INSURANCE PACKET 202 5
ROTTLER
PEST SOLUTIONS
Available to each full-time employee on the 90th day of employment, comprehensive group health care insurance coverage for the employee and their family.
INSURANCE PROGRAMS
�- BASE , BUY-UP , and HSA MEDICAL PLAN OP T IONS ----------� Affordable medical plan with multiple options to accommodate the employee's family needs (employee only, employee/spouse, employee/ child(ren) & family). Choices are base for basic medical cover-age, buy up with lower deductibles, or start tax-deferred savings on the HS A H ealth S avings P lan. Primary Care office visits are only $15 and Urgent Care is only $25 on t h e B ase and Bu y - Up plans! Affordable dental plan with multiple options to accommodate the employee's family needs (employee only, employee/spouse, employee/child(ren) & family). Very Affordable way to cover preventative and emergency dental services! �-DEN T AL---------------
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� VISION----------------
Affordable vision plan with multiple options to accommodate the employee's family needs (employee only, employee/spouse, •
employee/child(ren) & family). Includes a comprehensive exam, eyeglasses with standard single vision, lined bifocal, lined trifocal, or lenticular lenses, standard scratch-resistant coating, and the frame, or contact lenses in lieu of eyeglasses.
Rottler Pest Solutions currently contributes almost 75% towards employee health benefit costs (health and dental) for eligible, full-time employees. Immediate family members of Rottler Pest Solutions employees may be added to an employee's policy.
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SUPPLEMENTAL INSURANCE PROGRAMS
In addition to the Group Health insurance policies, Rottler also offers short-term disability and life insurances to full-time regular employees effective on the employee's 90th day of employment.
These programs are available at special group rates through convenient payroll deductions. The Human Resource Department can provide specific plan information and enrollment materials prior to the conclusion of the 90-day introductory period.
SHORT-TERM DISABILITY This insurance ensures employees can continue to earn a percentage of their income if they're unable to work due to an injury or sickness. Short Term Disability Insurance replaces part of your income while you recover. As long as you remain disabled, you can receive payments for up to 11 weeks. TERM LIFE and AD & D Life insurance is an appreciated addition to an employee benefits package. Rottler lets employees choose how much life insurance they want to purchase through the company plan and the employee pays the associated premium. You choose the amount of coverage that's right for you, and you keep coverage for a set period of time. LONG-TERM DISABILITY Company sponsored, this insurance policy protects employees if they're unable to work for an extended amount of time because of an accident, injury, or illness. Rottler Pest Solutions pays the cost of this coverage! This policy covers 60% of your monthly income, up to a maximum payment of $13,000. Coverage is guaranteed so you don't have to answer medical questions.
Summary of Benefits and Coverage: What this Plan Covers & What You Pay For Covered Services
Coverage Period: 01/01/2025 – 12/31/2025 Coverage for: Single + Family | Plan Type: POS
Rottler Pest Control Welfare Benefit Plan: Base Plan
The Summary of Benefits and Coverage (SBC) document will help you choose a health plan. The SBC shows you how you and the plan would share the cost for covered health care services. NOTE: Information about the cost of this plan (called the premium) will be provided separately. This is only a summary. For more information about your coverage, or to get a copy of the complete terms of coverage, go to www.meritain.com or call (314) 426-6100. For general definitions of common terms, such as allowed amount, balance billing, coinsurance, copayment, deductible, provider, or other underlined terms see the Glossary. You can view the Glossary at www.healthcare.gov/sbc-glossary or call Meritain Health, Inc. at (800) 925-2272 to request a copy. Important Questions Answers Why This Matters: What is the overall deductible? Generally, you must pay all of the costs from providers up to the deductible amount before this plan begins to pay. If you have other family members on the plan, each family member must meet their own individual deductible until the total amount of deductible expenses paid by all family members meets the overall family deductible.
For participating providers: $4,000 person / $8,000 family For non-participating providers: $10,000 person / $20,000 family Yes. For participating providers: Preventive care, urgent care office visit charges, rehabilitation services, habilitation services, routine eye exams and office visit charges are covered before you meet your deductible.
Are there services covered before you meet your deductible?
This plan covers some items and services even if you haven’t yet met the deductible amount. But a copayment or coinsurance may apply. For example, this plan covers certain preventive services without cost-sharing and before you meet your
deductible. See a list of covered preventive services at www.healthcare.gov/coverage/preventive-care-benefits/.
Are there other deductibles for specific services? What is the out-of-pocket limit for this plan?
No.
You don’t have to meet deductibles for specific services.
For participating providers: $7,150 person / $14,300 family For non-participating providers: $20,000 person / $40,000 family Premiums, preauthorization penalty amounts, balance billing charges and health care this plan doesn’t cover. Yes. See www.aetna.com / docfind/custom/my meritain or call (800) 343-3140 for a list of network providers.
The out-of-pocket limit is the most you could pay in a year for covered services. If you have other family members in this plan, they have to meet their own out-of- pocket limits until the overall family out-of-pocket limit has been met.
What is not included in the out-of-pocket limit?
Even though you pay these expenses, they don’t count toward the out-of-pocket limit.
Will you pay less if you use a network provider?
