Reliable Wireline 2021 Enrollment Guide FINAL

EMPLOYEE BENEFITS 

ENROLLMENT GUIDE 

Plan Year 2021-2022 

Effective August 1, 2021 to July 31, 2022 

2 

2021-2022

Mark your calendar for 

OPEN ENROLLMENT! 

July 12 to July 18 

DEADLINE 

JUNE 

18 

REMEMBER: Open Enrollment must be completed by the deadline or 

you may not be able to enroll yourself and/or your eligible dependents until our 

next open enrollment, or a qualifying event occurs.

CONTENTS 

04 Benefits Overview 

06 Medical Insurance 

09 Dental Insurance 

16 Vision Insurance 

22 Employer Paid Life and Accidental Death & Dismemberment Insurance 

23 Supplemental Life and Accidental Death & Dismemberment Insurance 

32 Voluntary Short Term Disability 

35 Employer Paid Long Term Disability 

37 Open Enrollment Instructions 

38 Important Contacts 

3

BENEFITS OVERVIEW 

ENROLLMENT 

You can enroll in benefits or change your elections at the following times: 

• 30 days prior to your initial eligibility date (as a newly hired employee) 

• During the annual benefits open enrollment period 

• Within 30 days of experiencing a qualifying life event 

BENEFIT OPTIONS 

We offer a comprehensive benefits package consisting of: 

• Medical Insurance 

• Dental Insurance 

• Vision Insurance 

• Employer Paid Life and Accidental Death & Dismemberment Insurance 

• Supplemental Life and Accidental Death & Dismemberment Insurance 

• Voluntary Short Term Disability Insurance 

• Employer Paid Long Term Disability Insurance 

4

BENEFITS OVERVIEW 

ELIGIBILITY 

Full-time employees working at least 30 hours per week are eligible for 

benefits on the first of the month following date of hire. Many of the plans 

offer coverage for eligible dependents, including: 

• Your legal spouse 

• Your children to age 26, regardless of student, marital, or tax-dependent 

status (including stepchild, legally adopted child, a child placed with you 

for adoption, or a child for whom you are the legal guardian) 

• Your dependent children over age 26 who are physically or mentally 

unable to care for themselves 

CHANGING BENEFITS AFTER OPEN ENROLLMENT 

Due to IRS regulations, once you have made your elections for the plan 

year, you cannot change your benefits until the next annual open 

enrollment period. The only exception is if you experience a qualifying 

event, and election changes must be consistent with your life event. 

To request a benefits change, notify Human Resources within 30 days of 

the qualifying life event. Change requests submitted after 30 days cannot 

be accepted. You may need to provide proof of the life event. 

Qualifying life events include, but are not limited to: 

• Marriage, divorce, or legal separation 

• Birth or adoption of an eligible child 

• Death of your spouse or covered child 

• Change in your spouse’s work status that affects his or her benefits 

• Change in your child’s eligibility for benefits 

• Qualified Medical Child Support Order

MEDICAL INSURANCE 

CARRIER: UNITED HEALTHCARE 

NETWORK: CHOICE 

Please refer to the official plan documents for additional information on 

coverage and exclusions. 

COVERED BENEFITS 

BASE PLAN - AXKX / 2V 

In-Network 

Calendar Year Deductible - Individual/Family 

Out of Pocket Maximum - Individual/Family 

(Includes deductible, copays, and coinsurance) 

$3,000/$6,000 

$7,150/$14,300 

Coinsurance (plan pays/you pay) 80 / 20% 

Preventive Services 

No charge 

Physician Office Visit $0 copay under age 19; $15 copay if over age 19 

Specialist Office Visit 

Virtual Office Visit 

Urgent Care 

Emergency Room (non admitted) 

Outpatient Lab / X-ray 

Outpatient Complex Imaging 

Inpatient Care 

Outpatient Surgery 

$50 or $100 copay 

No charge 

$25 copay 

$300 copay + 20% after deductible 

20% after calendar year deductible 




PRESCRIPTION DRUGS Retail (30 day supply) Mail Order (90 day supply) 

Tier 1 $10 copay $25 copay 

Tier 2 $35 copay $87.50 copay 


COVERAGE LEVEL BI-WEEKLY DEDUCTION SEMI-MONTHLY DEDUCTION 

Employee Only $38.92 $42.17 

Employee & Spouse $85.62 $92.76 

Employee & Child(ren) $72.01 $78.01 

Employee & Family $124.54 $134.92

MEDICAL INSURANCE 


NETWORK: CHOICE 

Please refer to the official plan documents for additional information on 

coverage and exclusions. 

COVERED BENEFITS BUY UP PLAN - ANDO / 454 

In-Network 

Calendar Year Deductible - Individual/Family 

Out of Pocket Maximum - Individual/Family 

(Includes deductible, copays, and coinsurance) 

$1,000/$2,000 

$6,500/$13,000 

Coinsurance (plan pays/you pay) 80 / 20% 

Preventive Services 

Physician Office Visit 

Specialist Office Visit 

Virtual Office Visit 

Urgent Care 

Emergency Room (non admitted) 

Outpatient Lab / X-ray 

Outpatient Complex Imaging 

Inpatient Care 

Outpatient Surgery 

No charge 

No charge 

$100 copay 

No charge 

$50 copay 

$250 copay + 20% after deductible 





PRESCRIPTION DRUGS Retail (30 day supply) Mail Order (90 day supply) 



Tier 3* $100 copay $250 copay 

Tier 4* $250 copay $625 copay 

* Prescription Deductible (Individual / Family) of $250 / $500 (does not apply to Tier 1 & 2) 

COVERAGE LEVEL BI-WEEKLY DEDUCTION SEMI-MONTHLY DEDUCTION 




Employee & Family $298.00 $322.83

Visit with a doctor 

24/7 — whenever, 

wherever. 

With a Virtual Visit, you can talk — by phone or video — to 

a doctor who can diagnose common medical conditions 

and even prescribe medications, if needed.* 

Virtual Visits may make it easier than 

ever to get treated by a doctor. 

Whether using myuhc.com® or the UnitedHealthcare® app, Virtual Visits let 

you video chat with a doctor 24/7 — without setting up additional accounts 

or apps. But, if you’d rather just speak with a doctor, you can simply do a 

Virtual Visit over the phone. 

With a UnitedHealthcare plan, your cost for a Virtual Visit is $0 .** 

Use a Virtual Visit for these common conditions: 

• Allergies • Flu • Sore throats 

• Bronchitis • Headaches/migraines • Stomachaches 

• Eye infections • Rashes • And more 

$ 

0cost 

An estimated 25% of ER 

visits could be treated with 

a Virtual Visit — bringing a 

potential $2,100 *** cost 

down to $0. 

Get started. Sign in at myuhc.com/virtualvisits | Download the UnitedHealthcare app | Call 1-855-615-8335 

*Certain prescriptions may not be available, and other restrictions may apply. 

**The Designated Virtual Visit Provider’s reduced rate for a virtual visit is subject to change at any time. 

***UnitedHealthcare data: based on analysis of 2016 UnitedHealthcare ER claim volumes, where ER visits are low acuity and could be treated in a Virtual Visit, primary care physician or urgent/convenient care setting. 

