Benefits Guide 2022
Dear Team Members, I think we can all agree we’ve been through a lot in the past year. That’s why there’s no better time to focus on our total wellbeing. On the whole you: your physical, mental, financial, social, community and career wellbeing. We know that the benefits we offer play a huge role, and we’re always exploring options and solutions that are most meaningful in your life’s journey. For 2022, we’re adding and enhancing some programs that can help improve your overall wellbeing. As you choose the benefits that offer the best solutions for you and your loved ones, I encourage you to consider all your options—from health care and emotional support to financial security, and even pet insurance (it’s new in 2022). Together we can make a difference in our lives and overall wellbeing. Anahita Cameron Chief Human Resources Officer
In this guide, we use the term “we” and “our” to refer to: Aspen Dental Management Inc., the independently owned and operating practices under the brand Aspen Dental, the urgent care centers operating under the brand WellNow Urgent Care, and the medical aesthetic studios under the brand Chapter. This guide is intended to describe the eligibility requirements, enrollment procedures, and coverage effective dates for the benefits offered by the company. It is not a legal plan document and does not imply a guarantee of employment or a continuation of benefits. Full details of the plans are contained in the summary plan descriptions (SPDs), which govern each plan’s operation. Whenever an interpretation of a plan benefit is necessary, the actual plan documents will be used. ©2021 Aspen Dental Management, Inc. All rights reserved.
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Benefits Guide 2022
Explore your options This guide includes an overview of all your benefit options. Explore them carefully so you can choose the ones that best support you and your needs. Whether you’re single, building a family or on your way to retirement, you can customize your benefits to fit your life. You’ll also find helpful programs and resources to help you save money.
Get help determining your needs Sometimes we can buy more insurance than we need. Or not enough. The information you’ll find on myaspenbenefits.com can help you determine what you need.
well-be•ing (noun)
the state of being comfortable, healthy and happy
We have options to help you in every aspect of your wellbeing.
Physical wellbeing Caring for your health and wellness
Financial wellbeing
Protecting your future and finances
Medical and prescription...............................8
Life and AD&D.......................15
Health savings account (HSA)............................................11
Supplemental AD&D..........16
Dental..........................................12 Vision...........................................13 Flexible spending accounts (FSAs)...................14
Supplemental life.................15 Disability insurance............ 17 Critical illness......................... 17 Accident insurance............ 17 Hospital indemnity.............. 17
Social, community and career wellbeing Balancing your work and life
Who’s eligible........ 4
Employee assistance program (EAP).......................19
Who to contact..................... 21
Paid time off............................19
Required notices.................... 22
Holidays......................................19 Continuing education.......19 Aspen relief fund.................19
Pet insurance..........................18
Student loan refinancing.............................. 20
ID theft protection..............18 401(k) retirement plan..... 20
How to enroll.......... 5
Other leaves............................19
Pet discounts..........................18 Legal assistance...................18
Other important information
Employee discounts.......... 20
Learn ways to save On your premiums................. 6
Payroll purchasing............. 20
On your health care............. 10
Employee referral program.................. 20
Through an HSA...................... 11
one stop
or an FSA................ 14 One stop for your benefits: myaspenbenefits.com • Enroll in your benefits • Access your benefits all year • Estimate your insurance needs Benefits Guide 2022
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Eligibility and enrollment Below are general rules for who can enroll and when. If you have specific questions, call the Benefit Service Center at 844-407-9444.
Who’s eligible
Have documents handy
Team members Full-time team members working (on average) 30+ hours per week
Dependent family members • Spouse or domestic partner • Children up to age 26, or any age if disabled before age 26
When can you enroll or make changes As a new team member Enroll within 30 days of your hire date. Coverage starts the first of the month after 30 days of employment.
During Open Enrollment Enroll or make changes each fall. Your new coverage starts on January 1 the following year.
When your life changes Make changes within 30 days of a qualified life event. Your new coverage starts on the date of the event.