This plan uses a provider network. You will pay less if you use a provider in the plan ’s network. You will pay the most if you use an out-of-network provider, and you might receive a bill from a provider for the difference between the provider’s charge and what your plan pays (balance billing). Be aware, your network provider might use an out-of-network provider for some services (such as lab work). Check with your provider before you get services.
Do you need a referral to see a specialist?
No.
You can see the specialist you choose without a referral.
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All copayment and coinsurance costs shown in this chart are after your deductible has been met, if a deductible applies.
What You Will Pay
Common Medical Event
Limitations, Exceptions, & Other Important Information
Non-Participating Provider (You will pay the most)
Services You May Need
Participating Provider (You will pay the least) Office visits: No Charge (under age 19)/$15 copay/visit (age 19 & over)/20% coinsurance (all other services) $50 copay/visit (office visit)/ 2% coinsurance (all other services)
If you visit a health care provider’s office or clinic
Primary care visit to treat an injury or illness
50% coinsurance
Copay applies to the physician office visit only. Includes telemedicine. There is no charge and the deductible does not apply for services received at a MinuteClinic.
Specialist visit
50% coinsurance
Preventive care/screening/ immunization
No Charge
50% coinsurance
You may have to pay for services that aren’t preventive. Ask your provider if the services you need are preventive. Then check what your plan will pay for. Lab services limited to 18 presumptive drug tests and 18 definitive drug tests per year. Preauthorization required for PET scans and non- orthopedic CT/MRI’s. If you don't get preauthorization, non- participating provider benefits could be reduced by 50% of the total cost of the service. Deductible does not apply. Covers up to a 90-day supply (retail prescription); 90-day supply (Maintenance Choice Network (MCN) or mail order prescription); 30-day supply (specialty drugs). The copay applies per prescription. There is no charge for preventive drugs. Dispense as Written (DAW) provision applies. Specialty drugs must be obtained from the
If you have a test
Diagnostic test (x-ray, blood work)
20% coinsurance
50% coinsurance
Imaging (CT/PET scans, MRIs)
$500 copay/visit, then 50% coinsurance
$500 copay/visit, then 50% coinsurance
If you need drugs to treat your illness or condition More information about prescription drug coverage is available at www.caremark.com
Generic drugs
$20 copay (30-day retail)/$50 copay (90-day retail or MCN or mail order) $45 copay (30-day retail)/$112.50 copay (90- day retail or MCN or mail order)
Not Covered
Preferred brand drugs
Not Covered
Non-preferred brand drugs $80 copay (30-day
Not Covered
retail)/$200 copay (90-day
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What You Will Pay
Common Medical Event
Limitations, Exceptions, & Other Important Information
Non-Participating Provider (You will pay the most)
Services You May Need
Participating Provider (You will pay the least) retail or MCN or mail order) Paid the same as generic, preferred and non- preferred drugs (retail)
specialty pharmacy network. Certain specialty drugs are eligible for copay assistance programs through CVS True Accumulation Program. Preauthorization required for certain surgeries. If you don't get preauthorization, non-participating provider benefits could be reduced by 50% of the total cost of the service. See your plan document for a detailed listing. Non-participating providers paid at the participating provider level of benefits. Copay is waived if admitted to the hospital. Non-participating providers paid at the participating provider level of benefits for emergency services for ground & air ambulance and non-emergency services for air ambulance.
Specialty drugs
Not Covered
If you have outpatient surgery
Facility fee (e.g., ambulatory surgery center)
20% coinsurance
50% coinsurance
Physician/surgeon fees
20% coinsurance
50% coinsurance
If you need immediate medical attention
Emergency room care
$300 copay/visit, then 20% coinsurance
$300 copay/visit, then 20% coinsurance
Emergency medical transportation
20% coinsurance (emergency & non- emergency services- ground & air)
20% coinsurance (emergency services – ground & air)/ 20% coinsurance (non- emergency services - air)/50% coinsurance (non- emergency services – ground)
Urgent care
$25 copay/visit (office visit)/20% coinsurance (all other services)
50% coinsurance
Copay applies to the physician office visit only.
If you have a hospital stay
Facility fee (e.g., hospital room) Physician/surgeon fees
20% coinsurance
50% coinsurance
Preauthorization required. If you don't get preauthorization, non-participating providers benefits could be reduced by 50% of the total cost of the service.
20% coinsurance
50% coinsurance
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What You Will Pay
Common Medical Event
Limitations, Exceptions, & Other Important Information
Non-Participating Provider (You will pay the most)
Services You May Need
Participating Provider (You will pay the least)
If you need mental health, behavioral health, or substance abuse services
Outpatient services
Office visits: No Charge (under age 19)/$15 copay/visit (age 19 & over)/20% coinsurance (all other outpatient)
50% coinsurance
Includes telemedicine.
