Benefits Overview

Medical Insurance

 Prescription Drug Coverage

Dental Insurance

Vision Insurance

COBRA

Employee Assistance Program

Benefits Overview

Benefit Eligibility

All regular, full-time employees who have met the required waiting periods are benefit-eligible.

Dependent Eligibility

Dependents eligible for coverage include:

  • Employee’s legal spouse
  • Employee’s dependent children: related by birth, marriage, legal adoption or legal guardianship. Dependent children are eligible for coverage until the end of the month in which they turn age 26 for medical and the end of the year in which they turn 19 for dental/vision, unless they are a full-time student, in which case they will be covered until the end of the year in which they turn 23

Benefit Enrollment

Employees can enroll or change benefit elections:

  • Within 31 days of date of hire (as a newly hired employee)
  • During annual benefits open enrollment period (usually mid-October)
  • Within 31 days of experiencing a qualifying event

Qualifying Life Events

When one of the following events occurs, employees have 31 days from the date of the event to notify Human Resources and/or request changes to their coverage.  Evidence of the event is required.  The change in coverage must be consistent with the change in status.  Below are examples of qualifying events:

  • Change in legal marital status (marriage, divorce or legal separation)
  • Change in the number of dependents (for example, through birth or adoption, or if a child is no longer an eligible dependent)
  • Change in spouse’s employment status (resulting in a loss or gain of coverage)
  • Entitlement to Medicare or Medicaid

Medical Insurance

Medical insurance provides comprehensive coverage and wellness benefits to employees and  their eligible dependents.  WCRC offers two plans a PPO 4 and a PPO 7 administered by Blue Cross Blue Shields (BCBS).

Plan Comparison

Plan Feature PPO 4 PPO 7
Deductible $500 Individual/$1,000 Family $500 Individual/$1,000 Family
Annual Coinsurance Maximums $1,500 Individual/$3,000 Family $1,000 Individual/$2,000 Family
Annual Out-of-Pocket Maximums $6,350 Individual/$12,700 Family $6,350 Individual/$12,700 Family
Coinsurance Amounts 20% of approved amount for mental health care and substance abuse treatment

20% of approved amount for most other covered services

10% of approved amount for mental health care and substance abuse treatment

10% of approved amount for most other covered services

Office Visit Copay $20 Copay $20 Copay
Emergency Room Copay $100 Copay $100 Copay
Online Doctor Visit Copay $5 Copay $5 Copay

Deductible Copay Example PPO 4
Deductible Copay Example PPO 7

2019 Employee Contributions (per pay)

Tier PPO 4 PPO 7
Single $5.51 $12.61
2-Person $13.22 $30.26
Family $16.52 $37.83

Coordination of Benefits

Coordination of Benefits (COB) is how health care carriers coordinated benefits when members or their dependents are covered by more than one health care plan.  Under COB, carriers work together to make sure members receive the maximum benefits available under their health plan.  If an employee or any of their dependents have more than one health insurance plan it is their responsibility to notify BCBS and to complete the Coordination of Benefits Form.

Medical Buy-Out

If an employee and their dependents have medical coverage elsewhere, they can choose to waive medical insurance and receive a buy-out of $75 per pay period (up to $1,950 per year).  Proof of coverage must be provided in order to receive the buy-out. Employees and eligible dependents will still be eligible to participate in the flexible spending accounts, dental and vision insurance.

Blue 365

As a member of BCBS, employees get exclusive discounts on healthy products and services through Blue365. Log into your account at bcbsm.com to browse and redeem the discounts.  Here’s some of the discounts offered:

  • Deals on products and services such as hearing aids, fitness gear and nutrition resources
  • Access to $25 per month gym memberships through Healthways Fitness Your Way. There are more than 9,500 participating gyms including L.A. Fitness and Snap Fitness
  • Discounts on LASIK and eye care services

24/7 Online Health Care

WCRC medical plans now include 24/7 online health care through Blue Cross Online Visits™.  With online health care, you can see a U.S. board-certified doctor anytime, anywhere.  No appointment needed.  When your doctor is unavailable, you can either use a mobile device to log into the BCBSM Online Visits™ app, or a computer to log in to https://www.bcbsmonlinevisits.com/landing.htm.

