Teammate only, Teammate Plan.
There are three ways to change your coverage once you have signed up for insurance with Ōnin:
- Open Enrollment – every year around November, we allow our Teammates who have worked 30 days, or more, to change their health insurance coverage. You will be notified through the Teammates App, mail and with signs in our offices. Be sure you make changes during this time.
- A Life Changing Event – there are a few specific situations that happen in life where the government allows us to make changes to your insurance policy outside of open enrollment. These events include: marriage, birth or adoption of a child, death, divorce, gaining/losing coverage through a spouse’s employment or turning 26-years-old. If you experience one of these events, call the Enrollment Assistance line at 833-236-7463.
- Ending Employment with Ōnin – if you are out of an assignment for more than 13 weeks, your insurance coverage will be cancelled. We will be able to start a new policy for you on your first pay period 30 days after you begin working with Ōnin again.
Previously, under the Affordable Care Act, all US citizens were required to have qualifying healthcare coverage. If you did not have coverage, you could be penalized with fines. While there is no longer a federal tax penalty, some states may have their own penalties. It’s best to understand your state’s requirements.
The prescription coverage will vary based on the type of medicine you take and the plan you choose. Under the Teammate/Medical MEC Plan, generic prescriptions are $5.00. Under the Bronze Plan, generic prescriptions are $15.00. All prices are based on a 30-day prescription. For specific questions about other medications, please call the Advocate line at 833-751-1096.
- If you sign up for benefits for the first time with Ōnin: Your effective date is the pay period following 30 days after you started working for Ōnin.
- If you had medical benefits with Ōnin through the end of 2019: Your new medical plan starts at the beginning of the year, in January 2020.
Once you have insurance through Ōnin, we are unable to cancel your policy unless you have a qualifying life event (like marriage or birth of a new child), your assignment is ended for 13 weeks or you stop working with Ōnin. If you quit working at Ōnin, you are fired from Ōnin or you are hired permanently by a company, your insurance policy will be cancelled.
No. In order to get Ōnin’s Dental Plan, you must be signed up for Ōnin’s Teammate Plan.
No. In order to get Ōnin vision insurance, you must be signed up for Ōnin’s Teammate Plan or Ōnin’s Bronze Plan.
You must be employed with Ōnin for 30 days from your start date. When you have reached the pay period following 30 days of hire, you will receive an insurance card in the mail five to seven business days later. If you do not receive this card, call the Advocate line (833-751-1096) for help.
The Teammate Plan was custom-built for our Teammates’ unique needs. The plan offers extremely affordable options for the most popular medical needs, like doctor visits and generic prescriptions. This option has a low premium – less than $20 per week for the “Teammate-Only Plan. It is also a no deductible plan, which means the plan will immediately begin to cover your medical needs.”
The Bronze Plan has a high deductible. In other words, you will have to pay $3,000 with an individual plan or $9,000 with a family plan before your insurance starts to help pay your medical bills. It offers basic coverage and preventative health screenings. It includes our teledoctor service, EAP benefits and Vision Plan at no extra cost.Common services, like doctor visits, are more expensive on this plan, but the Bronze Plan provides a maximum-out-of-pocket of $6,500 for the individual plan and $13,200 for the family plan. If you expect your medical expenses to cost more than these amounts during your time at Ōnin, this plan may be a good option.
Enrolling your spouse or dependents into your insurance is a personal decision. We have custom-built our plans to be affordable and usable for our Teammates and their families. However, we encourage you to compare Ōnin’s insurance benefits with your husband or wife’s plan to see which offer is best for you and your family. If your spouse has a health insurance plan which works better for your needs, you can choose that plan and call the Enrollment Assistance line at 833-236-7463 to opt-out of automatic enrollment for the Teammate Plan.
We have representatives available to help you with all of your questions. Call the Enrollment Assistance line at 833-236-7463 if you are not currently enrolled in Ōnin benefits and have questions. If you are currently enrolled in an Ōnin benefits plan, call the the Advocate line at 833-751-1096. It is important to us that you understand how to use your insurance and make it work best for you.
It can be frustrating and scary when medical bills are coming in and not paid as you thought they would be. There can be many reasons for this, from coding errors to non-qualified services. Please call the Advocate line at 833-751-1096 and a representative will help you with your concerns.