You may be required to provide proof of dependent eligibility while enrolling. Examples of proof include: • Marriage certificate for a spouse • Birth certificate or adoption decree for a child • Affidavit for a domestic partner (find it on the enrollment site)
Qualified life events include: • Marriage or divorce • Birth or adoption of child • Change in employment status • Child turns age 26 • Dependent loses or gains other coverage
To request changes when you have a qualified life event, log on to myaspenbenefits.com. All requests for benefit changes will be reviewed to ensure you’re changing the coverage you need for your life event. 4
Benefits Guide 2022
How to enroll as a new hire and at Open Enrollment First! • Review this guide to explore all your options • Compare these options with others available to you, such as coverage through a spouse or partner’s employer • Gather the following: – Social Security numbers and birthdates for any family members you’re adding – Proof of dependent eligibility documents, such as a marriage certificate for a spouse or birth certificates for children
When ready: log on to myaspenbenefits.com First-time users:
Register to set up your user ID and password
Registered users: • Go to the “Enrolling in your Benefits” page • Click on the waving flag
Remember—save and accept Your enrollment isn’t complete if you don’t see the confirmation page.
Make note If you’re considering an HSA or FSA, be sure you enroll in the right one for you. There are different options to fit specific needs. See pages 11 and 14 for details.
• Follow the prompts to make your elections • On each page, click Next or Save Election to move on • When you’re finished, you’ll see the confirmation page
Important: Your enrollment isn’t complete and recorded until you save and accept your elections and see the confirmation page.
After you enroll • Review your confirmation summary—ensure it’s correct • Call the Benefit Service Center immediately if you see errors • Review your paycheck for accuracy
Will you get ID cards? If you’re new to the plans—yes, new cards will come in the mail to you. If you’re currently in coverage—you’ll only receive new cards if you change coverage or your current card expires.
Need help? Benefit Service Center 844-407-9444 Monday - Friday, 8 a.m. - 7 p.m. EST
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Be well and save Save on your medical plan premiums
Healthy employees make a healthy company. We’re committed to providing programs and resources to help you live a healthy life. Preventing and detecting disease is critical, and when you take action toward a healthy life, you’ll be rewarded with savings on your medical premiums.
Tobacco-free living
Save $300/plus $300 for a covered spouse or partner Verify your tobacco status during the enrollment process If you’re tobacco free, you’ll save on your medical premiums. The savings extends to spouses and partners, too. If you or a covered spouse/partner are a tobacco user, you can complete the tobacco cessation program and receive the tobacco-free savings. The program is free to anyone 18 years or older enrolled in our company medical plan. Get started today. Download the WellFrame mobile app One-on-one support: access code—EXCELLUS Self-guided program: access code—EXCELLUSFREE
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Benefits Guide 2022
Say yes to quitting Tobacco use is the #1 preventable cause of illness. Kicking the habit is the best thing you can do for your health. The WellFrame cessation program is through Excellus BlueCross BlueShield and offers one-on-one support plus selfguided programs and resources—all through a mobile app.
Annual wellness and biometric screening
New to the site?
Save $300/plus $300 for a covered spouse or partner
You can only fix what you know about. An annual wellness screening helps you and your family get ahead of health concerns. And it’s free. The medical plan covers this 100%.
Complete your biometric screening each year and save You’ll save on medical premiums for completing your screening. Spouses and domestic partners also save when having a screening. New hires and newly eligible: We highly recommend you have a biometric screening. But it’s not required—you and a covered spouse/partner automatically receive a lower medical rate this year and next. Steps to take (you and a covered spouse/partner): • Schedule your annual wellness screening with your primary care doctor • Go to my.onsitehd.com/signup/aspendental to print the biometric screening form • Have your doctor’s office complete and sign the form • Upload the completed form to the website or fax it to 214-203-0395 • Watch for an email from Onsite Health Diagnostics with your results
Medical and prescription premiums Biweekly premiums (pre-tax from your paycheck) These rates apply if you and a covered spouse/partner are tobacco free and have a biometric screening. $1500 PPO plan
$2000 HDHP plan
$3000 HDHP plan
Team member only
$190.69
$82.67
$39.96
Team member + spouse/partner
$399.93
$172.39
$85.26
Team member + child(ren)
$414.33
$179.26
$94.86
Team member + family
$627.69
$302.37
$172.40
Note: When you enroll, the system will show your specific premium rate if you’re a tobacco user or don’t have a screening. At any point if your paycheck is insufficient to cover the biweekly premiums for the benefits you elect, the premiums owed will accrue and will be due on the next paycheck. This will continue until the balance is paid in full. For details, see page 28.
