All completed forms should be sent to:
Cardington Yutaka Technologies – Ohio Plant
Attn: Juanita Thompson
575 West Main Street
Cardington, Ohio 43315
HRA Plan Information
Summary of Benefits and Coverage (SBC) – This is the
Summary Plan Description (SPD) – Detailed information about your plan, limitations, exclusions, appeals procedures, etc.
Annual Benefit Notices – DOL, ACA, ERISA and other required notices for new hires and during open enrollment.
WELLNESS Plan Information
Healthy Ways 400 Wellness Program – Summary of the WCUSA wellness program, point assignments, discount amounts
Wellness program Summary Plan Document – Information about CYT – Ohio Plant’s wellness program which is administered by WCUSA.
Cardington Yutaka Technologies – Ohio Plant handles the administration and notification of your rights under COBRA and ability to continue the insurance if a qualifying event. Please notify Juanita Thompson of any qualifying events so they can
HIPAA Authorization Form– UnitedHealthcare is not authorized to release protected health information without your consent. In most instances verbal authorization can be given to our insurance agent, Milestone Benefits Agency, Inc., for them to assist you or your dependent. However, in certain instances written authorization must be given to United Healthcare. If you want to authorize someone to have access to your information you must complete this form and send it to UnitedHealthcare.
As referenced above, network providers are responsible for submitting any claim forms to UnitedHealthcare on your behalf. However, if you have services provided by a non-network provider, you will need to pay that provider directly and complete the claim forms below for any reimbursements.
Prescription Mail Order Form – Complete this form and attach your prescription to receive up to a 90 day supply of your maintenance prescription medications.
Non-Network claim forms – Forms to be completed for non-network reimbursement (Not necessary for in-network services which are submitted directly by the provider)
United Healthcare Website: www.uhc.com
Medical Questions: 866.844.4864
Retail and Mailorder Rx Questions: 855.842.6337
Specialty Rx Questions: 888-739-5820
Real Appeal – Free weight loss program for you and your enrolled spouse.
Medical Plan Information:
Online Provider Lookup – (Select the “UnitedHealthcare Choice Plus” as the health plan or call UHC directly)
Treatment Cost Estimator – Video on UHC’s tools for estimating and comparing the costs of your procedures.
myuhc.com–UHC’s member and consumer self-service web site that provides a single source for online benefits and health related information. Access your personalized health care and benefits information. You may also take advantage of UHC’s online pharmacy for convenient services such as home delivery of prescriptions, over-the-counter medications and other health products can be sent right to your home. (Registration available to individuals currently enrolled with UnitedHealthcare.)
Virtual Visits – FREE SERVICE!!! – See and talk to a doctor from your mobile device or computer without an appointment. Doctors can send a prescription to the pharmacy of your choice. Ideal for treating non-emergency conditions for things like: Bronchitis, Colds/flu, Diarrhea, Pink eye, Sinus Infections and sore throats.
Where should I go for care – A summary guide of when it’s appropriate to go to your doctor’s office, virtual doctor, convenience care clinic, urgent care or emergency room.
Preventive Care Guidelines – Summary of the immunizations, screenings and other checkups for children and adults.
Health4Me – UHC’s mobile Smart Phone app. Find a network provider, view your ID card and other features on the go.
Health Risk Assessment and Coaching – Access instructions to the Health Assessment and online coaching programs for you and your covered spouse.
UHC Annual Rights & Resource Disclosure Notice – Information about your plan with UHC, your rights, how they use of your financial information, where to receive care other other generalities.
Healthy Pregnancy – Designed for expectant mothers to keep themselves and their babies healthy. The program helps determine if there are any high-risk factors and provides general health guidelines on child development.
FAQ’s for at home COVID testing starting 1-15-22 – Information on how to get free at home COVID tests for you and your covered dependents.
Prescription Drug Information:
Managing Pharmacy Benefits Online – Enables you to find lower-cost alternatives, refill mail prescriptions, view claim history and more
Drug Pricing information through myuhc.com – Instructions on how to check the cost of medications before you get them filled.
Benefit Summary – High level summary of the dental benefits and what is covered.
Certificate of Coverage – Detailed description of your benefits and exclusions.