You must call us at the Enrollment Assistance line at 833-236-7463 or visit worxenroll.com/oningroup before you have worked with Ōnin for 30 days from your start date to let us know you do not want the health insurance. If you do not call this number or visit the site, you will be enrolled in the Teammate only, Teammate Plan and will not be able to cancel or change it until open enrollment in November of next year unless you have a major life event.
If you want the Teammate Plan for a single person, you don’t have to take any action. You will automatically be enrolled after 30 days. If you want to add other family members, add dental insurance, pick the Bronze Plan, or opt-out of the plan, you will need to call us the Enrollment Assistance line at 833-236-7463 or visit worxenroll.com/oningroup to make those changes before 30 days after you are hired. Your local branch cannot do this for you, so you must call the Enrollment Assistance line or visit the website to make your selection.
2020 Medical Benefits Plan
Your health is important to us, and we know medical benefits should not be expensive and should be easy for you to use on your busy schedule.That’s why we offer our Teammates custom-built benefits that are affordable and convenient to use. By surveying Teammates and Ōninites in the field, speaking with experts and after a lot of thought, we have custom built the Teammate Plan, which has no deductible, low copays, as well as free teledoctor and counseling services. Your body, mind, mouth and eyes are taken care of. We know it’s hard to see a doctor if you can’t afford one. We hope these affordable and easy-to-use plans help you and your family to stay healthy and happy.
Choosing a Plan
No matter which plan you choose, when you have medical insurance through Ōnin Staffing, you also receive a Vision Plan, teledoctor services and an Employee Assistance Plan (EAP) at no extra cost!
You are not required to have health insurance in most states any longer. However, if you opt-out of coverage, you will not have access to the Vision Plan, telemedicine services or EAP. To opt-out, you must call the Enrollment Assistance line at 833-236-7463 or visit worxenroll.com/oningroup.
If you do not choose a plan or opt-out of insurance within 30 days of being hired, you will automatically be enrolled in the Teammate Plan. You will need to call the Enrollment Assistance line or visit worxenroll.com/oningroup before the end of your 30 days if you want the Bronze Plan instead, want to add dependents, or opt-out of the insurance.
Here’s a snapshot of our major medical plans:
The Teammate Plan is a no deductible plan. This means you will have medical insurance you can use the first pay period following 30 days from your start date with Ōnin. This plan offers lower copays, $5 generic prescriptions, two $5 in-person primary care visits, and is truly usable insurance. There is no out-of-pocket maximum, which means you will pay your copay each time you receive medical care for all covered visits and procedures.
The Bronze Plan meets the Affordable Care Act requirements. Common services, like doctor visits, are more expensive on this plan, but the Bronze Plan provides a maximum-out-of-pocket is a high-deductible plan where you will pay more out-of-pocket when you use a doctor for more than preventative care. Copays to see a doctor or specialist are higher than our Teammate Plan. Also, you must meet your deductible ($3,000/$9,000) before the insurance begins to help cover some of the medical costs. This plan does offer a maximum out-of-pocket of $6,500 for the individual plan and $13,200 for the family plan, which means you will not spend more than this amount in a year, although you will still have to pay your premiums.
It is important to remember, you can use our teledoctor services for free, from anywhere, to avoid traditional, time-consuming office visits and fees by selecting one of our insurance plans.
Andre is a busy single dad dealing with a full-time job. Andre is constantly on the go, but that doesn’t stop him from keeping up with his health needs. Andre alternates between working first and second shift, which can make it hard to visit the doctor’s office during normal hours. Having healthcare options that work with his schedule is important. Andre has the Teammate and Children, Teammate Plan.
Lisa is a single woman working full-time. When she’s not at work, she enjoys an active social life, but she also deals with anxiety and has had some financial issues in the past year. Lisa cares about having healthcare options that are affordable and allow her to take care of her physical and mental health. Lisa has the Teammate-Only, Teammate Plan.
When you are sick, you don’t always have time to go to the doctor. Missing work costs you in more than one way. With our teledoctor (also called a telemedicine) benefit, you can speak with a doctor any time of day, any day of the week for FREE. You don’t have to leave your home, and you can even call from work on your break!
What Ōnin Provides
24-hour access to U.S. board-certified physicians, seven days a week, 365 days a year.
A doctor will consult with you about your condition, diagnose your issue and can prescribe medication for you. They can even send your prescription to your pharmacy of choice.
You can speak to a doctor by phone or video chat. You can use a landline phone, a mobile device or computer. There is an app, a website and a phone number to use (below).