You will need your employee ID to register. A covered spouse or partner will need to register separately, also using your employee ID.
Your health is private Your personal health information is only your business. We take this very seriously. We never have access to individual health information. It’s the law.
Tobacco users or those not having a biometric screening If you’re a tobacco user: add $11.54 per user (you and/or covered spouse/partner) to the rates shown. If you’re not having a screening: add $11.54 per person (you and/or covered spouse/partner) to the rates shown. This can add between $600 to $1,200 more per year!
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Medical and prescription Three options through Excellus BlueCross BlueShield
Compare the coverage levels and the premium costs of each plan, then choose the one that best fits your needs.
$1500 PPO plan It has the lowest deductible of all the options and the highest premium cost. Prescription costs are more predictable, but deductions from your pay are much higher.
$2000 and $3000 HDHP plans With higher deductibles, these plans offer discounted premium costs. Plus, you also can contribute to a tax-free health savings account (HSA) to help pay health expenses now, or to use as a retirement account. Costs are higher for initial services, but deductions from your pay are much lower. Learn more about the HSA on page 11.
All medical options feature • 100% paid in-network preventive care, even before you meet your deductible • The same national Excellus BCBS network of doctors and facilities
Shop around for care Use Excellus online tools at excellusbcbs.com/ aspendental to: Find in-network doctors and facilities. Search for freestanding or independent labs and imaging centers (hospitals cost more). Estimate costs in advance for common procedures and conditions. Search for discounts on services and supplies.
• MDLive doctor visits online or by phone (more on page 10) • Prescription benefits through Excellus
Who to contact: Excellus BCBS excellusbcbs.com/aspendental 877-253-4797
Terms to know Premium The amount deducted from your pay each pay period for medical coverage.
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Coinsurance Your share in the cost of covered services. You pay a percent; the plan pays the other percent. If an office visit costs $100, your share is $20 (at 20% coinsurance).
Benefits Guide 2022
Deductible The amount you pay each year before the plan begins paying toward covered expenses. The deductible doesn’t apply for some services, such as preventive care, which is always covered 100%.
Out-of-pocket maximum The most you could pay in a year. The plan then pays 100% of all covered expenses. You will always pay for charges and expenses your plan doesn’t cover.
Prescription tiers Generics are non-branded drugs, chemically identical to the branded version but typically for a lower cost. Preferred drugs are branded drugs approved by the plan for effectiveness and cost. Non-preferred drugs are branded drugs not approved by the plan, typically newer and higher cost.
Medical and prescription summary of benefits This is a summary of in-network coverage. The plans help cover out-of-network costs, but these costs are higher. For details, go to excellusbcbs.com/aspendental. $1500 PPO plan (in-network)
$2000 HDHP plan (in-network)
$3000 HDHP plan (in-network)
No
Yes
Yes
Annual deductible
$1,500 individual $3,000 family
$2,000 individual $4,000 family
$3,000 individual $6,000 family
Annual out-of-pocket maximum (includes deductible)
$3,800 individual $7,600 family
$5,200 individual $6,550 family
$6,550 individual $13,100 family
100% covered
100% covered
100% covered
HSA eligible
Preventive services Coinsurance (you pay after deductible) Office visits
20%
20%
30%
Outpatient services
20%
20%
30%
Inpatient services
20%
20%
30%
Telemedicine/MDLive (often less than an office visit)
20%
20%
30%
Urgent care
20%
20%
30%
Emergency room
20%
20%
30%
Prescription Retail (30-day supply)
After deductible
Tier 1 (generic)
$15 copay*
20%
40%
Tier 2 (preferred)
$30 copay*
20%
40%
Tier 3 (non-preferred)
$45 copay*
20%
40%
Mail order (90-day supply)
After deductible
Tier 1 (generic)
$30 copay*
20%
40%
Tier 2 (preferred)
$60 copay*
20%
40%
Tier 3 (non-preferred)
$90 copay*
20%
40%
* $0 generic copay for kids This chart shows in-network coverage only. For out-of-network coverage, go to excellusbcbs.com/aspendental.
