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

Southeast Healthcare maintains a Cafeteria 125 Premium Only Plan which allows you to deduct your premium contributions for certain benefits on a pre-tax basis. In addition, a Summary Plan Description (SPD) Wrap Document is also included which describes the basic features of the plans including your rights and responsibilities.

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 

Effective 1/1/22 (United Healthcare)

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.

Standard Plan:

  • Certificate of Coverage – Detailed information about your medical and prescription benefits including coverages, exclusions and limitations.
  • Summary of Benefits and Coverage (SBC) – This is the standard benefits summary required to be made available under the Affordable Care Act. Also included is the Universal Glossary of Terms which is not specific to your plan but is very helpful for understanding various terms and how your plan works.
  • UHC’s Benefit Summary – A more detailed summary of the benefits than the SBC documents.

Buy-up Plan:

  • Certificate of Coverage – Detailed information about your medical and prescription benefits including coverages, exclusions and limitations.
  • Summary of Benefits and Coverage (SBC) – This is the standard benefits summary required to be made available under the Affordable Care Act. Also included is the Universal Glossary of Terms which is not specific to your plan but is very helpful for understanding various terms and how your plan works.
  • UHC’s Benefit Summary – A more detailed summary of the benefits than the SBC documents.

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

Effective until 12/31/21(Anthem)

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 the insurance company.

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

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.

    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

    UHC Welcome Flier – Learn all about UHC’s programs, services and ways you can get the most out of your benefits.

     Medical Plan Information:

    Online Provider Lookup – (Select the “UnitedHealthcare Choice Plus” as the health plan or call UHC directly)

    myuhc.com – UHC’s member and consumer self-service web site that provides a single source for online benefits and health related informationAccess 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 – 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.

    Employee Assistance Program – An EAP provides free 24/7 telephone access (888.887.4114) and 3 free face to face counseling sessions per incident per year with nurses, counselors, financial advisors and lawyers to you and your family members.

    Wellness Programs and Resources:

    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.

    Prescription Drug Listing Effective 1/1/22 (Subject to future changes) – See which drugs are covered, their copay tier, if they’re subject to prior authorizations, step therapy, etc.

      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

      Effective 1/1/22 (United Healthcare)

      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. 

      Effective until 12/31/21 (Anthem)

      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 the insurance company.

      Effective 1/1/22 (United Healthcare)

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

      Effective until 12/31/21 (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

       

      Effective 1/1/22 (United Healthcare)

      UHC’s vision website – Here you can access your claims, find providers and get various forms:

       Customer Service Phone: 800.638.3120

      Online Provider Lookup – Find in-network Spectera vision providers by name or location.

      Effective until 12/31/21 (Anthem)

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

       Customer Service Phone: 866.723.0515

      Online Provider Lookup – Find in-network vision providers by name or location. Under the plan selection filters. The Plan Type = “Vision Plans” and the Plan Name = “Blue View Vision”.

      Group Life and Disability

      Effective 1/1/22 (United Healthcare)

      Summary of Benefits and Welcome Brochure – High level summary of the life and disability benefits as well as value adds for each:

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

      Employee Assistance Program – This is available once you become eligible and are enrolled in the Group Life/AD&D insurance and is in addition to the EAP offered under the medical plan. This EAP provides free 24/7 telephone access (877.660.3806) and 3 free face to face counseling sessions per year.

      Effective until 12/31/21 (Anthem)

      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.

       

      Effective 1/1/22 (United Healthcare)

      UHC Life, STD and LTD 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 UHC knows who to pay the voluntary or group life and AD&D benefit to in the event of your death. 

      Evidence of Insurability Form – 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 UHC’s underwriting department within 30 days of signing the form.  Learn more about this by reading this Flier.

      Life Conversion and Portability Information:

      • Group Life Conversion – 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 UHC.
      • Supplemental Life Portability – Upon termination, you may have up to 31 days to “Port” your group voluntary term life coverage to an individual term life policy or Convert it to a Whole Life policy.  This is the form that needs to be completed by Southeast Healthcare and you before submitting to UHC.

       Effective until 12/31/21 (Anthem)

      Evidence of Insurability – 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.

       

      Effective 1/1/22 (United Healthcare)

      STD Claim Form – Need to file a short-term disability claim? Notify Human Resources and ask them to complete pages 1 & 2 of the STD Claim Form.  You’ll then need to complete the remaining pages and return it to UHC. 

      Effective until 12/31/21 (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

      Effective 1/1/22 (United Healthcare)

      FSA Summary Plan Description (Coming soon) – Description of the FSA benefits and what is covered and how the process works.

      FSA Employee Guide – General overview of how an FSA plan works, what is eligible for reimbursement and consideration you should keep in mind.

       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 January 1 to December 31 each year to to incur expenses and until February 28th to submit any requests for reimbursement.
      • See IRS Publication 502 for details on which expenses are allowable for reimbursement (ultimately it’s UHC who makes the final determination).

      Effective until 12/31/21 (Anthem)

      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.

       

      Effective 1/1/22 (United Healthcare)

      There are three ways to get reimbursed for qualified expenses:

      1. Debit Card – After you enroll, 2 cards will be mailed directly to your home. You should immediately activate them and store them safely. When you go to the doctor, pharmacy, etc. you can present and use your card to pay copays and other allowed expenses.  As long as the provider is an approved merchant and you’re paying for qualified expenses you shouldn’t have to send in any receipts.  If the claim is denied you can default to one of the two options below or call customer service at 866.755.2648 for assistance.
      2. Auto rollover – If a service is covered under the UHC medical or  prescription plans then UHC automatically sends processed claims to their FSA processing department on your behalf.
      3. Paper form – Complete a Health Care Reimbursement or Dependent Care reimbursement form and mail or fax it to UHC at the address indicated on the form.

       Effective until 12/31/21 (Anthem)

      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 1/1/22 (United Healthcare)

      Customer Service Phone: 866.755.2648

      myuhc.com [Instructions for Registering] – UHC’s member and consumer self-service web site that provides a single source for online benefits, health related information and viewing the medical, prescription drug and FSA claims processed by UHC. Here you can also access your personalized health care and benefits information.

      Additional Information:

      Effective until 12/31/21 (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:

        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