Your Summary
Medical
Dental
Vision
Wellness
Flexible Spending Accounts
Health Savings Accounts
Disability
Life Insurance
Voluntary Life Insurance
Voluntary Accidental Death and Dismemberment
Employee Assistance Program
Voluntary Plans
Additional Benefits
Your Monthly Total
Medical
Enrollment Options
Explanation of Benefits
- Physician Office Services
- Office Visit80% after deductible
- Amwell General Medical Services Telehealth$67, applied to deductible
- Amwell Behavioral Health TelehealthCost per visit = Psychotherapy: $96 Master Level / $122 Doctorate Level Psychiatry: $263 Initial Visit / $145 Follow-Up Visits
- Chiropractor80% after deductible
- Mental Health/Substance Abuse
Inpatient
Outpatient
Office visits
Other services80% after deductible
- Prescription Drugs
(Retail: 30-day supply / Mail order: 90-day supply) - Generic/Preferred Brand/Non-preferred Brand80% after deductible
- Specialty80% after deductible
- High Deductible Health Plan (PPO Providers)High Deductible Health Plan 2
- High Deductible Health Plan (PPO Providers)High Deductible Health Plan 2
- Preventive Care
- Cancer Screening
Mammogram, pap smear, prostate screening100% - Preventive Care
Routine physical exams, routine lab work, well-child visits100% - Vision exam
(Includes eyewear exam)100% - Tobacco Cessation
Counseling visits
Prescription drugs
Includes OTC nicotine replacement100%
Plan benefits reflected above assume in-network providers are utilized. Plan benefits & your out-of-pocket expense may vary based on provider network status. Please refer to your Summary Plan Description for full descriptions of plan benefits & exclusions.
To find information on the following, please visit www.nebraskablue.com or call the number on your ID card
- PPO providers: Network Blue / BlueCard Program
- Prescription drugs: Prescription Drugs: Prime
- Drugs requiring prior authorization or step therapy
Notification Requirements
Hospitalization and other services may require pre-certification or your benefits may be reduced or denied. Please contact Blue Cross Blue Shield Nebraska for more information on services requiring pre-certification. 833-513-5561
Important Notices
Schedule of Benefits SummarySummary of Benefits & Coverage
Contact
Blue Cross Blue Shield Nebraska
833-513-5561
www.nebraskablue.com
Prime
844-649-0493
Prime
Dental
Enrollment Options
Explanation of Benefits
- Ameritas
- Deductible per year$50 single / $150 family
- Annual maximum$2,000
- Preventive services
Cleanings, exams – two each calendar year
Fluoride – to age 16, once each calendar year
X-rays – two sets bitewings per year, one full mouth each 36 months
Sealants – to age 16100% - Basic services
Fillings, gum treatment, root canals, surgery80% after deductible - Major services
Bridges, crowns, dentures, implants50% after deductible - Orthodontic services
$2,500 lifetime, Adults and children50% after deductible
Participating Providers
To find information on providers, please visit www.ameritas.com or call the number on your ID card.
Pretreatment Review
Pretreatment authorization is not required for any procedure, but we recommend it for any dental work you consider expensive. As a smart consumer, it’s best for you to know your share of the cost upfront. Simply ask your dentist to submit the information for a pretreatment estimate to the Ameritas customer relations department.
Contact
Ameritas800-847-5553
www.ameritas.com
Vision
Enrollment Options
Explanation of Benefits
Please remember, The Standard Vision plan is for materials only (eyeglasses or contacts). Your eye exam will continue to be covered under the Cassling Medical Plan.
- Vision Plan 1 CoverageVision Plan 2 Coverage
- Eyeglasses Lens Coverage: $15 copay; eligible for new lenses every 12 monthsEyeglasses Lens Coverage: $10 copay; eligible for new lenses every 12 months
- Eyeglasses Frames Coverage: Eligible for frames every 24 months; Up to $130 covered + an additional 20% offEyeglasses Frames Coverage: Eligible for frames every 12 months; Up to $150 covered + an additional 20% off
- Contact Lens Coverage: Eligible for contacts every 12 months; Up to $130 covered + an additional 15% offContact Lens Coverage: Eligible for contacts every 12 months; Up to $150 covered + an additional 15% off
All benefits shown above reflect in-network participating providers. Benefits reduced at out of network providers. Please refer to your summary plan description for full details.