The UnitedHealthcare® app is available for download for iPhone® or Android. iPhone is a registered trademark of Apple, Inc. Android is a trademark of Google LLC. 

Virtual Visits phone and video chat with a doctor are not an insurance product, health care provider or a health plan. Unless otherwise required, benefits are available only when services are delivered through a Designated Virtual 

Network Provider. Virtual Visits are not intended to address emergency or life-threatening medical conditions and should not be used in those circumstances. Services may not be available at all times, or in all locations, or for all 

members. Check your benefit plan to determine if these services are available. 

Insurance coverage provided by or through UnitedHealthcare Insurance Company and its affiliates. Administrative services provided by United HealthCare Services, Inc. or their affiliates. Health Plan coverage provided by or 

through a UnitedHealthcare company. 

B2C EI1952932.2 8/20 ©2020 United HealthCare Services, Inc. 20-222351-B

DENTAL INSURANCE 


● You will pay less out of pocket when you choose an in-network provider. 

● Locate an in-network provider at www.myuhc.com. 

● Be sure to ask for a pre-treatment estimate. 

● Out-of-network providers can balance bill, or bill you for the difference between 

the provider’s charge and the allowed amount. 

ELECTION 

BI-WEEKlY 

DEDUCTIONS 

SEMI-MONTHlY 

DEDUCTIONS 




Employee & Family $22.18 $24.03 

Annual Deductible 

COVERED BENEFITS 

Annual Plan Benefit Maximum 

Preventive & Diagnostic Services 

Oral exams, cleanings, X-rays, fluoride treatments, sealants, 

space maintainers 

Basic Services 

Amalgam or composite restorations, occlusal guards, 

anesthesia, simple extractions, oral surgery, endodontics & 

periodontal maintenance 

Major Services 

Bridges, crowns (inlays/outlays), dentures (full/partial), 

implants 

PLAN PAYS 

$50 per person, $150 per family 

$2,000 per covered member 

100% 

80% 

50% 

Orthodontia Services (available for adults and children) 50% 

Lifetime Orthodontia Plan Max $2,000

Dental Plans 

Dental PPO 

Welcome to your 

dental plan. 

With the UnitedHealthcare Dental PPO Plan, you have one of the largest dental 

networks in the country, the freedom to see any specialist without a referral and 

a lot more. 

Dental benefits that give you freedom and choice. 

With this plan, you can see any dentist you want, anywhere across the country. When you choose a dentist 

who is part of your plan’s large national network, you may receive discounted rates only available to members. 

Preventive care. 

As long as you see a network dentist, your plan pays for all or most of your preventive dental 

care, including routine checkups, cleanings and annual oral cancer screens for adults. You can 

get 2 cleanings in a 12-month period — one every 6 months. Some plans cover more cleanings 

for an additional copay. 

Preventive visits are important because your dentist can catch problems early when they’re 

easier to treat. Good oral health helps protect your teeth and gums and is also linked to your 

overall health. 

Fillings, crowns and more. 

The plan also covers fillings and may cover procedures, such as crowns and bridges. Some 

plans only cover silver fillings for back teeth. If you choose white fillings, you may need to pay 

the difference. 

Cosmetic procedures are not covered. 

Your plan doesn’t cover services, such as teeth whitening, that are done only to improve the 

look of your teeth. 

Extra dental visits when you’re pregnant. 

Increased bacteria levels in a pregnant woman’s mouth can lead to tooth decay. Your plan 

covers extra visits for cleanings and gum treatments when you’re pregnant, as recommended 

by your dentist. Ask your dentist to submit a claim to the address on your ID card. Be sure to 

include the name of your OB/GYN and your pregnancy due date. 

CONTINUED

Make the most of your dental plan. 

Find a network dentist. 

You have 2 options to help you in your search: 

1 Log in to myuhc.com® and use the Find a 

Dentist tool to search by name, facility or location 

to see a list of dentists in your network. 

OR 

2 Call the number on your ID card. 

If a network dental provider is not available within a 

reasonable distance of where you live or work, you may 

be referred to an out-of-network dental provider and 

still receive services at the network rate. Please use 

myuhc.com to see your official dental plan documents 

for all of the details about your plan coverage or call the 

number on the back of your ID card. 

Use your dental ID card. 

All members receive an ID card. Your card only lists 

the name of the person who signed up for the plan, 

but everyone covered by your plan should use the 

card. Be sure to bring it with you each time you see 

the dentist. 

Print your ID card anytime at myuhc.com. 

Estimate your costs. 

Use the dental cost calculator on myuhc.com to 

calculate your out-of-pocket costs ahead of time. 

1. Select Coverage & Benefits. 

2. Select Dental. 

3. Select Dental Cost Calculator. 

How your plan works. 

Deductible. 

For services other than preventive care, you may have to pay a 

deductible—a set dollar amount—before your coverage kicks in. 

Cost sharing. 

Your dental plan benefits begin as soon as you meet the 

deductible. After that, you and your plan will share the costs of 

the services you receive. (This is known as coinsurance, the 

percentage of costs you pay for covered dental care after you’ve 

paid your deductible.) 

Annual maximum. 

Your plan pays for services up to a set dollar amount, called an 

annual maximum. Preventive services, including routine dental 

checkups, may count toward your annual maximum. If you reach 

the maximum amount, you’ll need to pay the entire cost of any 

additional dental care you receive that year. Find your annual 

maximum on myuhc.com or call the number on your ID card. 

Pre-treatment estimates. 

If you’re planning to have a procedure that may cost more than 

$500, ask your dentist to send UnitedHealthcare X-rays and notes 

about your condition. We will review the treatment to make sure 

it’s medically necessary. (The plan doesn’t cover unnecessary 

procedures.) After the review, your dentist will receive an estimate 

of what the plan will pay and what your out-of-pocket costs will be. 

Out-of-network services. 

If you use a dentist outside the network, you may need to pay 

the difference between what the plan covers and what your 

dentist charges for the services. Plus, you may need to submit 

your own claims. 

Submit claims online. 

You can easily submit claims on myuhc.com. It only takes 

a few minutes, helps reduce errors and helps you get 

reimbursed faster. 

Need help? 

Log in to myuhc.com or call 1-800-445-9090, TTY 711, 

Monday–Friday, 7 a.m.–10 p.m. CT. 

The company does not discriminate on the basis of race, color, national origin, sex, age, or disability in health programs and activities. 

We provide free services to help you communicate with us. Such as, letters in other languages or large print. Or, you can ask for an interpreter. 

To ask for help, please call the member toll-free phone number listed on your ID card. 

ATENCIÓN: Si habla español (Spanish), hay de asistencia de idiomas, sin cargo, a su disposición. Llame al número de teléfono gratuito que aparece 

en su tarjeta de identificación. 

請注意 : 如果您說中文 (Chinese), 我們免費為您提供語言協助服務。請致電 :1-800-445-9090, TTY 711. 

UnitedHealthcare dental coverage underwritten by UnitedHealthcare Insurance Company, located in Hartford, Connecticut, UnitedHealthcare Insurance Company of New York, located in Islandia, New York, or their affiliates. 

