We offer a choice of two different health insurance plans - Silver or Gold - coupled with a Health Reimbursement Arrangement. Both plans offer in-network and out-of-network benefits as well as prescription drug coverage.

Within each plan, you are able to choose from the following coverage options:

• Employee only
• Employee and Spouse
• Employee and Kids
• Family

If your spouse is eligible for health insurance through his or her employer, he or she is not eligible for primary coverage under our plan.

Your share of the cost is paid through pay deduction and will be paid with pre-tax dollars. Plan ID cards are sent out upon enrollment. A Summary Plan Description (SPD) is available on www.anthem.com. The SPD lists the specific benefits and contribution levels for each plan. In addition to the SPDs, you can review the Summary of Benefits and Coverage (SBC) on Roehlbenefits.com.

Changes to health coverage are only allowed when a  qualifying event occurs or during an annual open enrollment. Please contact the Pay and Benefits Services Department or refer to the plan SPD for more information regarding qualifying events.

Health Reimbursement Arrangement

The Health Reimbursement Arrangement is an important part of our plan. At the beginning of the year, Roehl will make a set amount available to you for your health reimbursement as outlined below:
 

2024 HRA Amounts
COVERAGE TIER	AUTOMATIC CONTRIBUTION	EARNED CONTRIBUTION	MAXIMUM CONTRIBUTION
Employee Only	$250	$250	$500
Employee + Spouse	$375	$375	$750
Employee + Kids	$375	$375	$750
Family	$500	$500	$1000

Visit the Medical Plan Wellness Incentives page for more information on HRA funding for the 2024 plan year.  To receive the maximum contribution, you would need to complete the Health Check through Virgin Pulse by November 30, 2023.

2023 HRA Amounts
Employee Only	$500
Employee + Spouse	$750
Employee + Kids	$750
Family	$1,000

Please note that if your benefits go into effect mid-year, these amounts will be prorated accordingly.  

The Health Reimbursement Arrangement will pay for the first dollars you spend on eligible healthcare expenses within our plan up to the amount available to you for the year. The only amount you will pay is the copay. Deductible and co-insurance amounts do not apply until you have used all of the health reimbursement for the year. When your claim is processed, the health reimbursement amount is paid first, so depending on the care received, you may never see a bill for that visit.

To view amounts paid from your Health Reimbursement Arrangement, log into your Anthem account at www.anthem.com.  Once logged in, select "My Plan" from the upper tool bar followed by "Spending Accounts."

Example:
You have had a persistent sore throat for a week and have single coverage on the Silver Plan. You decide to see your doctor to check it out. Upon arrival, you pay your $30 copayment. Your doctor determines you have strep throat and gives you a prescription. The cost of the office visit was $150. The prescription copayment was $15.
 
Your Health Reimbursement Arrangement will pay the cost of the office visit, totaling $150. Keep in mind co-pays are not covered by the HRA, just the cost of the services. This means you will pay the $30 office copay and the $15 prescription copay out of pocket, which will be applied to your out of pocket maximum. The remaining balance of your Health Reimbursement Arrangement is $350. This will also be applied to your deductible, meaning your remaining deductible is $2850. Any additional healthcare within the plan will be processed this way, until your health reimbursement amount is exhausted. After that, the deductible and coinsurance amounts will apply.  

 

Health Reimbursement Rollover

Any amount of health reimbursement you do not use during the year will rollover and be available to you the following year. The plan allows for up to two full years' worth of health reimbursement to rollover, plus the amount you get for the current year.

Example:
You have single coverage on the Silver plan. You are healthy and do all of your preventative care, which is covered other than the office visit copay. You did not see the doctor otherwise so you did not use the Health Reimbursement Arrangement. The $500 from this year will roll over to next year, plus you will get the allocation for the new year (another $500). Now you have $1000 available for health reimbursement on January 1st.

You continue to do preventative care and remain healthy. Again you do not use any health reimbursement. The $1000 you currently have will roll over to the following year, so you now have $1500 for health reimbursement. You have reached the plan maximum.
 

Your Costs

Roehl pays the lion's share of the cost of your health plan coverage, but it's important for our employees to understand the health plan components as well as their portion of the cost. We have put together a few definitions to help you through the process.

• Deductible - The expense you are responsible to pay before the plan begins to pay for covered services. Please note that deductibles do not cross accumulate when using in-network and out-of-network healthcare providers.
• Co-insurance - The percentage of eligible expenses that you will be required to pay for certain covered health services.
• Co-payments - A set amount that you will pay for certain covered health services. This amount is in addition to your deductible and co-insurance. Co-payments do not apply toward your deductible.
• Out-of-pocket maximum - The maximum amount that you will pay each calendar year. Please note that out-of-pocket maximums do not accumulate between in-network and out-of network healthcare providers.