Wellness
Enrollment Options
Wellness Screenings
Our goal is to provide you with resources to help you make smart, accountable healthcare decisions. Proactively managing your health will keep healthcare costs down for you and for our company.
The best way to receive appropriate healthcare guidance is to schedule an annual physical with your healthcare provider. Agreeing to have an annual physical with your healthcare provider can save individuals $960 per year and families $2,400 per year. These savings are reflected in your medical insurance premium rates.
Requirements
To receive the premium discount, you must elect to participate in the Wellness program & agree to have an annual physical with your healthcare provider of choice (employees & spouses, if applicable).
New Employees are expected to complete their annual physical within their first 90 days of employment OR have had a physical within the last 12 months.
Current Employees are expected to complete their physical by March 31 of each calendar year OR have had a physical within the last 12 months. Failure to meet these requirements will result in a loss of the premium discount.
Wellness Reminders
- QualificationTobacco-free Wellness StipendAdditional Tobacco-free Wellness StipendTobacco-free Community Wellness StipendTotal Annual
- Employee$300$150$150$600
- Family $500$250$150$900
Employees not participating in the group health plan are eligible for the additional wellness stipend if they complete an annual preventative screening.
EMPLOYEES PARTICIPATING IN THE HEALTH PLAN
- QualificationMonthly Health Premium DiscountTobacco-free Wellness StipendTobacco-free Community Wellness StipendTotal Annual
- Employee$80$300$150Up to $1,170
- Family$250$500$150Up to $3,050
Health plan participants must complete the annual preventative screening and certify a tobacco-free household to qualify for the wellness stipends.
Your health plan cares about health. Rewards for participating in the Wellness programs are available to all employees. If you think you might be unable to meet a standard for a reward under the wellness program, you might qualify for an opportunity to earn the same reward by different means. Contact People & Culture and we will work with you to find an alternate way to qualify.
Contact
People & CultureHR@cquencehealth.com
Flexible Spending Accounts
Enrollment Options
Enter your desired yearly contributions
Flexible Spending Accounts (FSAs)
The CQuence Health flexible benefit plan saves you money by allowing you to pay certain expenses with pre-tax dollars.
Important
If you contribute to a Health Savings Account (HSA), you may only elect a Limited Purpose Health FSA for dental and vision expenses.
Pre-Tax Premiums
Your medical, dental, vision, and voluntary plan contributions are automatically paid before taxes. If you wish to pay your premiums with after-tax dollars, you must notify Human Resources in writing.
Medical Spending Account
You may set aside up to $3,300 on a pre-tax basis to pay for qualifying healthcare expenses. Examples include your deductibles, copays, coinsurance, and other out-of-pocket medical, dental, pharmacy, and vision costs.
Up to $500 in unused funds may be carried over to the next year. Employees eligible to participate in a Medical Spending Account may not be enrolled in a Health Savings Account, either through CQuence Health or a spouse’s plan.
Limited Spending Account
You may set aside up $3,300 on a pre-tax basis to pay for qualifying health care expenses. Examples include out-of-pocket costs related to dental and vision only.
Up to $500 in unused funds may be carried over to the next year. Employees eligible to participate in a Limited Spending Account are those that are enrolled in a High Deductible Health Plan with a Health Savings Account, either through CQuence Health or a spouse’s plan.
Dependent Care Spending Account
You may set aside up to $5,000 on a pre-tax basis for qualifying dependent care expenses. This includes care for your dependents under the age of 13 while you and your spouse are working and/or attending school full-time.
Please note: Claims must be filed by March 31st following the end of the plan year.
Health Savings Accounts
Enrollment Options
Health Savings Accounts (HSAs)
If you choose to enroll in the High Deductible Health Plan (HDHP), you may be eligible to open and contribute to a Health Savings Account. See below for information regarding contribution limits, advantages of an HSA and eligibility requirements.
Contributions:
Up to $4,300 per individual and $8,550 per family (a discretionary HSA employer contribution may reduce the amount employees are eligible to contribute. Mid-year eligibility may result in a prorated annual limit).
