| 2025 Open Enrollment | |
|---|---|
| Question | Response |
| When is the Open Enrollment? | November 1 at 8am PST/11am EST– November 15, 2024 at 5pm PST/8pm EST. |
| I was not able to attend the 2025 Benefits Open Enrollment webinar. What did I miss? |
The webinar was recorded. The on-demand webinar can be found in Workday under “Announcement”. WH/DC team members, on-site event(s) to come from your local HR team. |
| What is Open Enrollment? |
Open Enrollment (OE) is an annual opportunity for team members to review and evaluate their benefit elections for the next year. During this time, you can add/drop/change your benefits plans and add/drop your eligible dependent(s). This year’s open enrollment is passive. If you do not enroll in any plans being offered during the Open Enrollment period, your current benefit elections will continue for the 2025 plan year, except Flexible Spending Accounts (FSAs) and Health Saving Account (HSA). However, it is highly suggested that you review and confirm your 2025 benefits coverages during Open Enrollment. If you wish to make changes or if this is your first time enrolling, you will need to log into Workday and elect or waive coverage. Note: Flexible Spending Accounts (FSA) and Health Saving Accounts (HSA) require re-enrollment each year during Open Enrollment. |
| How do I enroll for Open Enrollment? | Log into Workday via Okta from your desktop or through the Workday App on your mobile device. Select the “Team Member Benefits Open Enrollment Selection” link through the Workday announcement or access the “Open Enrollment Change” task in your Workday Inbox. A guide will be available in Workday. |
| When do the benefits I choose during Open Enrollment become effective and when will I see the new deductions? | Benefits elected during Open Enrollment will be effective January 1, 2025 through December 31, 2025. The new deductions will be reflected on the first paycheck in January 2025. |
| Who can I add to my benefits plans? What documentation is required to verify dependent eligibility? | Eligible dependents are legal spouse/eligible registered domestic partners (CA only), children to age 26, and unmarried children who are age 26 or older who are mentally or physically disabled. You will need to provide the required documentation (i.e. marriage certificate, birth certificate, registered domestic partner certificate) to verify their eligibility. |
| What is a Qualifying Life Event (QLE)? |
Qualifying life events allow you to make changes to your benefits plan within 30 days after the qualifying life event (QLE). Common QLEs include, but are not limited to marriage, divorce, birth or adoption of a child, spouse’s change in employment or health insurance status, etc. It is your responsibility to notify iHerb within 30 days after the qualifying life event. If you do not take action within the required time, you will have to wait until the next annual open enrollment period to make any changes. In Workday under “iHerb Forms & Policies”, there is a guide on How to Enroll in Benefits After QLE. |
| Do I need to take action, if I am not making any changes? |
This year open enrollment does not require action. However, it is highly suggested that you review and confirm your benefits coverage in Workday. If you would like to elect new/change coverages or waive benefits you no longer want in 2025, you will need to log into Workday by the deadline. Enrollment in the health care or dependent care flexible spending account (FSA) and Health Saving Account (HSA) is required each year. To re-certify your eligibility on the spousal surcharge waiver for 2025, a new spousal affidavit form must be completed and return by the OE deadline. |
| What if I miss the open enrollment period? | If you miss the open enrollment period, you will have to wait until the next open enrollment period to make changes, unless you experience a qualifying life event that permits you to make changes under IRS rules. |
| What is a spousal surcharge? | A spousal surcharge is an automatic additional $100 per month amount you pay, if you have elected to enroll your spouse/registered domestic partner in iHerb’s medical plan and your spouse/registered domestic partner are eligible for medical coverage through their employer. |
| Does the spousal surcharge apply in 2025? | Yes, the automatic $100 per month spousal surcharge will apply in 2025. To re-certify your eligibility on the spousal surcharge waiver for 2025, a new spousal affidavit form must be completed and returned by the Open Enrollment deadline. |
| Why is there a spousal surcharge? | The spouse surcharge encourages those participants eligible for other group medical insurance to take advantage of that coverage. It also allows iHerb to share medical costs with other employers and helps iHerb keep our medical plans more affordable. The spouse premium surcharge is a method adopted by many employers. |
| Who will be assessed the spousal surcharge? | All team members covering a spouse/registered domestic partner on iHerb’s medical plan, there will be automatic $100 monthly spousal surcharge, unless they are eligible for a waiver. |
| How do I obtain a waiver for the spousal surcharge? |
To be eligible for a waiver of the spousal surcharge in 2025, you are required to complete and submit the Spousal Affidavit Form by the Open Enrollment deadline. The spousal affidavit must be completed through your Workday 2025 Open Enrollment task. |
| Last year I completed the Spousal Affidavit form because my spouse was not eligible for medical coverage through their employer. This has not changed. Am I required to complete the Spousal Affidavit form again? | Yes, you need to complete and submit the Spousal Affidavit form every year to re-certify your eligibility and when there is a change in your spouse/registered domestic partner’s status. |
| I don’t need medical coverage but would like to dental, vision, LTD/STD, and/or Life Insurance. Am I able to do that? | Yes, you can enroll in these other benefits during Open Enrollment. |
| When will I receive a new medical ID card? | Blue Shield of CA will only be mailing out new ID cards to new subscribers or those changing medical elections for the 2025 plan year. These will be mailed mid-December, which means you should receive your ID card before January 1st. If you do not receive your new ID card, you may also log on to your blueshield.com/ca member account and download a copy of your ID card. |
| Who can I contact if I have questions regarding the benefit plans or need help finding in-network providers? |