You can set a time for the doctor to call back or receive a call within about 30 minutes.
The teledoctor service is great to use when you are considering an urgent care or ER visit for a non-emergency medical issue after hours; or if you don’t want to sit in a waiting room with other sick patients; or if you don’t want to wait to see your family doctor.
You and any covered family members older than 2 years old can use the service as a part of one of our medical plans.
Treated common conditions like the following:
Urinary tract infections
And much more
Call 855-879-4332 and enter MYIDR1489
Online at myidealdoctor.com
On the MYidealDOCTOR App
Download through Google Play or the App Store
Andre wakes up feeling terrible with a fever. He can barely get out of bed, so he doesn’t want to have to drive all the way to a doctor’s office or sit in a crowded waiting room. He calls the Teledoctor using the MYidealDOCTOR app. The doctor diagnoses him with the flu and prescribes him some medication. Because Andre has an Ōnin medical plan, his Teledoctor consultation is free. Andre drives to the pharmacy and pays a $5 copay for his generic prescription. At the end of the day, Andre only paid $5 for his treatment.
Lisa’s eye has been itchy and irritated all day. When Lisa gets off work, she notices her eye looks pink and puffy. She knows she should talk to a doctor, but she doesn’t want to drive across town to her doctor’s office and sit in the waiting room after a long day at work. Instead, Lisa calls the MYidealDOCTOR telephone number and talks to a doctor from the comfort of her car. The doctor is able to determine she has pink-eye and sends Lisa’s prescription to her local pharmacy. Lisa drives by the pharmacy on her way home to pick up her medicine. Lisa only has to pay for her medicine at the pharmacy because the Teledoctor is free with her Ōnin insurance!
This plan offers Teammates radically affordable, radically easy to use benefits. This plan was created just for our Teammates and their unique job situation. Our Teammates are part of the Ōnin team, and they deserve an incredible benefits plan.
|TEAMMATE PLAN SUMMARY|
|Prescription Drugs:||$5 copay on generic|
|Primary Care Visits:||$5 copay first 2 visits, $25 copay, visits 3 & 4|
|Specialist Visits:||$50 copay, up to 4 visits per year|
|Urgent Care:||$25 copay, up to 4 visits per year|
|Preventative Services:||Covered 100%|
|FIXED DOLLAR REIMBURSEMENT|
|X-ray Services||$200 up to 3 per year|
|Laboratory Services||$75 up to 5 per year|
|Magnetic Resonance Imaging(MRI)||$1,000 up to 1 per year|
|Computerized Tomography(CT)Scan||$200 up to 2 per year|
|EMERGENCY ROOM VISIT:|
|Treatment of an Accidental Injury||$500 up to 2 per year|
|Treatment of a Sickness||$50 up to 1 per year|
|Inpatient Hospital Services, Including Childbirth||$3,000 up to 3 days|
|Surgery||$1,000 up to 2 per year|
|Anesthesia Services||$600 up to 5 per year|
|Mental and Nervous Benefit||$150 up to 5 per year|
|Alcohol and Substance Abuse Benefit||$150 up to 5 per year|
|Inpatient/Outpatient Doctor Benefit||$125 up to 10 per year|
More Plan Details
Your first two visits are a $5.00 copay.
If you see a doctor a third or fourth time during the year, your copay will be $25.00 for those visits.
If you see a doctor more during the year, starting on visit five, you will pay the doctor’s office visit fee in full.
You can see a specialist as needed up to four times a year for a $50.00 copay.
Additional visits, starting with visit five, will be billed at the full rate the specialist charges to you.
You may visit an urgent care up to four times in a year for a $25 copay.
Additional visits, starting with visit five, will be billed at the full rate by the urgent care to you.
No copay, no fees, no waiting.
Use as an alternative to a traditional office visit.
24/7/365 access to licensed physician.
Contact by phone, computer or app.
Diagnosis and treatment for common conditions.
100% covered for these preventative services.
Generic prescriptions are a $5.00 copay.
Andre gets sick at work and has to leave early. He immediately heads to his local urgent care. Andre sees the doctor and is prescribed an antibiotic. He pays a $25 copay and leaves the urgent care office. He stops by the pharmacy to get his prescription. He pays $5 for his generic antibiotic. Andre goes home and returns to work a few days later feeling better. Andre paid $35 total for his care.