Find network doctors, hospitals and pharmacies. Excellus BCBS excellusbcbs.com/aspendental 877-253-4797
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Ways to save And get the best care at the best value
Nationally, medical and prescription costs significantly increase year after year. Our plans include programs and resources to help you save money.
See your doctor virtually with MDLive
Use urgent care versus the ER
Available to all team members—for less than an office visit (typically).
An ER visit costs 3.5 times more than urgent care.
You can talk with a doctor, therapist or psychiatrist anytime, anywhere, through your phone, computer or mobile app. MDLive docs can help with over 80 common conditions and call in prescriptions.
The ER is meant for life-threatening or serious conditions. An urgent care center is the place to go when you need fast care, but it’s not an emergency. Think of it as an extension of your primary doctor, with extended hours.
The cost ranges from $0-$82 for a medical consult. Behavioral health and dermatology visits may cost more. Have the app ready when you need it mdlive.com/mobileapp
Go generic
Save through mail order
On average, a generic costs 80-85% less than its brand‑name equivalent.
Typically, you get a 90-day supply at the 60-day retail cost.
Generic drugs are your most cost-effective option. They are comparable to the brand-name drug in every way, including dosage, strength and quality. If you’re happy with your current medication, see if there’s a generic option. You will maintain the same great health and save money, too.
Talk to your doctor or pharmacist about switching to generic
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Find your local urgent care center excellusbcbs.com/aspendental
Benefits Guide 2022
Cut your prescription costs by getting them in the mail instead of at the pharmacy. Mail-order prescriptions are usually for maintenance drugs for 90-day supplies. Besides saving money, it’s the convenience of home delivery.
Check out mail order excellusbcbs.com/aspendental
Health savings account (HSA) Available through WEX Benefits with the high deductible medical plans only With an HSA, you can save pre-tax money to pay for eligible health care expenses you incur now or later in life. It’s available if you enroll in the company $2000 or $3000 medical plan.
How the HSA benefits you Save in taxes (three ways)—The money in an HSA is typically never taxed*…not when you put money in, not when you take it out for eligible expenses, nor when you invest it to grow your account. Use now, save for later—It’s your money. You decide how to use it. Pay for eligible expenses as they occur, such as doctor visits, eye exams, prescriptions. Or save the money for expenses later in life. Control your own account—You can start, change or stop your contributions at any time. The account stays with you if you change plans or jobs. Invest it—Once your account reaches a certain balance, you can invest in a variety of options available through WEX Benefits.
IRS limits and rules The maximum you can contribute in 2022: •
$3,650 if single coverage
•
$7,300 if you cover any dependents
•
$1,000 catch-up contribution for anyone age 55+
Save receipts The IRS may request proof of valid HSA spending. Keep your receipts for up to seven years. For full details and a list of eligible expenses, see IRS Publications 969 and 502 on irs.gov.
Opening your HSA is quick and easy Once you enroll in the company’s $2000 or $3000 plan, WEX Benefits will set up your HSA for you. They’ll send you an email—click on the link to complete setup and they’ll send you a debit card.
You can’t contribute to an HSA if you are: •
Covered by another health plan that isn’t a high deductible plan
•
Contributing to a health care FSA (or if your spouse is)
•
Claimed as a dependent on someone else’s tax return
•
Enrolled in Tricare, Medicare or Medicaid
•
A recipient of Veterans Affairs (VA) benefits (except for preventive care) within the past three months, unless you have a disability rating from the VA
save more
* Each state can decide to follow federal guidelines for HSAs or establish its own. CA and NJ have chosen to tax HSA contributions.
