About Large Group Plans

We offer four innovative medical plan options that includes everything from familiar PPO and traditional indemnity plan to alternatives that work with special healthcare funding arrangements. This gives employees more control and responsibility over their healthcare spending while providing employers flexible funding options.

For specific plan details, please refer to the:

• 2016 benefit guide

Medical plans

Underwriting guidelines for groups with 51 or more employees may vary. Please talk to your sales representative for more information.

Optional benefits

In addition to our health plans, you can enhance your employee's health benefits by selecting these additional buy-up options:

Outpatient prescription drug plans

Affordable prescription drugs are important to your employees' health and healthcare costs. Each plan includes coverage of generic prescriptions or you may have the option to purchase an alternative four-level plan. See the benefit guide for more information.

Dental and orthodontia plans

LifeWise dental plans feature a range of annual deductibles, maximum annual benefits, and coinsurance payments. For groups of five or more employees, available options include traditional, PPO, and self-funded plans.

Enhanced benefits options for periodontal and endodontic services are available for groups of five or more employees. Orthodontia benefits are available to groups of 26 or more employees

Vision plans

You can offer employees the option of regular vision and hardware benefits through any of our health plans. See the benefit guide for more information.

LifeWise dental plans feature a range of annual deductibles, maximum annual benefits, covered services, and coinsurance payments. For groups of five or more employees, available options include traditional, PPO, and self-funded plans. With more than 120,000 access points nationwide, LifeWise dental plan members have convenient access to high-quality dental service providers-in Oregon and beyond.

Dental Plans Comparison

For more specific plan information, view the plan overviews below, check out the information below:

2016 plans

Information on dental plan options in 2016 can be found in the 2016 Medical benefit guide.

Dental Classic™

Constant benefit level

When employers choose Dental Classic, members get the same benefit level regardless of whether the provider they choose is preferred or non-preferred. Members can use any licensed dental care provider.

Dental Vantage Plus™

Network cost savings

With Dental Vantage Plus, members pay less out-of-pocket when they receive services from a preferred dental provider. They still have the freedom to choose non-preferred providers for covered services.

Dental Charter Plus™

Voluntary plan.

This plan offers the option for up to 100 percent of premiums to be funded by employees at group rates.* Members pay less out-of-pocket when they receive services from a preferred dental provider. They still have the freedom to choose non-preferred providers for covered services.

Preventive, Preventive+

Emphasis on prevention.

With Preventive and Preventive+ employers provide coverage for important preventive care at a fraction of the cost of more comprehensive coverage. Available with both employer funded or voluntary options.

* See underwriting guidelines for participation requirements.

Covered Services

Each plan covers a range of services, including:

• Diagnostic & Prevention
  • Routine oral exams
  • Cleaning
  • Fluoride treatments
  • Routine x-rays
  • Sealants
• Basic
  • Problem-focused exams
  • Non-routine x-rays
  • Space maintainers
  • Simple extractions
  • Fillings
  • Periodontal maintenance
  • Emergency palliative treatment
• Major
  • Oral surgery
  • Periodontal surgery
  • Periodontal scaling
  • Full mouth debridgement
  • General anesthesia
  • Inlays, onlays, crowns
  • Endodontics (root canal) treatment
  • Dentures and fixed bridgework
  • Repair of crowns, inlays, bridgework, and dentures
  • Crown, inlay, bridgework replacement

Enhanced Benefits Options

To provide additional dental benefits for your employees, you can also select:

Periodontal, endodontic services

Employers with 5 or more employees can lower out-of-pocket costs for employees by choosing to move periodontal and endodontic (root canal) services from the Major to the Basic category under the Dental Classic and the Dental Vantage Plus plans.

Orthodontia

Employers with 26 or more employees can select from two orthodontia plans to offer employees. The plans offer a range of lifetime benefit maximums and age limits.

Health Savings Accounts (HSA)

HSAs are employee-owned, tax-advantaged, fully portable accounts that work in combination with a qualified, high- deductible health plan. With an HSA, employees will have the opportunity to:

• Save tax free for current and future medical costs
• Choose whether and when to withdraw funds, tax-free, to pay for qualified medical expenses
• Carry unused funds from year to year, allowing those funds to grow tax-deferred
• Employee contributions are made pre-tax, saving both the employee and the employer taxes

View the "Learn more about Health Savings Accounts" video.

Review this HSA solution flyer

Health Reimbursement Arrangements (HRA)

HRAs are employer-owned and -funded arrangements that members can use to pay their cost-share for covered expenses. It is important to note that HRAs are not portable. If the employee leaves the company, any unused portion of the HRA (after all prior claims have been paid) reverts back to the employer.

Flexible Spending Accounts (FSA)

FSAs are employer-sponsored, tax-advantaged healthcare spending accounts that members can use to pay for eligible expenses. Here are a few things to know about FSAs:

• Employee contributions are made pre-tax
• Employer contributions are tax-deductible
• FSA funds do not roll over for future use: “Use it or lose it”
• The employer is not permitted to refund any part of the balance to the employee

View the "Learn more about Flexible Spending Accounts" video.

Review this FSA solution flyer

LifeWise has selected USAble Life Inc., a company focused on supporting health plans with Life and Disability offerings, to assist groups to create an integrated benefits program to help reduce disability and healthcare costs, improve health and increase workforce productivity.

Employers of 10 or more enrolled employees can choose from the following:

•  Group Life Insurance: Provides benefits to a beneficiary in the event of an employee's death
• Accidental Death and Dismemberment: Provides benefits in the event of accidental death or dismemberment
• Dependent Life: Provides benefits to the employee in the event of dependent's death(s)
•  Short-Term and Long-Term Disability Coverage: Provides benefits for income replacement in the event an employee is unable to work due to an illness or injury

Stop Loss

Our affiliate, LifeWise Assurance Company, assists groups to create just the right Medical Stop Loss for their needs. This product provides employers that elect to self-fund their medical plan a reinsurance contract to protect from catastrophic loss.

Ask your LifeWise representative for details.

Large Group (51+ employees)

Enrollment Checklist

2015 Master Application

2014 Master Application

Master Application Benefit Selections - HRA

Enrollment and Renewals

Business Employment Verification Statement

Coordination of Benefits Questionnaire

Deductible Credit Form

HRA - Electronic Funds Authorization

Standardized Group Profile

Tax Documentation - What's Needed

Disclosure and Privacy

Information Release Form - Give someone permission to obtain and discuss your personal and health information, including sensitive information such as substance abuse, reproductive health, and mental health. You can also authorize members on your plan to see your sensitive information on LifeWiseOR.com or ConnectYourCare (medical funding account).

Authorization for Release of Psychotherapy Notes

Disclosure Accounting Request

Information Release Form - Give someone permission to obtain and discuss your personal and health information, including sensitive information such as substance abuse, reproductive health, and mental health. You can also authorize members on your plan to see your sensitive information on Premera.com or ConnectYourCare (medical funding account).

Request for Amendment of Records

Request for Inspection of Records