Cardington Yutaka Technologies – Ohio Plant handles the administration and notification of your rights under COBRA and ability to continue the insurance if a qualifying event. Please notify Juanita Thompson of any qualifying events so they can in turn notify Delta Dental.
Dental Claim Form – In-network dentists will complete and send your claims to Delta Dental on your behalf. However, if you use a non-network dentist you may have to pay up front, complete this form and send it to Delta Dental at the address below:
Delta Dental of Ohio
P.O. Box 9085
Farmington Hills, MI 48333-9085
Delta Dental Website: www.deltadentaloh.com
Customer Service Phone: 800-524-0149
Online Provider Lookup – Be sure to select either the “Delta Dental PPO” or “Delta Dental Premier” network.
How to use your Delta Dental Benefits – Information on how to find a participating dentist, telephonic and online resources, claims submissions, etc.
Reference ID cards – Delta Dental does not provide personalized ID cards but these can be printed and given to your dentist when you visit them.
Other helpful information and flyers:
- Apple and Android app information for your smart phone
- Easy Reference Card to Delta’s telephonic service inquiry system
- How benefits coordinate with other dental insurance
- How Delta Dental pays for orthodontic services
Benefit Summary – High level summary of the vision benefits and what is covered.
Certificate of Coverage – Important information about plan eligibility, benefits, limitations and exclusions.
Cardington Yutaka Technologies – Ohio Plant handles the administration and notification of your rights under COBRA and ability to continue the insurance if a qualifying event. Please notify Juanita Thompson of any qualifying events so they can in turn notify EyeMed.
Non-Network Claim Form– In-network vision providers will complete and send your claims to EyeMed on your behalf. However, if you use a non-network vision provider you may have to pay up front, complete this form and send it to EyeMed:
Member Login: Access benefits, claims and other information about your benefits
EyeMed Customer Service Phone: 866.939.3633
Online Provider Lookup – Choose the “Select” Network when prompted.
Group Term Life and AD&D (Paid by CYT – Ohio Plant)
$50,000 Per Associate (up to age 64 with reductions at age 65 and 70)
Associate & Dependent Supplemental Term Life
- Associate Supplemental Life:
- 1, 2 or 3 times your annual compensation to a maximum of $500,000.
- Guarantee Issue is the lessor of 3 times your annual compensation or $150,000.
- Age reductions after age 64
- Dependent Supplemental Life:
- Spouse: $10,000 or $20,000 guarantee issue and benefit maximum.
- Child(ren): $5,000 or $10,000 per child that are older than 6 months. Children under 6 months are limited to $500.
Free Will Prep Service:
Mutual of Omaha provides a totally FREE Will Prep service for you, your legal spouse and adult children to the age of 26 for anyone covered under their group life or voluntary life insurance plans.
Documents include: Last Will and Testament for single/married persons, Power of Attorney, Healthcare Directive and Living Trusts.
To get started, download the flier which includes the website address and user code.
Mutual of Omaha’s Privacy Notice.
Evidence of Insurability – For late enrollees or those electing coverage amounts in excess of the Guarantee Issue levels.
Conversion and Portability – When you leave CYT – Ohio Plant, you have up to 30 days from your date of termination, to convert (Conversion Application) the group or supplemental term life insurance to an individual whole life plan. You can also “Port” (Portability Application) your supplemental term life insurance. This allows you to maintain the coverage as a term life benefit which is typically less expensive but increases in cost over time.
Other Forms and Information:
In the event a claim needs to be filed, please contact Juanita Thompson in Human Resources.
Short Term Disability Benefit (Eff 4/1/22):
Non-Exempt (Hourly Associates):
In the event you become disabled and after satisfying a 7 day elimination period, the play will pay you 40% of your base weekly earnings for the first 12 weeks. This benefit is paid for by CYT – Ohio Plant at no expense to Associates. In addition, Associates can purchase a 20% supplemental benefit for a total benefit of 60% of your base earnings. The premiums for this supplemental benefit are paid by the Associates through pre-tax payroll deductions. This benefit is issued as guaranteed issue (no medical questions) but you must sign up for this benefit within your first 30 days of becoming eligible.
In the event you become disabled and after satisfying a 7 day elimination period, the plan will pay 100% of your base weekly earnings for the first 9 weeks and then 60% of your base weekly earning for the remaining 4 weeks.