Maximize your savings If you max out your HSA every year and want to save for things like glasses and braces, consider a limited purpose flexible spending account (FSA). Learn more on page 14.
Who to contact: WEX Benefits benefitslogin.wexhealth.com 866-451-3399
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Dental
Discounts through Aspen Dental, child dental plan through Level
Dental discounts When you use an Aspen Dental practice, you and your eligible dependents receive discounts for covered services. You pay no annual deductible and benefits are unlimited for covered services. To schedule an appointment: New patients: call 866-541-5652 and identify yourself as a team member. Current patients: speak with your local Aspen office.
Summary of discount program Services at Aspen Dental facilities only Annual deductible
None
Benefit maximum
Unlimited
Discounts on covered services Preventive care (routine exams, cleanings, fluoride treatments, sealants, bitewing X-rays)
You pay 0%
Basic care (full-mouth X-rays, extractions, fillings)
You pay 20%
Major services (root canals, oral surgery, gum disease treatment, crowns, bridges, dentures)
You pay 50%
Please note: This is a dental discount program, not an insurance plan. If you have a dental insurance plan, Aspen Dental will apply your discount before submitting charges to your insurance. Practices owned and operated under the Aspen Dental trade name make independent clinical decisions and determine whether or not they will see pediatric patients.
Clear aligner discount
Child dental plan—New for 2022!
You and your eligible dependents can get a significant discount on orthodontia treatments at an Aspen Dental office. Availability of treatment and benefits are at the discretion of the practice owner and treating dentist.
The child dental plan is a $1,000 dental benefit for children 12 years and younger. It works similar to a flexible spending account (FSA). You get a debit card which you use to pay for child dental services up to a maximum of $1,000 per year, per covered child.
Three ways to pay for treatments: 1. Pay the full cost up front 2. Finance the costs through Care Credit 3. Make payments through payroll deductions (for team members only)
Plus, the company pays a portion of the premium. You may choose any dentist. The plan includes a network of dentists who offer discounted rates for big savings, helping your $1,000 go further. Biweekly premium (pre-tax from your paycheck) Per child: $20.09 Who to contact:
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Benefits Guide 2022
Level support@level.com 855-400-5705
Vision
Two options through Aetna It’s important to keep an eye on your vision health. An annual exam can catch eye diseases before they become critical. Get the best value by seeing an Aetna eye care professional. You’ll also get discounts on additional services. Find network eye care professionals at aetna.com.
Summary of benefits This is a summary of in-network coverage. The plans help cover out-of-network costs, but these costs are higher. For more details, go to aetna.com.
Examination Once every 12 months
Enhanced plan (in-network)
Standard plan (in-network)
$10 copay
$10 copay Once every 12 months
Lenses Single vision
$10 copay
$25 copay
Bifocal
$10 copay
$25 copay
Trifocal
$10 copay
$25 copay
Lenticular
$10 copay
$25 copay
See details on aetna.com
See details on aetna.com
Once every 12 months
Once every 24 months
$175 allowance (additional 20% off balance over the allowance)
$130 allowance (additional 20% off balance over the allowance)
Progressive Frames benefit Private practice or retail Contact lenses in lieu of eyeglasses Medically necessary Elective
Once every 12 months $0 copay
$0 copay
$175 allowance (additional 15% off balance over the allowance for conventional lenses)
$130 allowance (additional 15% off balance over the allowance for conventional lenses)
This chart shows in-network coverage only. For out-of-network coverage, go to aetna.com.
Biweekly premiums (pre-tax from your paycheck)
Enhanced plan
Standard plan
Team member only
$4.08
$2.15
Team member + 1 dependent
$7.46
$3.94
Team member + family
$12.96
$6.86
Who to contact: Aetna aetna.com 877-973-3238
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Flexible spending accounts (FSAs) Available through Benefit Strategies
If you have typical expenses each year, why pay taxes on money you’ll be spending? An FSA is an easy way to set aside pre-tax money to pay for health care or dependent care expenses. Estimate carefully. These are “use it or lose it” accounts. During enrollment, you decide the amount you’d like to set aside for the year. The money is deducted pre-tax from your biweekly paycheck. You must re-enroll each year.