Lisa’s stuffy nose and headache are making her feel awful. She calls her primary care doctor’s office and gets an appointment for the following day. The next day, Lisa goes to the doctor’s office and is diagnosed with a sinus infection. The doctor prescribes Lisa a generic prescription and sends it to her local pharmacy. Before she leaves the doctor’s office, Lisa pays a $5 copay since it is her first visit of the year. Lisa then drives to the pharmacy where she pays a $5 copay for her prescription. After taking her first dose of medication, she feels well enough to head to work. Because Lisa was on the Teammate Plan, she paid $10 total for her primary care visit and prescription copays.
At Ōnin, you have insurance options! The Bronze Plan is a high-deductible plan, unlike the Teammate Plan, which is a no deductible plan. This means you must first meet your deductible ($3,000/$9,000) before the insurance begins to help cover some of the medical costs. This plan offers a maximum out-of-pocket of $6,500 for the individual plan and $13,200 for the family plan, which means you will not spend more than this amount in a year, although you will still have to pay your premiums.
|Annual Calendar Year Deductible||In Network||Out of Network|
|Individual | Family||$3,000 | $9,000||$5,000 | $10,000|
|Maximum Calendar Year Out-of-Pocket|
|Individual | Family||$6,500 | $13,200||Unlimited|
|Primary Care Physician (PCP) | Specialist||$40 copay||Deductible + 40%|
|Specialist Visit||$80 copay||Deductible + 40%|
|Preventive Care Exam | Well Baby||Covered 100%||Deductible + 40%|
|Diagnostic Test Lab & Path X-ray & Imaging Other Diagnostic Examination||Deductible + 20%||Deductible + 40%|
|Imaging (CT/PET scans, MRIs) Outpatient Radiology Center Outpatient Hospital||Deductible + 20%||Deductible + 40%|
|Inpatient||Deductible + 20%||Deductible + 40%|
|Outpatient Surgery (Outpatient Hospital)||Deductible + 20%||Deductible + 40%|
|Emergency Room||Deductible + 20%||Deductible + 20%|
|Urgent Care||Deductible + 20%||Deductible + 40%|
|Retail (30 day supply)||Mail Order (90 day supply)|
|Preferred Brand||30% min $35||30% min $70|
|Non-Preferred Brand||40% min $70||40% min $150|
More Plan Details
Meets ACA requirements
Preventative, basic exams are covered at 100%
High deductible plan – $3,000/$9,000
Services are provided by the CIGNA network
You will be able to see your family doctor for a $40.00 copay each visit.
You will be able to see a specialist for a $80.00 copay.
For other medical services, you must meet your deductible ($3,000/$9,000) before insurance will pay. After you meet your deductible, you will pay 20% of the bill.
You can use urgent care for an $80.00 copay.
Generic prescriptions are $15.00.
Mental Health Employee Assistance Program (EAP)
We don’t just care about your physical health. Your mental health is just as important to us. If you need someone to talk to about a recent loss, depression, anxiety, debt or other issues for yourself or your covered family members, you can speak with a mental health counselor – for FREE.
More Plan Details
Counselors available 24 hours a day, 365 days a year by phone at 800-531-0200.
No copay or out-of-pocket cost…it is FREE.
Personal counseling services for mental health needs.
Professional counselors who possess either a master’s degree or Ph.D. with more than five years experience.
English, Spanish and French speaking therapists available.
Other languages available through interpretation services for counseling.
Available to all covered dependents.
Referrals available for in-person services (fees may apply at office).
Tools to help you be your best.
Andre’s son keeps getting in trouble at school, and Andre feels like he’s at his wit’s end. Andre covers his son with his medical insurance, so he decides to use his EAP benefits. After Andre’s son gets home after another hard day, Andre calls the EAP line. The EAP counselor talks with Andre and his son together. Overtime, Andre and his son begin to cope better and they work through some issues they didn’t know they had in the first place. The EAP is free, so Andre pays nothing for these services.
Lisa is dealing with some anxiety, especially about her financial situation. Lisa calls the EAP counseling number to talk with a counselor. Lisa and the counselor talk about her recent feelings and her struggles to pay off her car loans. The counselor gives Lisa some useful resources to help her with her finances. Lisa and the counselor agree to speak regularly, and Lisa keeps in contact with the counselor on her bad days. Lisa pays nothing for these services.
