Toyoda Gosei Americas

US Healthcare Benefits Information

Toyoda Gosei provides you with an excellent healthcare benefits package. We offer two options for your medical care. Our Prime Plan is a traditional PPO plan with a $750 deductible and 80%/20% coinsurance. Our Optimal HSA plan is a High Deductible Health Plan (HDHP) that is paired with a Healthcare Savings Account (HSA). This plan has a $1,600 deducible with 80%/20% coinsurance. Toyoda Gosei also contributes funds into your HSA.

Other plan information you will find here includes Dental, Vision, Virtual Visits and Prescription coverages.

See full details of the plan in the grids and PDF links below.

For Contact Information, please click here.

To view the 2024 Benefits Guide in English, please click here.

To view the 2024 Benefits Guide in Spanish, please click here.

To view the 2024 New Hire Video, please click here.

To view the bswift How to Guide in English, please click here.

To view the bswift How to Guide in Spanish, please click here.

Are your beneficiaries up to date?

It is a good idea to check your beneficiaries once a year, but especially important if you have any life events to ensure that your beneficiaries listed for your life insurance and 401K are still correct! To change your beneficiaries on your 401K, login to your account at myadp.com. You can check your life insurance beneficiaries by logging in to your account at tggroupbenefits.bswift.com.

MEDICAL PLAN SUMMARY

	OPTIMAL PLAN $1,600/$3,200 DEDUCTIBLE		PRIME PLAN $750/$1,500 DEDUCTIBLE
HEALTH SAVINGS ACCOUNT
HSA Eligible	Yes		No
HSA Employer Funding	$650/Individual \| $1,300/Family		Not applicable
	IN-NETWORK	OUT-OF-NETWORK	IN-NETWORK	OUT-OF-NETWORK
ANNUAL DEDUCTIBLE
Individual	$1,600	$3,000	$750	$1,000
Family	$3,200	$6,000	$1,500	$2,000
OUT-OF-POCKET MAXIMUM
Individual	$3,000	$7,500	$3,500	$7,500
Family	$6,000	$15,000	$7,000	$15,000
Rx	Not applicable	Not applicable	$3,000/Individual \| $6,000/Family	Not applicable
MEDICAL BENEFIT COVERAGE
Your Coinsurance	20%**	40%**	20%**	40%**
Preventive Care	100% covered	40%**	100% covered	40%**
Primary Care Visit	20%**	40%**	$20 copay*	40%**
Specialist Visit	20%**	40%**	$40 copay*	40%**
Behavioral Health Visit	20%**	40%**	$40 copay*	40%**
Outpatient Behavioral Health Visit	20%**	40%**	$40 copay*	40%**
Virtual Office Visit	$49 before Deductible, after deductible the cost is $0.	Not applicable	100% covered	Not applicable
Urgent Care	20%**	40%**	$25 copay*	40%**
Inpatient Hospital	20%**	40%**	20%**	40%**
Outpatient Hospital	20%**	40%**	20%**	40%**
Emergency Room	20%**	20%**	$300 – waived if admitted	$300 – waived if admitted

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prescription PLAN SUMMARY

	OPTIMAL PLAN $1,600/$3,200 DEDUCTIBLE		PRIME PLAN $750/$1,500 DEDUCTIBLE

Out Of Pocket Rx Max	Not applicable	Not applicable	$3,500/Individual $7,000/Family	Not applicable
RETAIL PRESCRIPTIONS (30-DAY SUPPLY)
Tier 1 Generic	20%** ($10 min/ $20 max)	Not covered	$10 copay*	Not covered
Tier 2 Preferred Brand	20%** ($25 min/ $50 max)	Not covered	$30 copay*	Not covered
Tier 3 Non-Preferred Brand	20%** ($50 min/ $100 max)	Not covered	$50 copay*	Not covered
Tier 4 Specialty	20%** ($100 min/ $200 max)	Not covered	$100 copay*	Not covered
MAIL-ORDER PRESCRIPTIONS (90-DAY SUPPLY)
Tier 1 Generic	20%** ($20 min/ $40 max)	Not covered	$20 copay*	Not covered
Tier 2 Preferred Brand	20%** ($50 min/ $100 max)	Not covered	$60 copay*	Not covered
Tier 3 Non-Preferred Brand	20%** ($100 min/ $200 max)	Not covered	$100 copay*	Not covered

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*Deductible does not apply | **After Deductilbe

DENTAL PLAN SUMMARY

(The following benefits are included in your plan options. Unless otherwise noted, benefits are per insured person and after deductible.)

	PREMIER WITH ORTHODONTIA
ANNUAL DEDUCTIBLE
Eligibility	Eligible children to age 26
Individual	$0
Family	$0
BENEFIT MAXIMUM
Annual Maximum	$1,200
DENTAL BENEFIT COVERAGE
Preventive Services	Plan pays 100%*
Basic Services	Plan pays 80%
Major Services	Plan pays 50%
ORTHODONTIA
Benefit Coverage	Plan pays 50%
Lifetime Maximum	$1,200
Eligibility	Eligible children to age 19

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Vision PLAN SUMMARY

(The following in-network benefits are included in your plan options. Unless otherwise noted, benefits are per insured person. Please refer to plan documents for out-of-network benefits.)

	Standard
	COPAY	FREQUENCY
Exam	$10	Once per calendar year
Lenses	$25	Once per calendar year
Contact Lens Fitting	Not to exceed $60	Once per calendar year
	RETAIL ALLOWANCE	FREQUENCY
Frames	Up to $150**	Once per calendar year
Contact Lenses	Up to $150**	Once per calendar year

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*Contact lens coverage provided in lieu of frames and lenses | **20% off any amount over the retail allowance

Medical Plan Rates (per pay period)

	OPTIMAL PLAN $1,500/$3,000 DEDUCTIBLE		PRIME PLAN $750/$1,500 DEDUCTIBLE

	Non tobacco user	Tobacco User	non tobacco user	Tobacco User
Employee Only	$0	$10	$31	$41
Employee + Spouse	$3	$13	$113	$123
Employee + Child(ren)	$2	$12	$59	$69
Employee + Family	$5	$15	$142	$152

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Dental Plan Rates (per pay period)

	Basic Plus
Employee Only	$1
Employee + Spouse	$3
Employee + Child(ren)	$3
Employee + Family	$4

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Vision Plan Rates (per pay period)

	Standard
Employee Only	$0
Employee + Spouse	$2
Employee + Child(ren)	$2
Employee + Family	$3

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Downloadable Links

US Healthcare Benefits Information

Are your beneficiaries up to date?

MEDICAL PLAN SUMMARY

prescription PLAN SUMMARY

DENTAL PLAN SUMMARY

Vision PLAN SUMMARY

Medical Plan Rates (per pay period)

Dental Plan Rates (per pay period)

Vision Plan Rates (per pay period)

Downloadable Links

Delta Dental

EyeMed

OPTUMRX

United Health Care (UHC)