You can enroll in both FSAs—one covers health care; the other, dependent day care If you have an HSA, the health care FSA is not available to you. You can have a limited purpose FSA to help cover dental and vision expenses. (See information in the right margin.)
Annual contribution limit Eligible/qualified expenses See a full listing in Publication 502 on irs.gov
Health care FSA Not available to you if you contribute to an HSA
Dependent care FSA Available to everyone for dependent day care expenses—not for health care
$2,750
$5,000* ($2,500* if married and filing separate tax returns)
Medical, prescription, dental and vision expenses
Day care, elder care or disabled dependent care, so you and your spouse can work or attend school (funds cannot be used for a domestic partner or their children) Does not cover health care expenses
Over-the-counter products, such as medications, hearing aids, feminine products and wigs
When funds are available
Your total designated amount at the start of the plan year
Funds are available following each payroll deposit
Deadline to use your funds
By December 31 (but $550 can roll to the next year)
By December 31 (no rollover)
Yes
No
Includes a debit card
Have an HSA? Maximize your savings with a limited FSA A limited purpose FSA is the only option for HSA holders to set aside more pre-tax money. It’s a spending account for dental and vision expenses only. Since medical expenses and over-the-counter products are HSA-reimbursable, they’re not eligible in this FSA.
* The dependent care FSA is subject to federal testing, and the company needs to meet certain criteria regarding these accounts. The company may need to change your contribution amount or pre-tax savings to meet those criteria. We will always try to notify you first, but we may need to take action sooner. For details, see page 28.
Save receipts: In most cases, Benefit Strategies can auto-verify your eligible purchases. But there may be instances when you’ll need to provide a receipt. It’s best to save all receipts. 14
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Who to contact: Benefit Strategies benstrat.com 888-401-3539
Life and accidental death and dismemberment (AD&D) Provided through Prudential
Life and AD&D insurance offers financial assistance if you die or are injured in an accident. The company provides basic life and AD&D insurance for you. You have the option to purchase additional coverage. Whether you’re single or raising a family, think about your lifestyle and your loved ones, and decide the level of protection you need.
Basic life and AD&D
Protect your loved ones
Automatic, company-paid
Ensure your money goes to the person you want to have it. Keep your beneficiaries up to date on myaspenbenefits.com through 2021. Then in 2022, on prudential.com/ mybenefits.
The company pays the full cost of your basic life and AD&D insurance. For each benefit, you’re covered for 1x your annual earnings, up to $50,000. What is AD&D insurance? AD&D pays a benefit directly to you if you’re injured in a qualifying accident which results in a loss, such as arm, leg or eyesight. If you die in an accident, it pays a benefit to your beneficiary, in addition to the life benefit. Learn more on myaspenbenefits.com.
Supplemental life Optional, paid by you, after-tax from biweekly pay If you purchase coverage for yourself, you may also purchase coverage for a spouse/partner and dependent children. Medical review may be required. Attention new hires! Take advantage and enroll now—no medical review up to a certain amount. Coverage options: You
Spouse/partner
Increments of $25,000, up to $1 million
Increments of $10,000, up to $250,000 or 50% of your supplemental life amount
New hires: Medical review required for amounts greater than 2x your annual earnings
Dependent children (one rate covers all children) Increments of $5,000, up to $20,000
New hires: Medical review required for amounts greater than $20,000
No medical review for children
Note about medical review Medical review (often referred to as evidence of insurability or EOI) is completed via the enrollment site.
Current team members: Medical review is required if you’re adding coverage or increasing your amount during Open Enrollment. View the premium rates on myaspenbenefits.com. Support for loved ones For up to one year following a death, beneficiaries can contact ComPsych GuidanceResources 24 hours a day, seven days a week, for emotional and grief counseling or family, legal and financial matters. Call 833-962-0064 to be connected.