Inpatient services
20% coinsurance
50% coinsurance
Preauthorization required. If you don't get preauthorization, non-participating provider benefits could be reduced by 50% of the total cost of the service. Preauthorization required for inpatient hospital stays in excess of 48 hrs. (vaginal delivery) or 96 hrs. (c-section). If you don't get preauthorization, non- participating provider benefits could be reduced by 50% of the total cost of the service. Cost sharing does not apply to preventive services from a participating provider. Maternity care may include tests and services described elsewhere in the SBC (i.e. ultrasound). Baby counts towards the mother’s expense. Limited to 60 visits per year. Preauthorization required. If you don't get preauthorization, non-participating provider benefits could be reduced by 50% of the total cost of the service. Physical, occupational, cognitive, respiratory/pulmonary therapy limited to 20 visits per each type of therapy per year. Post-cochlear implant aural therapy limited to 30 visits per year. Cardia rehab limited to 36 visits per year.
If you are pregnant
Office visits
No Charge ($15 copay for initial visit)
50% coinsurance
Childbirth/delivery professional services
20% coinsurance
50% coinsurance
Childbirth/delivery facility services
20% coinsurance
50% coinsurance
If you need help recovering or have other special health needs
Home health care
20% coinsurance
50% coinsurance
Rehabilitation services
$15 copay/visit
50% coinsurance
Habilitation services
$15 copay/visit
50% coinsurance
----------------none----------------
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What You Will Pay
Common Medical Event
Limitations, Exceptions, & Other Important Information
Non-Participating Provider (You will pay the most)
Services You May Need
Participating Provider (You will pay the least)
Skilled nursing care
20% coinsurance
50% coinsurance
Limited to 60 days per year. Preauthorization required. If you don't get preauthorization, non-participating provider benefits could be reduced by 50% of the total cost of the service. Limited to 1 type of DME (including repair/replacement) every 3 years. Preauthorization required for electric/ motorized scooters or wheelchairs and pneumatic compression devices. If you don't get preauthorization, non- participating provider benefits could be reduced by 50% of the total cost of the service. Bereavement counseling is covered. Limited to 1 exam every 24 months.
Durable medical equipment 20% coinsurance
50% coinsurance
Hospice services
20% coinsurance $15 copay/visit
50% coinsurance 50% coinsurance
If your child needs dental or eye care
Children’s eye exam Children’s glasses
Not Covered Not Covered
Not Covered Not Covered
Not Covered Not Covered
Children’s dental check -up
Excluded Services & Other Covered Services: Services Your Plan Generally Does NOT Cover (Check your policy or plan document for more information and a list of any other excluded services.) • Acupuncture • Bariatric surgery • Cosmetic surgery • Dental care (Adult & Child) • Glasses (Adult & Child) • Infertility treatment • Long-term care • Non-emergency care when traveling outside the U.S. • Private-duty nursing (except for home health care & hospice) • Routine foot care (except for metabolic or peripheral vascular disease) • Weight loss programs Other Covered Services (Limitations may apply to these services. This isn’t a complete list. Please see your plan document.) • Chiropractic care • Hearing aids (1 aid per hearing impaired ear every 3 years) • Routine eye care (Adult & Child-1 exam every 24 months)
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Your Rights to Continue Coverage: There are agencies that can help if you want to continue your coverage after it ends. The contact information for those agencies is: the U.S. Department of Labor, Employee Benefits Security Administration at (866) 444-3272 or www.dol.gov/ebsa/healthreform or Rottler Pest Control Company at (314) 426-6100. Other coverage options may be available to you too, including buying individual insurance coverage through the Health Insurance Marketplace. For more information about the Marketplace, visit www.HealthCare.gov or call 1-800-318-2596. Your Grievance and Appeals Rights: There are agencies that can help if you have a complaint against your plan for a denial of a claim. This complaint is called a grievance or appeal. For more information about your rights, look at the explanation of benefits you will receive for that medical claim. Your plan documents also provide complete information on how to submit a claim, appeal, or a grievance for any reason to your plan. For more information about your rights, this notice, or assistance, contact the U.S. Department of Labor, Employee Benefits Security Administration at (866) 444-3272 or www.dol.gov/ebsa/healthreform or Rottler Pest Control Company at (314) 426-6100. Does this plan provide Minimum Essential Coverage? Yes Minimum Essential Coverage generally includes plans, health insurance available through the Marketplace or other individual market policies, Medicare, Medicaid, CHIP, TRICARE, and certain other coverage. If you are eligible for certain types of Minimum Essential Coverage, you may not be eligible for the premium tax credit.
Does this plan meet the Minimum Value Standards? Yes If your plan doesn’t meet the Minimum Value Standards, you may be eligible for a premium tax credit to help you pay for a plan through the Marketplace.
Language Access Services: Spanish (Español): Para obtener asistencia en Español, llame al 1-800-378-1179. Tagalog (Tagalog): Kung kailangan ninyo ang tulong sa Tagalog tumawag sa 1-800-378-1179. Chinese ( 中文 ): 如果需要中文的帮助， 请拨 打 这 个号 码 1-800-378-1179. Navajo (Dine): Dinek'ehgo shika at'ohwol ninisingo, kwiijigo holne' 1-800-378-1179.
To see examples of how this plan might cover costs for a sample medical situation, see the next section.
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About these Coverage Examples:
This is not a cost estimator. Treatments shown are just examples of how this plan might cover medical care. Your actual costs will be different depending on the actual care you receive, the prices your providers charge, and many other factors. Focus on the cost sharing amounts (deductibles, copayments and coinsurance) and excluded services under the plan. Use this information to compare the portion of costs you might pay under different health plans. Please note these coverage examples are based on self- only coverage.
