Eligibility

Medical Insurance (Luminare) is offered to employees working a minimum of 30 hours a week, and your dependents on the 1st of the month following 30 days of employment The medical plan is administered by Luminare and provides access to the Aetna Signature Administrators network. When you enroll in the medical plan, you will also have prescription coverage through US-Rx.

Luminare Health UKG Benefits

Importance of Preventive Care

  • Deductible


    The amount of covered expenses you must pay before the Plan starts paying benefits.

    In-network:

    Individual: $750 Family: $1,500

    Out-of-network:

    Individual: $4,000 Family: $8,000

  • Coinsurance


    Cost-sharing between you and the company. This is applied after you meet your deductible.

    In-network:

    You pay 20%
    Plan pays 80%

    Out-of-network:

    You pay 50% Plan pays 50%

  • Out-of-Pocket Maximum


    The most you are required to pay out of your own pocket in a plan year. Some expenses may not apply.

    In-network:

    Individual: $5,500 Family: $11,000

    Out-of-network:

    Individual: $7,000 Family: $14,000

  • Doctor’s Office Visit


    Doctor’s Office Visit

    In-network:

    You pay $30 copay

    Out-of-network:

    You pay 50% (after deductible) Plan pays 50%

  • Specialist Office Visit


    Specialists include doctors trained in a specific area or function of the body, or a specific age group (cardiologist, pediatrician, orthopedic surgeon, neurologist, etc.).

    In-network:

    You pay $50 copay

    Out-of-network:

    You pay 50% (after deductible) Plan pays 50%

  • Preventive/Well Child Care


    Care focused on prevention or early detection of health conditions. Includes routine physical exam, immunizations, cancer screenings, vision and hearing exams, etc.

    In-network:

    Covered in Full

    Out-of-network:

    You pay 50% (Deductible Waived) Plan pays 50%

  • Emergency Room


    Provides accidental injury and medical emergency care. Note: Call your plan immediately if you are admitted to the hospital.

    In-network:

    You pay 20% after deductible

    Out-of-network:

    You pay 20% after deductible

  • Urgent Care


    Non-emergency care received from an urgent care clinic or other medical facility; typically used after hours or when your regular doctor is not available.

    In-network:

    You pay $50 copay

    Out-of-network:

    You pay $50 copay

  • Hospitalization


    Inpatient In-network:

    You pay 20% after deductible

    Inpatient Out-of-network:

    You pay 50% (after deductible) Plan pays 50%

    Outpatient In-network:

    You pay 20% after deductible

    Outpatient Out-of-network:

    You pay 50% (after deductible) Plan pays 50%

  • Orthotics and Prosthetics


    In-network:

    Covered in Full

    Out-of-network:

    You pay 50% (after deductible) Plan pays 50%

  • Routine/Complex Radiology


    In-network:

    You pay $50/$150 copay

    Out-of-network:

    You pay 50% (after deductible) Plan pays 50%

  • Therapeutic Services


    In-network:

    You pay $25 copay

    Out-of-network:

    You pay 50% (after deductible) Plan pays 50%

  • Chiropractic Services


    In-network:

    You pay $50 copay Limited to 25 visits per plan year

    Out-of-network:

    You pay 50% (after deductible) Plan pays 50%

  • Behavioral Health


    Inpatient In-network:

    You pay 20% (after deductible)

    Outpatient In-network:

    You pay $25 copay for Office You pay $30 copay for Virtual

    Inpatient Out-of-network:

    You pay 50% (after deductible) Plan pays 50%

    Outpatient Out-of-network:

    You pay 50% (after deductible) Plan pays 50%

  • Physical Therapy


    Inpatient In-network:

    You pay $25 copay Limited to 30 visits per occurrence

    Outpatient Out-of-network:

    You pay 50% (after deductible) Plan pays 50%

  • Occupational and Speech Therapy


    Inpatient In-network:

    You pay $25 copay Limited to 30 visits combined per plan year

    Outpatient Out-of-network:

    You pay 50% (after deductible) Plan pays 50%

  • Are you required to use network providers?


    No (but your costs will be lower when you do)

  • Do you need a referral to a specialist?


    No.

  • Can I use a Health Savings Account (HSA) or Health Reimbursement Account (HRA)?


