Page 47 - EJS Flipbook Employees
P. 47

Maximum Rollover Feature

                   … Rolls over a portion of a member’s unused annual maximum for future use

                   ► Get More for Less: An innovative tool to stretch annual maximums while lowering premium.
                        A $1000 maximum benefit with maximum rollover is comparable to a $1500 Maximum benefit
                        plan, and costs less!
                   ► Promote Cost Saving Network: Participants receive additional funds in their Maximum Rollover
                        Account if they visit an in-network dentist for all their dental needs during the benefit year.
                        This is in addition to network discounts averaging 30%.
                        * Not available to members residing in Texas or groups sitused in Georgia.
                   ► A Solution for Everyone:  Feature is available for all groups sizes, and for both employer paid
                        and voluntary plans.




                   How the Maximum Rollover Account (MRA) Works - $1,500 Annual Max

                                Claims                         Rollover Amount (W/
                               Threshold     Rollover Amount     Network Bonus)     MRA Limit

                                 $700            $350                 $500            $1,250




                   Sample Member Experience
                   ► Year 1 (2020)           MRA: $0           Paid Claims: $400 (some out-of-network)
                   The paid claims do not exceed the $700 threshold for the Plan Annual Maximum of $1,500.
                   Therefore, $350 is added to the MRA for Year 2.
                   ► Year 2 (2021)           MRA: $350         Paid Claims: $900
                   The paid claims exceed the threshold of $700. Therefore, no additional amount is added to the MRA
                   for Year 3 (2021). None of the MRA is used.
                   ► Year 3 (2022)           MRA: $350        Paid Claims: $1,350
                   The member's Year 3 paid claims exceed the $1,250 annual maximum; therefore, $100 of the MRA is
                   used. No additional amount is added to the member’s MRA because Year 3 paid claims exceeded the
                   threshold of $700.
                   ► Year 4 (2023)           MRA: $250         Paid Claims: $400 (all in-network)
                   The member’s MRA for the next year is now $750. Year 4 paid claims did not exceed the threshold
                   and $500 was added to the account since the member used network providers.
                   ► Year 5 (2024)           MRA: $750         Paid Claims: $400 (all in-network)
                   The member’s MRA for the next year is now $1,250, meaning they are covered for $2,750 next year
                   ($1,500 plan maximum plus the $1,250 MRA built from two years of claims below the threshold
                   submitted by network providers).
























                                      The Guardian Life Insurance Company of America, 7 Hanover Square, New York, NY 10004  Page 4/5
   42   43   44   45   46   47   48   49   50   51   52