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Backyard Brick Oven Pizza and Sports Pub
Backyard Brick Oven Pizza
Employee Benefit Programs
Documents and Resources September 2022 -August 2023
Providence Health Plan
Standard Bronze Benefit Summary
Standard Bronze Summary of Benefits and Coverage
Standard Silver Benefit Summary
Standard Silver Summary of Benefits and Coverage
Standard Gold Benefit Summary
Standard Gold Summary of Benefits and Coverage
Enrollment/Change Form
Provider directory
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LifeBalance
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ProvRN
Notices
ACA Model Notice
Medicare Creditable Pharmacy Disclosure
Standard Gold
Medicare Creditable Pharmacy Disclosure Standard Silver
Medicare Non-Creditable Pharmacy Disclosure Standard Bronze
Paid Leave Model Notice-Poster
Eligibility and Contribution
30 hours per week on a regularly scheduled basis
Coverage begins first of the month following 60 days of working the required amount of hours
Open enrollment is from Aug 1 through Aug 15 annual for Sept 1 start date
Employer pays 50% for employee only on the Providence Standard Bronze Plan
Employees may enroll dependents on the plan with premium contributions
The Providence health plans renew on September 1st each year
Premium Contribution Reference Shee
t
Account Manager and Support Staff Contact Information
Contact Paris Laughlin - Agent
Contact Katie Ostgarden - Account Manager
Contact Sarah Selix - Assistant