DeWinter Group Health & Welfare Benefit Plan Appendix

Remote Workers – CA Employees

Medical - Cigna - PPO 500

Group Number:

10542601

Phone:

800-997-1654

Claims Address:

CIGNA PO Box 188061 Chattanooga, TN 837422-8061

Website:

www.cigna.com

Eligibility:

Employee’s work at least 30 hours. Must work 30 days and effective the first day of the following month.

Waiting Period:

Employees are eligible to participate when they work 30 days and will be effective the first day of the following month.

How to Find a Doctor:

Go to: www.cigna.com

Network: Open Access Plus Buy Up Plan

  • Click 'Find a Doctor, Dentist or Facility' on the top right of the page
  • Login to myCigna or register for an account 
  • Enter location
  • Select a plan
  • Search for provider or specialty

 

Medical – Cigna PPO 1500

Group Number:

1054261

Phone:

800-997-1654

Claims Address:

CIGNA PO Box 188061 Chattanooga, TN 837422-8061

Website:

www.cigna.com

Eligibility:

Employee’s work at least 30 hours. Must work 30 days and effective the first day of the following month.

Waiting Period:

Employees are eligible to participate when they work 30 days and will be effective the first day of the following month.

How to find a Doctor:

Go to: www.cigna.com

Network: Open Access Plus Base

  • Click 'Find a Doctor, Dentist or Facility' on the top right of the page
  • Login to myCigna or register for an account
  • Enter location
  • Select plan
  • Search for provider or specialty

 

Medical - Cigna – HSA 2800 Local Plus

Group Number:

10542601

Phone:

800-997-1654

Claims Address:

CIGNA PO Box 188061 Chattanooga, TN 837422-8061

Website:

www.cigna.com

Eligibility:

Employee’s work at least 30 hours. Must work 30 days and effective the first day of the following month.

Waiting Period:

Employees are eligible to participate when they work 30 days and will be effective the first day of the following month.

How to Find a Doctor:

Go to: www.cigna.com

Network: Local Plus IN HDHP

  • Click 'Find a Doctor, Dentist or Facility' on the top right of the page
  • Login to myCigna or register for an account
  • Enter location
  • Select a plan
  • Search for provider or specialty

 

Medical - Cigna – PPO 1500 Local Plus

Group Number:

10542601

Phone:

800-997-1654

Claims Address:

CIGNA PO Box 188061 Chattanooga, TN 837422-8061

Website:

www.cigna.com

Eligibility:

Employee’s work at least 30 hours. Must work 30 days and effective the first day of the following month.

Waiting Period:

Employees are eligible to participate when they work 30 days and will be effective the first day of the following month.

How to Find a Doctor:

Go to: www.cigna.com

Network: LocalPlus Base

  • Click 'Find a Doctor, Dentist or Facility' on the top right of the page
  • Login to myCigna or register for an account
  • Enter location
  • Select a plan
  • Search for provider or specialty

 

Dental – Cigna PPO

Group Number:

00630804

Phone:

800-244-6224

Claims Address:

CIGNA PO Box 188037 Chattanooga, TN 37422-8037

Website:

www.cigna.com

Eligibility:

Employee’s work at least 30 hours. Must work 30 days and effective the first day of the following month.

Waiting Period:

Employees are eligible to participate when they work 30 days and will be effective the first day of the following month.

How to Find a Doctor:

Go to: www.cigna.com

Network: Cigna Dental PPO

  • Click 'Find a Doctor, Dentist or Facility' on the top right of the page
  • Login to myCigna or register for an account
  • Enter Location
  • Select a plan
  • Search for provider or specialty

 

Vision – VSP

Group Number:

30058521

Phone:

800-877-7195

Claims Address:

PO Box 385018 in Birmingham, AL 35238-5018

Website:

www.vsp.com

Eligibility:

Employee’s work at least 30 hours. Must work 30 days and effective the first day of the following month.

Waiting Period:

Employees are eligible to participate when they work 30 days and will be effective the first day of the following month.

How to Find a Doctor:

Go to: www.vsp.com

Network: VSP Choice

  • Click 'Find a Doctor'
  • Search by the 'Location, Doctor of Office Name'
  • Doctor Network is 'Choice'
  • Choose the doctor that works best for you on your plan

 

 

 

Health HSA

Administrator

WEX

Group Number:

N/A

Phone:

866-244-6224

2022 IRS Max Contribution

$3,650 Individual

$7300 Family

Website:

www.wexinc.com

Eligibility:

Employee’s work at least 30 hours. Must work 30 days and effective the first day of the following month.

Waiting Period:

Employees are eligible to participate when they work 30 days and will be effective the first day of the following month.

 

Health FSA

Administrator

WEX

Group Number:

N/A

Phone:

866-244-6224

2022 IRS Max Contribution

$2750

Website:

www.wexinc.com

Eligibility:

Employee’s work at least 30 hours. Must work 30 days and effective the first day of the following month.

Waiting Period:

Employees are eligible to participate when they work 30 days and will be effective the first day of the following month.

 

Dependent Care FSA

Administrator

WEX

Group Number:

N/A

Phone:

866-244-6224

2022 IRS Max Contribution

$5000

Website:

www.wexinc.com

Eligibility:

Employee’s work at least 30 hours. Must work 30 days and effective the first day of the following month.

Waiting Period:

Employees are eligible to participate when they work 30 days and will be effective the first day of the following month.

 

 

 

Basic Life, AD&D Insurance

Administrator

Cigna

Group Number:

SGM611351 – Life

SOK608474 – AD&D

Phone:

800-362-4462

Website:

www.cigna.com

Enrollment

Automatically enrolled at a flat amount of $25000.

Coverage:

Flat Amount of $25,000 for Life and AD&D – Employer paid.

 

Voluntary Life, AD&D Insurance – Employee, Spouse, Children

Administrator

Cigna

Group Number:

SGM611351 – Life

SOK608474 – AD&D

Phone:

800-362-4462

Website:

www.cigna.com

Enrollment

Subject to submit an Evidence of Insurability application (EOI) to be approved to be enrolled in this employee paid coverage.

Coverages  

 

  • Employee: Purchase up to $500,000 to max of 5x annual salary in $10,000 increments- Guarantee issued $50,000
  • Spouse: Purchase up to $50,000 in $5,000 increments (no more than 100% of employee amount) - Guarantee issue: $15,000
  • Child(ren): Purchase up to $10,000 in $2,000 increments. Max coverage up to age 6 month is $1,000. Guarantee issue: $10,000