Peg is Having a Baby (9 months of in-network pre-natal care and a hospital delivery)
Managing Joe’s Type 2 Diabetes (a year of routine in-network care of a well- controlled condition)
Mia’s Simple Fracture (in-network emergency room visit and follow up care)
◼ The plan’s overall deductible
◼ The plan’s overall deductible
◼ The plan’s overall deductible
$4,000
$4,000
$4,000
◼ Primary care physician coinsurance ◼ Hospital (facility) coinsurance
◼ Specialist copayment
◼ Specialist copayment
0%
$50
$50
◼ Hospital (facility) coinsurance
◼ Hospital (facility) copayment
20% 20%
20% 20%
$300 20%
◼ Other coinsurance
◼ Other coinsurance
◼ Other coinsurance
This EXAMPLE event includes services like: Primary care physician visits ( prenatal care) Childbirth/Delivery Professional Services Childbirth/Delivery Facility Services Diagnostic tests ( ultrasounds and blood work) Specialist visit (anesthesia)
This EXAMPLE event includes services like: Specialist office visits ( including disease education) Diagnostic tests (blood work) Prescription drugs Durable medical equipment (glucose meter)
This EXAMPLE event includes services like: Emergency room care (including medical supplies) Diagnostic test (x-ray)
Durable medical equipment (crutches) Rehabilitation services (physical therapy)
Total Example Cost
$12,700
Total Example Cost
$5,600
Total Example Cost
$2,800
In this example, Peg would pay: Cost Sharing Deductibles
In this example, Joe would pay: Cost Sharing Deductibles
In this example, Mia would pay: Cost Sharing Deductibles
$4,000
$900 $900
$2,100
Copayments Coinsurance
$10
Copayments Coinsurance
Copayments Coinsurance
$200
$1,700
$0
$0
What isn’t covered
What isn’t covered
What isn’t covered
Limits or exclusions
$60
Limits or exclusions
$20
Limits or exclusions
$0
The total Peg would pay is
$5,770
The total Mia would pay is
$2,300
The total Joe would pay is
$1,820
The plan would be responsible for the other costs of these EXAMPLE covered services.
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Summary of Benefits and Coverage: What this Plan Covers & What You Pay For Covered Services
Coverage Period: 01/01/2025 – 12/31/2025 Coverage for: Single + Family | Plan Type: HDHP
Rottler Pest Control Welfare Benefit Plan: HDHP Plan
The Summary of Benefits and Coverage (SBC) document will help you choose a health plan. The SBC shows you how you and the plan would share the cost for covered health care services. NOTE: Information about the cost of this plan (called the premium) will be provided separately. This is only a summary. For more information about your coverage, or to get a copy of the complete terms of coverage, go to www.meritain.com or call (314) 426-6100. For general definitions of common terms, such as allowed amount, balance billing, coinsurance, copayment, deductible, provider, or other underlined terms see the Glossary. You can view the Glossary at www.healthcare.gov/sbc-glossary or call Meritain Health, Inc. at (800) 925-2272 to request a copy. Important Questions Answers Why This Matters: What is the overall deductible? Generally, you must pay all of the costs from providers up to the deductible amount before this plan begins to pay. If you have other family members on the plan, each family member must meet their own individual deductible until the total amount of deductible expenses paid by all family members meets the overall family deductible.
For participating providers: $4,000 person / $8,000 family For non-participating providers: $10,000 person / $20,000 family Yes. For participating providers: Preventive care services are covered before you meet your deductible.
Are there services covered before you meet your deductible?
This plan covers some items and services even if you haven’t yet met the deductible amount. But a copayment or coinsurance may apply. For example, this plan covers certain preventive services without cost-sharing and before you meet your
deductible. See a list of covered preventive services at www.healthcare.gov/coverage/preventive-care-benefits/. You don’t have to meet deductibles for specific services.
Are there other deductibles for specific services? What is the out-of-pocket limit for this plan?
No.
For participating providers: $7,000 person / $14,000 family For non-participating providers: $20,000 person / $40,000 family Premiums, preauthorization penalty amounts, balance billing charges and health care this plan doesn’t cover. Yes. See www.aetna.com / docfind/custom/my meritain or call (800) 343-3140 for a list of network providers.
The out-of-pocket limit is the most you could pay in a year for covered services. If you have other family members in this plan, they have to meet their own out-of- pocket limits until the overall family out-of-pocket limit has been met.
What is not included in the out-of-pocket limit?
Even though you pay these expenses, they don’t count toward the out-of-pocket limit.
Will you pay less if you use a network provider?
This plan uses a provider network. You will pay less if you use a provider in the plan ’s network. You will pay the most if you use an out-of-network provider, and you might receive a bill from a provider for the difference between the provider’s charge and what your plan pays (balance billing). Be aware, your network provider might use an out-of-network provider for some services (such as lab work). Check with your provider before you get services.
Do you need a referral to see a specialist? Is a Health Savings Account (HSA) available under this plan option?
No.
You can see the specialist you choose without a referral.
