2023 Medical

www.mymarinerbenefits.com
833-740-3135

Quantum Health specializes in health care navigation and care coordination that goes far above and beyond
any traditional definition or model. Some call it advocacy, others a concierge. Quantum Health provides a family assigned nurse, benefits experts and claims specialists to support your unique health care journey. You have diverse needs, from billing questions to complex condition management. Quantum Health has them covered.

You will work through Quantum Health for all your service needs.

When to Call Quantum

  • To Verify Coverage
  • Help Find Health-Education Resources
  • Advocate for your care
  • Manage Chronic Conditions
  • Find In Network Providers
  • Provider Contact to discuss Treatment
  • Answer claims, billing and benefits questions
  • Create health-improvement plans
  • Avoid unnecessary out-of-pocket costs

Just who is Quantum?

To learn a little more about Quantum, please view the Q&A videos below!

Premium Rate Sheet

Comparing Options?

Nayya provides unparalleled personalization—offering benefits enrollment decision recommendations for lifestyle and needs while estimating your annual cost savings. You’ll complete a guided survey in less than 10 minutes. Nayya recommends the right amount of benefits to help you not only save money but also feel more confident in your health and financial wellness.

To begin your enrollment journey with Nayya, please click on the link below:

https://app.nayya.com/users/sign_up

You will utilize your same ADP user id and password to login!

provider search

The insurance network and claims processor for Mariner Wealth Advisors medical plans is Meritain Health, an Aetna Company. You can use the link below confirm In network Status of your providers:

Meritain Provider Search

You will input your zip code and then chose the Aetna Choice POS II from the list.

WHO IS ELIGIBLE AND WHEN:

Active associates working a minimum of 30 hours per week, their spouse and dependent children are all eligible for coverage. Qualified Associates have up to 30 days to enroll in the plan after they become benefit eligible. Most benefit changes require a “qualifying life event” and must be identified within 30 days. Failure to do so will disqualify you from changing coverage until the next open enrollment.

Coverage in the medical plan is effective the first of the month coincident with or following the date of hire. Coverage terminates on the last day of the month coincident with or following the date in which an associate no longer meets the criteria for eligibility.

Plan
Features

HSA Plan In-Network Coverage

Copay Plan
In-Network Coverage

Deductible

 $3,000 Individual
$6,000 Family		 $1,500 Individual
$3,000 Family

Coinsurance

 100% 80%

Out of Pocket

 $3,000 Individual
$6,000 Family		 $3,000 Individual
$6,000 Family

Office Visit

 100% up to deductible, no copay

Primary: $0 Copay

Specialist: $50 Copay

Urgent Care: $40 Copay

First Stop Health – Telemedicine Consult

 Free of Charge Free of Charge

Emergency Services

 100% up to deductible, no copay 100% up to deductible, no copay

Preventative Services

 No deductible, no copay No deductible, no copay

Outpatient / Laboratory / Facility

 100% up to deductible, no copay Deductible + 20%

Prescription Drug Coverage

(1 month)

 100% up to deductible, no copay $0 / $40 / 30%

Mail Order Drug Coverage

(3 months)

 100% up to deductible, no copay $0 / $80 / 30%

Specialty Drug Coverage

 100% up to deductible, no copay 30%

 

 

 

Complete information on medical benefits can be found in the Mariner Wealth Advisors, LLC Health Care Plan Summary Plan Description and SPD Supplement on the Annual Notices Page.

Overview

Summary of Benefits (SBC) – Copay Plan

Summary of Benefits (SBC) – HSA Plan

Medical Plan Comparison

Prescription Drug List – CVS Caremark

90 Day Pharmacies- CVS Caremark

National Network Retail Pharmacies – CVS Caremark

Specialty Rx Benefit

Prior Authorization From – RxBenefits

Travel Outside the U.S.

 

Resources

Physician and Cost Lookup

 

Forms

Medical Claims

Frequently Asked Questions

FAQ - Display Set to None

New Medical cards can be ordered through your online portal at www.mycigna.com. You also have access to a mobile ID card through the MyCigna Smartphone App.

I have misplaced my Medical ID Card, how can I order a new one?

New Medical cards can be ordered through your online portal at www.mymarinerbenefits.com. You also have access to a mobile ID card through the Quantum Smartphone App.

I recently moved, how can I update my address with Quantum?

Your address can be updated directly through ADP (www.workforcenow.adp.com). After logging in you will go to “Myself” –> “My Information” -> “Profile”. From there you can update all personal information, including your address by clicking on the “View More” icon in the Personal information Section.

After you update your address in ADP, it will update with all benefit providers.

I am getting married, can I add my new spouse to my Medical election?

Getting married is considered a Qualifying Life Event (QLE). You have up to 30 days after the Qualifying Life Event to make changes to your benefit elections, including canceling your coverage, or adding your new spouse to any benefits. If you want to make any additional changes, you can do so directly through ADP.

Coverage for your spouse will begin on the first of the month coinciding with or following your marriage effective date. In order to activate the work event in ADP, we require a signed marriage license.

What is not included in the out-of-pocket limit?

Penalties for failure to obtain pre-authorization for services, premiums, balance-billed charges and other health care this plan doesn’t cover

I went to an Out of Network provider, how will I be billed?
Associate Claims are paid using Medicare Plus {+} pricing. Medicare + establishes a standardized rate that has been agreed upon between the provider and the government. However the provider could charge higher fees than Medicare’s fee schedule. Associate cost sharing Includes Medicare standard coinsurance PLUS the portion of the provider’s charge that exceeds Medicare’s fee schedule amount. Excess amount’s over Medicare is not recognized by Out-of-Network Deductible and Out-of-Pocket Max thus increasing the potential cost payable by the Associate.
FAQ - Display Set to None
Do I need to designate a beneficiary?

A beneficiary does not need to be designated for medical insurance. Your dependent(s) will be assumed as a beneficiary for this benefit.

Is my Domestic Partner Eligible for Medical Insurance?

Our Medical plan does not allow enrollment for girlfriends, boyfriends, siblings, domestic partners or grandchildren (unless adopted by you)

I am leaving the plan, when does my coverage end?

Coverage will end the last calendar day of the month.

When is my child no longer eligible for Medical coverage with Mariner?

Dependents are eligible to remain on our medical plan until the end of the year in which they turn 26. This includes children who are married or have employment elsewhere. Continuation of coverage under the Mariner plan can be obtained by the 26 year old dependent through COBRA.

My daughter is pregnant, is medical coverage through Mariner available for my new grandchild?

Grandchildren are only covered as qualifying dependents if you are the legal guardian.  The plan does cover labor and delivery for dependent children; however, the newborn baby is not considered a qualified dependent.

Transparency in Coverage