Administrative services provided by Dental Benefit Providers, Inc., Dental Benefit Administrative Services (CA only), DBP Services (NY only), United HealthCare Services, Inc. or their affiliates. Plans sold in Virginia use policy 

form number DPOL.06.VA and associated COC form number DCOC.CER.06.VA. 

This policy has exclusions, limitations and terms under which the policy may be continued in force or discontinued. For costs and complete details of the coverage, contact the company. 

Facebook.com/UnitedHealthcare Twitter.com/UHC Instagram.com/UnitedHealthcare YouTube.com/UnitedHealthcare 

MT-1112486.1 5/18 ©2018 United HealthCare Services, Inc. 18-7716-B

Dental Plans 

Consumer MaxMultiplier 

$2,000 annual maximum 

Get rewarded for 

taking care of your smile. 

Our Consumer MaxMultiplier® program rewards you for keeping 

up with your dental care by adding dollars to next year’s annual 

maximum. And it’s included as part of your dental plan. 

Earn up to 

$ 

6001 

to add to your $2,000 

annual maximum. 

Program highlights: 

Earn award dollars for 

visiting your dentist at 

least once a year. 1 

Your award dollars will help to 

pay for claims that go beyond 

your annual maximum. 

Unused award dollars 

can roll over each year. 

How your award 

dollars add up: 

Here's an example of the award dollars you could 

earn if you visit your dentist at least once this year. 

This year's annual 

maximum is: 

If your total claims 

are less than: 

$ 

2,000 

$ 

1,000 

You'll earn an award of: 

$ 

500 

Plus, if you have a Dental PPO plan 

and all claims are with network 

dentists, you'll earn an extra $100. 

Your award dollars will be added to 

next year’s annual maximum to pay for 

qualifying claims. 

CONTINUED

Program rules: 

1. $1,500 is the most award dollars that can be rolled 

over to the annual maximum. The total annual 

maximum cannot go above $3,500. 

2. If your plan has different annual network and 

out-of-network maximums, the award dollars will 

be based on the annual out-of-network maximum. 

3. Award dollars can be used for claims filed up to 

180 days after your benefit period ends. 

4. Award dollars can be used for both network and 

out-of-network claims. 

5. Award dollars do not apply to orthodontic services. 

6. If you sign up for a UnitedHealthcare Dental PPO 

or Dental In-Network Only (INO) plan in the last 

three months of a benefit period, you will have to 

wait until the end of the first full month of the next 

benefit period to participate in this program. 

7. If you end your coverage, but sign up again within 

six months with the same employer, you can keep 

your award balance as long as your employer still 

offers a dental plan with Consumer MaxMultiplier. 

If six months or more pass, you will lose the 

award balance. 

8. If your employer decides to change your dental 

plan, your award balance will move with you as long 

as the new plan includes Consumer MaxMultiplier. 

View your annual maximum 

balance on myuhc.com®. 

Questions? Call the number 

on the back of your ID card. 

1 

You will not actually earn cash that you can access or withdraw. UnitedHealthcare adds the award dollars to your annual maximum for the following year and applies them 

to qualifying claims. 

The company does not discriminate on the basis of race, color, national origin, sex, age, or disability in health programs 

and activities. 

We provide free services to help you communicate with us. Such as, letters in other languages or large print. Or, you can 

ask for an interpreter. 

ATENCIÓN: Si habla español (Spanish), hay de asistencia de idiomas, sin cargo, a su disposición. Llame al número de 

teléfono gratuito que aparece en su tarjeta de identificación. 

請注意 : 如果您說中文 (Chinese), 我們免費為您提供語言協助服務。請致電 

This program may not be available in all states. Components subject to change. 

This policy has exclusions, limitations and terms under which the policy may be continued in force or discontinued. For costs and complete details of the coverage, contact either 

your broker or the company. 

UnitedHealthcare dental coverage underwritten by UnitedHealthcare Insurance Company, located in Hartford, Connecticut, UnitedHealthcare Insurance Company of New York, 

located in Islandia, New York, or their affiliates. Administrative services provided by Dental Benefit Providers, Inc., Dental Benefit Administrative Services (CA only), DBP Services (NY 

only), United HealthCare Services, Inc. or their affiliates. Plans sold in Texas use policy form number DPOL.06.TX, DPOL.12.TX and DPOL.12.TX (Rev. 9/16) and associated COC 

form numbers DCOC.CER.06, DCOC.CER.IND.12.TX and DCERT.IND.12.TX. Plans sold in Virginia use policy form number DPOL.06.VA with associated COC form number DCOC. 

CER.06.VA and policy form number DPOL.12.VA with associated COC form number DCOC.CER.12.VA. 

MT-1146317.0 10/17 © 2017 United HealthCare Services , Inc. BST00061 17-4258

Dental Plans 

SmileDirectClub 

Get a smile you’ll love — 

for a lifetime of confidence. 

Now available as part of your UnitedHealthcare orthodontic 

benefit, SmileDirectClub straightens teeth with clear aligners 

sent directly to you. 

SmileDirectClub is now in our network. This means your UnitedHealthcare 

dental plan may help you get a smile you’ll love, in most cases, for less than 

$1,000 out of pocket. 1 That’s something to bring a smile to any face. 

With SmileDirectClub, most new smiles only take about 6 months on 

average 2 — plus, you can look forward to: 

• Not having braces. 

• Not scheduling monthly office visits. 

Get started on a straighter, brighter smile 

with this new benefit. 

If you’re a candidate, your dental plan may pay half the cost of your aligner 

treatment. Your benefit also includes these services at no extra cost: 

• A free 3D digital image at one of 235 SmileShops ($0 cost) or an at-home 

impression kit ($0 cost with rebate). 

• A free retainer following completion of your smile journey ($0 cost 

with subscription). 

• bright on premium teeth whitening ($0 cost). 

• You’ll be assigned a duly licensed dentist or orthodontist to develop 

your treatment plan and monitor your progress. 

SmileDirectClub + 

UnitedHealthcare = 

A smile you may love 

for less than $1,000 

out of pocket. 1 

Don’t wait — find out if you’re a candidate today at 

smiledirectclub.com/uhc. 

CONTINUED

Smiling is contagious. Join the club. 

If you or your covered dependents are candidates, you can transform your 

smile in 3 easy steps with SmileDirectClub’s innovative at-home program. 

Here’s how it works. 

1 

Make an impression. 

Visit one of SmileDirectClub’s more than 235 SmileShops for 

a free 3D digital image of your smile ($0 cost). Or, you can order 

an at-home impression kit online ($0 cost with rebate). 

2 

3 

Get aligned. 

A duly licensed dentist or orthodontist will create your smile plan 

and your clear aligners will be sent to your door. Your new smile kit 

will also include bright on premium teeth whitening, so you can 

show off those pearly whites. 

Keep smiling. 

Your dentist will check in with you online every 90 days to monitor 

your progress. After your new smile is complete, you’ll get your 

first retainer ($0 cost with subscription). Wear it at night to keep 

your new smile in place, and feel free to order touch-up whitening 

treatments anytime. 