HSA Advantages:
- Tax savings on qualifying health expenses
- Carryover of unused account balance to future years
- Contribution changes may be made at any time
- Contributions are allowed after you have medical expenses (you must make the contribution on or before April 15th of the following year)
Eligibility:
- High Deductible Health Plan (HDHP) that meets Federal guidelines for deductibles and out-of-pocket limits
- No other health coverage (including spouse Medical Flexible Spending Account (FSA) and Medicare)
- You may not be a dependent on another tax return
- An additional $1,000 if you are age 55 -64
- Refer to the Health Savings Account Questions and Answers for more information
Disability
- Short Term Disability
Provided by Cassling / CQuence HealthLong-Term Disability
The Standard - Waiting Period7 days of disability
Available PTO must be used during waiting period before benefits are payable180 days of disability - BenefitWeeks 2-10 100% of salary; weeks 11-6 months 60% of salary60% of salary up to $8,000 per month
- Maximum PeriodUp to 180th day of disabilityUp to Social Security Normal Retirement Age
Life Insurance
- Basic Life - Paid for by CQuence Health
- For You
Benefits reduce at age 65200% of annual earnings up to $300,000;
Includes Accidental Death & Dismemberment
Note: Employer-provided amounts greater than $50,000 are subject to tax - For Your Spouse$10,000
- For Your Eligible Children Birth to 26th birthday$10,000
Voluntary Life Insurance
Voluntary Life Insurance Plan Details
- Voluntary Life
Available via payroll deduction - For You
Benefits reduce at age 65$10,000 to $500,000 in multiples of $10,000 up to 700% of annual earnings. Amounts over $150,000 require medical questions and coverage may be denied. - For Your Spouse
Benefits reduce at age 65$5,000 to $250,000 in multiples of $5,000 up to 50% of employee amount. Amounts over $50,000 require medical questions and coverage may be denied. - For Your Eligible Children
From 14 days to 26th birthday$2,000 to $10,000 in multiples of $2,000 up to 50% of employee amount.
Calculate Your Monthly Payment
*Calculate your spouse’s rate based on your age **One premium covers all of your eligible children
- Voluntary Life Cost (Personal)
-
$
- ÷ $10,000
-
x
See rate table
- = $0.00 / Month
- Voluntary Life Cost (Spouse)
-
$
- ÷ $10,000
-
x
See rate table
- = $0.00 / Month
- Voluntary Life Cost (Children)
-
$
- ÷ $1,000
- x 0.10
- = $0.00 / Month
Monthly Premiums
Voluntary Life Cost is based off employee age. Please contact People & Culture for more information on your rate. Spouse’s rate is based on employee age. One premium covers all eligible children.
Contact
People & CultureHR@cquencehealth.com
Voluntary Accidental Death and Dismemberment
Voluntary Death & Dismemberment Insurance Plan Details
- Voluntary Accidental Death and Dismemberment
Available via payroll deduction - For You
Benefits reduce at age 65$10,000 to $500,000 in multiples of $10,000, up to 700% of annual earnings. - For Your Spouse
Benefits reduce at age 65$5,000 to $250,000 in multiples of $5,000 up to 50% of employee amount. - For Your Eligible Children
From 14 days to 26th birthday$2,000 to $10,000 in multiples of $2,000 up to 50% of employee amount.
Calculate Your Monthly Payment
*Calculate your spouse's rate based on your age **One premium covers all of your eligible children
- Voluntary Life Cost (Personal)
-
$
- ÷ $1,000
- x $0.05
- = $0.00 / Month
- Voluntary Life Cost (Spouse)
-
$
- ÷ $1,000
- x $0.02
- = $0.00 / Month
- Voluntary Life Cost (Children)
-
$
- ÷ $1,000
- x $0.01
- = $0.00 / Month
AD&D Cost (Total) = $0.00 / Month
Monthly Premiums
Voluntary AD&D Cost is a flat rate for employee, spouse, and child. Please contact People & Culture for more information on your rate. One premium covers all eligible children.