Dental – Metlife
Your dental coverage plan is part of your plan for no additional premium for the Teammate-Only plan. We think that’s something to smile about.
|Annual Deductible - (Individual/Family)||$50/$150|
|Calendar Year Maximum Benefit||$1,000|
|In Network/Out of Network Coverage|
|DIAGNOSTIC AND PREVENTIVE SERVICES|
|Exams (once every 6 months)||Covered 100%|
|Cleanings (once every 6 months)|
|Fluoride Treatments (children under 14)|
|Emergency Room Visit|
|sealants (children under 16)|
|Endodontic (root canal)|
More Plan Details
Exams once every six months.
Cleanings once every six months.
Fluoride one time in 12 months for children under 14.
Your copay is $50 as an individual or $150 for the family plan. After your copay, the expenses for the services below are covered at 50% by this insurance plan.
- Simple extractions
- Sealants for children under 16
Andre’s son has some cavities that need to be fixed. They go to the dentist where his son has an exam, a routine cleaning and receives fillings on two teeth. The fillings cost $138 and the exam and cleaning were not billed to Andre, since they are preventative services. Andre pays $138. He now has $12 before he meets his $150 deductible for the year. Once this happens, his insurance will pay 50% of the cost for fillings.
Lisa likes to check on her oral health every year to prevent problems. Lisa goes to the dentist and has an examination and routine cleaning done. After paying her $50 deductible, these services don’t cost her anymore.
The ability to see is a gift often taken for granted. Good vision is important for learning, safety and your overall well-being. Our Vision Plan offers affordable care for you and your family members.
|Waiting Period/Coverage Election Date||1st Pay Period Following 30 Days of Employment|
|Basic Information||In Network|
|Eye Exam||100% after $10 copay|
|Contacts: Elective||Up to $100 Allowance|
|Eyeglass Lenses: Single, Bifocal, Trifocal||100% after $25 copay|
|Standard Frame||*Up to $100 Allowance|
|Frequency of Services||In Network|
|Comprehensive Eye Examination||12 Months|
|Laser Vision Correction||Discounts range from 10% to 50%|
|Name of Network||Superior National Network|
|Plan Provisions||*Frames: Up to 20% off amount over allowance|
More Plan Details
One eye exam each year.
You receive $100 for contacts
You can choose single, bifocal or trifocal lenses for a $25 copay.
You receive $100 for standard frames.
If your frames cost more than $100, you can save up to 20% on the remaining amount.
Andre wears contacts, but his contacts aren’t helping him see as well as they used to, so he goes to the eye doctor. Andre pays $10 for an eye exam and receives a new diagnosis for vision. He buys new contacts for his new vision diagnosis. The contacts cost him $125. Insurance pays $100 of this cost, so Andre pays just $25. His total is $35 for the visit.
Lisa’s backup pair of glasses breaks. She goes to the eye doctor and pays $10 for the exam and $25 for new lenses.
Her new lenses cost $150. Her insurance pays for $100 of that cost and covers 20% of the remaining $50 cost. Her total cost for new lenses is $40.
In total, Lisa pays $75 for her vision visit.
Affordable Care Act - this federal law requires employers to provide healthcare insurance to their workers which meets minimum standards. Starting in 2019, employees are no longer required to have insurance by law, but employers must still offer it. Some states do require all citizens have healthcare insurance; Some states do require all citizens to have healthcare insurance, so check what the rules are in your state before making a decision.
Antibiotic - a type of medicine which treats bacterial infections.
Balance Billing - this is the difference between the medical provider’s charge and the allowed covered amount. For example, if the doctor charges $100, but the allowed amount is $70, you will receive a bill for the remaining $30. You will need to pay this to the medical provider.
Brand Prescriptions - these are drugs which have a labelled name, for example, amoxicillin is an antibiotic which is available generically as amoxicillin. It’s brand names are Amoxil, Moxatag or Larotid. You may pay more for the brand name drug. You can choose between generic or brand name in many cases. However, some branded drugs do not have generic counterparts, and are not available at a lower prices.
Claim - a bill for your medical services received.
Coinsurance - the part of the bill you pay after you meet your deductible.
Consultation - the exam the doctor does to find out what the problem is or from what illness you are suffering.
Copay - what you pay when you walk in the doctor’s office (which can vary depending on what services you are using and what kind of doctor you are seeing).
Covered Services - this is the medical treatment you receive for which your insurance company pays part or all of the bill.