Your new smile is waiting. 

Visit smiledirectclub.com/uhc. 

1 

SmileDirectClub is available to members enrolled in a UnitedHealthcare Dental Preferred Provider Organization (PPO) or In-Network Only (INO) plan that includes orthodontic coverage. Cost of less than $1,000 is based on 

a UnitedHealthcare national dental plan design for employee-only coverage with a 50 percent orthodontic benefit. Not all individuals are suitable candidates for clear aligners. These services are intended for certain 

individuals who have mild or moderate orthodontic needs. 

2 

SmileDirectClub treatment plan average results, 2018. 

All trademarks are the property of their respective owners. 

Benefits and programs may not be available in all states or for all group sizes. Components subject to change. These policies have exclusions, limitations and terms under which the policy may be continued in force or 

discontinued. For costs and complete details of the coverage, see your official dental plan documents. 

UnitedHealthcare dental coverage underwritten by UnitedHealthcare Insurance Company, located in Hartford, Connecticut, UnitedHealthcare Insurance Company of New York, located in Islandia, New York, or their affiliates. 

Administrative services provided by Dental Benefit Providers, Inc., Dental Benefit Administrative Services (CA only), DBP Services (NY only), United HealthCare Services, Inc. or their affiliates. Plans sold in Texas use policy 

form number DPOL.06.TX, DPOL.12.TX and DPOL.12.TX (Rev. 9/16) and associated COC form numbers DCOC.CER.06, DCOC.CER.IND.12.TX and DCERT.IND.12.TX. Plans sold in Virginia use policy form number 

DPOL.06.VA with associated COC form number DCOC.CER.06.VA and policy form number DPOL.12.VA with associated COC form number DCOC.CER.12.VA. 


8966207.1 6/19 ©2019 United HealthCare Services, Inc. 19-12516 C

VISION INSURANCE 


NETWORK: SPECTERA 

● You will pay less out of pocket when you choose an in-network provider. 

● Locate an in-network provider at www.myuhcvision.com. 

● You must submit a claim form for out-of-network expenses. 

● LASIK surgery discounts available 

ELECTION 

BI-WEEKlY 

DEDUCTIONS 

SEMI-MONTHlY 

DEDUCTIONS 




Employee & Family $5.55 $6.02 

COVERED BENEFITS IN-NETWORK OUT-OF-NETWORK 

Copays 

Exams (every 12 months) 

Contact lenses & eyeglasses 

$10 copay 

$25 copay 

Up to $40 

Standard Plastic Lenses (every 12 months) 

Single: $25 copay 

Bifocal: $25 copay 

Trifocal: $25 copay 

Lenticular: $25 copay 

Single: Up to $40 

Bifocal: Up to $60 

Trifocal: Up to $80 

Lenticular: Up to $80 

Frames (every 24 months) $130 allowance + 30% off balance Up to $45 

Elective Contact Lenses (every 12 months) 

Elective Contact Lens Fitting & Evaluation 

Medically Necessary 

$125 allowance (copay waived) 

$40 allowance 

Covered in full after copay 

Up to $100 

Up to $0 

Up to $210

Vision 

Get to know 

your vision plan 

Learn what the plan covers and how you can save money

What’s covered? 

Eye exam 

Your plan includes a fully covered exam. A copay may apply. 

Your plan uses Spectera Eyecare Networks, a national network of eye doctors, 

which includes optometrists and ophthalmologists. You may visit a local doctor or a 

well-known retail provider, and you can fnd them at myuhcvision.com. Network eye 

doctors can help save you money. 

Frame allowance* 

When you use a network provider, you can spend a frame allowance to help 

buy any frame your eye doctor ofers. You get a discount on any cost over the 

allowance amount. 

Contact lens benefit* 

You may have coverage for a ftting and follow-up visits depending on your plan 

design and lens choice. Log in to myuhcvision.com to learn more about your 

specifc beneft. 

Lens options* 

Popular lens options, like UV protection or anti-refective coating, are available to 

you at price-protected amounts. Plus, standard scratch coating and polycarbonate 

lenses for dependent children are available at no cost. 

Additional pairs of glasses* 

Receive a 20% discount on additional pairs of eyeglasses, including 

prescription sunglasses. 

Need help? 

Visit myuhcvision.com 

Log in for 24/7 access to details 

about your vision plan. 

Sign in to myuhc.com® 

If you have a UnitedHealthcare 

health plan, you can access both 

your vision and health plan 

benefits here. 

Call toll-free 

1-800-638-3120, TTY 711 

If you don’t have computer 

access, need language 

assistance or need other help, call 

us Monday through Friday, 7 a.m. 

to 10 p.m. CT or Saturday, 8 a.m. 

to 5:30 p.m. CT. 

* Plans may vary. Check your coverage at myuhcvision.com to verify benefts.

Take steps to protect your eyes 

1 Find an eye doctor in your network* 

Choose from local and national providers in Spectera Eyecare Networks. 

It ofers a broad choice with more than 100,000 access points for care.* 

Log in to myuhcvision.com to search by provider name, specialty or location. 

2 Schedule your eye exam 

Regular visits to an eye doctor can help keep your eyes healthy and improve 

your overall health. 

Get a complete eye exam 

A dilated exam lets your doctor look inside your eye and check your eye 

health. The exam can also show early signs of illness, even before other 

parts of your body are afected. At your appointment, be sure to: 

• Tell your doctor you have a UnitedHealthcare Vision plan 

• Give your name and date of birth 

You don’t need your ID card to use your benefts. If you would prefer to 

have an ID card, you can print it from your computer or save it to your mobile 

device at myuhcvision.com. 

Here are just some 

of the well-known 

retail locations in 

your network: 

3 

Discover more ways to save at myuhcvision.com 

Laser vision correction 

Save up to 35% of the national average price of laser vision correction at 

more than 900 QualSight® LASIK locations nationwide.* 

Contact lenses 

Order extra contact lenses at uhccontacts.com for 10% of. 

Hearing aids 

Get preferred pricing on custom-programmed hearing aids, starting at 

$699 each, through UnitedHealthcare Hearing. 

* Not all providers participate in all plans. Check with your provider before using your benefts. Network count as of Aug. 6, 2020.

Vision Plans | Network Options 

With our large vision network, 

there’s always a provider in sight. 

Finding a trustworthy provider who meets your lifestyle, eye care and eyewear needs is easier 

with UnitedHealthcare. 

With our large national eye care network, Spectera Eyecare Networks, you can take advantage of personalized care at a private 

practice or convenient evening and weekend hours at your favorite retail chain. 

Well- known practices and brands in our 

large national network include: 

• NEW! 1-800 Contacts 

• 20/20 Vision Center 

• 3 Guys Optical 

• Accurate Optical 

• All About Eyes 

• Allegany Optical 

• America’s Best 

• Bard Optical 

• Boscov’s Optical 

• Clarkson Eyecare 

• Co/Op Optical 

• Cohen’s Fashion Optical 

• Costco Optical 

• Crown Vision Center 

• CVS Optical Center 

• Dr. Tavel Family Eye 

Care 

• Eye Boutique 

• EyeCare Associates 

• Eye Express 

• Eye Care Center 

• Eyeglass World 

• EyeMart Express 

• Eyetique 

• For Eyes 

• General Vision Services 

• GlassesUSA.com 

• H. Rubin Vision Centers 

• Henry Ford OptimEyes 

• Horizon Eye Care 

• Houston Eye Associates 

• JCPenney Optical 

• NEW! LensCrafters 

• Midwest Vision Centers 

• MyEyeDr. 

