2027 Benefits FAQs

Starting January 1, 2027, Pye-Barker will offer the Buy-Up Plan, Copay Plan and Base HDHP, each covering medical care and prescriptions. The changes aim to make benefits more consistent, manage costs through fair pricing and provide more hands-on support. Choose your medical coverage in Workday during Annual Enrollment, November 2–13, 2026.

Pye-Barker pays covered medical claims. Imagine360 administers the plan, reviews claims and arranges provider payments. Quantum Health helps you understand benefits and find care. Tell providers you have Pye-Barker’s medical plan, administered by Imagine360, and ask them to follow your ID card’s billing instructions.

Review the 2027 Benefits Guide and each plan’s Summary of Benefits and Coverage (SBC) on this microsite or in Workday. During Annual Enrollment, November 2–13, 2026, Workday will show your costs per paycheck. Compare those costs along with deductibles, copays, coinsurance and out-of-pocket maximums.

The Buy-Up Plan costs the most per paycheck and has the lowest deductible, with copays for common office visits and prescriptions. It generally lowers what you pay when receiving care. Compare your family’s total yearly costs for coverage and care before choosing.

The Copay Plan and Base HDHP have benefits similar to the 2026 plans. The Buy-Up Plan is most like the current Surest option; Surest will no longer be offered. Review the 2027 plan documents for the actual coverage and cost differences.

Yes. Care Coordinators can explain benefits, compare how plans fit your expected care needs and check providers. They will help you evaluate options, but will not recommend a specific plan. Complete enrollment in Workday. Contact Pye-Barker’s Benefits team about employee contribution rates or enrollment steps.

Tiers identify providers with agreed pricing; available networks vary by location. Open Access providers do not have agreed prices. A tier alone does not tell you your cost or rank a doctor’s quality. Use the provider search or ask Quantum Health to compare your provider options and benefits before care.

Use the microsite’s provider search or call Quantum Health with the provider’s name, location and planned care. A missing listing does not automatically rule out coverage. Confirm that the provider accepts the plan and the service is covered. Current Kaiser members must establish care with non-Kaiser providers.

Show your current benefits ID card and ask the office to call the provider number listed on it. If the office still has questions, call Quantum Health. Your Care Coordinator can speak with the provider and involve Imagine360 when needed.

Open Access lets you seek care from providers without agreed pricing. It does not automatically mean care is uncovered or works like traditional PPO out-of-network care. Before a planned visit, hospital stay, surgery or advanced imaging, call Quantum Health to check the provider, benefits and potential costs.

Yes. Each family member can use different providers based on their care needs. Ask Quantum Health to check each person’s doctors and facilities and explain the benefits that apply.

Call Quantum Health at 877-231-7333 before coverage starts January 1, 2027. Care Coordinators are available beginning October 19, 2026, to help check providers, ongoing treatment, prescription requirements and prior authorizations. Contact them early if you take specialty medicines or have care scheduled in January.

Yes. Care Coordinators can identify specialists, work with provider offices and connect you with clinical support. Call before January 1 to plan ongoing care. Appointment timing depends on the provider, so same-day or next-day appointments cannot be guaranteed.

No call is needed for every visit. Check with Quantum Health before Open Access care, planned hospital stays, surgery, advanced imaging or ongoing treatment. A referral sends you to another provider; prior authorization is a required plan review for certain services. Ask which steps apply. Authorization does not guarantee payment. Do not delay emergency care.

Have provider names, medication names and doses, planned procedures, ongoing treatment details and authorization letters ready. Explain urgent timing at the start. Some questions are resolved during the call; others need follow-up. Ask when to expect an update. Care Coordinators are available Monday–Friday, 8:30 a.m.–10 p.m. Eastern.

Travel does not automatically place you in Tier 4. Before planned care away from home, ask Quantum Health to help find local options. For an emergency, get care immediately and contact the support team afterward when you can.

No. Tiers reflect provider agreements and pricing, not quality rankings. Find quality information next to Network Affiliations in the provider search at myPyeBarkerBenefits.com. Quantum Health can help compare options and connect you with clinical support for ongoing or complex care.

Coverage depends on the specific service, medical necessity and plan rules. Before scheduling, ask Quantum Health to review the provider, service and billing codes. The label “functional medicine” alone does not establish coverage.

For planned care, call Quantum Health before agreeing to full payment or reimbursement arrangements. Imagine360’s provider-access team can review the situation and your options. You may still owe the copay, deductible or other amount required by your plan.