Deductible - how much you will pay before any medical bills are paid by your insurance.
Dependents - these are the other people in your immediate family you want to add to your policy. This can include your legal children, stepchildren, adopted children and children for which you have legal custody. This would not include parents, other relatives, domestic partners, significant others, your spouse or roommates.
Diagnosis - the health concern the doctor finds during the exam. This happens when the doctor identifies what kind of disease or condition you have.
Effective Dates - this is the date your insurance coverage begins and ends each year.
Employee Assistance Plan (EAP) - a program provided by an employer for their workers to use for many different types of services. For The Ōnin Group, this means our Teammates get free access to mental healthcare by phone 24/7/365.
Generic Prescriptions - these are prescription drugs that are not name brand and often cost less. It is like the difference between your store brand (generic) tomato sauce and Hunt’s or DelMonte (name brand) tomato sauce. You can usually decide which you prefer at the pharmacy.
In-patient Hospital - when you are admitted to the hospital for treatment.
In-Network - this means your doctor or hospital has a contract with your health insurance company for lower rates.
Insurance Policy - a contract between you and the insurance policy about who pays what on your medical bills.
Licensed Physician - a U.S. board-certified physician is licensed to practice medicine in the United States.
No Deductible Plan - this type of plan means your insurance pays part of the bill from the first time you use the service. With this type of plan, you will rarely pay the full amount of your bills for services covered by your insurance policy. You will pay a copay, or, a copay and your part of the coinsurance.
Office Visits - these are appointments at your family doctor’s office or general practitioner, not at urgent care, an emergency room or hospital. It may also be an appointment with your dentist or eye doctor as well.
Opt-out - choosing not to sign up for health insurance. With The Ōnin Group, you must call us at 833-236-7463 to let us know that you do not want any insurance benefits before the end of 30 days after your start date.
Out-of-pocket (Deductible) - this is your part of the medical bill that you must pay yourself.
Out-of-pocket Maximum - the most you will have to pay all year for medical expenses. If you have met your out-of-pocket maximum, you do not have to pay any more for copays, coinsurance payments or deductibles. After you pay this amount, your insurance will cover 100% of your medical claims for the rest of the policy year, although you will still have to pay for your premiums.
Out-of-Network - this means your doctor or hospital does not have a contract with your health insurance company, so your bills and copayments will be higher in most cases.
PPO - a preferred provider organization is a group of doctors, hospitals and urgent care facilities you can use for your healthcare needs. These providers have an agreement with your insurance company to treat you at certain rates for agreed upon services. If you use a PPO plan, you need to be sure you stay “in-network” to receive these lower rates. Your part of the medical bills will be lower than “out-of-network” would be. If you have questions about finding an “in-network” doctor, call the Advocate line at 833-751-1096.
Premium - how much you pay each month for your insurance, usually taken directly out of your check each week.
Preventative Services - basic services from a doctor to prevent illness or disease, like certain immunizations or health screenings, to keep you healthy.
Primary Care Provider - the doctor you see for most common illnesses, also called a general practitioner, family doctor or regular doctor.
Primary Care Visit - also know as an office visit; an appointment with your regular doctor for non-emergency appointments.
Referral - when your general doctor is unable to take care of your health issue themselves, and they send you to a specialist.
Specialist - this doctor is not your general doctor you see for colds and flus. A specialist helps you with specific issues in certain areas of the body. For example, an ENT (ear nose and throat) doctor will see you for severe allergies or related issues, but not for hip replacements. A cardiologist will see you if you have heart health issues or had a stroke. Their fees are usually higher than a general doctor’s would be, and you may be referred to a specialist if your regular doctor can’t solve your health concerns themselves.
Specialist Office Visits - an appointment with a specialist doctor.
Specialty Drugs - drugs which are not generic, but may be brand name, that are made for specific issues or require more involved formulation.
Treatment - the solution to your health issue, which can be what actions you must take to feel better and/or what medicine you will take.
Urgent Care - these offices are open later hours and sometimes on weekends, as well as during the week. They will see you without an appointment, like an ER, but charge lower rates and have limited services they provide. Rates are higher than your doctor’s office, but are a good choice when you are sick outside normal doctor’s hours or have a severe illness but not life-threatening and can’t wait to see a doctor. Our free teledoctor service is a good place to start if you are considering a trip to urgent care with a non-life-threatening illness.