Yes.
An HSA is an account that may be set up by you or your employer to help you plan for current and future health care costs. You may make contributions to the HSA up to a maximum amount set by the IRS.
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All copayment and coinsurance costs shown in this chart are after your deductible has been met, if a deductible applies.
What You Will Pay
Common Medical Event
Limitations, Exceptions, & Other Important Information
Non-Participating Provider (You will pay the most)
Services You May Need
Participating Provider (You will pay the least)
If you visit a health care provider’s office or clinic
Primary care visit to treat an injury or illness
20% coinsurance
50% coinsurance
Includes telemedicine. There is no charge after the deductible for services received at a MinuteClinic. You may have to pay for services that aren’t preventive. Ask your provider if the services you need are preventive. Then check what your plan will pay for. Lab services limited to 18 presumptive drug tests and 18 definitive drug tests per year. Preauthorization required for PET scans and non- orthopedic CT/MRI’s. If you don't get preauthorization, non- participating provider benefits could be reduced by 50% of the total cost of the service. Major medical deductible applies. Covers up to a 90-day supply (retail prescription); 90-day supply (Maintenance Choice Network (MCN) or mail order prescription); 30-day supply (specialty drugs). There is no charge for preventive drugs. Dispense as Written (DAW) provision applies. Specialty drugs must be obtained from the specialty pharmacy network. Certain specialty drugs are eligible for copay assistance programs through CVS True Accumulation Program.
Specialist visit
20% coinsurance
50% coinsurance 50% coinsurance
Preventive care/screening/ immunization
No Charge
If you have a test
Diagnostic test (x-ray, blood work)
20% coinsurance
50% coinsurance
Imaging (CT/PET scans, MRIs)
20% coinsurance
50% coinsurance
If you need drugs to treat your illness or condition More information about prescription drug coverage is available at www.caremark.com
Generic drugs
20% coinsurance (retail & MCN or mail order) 20% coinsurance(retail & MCN or mail order)
Not Covered
Preferred brand drugs
Not Covered
Non-preferred brand drugs 20% coinsurance(retail & MCN or mail order)
Not Covered
Specialty drugs
20% coinsurance
Not Covered
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What You Will Pay
Common Medical Event
Limitations, Exceptions, & Other Important Information
Non-Participating Provider (You will pay the most)
Services You May Need
Participating Provider (You will pay the least)
If you have outpatient surgery
Facility fee (e.g., ambulatory surgery center)
20% coinsurance
50% coinsurance
Preauthorization required for certain surgeries. If you don't get preauthorization, non-participating provider benefits could be reduced by 50% of the total cost of the service. See your plan document for a detailed listing. Non-participating providers paid at the participating provider level of benefits. Non-participating providers paid at the participating provider level of benefits for emergency services for ground & air ambulance and non-emergency services for air ambulance.
Physician/surgeon fees
20% coinsurance
50% coinsurance
If you need immediate medical attention
Emergency room care
20% coinsurance
20% coinsurance
Emergency medical transportation
20% coinsurance (emergency & non- emergency services- ground & air)
20% coinsurance (emergency services – ground & air)/ 20% coinsurance (non-
emergency services - air)/50% coinsurance (non-emergency services – ground)
Urgent care
20% coinsurance 20% coinsurance
50% coinsurance 50% coinsurance
----------------none----------------
If you have a hospital stay
Facility fee (e.g., hospital room) Physician/surgeon fees
Preauthorization required. If you don't get preauthorization, non-participating providers benefits could be reduced by 50% of the total cost of the service.
20% coinsurance
50% coinsurance
If you need mental health, behavioral health, or substance abuse services
Outpatient services
20% coinsurance
50% coinsurance
Includes telemedicine.
Inpatient services
20% coinsurance
50% coinsurance
Preauthorization required. If you don't get preauthorization, non-participating provider benefits could be reduced by 50% of the total cost of the service. Preauthorization required for inpatient hospital stays in excess of 48 hrs. (vaginal delivery) or 96 hrs. (c-section). If you don't get preauthorization, non- participating provider benefits could be reduced by 50% of the total cost of the service. Cost sharing does not apply to preventive services from a
If you are pregnant
Office visits
20% coinsurance
50% coinsurance
Childbirth/delivery professional services
20% coinsurance
50% coinsurance
Childbirth/delivery facility services
20% coinsurance
50% coinsurance
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What You Will Pay
Common Medical Event
Limitations, Exceptions, & Other Important Information
Non-Participating Provider (You will pay the most)
Services You May Need
Participating Provider (You will pay the least)
participating provider. Maternity care may include tests and services described elsewhere in the SBC (i.e. ultrasound). Baby does not count toward the mother’s expense; therefore the family deductible amount may apply. Limited to 60 visits per year. Preauthorization required. If you don't get preauthorization, non-participating provider benefits could be reduced by 50% of the total cost of the service. Physical, occupational, cognitive, respiratory/pulmonary therapy limited to 20 visits per each type of therapy per year. Post-cochlear implant aural therapy limited to 30 visits per year. Cardia rehab limited to 36 visits per year.