The plan combines contracted preferred providers with Open Access and reference-based pricing. It is not simply a traditional PPO, even if PPO appears in a plan name. Familiarity varies by office and location. Ask Quantum Health to check your providers and help explain the plan to their offices.

After you meet the applicable deductible, you generally pay 20% of the plan’s allowed cost for covered care and the plan pays 80%, until you reach the applicable out-of-pocket maximum. The allowed cost can differ from the provider’s charge. Copays and noncovered services may work differently.

For covered costs that count toward that maximum, the plan generally pays 100% of allowed costs for the rest of the plan year. Payroll contributions, noncovered services and amounts that do not count toward the limit are different. Call Quantum Health if you are asked to pay after reaching the limit.

Contracted providers agree to prices with the plan or a network. For noncontracted providers, Imagine360 reviews claims using the plan’s payment rules and price benchmarks, called reference-based pricing. It also checks for errors and overcharges. Not every price is agreed before care.

Call Quantum Health with the provider, facility, planned date, procedure details and billing codes, if available. Ask whether the estimate includes the surgeon, facility, anesthesia and related services. Estimates are not guarantees; final costs depend on actual care, claims processing and your remaining deductible or out-of-pocket limit.

Compare the bill with your Explanation of Benefits (EOB) for the same provider and date. If they differ, or a provider bills above the plan’s payment, call Quantum Health for Imagine360 billing support. You still owe your share and noncovered costs. Do not assume the entire difference is yours or will be waived; let the team review it.

Call Quantum Health right away and share every notice, including collection letters or legal papers. Ask for Imagine360’s billing-resolution team. Keep copies of bills, EOBs and messages, and respond to requests and deadlines. A payment dispute does not automatically stop collections; do not ignore notices.

EOBs are available in the Quantum Health portal and app. Imagine360 also mails paper EOBs unless you choose Go Paperless in your Quantum Health portal.

All three medical plans include prescriptions, but covered medicines and pharmacy rules may change. Before January 1, use the OptumRx link on the microsite or call Quantum Health with medication names and doses. Ask about costs, prior approvals and specialty or mail-order requirements. From January 1, 2027, find the formulary and prior approval requirements under Plan at myPyeBarkerBenefits.com.

Use the pharmacy search on the 2027 benefits microsite or ask Quantum Health. Confirm your regular, specialty and mail-order pharmacies before your first refill under the new plan. Give the pharmacy your new prescription ID card details when coverage starts January 1, 2027.

Upland Access is for employees who do not enroll in a Pye-Barker medical plan. It is a separate discount program, not insurance. Eligible enrolled employees and household members may receive discounts on some generic medicines. Check whether your medicine qualifies and compare prices; savings vary.

Recuro Health offers virtual urgent care, primary care and behavioral health visits at $0 for members enrolled in Pye-Barker’s medical plans. Use the Recuro website or Recuro Care app, or call 844-715-1724.

No. Recuro Health is available only inside the United States. You will be connected with a provider licensed to deliver care and prescribe where you are located.

Schedule a primary care visit and ask the provider after the exam. A note depends on the provider’s judgment, Recuro’s rules and the school’s requirements; it cannot be promised before the visit.

An existing health condition does not prevent you from enrolling in the medical plan or receiving benefits for covered care. Tell Quantum Health about ongoing treatment to help prepare for the transition. Ask Pye-Barker’s Benefits team to confirm any required enrollment forms or questionnaires.

The Benefits Guide includes durable medical equipment coverage, but rules vary by equipment, supplies or rental. A supplier missing from the search does not settle coverage. Before ordering, ask Quantum Health to check your supplier, prescription, rental agreement, medical-necessity requirements, prior authorization and costs.

Eligible children can be covered up to age 26. Coverage for a child aging off the plan ends at the end of the month.

If your child is eligible and enrolled, ask Quantum Health to check providers where the child lives. Networks may differ from yours. Tell the team about any coverage through the other parent so it can check how the plans coordinate payment.

The other parent should call Quantum Health to confirm required identification and permission. Access depends on privacy rules, the child’s age and circumstances, and legal rights to the information. Being a parent or having the employee’s request does not automatically grant access.

Yes. Your choices depend on whether you are working, other coverage and your circumstances. Call Alliant Medicare Solutions at 877-888-0165 for help comparing options.

