2019 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, in 2019, we are offering new, custom-built benefits which are affordable and usable. By surveying Teammates and Ōninites in the field, speaking with experts and after a lot of thought, we have custom built the Teammate/Medical MEC 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.

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Group 7

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!

Starting in 2019, 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/Medical MEC 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.

Group 15

Here’s a snapshot of our major medical plans:

Group 56-2

The Teammate/Medical MEC 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. This plan 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/Medical MEC 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.

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Our Teammates

How-It-works_03

Joe

Joe is a single guy who works a late second shift, but he doesn’t let this stop him from keeping up with his health needs. Joe is trying to deal with his recent divorce and is having some financial problems. Since he works later than most doctor’s offices are open, having healthcare options that work with his schedule is important.

Lisa

Lisa

Lisa is a woman on the move with her busy family life and a full-time job. Being married with three children means great medical options are a must to keep her family healthy, happy and cared for. With so many responsibilities, Lisa needs on-the-go options for her family’s physical and mental health needs.


teledoctor

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What Ōnin Provides

Teledoctor Details
Teledoctor Services
How To Contact
How It Works - Joe
How It Works - Lisa
Teledoctor Details

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.

Teledoctor Services

Treated common conditions like the following:

Cold

Flu

Cough

Congestion

Nausea

Sinus issues

Urinary tract infections

Allergies

Pink eye

Rashes

And much more

How To Contact

Call 855-879-4332 and enter MYIDR1489

Online at myidealdoctor.com

On the MYidealDOCTOR App

Download through Google Play or the App Store

How It Works - Joe

How-It-works_03Joe is a single guy who works second shift. He gets off work on Friday at 11:00 PM and feels feverish with a nasty cough. His doctor won’t be in the office until Tuesday, due to the holiday weekend. He doesn’t want to sit at the ER all night.

Joe uses his MYidealDoctor app to request a doctor consultation. He then drives home. Fifteen minutes later, the doctor calls him back on his smartphone using the app.

The doctor asks Joe about his symptoms and has Joe take his own temperature. The doctor examines Joe’s mouth and throat through the camera on Joe’s phone using the app. The doctor concludes Joe most likely has the flu.

The doctor sends a prescription to a nearby 24-hour pharmacy. Joe drives to pick up the medication. On Monday, Joe is better and back at work.

Joe does not receive a bill, since teledoctor services are free. His only cost was the price of the prescription.

How It Works - Lisa

How-It-works_06Lisa picks up her daughter at school on Wednesday after receiving a call from the nurse. Her daughter’s eye is itchy and watery.

Before heading home, Lisa calls the MYidealDoctor phone line to set up a callback. When she arrives home, she and her daughter talk to the doctor on the laptop.

The doctor looks at the little girl’s eye and sees that there is some mucus and drainage. The doctor determines it is pink-eye.

The doctor sends a prescription to Lisa’s neighborhood pharmacy. Lisa picks up the eye drops that afternoon.

By Friday, Lisa’s daughter is back at school and her condition is all cleared up.

Lisa only paid for the eye drops at the pharmacy because the teledoctor service is free!

Teammate / Medical MEC Plan

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 / MEDICAL MEC PLAN SUMMARY
Network: PHCS
Deductible: $0/$0
Prescription Drugs (retail, 30-day supply): $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: $60 copay up to 4 visits per year
Preventative Services: Covered 100%
Teledoctor: $0 consultation fee, 24/7/365
INPATIENT HOSPITAL BENEFITS FIXED DOLLAR REIMBURSEMENT
Hospital Room & Board Benefits:
Daily Benefit for the Treatment of Mental & Nervous Conditions $100 per day, up to 25 days
Daily Benefit for the Treatment of Alcohol & Substance Abuse $100 per day, up to 25 days
Daily Benefit for the Treatment of All Other Covered Conditions $200 per day, up to 90 days
Hospital Admission Benefit For Specified Conditions:
Daily Benefit for Cancer (Malignant Neoplasm) $2,000 per day, up to 1 day
Daily Benefit for Heart Attack (Myocardial Infarction) OR $1,500 per day, up to 1 day
Daily Benefit for Heart Disease $1,000 per day, up to 1 day
Daily Benefit for Accidental Injury $1,000 per day, up to 1 day
Daily Benefit for Stroke (Cerebrovascular Accident - CVA) $1,000 per day, up to 1 day
Daily Benefit for Childbirth $1,000 per day, up to 1 day
Maximum Surgery Benefit Per Procedure $500 per day
Maximum Anesthesia Benefit $100 per day
OUTPATIENT BENEFITS FIXED DOLLAR REIMBURSEMENT
Doctor Visit Benefits:
Daily Benefit for a New Patient Office Visit $75 per day, up to 1 day
Daily Benefit for an Established Patient Office Visit $60 per day, up to 3 days
Daily Benefit for a Consultation Office Visit $75 per day, up to 1 day
Daily Benefit for an Emergency Room Doctor Visit $50 per day, up to 1 day
Radiology Benefits:
Daily Benefit for a Magnetic Resonance Imaging (MRI) $100 per day, up to 1 day
Daily Benefit for a Computerized Tomography (CT) Scan $50 per day, up to 1 day
Daily Benefit for all other Radiology Services $40 per day, up to 3 days
Pathology Benefits:
Daily Benefit for all Pathology Services $40 per day, up to 3 days
Urgent Care Benefits:
Daily Benefit for an Urgent Care Facility Visit $50 per day, up to 1 day
Emergency Room Visit Benefits:
Daily Benefit for the treatment of an Accidental Injury $500 per day, up to 2 days
Daily Benefit for the treatment of a Sickness $50 per day, up to 3 days
Maximum Surgery Benefit Per Procedure $500 per day
Maximum Anesthesia Benefit $100 per day

