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Tiffany & O'shea
Tiffany & O'shea, Inc
Employee Benefit Programs
Documents and Resources November 2024 - October 2025
Providence Health Plan
Connect 6000 Benefit Summary
Connect 6000 Summary of Benefits and Coverage
Total Enhanced 500 Platinum Benefit Summary
Total Enhanced 500 Platinum Summary of Benefits and Coverage
Enrollment/Change Form
- Connect
Enrollment/Change Form - Total Enhanced
Provider directory
Pharmacy resources
About Providence
Customer Service
MyProvidence
MyChart
LifeBalance
Virtual Care
How to use your benefits
ProvRN
Employee Assistance Program
Companion Life Dental
Employee Enrollment Form
Benefit Summary
Find a Dentist
Employee Online Account Access
Notices
ACA Exchange Model Notice
Medicare Creditable Pharmacy Disclosure - Connect 6000 Silver
Medicare Creditable Pharmacy Disclosure
- Total Enhanced 500 Platinum
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
24 hours per week on a regularly scheduled basis
Coverage begins on the first of the month following date of hire
Open enrollment is from October 1st through October 31st for a November 1st start date
Employer pays 50% for employee only on the Providence Connect 6000 plan, and employees can enroll in the Total Enhanced Platinum 500 Plan with additional premium contribution
Employer pays 50% for employee on the Companion Life dental plan
Employees may enroll dependents on the plan with premium contributions
Premium Contribution Summary
IRS Forms
Form W-4
Form I-9
Account Manager and Support Staff Contact Information
Paris Laughlin - Agent
Katie Ostgarden - Account Manager
Sarah Selix - Assistant