TouchCare: Toll Free: 866-486-8242, 8am-9pm EST Monday through Friday or email assist@touchcare.com, TouchCare online portal at touchcare.com or iOS /Android app. For a list of in-network PCPs, specialists and hospitals, you can access the links below: Inside California: Outside California (within the U.S): |
| What benefit resources are available? |
TouchCare: Toll Free: 866-486-8242, 8am-9pm EST Monday through Friday or email assist@touchcare.com, TouchCare online portal at touchcare.com or iOS /Android app iHerb Total Rewards Portal: iherbbenefits.com Workday -> iHerb Forms & Policies -> Benefits & LOA |
| Medical Benefits | |
|---|---|
| Blue Shield of CA Trio ACO HMO | The HMO (Health Maintenance Organization) plan requires members to select a primary care physician (PCP), a doctor who acts as a “gatekeeper” to direct access to medical services. PCPs are usually internists, pediatricians, family doctors or general practitioners (GPs). Except for a medical emergency and obstetric/gynecologic visits, patients need a referral from their PCP in order to see a specialist or other doctor. There is no coverage outside of the HMO network. |
| Blue Shield of CA PPO/HDHP | The PPO/HDHP has an extensive network that allows you to choose a physician from within or outside of the network. All maximums included in these plans are combined maximums between in-network and out-of-network, where applicable, unless specifically stated otherwise. |
| Care from a Participating Provider (PPO/HDHP) | If you use a provider who participates in the network (in-network care), your out-of-pocket expenses are generally lower because network providers agree to charge pre-set negotiated fees for these services. Some services require a copay, depending on the type of service provided. Otherwise, the Plan generally pays a percentage of the cost of covered expenses, after the annual deductible has been met. Also, as an added convenience, network providers generally file claims on your behalf. |
| Care from a Non-Participating Provider (PPO/HDHP) |
If you choose to use a health care provider who does not participate in the network, your eligible expenses are still covered, but the Plan generally pays a lower percentage of the cost for covered services, subject to Blue Shield of CA Allowable Amount reimbursement limits. You may or may not have to file claim forms for reimbursement, depending on the provider you use.
|
| Pre-Certifying Care |
If you are enrolled in the PPO/HDHP and obtain care from a participating provider, your provider is responsible for obtaining pre-certification/prior-authorization from Blue Shield of CA before you incur a major expense (e.g., hospital care, surgery). This will ensure you receive the maximum allowed benefit. If you are enrolled in the Trio HMO plan, your PCP or specialist will coordinate your care on your behalf and will obtain authorizations from your assigned medical group as required. Mental Health prior authorization for the PPO/HDHP plan is the member’s responsibility. |
| Prescription Drugs | |
|---|---|
| Prior Authorization |
The Prior Authorization program monitors certain prescription drugs and their cost so that you can get the right drug at the best cost. When your provider prescribes one of these drugs, he or she simply needs to contact Blue Shield of CA. A representative will see if your plan can cover your prescription drug:
|
| Step Therapy | Step Therapy is a program specially designed for people who take prescription drugs regularly to treat ongoing medical conditions such as arthritis, asthma or high blood pressure. The program is an approach to providing you with the prescription drugs you need, keeping safety, cost and – most importantly – your health in mind. The program makes prescription drugs more affordable for most members and helps iHerb control the rising cost of drugs. In Step Therapy, the covered prescription drugs you take are organized in a series of “steps” with your provider approving and writing your prescriptions. |
| Specialty Drugs | CVS Caremark is the exclusive specialty pharmacy for specific oral and injectable medications for chronic illnesses. Should you need specialty drugs, CVS Caremark will require that you utilize this service and will notify you, your retail pharmacy and your provider on how to proceed using CVS Caremark’s mail order program. |
| Important Definitions | |
|---|---|
| Deductible | The dollar amount you are responsible for before the insurance carrier will pay for all or part of the remaining covered services. |
| Out-of-Pocket Maximum | The total dollar amount you must pay, after meeting your deductible, before the plan pays 100% of covered services. You are responsible for a portion of your costs until you reach this amount. |
| Copayment (Copay) | The fixed, predetermined dollar amount you are responsible for paying (usually for network expenses like a doctor’s office visit or prescription drugs). |
| Allowable Amounts | When receiving service from an out-of-network provider, any charges above the allowable amount are your responsibility. Charges above the allowable amount are not counted towards your deductible or out-of-pocket maximum. |
| Emergency Care |
Emergency Medical – Emergency care for the initial treatment of a condition that:
Note: Emergency care must begin within 48 hours of the accident, trauma or onset of the illness. |
| Medicare Reimbursement Level | A percentage of the published rates allowed by the Centers for Medicare and Medicaid Services (CMS) for the same or similar service within the geographic market. |
| Network | A group of providers (doctors, hospitals, dentists, etc.) who meet certain credentialing standards and agree to charge pre-set negotiated fees for their services to participating patients. |
| Leave of Absence | Includes, but is not limited to Family Medical Leave Act (FMLA), Personal Medical Leave, Personal non-medical Leave, Workers Compensation and Military Leave. Please refer to the iHerb Team Member Handbook for the Leave policy. |
This website highlights some of your benefit plans. Your actual rights and benefits are governed by the official plan documents. If any discrepancy exists between this communication and the official plan documents, the plan documents will prevail. The company reserves the right to change any benefit plan without notice. Benefits are not a guarantee of employment.
For benefit questions & claims assistance, contact TouchCare at 866-486-8242 or assist@touchcare.com.
For HR related questions, contact the HR Service Desk.
