What is a Modular Flex Plan?

A Modular Flexible Plan differs from a standard benefit plan because it gives the members the ability to choose aspects of their benefit plan. These options are primarily Health and Dental. 

Health and Dental plans will have tiered options with varying benefit coverages and maximums.

For Example:

Extended Health Care                                                Dental Coverage

Tier 1 may have 100% drug coverage                        Tier 1 may have 100% Basic Coverage

Tier 2 may have 90% drug coverage                          Tier 2 may have 90% Basic Coverage

Tier 3 may have 80% drug coverage                          Tier 3 may have 80% Basic Coverage

A Member may choose Tier 1 for Health but Tier 3 for dental.

Tiers and Premiums 

Premiums per tier may vary, depending on each group set up. A higher tier (i.e. Gold) will likely have a higher premium that is charged for the members group benefits. Please consult with your Group Benefits Advisor or review your Invoice to better understand the different premiums per tier. 

Can a Member Change Tiers?

A member can switch their tier preference during the first month of the policy, or during their eligibility month. After this initial or eligibility month, a member can not change their tiers until renewal or after a life event. If a member is changing tiers due to a life event, they can only increase/decrease their tier by one level.

For example:
A Member with Tier 3 Health and Dental can only increase to Tier 2 Health and Dental, after a life event. 

How Do I Change A Member's Tier?

Group Change Form must be completed by the Member and signed/approved by the Administrator indicating the requested tier change and life event, and then uploaded to Simply Benefits via the Secure File Storage in the Administrator Portal. 

What is a Life Event?

A life event refers to any significant change in an individual's life that may impact their benefits coverage.

Life events encompass a broad range of changes for employees. Some common examples include:

  • Changes in marital status (e.g., marriage, separation, divorce) with associated name changes.

  • Additions to families, such as the birth or adoption of a child or the merging of two families.

  • Death of a dependent or beneficiary.

  • Change of address.

  • Milestone birthdays of dependent children affecting their eligibility under parents' benefits plan (21st or 25th birthday)

  • Changes in an alternate group benefits plan.

Spending Accounts and Mod Flex

If your plan includes additional Spending accounts coverages, the coverage option will be tied to a specific Health Tier available to be chosen by the member.