More Plan Details

Primary Care Visits
Specialist Visits
Urgent Care
Free, Unlimited Teledoctor Use
After Copay
Prescription Drugs
How It Works - Joe
How It Works - Lisa
Primary Care Visits

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.

Specialist Visits

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.

Urgent Care

You may visit an urgent care up to four times in a year for a $60.00 copay.

Additional visits, starting with visit five, will be billed at the full rate by the urgent care to you.

Free, Unlimited Teledoctor Use

The full details are listed above.

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.

After Copay

100% covered for these preventative services.

Prescription Drugs

Generic prescriptions are a $5.00 copay.

How It Works - Joe

How-It-works_03Joe is a single man who works second shift. He gets sick at work. He leaves early and goes urgent care.

He sees a doctor and is prescribed an antibiotic. He pays his $60.00 copay before leaving the urgent care office.

He stops by the 24-hour pharmacy to get his prescription nearby. He pays $5.00 for his generic antibiotic.

Joe goes home and returns to work a few days later feeling better.

How It Works - Lisa

How-It-works_06Lisa is a mother of three children. Her son, Thomas, has been coughing and sneezing for a few days. He wakes up with a 101 degree fever.

Lisa calls her family doctor and gets an appointment for Thomas for the following day.

Lisa and Thomas visit the doctor. Thomas has a common cold, and is told to take acetaminophen for the fever, drink lots of fluids and get plenty of rest.

Lisa pays $5.00 for her copay before leaving the office.

After a few days of following the doctor’s orders, Thomas is better and back at school.

Bronze Plan

At Ōnin, you have insurance options! The Bronze Plan is a high-deductible plan, unlike the Teammate/Medical MEC 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.

Plan Highlights
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
Professional Services
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%
Hospital Services
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%
Prescription Drugs
Retail (30 day supply) Mail Order (90 day supply)
Generic $15 $30
Preferred Brand 30% min $35 30% min $70
Non-Preferred Brand 40% min $70 40% min $150

More Plan Details

Bronze Plan Details
Primary Care Visits
Specialist Visits
Other Services
Urgent Care
Prescription Drugs
Bronze 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

Primary Care Visits

You will be able to see your family doctor for a $40.00 copay each visit.

Specialist Visits

You will be able to see a specialist for a $80.00 copay.

Other Services

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.

Urgent Care

You can use urgent care for an $80.00 copay.

Prescription Drugs

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.

Group 8

EAP

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More Plan Details

EAP Details
Online Self-help Resources
Online Wellness Library
How It Works - Joe
How It Works - Lisa
EAP 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).

Completely confidential.

Online Self-help Resources
Online Wellness Library

Tools to help you be your best.

Charlesnechtem.com/the-wellness-library

How It Works - Joe

How-It-works_03Joe is a single, recently divorced man working second shift. He doesn’t get a lot of time to socialize because most of his friends work days. He has been feeling tired lately and has no interest in trying to meet new people. His best friend thinks Joe may be depressed.

Joe calls and speaks with a counselor about his recent feelings, his anger at his ex-wife, the bills he can’t seem to keep paid, and that he doesn’t even try to meet new people.

The counselor talks to Joe about his finances and sends him some useful information by email. They discuss his anger with his ex-wife and ways to deal with her respectfully. They also talk about Joe’s mental state and possible depression.

The counselor and Joe agree to speak regularly and Joe keeps in contact with the counselor on bad days.

Joe is getting out with new and old friends, paying off debt and has a better life all around. And he pays nothing for these services.

How It Works - Lisa

How-It-works_06Lisa is a mother of three children, and her son, Michael is always in trouble at school. Michael is angry and fights a lot with others in class and at home. Lisa is at her wit’s end.

Lisa calls the EAP line after Michael gets suspended from school for three days.

The EAP counselor talks to Lisa and Michael together and then invites the family to participate on the next call.

On the next phone call, Lisa, her husband, and three children talk to the counselor together by speakerphone. Overtime, Michael is doing better at school and the family has worked through some issues they didn’t realize were affecting them all.

Lisa still calls the EAP line from time to time. Sometimes she speaks to a counselor alone or she and the family talk to a counselor via speakerphone. Michael even talks to a counselor when he has had a rough week.

Lisa and her family pay nothing for these services.

