Hospital Indemnity
Elmet Technologies offers voluntary Hospital Indemnity coverage through Voya which provides a daily fixed indemnity benefit for eligible hospital confinements. The fixed indemnity benefits may be used as you choose to help offset deductibles, coinsurance, and other expenses.
| Benefits | Low Plan | High Plan |
|---|---|---|
| Admission Benefits | ||
| Initial Hospital Confinement | $1,100 | $2,200 |
| Daily Benefit Amount | $100 | $200 |
| Facility Confinement Benefit | ||
| Daily Hospital Confinement Benefit | $100/day, up to 31 days per confinement | $200/day, up to 31 days per confinement |
| Daily Critical Care Unit Confinement Benefit | $200/day, up to 30 days per confinement | $400/day, up to 30 days per confinement |
| Inpatient Rehabilitation Facility | $100/day, up to 30 days per confinement | $200/day, up to 30 days per confinement |
| Observation Unit Daily Benefits | $250/day, up to a max of 1 day per calendar year | $250/day, up to a max of 1 day per calendar year |
| Dependent Benefits | ||
| Spouse | 100% of employee amount | 100% of employee amount |
| Child(ren) | 100% of employee amount | 100% of employee amount |
Accident
Elmet Technologies offers an accident plan through Voya to protect you from unexpected accidents that result in medical treatment, as it can be difficult to financially plan for the unexpected. This plan provides a benefit payable according to a schedule, and the funds may be used for any purposes, including helping to pay for medical out-of-pocket costs like deductibles and coinsurance.
This plan reimburses you for your actual medical expenses and the benefit is paid directly to you. Coverage options are available for you, your spouse, and your dependent child(ren). It also includes a benefit for death, loss of limbs, hospital visits, and transportation by ambulance – as a result of a covered accident. Reference the plan summary below for more details.
| Benefit | Accident Insurance Coverage |
|---|---|
| Accidental Death |
Employee: $20,000 Spouse: $20,000 Child: $4,000 x4 for common carrier |
| Accidental Dismemberment |
Loss of hands, feet, sight: $10,000 Loss of fingers, toes: $1,200 Organ Loss: $2,500 |
| Accidental Injury |
Fractures: up to $5,000 Dislocations: up to $3,600 Burns: $750 - $7,500 Concussion: $60 Coma: $7,500 Lacerations: $20 - $300 Eye Injury: $200 |
| Medical Treatment |
Ground Ambulance: $250 Air Ambulance: $1,000 Emergency Room: $150 Urgent Care: $150 Office Visit: $60 X-rays: $20 CT, MRI: $100 Transportation: $300 per trip, up to 3 trips Physical Therapy: $25 per visit, up to 10 visits Chiropractic Care: $25 per visit, up to 3 visits Prosthetics: $500 Medical Appliances: $75 Blood: $200 |
| Hospital |
Standard Hospital Admission: $750 ICU Admission: $1,050 Hospital Confinement: $150 per day, up to 365 days ICU Confinement: $300 per day, up to 30 days Rehab Admission: $500 |
| Other Benefits |
First Accident Benefit: $100 Health Screening Benefit: $100 per person, per year Organized Sporting Activity: +25% benefit, up to $1,000 per person per year |
Health Screening Benefit
The Critical Illness plan includes a wellness benefit of $100 per covered member per calendar year. The benefit covers one test per insured per 12 months.
Organized Sporting Activity Benefit
The Voya Accident plan pays an additional 25% of the accident benefit to a maximum of $1,000 if the covered accident is a result of an organized sporting activity.
Exclusions
Accidents caused by felonies, substance abuse/drugs, suicide attempt, war, self-inflicted injury, alcohol, infection, dental or plastic surgery for cosmetic purposes, food poisoning, armed forces, aircraft, parachuting, motor vehicle racing/stunts, competitive paid athletic activity, bungee jumping and other activities as described in the certificate.
Critical Illness
Elmet Technologies offers a voluntary critical illness benefit through Voya that provides a monetary benefit to help with the out-of-pocket medical and non-medical expenses upon diagnosis of a covered illness. Critical illness insurance helps you and your family maintain financial security during the recovery period of a serious medical event, such as cancer, heart attack, or stroke. This plan pays a benefit if the initial diagnosis for a covered illness is while the certificate is in force. (See certificate for complete details.)