• National Optometry 

• National Vision 

• Nationwide Vision 

• Optical Shop at Meijer 

Making it easier for 

you to find a provider. 

To find the provider who best 

meets your needs, sign in 

to myuhcvision.com or call 

1-800-638-3120. 

Some providers or locations may 

not participate in your plan. 

continued

Well- known practices and brands in our 

large national network include: 

• Optyx 

• Ossip Optometry 

• Pearle Vision 

• Rosin Eyecare 

• Rx Optical 

• Sam’s Club 

• Schaeffer Eye Center 

• Sears Optical 

• SEE Inc. 

• Shawnee Optical 

• Shopko 

• Site for Sore Eyes 

• Standard Optical 

• Stanton Optical 

• Sterling Optical 

• SVS Vision 

• Target Optical 

• Texas State Optical 

• The Eye Gallery 

• The Hour Glass 

• Today’s Vision 

• Virginia Eye Institute 

• Vision4Less 

• Visionmart Express 

• Visionworks 

• Vision Source 

• Vista Optical 

• Walmart 

• Warby Parker — 

including warbyparker.com 

• Wisconsin Vision 

Call. 

1-800-638-3120 

Visit. 

myuhcvision.com 

The company does not discriminate on the basis of race, color, national origin, sex, age, or disability in health programs and activities. 

We provide free services to help you communicate with us. Such as, letters in other languages or large print. Or, you can ask for an interpreter. 

To ask for help, please call 1-800-638-3120, TTY 711, Monday through Friday, 7 a.m. to 10 p.m. CST. 

ATENCIÓN: Si habla español (Spanish), hay servicios de asistencia de idiomas, sin cargo, a su disposición. Llame al 1-800-638-3120, TTY 711. 

請注意 : 如果您說中文 (Chinese), 我們免費為您提供語言協助服務。請致電 :1-800-638-3120, TTY 711。 

Note: Our doctors may also refer to us as Spectera Eyecare Networks. 

UnitedHealthcare vision coverage provided by or through UnitedHealthcare Insurance Company, located in Hartford, Connecticut, UnitedHealthcare Insurance Company of New York, located in Islandia, New York, or 

their affiliates. Administrative services provided by Spectera, Inc., United HealthCare Services, Inc. or their affiliates. 

B2C EI20206988.1 1/21 ©2020 United HealthCare Services, Inc. 20-206989

Vision | Child & Maternity Benefits 

Benefits for moms and 

kids at no extra cost 

Get vision benefits for optimal eye health when it’s needed 

most. Women who are pregnant or breastfeeding may 

experience eye or vision changes. Growing kids may also have 

more frequent vision needs. 

Your UnitedHealthcare® Vision plan includes expanded benefits for women who 

are pregnant or breastfeeding, as well as covered children up to age 13, at no 

additional premium cost. 

Did you know? 

15% of pregnant women 

experience a change in 

their vision 2 

• Coverage for a second eye exam 

If you notice changes to your vision during the plan year, you can get your 

eyes checked a second time without paying an additional premium; standard 

copays apply 

• Coverage for 1 new pair of glasses (frames and lenses) Fewer than 15% 

If your prescription changes .5 diopter * or more in a plan year, you can get 

new glasses without paying an additional premium; standard copays apply 

Find a provider close by 

See doctors at over 100,000 locations 1 across the country. Visit myuhcvision.com 

to find an eye doctor near you. 

The importance of 

vision care for kids 

of preschool children get 

an eye exam, and 

Fewer than 22% 

receive a vision screening³ 

Schedule an eye exam if you notice a change in your vision 

1 

UnitedHealthcare point-of-service data report, October 2019. 

2 

Baby Center. Vision changes during pregnancy. babycenter.com/pregnancy/your-body/vision-changes-during-pregnancy_1456567. Accessed Oct. 27, 2020. 

3 

Centers for Disease Control and Prevention. Keep an eye on your vision health. cdc.gov/features/healthyvision/index.html. Accessed Oct. 27, 2020. 

UnitedHealthcare vision coverage provided by or through UnitedHealthcare Insurance Company, located in Hartford, Connecticut, UnitedHealthcare Insurance Company of New York, located in Islandia, New York, or their 

affiliates. Administrative services provided by Spectera, Inc., United HealthCare Services, Inc. or their affiliates. Plans sold in Texas use policy form number VPOL.06.TX or VPOL.13.TX and associated COC form number 

VCOC. INT.06.TX or VCOC.CER.13.TX. Plans sold in Virginia use policy form number VPOL.06.VA or VPOL.13.VA and associated COC form number VCOC.INT.06.VA or VCOC.CER.13.VA. This policy has exclusions, 

limitations and terms under which the policy may be continued in force or discontinued. For costs and complete coverage details, contact your company. 

B2C EI20357828.0 11/20 © 2020 United HealthCare Services, Inc. All Rights Reserved. 20-356202

GROUP LIFE INSURANCE 


LIFE and ACCIDENTAL DEATH & DISMEMBERMENT (AD&D) 

Basic life and AD&D insurance are automatically provided to all benefits-eligible 

employees at no cost. If you die as a result of an accident, your beneficiary 

would receive both the life and the AD&D benefit. 

● Life Insurance Amount: $25,000 

● AD&D Amount: Equal to life insurance amount 

● Benefit Reduction Schedule: 65% at age 65 and 50% at age 70; 

terminates at retirement 

REMINDER 

Review your beneficiary designations

SUPPLEMENTAL LIFE INSURANCE 


WHY PURCHASE SUPPLEMENTAL LIFE INSURANCE? 

● This type of life insurance has limited underwriting required. This allows for people with health 

conditions or lifestyles that might otherwise disqualify them to qualify for life insurance. 

● The group rates are lower than what you could purchase on your own. 

● You may purchase a policy for your spouse and children. 

● You may purchase a policy for your spouse and children IF you elect coverage for yourself. 

Employee 

● $10,000 increments to a maximum of $300,000, not to exceed 5x annual earnings 

● A minimum benefit of $10,000 

● Guarantee Issue Amount: $100,000 

● Age Reduction: 65% at age 65 and 50% at age 70; benefits terminate at retirement 

● AD&D amount is 100% of supplemental life benefit amount 

Spouse 

● $5,000 increments to a maximum of $100,000, not to exceed 50% of employee’s life amount 

● A minimum benefit of $5,000 

● Guarantee Issue Amount: $25,000 

● Age Reduction: 65% at age 65 and 50% at age 70; benefits terminate at employee’s retirement 

● AD&D amount is 100% of supplemental life benefit amount 

● Spouse cost is based on employee age 

Child(ren) 

● Newborn child to 14 days old: $0 

● Child 14 days to 6 months old: $500 

● Child more than 6 months old: $10,000 

● Guarantee Issue Limit: $10,000 

● Increments of $5,000, a minimum of $5,000, to a maximum of $10,000, not to exceed 100% 

employee’s life amount 

If you are currently enrolled in Voluntary Life your current elections will roll over to United Healthcare. ONLY 

at this annual open enrollment for August 1, 2021, United Healthcare will allow all employees and spouses to 

elect coverage up to the Guaranteed Issue limit without proof of good health. Employees can elect up to 

$100,000 and spouses up to $25,000. This is a one time offer so if you are interested in electing for the first 

time or want to increase your amount this is the time to do it! Any elections over the guarantee amount will 

require proof of good health.

