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