Benefit amounts for employees, spouses, and children are as follows:
Employee: $5,000 to $ 30,000
Spouse: 50% of the employee amount elected
Child(ren) to age 26: 50% of the employee covered amount
Employees may elect up to the maximum amount of coverage with no health questions.
Features
Benefits are paid in addition to any other insurance that you may have, and benefits are paid directly to you. This plan pays a benefit if the initial diagnosis for a covered illness is while the certificate is in force. (See certificate for complete details.)
Benefits may be used however you'd like. Typical uses include:
- Out-of-pocket medical and non-medical expenses
- Home health care needs and home modifications
- Recovery and rehabilitation
- Child care or caregiver expenses
- Travel expenses to and from treatment centers
You may elect Critical Illness at this time with no health questions. The plan includes a recurrence benefit for certain diagnoses. The lifetime maximum is up to 3 times the benefit amount.
| Illness | Coverage |
|---|---|
| Benign Brain Tumor | 100% |
|
Cancer
Cancer (except skin cancer) Carcinoma in Situ Skin Cancer |
100% 25% 10% |
| Coronary Artery Obstruction | 25% |
| Coma | 100% |
| Heart Attack | 100% |
| End Stage Renal Failure | 100% |
| Major Organ Failure | 100% |
| Multiple Sclerosis | 100% |
| Stroke | 100% |
Health Savings Account (HSA)
If you have signed up for the company's HSA health plan, you are eligible for a free Health Savings Account (HSA). This savings account stays with you even after leaving the company, and Elmet will contribute up to $500 per year ($41.67 per month) to the account as long as you contribute each year. The money from this HSA is tax-free and can be spent on qualified medical-related costs, such as over-the-counter medications, prescriptions, medical, dental, or vision expenses. You receive a free debit card with this account and also can reimburse yourself for any eligible costs you pay out of pocket.
HSA funds are ALWAYS YOURS; rolling over from year-to-year and staying usable even if your employment status changes. Your Health Savings Account will start with $0 and funds will build up as you contribute to your account (just like a standard savings account). Your contributions to the account are flexible and can be changed throughout the year.
According to Federal regulations, you must be enrolled in a High Deductible Health Plan (HDHP) to elect and to contribute to a Health Savings Account (HSA). HPI PPO Plan participants do not qualify.
You are also eligible to enroll in a Flexible Spending Account (FSA) which can also be used for medical, dental, vision, pharmacy, and other related expenses. However, you cannot participate in both a Health Savings Account (HSA) and a Flexible Spending Account (FSA); you must choose one or the other.
Opening an Account
Open your KeyBank HSA by visiting https://www.key.com/key-work/elmet4
Need some help? Contact KeyBank by calling (207) 262-5712
Important Notes:
- Eligibility does require that you are not considered a dependent on someone else’s tax return and that you’re not covered by Medicare, Tri-Care, or another health insurance plan (other than as permitted in IRS Publication 969).
- If you do not elect an HSA account within Zevo, and either open the account with Key Bank or provide HR with the account information for your own independent HSA account, you will not receive the Elmet employer contribution to your HSA account.
- There is no minimum contribution requirement, but employees must elect an HSA account in Zevo, and contribute at least $1 per pay period, for your account to be opened and for you to receive the Elmet employer contribution to your HSA account.
2026 Contribution Maximums
Individual Medical Coverage: $4,400
Family Medical Coverage: $8,750
Over 55 Catch-Up: $1,000
Employees over the age of 55 can add $1,000 to the standard maximums for their tier.
***The maximums listed above have factored in Elmet's $500 annual contribution to your HSA Account***
Employee Assistance Program (EAP)
Life presents complex challenges. If the unexpected happens, you want to know that you and your family have simple solutions to help you cope with the stress and life changes that may result. That’s why Elmet Technologies provides ComPsych's GuidanceResources employer-paid Employee Assistance Program (EAP) to you and household family members. Their straightforward approach takes the complexity out of managing stress when life throws you a curve. Getting in touch is easy: simply call (855) 387-9727.
