iRenewal Open Enrollment
Meeting Presentation Template
OVERVIEW & EDITING INSTRUCTIONS
Overview
 This template was created to save you time in developing PowerPoint
Presentations for your Enrollment meetings.
 Please read the instructions on how to efficiently edit this template to fit
your needs.
 This is a template. Please save a copy of this template to a safe location
and do not save over the template version. Always save your edits as a
new document.
 This template is broken up into sections. If you don’t need any slides from
a section, you can delete the section and it’s slides by selecting the section
header, right clicking and selecting “remove section and slides”.
 Many of the slides in this template have items marked in parenthesis,
these are items that need to be completed by you. – Example: (Group
Name)
Group & Broker Info Section
 Cover Slide – This will be your first slide in your
PowerPoint Presentation (PPT)



Add your Group’s Name
Add the date of the presentation
You can also add your group’s logo, by inserting an image.
 Agency Slide
 Add Broker/Agency Logo
 Enter Broker/Agency Info
Medical Carrier/Plan Information
 There is a section for each major medical carrier.
 There is also a section for you to add any carriers not contained in this template.
 For any carriers you don’t need, simply delete the section, by selecting the section
header, right clicking and selecting “remove section and slides”.
 Each carrier contains a carrier logo, a listing of their value add services as well as
carrier contact information for members.
 There is a slide for entering information about a carrier or plan. Delete the example
wording already listed and type the new information in it’s place.
 You also have the ability to enter specific plan benefit information. If you have more
than one of any type of plan, you can duplicate that slide to enter additional plans.
Ancillary Lines Carrier/Plan Information
 There is a section each for Dental, Vision, Life and Disability
Carrier/Plan information.
 For any lines of coverage you don’t need, simply delete the
section, by selecting the section header, right clicking and
selecting “remove section and slides”.
 There is a slide for entering information about a carrier or
plan. Delete the example wording already listed and type the
new information in it’s place.
 You also have the ability to enter specific plan benefit
information. If you have more than one of any type of plan,
you can duplicate that slide to enter additional plans.
Summary Information
 This section contains slides for you to note costs,
important information and to answer any questions.
 There are some examples of information you may
want to include but are not necessary.
 Either delete or write over any information you do not
wish to include in this section.
Other Carrier Information
 At the end of this PPT we have included carrier logo’s
and contact sheets for our ancillary lines carriers.
 You can add these to the Ancillary Lines section as
needed.
 If you have the same carrier for more than one ancillary
line, you can duplicate the appropriate slide and move
one to each ancillary section as necessary.
 A CoPower section is also available. This section also
has slides for the Value Add services available to
CoPower groups.
Finalize Your Presentation
 Once you have all the plan and carrier information
entered, finalize your presentation and remove unneeded
slides.
 The easiest way to remove slides is by going to the slide
sorter view, highlighting a slide and right click, then select
delete from the pop-up menu. (Don’t forget to remove the
instruction section you just read!)
 Once all unneeded slides are removed and your order is
how you want it, save your PPT and you are done!
Presentation Best Practices
 Speak clearly and breath normally.
 Always have a beverage (water, coffee, etc.) nearby just
in case during your presentation.
 Practice your presentation so you are comfortable
delivering the material.
 Do not read each word on a slide. Use the presentation
to supplement your speaking points.
 Relax, remember, you are the professional!
(Group Name)
Benefits Enrollment
( D AT E )
Presented by:
(Broker Name)
(Agency Name)
(Agency Address)
(Agency City, State, Zip)
(Broker Phone)
(Broker Email)
 (Agency Logo)
 To add logo, delete all text in this box
 Click on the Picture icon “Insert Picture
from File”
 Locate the Agency Logo file on your
computer in the finder window and click
the “Open” button
 You may need to resize the logo to make
sure it is not distorted
Health Insurance
Value Add Services
 Member Management Tools
 Member Savings on…
 24/7 Nurse Hotlines

 EAP Program

 Disease Management Program
 Healthy Lifestyles Coaching






Fitness Discount Program
Weight-loss Programs
Hearing exams and devices
Eye Care, Eyewear &
Accessories
LASIK Eye surgery
Massage Therapy
Chiropractic & Acupuncture
Dietetic Counseling
Plan Highlights
 For Example Ded applies to OOP max
 For Example Self Injectables covered under OV
 For Example Ped Dental benefit counts toward OOP
 For Example Preventative Covered in full
Plan Benefits - HMO
(Plan Name/Network)
Single Annual Deductible
Family Annual Deductible
Annual Out-of-Pocket Maximum
Family Annual Out-of-Pocket Maximum
Office Visit Copay
Coinsurance
In Patient Hospitalization
Generic Prescription Drugs Copay
Brand Name Prescription Drug Deductible
Brand Name Prescription Drug Copay
Pediatric Dental
Benefits
Plan Benefits – PPO
(Plan Name/Network)
Single Annual Deductible
Family Annual Deductible
Annual Out-of-Pocket
Maximum
Family Annual Out-of-Pocket
Maximum
Office Visit Copay
Coinsurance
In Patient Hospitalization
Generic Prescription Drugs
Copay
Brand Name Prescription
Drug Deductible
Brand Name Prescription
Drug Copay
Pediatric Dental
In-Network Benefits
Out-of-Network Benefits
Plan Benefits –CDHP
(Plan Name/Network)
Single Annual Deductible
Family Annual Deductible
Annual Out-of-Pocket
Maximum
Family Annual Out-of-Pocket
Maximum
Office Visit Copay
Coinsurance
In Patient Hospitalization
Generic Prescription Drugs
Copay
Brand Name Prescription Drug
Deductible
Brand Name Prescription Drug
Copay
Pediatric Dental
In-Network Benefits
Out-of-Network Benefits
Complete the sections applicable in its entirety.
Medical Enrollment
Form Completion
Do not fill out any ancillary sections if the ancillary
plans are not being offered with your medical
carrier.
Below are commonly missed fields which are required
and may hold up your group’s approval.








Complete SSN for each member of your family
Complete address
Pick your plan/network
Complete date of hire mm/dd/yy
HMO members – indicate PCP assignment
Complete a waiver for you or any family member
not enrolling
Sign and date application for enrolling in
coverage.
Signature date needs to be before effective date
Contact Info
On the Phone:
On the Web:
Member Services/Claims
HMO 877-702-3862
PPO 877-802-3862
Carrier Website:
http://www.aetna.com/
Find a Provider:
Pharmacy Info:
800-238-6279
http://www.aetna.com/docfind/
Health Insurance
Value Add Services
 Member Management




Tools
LiveHealth Online
24/7 Nurse Hotline
BlueCard
Wellness


Smoking Cessation
programs
Stress Management
 Savings







Gym Memberships
Holistic Care
Eye Care
Weight Management
Hearing exams, devices,
audio gear
Allergy Control
LifeMart Membership
Plan Highlights
 For Example Ded applies to OOP max
 For Example Self Injectables covered under OV
 For Example Ped Dental benefit counts toward OOP
 For Example Preventative Covered in full
Plan Benefits - HMO
(Plan Name/Network)
Single Annual Deductible
Family Annual Deductible
Annual Out-of-Pocket Maximum
Family Annual Out-of-Pocket Maximum
Office Visit Copay
Coinsurance
In Patient Hospitalization
Generic Prescription Drugs Copay
Brand Name Prescription Drug Deductible
Brand Name Prescription Drug Copay
Pediatric Dental
Benefits
Plan Benefits – PPO
(Plan Name/Network)
Single Annual Deductible
Family Annual Deductible
Annual Out-of-Pocket
Maximum
Family Annual Out-of-Pocket
Maximum
Office Visit Copay
Coinsurance
In Patient Hospitalization
Generic Prescription Drugs
Copay
Brand Name Prescription
Drug Deductible
Brand Name Prescription
Drug Copay
Pediatric Dental
In-Network Benefits
Out-of-Network Benefits
Plan Benefits –CDHP
(Plan Name/Network)
Single Annual Deductible
Family Annual Deductible
Annual Out-of-Pocket
Maximum
Family Annual Out-of-Pocket
Maximum
Office Visit Copay
Coinsurance
In Patient Hospitalization
Generic Prescription Drugs
Copay
Brand Name Prescription Drug
Deductible
Brand Name Prescription Drug
Copay
Pediatric Dental
In-Network Benefits
Out-of-Network Benefits
Complete the sections applicable in its entirety.
Medical Enrollment
Form Completion
Do not fill out any ancillary sections if the ancillary
plans are not being offered with your medical
carrier.
Below are commonly missed fields which are required
and may hold up your group’s approval.







Complete SSN for each member of your family
Complete address
Pick your plan/network
Complete date of hire mm/dd/yy
HMO members – indicate PCP assignment
Complete a waiver for you or any family member
not enrolling
Sign and date application for enrolling in
coverage.
Contact Info
On the Phone:
On the Web:
Member Services/Claims
800-627-8797
Carrier Website:
Pharmacy Info:
866-297-1013
Find a Provider:
http://www.anthem.com/ca
https://www.anthem.com/healthinsurance/providerdirectory/searchcriteria?qs
Health Insurance
Value Add Services
 Carrier Member Perks
24/7 Nurse Hotline
 Member management
tools
 Wellness programs
 Savings on a variety of
personal health items
and healthy living
programs

** Every carrier varies on the amount and program
discounted. Please contact your enrolled carrier for
additional information.
• Additional California
Choice Savings
• Savings on hearing
exams and hearing
devices
• Dental Discount Plan
• Discounts on EyeMed
Vision Care
• Cal Perks – Access to
employee discounts on
tickets, membership and
more.
Plan Highlights
 For Example Ded applies to OOP max
 For Example Self Injectables covered under OV
 For Example Ped Dental benefit counts toward OOP
 For Example Preventative Covered in full
Plan Benefits - HMO
(Plan Name/Network)
Single Annual Deductible
Family Annual Deductible
Annual Out-of-Pocket Maximum
Family Annual Out-of-Pocket Maximum
Office Visit Copay
Coinsurance
In Patient Hospitalization
Generic Prescription Drugs Copay
Brand Name Prescription Drug Deductible
Brand Name Prescription Drug Copay
Pediatric Dental
Benefits
Plan Benefits – PPO
(Plan Name/Network)
Single Annual Deductible
Family Annual Deductible
Annual Out-of-Pocket
Maximum
Family Annual Out-of-Pocket
Maximum
Office Visit Copay
Coinsurance
In Patient Hospitalization
Generic Prescription Drugs
Copay
Brand Name Prescription
Drug Deductible
Brand Name Prescription
Drug Copay
Pediatric Dental
In-Network Benefits
Out-of-Network Benefits
Plan Benefits –CDHP
(Plan Name/Network)
Single Annual Deductible
Family Annual Deductible
Annual Out-of-Pocket
Maximum
Family Annual Out-of-Pocket
Maximum
Office Visit Copay
Coinsurance
In Patient Hospitalization
Generic Prescription Drugs
Copay
Brand Name Prescription Drug
Deductible
Brand Name Prescription Drug
Copay
Pediatric Dental
In-Network Benefits
Out-of-Network Benefits
Complete the sections applicable in its entirety.
Medical Enrollment
Form Completion
Do not fill out any ancillary sections if the ancillary
plans are not being offered with your medical
carrier.
Below are commonly missed fields which are required
and may hold up your group’s approval.







Complete SSN for each member of your family
Complete address
Pick your plan/network
Complete date of hire mm/dd/yy
HMO members – indicate PCP assignment
Complete a waiver for you or any family member
not enrolling
Sign and date application for enrolling in
coverage.
Contact Info
Medical Carriers
Ancillary Carriers
Aetna:
888-702-3862
Anthem:
866-524-5659
Health Net: 800-361-3366
Kaiser:
800-464-4000
SHARP:
800-359-2002
Western Health Advantage:
888-563-2250
Ameritas:
FDH:
Smile Saver:
EyeMed:
Landmark:
www.calchoice.com
877-203-0036
800-558-8003
800-333-9561
866-939-3633
800-638-4557
Health Insurance
Value Add Services
 Member Management
Tools
 24/7 Nurse Hotline
 Wellness


Smoking Cessation
programs
Stress Management
 Savings







Gym Memberships
Holistic Care
Eye Care
Weight Management
Hearing exams, devices,
audio gear
Allergy Control
LifeMart Membership
Member perks offered by Anthem Blue Cross
Plan Highlights
 For Example Ded applies to OOP max
 For Example Self Injectables covered under OV
 For Example Ped Dental benefit counts toward OOP
 For Example Preventative Covered in full
Plan Benefits - HMO
(Plan Name/Network)
Single Annual Deductible
Family Annual Deductible
Annual Out-of-Pocket Maximum
Family Annual Out-of-Pocket Maximum
Office Visit Copay
Coinsurance
In Patient Hospitalization
Generic Prescription Drugs Copay
Brand Name Prescription Drug Deductible
Brand Name Prescription Drug Copay
Pediatric Dental
Benefits
Plan Benefits – PPO
(Plan Name/Network)
Single Annual Deductible
Family Annual Deductible
Annual Out-of-Pocket
Maximum
Family Annual Out-of-Pocket
Maximum
Office Visit Copay
Coinsurance
In Patient Hospitalization
Generic Prescription Drugs
Copay
Brand Name Prescription
Drug Deductible
Brand Name Prescription
Drug Copay
Pediatric Dental
In-Network Benefits
Out-of-Network Benefits
Plan Benefits –CDHP
(Plan Name/Network)
Single Annual Deductible
Family Annual Deductible
Annual Out-of-Pocket
Maximum
Family Annual Out-of-Pocket
Maximum
Office Visit Copay
Coinsurance
In Patient Hospitalization
Generic Prescription Drugs
Copay
Brand Name Prescription Drug
Deductible
Brand Name Prescription Drug
Copay
Pediatric Dental
In-Network Benefits
Out-of-Network Benefits
Complete the sections applicable in its entirety.
Medical Enrollment
Form Completion
Do not fill out any ancillary sections if the ancillary
plans are not being offered with your medical
carrier.
Below are commonly missed fields which are required
and may hold up your group’s approval.







Complete SSN for each member of your family
Complete address
Pick your plan/network
Complete date of hire mm/dd/yy
HMO members – indicate PCP assignment
Complete a waiver for you or any family member
not enrolling
Sign and date application for enrolling in
coverage.
Contact Info
On the Phone:
On the Web:
Anthem Member
Carrier Website:
http://www.calcpa.com
Services/Claims
800-627-8797
Pharmacy Info:
866-297-1013
Delta Dental of California
888-335-8227
VSP
800-877-7195
Find a Provider:
https://www.anthem.com/healthinsurance/providerdirectory/searchcriteria?qs
Health Insurance
Plan Highlights
 For Example Ded applies to OOP max
 For Example Self Injectables covered under OV
 For Example Ped Dental benefit counts toward OOP
 For Example Preventative Covered in full
Plan Benefits - HMO
(Plan Name/Network)
Single Annual Deductible
Family Annual Deductible
Annual Out-of-Pocket Maximum
Family Annual Out-of-Pocket Maximum
Office Visit Copay
Coinsurance
In Patient Hospitalization
Generic Prescription Drugs Copay
Brand Name Prescription Drug Deductible
Brand Name Prescription Drug Copay
Pediatric Dental
Benefits
Plan Benefits – PPO
(Plan Name/Network)
Single Annual Deductible
Family Annual Deductible
Annual Out-of-Pocket
Maximum
Family Annual Out-of-Pocket
Maximum
Office Visit Copay
Coinsurance
In Patient Hospitalization
Generic Prescription Drugs
Copay
Brand Name Prescription
Drug Deductible
Brand Name Prescription
Drug Copay
Pediatric Dental
In-Network Benefits
Out-of-Network Benefits
Plan Benefits –CDHP
(Plan Name/Network)
Single Annual Deductible
Family Annual Deductible
Annual Out-of-Pocket
Maximum
Family Annual Out-of-Pocket
Maximum
Office Visit Copay
Coinsurance
In Patient Hospitalization
Generic Prescription Drugs
Copay
Brand Name Prescription Drug
Deductible
Brand Name Prescription Drug
Copay
Pediatric Dental
In-Network Benefits
Out-of-Network Benefits
Complete the sections applicable in its entirety.
Medical Enrollment
Form Completion
Do not fill out any ancillary sections if the ancillary
plans are not being offered with your medical
carrier.
Below are commonly missed fields which are required
and may hold up your group’s approval.








Complete SSN for each member of your family
Complete address
Pick your plan/network
Pick your Pediatric Dental Plan
Complete date of hire mm/dd/yy
HMO members – indicate PCP assignment
Complete a waiver for you or any family member
not enrolling
Sign and date application for enrolling in
coverage.
Contact Info
On the Phone:
On the Web:
Blue Shield of California
800-325-5166
Chinese Community Health Plan
888-775-7888
Health Net
888-926-5122 or 800-522-0088
Kaiser Permanente
800-464-4000
Sharp Health Plan
800-359-2002
Western Health Advantage
888-563-2250
http://www.blueshieldca.com/
http://www.cchphmo.com/
http://www.healthnet.com/
http://www.kp.org/
http://www.sharphealthplan.com/
http://www.westernhealth.com/
Health Insurance
Value Add Services
 Member Management




Tools
Decision Power: Health
& Wellness Program
Smoking Cessation
Programs
Health Net Mobile App
24/7 Nurse Hotline
 Savings
 Gym Memberships
 Holistic Care
 Eye Exams, Glasses,
Frames and Contacts
 Hearing Exams and
Devices
 Weight Management
Programs
 Vitamins, Minerals and
Herbal Supplements
Plan Highlights
 For Example Ded applies to OOP max
 For Example Self Injectables covered under OV
 For Example Ped Dental benefit counts toward OOP
 For Example Preventative Covered in full
Plan Benefits - HMO
(Plan Name/Network)
Single Annual Deductible
Family Annual Deductible
Annual Out-of-Pocket Maximum
Family Annual Out-of-Pocket Maximum
Office Visit Copay
Coinsurance
In Patient Hospitalization
Generic Prescription Drugs Copay
Brand Name Prescription Drug Deductible
Brand Name Prescription Drug Copay
Pediatric Dental
Benefits
Plan Benefits – PPO
(Plan Name/Network)
Single Annual Deductible
Family Annual Deductible
Annual Out-of-Pocket
Maximum
Family Annual Out-of-Pocket
Maximum
Office Visit Copay
Coinsurance
In Patient Hospitalization
Generic Prescription Drugs
Copay
Brand Name Prescription
Drug Deductible
Brand Name Prescription
Drug Copay
Pediatric Dental
In-Network Benefits
Out-of-Network Benefits
Plan Benefits –CDHP
(Plan Name/Network)
Single Annual Deductible
Family Annual Deductible
Annual Out-of-Pocket
Maximum
Family Annual Out-of-Pocket
Maximum
Office Visit Copay
Coinsurance
In Patient Hospitalization
Generic Prescription Drugs
Copay
Brand Name Prescription Drug
Deductible
Brand Name Prescription Drug
Copay
Pediatric Dental
In-Network Benefits
Out-of-Network Benefits
Complete the sections applicable in its entirety.
Medical Enrollment
Form Completion
Do not fill out any ancillary sections if the ancillary
plans are not being offered with your medical
carrier.
Below are commonly missed fields which are required
and may hold up your group’s approval.







Complete SSN for each member of your family
Complete address
Pick your plan/network
Complete date of hire mm/dd/yy
HMO members – indicate PCP assignment
Complete a waiver for you or any family member
not enrolling
Sign and date application for enrolling in
coverage.
Contact Info
On the Phone:
On the Web:
Member Services
(membership questions,
claims and Rx)
800-3611-336
Carrier Website:
http://www.healthnet.com
Find a Provider:
https://www.healthnet.com/portal/
providerSearch.action
Health Insurance
Value Add Services
 Member Management
Tools
 Workforce Health
Program
 Smoking Cessation
Programs
 24/7 Nurse Hotline
 Savings





Gym Membership
Holistic Care
Eye Exams, Glasses,
Frames and Contacts
Weight Management
Programs
Private Duty – Home
Support Services
Plan Highlights
 For Example Ded applies to OOP max
 For Example Self Injectables covered under OV
 For Example Ped Dental benefit counts toward OOP
 For Example Preventative Covered in full
Plan Benefits - HMO
(Plan Name/Network)
Single Annual Deductible
Family Annual Deductible
Annual Out-of-Pocket Maximum
Family Annual Out-of-Pocket Maximum
Office Visit Copay
Coinsurance
In Patient Hospitalization
Generic Prescription Drugs Copay
Brand Name Prescription Drug Deductible
Brand Name Prescription Drug Copay
Pediatric Dental
Benefits
Plan Benefits – PPO
(Plan Name/Network)
Single Annual Deductible
Family Annual Deductible
Annual Out-of-Pocket
Maximum
Family Annual Out-of-Pocket
Maximum
Office Visit Copay
Coinsurance
In Patient Hospitalization
Generic Prescription Drugs
Copay
Brand Name Prescription
Drug Deductible
Brand Name Prescription
Drug Copay
Pediatric Dental
In-Network Benefits
Out-of-Network Benefits
Plan Benefits –CDHP
(Plan Name/Network)
Single Annual Deductible
Family Annual Deductible
Annual Out-of-Pocket
Maximum
Family Annual Out-of-Pocket
Maximum
Office Visit Copay
Coinsurance
In Patient Hospitalization
Generic Prescription Drugs
Copay
Brand Name Prescription Drug
Deductible
Brand Name Prescription Drug
Copay
Pediatric Dental
In-Network Benefits
Out-of-Network Benefits
Complete the sections applicable in its entirety.
Medical Enrollment
Form Completion
Do not fill out any ancillary sections if the ancillary
plans are not being offered with your medical
carrier.
Below are commonly missed fields which are required
and may hold up your group’s approval.







Complete SSN for each member of your family
Complete address
Pick your plan/network
Complete date of hire mm/dd/yy
HMO members – indicate PCP assignment
Complete a waiver for you or any family member
not enrolling
Sign and date application for enrolling in
coverage.
Contact Info
On the Phone:
On the Web:
Member Services/Claims
800-464-4000
Carrier Website:
http://www.kp.org
Pharmacy Info:
800-390-3510
Find a Provider:
https://healthy.kaiserpermanente.org/
health/care/consumer/locate-ourservices/doctors-and-locations
Health Insurance
Value Add Services
 Member Management
Tools
 Smoking Cessation
Programs
 24/7 Nurse Hotline
 Savings
 Gym Membership
 Dental Products
 Holistic Care
 Stress Management
 Weigh Management
 Wellness Products






Vitamins
Nutritional Supplements
Books
DVDs
Fitness
Skin Care
Plan Highlights
 For Example Ded applies to OOP max
 For Example Self Injectables covered under OV
 For Example Ped Dental benefit counts toward OOP
 For Example Preventative Covered in full
Plan Benefits - HMO
(Plan Name/Network)
Single Annual Deductible
Family Annual Deductible
Annual Out-of-Pocket Maximum
Family Annual Out-of-Pocket Maximum
Office Visit Copay
Coinsurance
In Patient Hospitalization
Generic Prescription Drugs Copay
Brand Name Prescription Drug Deductible
Brand Name Prescription Drug Copay
Pediatric Dental
Benefits
Plan Benefits – PPO
(Plan Name/Network)
Single Annual Deductible
Family Annual Deductible
Annual Out-of-Pocket
Maximum
Family Annual Out-of-Pocket
Maximum
Office Visit Copay
Coinsurance
In Patient Hospitalization
Generic Prescription Drugs
Copay
Brand Name Prescription
Drug Deductible
Brand Name Prescription
Drug Copay
Pediatric Dental
In-Network Benefits
Out-of-Network Benefits
Plan Benefits –CDHP
(Plan Name/Network)
Single Annual Deductible
Family Annual Deductible
Annual Out-of-Pocket
Maximum
Family Annual Out-of-Pocket
Maximum
Office Visit Copay
Coinsurance
In Patient Hospitalization
Generic Prescription Drugs
Copay
Brand Name Prescription Drug
Deductible
Brand Name Prescription Drug
Copay
Pediatric Dental
In-Network Benefits
Out-of-Network Benefits
Complete the sections applicable in its entirety.
Medical Enrollment
Form Completion
Do not fill out any ancillary sections if the ancillary
plans are not being offered with your medical
carrier.
Below are commonly missed fields which are required
and may hold up your group’s approval.







Complete SSN for each member of your family
Complete address
Pick your plan/network
Complete date of hire mm/dd/yy
HMO members – indicate PCP assignment
Complete a waiver for you or any family member
not enrolling
Sign and date application for enrolling in
coverage.
Contact Info
On the Phone:
On the Web:
Carrier Website:
http://www.sharphealthplan.com/
Member Services:
800-359-2002
Find a Provider:
https://www.sharphealthplan.com
/index.php/find-a-doctor/
Health Insurance
Value Add Services
 Member Management





Tools
UnitedHealth Wellness
Fitness Reimbursement
Program
Smoking Cessation
24/7 Nurse Hotline
Multicultural Solutions
 Savings
 Biometric
Screenings/Coaching
 Cosmetic Dental
 Holistic Care
 Smoking Cessation
 Eye Exams, Glasses,
Contacts and Frames
 Weight Management
 Hearing Exams and
Devices
Plan Highlights
 For Example Ded applies to OOP max
 For Example Self Injectables covered under OV
 For Example Ped Dental benefit counts toward OOP
 For Example Preventative Covered in full
Plan Benefits - HMO
(Plan Name/Network)
Single Annual Deductible
Family Annual Deductible
Annual Out-of-Pocket Maximum
Family Annual Out-of-Pocket Maximum
Office Visit Copay
Coinsurance
In Patient Hospitalization
Generic Prescription Drugs Copay
Brand Name Prescription Drug Deductible
Brand Name Prescription Drug Copay
Pediatric Dental
Benefits
Plan Benefits – PPO
(Plan Name/Network)
Single Annual Deductible
Family Annual Deductible
Annual Out-of-Pocket
Maximum
Family Annual Out-of-Pocket
Maximum
Office Visit Copay
Coinsurance
In Patient Hospitalization
Generic Prescription Drugs
Copay
Brand Name Prescription
Drug Deductible
Brand Name Prescription
Drug Copay
Pediatric Dental
In-Network Benefits
Out-of-Network Benefits
Plan Benefits –CDHP
(Plan Name/Network)
Single Annual Deductible
Family Annual Deductible
Annual Out-of-Pocket
Maximum
Family Annual Out-of-Pocket
Maximum
Office Visit Copay
Coinsurance
In Patient Hospitalization
Generic Prescription Drugs
Copay
Brand Name Prescription Drug
Deductible
Brand Name Prescription Drug
Copay
Pediatric Dental
In-Network Benefits
Out-of-Network Benefits
Complete the sections applicable in its entirety.
Medical Enrollment
Form Completion
Do not fill out any ancillary sections if the ancillary
plans are not being offered with your medical
carrier.
Below are commonly missed fields which are required
and may hold up your group’s approval.







Complete SSN for each member of your family
Complete address
Pick your plan/network
Complete date of hire mm/dd/yy
HMO members – indicate PCP assignment
Complete a waiver for you or any family member
not enrolling
Sign and date application for enrolling in
coverage.
Contact Info
On the Phone:
On the Web:
Member Services/Claims
877-844-4999
Carrier Website:
PPO: www.myuhc.com
HMO: www.uhcwest.com
Pharmacy Info:
800-788-7871
Find a Provider:
PPO: www.myuhc.com
HMO: www.uhcwest.com
Health Insurance
Plan Highlights
 For Example Ded applies to OOP max
 For Example Self Injectables covered under OV
 For Example Ped Dental benefit counts toward OOP
 For Example Preventative Covered in full
Plan Benefits - HMO
(Plan Name/Network)
Single Annual Deductible
Family Annual Deductible
Annual Out-of-Pocket Maximum
Family Annual Out-of-Pocket Maximum
Office Visit Copay
Coinsurance
In Patient Hospitalization
Generic Prescription Drugs Copay
Brand Name Prescription Drug Deductible
Brand Name Prescription Drug Copay
Pediatric Dental
Benefits
Plan Benefits – PPO
(Plan Name/Network)
Single Annual Deductible
Family Annual Deductible
Annual Out-of-Pocket
Maximum
Family Annual Out-of-Pocket
Maximum
Office Visit Copay
Coinsurance
In Patient Hospitalization
Generic Prescription Drugs
Copay
Brand Name Prescription
Drug Deductible
Brand Name Prescription
Drug Copay
Pediatric Dental
In-Network Benefits
Out-of-Network Benefits
Plan Benefits –CDHP
(Plan Name/Network)
Single Annual Deductible
Family Annual Deductible
Annual Out-of-Pocket
Maximum
Family Annual Out-of-Pocket
Maximum
Office Visit Copay
Coinsurance
In Patient Hospitalization
Generic Prescription Drugs
Copay
Brand Name Prescription Drug
Deductible
Brand Name Prescription Drug
Copay
Pediatric Dental
In-Network Benefits
Out-of-Network Benefits
Complete the sections applicable in its entirety.
Medical Enrollment
Form Completion
Do not fill out any ancillary sections if the ancillary
plans are not being offered with your medical
carrier.
Below are commonly missed fields which are required
and may hold up your group’s approval.







Complete SSN for each member of your family
Complete address
Pick your plan/network
Complete date of hire mm/dd/yy
HMO members – indicate PCP assignment
Complete a waiver for you or any family member
not enrolling
Sign and date application for enrolling in
coverage.
Dental Insurance
Dental Carrier: (_______________)
(________________)Plan Highlights
 For example DP waiver
 For example benefit roll over
 For example additional cleaning for pregnant women
 For example implants are covered, no missing tooth
clause
 For example endo/perio in basic
 For example composite fillings covered
Plan Benefits - DHMO
(Plan Name/Network)
Calendar Year Deductible
Calendar Year Maximum
Diagnostic & Preventive Services (D0210)
Basic Restorative (D2104)
Periodontics (D4341)
Endodontics (D3310 and D3330)
Oral Surgery (D7140 and D7240)
Restorative (D2790 and D2750)
Prosthodontics (D5110 and D 5211)
Orthodontics (D8070 and D8090)
Benefits
Plan Benefits - PPO
(Plan Name/Network)
Reimbursement Basis
Calendar Year Max
Annual Deductible
Diagnostic & Preventive
Services
Basic
Major
Endo/Perio/Oral Surgery
Orthodontia
In-Network Benefits
Out-of-Network Benefits
Complete the sections applicable in its entirety.
Dental Enrollment
Form Completion
These are some commonly missed fields which are
required and may hold up your group’s approval.
Complete SSN for each member of your family
 Complete address
 Pick your plan
 Complete date of hire mm/dd/yy
 DHMO members – pick your PCP
 Complete a waiver for you or any family member
not enrolling
 Sign and date application for enrolling in
coverage.

Vision Insurance
Vision Carrier: (_______________)
(________________)Plan Highlights




Plan Benefits
(Plan Name/Network)
Annual Copayment
Eye Exam
Single-Vision Lenses
Bifocal Lenses
Trifocal Lenses
Frames
Contact Lenses
Eye Exam Frequency
Lenses Frequency
Frames Frequency
Contact Lenses (In lieu of
Lenses and Frames
In-Network Benefits
Out-of-Network Benefits
Complete the sections applicable in its entirety.
Vision Enrollment
Form Completion
These are some commonly missed fields which are required
and may hold up your group’s approval.
Complete SSN for each member of your family
 Complete address
 Pick your plan
 Complete date of hire mm/dd/yy
 Complete a waiver for you or any family member
not enrolling
 Sign and date application for enrolling in
coverage.

Life Insurance
Life Carrier: (_______________)
(________________)Plan Highlights




Life Plan Benefits
(Plan Name)
Base Volume
Guarantee Issue Amount
Age Reduction Schedule
Buy Up Option
Dependent Coverage
Benefits
Life Enrollment
Form Completion
Complete the sections applicable in its
entirety.
These are some commonly missed fields which are required
and may hold up your group’s approval.
Complete SSN
 Complete address
 Complete date of hire mm/dd/yy
 Name your beneficiary
 If your benefit is salary amount, indicate annual
salary
 Sign and date application for enrolling in
coverage.

Disability Insurance
Disability Carrier: (_______________)
(________________)Plan Highlights




Disability Plan Benefits
(Plan Name)
Elimination Period
Maximum Monthly Benefit
Maximum Coverage Period
Benefit Amount
Elimination Period
Benefits
Life Enrollment
Form Completion
Complete the sections applicable in its
entirety.
These are some commonly missed fields which are required
and may hold up your group’s approval.
Complete SSN
 Complete address
 Complete date of hire mm/dd/yy
 Name your beneficiary
 If your benefit is salary amount, indicate annual
salary
 Sign and date application for enrolling in
coverage.

Costs
 Your employer contributions:




Medical
Dental
Vision
Life
Important Information
 Paperwork must be received by:
 Return forms to:
 Have Questions? Call:
Questions?
Dental Insurance
Through
Value Add Services
•Discount Rx – up to 75% off on prescription drugs
•Telecure – access to medical providers over the
phone.
•Wild at Work – savings on dining, theme parks,
shopping and a host of other services
Vision Insurance
Through
Value Add Services
• Discount Rx – up to 75%
 Savings



20% off Additional
Sunglasses and Glasses
15% off cost of contact
lens exam
15% off Laser Vision
Correction or 5% off the
promotional price.
off on prescription drugs
• Telecure – access to
medical providers over the
phone.
• Wild at Work – savings
on dining, theme parks,
shopping and a host of
other services
Basic Life Insurance
Through
Value Add Services
 Accidental Death and
• Discount Rx – up to 75%
Dismemberment
coverage
 Work Life Balance EAP
 Life Planning Financial
and Legal Resources
 World Wide Emergency
Travel Assistance.
off on prescription drugs
• Telecure – access to
medical providers over the
phone.
• Wild at Work – savings on
dining, theme parks,
shopping and a host of
other services
Long Term Disability Insurance
Through
Value Add Services
• Discount Rx – up to 75%
 Standard Waiver of
Premium
 Work Life Balance EAP
 World Wide Emergency
Travel Assistance.
off on prescription drugs
• Telecure – access to
medical providers over the
phone.
• Wild at Work – savings on
dining, theme parks,
shopping and a host of
other services
Contact Info
On the Phone:
On the Web:
Delta Dental of California
888-335-8227
Delta Care USA
800-422-4234
MetLife
800-275-4638
Unum
866-679-3054
VSP
800-877-7195
http://www.deltadentalins.com/
http://www.deltadentalins.com/
http://www.metlife.com/
http://www.unum.com/
http://www.vsp.com/
Find a Provider:
http://copower.com/contact
-us/finding-a-provider/
(Line of Coverage) Insurance
Contact Info
On the Phone:
On the Web:
Carrier Website:
http://www.ameritasgroup.com/
Member Services:
800-487-5553
Find a Provider:
http://www.ameritasgroup.com/
resources/419.asp
(Line of Coverage) Insurance
Contact Info
On the Phone:
On the Web:
Member Services/Claims
877-433-6825
Ext 3
Carrier Website:
http://www.caldental.net
Find a Provider:
http://www.caldental.net/CDN
Website/FindDentist.do
(Line of Coverage) Insurance
Contact Info
On the Phone:
On the Web:
Member Services:
800-275-4638
Carrier Website:
http://www.metlife.com/
Claims:
Find a Provider:
Life: Option 2, then 4, then 1
Dental: Option 2 then 2
Disability: Option 2, then 3,
then 1
Vision: Option 2 then 5
https://metlocator.metlife.com/
metlocator/execute/Search
(Line of Coverage) Insurance
Contact Info
On the Phone:
Member Services:
888-715-0760
On the Web:
Carrier Website:
http://www.premierlife.com/
(Line of Coverage) Insurance
Contact Info
On the Phone:
On the Web:
Member Services Dental
and Vision:
800-247-4695
Carrier Website:
http://www.principal.com/
Member Services Life
and Disability
800-245-1522
Find a Provider:
http://www.principal.com/
partners/providers/prov
iderdirectory.htm
(Line of Coverage) Insurance
Contact Info
On the Phone:
On the Web:
Member Services:
800-351-7500
Carrier Website:
Claims:
800-351-7500 ext 4149
Find a Provider:
http://ameritasdental.prismisp.com/
http://www.reliancestandard.com/
(Line of Coverage) Insurance
Contact Info
On the Phone:
On the Web:
Member Services:
Carrier Website:
Disability: 800-303-9744
Life: 888-563-1124
http://www.thehartford.com/
Health Insurance
Value Add Services
 Member Management
Tools
 24/7 Nurse Hotline
 California State Parks –
Free Day Access to all
CA State Parks
 Savings




Weight Management
Baby Books
DVDs
Emergency Kits
Contact Info
On the Phone:
On the Web:
Member Services/Claims
866-218-6009
Carrier Website:
Pharmacy Info:
800-325-1404
Find a Provider:
www.seechangehealth.com
http://www.cigna.com/hcpdirectory