24/7 Online Health Care

Prescription Drug Coverage

All WCRC medical plans include prescription drug coverage through BCBS, available via mail-order service and nationwide retail pharmacy.

Summary of Coverage

90-Day Retail Network Pharmacy *In-Network Mail Order Provider In-Network Pharmacy (not part of the 90-day retail  network) Out-of-Network Pharmacy
Generic Prescription Drugs 1 to 30-day period $0 Copay $0 Copay $0 Copay 25% prescription drug out-of-network retail pharmacy provider
31 to 83-day period No Coverage $0 Copay No Coverage No Coverage
84 to 90-day period $0 Copay $0 Copay No Coverage No Coverage
Brand Name Prescription Drugs 1 to 30-day period $30 Copay $30 Copay $30 Copay $30 copay plus an additional 25% prescription drug out-of-network retail pharmacy provider
31 to 83-day period No Coverage $30 Copay No Coverage No Coverage
84 to 90-day period $30 Copay $30 Copay No Coverage No Coverage

Lifestyle Drugs

Lifestyle drugs are excluded from the prescription drug plan.  Lifestyle drugs are health habit and reproductive drugs such as those that treat sexual impotency or infertility, help in weight loss or help to stop smoking. They are not designed to treat acute or chronic illnesses or be prescribed for medical conditions that have no demonstrable physical harm if not treated.

Lifestyle Drugs

Prior Authorization/Step Therapy

BCBS requires review of certain drugs before the plan will cover them, which is called prior authorization.  BCBS will review the member’s medication history to determine whether they’ve tried a preferred alternative first, which is known as step therapy.  Step therapy requires members to try less expensive options before “stepping up” to drugs that cost more.  Prior authorization and step therapy ensure that medically sound and cost-effective medications are prescribed appropriately.  A complete list of medications that require prior authorization or step therapy can be found at bcbsm.com/pharmacy.

Prior Authorization – Step Therapy

Mail Order

Save money and time with fewer refills when you get a 90-day supply of the medication you take regularly.  Please note that not all medications are available in a 90-day supply.  Here’s how to find out if your prescription is eligible:

  1. Log in to your account at bcbsm.com
  2. Hover over My Coverage in the blue bar at the top of the page
  3. Select Prescription Drugs from the drop down
  4. Click the link, Price a drug and view additional benefit requirements. It will take you directly to Express Scripts®. You won’t have to log in again
  5. Enter the name of the drug and follow the instructions. You’ll need to know the dosage and how often you’ll be taking it
  6. You’ll get an alert if your medication has a quantity limit

Dental Insurance

Dental insurance provides coverage for many dental services that employees and their eligible dependents may need.  The dental insurance is self-funded and administered by Varipro.

Summary of Coverage

Plan Feature Base Enhanced
Deductible $25 Individual/$75 Family $25 Individual/$75 Family
Maximum Benefit Amount

(Class A, B and C Services)

$1,000 (per calendar year, per person) $2,000 (per calendar year, per person)
Maximum Benefit Amount

(Class D Services – Orthodontia up to age 19)

$1,000 (lifetime maximum, per person) $2,000 (lifetime maximum, per person)
Dental Percentage Payable Class A Services (Preventative) – 100%

Class B Services (Basic) – 100%

Class C Services (Major) – 50%

Class D Services (Orthodontia) – 50%

Class A Services (Preventative) – 100%

Class B Services (Basic) – 100%

Class C Services (Major) – 50%

Class D Services (Orthodontia) – 50%

Employee Contributions (per pay)

Tier Base Enhanced
Single $3.39 $4.23
2-Person $8.13 $10.15
Family $10.16 $12.69

How to Submit a Claim

Provide your dental/vision card to your provider and they will file the claim on your behalf.  Use the manual claim form only if you did not have your insurance cards and paid your dental bill up front.