From the everyday issues like job pressures, relationships, retirement planning, personal grief, loss, or a disability, the Employee Assistance Program can be your resource for professional support.
The service includes unlimited telephonic support for emotional or work-life counseling, so each member of your family can get counseling help for their own unique needs. Legal and financial counseling are also available by telephone during regular business hours.
Confidential Emotional Support
Emotional or Work-Life Counseling
Highly trained clinicians will listen to your concerns and help you or your family members with any issues, including:
-
Stress, anxiety, and depression
-
Grief, loss, and life adjustments
-
Relationship/marital conflicts
Work-Life Solutions
Specialists provide qualified referrals and resources for just about anything on your to-do list, such as:
-
Finding child and elder care
-
Hiring movers or home repair contractors
-
Planning events or locating pet care
Legal Guidance
Talk to attorneys for practical assistance with your most pressing legal issues, including:
- Divorce
- Adoption
- Family law
- Wills and trusts
- and more!
Need representation? Get a free 30-minute consultation and a 25% reduction in fees.
Financial Resources
Financial experts can assist with a wide range of issues. Talk to them about:
- Retirement planning and taxes
- Relocation
- Mortgages
- Insurance
- Budgeting
- Debt and bankrupty
- and more
Online Support
GuidanceResources Online is your 24/7 link to vital information, tools, and support. Log on for:
- Articles, podcasts, videos, and slideshows
- On-demain trainings
- Ask the Expert personal responses to your questions
Free Online Will Preparation
EstateGuidance lets you quickly and easily create a will online.
- Specify your wishes for your property
- Provide funeral and burial instructions
- Choose a guardian for your children
Contact GuidanceResources
Flexible Spending (FSA)
Flexible Spending Accounts (FSA) allow you to designate a set amount of money and have it taken out of each paycheck and deposited into an account to be used for specific expenses. Federal Income and Social Security taxes will not be withheld from your contributions, making your taxable income lower. You may enroll in the Healthcare FSA (for medical, dental, vision, pharmacy, and other related expenses) and/or the Dependent Care FSA (primarily for dependent daycare expenses). Use the money in these accounts to pay for eligible out-of-pocket healthcare (medical, dental, vision expenses) and dependent care (daycare) expenses for yourself, your spouse, your children or any person you claim as a dependent on your federal income tax return.
Over-the-counter (OTC) drugs are available without requiring a prescription. Some examples of allowed OTC items are:
- Cough medicines
- Cold medicines
- Allergy medicines
- Pain relievers, such as acetaminophen
Healthcare FSA's are limited to $3,400 per year per employer for 2026. If you're married, your spouse may contribute up to the max his employer allows as well.
For Dependent Care FSAs, you may contribute up to $7,500 if you are married and filing a joint return or if you are a single parent. If you are married and filing separately, you may contribute up to $3,750 per year per parent.
Remember to carefully estimate your plan year expenses when making an election. You must use all of the funds in your account by the end of the plan year or the money is forfeited per the IRS regulations.
The debit card provides a convenient way to pay for eligible expenses, thus eliminating the need to pay out of pocket, file claims, and be reimbursed. Medcom may request receipt documentation for your debit card transactions. Remember to retain all receipts, per IRS guidelines. Not all providers accept the FSA debit card, and for those providers who do not, you will pay at the time of transaction and complete a claim form to request reimbursement.
The IRS requires that any unused money in your account at the end of the plan year be forfeited. Be sure to use the entire amount of your FSA balance in order to avoid forfeitures.
2026 Plan Year Maximums
Healthcare FSA: $3,400
Dependent Care FSA: $7,500
If you are enrolled in the HSA Medical Plan (a High Deductible Health Plan), you also have the option to enroll in a Health Savings Account (HSA), which can also be used for medical, dental, vision, pharmacy, and other related expenses. A Limited Purpose Healthcare FSA is available for HSA plan participants. Limited Purpose FSAs are for dental and vision expenses only.
Healthcare FSA
For 2026, you may roll over up to $680 of unused Healthcare FSA monies into the next year's FSA plan, but you still want to estimate your current year FSA plan contribution carefully. If you are not electing the Healthcare FSA for the next plan year, a minimum balance of $25 is required to rollover your existing balance, and funds must be used in the following plan year. According to the IRS guidelines, all unused FSA funds in excess of $660 will be forfeited.
You are not eligible to participate in the Healthcare Flexible Spending Account (FSA) plan if you are currently enrolled in a Health Savings Account (HSA).
A list of eligible vs ineligible expenses is available on the Resources page.
Limited Purpose FSA
A Limited Purpose FSA is a healthcare spending account that can only be used for eligible vision and dental expenses. Unlike a Healthcare FSA, this account can be held at the same time as a Health Savings Account (HSA). When coordinated with an HSA, the limited purpose FSA can further reduce your taxes while allowing you to allocate HSA funds to other purposes – including retirement.
By eliminating the need to use your HSA funds for these expenses, you have more to spend on regular medical expenses. More important, funding dental and vision expenses from a limited purpose FSA may also allow you to keep more savings in your HSA. Over time, those additional savings can really add up.
Dependent Care FSA
If your spouse is not employed, your dependent care expenses are not eligible for reimbursement unless your spouse is a full-time student or is physically or mentally incapable of caring for himself / herself.
Eligible Dependent Care FSA expenses include before and after-school programs, licensed daycare centers, nursery school or preschool, summer day camps, transportation to and from eligible care, an adult-day-care center, or elder care (in your own home or someone else’s). You can elect a Dependent Care FSA even if you have declined health coverage
Eligible childcare providers can be individuals, such as a family member or friend. However, it's important to note that this category excludes individuals under the age of 19 who are related to you, including your own child or stepchild. Additionally, the caregiver cannot be someone whom you list as a dependent on your federal tax return.
To claim reimbursements for dependent care through this FSA, you must ensure that the service provider has either a federal tax ID number or a valid social security number. This documentation is essential to facilitate the reimbursement process.
Eligible Expenses Must Be for the Care of:
- A dependent child who is under age 13 and whom you claim as an exemption on your tax return
- A dependent child, elderly parent, or relative who is physically or mentally incapable of caring for himself or herself
Mobile and Online Member Tools
Once you are enrolled, you may access https://medcom.wealthcareportal.com and register as a member. You may access your balance and claims information, and view other important FSA plan information on this website.
Medcom also offers a free mobile app for FSA participants to access your accounts from anywhere at any time. You will enjoy convenient mobile options to check balances, view transaction details, request a reimbursement, and submit documentation on the go.
Debit Cards & Manual Claims
You will either use your debit card to pay for claims at the point-of-service, or submit a claim to the administrator for reimbursement.
Debit Card Purchases
You will receive a debit card for your FSA plan. This debit card may be used to pay for eligible medical care expenses. Using a debit card is a convenient way to pay for your FSA expenses as many health providers accept the debit card. When you use your debit card, the funds are pulled from your account and paid to the health provider directly. This eliminates the need for you to pay out-of-pocket and file a claim to be reimbursed.
Please remember to keep all FSA claim receipts, even if you use your debit card. Some debit card claims will require you to provide a receipt to the plan administrator. In the event the FSA administrator needs additional information from you, you will receive a communication requesting receipt(s).
Manual Claims
Not all vendors accept the debit card. Should you need to pay for an eligible expense and be reimbursed from your FSA, you will need to submit a claim to the address indicated on the claim form with appropriate documentation.
Disability
Disability Insurance is protection for one of your most important assets: your ability to earn an income. Disability coverage provides an income replacement benefit if you are ill or injured and unable to work.
Elmet Technologies generously provides both Short Term Disability and Long Term Disability to all employees. Short Term Disability replaces your income for up to 25 weeks, and the benefit becomes payable on the 8th day of your disability.
Should you remain disabled beyond 25 weeks, the Long Term Disability plan pays from your 180th day of disability until Normal Social Security Retirement age.
Short Term Disability
Long Term Disability
Pre-Existing Conditions - Long Term Disability
You have a pre-existing condition if you received medical treatment, consultation, care or services including diagnostic, or took prescribed drugs in the 3 months just prior to your effective date of coverage; and the disability begins in the first 12 months after your effective date of coverage. Once you have been insured on the plan for 12 months, no limitation applies.
Life Insurance
Elmet Technologies provides employer-paid basic life insurance for employees through OneAmerica. The plan includes Accidental Death and Dismemberment coverage, or AD&D. If you pass away as a result of an accident, the plans also pay either the amount of your life insurance or a percentage for loss of limbs, speech, hearing, and more.
Elmet Technologies also offers voluntary term life insurance for employees, spouses, and children. Consider your current coverage and whether it would provide adequate protection for your family in the event of your death. These plans also include AD&D coverage.
BASIC LIFE
Elmet Technologies provides basic life coverage at no cost to you in the amount equal to 1.5X base annual earnings, rounded to the next highest $1,000, up to a maximum of $500,000.
VOLUNTARY LIFE
You may elect voluntary life insurance for yourself and your dependents through payroll deduction to supplement the basic life benefit.
- Employee Life: Up to a maximum of the lesser of $750,000 or 5 times your annual earnings in increments of $1,000.
- Spouse Life: Up to 100% of employee amount to a maximum of $250,000 in the increments of $5,000. Spouse rate is based on employee age.
- Child Life: $5,000 or $10,000 up to age 26 (Guarantee Issue: Up to $10,000)
NEW HIRE GUARANTEE ISSUE
As a new hire, you are able to elect up to the Guarantee Issue amounts of $200,000 for yourself, $30,000 for your spouse, and $10,000 for your child(ren) with no health questions.
Should you wish to elect an amount that exceeds the Guarantee Issue, an Evidence of Insurability (EOI) application is required.
Evidence of Insurability (EOI)
New elections at Annual Open Enrollment, or New Hire elections above the Guarantee Issue amount(s), require Evidence of Insurability (EOI) application(s).
You will not be payroll deducted for your pending amount unless/until you are approved.
Selecting the right amount of insurance is important to ensure you and your loved ones are financially protected. OneAmerica's enhanced Evidence of Insurability (EOI) digital solution streamlines the process with a secure step-by-step easy to comprehend application, available 24/7 on any smartphone, tablet or computer.
Login Process
- Get started by going to www.oneamerica.com/eoi
- Choose your login type: Employee.
- Fill in your client ID, work email address, first and last name. Hit “Submit”.
- You will receive an email containing your unique link and additional information on accessing the online EOI application.
- Click your unique email link to continue to our secure digital solution.
Application Process
- Once your personal identification information is verified, click “Start Now” to begin the process.
- Select your OneAmerica Company Insurance coverage(s).
- Fill in personal demographic information
- If you are requesting spouse/domestic partner coverage when EOI is required, please fill-in their name and unique email address so they can be prompted to complete the EOI process once you have submitted your application.
- Complete health questions
- Review and sign via DocuSign
Response Process
- Receive immediate response.
- If approved, you and your employer will receive a confirmation email.
- Please also send the Elmet Benefits Service Center a copy of the confirmation email at questions@elmetbenefits.com
- If referred, you will receive an email or letter via the United States Postal Service (USPS) outlining the additional information needed.
- If declined, you will receive a letter via USPS with more information.
- If approved, you and your employer will receive a confirmation email.
Please visit bit.ly/eoiDigitalSolutionFAQ to view One America's frequently asked questions, or contact One America's Employee Benefits Customer Engagement Center at (800) 553-5318.
Client ID: U528135
Policy #: 00621823-0000-000
Age Reductions
The basic life benefits are reduced due to age based on the schedule below. The change will take place on January 1 following the 65th birthday.
35% reduction at age 65
60% reduction at age 70
75% reduction at age 75
The voluntary life benefits are reduced due to age based on the schedule below. The change will take place on January 1 following the 70th birthday.
60% reduction at age 70
75% reduction at age 75
Continuing Coverage After Separation
You have the opportunity to continue your life insurance benefit should you terminate employment with Elmet Technologies if certain conditions are met and if application and premium payment are made within 31 days of your coverage end date.
Additional information regarding your options may be obtained by contacting OneAmerica or by visiting the Resources page.
Important Notes
- There is no age cap to be eligible to enroll
- Spouse life cannot exceed 100% of employee amount
- Child(ren) can be covered until age 26
- Beneficiary information is required upon enrollment
- Accidental Death and Dismemberment (AD&D) coverage is included
- Benefit is doubled in the event of death due to accident
- Dismemberment benefit is paid according to a schedule outlined in the certificate
- If you are married to another Elmet Technologies employee:
- Duplicate coverage is allowed:
- You can both elect employee and spouse life coverage
- You can both elect to cover the child(ren)
- Duplicate coverage is allowed:
Vision
The Elmet Technologies Vision Plan with Ameritas provides a benefit for an exam, and either contact lenses or eyeglass lenses and frames. If you see an in-network provider, you pay a copay for your standard eye exam and lenses, and the plan pays a benefit of up to $130 for frames, and contact lenses. Additional copays apply for eyeglass lens options. Dependent children can be covered to age 26.
With the Ameritas Vision Plan, you may visit any vision provider. However, in order to maximize your Ameritas vision benefit, we encourage you to visit an in-network provider.
Locate participating providers by visiting www.ameritas.com. Select "Find a Health Provider," scroll down to "Vision," and select either VSP or EyeMed (depending on the plan you chose). This link will take you to appropriate VSP or EyeMed provider search option.
Vision Summary
Frequencies
Examination: Once per 12 months
Lenses: One pair per 12 months
Frames: One pair per 12 months
** Either eyeglass lenses or contact lenses are allowed per frequency **
Dental
Elmet Technologies offers a comprehensive dental plan through Northeast Delta Dental with a generous $1,500 calendar year maximum. You are encouraged to visit in-network dentists to reduce your out-of-pocket costs and avoid getting balance billed. Please refer to the Benefits Summary for complete details about the Northeast Delta Dental dental plan.
To locate participating providers, access www.nedelta.com and select “Find a Dentist” to get started. You may select “Delta Dental PPO” or “Delta Dental Premier” as the dental network.
You can also call Northeast Delta Dental at (800) 832-5700.
Below is a benefit summary of your annual deductible and co-insurance costs.
| NORTHEAST DELTA DENTAL | Delta Dental PPO Network + Delta Dental Premier Network |
|---|---|
|
Deductible
|
$50 individual | $150 Family |
|
Type A - Preventive Services (Deductible Waived): Exams, cleanings, and bitewing x-rays
|
Plan pays 100% |
|
Type B - Basic Services (After Deductible): Fillings, simple & surgical extractions, and more
|
Plan pays 80% |
|
Type C - Major Services (After Deductible): Crowns, implants, dentures, and more
|
Plan pays 50% |
|
Type D - Orthodontia; Adults & Children (After Deductible):
|
Plan pays 50% |
|
Orthodontia Lifetime Maximum
|
$1,500 per person |
|
Annual Maximum (per person)
|
$1,500 per person |
Important Notes
-
No age limitations for coverage
-
Deductible (waived for preventive)
-
Members utilizing Northeast Delta Dental participating dentists will enjoy discounted dental fees in addition to protection from balance billing for charges above the dentist’s maximum allowable charges. Members utilizing non-participating dentists will have the same benefits but may be subject to balance billing.
-
Claims for any of your covered dependents should be submitted under your Subscriber ID
Claims Process
In-Network
- Participating Northeast Delta Dental dentists file the claim and accept payment from Northeast Delta Dental
- Employees should not need to pay at the time of service for participating providers
Out-of-Network
- For out-of-network dentists, employee pays at the time of service and files a claim for reimbursement
- The plan reimburses the lesser of the dentist's actual submitted charge or Delta Dental's allowance for non-participating dentists in the geographic area in which services were provided
Medical
Elmet Technologies offers three medical plans administered by Health Plans, Inc. (HPI). HPI offers excellent customer care and utilizes
- The Harvard Pilgrim Health Care (HPHC) network of providers - Inside New England
- The United Healthcare (UHC) Choice Plus network of providers - Outside New England
You may choose between the HSA Plan, PPO Silver Plan, and PPO Gold Plan.
This will be different for union members hired before April 15th, 2013. If you are enrolled in the union-contracted Allegiant Care plan, you are not eligible to elect these plans.
The HSA plan is a High Deductible Health Plan (HDHP), which qualifies participants to contribute to a Health Savings Account (HSA). If you elect the HSA plan, you are not required to open or contribute to a Health Savings Account (HSA). However, those who do contribute to an HSA will reduce their taxable income and be able to pay for medical, dental, vision, and prescription expenses federal income tax-free. See the Health Savings Account (HSA) page for more information. Preventive care is always covered at 100% before the deductible, as long as it is coded as preventive.
The PPO plans offer copays for services like office visits, ER visits, and prescription drugs. For most other services, you are responsible for your deductible and coinsurance until you meet your out-of-pocket maximum. Please be aware that copays do not count towards your deductible, only your out-of-pocket maximum. Copay services are covered at 100% after a copay, as long as you stay in-network. For out-of-network services, you will be responsible for a separate out-of-network deductible and coinsurance until you meet your out-of-network out-of-pocket maximum.
Preventive care is always covered 100% before the deductible. However, for preventive care to be covered in full, the service must be coded as preventive. If the service is coded as diagnostic, a member out-of-pocket (deductible, copay, or coinsurance, depending on the service) will be associated with the claim.
Medicare
For active employees with HPI-enrolled spouses who are enrolled in Medicare and not disabled, the HPI medical plan is primary. The spouse is not required to elect Part B (medically necessary services such as outpatient care and preventive care) until the active employee retires. However, the spouse will automatically receive Part A (hospital insurance).
HPI Online Access
With HPI's My Plan Portal, you can access your Medical ID Card online and manage your account 24/7.
Register in Minutes!
- Go to https://hpitpa.com/.
- Visit the Members section and click the link to register.
- Enter your information to create your username and password.
Access all of your account details* in one secure location anytime, anywhere!
- Review your claims
- Check your benefits
- Access your prescription drug plan
- Search your provider network
- Download a report of your claims
- Request claim reimbursements
- View, print, or order your member ID card
- View or print applicable tax forms
- Find a Primary Care Provider (PCP)
- View your health spending account details
Healthcare Excellence Hubs
We believe that distance and cost should never get in the way of you receiving the best possible medical care. Elmet employees have full access to top hospitals in New England, Ohio, and Michigan at zero out-of-pocket costs for complex medical conditions and procedures. As you explore these options, we want you to know that all possible barriers have been removed, and travel expenses will be covered for you and a companion. All employees, spouses, and dependent children who are enrolled in an Elmet health plan are eligible.
The Healthcare Excellence Hubs Program covers the following procedures:
- Cancer Treatment
- Joint Replacement
- Back Surgery
- Heart Procedures
- Organ Transplant
Additional medical procedures may be included on a case-by-case basis. To learn more, contact the Elmet Benefits Service Center or HPI's Pathways Concierge team.
HPI's Pathways Concierge - HPI Plans Only
Healthcare can be confusing—we’re here to help!
The concierge team knows all about your benefits and can help you with anything related to healthcare. These services are part of your benefit plan, so they will never charge you for their help.
Your Personal Healthcare Concierge—Whenever You Need It
- What is Pathways Concierge?
- With Pathways Concierge, you have direct access to an experienced, compassionate Member Advocate who will serve as your personal healthcare concierge whenever you have a question about your health plan, claims, or how to use your benefits.
- What will Pathways Concierge do for me?
- Pathways Concierge is here to help with all things healthcare-related, ensuring you and your family members receive the right care at the right time.
- Pathways Concierge:
- They can help with things like coordinating prescriptions or calling a provider about a bill
- They are trained to know everything about your health plan benefits.
- They will take the time to get to know you and your family
- A Few Ways Pathways Concierge Can Help You
- They can help you understand your benefits coverage and claims
- Find in-network specialty providers
- Recognize when support from other resources may be needed
- Leverage available resources
- Coordinate time with a care manager or health coach
Just one more thing to know:
- MedWatch is the name of the company that provides these services. They’re part of the Health Plans, Inc. (HPI) family of companies, and they may reach out to you to help you with your healthcare needs.
Help is just a phone call away.
