Empowered Care Benefits Overview

Empowered Care offers eligible employees access to medical, dental, and vision benefits through UnitedHealthcare. These benefits are intended to help support employees and their families with access to preventive care, medical services, dental care, and routine vision care. This page is meant to provide a clear and easy-to-understand summary. Official plan documents always govern if there is any difference between this summary and the insurance carrier materials.

Eligibility & Enrollment

Eligibility

Eligible employees may enroll in benefits beginning on the first day of the month following their hire date. Eligible dependents, including a spouse and eligible children, may also enroll on the same effective date, subject to plan rules and enrollment requirements. Employees are eligible for benefits if they are regularly scheduled to work at least 30 hours per week and maintain that average on an ongoing basis. Continued eligibility for benefits depends on maintaining this average. Temporary or short-term increases in hours do not, by themselves, create or guarantee benefits eligibility.

How to Enroll

Employees who are eligible for benefits will receive enrollment access and instructions through the Flock section within the Paychex Flex app. Enrollment must be completed within the applicable enrollment window and according to plan requirements. Employees should review plan options carefully before making elections.
For help with enrollment, payroll deductions, or benefit questions, employees should contact Nathan or Sue. The general benefits summary also directs employees to Nathan or Sue for questions regarding benefits, enrollment, or payroll deductions.

Medical Coverage

Empowered Care offers two UnitedHealthcare medical plan options through the UHC NexusACO OAP network: a Silver plan and a Gold plan. Both plans include preventive care coverage in-network and allow access to a broad provider network.

Silver

The Silver plan is generally the lower-premium option, but it comes with a higher deductible and higher out-of-pocket costs when care is needed. This may be a better fit for employees who want lower payroll deductions and do not expect frequent medical expenses.

Key Silver Plan details

  • Primary care visit copay: $60

  • Specialist visit copay: $80

  • In-network deductible: $5,500 individual / $11,000 family

  • In-network out-of-pocket maximum: $9,200 individual / $18,400 family

  • Preventive care: covered in-network

  • Telehealth through UnitedHealthcare’s designated virtual provider: no charge

  • First 3 primary care and/or behavioral health visits: $0, deductible does not apply

Monthly employee cost

  • Employee only: $93.10

  • Employee + spouse: $186.20

  • Employee + child(ren): $172.23

  • Employee + family: $265.33

Prescription highlights

  • Tier 1 retail: $20 copay

  • Tier 2 retail: $80 copay

  • Tier 3 and Tier 4: 50% coinsurance

  • Separate prescription deductible: $500 individual / $1,000 family, not applied to Tier 1 and Tier 2 drugs

Gold

The Gold plan has higher monthly premiums, but lower deductibles and lower out-of-pocket costs when care is needed. This may be a better fit for employees who expect more regular doctor visits, prescriptions, or ongoing treatment during the year.

Key Gold Plan details

  • Primary care visit copay: $55

  • Specialist visit copay: $65

  • In-network deductible: $1,000 individual / $2,000 family

  • In-network out-of-pocket maximum: $9,100 individual / $18,200 family

  • Preventive care: covered in-network

  • Telehealth through UnitedHealthcare’s designated virtual provider: no charge

  • First 3 primary care and/or behavioral health visits: $0, deductible does not apply

Monthly employee cost

  • Employee only: $106.41

  • Employee + spouse: $212.83

  • Employee + child(ren): $196.87

  • Employee + family: $303.28

Prescription highlights

  • Tier 1 retail: $10 copay

  • Tier 2 retail: $40 copay

  • Tier 3 and Tier 4: 50% coinsurance

  • Separate prescription deductible: $50 individual / $100 family, not applied to Tier 1 and Tier 2 drugs

Dental

Empowered Care offers a voluntary dental plan through UnitedHealthcare using the National Options PPO 20 network. Preventive services are covered at 100% in-network, and the plan includes benefits for basic and major dental services.

Key Dental Plan details

  • Individual deductible: $50

  • Family deductible: $150

  • Annual maximum benefit: $1,800 per person per calendar year

  • No waiting period

  • Preventive and diagnostic services: 100% in-network

  • Basic dental services: generally 80% in-network

  • Major dental services: generally 50% in-network

Examples of covered preventive services

  • Oral exams

  • Bitewing x-rays

  • Cleanings

  • Fluoride for covered persons under age 16

  • Sealants for covered persons under age 16, subject to plan limits

Per pay period employee cost

  • Employee only: $0.00

  • Employee + spouse: $20.20

  • Employee + child: $20.78

  • Employee + family: $43.66

Vision

Empowered Care offers a voluntary vision plan through UnitedHealthcare Vision, Plan SH506, which helps cover routine eye care and eyewear expenses.

Key Vision Plan details

  • Comprehensive exam: once every 12 months

  • Comprehensive exams for persons with diabetes: twice every 12 months

  • Eyeglass lenses: once every 12 months

  • Frames: once every 12 months

  • Contact lenses instead of eyeglasses: once every 12 months

  • In-network exam copay: $0

  • In-network eyeglasses copay: $0

  • In-network contact lenses instead of eyeglasses: $0

  • Frame allowance: $200

  • Elective contact lens allowance: $200

  • Contact lens fitting/evaluation allowance: $40

  • Necessary contact lenses: covered in full after copay, if applicable

Per pay period employee cost

  • Employee only: $0.00

  • Employee + spouse: $4.75

  • Employee + child: $6.48

  • Employee + family: $11.28