The
ShopRite benefit plans described in this guide are available to full-time, non-union
associates and their eligible dependents.
Your eligible dependents include:
We know that benefits can be confusing, especially with all
of the terms that are used to describe them. To help you better understand your
options, we put together a listing of commonly
used benefit terms.
Coinsurance — percentage of covered expenses
you pay after the plan’s applicable deductible.
Consumerism features — choices
you make to save money, such as using network providers instead of
out-of-network providers, or requesting a generic drug instead of a brand-name drug
alternative.
Contributions — the amount that is deducted from your
paycheck to pay for your share of benefits.
Copayment — the fixed dollar amount you pay to the provider for some services, such as
office visits and prescription drugs.
Deductible — the amount
you pay each calendar year before the plan reimburses you for covered
expenses.
Exchange — another name
for the Health Insurance Marketplace that has been available since October 1,
2013 to help individuals and small employers
compare and purchase health insurance.
Health Assessment — online questionnaire that you
complete to help you identify potential health risks.
Health Care Reimbursement.
Account
(HCRA) —
a company-funded account that can be used to pay for a portion of your deductible or coinsurance. (Only
available with the Health Care Reimbursement Account Plan).
Health Insurance
Marketplace — a way for individuals and small employers to compare
and purchase health insurance.
In-network — service
received from a participating medical, dental or vision care network provider.
Also, can be used to define
the level of benefits paid when
you use a network provider.
Out-of-network — service
received from a provider that does NOT participate in the applicable Aetna,
MetLife and/or EyeMed
networks. The medical
plan pays out-of-network benefits based on Medicare reimbursement levels
(up to 110% of Medicare for professional services and 140% for facility charges).
In addition to your coinsurance, you are responsible for amounts that exceed these levels.
Out-of-pocket maximum — maximum
expense limit you are responsible for paying such as your deductible,
coinsurance, and copays in a given plan year - this does not include your contributions. After this limit is
reached, the plan reimburses 100% for most remaining
covered medical expenses (excluding prescription drugs and the amount above the
reimbursement level.).
Primary care
physician (PCP) — the network doctor,
generally a family practice, internist or pediatrician, you choose to provide
care for you and to help you coordinate your overall
health care, and make referrals to specialists, when
appropriate.
Reasonable
and Customary (R&C) Charges (for Dental Plan) — the negotiated fee your network
dentist and the insurance provider have agreed on to perform certain
services. If you visit an out-of-network provider, you will be required
to pay any charges that exceed the R&C charge.