To get in touch with a Member Advocate, call (888) 340-5487 (M-F, 8 am-8 pm, ET)
***Don’t worry, your information is completely confidential and secure, which means they'll never share it with anyone without your permission first.***
Fairos Rx Pharmacy Benefits - HPI Medical Plans
- For the PPO Plan
- Generic, Preferred Brand, and Non-Preferred Brand Drugs are covered in full, after the applicable tier copay.
- Specialty Drugs are covered at 75% coinsurance
- For the HSA Plan (High Deductible Health Plan)
- Prescription drugs are subject to the deductible and then coinsurance, similar to other medical services.
Fairos Rx Navigator Program
Are you or a dependent taking a high-cost medication? You may be eligible for programs to
reduce your medication costs. The FairosRx Navigator program is focused on simplifying the process of obtaining your medication at a lower cost to you and Elmet Technologies.
What should you expect from FairosRx Navigator if you are taking an eligible medication?
- You will receive a call from a member of the Navigator team to provide program education and an overview of the next steps.
- Based on eligibility criteria, the FairosRx Navigator program determines the appropriate program for you and will provide enrollment assistance.
- The Navigator team will communicate with your prescriber about your program and request a new prescription.
- You are provided with tracking information for your medication, and your package is tracked to ensure delivery.
Examples of the Top 9 Medications (by volume) that are eligible for the FairosRx Navigator Program. This is not intended to be a complete list of the covered medications.
- Jardiance
- Trulicity
- Eliquis
- Nurtec
- Farxiga
- Mounjaro
- Xarelto
- Trelegy Ellipta
- Humalog Kwikpen
Questions? Please call the FairosRx Navigator program at 833-464-9600. You can also email Fairos at: ContactUs@FairosRx.com.
AchieveHealth Tobacco Cessation Program
A tobacco-free life is within reach!
Your health goals are unique to you; your tobacco cessation program should be, too. With AchieveHealth, you’ll get a coaching approach tailored to you, your life, and your health, to help you quit smoking for good.
The program is:
- Free to you
- Individualized
- Convenient—you’ll talk with your coach over the phone when it works best for you.
How can they help?
- Together, you and your health coach will:
- Create your customized quit plan
- Identify barriers to quitting
- Explore new ways to cope with triggers and cravings
How it works
- Appointments range from 15-30 minutes.
- Your coach will call you at your scheduled appointment time, anytime Monday through Thursday, 8:00 a.m. to 10:00 p.m. (EST), or Friday, 8:00 a.m. to 6:00 p.m. (EST).
- Outside of scheduled appointments, you’ll be able to contact your coach through a toll-free number.
- Complete a minimum of 6 conveniently scheduled, telephonic coaching sessions to qualify for a premium reduction.
Not quite ready to quit?
That’s okay. Give them a call, and they'll discuss when and how you'll be able to quit.
Transparency in Coverage - Machine-Readable Files (MRFs) - HPI Medical Plans
As part of the Transparency in Coverage Final Rule issued by the U.S. Department of the Treasury, the U.S. Department of Labor, and the U.S. Department of Health and Human Services, health insurers and self-funded health benefit plans must post machine-readable files (MRFs) on a public internet website that includes:
- Negotiated rates for all covered items with in-network providers, and
- Historical payments to and billed charges from out-of-network providers.
These files will permit the public access to health plan payment information to help understand pricing and costs for health care services. The MRFs are accessible free of charge, without establishing a user account, password, or other credentials, and without submitting identifying information such as a name, email address, or telephone number. The machine-readable files are formatted to allow researchers, regulators, and application developers to access and analyze data more easily.
Download machine-readable files (MRFs) here
For more information, please visit the HPI Transparency in Coverage - Machine Readable Files page
Dependent Eligibility Verification
If you choose to cover dependent(s) on your medical, dental, or vision plan(s), you will receive an email from the Benefits Service Center following enrollment requesting dependent verification documents. Please be sure to provide the dependent(s) verification by the deadline so that your dependents remain covered.
- Only legal spouses and registered domestic partners are eligible for coverage.
- Children are eligible until their 26th birthday.
You will receive detailed information on the required documentation after your enrollment, if applicable.