Contact
People & CultureHR@cquencehealth.com
Employee Assistance Program
Assistance for you and members of your household
- Alcohol / drug problems
- Anxiety / depression
- Financial problems
- Legal issues
- Marriage / family problems
- Personal relationship issues
- Stress management
Up to 6 free counseling sessions per person per issue annually
To find out more about the Employee Assistance Program, visit www.resourcesforliving.com
To set up a confidential appointment:
1-800-342-8111
Username: CQUENCE
Password: EAP
Contact
Aetna Resources for Living
800-342-8111
www.resourcesforliving.com
Mental Health Telehealth Services
First Stop Health
Free mental health Telehealth services offered to employees and members of their household. First Stop Health specializes in short-term, solution-focused counseling via their app, website, or telephone. Services are offered in every state and are completely confidential.
To find out more about First Stop Health, visit https://www.fshealth.com/
Contact
People & Culture
HR@cquencehealth.com
Voluntary Plans
You may select the following optional benefits:
- Accident Insurance
- Critical Illness*
- Hospital Indemnity*
*If you do not enroll in Critical Illness or Hospital Indemnity when you are first eligible, you will be required to complete Evidence of Insurability.
Accident Insurance Enrollment Options
Critical Illness Enrollment Options
Critical Illness premiums are based on age, coverage option ($10,000 or $20,000), and tobacco status. Please contact People & Culture for more information on your rate.
Spouses and children are covered at 50% of the employee's elected amount.
Hospital Indemnity
Important Notices
Group Accident Insurance
Group Critical Illness Insurance
Hospital Indemnity Insurance
Health Maintenance Screening Benefits
Contact
People & CultureHR@quencehealth.com
Additional Benefits
Parental Leave Benefits
CQuence will provide up to 10 consecutive weeks of paid parental leave to eligible employees following the birth of an employee’s child or the placement of a child with an employee in connection with adoption or foster care. To be eligible for paid parental leave, employees must meet the following criteria:
- Be a full-time or part-time regular employee and have been employed by CQuence for at least 12 consecutive months
- Have given birth to a child, be a spouse or committed partner of a woman who has given birth to a child, have adopted a child (age 17 or younger) or been placed with a foster child (age 17 or younger)
Travel Assistance Benefits
Assistance when you travel for business or personally including pre-trip information, emergency personal services, emergency medical assistance and identity theft assistance.
Business Travel Accident Benefits
This plan will pay 300% of annual earnings with maximum of $500,000 of your accidental death or dismemberment occurs when you are traveling on business.
Coverage Outside of the United States
- The CQuence Health plan provides coverage for emergencies when you are traveling outside of the United States. Services outside of the United States will be reimbursed at the PPO benefit level.
- You will present your health plan identification card at the time of service; because it will not be a PPO provider, you may be expected to pay for the service.
- It is important to get a detailed statement of services from the provider to submit to Aetna. You should understand that there may be processing delays for foreign language translation and foreign currency exchange.
- The Hartford travel assistance provides worldwide emergency assistance and evacuation.
- Please contact Human Resources with your foreign travel questions.
Tobacco Cessation Program
You and your spouse are eligible for the Alere Wellbeing program. The entire cost is paid by the CQuence Health.
Tobacco Cessation Contact
Alere Wellbeing
(866) 784-8454
www.alerewellbeing.com
Other Benefits / Questions Contact
Bruce Stec, Vice President of People & Culture
(402) 334-5000 x1137
bstec@cquencehealth.com
Kayla Engel, Director of People & Culture
(402) 334-5000 x1166
kengel@cquencehealth.com
Tayler Metzger, Business Partner, People & Culture
(402) 334-5000 x1117
tmetzger@cquencehealth.com
Important Notices
Please be sure to review the important notices below regarding eligibility, enrollment options, privacy, and other essential notices concerning CQuence employee benefits.
Disclaimer
This personalized benefits calculator serves to provide estimated costs and eligibility only. This calculator does not guarantee eligibility, and eligibility requirements must still be met. CQuence Health may modify plan offerings, plan premiums, and eligibility requirements.
Please be sure to review the Important Notices regarding employee benefits.
In addition, this calculator does not take the place of formal benefits enrollment once eligibility requirements have been met.