If you need help recovering or have other special health needs
Home health care
20% coinsurance
50% coinsurance
Rehabilitation services
20% coinsurance
50% coinsurance
Habilitation services Skilled nursing care
20% coinsurance 20% coinsurance
50% coinsurance 50% coinsurance
----------------none----------------
Limited to 60 days per year. Preauthorization required. If you don't get preauthorization, non-participating provider benefits could be reduced by 50% of the total cost of the service. Limited to 1 type of DME (including repair/replacement) every 3 years. Preauthorization required for electric/ motorized scooters or wheelchairs and pneumatic compression devices. If you don't get preauthorization, non- participating provider benefits could be reduced by 50% of the total cost of the service. Bereavement counseling is covered. Limited to 1 exam every 24 months.
Durable medical equipment 20% coinsurance
50% coinsurance
Hospice services
20% coinsurance
50% coinsurance 50% coinsurance
Children’s eye exam
No Charge
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What You Will Pay
Common Medical Event
Limitations, Exceptions, & Other Important Information
Non-Participating Provider (You will pay the most)
Services You May Need
Participating Provider (You will pay the least)
Children’s glasses
Not Covered Not Covered
Not Covered Not Covered
Not Covered Not Covered
If your child needs dental or eye care
Children’s dental check-up
Excluded Services & Other Covered Services: Services Your Plan Generally Does NOT Cover (Check your policy or plan document for more information and a list of any other excluded services.) • Acupuncture • Bariatric surgery • Cosmetic surgery • Dental care (Adult & Child) • Glasses (Adult & Child) • Infertility treatment • Long-term care • Non-emergency care when traveling outside the U.S. • Private-duty nursing (except for home health care & hospice) • Routine foot care (except for metabolic or peripheral vascular disease) • Weight loss programs Other Covered Services (Limitations may apply to these services. This isn’t a complete list. Please see your plan document.) • Chiropractic care • Hearing aids (1 aid per hearing impaired ear every 3 years) • Routine eye care (Adult & Child) Your Rights to Continue Coverage: There are agencies that can help if you want to continue your coverage after it ends. The contact information for those agencies is: the U.S. Department of Labor, Employee Benefits Security Administration at (866) 444-3272 or www.dol.gov/ebsa/healthreform or Rottler Pest Control Company at (314) 426-6100. Other coverage options may be available to you too, including buying individual insurance coverage through the Health Insurance Marketplace. For more information about the Marketplace, visit www.HealthCare.gov or call 1-800-318-2596. Your Grievance and Appeals Rights: There are agencies that can help if you have a complaint against your plan for a denial of a claim. This complaint is called a grievance or appeal. For more information about your rights, look at the explanation of benefits you will receive for that medical claim. Your plan documents also provide complete information on how to submit a claim, appeal, or a grievance for any reason to your plan. For more information about your rights, this notice, or assistance, contact the U.S. Department of Labor, Employee Benefits Security Administration at (866) 444-3272 or www.dol.gov/ebsa/healthreform or Rottler Pest Control Company at (314) 426-6100. Does this plan provide Minimum Essential Coverage? Yes Minimum Essential Coverage generally includes plans, health insurance available through the Marketplace or other individual market policies, Medicare, Medicaid, CHIP, TRICARE, and certain other coverage. If you are eligible for certain types of Minimum Essential Coverage, you may not be eligible for the premium tax credit.
Does this plan meet the Minimum Value Standards? Yes If your plan doesn’t meet the Minimum Value Standards, you may be eligible for a premium tax credit to help you pay for a plan through the Marketplace.
Language Access Services: Spanish (Español): Para obtener asistencia en Español, llame al 1-800-378-1179.
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Tagalog (Tagalog): Kung kailangan ninyo ang tulong sa Tagalog tumawag sa 1-800-378-1179. Chinese ( 中文 ): 如果需要中文的帮助， 请拨 打 这 个号 码 1-800-378-1179. Navajo (Dine): Dinek'ehgo shika at'ohwol ninisingo, kwiijigo holne' 1-800-378-1179.
To see examples of how this plan might cover costs for a sample medical situation, see the next section.
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About these Coverage Examples:
This is not a cost estimator. Treatments shown are just examples of how this plan might cover medical care. Your actual costs will be different depending on the actual care you receive, the prices your providers charge, and many other factors. Focus on the cost sharing amounts (deductibles, copayments and coinsurance) and excluded services under the plan. Use this information to compare the portion of costs you might pay under different health plans. Please note these coverage examples are based on self- only coverage.