Reliable Wireline (formerly Screentek, Inc 

Premium Calculation Sheet 

Rates Effective August 1, 2021 

Eligibility: All Active Full Time Employees working a minimum of 30 hours per week. 

Employee Supplemental Life - Current Bi-Weekly Cost by Age Band 

Current Monthly Rates per $1,000: 

0.083 0.083 0.102 0.134 0.196 0.320 0.509 0.884 4.363 2.504 5.183 5.183 

Coverage Age




Spouse Supplemental Life - Current Bi-Weekly Cost by Age Band 


0.083 0.083 0.102 0.134 0.196 0.320 0.509 0.884 4.363 2.504 5.183 5.183 

Coverage Age




Employee Supplemental AD&D - Current Bi-Weekly Cost: 

Current Monthly Rates per $1,000: 0.031 

Coverage Cost Coverage Cost Coverage 

Cost 

$10,000 0.14 $20,000 0.29 $30,000 

0.43 

$40,000 0.57 $50,000 0.72 $60,000 

0.86 

$70,000 1.00 $80,000 1.14 $90,000 

1.29 

$100,000 1.43 $110,000 1.57 $120,000 

1.72 

$130,000 1.86 $140,000 2.00 $150,000 

2.15 

$160,000 2.29 $170,000 2.43 $180,000 

2.58 

$190,000 2.72 $200,000 2.86 $210,000 

3.00 

$220,000 3.15 $230,000 3.29 $240,000 

3.43 

$250,000 3.58 $260,000 3.72 $270,000 

3.86 

$280,000 4.01 $290,000 4.15 $300,000 

4.29 

To calculate the cost of coverage for an amount not shown in the table above, use the formula below: 

_________________ X 0.031 = __________ ÷ 1,000 = _____________ X 12 ÷ 26 = ________________ 

Benefit Amount Subtotal Monthly Cost Bi-Weekly Cost 

Spouse Supplemental AD&D - Current Bi-Weekly Cost: 



Cost 

$5,000 0.07 $10,000 0.14 $15,000 

0.21 

$20,000 0.29 $25,000 0.36 $30,000 

0.43 

$35,000 0.50 $40,000 0.57 $45,000 

0.64 

$50,000 0.72 $55,000 0.79 $60,000 

0.86 

$65,000 0.93 $70,000 1.00 $75,000 

1.07 

$80,000 1.14 $85,000 1.22 $90,000 

1.29 

$95,000 1.36 $100,000 

1.43 


_________________ X 0.031 = __________ ÷ 1,000 = _____________ X 12 ÷ 26 = ________________ 

Benefit Amount Subtotal Monthly Cost Bi-Weekly Cost 

Dependent Child(ren) Supplemental AD&D - Current Bi-Weekly Cost: 

Monthly Rate per $1,000 $5,000 $10,000 $0 $0 $0 $0 $0 $0 $0 $0 

$0.031 

0.072 0.143 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 

Supplemental Life Insurance can be purchased without Supplemental AD&D Insurance, however you cannot purchase Supplemental AD&D 

Insurance without Supplemental Life Insurance. If you do elect Supplemental AD&D Insurance, the amount elected must not exceed the 

amount of Supplemental Life elected and approved. 

This applies to you, your Spouse and your Dependent Child(ren). 

Rates shown are current as of the effective date and are subject to change over time. 

Costs shown are estimates only. Your actual payroll deduction may be slightly higher or lower from those provided here. 

Any applicable age-related benefit reductions are not included. 

UnitedHealthcare Life and Disability products are provided by UnitedHealthcare Insurance Company, and certain products in California by 

Unimerica Life Insurance Company. Texas Coverage is provided on Form LASD-POL-TX (05/03), Form UHCLD-POL 2/2008-TX, or UICLD-POL- 

TX 4/5. 

© 2018 United HealthCare Services, Inc. All Rights Reserved.




Eligibility: All Active Full Time Employees working a minimum of 30 hours per week. 

Employee Supplemental Life - Current Semi-Monthly Cost by Age Band 


0.083 0.083 0.102 0.134 0.196 0.320 0.509 0.884 4.363 2.504 5.183 5.183 

Coverage Age




Spouse Supplemental Life - Current Semi-Monthly Cost by Age Band 


0.083 0.083 0.102 0.134 0.196 0.320 0.509 0.884 4.363 2.504 5.183 5.183 

Coverage Age




Employee Supplemental AD&D - Current Semi-Monthly Cost: 



Cost 

$10,000 0.16 $20,000 0.31 $30,000 

0.47 

$40,000 0.62 $50,000 0.78 $60,000 

0.93 

$70,000 1.09 $80,000 1.24 $90,000 

1.40 

$100,000 1.55 $110,000 1.71 $120,000 

1.86 

$130,000 2.02 $140,000 2.17 $150,000 

2.33 

$160,000 2.48 $170,000 2.64 $180,000 

2.79 

$190,000 2.95 $200,000 3.10 $210,000 

3.26 

$220,000 3.41 $230,000 3.57 $240,000 

3.72 

$250,000 3.88 $260,000 4.03 $270,000 

4.19 

$280,000 4.34 $290,000 4.50 $300,000 

4.65 


_________________ X 0.031 = __________ ÷ 1,000 = _____________ ÷ 2 = __________________ 

Benefit Amount Subtotal Monthly Cost Semi-Monthly Cost 

Spouse Supplemental AD&D - Current Semi-Monthly Cost: 



Cost 

$5,000 0.08 $10,000 0.16 $15,000 

0.23 

$20,000 0.31 $25,000 0.39 $30,000 

0.47 

$35,000 0.54 $40,000 0.62 $45,000 

0.70 

$50,000 0.78 $55,000 0.85 $60,000 

0.93 

$65,000 1.01 $70,000 1.09 $75,000 

1.16 

$80,000 1.24 $85,000 1.32 $90,000 

1.40 

$95,000 1.47 $100,000 

1.55 


_________________ X 0.031 = __________ ÷ 1,000 = _____________ ÷ 2 = __________________ 

Benefit Amount Subtotal Monthly Cost Semi-Monthly Cost 

Dependent Child(ren) Supplemental AD&D - Current Semi-Monthly Cost: 

Monthly Rate per $1,000 $5,000 $10,000 $0 $0 $0 $0 $0 $0 $0 $0 

$0.031 

0.078 0.155 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 

Supplemental Life Insurance can be purchased without Supplemental AD&D Insurance, however you cannot purchase Supplemental AD&D 

Insurance without Supplemental Life Insurance. If you do elect Supplemental AD&D Insurance, the amount elected must not exceed the 

amount of Supplemental Life elected and approved. 

