_private/qwestly-private-docs/HR/Benefits/medical-benefits.md
Table of Contents
QWESTLY MEDICAL BENEFITS
Effective Date: November 1, 2026 Plan Year: November 1, 2026 – October 31, 2027 Provider: Anthem (administered via Gusto) Version: 1.0
Overview
Qwestly offers comprehensive medical insurance through Anthem, administered via Gusto. All benefits-eligible employees may enroll in the base plan, and may choose to upgrade to a higher-tier plan at their own cost for the premium difference.
Eligibility & Waiting Period
Eligibility
All full-time W-2 employees are eligible for medical benefits.
Waiting Period
Benefits begin on the 1st of the month on or following 1 month after hire.
| Hire Date | Benefits Effective |
|---|---|
| January 10 | March 1 |
| March 1 | April 1 |
| August 28 | October 1 |
Dependents
Eligible dependents include:
- Legal spouse
- Children under age 26
Plan Options
Base Plan
| Plan Name | Anthem Gold PPO |
| Plan Code | 5/1500/30% 8V7T |
| Type | PPO (Preferred Provider Organization) |
Plan Details
Cost Sharing
| Deductible (Individual) | $1,500 |
| Max Out-of-Pocket | $8,100 |
| Co-Insurance | 30% (plan pays 70% after deductible) |
Doctor Visits
| Service | Your Cost |
|---|---|
| Preventative Care | $0 (no deductible) |
| Primary Physician Office Visit | $5 |
| Specialist Office Visit | $65 |
| Urgent Care | $5 |
Facilities
| Service | Your Cost |
|---|---|
| Emergency Room | $250 copay, then 30% coinsurance |
| Inpatient Facility | 30% coinsurance (after deductible) |
| Surgery | 30% coinsurance (after deductible) |
Prescription Drug Coverage
| Drug Deductible | $0 |
| Generic Drugs | $5 per script (after deductible) |
| Preferred Brand Drugs | $60 per script (after deductible) |
Note: 30% coinsurance applies after the deductible is met. All coverages are subject to the terms, conditions, and exclusions of the actual policy. See the full plan document for complete details.
Other Plan Tiers
Employees may choose a higher-tier plan (e.g., Platinum PPO). The company contribution is capped at the base plan level — you pay the difference in premium if you select a more expensive plan. Contact HR for current plan options and pricing.
Company Contribution
Qwestly contributes separately to employees' and dependents' premiums:
| Coverage | Company Contribution |
|---|---|
| Employee | 75% of the base plan premium |
| Dependents | 50% of the base plan premium |
How it works:
- If you enroll in the base plan (Anthem Gold PPO), the company pays 75% of your employee premium and 50% of any dependent premium. You pay the remainder.
- If you choose a more expensive plan, the company contribution stays fixed at the base plan amounts. You pay the difference in premium plus your normal share.
Monthly Premiums — Base Plan (Anthem Gold PPO)
Premiums for the 2026–2027 plan year:
| Employee | Employee Premium | Dependent Premium | Total Premium | Employee Pays | Company Pays |
|---|---|---|---|---|---|
| Yuan Gao | $781.32 | $0.00 | $781.32 | $195.33 | $585.99 |
| Adam Boender | $1,076.55 | $0.00 | $1,076.55 | $269.14 | $807.41 |
| Dominick Pham | $952.79 | $2,651.85 | $3,604.64 | $1,564.13 | $2,040.51 |
| Mikelle Masciantonio | $911.04 | $0.00 | $911.04 | $227.76 | $683.28 |
| David Hsu | $810.39 | $0.00 | $810.39 | $202.60 | $607.79 |
| Total | $4,532.09 | $2,651.85 | $7,183.94 | $2,458.96 | $4,724.98 |
Note: Premiums vary by age, location, and coverage tier. Your exact premium will be shown during enrollment in Gusto. Premiums are deducted pre-tax through payroll on a monthly basis.
Enrollment
New Hires
You'll receive a Gusto enrollment invitation after your hire date. You have 30 days from your benefits effective date to enroll. If you miss the window, you must wait until the next open enrollment period unless you have a qualifying life event.
Open Enrollment
Open enrollment is held annually before the plan renewal date (November 1). You'll receive communication via Gusto with instructions and deadlines.
Mid-Year Changes
You may change your election outside of open enrollment only with a qualifying life event, such as:
- Marriage or divorce
- Birth or adoption of a child
- Loss of other coverage
- Change in spouse's employment status
You have 30 days from the qualifying event to make changes in Gusto.
How to Access Your Benefits
- ID Card: Anthem will mail a physical insurance card to your address on file. You can also access a digital card via the Anthem Sydney Health app.
- Find a Doctor: Visit anthem.com or use the Sydney Health app to search for in-network providers.
- Claims & Coverage: Log in to your Anthem member account to view claims, deductibles, and benefits usage.
Key Contacts
| Benefits Administration | Gusto (enrollment, premiums, life events) |
| Insurance Provider | Anthem Blue Cross (claims, coverage, ID cards) |
| HR Questions | hr@qwestly.com |
Full Plan Documents
This document is a summary of benefits and is not a substitute for the official plan documents. In the event of any discrepancy, the official plan documents govern.