Peg is Having a Baby (9 months of in-network pre-natal care and a hospital delivery) $4,000 ◼ Primary care physician coinsurance 20% ◼ Hospital (facility) coinsurance 20% ◼ Other coinsurance 20% ◼ The plan’s overall deductible This EXAMPLE event includes services like: Primary care physician visits ( prenatal care) Childbirth/Delivery Professional Services Childbirth/Delivery Facility Services Diagnostic tests ( ultrasounds and blood work) Specialist visit (anesthesia)
Managing Joe’s Type 2 Diabetes (a year of routine in-network care of a well- controlled condition)
Mia’s Simple Fracture (in-network emergency room visit and follow up care)
◼ The plan’s overall deductible
◼ The plan’s overall deductible
$4,000
$4,000
◼ Specialist coinsurance
◼ Specialist coinsurance
20% 20% 20%
20% 20% 20%
◼ Hospital (facility) coinsurance
◼ Hospital (facility) coinsurance
◼ Other coinsurance
◼ Other coinsurance
This EXAMPLE event includes services like: Specialist office visits ( including disease education) Diagnostic tests (blood work) Prescription drugs Durable medical equipment (glucose meter)
This EXAMPLE event includes services like: Emergency room care (including medical supplies) Diagnostic test (x-ray)
Durable medical equipment (crutches) Rehabilitation services (physical therapy)
Total Example Cost
$12,700
Total Example Cost
$5,600
Total Example Cost
$2,800
In this example, Peg would pay: Cost Sharing Deductibles
In this example, Joe would pay: Cost Sharing Deductibles
In this example, Mia would pay: Cost Sharing Deductibles
$4,000
$4,000
$2,800
Copayments Coinsurance
$0
Copayments Coinsurance
$0
Copayments Coinsurance
$0 $0
$1,700
$300
What isn’t covered
What isn’t covered
What isn’t covered
Limits or exclusions
$60
Limits or exclusions
$20
Limits or exclusions
$0
The total Peg would pay is
$5,760
The total Mia would pay is
$2,800
The total Joe would pay is
$4,320
The plan would be responsible for the other costs of these EXAMPLE covered services.
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Summary of Benefits and Coverage: What this Plan Covers & What You Pay For Covered Services
Coverage Period: 01/01/2025 – 12/31/2025 Coverage for: Single + Family | Plan Type: POS
Rottler Pest Control Welfare Benefit Plan: Buy Up Plan
The Summary of Benefits and Coverage (SBC) document will help you choose a health plan. The SBC shows you how you and the plan would share the cost for covered health care services. NOTE: Information about the cost of this plan (called the premium) will be provided separately. This is only a summary. For more information about your coverage, or to get a copy of the complete terms of coverage, go to www.meritain.com or call (314) 426-6100. For general definitions of common terms, such as allowed amount, balance billing, coinsurance, copayment, deductible, provider, or other underlined terms see the Glossary. You can view the Glossary at www.healthcare.gov/sbc-glossary or call Meritain Health, Inc. at (800) 925-2272 to request a copy. Important Questions Answers Why This Matters: What is the overall deductible? Generally, you must pay all of the costs from providers up to the deductible amount before this plan begins to pay. If you have other family members on the plan, each family member must meet their own individual deductible until the total amount of deductible expenses paid by all family members meets the overall family deductible.
For participating providers: $3,000 person / $6,000 family For non-participating providers: $7,500 person / $15,000 family Yes. For participating providers: Preventive care, urgent care office visit charges, rehabilitation services, habilitation services, routine eye exams and office visit charges are covered before you meet your deductible.
Are there services covered before you meet your deductible?
This plan covers some items and services even if you haven’t yet met the deductible amount. But a copayment or coinsurance may apply. For example, this plan covers certain preventive services without cost-sharing and before you meet your
deductible. See a list of covered preventive services at www.healthcare.gov/coverage/preventive-care-benefits/.
Are there other deductibles for specific services? What is the out-of-pocket limit for this plan?
No.
You don’t have to meet deductibles for specific services.
For participating providers: $6,000 person / $12,000 family For non-participating providers: $15,000 person / $30,000 family Premiums, preauthorization penalty amounts, balance billing charges and health care this plan doesn’t cover. Yes. See www.aetna.com / docfind/custom/my meritain or call (800) 343-3140 for a list of network providers.
The out-of-pocket limit is the most you could pay in a year for covered services. If you have other family members in this plan, they have to meet their own out-of- pocket limits until the overall family out-of-pocket limit has been met.
What is not included in the out-of-pocket limit?
Even though you pay these expenses, they don’t count toward the out-of-pocket limit.
Will you pay less if you use a network provider?
This plan uses a provider network. You will pay less if you use a provider in the plan ’s network. You will pay the most if you use an out-of-network provider, and you might receive a bill from a provider for the difference between the provider’s charge and what your plan pays (balance billing). Be aware, your network provider might use an out-of-network provider for some services (such as lab work). Check with your provider before you get services.
Do you need a referral to see a specialist?
No.
You can see the specialist you choose without a referral.
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All copayment and coinsurance costs shown in this chart are after your deductible has been met, if a deductible applies.
What You Will Pay
Common Medical Event
Limitations, Exceptions, & Other Important Information
Non-Participating Provider (You will pay the most)
Services You May Need
Participating Provider (You will pay the least) Office visits: No Charge (under age 19)/$15 copay/visit (age 19 & over)/ 20% coinsurance (all other services) $50 copay/visit (office visit)/ 2% coinsurance (all other services)
If you visit a health care provider’s office or clinic
Primary care visit to treat an injury or illness
50% coinsurance
Copay applies to the physician office visit only. Includes telemedicine. There is no charge and the deductible does not apply for services received at a MinuteClinic.