Update eligible dependents in Workday during Annual Enrollment, November 2–13, 2026, for coverage beginning January 1, 2027. Outside enrollment, changes require a qualifying life event, such as marriage, divorce, birth, adoption or certain coverage or employment changes. Complete life-event enrollment within 30 days of the event and provide documentation if requested.

An eligible spouse may be added during Annual Enrollment or after a qualifying loss of other coverage. Retirement alone does not determine eligibility. Before coverage ends, ask Pye-Barker’s Benefits team about eligibility, documents and deadlines.

Do not assume records transfer automatically. Kaiser members must establish care with non-Kaiser providers. Ask Kaiser how to obtain or authorize sharing your records, and ask your new provider what is needed. Quantum Health can help plan the transition and ongoing care.

HIPAA protects your medical information. Only people specifically authorized for health plan administration may access identifiable information as needed for those duties. Self-funding does not give managers or company leadership unrestricted access to your records. For privacy questions or concerns, contact privacy@pyebarkerfs.com.

Quantum Health follows applicable privacy laws, including HIPAA. Relevant information may be securely shared with authorized providers, Imagine360 or benefit partners to support care or administer benefits. This does not mean calls are shared with your manager. Ask Quantum Health for its privacy notice and details about information use.

Yes. Dental coverage is through MetLife; vision coverage is through EyeMed. Review costs and make new elections in Workday during Annual Enrollment, November 2–13, 2026. Your 2026 medical, dental and vision elections will not carry over.

Paid parental leave is not part of the 2027 benefits program. Eligible employees may have leave benefits under state law. Check your state’s program for availability and eligibility requirements.

Yes. Critical Illness, Accident and Hospital Indemnity Insurance remain separate benefit options for 2027. Review the final enrollment materials for coverage details and any changes you want to make.

Your policy may allow portability or conversion to an individual policy. Deadlines and costs apply. Contact Pye-Barker’s Benefits team and Sun Life before employment or coverage ends.

Contact Pye-Barker’s Benefits team and Sun Life to confirm whether your policy offers an accelerated death benefit, who qualifies and how an early payment would affect the amount paid to beneficiaries.

No. Eligible employees receive this coverage at no cost and cannot decline it.

This separate policy may pay cash for a covered condition, such as qualifying cancer, heart attack or stroke. Definitions, exclusions and payment amounts vary; not every diagnosis qualifies for the same payment. Review the 2027 Benefits Guide and policy details.

Critical Illness Insurance has different rules from medical coverage. A past diagnosis may affect enrollment or payment, and exclusions or look-back rules may apply. A recurrence benefit may be payable for a later diagnosis of the same covered condition, subject to the policy’s rules.

The 401(k) remains with Empower, brokered through Mercer Wise. There are no retirement plan changes for 2027, so current participants do not need to re-enroll because of this benefits transition.

Take action in Workday during Annual Enrollment, November 2–13, 2026, for medical, dental, vision, HSA and FSA elections. These choices do not renew automatically. Current Sun Life life, disability and voluntary benefits continue if you make no changes. Review all elections before submitting.

Your HSA balance remains yours when administrators change. A bulk transfer opportunity to Pinnacle Financial Partners is planned for March/April 2027, with details in February. Payroll contribution elections do not carry over; make a new 2027 election if eligible and you want to contribute.

If you re-enroll, you may carry over up to $680 in a Health Care or Limited Purpose FSA; amounts above $680 are forfeited. Dependent Care FSA funds do not roll over. FSA contribution elections do not renew automatically.

The Copay and Buy-Up Plans offer a general-purpose FSA for eligible medical, prescription, dental and vision expenses. With the Base HDHP, you may qualify for an HSA and a Limited Purpose FSA for eligible dental and vision costs. Other coverage, including a spouse’s general-purpose FSA, may affect HSA eligibility.

Yes. Your digital ID card will be in the Quantum Health portal and app. A physical card will be mailed to your home in late December or early January. Give your new card details to providers and your pharmacy when coverage starts January 1, 2027.

Yes. Your card lists contacts, provider networks and claims instructions. Tell the office that Imagine360 administers your Pye-Barker medical plan and ask it to follow the card. Networks vary by location, so use your own current card. Call Quantum Health if the office needs help.

Registration opens January 1, 2027. Before then, use the benefits microsite for plan details and provider searches. Quantum Health Care Coordinators are available beginning October 19, 2026, at 877-231-7333.

Yes. A session is planned for January 2027 to help employees use the new coverage. You can also call Quantum Health for help with your family’s transition.