What is a Modular Flex Plan?

A Modular Flexible Plan differs from a standard benefit plan because it gives you the ability to choose aspects of your 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

You may choose Tier 1 for Health but Tier 3 for Dental.

Can I Change Tiers?

You can switch your tier preference during the first month of the policy, or during your eligibility month. After this initial or eligibility month, you can not change their tiers until renewal or after a life event. If you are changing tiers due to a life event, you 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. 

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. Please consult with your Plan Administrator to better understand the different premiums per tier. 

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 the plan includes additional Spending accounts, your coverage option will be tied to a specific Health Tier, available to be chosen when you choose your Health Tier.