Summary of Benefits, Forms and Contact Information

Overview


Southeast Healthcare is proud to provide a comprehensive and competitive benefits package to all of its qualified employees. This website contains summaries and links to the various components of these coverages and should be used as a portal to your benefit needs. The Wrap Plan Summary Plan Description (SPD) is also included as an overviews of the plans.

For a high level summary you can view our 2-page Benefits Overview which highlights the various benefits detailed below.

In most cases, you have up to 31 days from your date of hire or eligibility date to complete all of the necessary applications and forms to be retroactively enrolled in the benefits as outlined below. Failure to complete these materials in the allotted time will result in you forfeiting your eligibility for these benefits until the next open enrollment period unless you have a qualifying event.

All completed forms should be sent to:

Southeast Healthcare
Attn: Edward Alpha
Human Resources Department
16 West Long Street
Columbus, OH 43215

Medical and Prescription Drug Insurance 

Standard Plan:

Buy-up Plan:

Annual Benefit Notices – DOL, ACA, ERISA and other required notices for new hires and during open enrollment.

Anthem’s Medical and Rx Benefit Booklet – Excellent high level summary of the benefit plans and other resources available to you through Anthem.  

Southeast Healthcare contracts with WageWorks to handle the administration and notification of your rights under COBRA and ability to continue the insurance if a qualifying event. While Southeast Healthcare is aware of events such as terminations of employment, it is YOUR responsibility to notify Human Resources of any qualifying events so they can in turn notify Anthem.

Anthem’s network providers are responsible for submitting any claim forms to Anthem 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.

      Dental Insurance 

      Summary of Benefits – High level summary about your dental plan including deductibles, coinsurance amounts and benefit maximums.

      Certificate of Coverage – Detailed information about your dental benefits including coverages, exclusions and limitations.

      Point of Service Payment Summary – Shows how your benefits can be enhanced by using Delta Dental’s different networks.

      Southeast Healthcare contracts with WageWorks is to handle the administration and notification of your rights under COBRA and ability to continue the insurance if a qualifying event. While While Southeast Healthcare is aware of events such as terminations of employment, it is YOUR responsibility to notify the Human Resources of any qualifying events so they can in turn notify Delta Dental.

      Dental Claim Form

      Mail your completed form to:
      Delta Dental
      P.O. Box 9085
      Farmington Hills, MI 48333-9085.

      Web: www.deltadental.com

      Customer Service Phone: 800-282-0749

      Member Portal – Online access to your claims, online ID cards, Explanation of Benefits (EOB’s), deductibles, usage levels and        more.  See Flyer for more details.

      Online Provider Lookup – Direct link to looking up providers online. 

       

      Voluntary Vision Insurance

      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. 

       

      Southeast Healthcare contracts with WageWorks to handle the administration and notification of your rights under COBRA and ability to continue the insurance if a qualifying event. While Southeast Healthcare is aware of events such as terminations of employment, it is YOUR responsibility to notify the Human Resources of any qualifying events so they can in turn notify Anthem.

      Non-Network Claim Form– In-network vision providers will complete and send your claims to Anthem 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 Anthem at the address on the bottom of the form

       

      Anthem’s vision website where you can access your claims, find providers and get various forms:http://www.anthem.com/mydentalvision/

       

       

      Group Life and Disability

      Benefit Highlight Sheets – High level summary of the life and disability benefits:

      Certificates of Coverage – Detailed information on the life and disability benefits:

      Anthem’s Life and DI Benefit Booklet – Excellent high level summary of the benefit plans and other resources available to you through Anthem.   

      Anthem’s value added services – Summary of additional services available to you at no additional cost such as: Employees Assistance Program (EAP), Travel assistance and  discounts on other services.

       

      Anthem Enrollment Form – Even if you don’t want to elect voluntary life insurance, all newly eligible employees are required to complete the enrollment form so that Anthem  knows who to pay the voluntary or group life and AD&D benefit to in the event of your death.

      Personal Health Application – If you elect voluntary life coverage for you or your spouse in excess of the Guarantee Issue ($100,000 for you and $30,000 for your spouse) you must complete and submit this form to Anthem’s underwriting department within 30 days of signing the form.

      Anthem Beneficiary Designation Form – The purpose of designating beneficiaries for this policy is to tell Anthem Life Insurance Company exactly how you wish the proceeds of your policy to be paid.

       

      Life Conversion and Portability Information:

      Conversion Vs. Portability – Summary of the options available to you for taking your life insurance with you when your employment ends.  To elect coverage you must work with Human Resources to complete the appropriate form below.

      • Group Life Conversion Form – Upon termination you have up to 31 days to convert your $25,000 of group life and/or voluntary term life to a whole life policy.  This is the form that needs to be completed by Southeast Healthcare and you before submitting to Anthem.
      • Voluntary Life Portability Form – Upon termination, you may have up to 31 days to “Port” your group voluntary term life coverage to an individual term life policy.  This is the form that needs to be completed by Southeast Healthcare and you before submitting to Anthem.

       

      STD Claim Form and Telephonic Intake Flier – Need to file a short-term disability claim? Just read through this flier and call Anthem to get your claim started.

      Flexible Spending Accounts

      Summary Plan Description and Amendment – Detailed information about the Health and Dependent Care FSA plans. In addition, this document addresses your pretax deductions for the premiums you pay for medical, dental and vision insurance.

       

      There are two ways to get reimbursed for qualified expenses:

      1. If a service is covered under the Anthem medical, prescription or vision plans then Anthem automatically sends processed claims to Health Equity for processing.
      2. Other health or dependent care allowed expenses – If you have a service which is not covered by the Anthem plan (i.e., dental expenses, over the counter prescriptions, dependent care) then you should use Health Equity’s Mobile App to submit your claims for reimbursement.

      Effective 1.1.21 (Health Equity)

      Customer Service Phone Number: 866.346.5800

      Online Access or Mobile App – Login to check your FSA balance, reimbursed claims, sign up for direct deposit, view an expense guide of what is and is not eligible for reimbursement and other information.

      Additional Information:

      Until 12.31.20 (WageWorks)

      Customer Service Phone Number: 866.599.3061

      Online Access – Login to check your FSA balance, reimbursed claims, sign up for direct deposit, view an expense guide of what is and is not eligible for reimbursement and other information.

       Frequently Asked Questions:

      • Medical FSA – FAQ’s about the medical FSA, how it works and what’s covered.
      • Dependent Care FSA – FAQ’s about the dependent care FSA, how it works and what’s allowed.
      • Automatic Claims Rollover – By default, once Anthem’s claims system has processed your medical and prescription claims they are automatically forwarded to the FSA system for reimbursement. This document explains this process in more detail.

      Insurance Benefits Specialist (Agent)

      Milestone Benefits Agency, Inc.
      521 Village Park Drive
      PO Box 2038
      Powell, OH 43065

      Phone: 614-431-9540
      Fax: 614-844-5364

      Milestone Benefits Agency: www.milestonebenefits.com

      Contact information signs – Content information about this website and how to contact your representatives at Milestone

      Stacy Green
      Direct: (614) 318-3163
      E-mail: Stacy@milestonebenefits.com

      Kent Bermingham Jr.
      Direct: (614) 318-5485
      E-mail: kentjr@milestonebenefits.com

      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.

      Our Location:

      521 Village Park Drive
      PO Box 2038 
      Powell, Ohio 43065

      Contact Info:

      614.431.9540 (Phone)
      614.844.5364 (Fax)
      info@milestonebenefits.com

      Hours of Operation:

      M-F: 8:00 - 5:00 Eastern