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Benefits

Group Health Insurance

Insurance Provider – City of Sparks

Medical, Dental, Rx, Vision, Employee Assistance Program, FSA & Life Insurance
This Group Health plan is governed by the City of Sparks 2017 Plan Document. The Group Health Plan Document is the final and binding document to determine health insurance benefits or interpretation of those benefits.  The Benefits At-A-Glance provides contact information as well as a summary of benefits.

City of Sparks 2017 Plan Document
City of Sparks 2017 Benefits At-A-Glance

Group Health Committee Members
Insurance Updates November-December 2016
Enrollment/Change Form
2016-2017 Premiums

MEDICAL & DENTAL & HEALTHY LIFESTYLE

Plan Administrator –  Hometown Health
830 Harvard Way
Reno, NV 89502

www.hometownhealth.com
(775) 982-4150 or (866) 991-4150

Healthy Lifestyle Benefit ($150) Claim Form
2017 Approved Healthy Lifestyle List
2016 Approved Healthy Lifestyle List

The Healthy Lifestyle Benefit form must be completed with receipts attached and faxed or mailed to Hometown.  You have 365 days from date of purchase to submit for reimbursement.  Please see the 2016 list of approved items and the 2017 list of approved items.  Reimbursement takes 3-4 weeks.  Contact Hometown if you haven’t received after that time period.  See the 2017 Plan Document – Appendix G for more information.

Medical & Dental Claim Form

Hometown App Instructions
HIPAA Release Form to Hometown

PHARMACY RX

Plan Administrator –  WellDyne Rx

www.welldynerx.com
844-635-7351

 

WellDyneRx Claim Form
WellDyneRx Welcome Letter
WellDyneRx Mail Order Instructions
CVS 2016 Claim Form

VISION

Plan Administrator – VSP
333 Quality Drive
Rancho Cordova, CA 95670-7985

www.vsp.com
(800) 877-7195

 

EMPLOYEE ASSISTANCE (EAP)

Plan Administrator- Guidance Resources

http://www.guidanceresources.com

Website ID: SPARKS
(855) 770-3190

EAP Brochure

FLEXIBLE SPENDING ACCOUNTS (FSA)

Plan Administrator – Infinisource
www.infinisource.com
(866) 370-3040

FSA Reimbursement Form
FSA Approved Expenses

LIFE INSURANCE

Plan Administrator – Symetra

Life Insurance Beneficiary Change
Certificate of Insurance

BACK ON TRACK PROGRAM

Plan Administrator – Specialty Health

(775) 398-3620

Back-on-Track

 VIRTUAL VISITS 

Plan Administrator – Renown

Virtual Visits

Virtual Visit Steps

MEDICAL PROVIDERS – PREFERRED PROVIDER ORGANIZATION (PPO)

We are a Preferred Provider Organization (PPO) group health plan, which means you have a choice of obtaining health care services and supplies from a PPO or any other provider of your choice (Non-PPO).  PPO’s are In-Network providers that bill Covered Members at negotiated rates. If you choose a Non-PPO, also known as Out-of-Network, rates will be significantly higher and Non-PPO’s will typically bill more than the UCR.  See the Plan Document for more information.

PPO’s and In-Network, are determined by a Covered Member’s physical residence.

A PPO directory can be obtained by visiting the website or contacting:
Hometown Health (866) 991-4150 or (775) 982-4150

 DENTAL PROVIDERS
Guardian Dental does not confirm dental benefits or pay dental claims.
They just provide our network of dentists, endodontists & orthodontists.
Current Dental Provider List

http://www.guardianlife.com

MEDEX TRAVEL ASSISTANCE

Please be sure to familiarize yourself with the City’s travel assistance program for health emergencies. The employee, named spouse and/or dependent children are eligible for MEDEX Travel Assist when traveling at least 100 miles from home or in a foreign country.

Medex Brochure & ID Card

United States, Canada, Puerto Rico, U.S. Virgin Islands, and Bermuda: (800) 527-0218
Other locations worldwide, call collect: (410) 453-6330