Please review the following information ad the proceed to complete the attached form. Upon clicking the SUBMIT button, you will be redirected according to your selections. Open enrollment needs to be completed by no later than February 1, 2017. Please provide your selection information as quickly as possible.
Transportation Demand Management, LLC –
2017 Insurance Benefits
Transportation Demand Management, LLC, contributes at least 75% of the premium for medical (base plan).
In-network providers consist of AETNA Contracted Preferred Providers.
When using in-network providers, the health plan generally requires each member to choose a provider who will help manage their care and will arrange referrals to see other specialists when needed. Members are also able to self-refer to a number of in-network providers, and won’t need referrals for these providers.
Members choose a primary care provider in-network by calling the Customer Service Department once they are enrolled, and specifying the provider they would like to see. Customer Service will check on the availability of the provider at the same time.
The pharmacy benefit, for the purposes of creditable coverage, is actuarially equal to or greater than the Medicare Part D prescription drug benefit. Eligible members who are also eligible under Medicare Part D pharmacy benefits can remain covered under the Agreement and not be subject to Medicare-imposed late enrollment penalties should they decide to enroll in a Medicare Part D pharmacy plan at a later date.
Out-of-network, members may seek services from any licensed provider for covered benefits. When out-of-network, members may direct their own care by self-referring to the provider they would like to see – no referrals are needed. They may receive all their services for covered benefits out–of-network. When members seek care they will not be covered at the Level 1 benefits and will be covered at out-of-network benefits level and subject to higher deductible and out of pocket limits and are not protected against balance billing. Balance billing is when a provider’s fees exceed the Contracted rate paid by Aetna or and bills the patient the balance.
Aetna Puget Sound Aetna Whole Health OAMC providers or Aetna PPO Providers can be found at:
Find a Doctor on www.aetna.com
Find a Doctor is to the left of the search box, then choose search without logging in
When you get to the part about picking a plan – choose WA Aetna Whole Health Puget Sound (AWH plans are the first ones)
Transportation demand Management, LLC offers a voluntary dental plan to their employees & their dependents. This plan is offered through Principal Financial Co.
• Covered charges will include charges performed by any licensed dentist if the service was performed within the lawful scope of such person’s license. However, Principal Financial recommends that you utilize a licensed dentist or denturist within their Provider Network. If you choose to receive your care through a PPO provider (in-network), you will incur less out-of-pocket expense.
• Directory can be accessed online at: http://m3fad.go2dental.com/m_provsel.cgi
Symetra Select Benefits Fixed-Payment Medical Insurance
Select Benefits insurance policies are designed to provide benefits at a preselected, fixed dollar amount. They are not a replacement for a major medical policy or other comprehensive coverage and do not satisfy the minimum essential coverage requirements of the Affordable Care Act. There are a number of benefits to choose from when creating a custom benefit design. These include, but are not limited to:
• Doctor visits
• Outpatient diagnostic labs and X-rays
• Hospital stays and inpatient admission
• Prescription drug
• Surgeries (including anesthesia)
Enrollment Eligibility and Rights Description
If you are declining enrollment for yourself and/or your dependents (spouse and/or children), you must sign a waiver of benefits form. If you waive benefits because of other health insurance coverage, you may, in the future, be able to enroll yourself and/or your dependents in Transportation Demand Management, LLC plans, provided you request enrollment within 30 days after the other coverage ends.
In addition, if you have a new dependent(s) as a result of marriage, birth, adoption or placement for adoption, you may be able to enroll your dependent(s), provided that your request enrollment within 60 days after the marriage, birth, adoption or placement for adoption.
Unless the above applies, understand that you may not be able to obtain coverage under the group insurance plan until the next open enrollment period. Obtaining coverage in the future will be subject to administrative rules and laws in force at that time.
Definition of Dependent Child
Any dependent under the age of 26 will be covered as a dependent through the end of the month that they turn 26, regardless of student status. Your children include: biological, adopted, stepchildren or any child for whom you have legal custody. No person may be covered both as an employee and dependent; and no person may be covered as a dependent of more than one employee.
Definition of Domestic Partner
Domestic partners are eligible if an affidavit of marriage/domestic partnership is signed. The affidavit specifies that domestic partners must: share the same regular and permanent address, and have a close personal committed relationship, and are jointly responsible for “basic living expenses“, and are not married to anyone, and are each 18 years of age or older, and are not related by blood closer than would bar marriage in Washington or Idaho, and were mentally competent to consent to contract when domestic partnership began, and are each other’s sole domestic partner, and are responsible for each other’s common welfare.
By selecting the HOT-LINK below, you may download and print the information you choose.