West Valley values the contributions of our employees. In appreciation of your dedicated service, we are pleased to offer The American Worker program. Please carefully review this enrollment guide so you understand the benefits being provided and can make the right choices for you and your family.
All employees must enroll in coverage within 30 days of their start date.
- All employees outside of Vermont and New Hampshire are eligible for The American Worker program.
- Employees in Vermont and New Hampshire are only eligible for the MEC, Major Medical Plan, as well as Dental and Vision.
How To Enroll (Two Ways)
- Enroll Online: www.TheAmericanWorker.com
- Enroll by Phone: (866) 866-3424
- Group Number: FV1319
Can I Change My Coverage Anytime?After you enroll, if you’ve had certain qualifying life events, including losing health coverage, moving, getting married, having a baby, or adopting a child, you may qualify for a Special Enrollment Period which allows you to make changes to your coverage.
If a qualifying event occurs, there is a 30 day window to contact The American Worker that allows for changes to your benefits. If you would like to make a change to your coverage or cancel, you will need to call member services at (866) 866-3424 or visit www.TheAmericanWorker.com
Examples of Qualified Life Events
Below is a list of example Qualified Life events.
- Marriage, legal separation or divorce
- Birth or adoption of a child
- Change in eligibility of a child
- Death of a dependent family member
- Change in the employment status of your Spouse / Domestic Partner
- Your Spouse / Domestic Partner reaches age 65 and is covered by Medicare
- FMLA special requirements
- HIPAA special enrollment rights
- Increase or reduction of hours that changes employment status
- Transfer to or from a benefits-eligible position
Employee Cost of Coverage and Missed Premium Payments
Your cost of coverage will vary depending on the plan option and tier you choose. Medical, dental, and vision health premiums are deducted pre-tax from each paycheck, saving you tax dollars.
IMPORTANT INFORMATION ABOUT MISSED PREMIUM PAYMENTS:
- Your coverage will continue uninterrupted as long as the premium is deducted from your paycheck. If you receive a paycheck without a premium deduction, your benefits will be suspended. Coverage will remain suspended until the Monday following the date you receive your next paycheck with a premium deduction, unless you make a premium payment for the missed deduction.
- To avoid having coverage suspended you must make a missed premium payment every time a deduction is not processed from your paycheck. You have 30 days from the date of your paycheck without a deduction to make a missed premium payment. If you do not pay for the missed premium deduction within 30 days, you will not be able to pay for that coverage period at a later date.
- You can pay for missed premium deductions online, over the phone or by mail. Payment options include electronic check, credit/debit card, check or money order.
- You can also authorize an automatic payment be processed every time premium is not deducted from your paycheck; however, you are responsible for contacting The American Worker to cancel the automatic payment once your employment has been terminated. If you do not, your account will be charged for coverage and you will not receive a refund.
About Your Coverage Options
Minimum Essential Coverage (MEC) Plan
- The Minimum Essential Coverage (MEC) plan satisfies the requirement set forth by the Affordable Care Act (ACA) and covers a multitude of common screenings and preventive services at 100%.
- You MUST visit a First Health Network provider for services to be covered. Services from out-of-network providers are NOT covered. To find a provider, visit www.FirstHealthLBP.com.
Please note, the U.S. Preventive Services Task Force periodically updates these lists and sets the requirements such as age, gender, or health conditions for services to be covered. For a current list including all requirements, visit www.healthcare.gov/preventive-care-benefits/.
The Fixed Indemnity Plan is (a) not a substitute for minimum essential health coverage under the Affordable Care Act (ACA); and (b) does not qualify as minimum essential coverage under the ACA (This plan is not available in NH or VT).
The Fixed Indemnity Plan is underwritten by Nationwide Life Insurance Company. The plan includes AWP Value Rx, First Health Network and Teladoc, which are provided by separate vendors. All benefits pay on a calendar year basis per person, unless stated otherwise.
- National PPO Network and access to the First Health Network, which provides savings on Physician and Hospital services. By visiting a First Health provider you can reduce your out-of-pocket expenses. To locate a provider online, visit www.FirstHealthLBP.com .
- Key features include no deductibles, copays, pre-existing condition limitations or waiting period.
- First dollar coverage for Doctor Office Visits, Diagnostic X-Rays and Lab Work, Hospital Stays, and more.
New Neighborhood Pharmacy Discount Program assures members the lowest price on prescription drugs, saving 10% to 85% on most prescriptions and discounted services such as Vision, Hearing, Medical Equipment, may vary based on geographic location and at participating providers.
- 24/7 access to doctors by phone - provided by Teladoc.
- Does this satisfies the requirement set forth by the Affordable Care?
- Major Medical Plan with Preferred Provider Organization (PPO) Plan which offers the freedom to receive care from any in- or out-of-network doctor, specialist or hospital without a referral. You have a deductible to meet and once the deductible is met, coinsurance (or the cost share between you and carrier) kicks in.
- The types of medical services that accumulate towards your deductible are inpatient hospital stays, outpatient surgeries, (MRIs, PET scans, CT scans, etc.). If you go to the doctor, see a specialist, utilize the ER or take a prescription drug, you’ll pay a copay for those specific services. Copays do not accumulate towards your deductible but they do accumulate towards your overall out-of-pocket maximum.
Comprehensive coverage for healthcare services due to accidents or illnesses as well as prescription drugs after the applicable deductible.
100% coverage for preventive services without a copay or having to satisfy the deductible.
West Valley Staffing Group will be compliant with the MVP affordability requirements and will vary rates based on your hourly rate. For a specific cost for individual coverage contact firstname.lastname@example.org .
To find a network provider, visit www.FirstHealth.com or call (800) 226-5116.
- Dental Benefits: To select a provider, call (800) 659-2223 or visit www.Ameritas.com . On the site be sure to select "Find a Provider", select "Dental", select " Network Procider", then "Classic PPO" network.
- Vision Coverage: TTo select a provider, call (800) 659-2223 or visit www.Ameritas.com . On the site be sure to select "Find a Provider", select "Vision:VSP", then "Look Up VSP Providers".
- Short-Term Disability and Life/AD&D Insurance: Nationwide Mutual Insurance Company contact info?
COBRA: Continuation of coverage can become available to you when you would otherwise lose your group health coverage.