    A feature of high-deductible or consumer-driven medical plans, this is a tax-advantaged savings account you can use for medical expenses now or save for later.

    No.

  • Can I use a Health Care Flexible Spending Account (FSA)?


    An account you contribute to before taxes, then use the money for qualified health-related expenses.

    Yes.

  • Prescription Drug


    Deductible – See Deductible above

    Retail (Up to 30-day supply)

    In-network Only

    Tier 1: $10 copay
    Tier 2: $50 copay
    Tier 3: $100 copay

    Mail Order (Up to 90-day supply)

    In-network Only

    Tier 1: $20 copay
    Tier 2: $100 copay
    Tier 3: $200 copay

    Out-of-network

    Not Applicable

    GLP-1 drugs are covered for a Type 2 Diabetes diagnosis only.

  • US-Rx Home Delivery Pharmacy – save time and money


    For help with your prescription:
    • Call 877-200-5533
    – Talk with a prescription specialist.
    • Mail

    • Complete a home delivery order form.
    • Get a 90-day prescription from your doctor.
    • Mail your form, payment (or payment info) and prescription to the address on the form.

PPO Plan

Provider: Aetna

Plan ID# VG0000

Phone: 877-498-8937

http://www.aetna.com/

Find an In-Network Provider

• Go to www.aetna.com/asa.
• Enter your search criteria –a provider’s name or type of provider OR         select what you need by category.
• Review the In-Network Results near the location you selected.

Register for Online Access

1. Go to: www.myLuminareHealth.com
2. On the right side of the screen, under “Register”, click to create your Participant account.
3. Follow the instructions to enter your Member ID (or SSN), last name, zip
code, and date of birth.
4. You will then create a username, password, and security questions of
your choice.
5. Log in and see your ID card, find a doctor or hospital, view your recent
claims, and more!

Luminare Health Benefits 

myLuminareHealth Mobile App

You can connect with your health benefits while you’re on the go. Find a doctor, connect with Luminare Health customer service, access your benefit ID card, review your claims and much more using our mobile app.

Download it for free today from Apple’s App Store or Google Play.

Prescription - Member portal

Go to: https://usrxcare.com/member/

Reminder: each plan member over the age of 18 must register their own account on the Member Portal.

Member Services at 877-200-5533 to obtain this number. 

Prescription (US-Rx)- Understanding Your Prescription Drug Benefit

USRx - Mobile App

With this app, members can locate network pharmacies, look up copays, compare drug costs, and access your ID Card! Please note, you will need the cardholder ID and your group number on your benefits card to register for access to the member portal. Download it for free today from Apple’s App Store or Google Play.

  • Deductible


    The amount of covered expenses you must pay before the Plan starts paying benefits. Anyone enrolled with dependents will need to satisfy the full Family deductible.

    In-network:

    Individual: $3,200 Family: $6,400

    Out-of-network:

    Not Covered

  • Coinsurance


    Cost-sharing between you and the company. This is applied after you meet your deductible.

    In-network:

    You pay 20%
    Plan pays 80%

  • Out-of-Pocket Maximum


    The most you are required to pay out of your own pocket in a plan year. Some expenses may not apply. Anyone enrolled with dependents will need to satisfy the full Family Max Out of Pocket.

    In-network:

    Individual: $6,000
    Family: $12,000

  • Doctor’s Office Visit


    Doctor’s Office Visit

    In-network:

    Covered 80%, after deductible

  • Specialist Office Visit


    Specialists include doctors trained in a specific area or function of the body, or a specific age group (cardiologist, pediatrician, orthopedic surgeon, neurologist, etc.).

    In-network:

    Covered 80%, after deductible

  • Preventive/Well Child Care


    Care focused on prevention or early detection of health conditions. Includes routine physical exam, immunizations, cancer screenings, vision and hearing exams, etc.

    In-network:

    Covered in Full

  • Emergency Room


    Provides accidental injury and medical emergency care. Note: Call your plan immediately if you are admitted to the hospital.

    In-network:

    Covered 80%, after deductible

    Out-of-network:

    Covered 80%, after deductible

  • Urgent Care


    Non-emergency care received from an urgent care clinic or other medical facility; typically used after hours or when your regular doctor is not available.