This applies to you, your Spouse and your Dependent Child(ren). 

Rates shown are current as of the effective date and are subject to change over time. 

Costs shown are estimates only. Your actual payroll deduction may be slightly higher or lower from those provided here. 

Any applicable age-related benefit reductions are not included. 

UnitedHealthcare Life and Disability products are provided by UnitedHealthcare Insurance Company, and certain products in California by 

Unimerica Life Insurance Company. Texas Coverage is provided on Form LASD-POL-TX (05/03), Form UHCLD-POL 2/2008-TX, or UICLD-POL- 

TX 4/5. 

© 2018 United HealthCare Services, Inc. All Rights Reserved.

Financial Protection | Life Insurance 

Helping your employees 

get the most out of their 

life insurance benefits. 

24/7 support for employees and their beneficiaries. 

UnitedHealthcare plans include many resources and personal support services to help your employees prepare to help their loved 

ones cope with loss. These services are available 24/7 and at no additional cost. 

Will and trust preparation. 

Creating a will and trust may help give your employees more control over future events and allows their families to follow their wishes. 

Life insurance plans include online will and trust services to help employees: 

• Create and prepare a will — registration required. 

• Locate nearby attorneys, search legal forms, find helpful articles by legal experts and more. 

• Access financial planning help and helpful cost calculations. 

Beneficiary services. 

After a death, there’s so much to deal with that it can be overwhelming. It’s nice to know beneficiaries will have a team of 

professionals — included in the plan — ready to help provide emotional, financial and legal guidance. All services are confidential, 

and specialists are available 24/7. 

Grief support: 

• Unlimited phone access to masters-level specialists, 24/7. 

• Up to 2 referrals for face-to-face grief counseling sessions, 1 with access to a national network of 144,000-plus clinicians. 2 

Financial and legal support: 

• One 30- to 60-minute financial consultation with a credentialed financial professional who can discuss estate taxes and other 

financial matters. 

• One 30-minute legal consultation. Beneficiaries can retain an attorney for ongoing services at a discounted rate. 3 

Wealth management account: 

• Option to open a bank account from Optum Bank® for help managing money. Visit optumbank.com to learn more. 

• An account automatically opens for payments of $5,000 or more. 

CONTINUED

Beneficiary Companion. 

The Beneficiary Companion Program provides 24/7 guidance for beneficiaries on closing estates and protecting identity. 

Guidance services. 

Help is available anytime to obtain death certificate copies 

and to notify: 

• Social Security Administration. 

• Credit reporting agencies. 

• Credit card companies/financial institutions. 

• Third-party vendors. 

• Government agencies. 

Fraud resolution. 

Identity theft is a growing risk. Expert help is available to help 

protect it — and lend a hand if it is stolen. 

Services include: 

• A credit report review. 

• Suppression of the credit report or freezing/closing the account. 

• Full-service resolution assistance — including affidavit assistance, 

credit bureau and fraud department notification — help to file a 

police report and creditor follow up. 

Social media shut-down. 

It can be a time-consuming process to close social media 

accounts. Help is available to: 

• Discontinue access to social media accounts (e.g., Facebook, 

Instagram, Twitter, LinkedIn, Google properties, etc.). 

• Assist with memorialization of specific accounts to preserve 

digital profiles for friends and family. 

Travel assistance. 

If your employees or their beneficiaries travel 100 miles or more away from home or outside the country, they can access these travel 

assistance services 24 hours a day, anywhere in the world. Here are a few of the services UnitedHealthcare Global travel provides. 

Travel assistance services: 

• Emergency travel arrangements. 

• Assistance in replacing lost or stolen travel documents. 

• Emergency translation services. 

Medical assistance services: 

• Worldwide medical and dental referrals. 

• Relay of insurance and medical information. 

• Assistance in replacing corrective lenses, medical devices 

and much more. 

Contact your UnitedHealthcare representative for more information. 

1 

Optum internal network analysis, February 2019. 

2 

There is no charge for referrals or for seeing a clinician within our network for up to 3 visits per issue. 

3 

Due to the potential for a conflict of interest, legal consultation will not be provided on issues that may involve legal action against UnitedHealthcare, its affiliates or any entity through which the caller is receiving services directly 

or indirectly. 

All trademarks are the property of their respective owners. 

UnitedHealthcare Life and Disability products are provided by UnitedHealthcare Insurance Company and certain products in California by Unimerica Life Insurance Company. Life and Disability products are provided on 

policy forms LASD-POL (05/03) et al. and UHCLD-POL 2/2008 et al., in Texas on forms LASD-POL-TX(05/03) and UHCLD-POL 2/2008-TX and in Virginia on LASD-POL(05/03) and UHCLD-POL 2/2008. The policies have 

exclusions, limitations, reductions of benefits, and terms under which the policy may be continued in force or discontinued. For costs and complete details of the coverage, call or write your insurance agent or the company. Some 

products are not available in all states. UnitedHealthcare Insurance Company is located in Hartford, CT and Unimerica Life Insurance Company is located in Milwaukee, WI. 

Noninsurance services are offered only on specific lines of coverage and are not insurance. These services may be modified or terminated at any time, may not be available in all states and may vary depending on state laws and 

regulations. Will and Trust and Beneficiary Services are offered through Optum. Optum is an affiliate of UnitedHealthcare. Travel Assistance services are provided by UnitedHealthcare Global Assistance. Beneficiary Companion is 

provided by Generali Global Assistance, LLC, a service provider not affiliated with UnitedHealthcare. UnitedHealthcare is not responsible or liable for care, services, or advice given by the provider or vendor of these services. 


B2C EI20146419.0 6/20 ©2020 United HealthCare Services, Inc. 20-146845

VOLUNTARY SHORT TERM DISABILITY 

INSURANCE 


Short-Term Disability (STD) insurance is designed to help you meet your 

financial needs if you become unable to work due to a non-work related illness 

or injury. This is a voluntary plan; employees are responsible for 100% of the 

cost. Premiums are calculated as a percentage of your annual base salary. 

Benefit may be offset due to other benefits such as paid sick leave, workers’ 

compensation. 

• Benefit – 60% of base weekly salary up to $1,000 per week 

• Elimination Period: 7 days for injury / 7 days for sickness 

• Benefit Durations: Up to 13 weeks 

• Pre-Existing Condition Waiting Period: 12/12; number of months before 

effective date that employee must be treatment free for a pre-existing 

condition / number of months after effective date that employee must wait 

before receiving benefits for a pre-existing condition. 

REMINDER 





Eligibility: All Active Full Time Employees working a minimum of 30 Hours per week. 

Employee Voluntary Short Term Disability - Current Bi-Weekly Cost by Age Band 

Current Monthly Rates 

per $10: 

Annual 

Earnings 

Weekly 

Benefit 

0.250 0.260 0.250 0.230 0.270 0.250 0.300 0.361 0.431 0.471 

Age 




Eligibility: All Active Full Time Employees working a minimum of 30 Hours per week. 

