Caerus Insurance

Caerus Insurance
Employee Benefit Programs
Documents and Resources
October 1, 2025 to September 30, 2026

Providence Health Plan
Connect 4000 Silver Benefit Summary
Connect 4000 Silver Summary of Benefits and Coverage
Advantage Access Dental Benefit Summary
Enrollment/Change Form
Provider directory – Connect
Pharmacy resources
About Providence
Customer Service
MyProvidence
MyChart
LifeBalance
Virtual Care
How to use your benefits
ProvRN

125b Cafeteria Plan
125b Summary Plan Description
Pre-Tax Savings Calculator

Notices
ACA Exchange Model Notice
Erisa Wrap Document
Medicare Creditable Pharmacy Disclosure
Primary Care Provider Model Disclosure
Notice of Rights Under The Women’s Health and Cancer Rights Act (WHCRA)
HIPAA Special Enrollment Rights Notice
Premium Assistance under Medicaid and the Children’s Health Insurance Program (CHIP)
Notice Regarding Patient Protections Against Surprise Billing
Paid Leave Model Notice-Poster

Eligibility and Contribution
40 hours per week on a regularly scheduled basis
Coverage begins first of the month following 90 days of working the required amount of hours
Open enrollment is from September 1 through September 30 for an October 1 start date annually
Employer pays 100% for employee premium on the Providence Connect 2500 Gold and Advantage Access Dental plan
Employees can enroll in the Providence Balance 2500 plan with premium contributions
Dependents are not eligible for medical or dental coverage
Premium Contributions Summary

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