Dental
Metlife

If you and your family need dental insurance, Ōnin has you covered. This optional dental plan is not required and is not included with your medical plan. However, you can add it to your benefits when you enroll for a medical plan. There is an additional premium which will be withheld from your weekly paycheck if you add the Dental Plan.

Group 8

DENTAL PPO
Annual Deductible - (Individual/Family) $50/$150
Calendar Year Maximum Benefit $1,000
Network PDP Plus Network
In Network/Out of Network Coverage
DIAGNOSTIC AND PREVENTIVE SERVICES
Exams, Cleanings, Fluoride Treatments, X-rays Covered 100%
BASIC SERVICES
Fillings, Simple Extractions, Basic Oral Surgery Covered 50%
MAJOR SERVICES
Periodontics, Endodontic (Root Canal),
Crowns, Inalys, Onlays, Bridges, Dentures
Covered 0%


More Plan Details

Free Preventative Services
Covered Basic Services
Other Services
How It Works - Joe
How It Works - Lisa
Free Preventative Services

WITH NO COPAY

Exams once every six months.

Cleanings once every six months.

Bitewing X-Rays once every 12 months.

Fluoride one time in 12 months for children under 14.

Covered Basic Services

AFTER YOUR COPAY

50% payment of these covered basic services after your copay of either $50 for an individual or $150 for a family.

Sealants for children under 16 on each molar every 60 months.

Space maintainers once per lifetime for children under 14.

Full mouth x-rays once in 60 months.

Amalgam fillings once replacement per surface every 24 months.

Periodontal maintenance twice per year including cleanings.

Scaling and root planing once every 24 months.

Other services at this rate are:

Emergency palliative treatment

Periapical x-rays

Other x-rays

Resin composite fillings

Pulpotomy

Pulp capping

Pulp therapy

Non-surgical periodontics

Oral surgery on simple extractions

Other Services

You will pay 100% of the cost of these services, as they are not covered by this plan.

Consultations twice in one year

Root canal once per tooth per lifetime

Periodontal surgery once in any 36 month period

Prefabricated crowns every 10 years per tooth

Crown build ups or post core every 10 years per tooth

Repairs once per year

Recementations once per year

Dentures once every 10 years

Rebases or relines for dentures once every 36 months

Denture adjustments once a year

Fixed bridges once every 10 years

Inlays, onlays or crowns every 10 years per tooth

Implant services every 10 years per tooth position

Implant repairs once a year per tooth

Implant supported prosthetic every 10 years per tooth

Tissue conditioning once every 36 months

Occlusal adjustments once a year

Other services include:

Apexification and recalcification

Periodontal surgery for soft and connective tissue grafts

Surgical oral extractions

Other oral surgery

How It Works - Joe

How-It-works_03Joe is a single guy who likes to check on his oral health every year. He calls the dentist for his normal appointment, and he:

Has an examination and routine cleaning

Joe pays nothing to see the dentist this year

How It Works - Lisa

How-It-works_06Lisa’s son needs to have cavities fixed. She calls the dentist and:

Her son has an exam and routine cleaning

Receives amalgam fillings on two teeth

Lisa is billed for 50% of the cost of the fillings after her $150 family deductible.

So, the two fillings were $69.00 each, or $138.00 total. The exam and cleaning were not billed to Lisa, as they are preventative services. Lisa pays her $138.00 which goes toward her deductible of $150.00. She still has $12.00 in services yet to be rendered before she meets her deductible. Preventative services are still without charge.

Vision

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.

Group 8

SUPERIOR VISION
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
Lenses 12 Months
Frames 24 Months
Other Features
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

Exam
Lenses
Frames
How It Works - Joe
How It Works - Lisa
Exam

$10 copay

One eye exam each year.

Lenses

You receive $100 for contacts

OR

You can choose single, bifocal or trifocal lenses for a $25 copay.

Frames

You receive $100 for standard frames.

If your frames cost more than $100, you can save up to 20% on the remaining amount.

How It Works - Joe

How-It-works_03Joe is a single man who wears glasses. He breaks his old ones, so he goes to the eye doctor, where he:

  • Pays $10 for his exam
  • Pays $25 for his bifocal lenses
  • Picks a $250 pair of frames
  • He saves 15% on his remaining $150 balance
  • Joe’s total amount he has to pay is $162.50
How It Works - Lisa

How-It-works_06Lisa’s daughter wears contacts, and needs a new set. So, Lisa has family medical insurance and takes her daughter to the eye doctor, where she:

  • Pays $10 for the exam
  • Orders $175 in contact lenses
  • Her total amount she has to pay is $85

 

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A | B | C | D | E | F | G | H | I | J | K | L | M | N | O | P | Q | R | S | T | U | V | W | X | Y | Z
A

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; as of late 2018, the following states were considering keeping the requirement for individuals to have health insurance or pay a penalty: Washington, California, Hawaii, Minnesota, Vermont, Massachusetts, Rhode Island, Connecticut, New Jersey, Maryland and the District of Columbia. If you live in one of these states, it will be important for you to check your state requirements before deciding to opt-out of insurance.

Antibiotic - a type of medicine which treats bacterial infections.