Employee Voluntary Short Term Disability - Current Semi-Monthly Cost by Age Band 

Current Monthly Rates 

per $10: 

Annual 

Earnings 

Weekly 

Benefit 

0.250 0.260 0.250 0.230 0.270 0.250 0.300 0.361 0.431 0.471 

Age 

EMPLOYER PAID LONG TERM DISABILITY 

INSURANCE 


Long-term disability (LTD) insurance is automatically provided to all 

benefits-eligible employees at no cost. LTD insurance is designed to help you 

meet your financial needs during longer disability periods. Benefit may be offset 

due to other benefits such as paid sick leave, workers’ compensation. 

• Benefits – 60% of base monthly salary up to $5,000 per month 

• Elimination Period: 90 days 

• Benefit Durations – Until Social Security Normal Retirement Age 

• Pre-Existing Condition Waiting Period: 3/12; number of months before 

effective date that employee must be treatment free for a pre-existing 

condition / number of months after effective date that employee must wait 

before receiving benefits for a pre-existing condition. 

• Mental Illness / Substance Abuse Limitation: 24 months 

REMINDER 


Financial Protection | Member Assistance Program 

Your well-being is 

what matters most. 

Unresolved medical issues can take a serious toll on your work and home life. To help you 

through difficult times, the UnitedHealthcare Member Assistance Program (MAP) provides 

members and their families personal and confidential support, available 24 hours a day, 

7 days a week. 

The help you may need, at no extra cost. 

• Unlimited phone access to master’s-level specialists, 24/7. 

• Up to 3 referrals for face-to-face counseling sessions.¹ Our national network includes 

144,000+ clinicians. * 

• One legal consultation of 30 minutes. You can choose to meet with an attorney by 

telephone or in-person to discuss legal concerns. You can also retain an attorney for 

ongoing services at a 25% discounted rate. ** 

• A 30 – 60 minute financial consultation. Credentialed financial professionals can help 

discuss estate taxes and other financial matters with you. 

• Access to liveandworkwell.com. From your desktop, mobile device or smartphone, 

you can easily and securely find a provider, discover community and work-life resources 

near you, and quickly and confidentially connect to expert guidance. You can also 

access news, events and thousands of expert articles and advice. 

Maintaining your privacy and confidentiality is of the greatest importance. All records, 

referrals and evaluations are kept private and confidential in accordance with federal and 

state laws. 

Access your MAP 

benefit today. 

Call 1-877-660-3806, TTY 711, for 

personal and confidential assistance. 

Translators are available for non- 

English speakers. 

Visit liveandworkwell.com. 

There are 2 ways to access: 

Sign in using your HealthSafe ID® 

to securely access your personal 

benefit information. 

Enter anonymously using access 

code: FP3EAP. 

1 

Optum internal network analysis, February 2019. 

*There is no charge for referrals or for seeing a clinician within our network for up to 3 visits per issue. 

**Due to the potential for a conflict of interest, legal consultation will not be provided on issues that may involve legal action against UnitedHealthcare, its affiliates or any entity through which the caller is receiving services directly 

or indirectly. 

Noninsurance services are offered only on specific lines of coverage and are not insurance. These services may be modified or terminated at any time, may not be available in all states and may vary depending on state laws and 

regulations. Employee Assistance Program (EAP) is offered through Optum. Optum is an affiliate of UnitedHealthcare. 

UnitedHealthcare Life and Disability products are provided by UnitedHealthcare Insurance Company and certain products in California by Unimerica Life Insurance Company. The policies have exclusions, limitations, reductions 

of benefits, and terms under which the policy may be continued in force or discontinued. For costs and complete details of the coverage, call or write your insurance agent or the company. Some products are not available in all 

states. UnitedHealthcare Insurance Company is located in Hartford, CT and Unimerica Life Insurance Company is located in Milwaukee, WI. 


B2C 9857285.0 11/19 ©2019 United HealthCare Services, Inc. 19-13803

OPEN ENROLLMENT INSTRUCTIONS 

The employee benefits enrollment will cover the extensive benefits package that Reliable Wireline, 

LLC offers eligible employees. 

REMEMBER: If you do not login to Employee Navigator all benefits from the previous year will 

rollover. Also, new hire enrollment must be completed immediately or you may not be able to 

enroll yourself and/or eligible dependents until our next open enrollment, or a qualifying event. 

STEP 1: Go to the following link to create an 

account as an employee: 

www.employeenavigator.com/benefits/account/ 

register 

STEP 2: You will be asked for personal 

identifying data as well as the following company 

identifier: reliablewireline 

STEP 3: Write down the username and password you created for future reference. 

STEP 4: You are ready to make your benefit elections! Please select the ‘’Start Enrollment” button. The 

system will guide you through the process when you select ‘Save & Continue’ on every screen. Note: IF you 

are covering a spouse and /or child, please have their full name, DOB, and SSN available. 

STEP 5: Select the “Click to Sign” button at the end to complete enrollment process. 

Once you have created your account, use the following link anytime to finish or view your benefit elections 

https://www.employeenavigator.com/benefits.login.aspx 

Note: If you have any questions or experience a Qualifying Event such as marriage, divorce, birth/adoption of 

a child or loss of coverage and need to make changes to your coverage, you MUST do so within 30 days of the 

event by contacting HR - Debbie Whitt at debbie.whitt@reliablewireline.com or 713-228-7056. 

REMEMBER: Open Enrollment must be completed by the deadline or 

you may not be able to enroll yourself and/or your eligible dependents until our 

next open enrollment, or a qualifying event occurs. 

This summary of benefits is not intended to be a complete description of the terms of Reliable Wireline insurance benefit plans. Please refer to the plan 

document(s) for a complete description. Each plan is governed in all respects by the terms of its legal plan document, rather than by this or any other 

summary of the insurance benefits provided by the plan. In the event of any conflict between a summary of the plan and the official document, the 

official document will prevail. Although Reliable Wireline maintains its benefit plans on an ongoing basis, Reliable Wireline reserves the right to 

terminate or amend each plan, in its entirety or in any part at any time.

IMPORTANT CONTACTS 

BENEFIT CARRIER PHONE WEBSITE 

Medical Insurance United Healthcare 800-782-3740 www.myuhc.com 

Dental Insurance United Healthcare 800-445-9090 www.myuhc.com 

Vision Insurance United Healthcare 800-638-3120 www.myuhcvision.com 

Group & Supplemental Life and AD&D United Healthcare 888-842-4571 www.myuhc.com 

Voluntary Short Term Disability United Healthcare 888-842-4571 www.myuhc.com 

Employer Paid Long Term Disability United Healthcare 888-842-4571 www.myuhc.com 

Human Resources Debbie Whitt 713-228-7056 Debbie.Whitt@ReliableWireline.com 

YOUR BXS INSURANCE ACCOUNT REPRESENTATIVE: 

Jolie Melton 

936-564-0221 

jolie.melton@bxsi.com 

38

Reliable Wireline 

Debbie.Whitt@ReliableWireline.com | 713-280-7995

Reliable Wireline 2021 Enrollment Guide FINAL

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