 

2024 Health Insurance Premiums

First Year of Employment:

Weekly Non-Tobacco Premiums			Weekly Tobacco Premiums
	Silver Plan	Gold Plan		Silver Plan	Gold Plan
Employee Only	$33.52	$53.88	Employee Only	$56.22	$76.58
Employee + Spouse	$116.47	$152.72	Employee + Spouse	$143.27	$179.52
Employee + Kids	$78.87	$116.19	Employee + Kids	$105.67	$142.99
Family	$140.93	$201.12	Family	$167.73	$227.92

 

 After One Year of Employment:

Weekly Non-Tobacco Premiums			Weekly Tobacco Premiums
	Silver Plan	Gold Plan		Silver Plan	Gold Plan
Employee Only	$26.13	$46.76	Employee Only	$48.84	$69.46
Employee + Spouse	$102.10	$139.05	Employee + Spouse	$128.90	$165.86
Employee + Kids	$64.09	$100.83	Employee + Kids	$90.89	$127.63
Family	$125.34	$185.16	Family	$152.14	$211.96

 

• Our policy defines a tobacco user as an individual that has used tobacco, on average, four or more times per week during the past six months (excluding religious and/or ceremonial use). Tobacco usage includes:
  • Smoking or inhaling the smoke of any substance by way of cigarettes, pipes, cigars, e-cigarettes or any other smoking or smoking-simulation items or devices.
  • Using tobacco or any tobacco product(s) in any other manner or by any other method or device whatsoever.
     
• The tobacco rates apply when at least one tobacco user is covered.

 

• If you are a tobacco user, we offer a tobacco cessation program.  By completing this program, you may qualify to pay the non-tobacco weekly premiums for the plan year.  Additional alternatives may be accommodated upon recommendations of your personal physician.  Please contact Roehl Benefits for more information.
   

• If you and your spouse (if applicable) completed a preventive care visit with your primary care provider between January 1, 2023 and December 31, 2023, deduct $11.00 from the above rates for Family and Employee + Spouse coverage or $5.50 for Employee and Employee + Kids coverage.  Visit the Medical Plan Wellness Incentives page for more information on preventive care visits, including how to receive the discount for 2025.    

2023 Health Insurance Premiums

First Year of Employment:

Weekly Non-Tobacco Premiums			Weekly Tobacco Premiums
	Silver Plan	Gold Plan		Silver Plan	Gold Plan
Employee Only	$31.74	$50.80	Employee Only	$54.44	$73.50
Employee + Spouse	$109.76	$143.70	Employee + Spouse	$136.56	$170.49
Employee + Kids	$74.20	$109.15	Employee + Kids	$101.00	$135.95
Family	$132.66	$189.02	Family	$159.46	$215.82

 

 After One Year of Employment:

Weekly Non-Tobacco Premiums			Weekly Tobacco Premiums
	Silver Plan	Gold Plan		Silver Plan	Gold Plan
Employee Only	$24.82	$44.13	Employee Only	$47.52	$66.84
Employee + Spouse	$96.30	$130.90	Employee + Spouse	$123.10	$157.70
Employee + Kids	$60.36	$94.76	Employee + Kids	$87.16	$121.56
Family	$118.06	$174.07	Family	$144.86	$200.87

 

• Our policy defines a tobacco user as an individual that has used tobacco, on average, four or more times per week during the past six months (excluding religious and/or ceremonial use). Tobacco usage includes:
  • Smoking or inhaling the smoke of any substance by way of cigarettes, pipes, cigars, e-cigarettes or any other smoking or smoking-simulation items or devices.
  • Using tobacco or any tobacco product(s) in any other manner or by any other method or device whatsoever.
     
• The tobacco rates apply when at least one tobacco user is covered.

 

• If you are a tobacco user, we offer a tobacco cessation program.  By completing this program, you may qualify to pay the non-tobacco weekly premiums for the plan year.  Additional alternatives may be accommodated upon recommendations of your personal physician.  Please contact Roehl Benefits for more information.
   

• If you and your spouse (if applicable) completed a preventive care visit with your primary care provider between August 1, 2021 and December 31, 2022, deduct $11.00 from the above rates for Family and Employee + Spouse coverage or $5.50 for Employee and Employee + Kids coverage.  Visit the Medical Plan Wellness Incentives page for more information on preventive care visits, including how to receive the discount for 2024.    

 

 

 

The Importance of Preventive Care