• Prescription – Express Scripts (HHC Residents Only)

ESI benefits:

• Member ID card

About this benefit:

This benefit is a supplemental RX coverage that should be used in conjunction with your employer’s primary prescription plan. The Plan highly recommends the member enroll in the employer prescription plan for themselves and their family. Whenever possible use your primary prescription carrier prior to the supplemental debit card. Employees will be mailed two cards per household and informational materials. You may use the cards immediately.

Please note: Employees and their dependents may not be issued a card if a completed enrollment card was not presented to the benefits office. Cards will be issued at $750 per eligible individual in the family. Members can obtain discounts for prescription drugs at any one of ESI’s participating providers nationwide. The card acts like a debit card. Cards are presented to the participating pharmacy for eligibility verification. Once eligibility is established, the cost of the prescription will be reduced by a discounted rate. Members will not have to pay any cash/payment upfront. When the balance on the card reaches zero, members can continue to use the cards to fill prescriptions at a discounted price.

In the event the card does not have a sufficient balance to pay for the full prescription, the cost of the purchase will be applied to the card and the remaining balance will be the member’s responsibility. Members are highly encouraged to submit any out of pocket cost for reimbursement.

It is important to note this card does not cover any over the counter drugs or medications. To determine the participating providers, you can logon and register at www.express-scripts.com or call the customer service phone number on the back of your card. ESI’s customer service representatives can also inform you of your card balance. Claim forms can be found at http://www.cirseiu.org/benefits/.

For additional savings you can use ESI’s mail order program to get a ninety day supply for the cost of two copayments. For replacement of a lost card, please contact ESI @ 1-800-467-2006.

• Vision Claim form

Davis Vision benefits:

• Eye Exam brochure
• Virtual Try-on Tool
• Member ID Card
• Davis Vision website

• Dental – Guardian (DPG) Claim form
• Dental – Supplemental*

Guardian Dental benefits:

• Find a Provider
• Benefits Demo
• Guardiananytime.com

Dental Guard Preferred – DGP (This Benefit is insured through HSBP):

If the employee or eligible dependent is enrolled in the DentalGuard Preferred through Guardian or another carrier, this supplement will pay an additional 20% to the member, of the amount reimbursed by the dental carrier for covered services. This 20% supplement will be calculated based on the total reimbursements received under the Dental Plan during the benefit year.

For Example: Managed DentalGuard – MDG

If the employee or eligible dependent is enrolled in the Managed DentalGuard, this supplement will pay 20% of what the employee has paid in connection with receipt of covered Managed DentalGuard. With your claim form, you must submit an itemized statement of covered charges from your primary care dentist with the exact date(s), diagnosis and procedure codes for which services were rendered. Only services that are covered by your dental carrier will be reimbursed by the Plan. Scanned copies of your receipts for eligible dental expenses must be submitted to the Benefits Plan Office with the appropriate claim form. The Managed DentalGuard or DentalGuard Preferred reimbursements in combination cannot exceed the maximum supplement per person per benefit year of $1,000.

• Hearing Aid*
• Epic Hearing’s website

• Mental Health*
• Major Medical – Supplemental*
• Obstetrical – Supplemental*
• Newborn Expenses*
• Urinalysis Monitoring*

The HSBP Transgender benefit gives those who need the ability to receive medical services such as psychology, hormones and surgery to develop the physical characteristics of the desired gender. Transgender benefit coverage includes: culturally appropriate, knowledgeable primary care and prescription care, access to gender specific care, transition-related care and mental health outpatient care. Read more here