    In-network:

    Covered 80%, after deductible

  • Hospitalization


    Inpatient In-network:

    Covered 80%, after deductible

  • Orthotics and Prosthetics


    In-network:

    Covered 80%, after deductible

  • Routine/Complex Radiology


    In-network:

    Covered 80%, after deductible

  • Therapeutic Services


    In-network:

    Covered 80%, after deductible

  • Chiropractic Services


    In-network:

    Covered 80%, after deductible
    Limited to 25 visits per plan year.

  • Behavioral Health


    Inpatient In-network:

    You pay 20% (after deductible), Plan pays 80%

    Inpatient Out-of-network:

    Not Covered

    Outpatient In-network:

    You pay 20% (after deductible), Plan pays 80%

    Outpatient Out-of-network:

    Not Covered

  • Physical Therapy


    In-network:

    You pay 20% (after deductible),
    Plan pays 80%
    Limited to 30 visits per occurrence.

    Out-of-network:

    Not Covered

  • Occupational and Speech Therapy


    In-network:

    You pay 20% (after deductible),
    Plan pays 80%
    Limited to 30 visits per plan year.

    Out-of-network:

    Not Covered

  • Are you required to use network providers?


    Yes, there are no out-of-network benefits

  • Do you need a referral to a specialist?


    No.

  • Can I use a Health Savings Account (HSA) or Health Reimbursement Account (HRA)?


    A feature of high-deductible or consumer-driven medical plans, this is a tax-advantaged savings account you can use for medical expenses now or save for later.

    Yes.

  • Can I use a Health Care Flexible Spending Account (FSA)?


    An account you contribute to before taxes, then use the money for qualified health-related expenses.

    Yes, Please keep in mind you can not have both the FSA and HSA.

  • Prescription Drug


    Deductible – See Deductible above

    Retail (Up to 30-day supply)

    In-network Only

    Tier 1: $10 copay, after deductible
    Tier 2: $50 copay, after deductible
    Tier 3: $100 copay, after deductible

    Mail Order (Up to 90-day supply)

    In-network Only

    Tier 1: $20 copay, after deductible
    Tier 2: $100 copay, after deductible
    Tier 3: $200 copay, after deductible

    Out-of-network

    Not Applicable

    GLP-1 drugs are covered for a Type 2 Diabetes diagnosis only.

  • US-Rx Home Delivery Pharmacy – save time and money


    For help with your prescription:
    • Call 877-200-5533
    – Talk with a prescription plan specialist.
    • Mail
    – Complete a home delivery order form
    – Get a 90-day prescription from your doctor.
    – Mail your form, payment (or payment info) and prescription to the address on the form.

High Deductible Health Plan (HDHP)

Provider: Aetna

Plan ID# VG0000

Phone: 877-498-8937

http://www.aetna.com/

This plan is compatible with having a Health Savings Account:

  • Having an HDHP allows you to attach a health savings account (HSA) to allow an opportunity to save money pre-tax to use towards your deductible and coinsurance. 
  • If you would like to set up a health savings account on your own, you can reach out to Fidelity or other local HSA vendors.
  • If you currently have a flexible spending account with Avalon Flooring you will be unable to open an HSA account until January 1, 2023.  As of January 1st, you would have to end your FSA account and set up an HSA account.  Prior to January 1, 2023, you can utilize the funds in your FSA for the deductible/coinsurance.

Find an In-Network Provider

• Go to www.aetna.com/asa.
• Enter your search criteria –a provider’s name or type of provider OR select what you need by category.
• Review the In-Network Results near the location you selected.

Register for Online Access

1. Go to: www.myLuminareHealth.com
2. On the right side of the screen, under “Register”, click to create your Participant account.
3. Follow the instructions to enter your Member ID (or SSN), last name, zip
code, and date of birth.
4. You will then create a username, password, and security questions of
your choice.
5. Log in and see your ID card, find a doctor or hospital, view your recent
claims, and more!

Luminare Health Benefits 

myLuminareHealth Mobile App

You can connect with your health benefits while you’re on the go. Find a doctor, connect with Luminare Health customer service, access your benefit ID card, review your claims and much more using our mobile app.

Download it for free today from Apple’s App Store or Google Play.

Prescription (US-Rx)- Understanding Your Prescription Drug Benefit