Long Term Disability Benefit (Eff 4/1/22):
Exempt and Non-Exempt:
After satisfying a 90 day elimination period (the end of the Short Term Disability Benefit), the plan will pay 60% of your basic weekly earnings to a maximum of $4,000 per month for up to 2 years.
How to file a claim: Since CYT – Ohio Plant provides both a Short and Long Term Disability benefit, all claims begin under the Short Term Disability benefit. To initiate a disability claim, follow the steps outlined in this link:
Step1: Notify your supervisor
Step2: Call MoO at 800.877.5176 Opt.1
Step3: Take forms to your doctors
If it appears your disability will extend beyond 90 days, your STD case worker will contact you and your physician to assist you with the LTD application process. In all cases, you must contact the Administration department and your supervisor to notify them of your status. You must also complete the Waiver of Premium Claim Form so your LTD benefits and premiums can continue without any further premium payments.
Check on the status of your claim
Contact Renee Summers:
Phone: 800-877-5176 x4149
FSA Summary Plan Description – Description of the FSA benefits and what is covered and how the process works.
Effective 4/1/22 the maximum annual election amount is increasing from $1,500 to $2,850.
Please note the following:
- There is a $25 minimum for a reimbursement check – This is waived on the last day of the plan year.
- You have from April 1 2022 to June 15, 2023 to incur expenses and then until June 30, 2023 to submit any receipts for reimbursement.
- See IRS Publication 502 for details on which expenses are allowable for reimbursement (ultimately it’s UHC who makes the final determination).
There are three ways to get reimbursed for qualified expenses:
- UHC covered medical services – If a service is covered under the UHC medical plan then UHC automatically sends processed claims to their FSA unit for processing. There is nothing you need to do and the check will be send directly to you. If you don’t want UHC to do this you can go into myuhc.com and remove this function.
- UHC covered pharmacy medications – Use the debit at your pharmacy to have the money automatically deducted from your FSA. This card is mailed directly to your home within two to three weeks after you enroll.
- Other medical care allowed expenses – If you have a service which is not covered by the UHC plan (i.e., dental expenses, over the counter prescriptions, etc.) then you must complete a UHC Claim Form and mail or fax it to UHC at the address indicated on the form:
Below are links to the claim forms for the three Aflac Products.
Up to $20,000 of Critical Illness coverage is “Guarantee Issue”. However, if you elect more than $20,000, you must complete Aflac’s Evidence of Insurability form and be approved.
The forms can be submitted by fax to 866.849.2970 or via e-mail to email@example.com
Aflac Customer Service: 800.433.3036
Enrollment elections, changes and terminations should be made in Kronos. However, if you have any questions about the plans during enrollment or throughout the year, you can contact Amber Stein at Aflac directly at:
Phone: (740) 815-8440
The CYT – Ohio Plant’s clinic is operated by Ohio Health and is available to all full-time Associates. The clinic is also available to covered dependents (age 2+) as long as they are covered by CYT – Ohio Plant’s group health plan. The clinic is free of charge and staffed by a Certified Nurse Practitioner and Medical Assistant. It’s ideally suited to treat acute health concerns such as upper respiratory infections, sinus infections, sore throats, sprains, earaches, flu shots (age 16+) and minor cuts or bruises
Tuesday: 11:30AM – 6:30PM
Wednesday: 8:30AM – 5:30PM
Thursday: 9:30AM – 5:30PM
Friday – Sunday: Closed
CYT – Ohio Plant Clinic
573 West Main Street
Cardington, OH 43315
Milestone Benefits Agency, Inc.
521 Village Park Drive
PO Box 2038
Powell, OH 43065
Local Phone: 614-431-9540
Milestone Benefits Agency: www.milestonebenefits.com
Contact information signs – Content information about this website and how to contact CYT – Ohio Plant’s representatives at Milestone Benefits Agency, Inc.
Disclaimer: The information contained on this site serves as a resource for the employees and administrators of your employer and in some instances only contains an overview of the benefits, provisions, limitations and exclusions of these programs. Information can sometimes change and may not be current on this site. In all instances, if the information contained on this site conflicts with the applicable plan documents or carrier administration of these programs, the plan documents and their administrative policies will prevail. Each company reserves the right to change these benefits at any time without prior notice and at their own discretion.
Powell, Ohio 43065
Hours of Operation: