Page 5 - Practice
P. 5
Suites 4 — balanced
Cover design Suite 4 Back cover Suite 4
20XX
OPEN
ENROLLMENT This Beneit Enrollment Guide is only intended to highlight some of the major
beneit provisions of the Company plan and should not be relied upon as
a complete detailed representation of the plan. Please refer to the plan’s
Summary Plan Descriptions for further detail. Should this guide difer from the
This publication contains important information Summary Plan Descriptions, the Summary Plan Descriptions prevail.
about your employee benefit program. © 2020 Lockton, Inc. All rights reserved.
Please read thoroughly. [Rev 01/13/20] RL\EB\EE Communications\BE Suite Templates\2020-21\Suite 4\Untitled-3.pdf
Inside spread design Suite 4
What is a Network? MEDICAL AND VISION Finding In-Network Providers
A network is a group of providers your plan contracts with at Remember to visit in-network dentists to receive the deepest
discounted rates. You will almost always pay less when you PRESCRIPTION DRUG We partner with [Carrier] to offer you and your family level of discount on your services.
receive care in-network. members vision insurance. Visit www.[Carrier].com to
[Client Name] partners with [carrier] to offer medical To ind a participating in-network dentist in your area go to
If you choose to see an out-of-network provider, you may and prescription drug insurance. ind in-network providers and access to a variety of [website.com] or call [555.555.5555] .
be balance billed, which means you will be responsible for online tools and programs.
charges above [Carrier]’s reimbursement amount.
Plan Highlights In-Network Out-of-Network
You have the option of choosing one of [X] plans. Copay
Important Insurance Terms Our plans offer coverage for most healthcare services. Exam
Materials
X Deductible: the amount of money you are responsible When you receive care in-network you beneit from our Lenses
for paying up-front before your plan shares your costs negotiated discounts with [Carrier]. Single
X Coinsurance: the percentage you and the plan pay; in Bifocal
our plans, you pay a smaller percentage and the plan [Carrier] Member Site
pays a larger percentage Visit www.[Carrier].com to take advantage of all the Trifocal
X Copay: a ixed amount for certain services you pay in helpful tools and resources available including the Lenticular
Frames
some of our plans following.
X Out-of-pocket maximum: the limit on your expenses; Contacts
once you reach this limit, the plan covers all eligible X In-network provider and pharmacy searches
expenses for the remainder of the plan year
X A list of prescription drugs covered by our plans Frequency
X Access to temporary ID cards and means to order Exam
another ID card Lenses
X Information regarding paid and pending claims Contacts (in lieu of
glasses)
Employee [Monthly/Weekly/Bi- Frames
Weekly] Medical Contributions This is a high level summary of your beneit coverage. Full coverage
details are available in your summary plan description (SPD). In the event
[Plan 1] [Plan 2] there is a discrepancy between what is relected in this guide and what is
communicated in your SPD, the terms of your SPD will prevail.
Employee Only $ $
Employee and $ $
Spouse Employee [Monthly/Weekly/Bi-
Employee and $ $ Weekly] Vision Contributions
Child(ren)
Family $ $ Employee Only $
Employee and Spouse $
Employee and Child(ren) $
Family $
4 20XX ENROLLMENT GUIDE 9
Cover design Suite 4 Back cover Suite 4
20XX
OPEN
ENROLLMENT This Beneit Enrollment Guide is only intended to highlight some of the major
beneit provisions of the Company plan and should not be relied upon as
a complete detailed representation of the plan. Please refer to the plan’s
Summary Plan Descriptions for further detail. Should this guide difer from the
This publication contains important information Summary Plan Descriptions, the Summary Plan Descriptions prevail.
about your employee benefit program. © 2020 Lockton, Inc. All rights reserved.
Please read thoroughly. [Rev 01/13/20] RL\EB\EE Communications\BE Suite Templates\2020-21\Suite 4\Untitled-3.pdf
Inside spread design Suite 4
What is a Network? MEDICAL AND VISION Finding In-Network Providers
A network is a group of providers your plan contracts with at Remember to visit in-network dentists to receive the deepest
discounted rates. You will almost always pay less when you PRESCRIPTION DRUG We partner with [Carrier] to offer you and your family level of discount on your services.
receive care in-network. members vision insurance. Visit www.[Carrier].com to
[Client Name] partners with [carrier] to offer medical To ind a participating in-network dentist in your area go to
If you choose to see an out-of-network provider, you may and prescription drug insurance. ind in-network providers and access to a variety of [website.com] or call [555.555.5555] .
be balance billed, which means you will be responsible for online tools and programs.
charges above [Carrier]’s reimbursement amount.
Plan Highlights In-Network Out-of-Network
You have the option of choosing one of [X] plans. Copay
Important Insurance Terms Our plans offer coverage for most healthcare services. Exam
Materials
X Deductible: the amount of money you are responsible When you receive care in-network you beneit from our Lenses
for paying up-front before your plan shares your costs negotiated discounts with [Carrier]. Single
X Coinsurance: the percentage you and the plan pay; in Bifocal
our plans, you pay a smaller percentage and the plan [Carrier] Member Site
pays a larger percentage Visit www.[Carrier].com to take advantage of all the Trifocal
X Copay: a ixed amount for certain services you pay in helpful tools and resources available including the Lenticular
Frames
some of our plans following.
X Out-of-pocket maximum: the limit on your expenses; Contacts
once you reach this limit, the plan covers all eligible X In-network provider and pharmacy searches
expenses for the remainder of the plan year
X A list of prescription drugs covered by our plans Frequency
X Access to temporary ID cards and means to order Exam
another ID card Lenses
X Information regarding paid and pending claims Contacts (in lieu of
glasses)
Employee [Monthly/Weekly/Bi- Frames
Weekly] Medical Contributions This is a high level summary of your beneit coverage. Full coverage
details are available in your summary plan description (SPD). In the event
[Plan 1] [Plan 2] there is a discrepancy between what is relected in this guide and what is
communicated in your SPD, the terms of your SPD will prevail.
Employee Only $ $
Employee and $ $
Spouse Employee [Monthly/Weekly/Bi-
Employee and $ $ Weekly] Vision Contributions
Child(ren)
Family $ $ Employee Only $
Employee and Spouse $
Employee and Child(ren) $
Family $
4 20XX ENROLLMENT GUIDE