Specialist visit
50% coinsurance
Preventive care/screening/ immunization
No Charge
50% coinsurance
You may have to pay for services that aren’t preventive. Ask your provider if the services you need are preventive. Then check what your plan will pay for. Lab services limited to 18 presumptive drug tests and 18 definitive drug tests per year. Preauthorization required for PET scans and non- orthopedic CT/MRI’s. If you don't get preauthorization, non- participating provider benefits could be reduced by 50% of the total cost of the service. Deductible does not apply. Covers up to a 90-day supply (retail prescription); 90-day supply (Maintenance Choice Network (MCN) or mail order prescription); 30-day supply (specialty drugs). The copay applies per prescription. There is no charge for preventive drugs. Dispense as Written (DAW) provision applies. Specialty drugs must be obtained from the
If you have a test
Diagnostic test (x-ray, blood work)
20% coinsurance
50% coinsurance
Imaging (CT/PET scans, MRIs)
$500 copay/visit, then 50% coinsurance
$500 copay/visit, then 50% coinsurance
If you need drugs to treat your illness or condition More information about prescription drug coverage is available at www.caremark.com
Generic drugs
$20 copay (30-day retail)/$50 copay (90-day retail or MCN or mail order) $45 copay (30-day retail)/$112.50 copay (90- day retail or MCN or mail order)
Not Covered
Preferred brand drugs
Not Covered
Non-preferred brand drugs $80 copay (30-day
Not Covered
retail)/$200 copay (90-day
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What You Will Pay
Common Medical Event
Limitations, Exceptions, & Other Important Information
Non-Participating Provider (You will pay the most)
Services You May Need
Participating Provider (You will pay the least) retail or MCN or mail order) Paid the same as generic, preferred and non- preferred drugs (retail)
specialty pharmacy network. Certain specialty drugs are eligible for copay assistance programs through CVS True Accumulation Program. Preauthorization required for certain surgeries. If you don't get preauthorization, non-participating provider benefits could be reduced by 50% of the total cost of the service. See your plan document for a detailed listing. Non-participating providers paid at the participating provider level of benefits. Copay is waived if admitted to the hospital. Non-participating providers paid at the participating provider level of benefits for emergency services for ground & air ambulance and non-emergency services for air ambulance.
Specialty drugs
Not Covered
If you have outpatient surgery
Facility fee (e.g., ambulatory surgery center)
20% coinsurance
50% coinsurance
Physician/surgeon fees
20% coinsurance
50% coinsurance
If you need immediate medical attention
Emergency room care
$300 copay/visit, then 20% coinsurance
$300 copay/visit, then 20% coinsurance
Emergency medical transportation
20% coinsurance (emergency & non- emergency services - ground and air)
20% coinsurance (emergency services – ground & air)/ 20% coinsurance (non- emergency services - air)/50% coinsurance (non- emergency services – ground)
Urgent care
$25 copay/visit (office visit)/ 20% coinsurance (all other services)
50% coinsurance
Copay applies to the physician office visit only.
If you have a hospital stay
Facility fee (e.g., hospital room) Physician/surgeon fees
20% coinsurance
50% coinsurance
Preauthorization required. If you don't get preauthorization, non-participating providers benefits could be reduced by 50% of the total cost of the service.
20% coinsurance
50% coinsurance
If you need mental health, behavioral health, or substance abuse services
Outpatient services
Office visits: No Charge (under age 19)/$15 copay/visit (age 19 & over)/20% coinsurance (all other outpatient)
50% coinsurance
Includes telemedicine.
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What You Will Pay
Common Medical Event
Limitations, Exceptions, & Other Important Information
Non-Participating Provider (You will pay the most)
Services You May Need
Participating Provider (You will pay the least)
Inpatient services
20% coinsurance
50% coinsurance
Preauthorization required. If you don't get preauthorization, non-participating provider benefits could be reduced by 50% of the total cost of the service. Preauthorization required for inpatient hospital stays in excess of 48 hrs. (vaginal delivery) or 96 hrs. (c-section). If you don't get preauthorization, non- participating provider benefits could be reduced by 50% of the total cost of the service. Cost sharing does not apply to preventive services from a participating provider. Maternity care may include tests and services described elsewhere in the SBC (i.e. ultrasound). Baby counts towards the mother’s expense. Limited to 60 visits per year. Preauthorization required. If you don't get preauthorization, non-participating provider benefits could be reduced by 50% of the total cost of the service. Physical, occupational, cognitive, respiratory/pulmonary therapy limited to 20 visits per each type of therapy per year. Post-cochlear implant aural therapy limited to 30 visits per year. Cardia rehab limited to 36 visits per year.
If you are pregnant
Office visits
No Charge ($15 copay for initial visit)
50% coinsurance
Childbirth/delivery professional services
20% coinsurance
50% coinsurance
Childbirth/delivery facility services
20% coinsurance
50% coinsurance
If you need help recovering or have other special health needs
Home health care
20% coinsurance
50% coinsurance
Rehabilitation services
$15 copay/visit
50% coinsurance
Habilitation services Skilled nursing care
$15 copay/visit 20% coinsurance
50% coinsurance 50% coinsurance
----------------none----------------
Limited to 60 days per year. Preauthorization required. If you don't get preauthorization, non-participating provider benefits could be reduced by 50% of the total cost of the service.
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