  1. Complete the Employee portion of the Dental Claim Form.  All questions must be answered
  2. Have the Dentist complete the provider’s portion of the form
  3. Attach bills for service rendered
  4. Send the above to the Claims Processor to the address listed on the form

Vision Insurance

Vision insurance provides coverage for many vision care services that employees and their eligible dependents may need.  This vision insurance is self-funded and administered by Varipro.

Summary of Coverage

Plan Feature Benefit
Eye Exam (per person, in a 12 month period) $60
Frame-Type Lenses (per pair, in a 12 month period)
  Single Vision $72
  Bi-Focal $96
  Tri-Focal $120
  Lenticular $144
Frames (per paid, in a 24 month period) $60
Contact Lenses (per pair, in a 12 month period) $180 ($60 exam & $72 contact lens in lieu of glasses)

Maximum Benefit Period – one exam and/or lenses in any consecutive 12 month period. One frame in any consecutive 24 month period.

Employee Contributions (per pay)

Tier Contribution
Single $0.34
2-Person $0.82
Family $1.03

How to Submit a Claim

Provide your dental/vision card to your provider and they will file the claim for on your behalf.  Use the manual claim form only if you did not have your insurance cards and paid your dental bill up front.

  1. Complete the Employee portion of the Vision Reimbursement Form.  All questions must be answered
  2. Attach bills for service rendered
  3. Send the above to the Claims Processor to the address listed on the form

COBRA

The Federal Consolidated Omnibus Budget Reconciliation Act (COBRA) gives employees and their qualified beneficiaries the opportunity to continue benefit coverage under the employer’s medical plan, dental plan, vision plan and flexible spending accounts when a “qualifying event” would normally result in the loss of eligibility.

Length of Coverage

Coverage may continue for differing lengths of time depending upon the reason for eligibility.  The time limitations are:

  • Up to 18 months if loss of coverage is due to termination of employment or reduction in work hours
  • Up to 36 months for dependents if loss of coverage is due to death, divorce, or a dependent child’s loss of eligibility
  • Up to 29 months if the individual is disabled at the time of eligibility for continued coverage or is disabled within 60 days of eligibility for continued coverage

COBRA Rates

PPO-4 PPO-7 Dental  Vision
Single  $529.19  $543.37  $38.34 $3.74
2-person $1,270.04 $1,304.09 $92.02 $9.00
Family $1,587.56 $1,630.11  $115.03  $11.25

Employee Resonsibility

WCRC makes every effort to comply with the guidelines regarding an employee’s and qualified dependent’s rights under COBRA. Under certain circumstances such as divorce and dependent eligibility, it is the employee’s responsibility to advise the Human Resources Department so the extended coverage may be offered to the employee’s dependents.

Employee Assistance Program

We all experience times when we need a little help managing our personal lives. WCRC understands this and is providing the Employee Assistance Program (EAP) to covered employees in connection with your group insurance from The Standard, to offer support, guidance and resources to help you and your family find the right balance between your work and home life.

What Can the EAP Do for Me?

Experienced master’s-degreed clinicians will confidentially consult with you over the telephone and direct you to the solutions and resources you need. You may also receive referrals to support groups, community resources, a network counselor or your health plan. These services are available for covered employees, their dependents, including children to age 26, and all household members.

What Services does the EAP Offer?

  • Child care and elder care
  • Alcohol and drug abuse
  • Life improvement
  • Difficulties in relationships
  • Stress and anxiety with work or family
  • Depression
  • Goal-setting
  • Emotional well-being
  • Financial and legal concerns
  • Grief and loss
  • Identity theft and fraud resolution
  • Online will preparation

How do I Access the EAP?

Over-the-phone consultation and online access to EAP services are always available. Simply call the toll-free number or log on to www.eapbda.com. In emergency situations, you may call the toll-free number to speak with a master’s-degreed clinician who can also connect you to emergency services.

Your program also includes up to three face-to-face assessment and consultative sessions per issue. A clinician will work with you to schedule appointments according to your needs.

Toll-free Number: 
888-293-6948

Online Access:
Login ID – standard
Password – eap4u