Who to contact: Prudential prudential.com/mybenefits 800-524-0542 Benefits Guide 2022
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Life and AD&D (continued) Provided through Prudential
Supplemental AD&D Optional, paid by you, after-tax from biweekly pay If you purchase coverage for yourself, you may also purchase coverage for a spouse/partner and dependent children. Medical review is never required for AD&D coverage. Coverage options: You Increments of $25,000, up to $1 million or 10x your annual earnings
Spouse/partner only 50% of your supplemental AD&D amount, up to $500,000
Dependent children only (one rate covers all children)
Spouse/partner and children (one rate covers all children)
15% of your supplemental AD&D amount, up to $150,000
Spouse/partner: 40% of your supplemental AD&D amount, up to $500,000 Children: 10% of your supplemental AD&D amount, up to $150,000
See the premium rates on myaspenbenefits.com.
Universal life (Transamerica) Optional, paid by you, after-tax from biweekly pay With a universal life insurance policy, you’re the policy owner and you maintain the coverage, whether or not you leave your employer. You keep the coverage for as long as you choose to pay the premium. See options and rates on myaspenbenefits.com.
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Benefits Guide 2022
If you’re a new hire, or newly eligible for benefits, there is no medical review required for universal life insurance. For other team members, medical review may be required to add or increase this coverage.
Additional insurance options Available to purchase through after-tax biweekly pay Learn more about these options and see rates on myaspenbenefits.com.
Short-term disability (Prudential)
Accident insurance (MetLife)
The plan pays a weekly benefit should you become unable to work due to a covered illness, injury or maternity leave. The benefit is based on the amount you purchase ($100-$750 weekly), which depends on your current earnings. Benefits start after seven days of absence and continue for up to 26 weeks.
Accident insurance can help financially as you recuperate from an accident. The plan pays a lump-sum benefit when you suffer a covered injury or undergo covered testing, medical services or treatments. There are more than 150 covered events and no limits on the number of different accidents the plan will cover for you.
Long-term disability* (Prudential) This plan pays a monthly benefit should your illness or injury continue for an extended period. The benefit is equal to 60% of your monthly earnings, capped at a certain amount for your job level. Benefits start after 26 weeks of continued disability and continue for as long as you’re disabled or until you reach retirement age. New hires, enroll now in short- or long-term disability! For existing team members, medical review is required to add or increase this coverage.
Critical illness (MetLife)
The plan pays the benefit directly to you and you can use the money as you see fit—cover medical bills, everyday living expenses or whatever else you need. Coverage is not dependent on prior health history.
Hospital indemnity (MetLife)— New for 2022! Be prepared to offset an expensive hospital stay with coverage of $1,000 per admission (up to four times per year) and $200 per day (up to 15 days). The plan pays a cash benefit directly to you to pay for medical expenses or everyday expenses. There’s no health exam to qualify and no pre-existing conditions.
Critical illness insurance helps protect against the financial impact of illnesses like heart attacks, stroke, cancer and more. It pays a lump-sum benefit directly to you. You can use the money to cover medical expenses or other expenses, such as lost income and household bills. Critical illness benefits are not limited or affected by your medical plan benefits. You are able to elect coverage regardless of prior health history.
* Long-term disability is company-paid for directors and above.
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Additional insurance options Available to purchase through after-tax biweekly pay
Learn more about these options and see rates on myaspenbenefits.com.
Pet discounts (Pet Benefit Solutions)—New for 2022! Get discounted services and prescriptions through in-network veterinarians, including an instant 25% discount at the vet’s office and up to 50% off food, toys and more through participating retailers. You also get access to real-time, online vet support when your vet’s office is closed. They offer a lost pet recovery service, too.
Pet insurance (ASPCA)—New for 2022! We now offer insurance coverage for your family pets. You can see any vet for preventive care, injuries or illnesses. Plans reimburse up to 90% of your veterinarian bills, depending on the option you choose. Coverage is completely customized by you. Exclusions apply for pre-existing conditions.
Legal assistance (ARAG) The ARAG Assistance Plan offers you economical access to attorneys for common legal services, such as will preparation, estate planning, family law and more. You also have the flexibility to use a participating attorney and the plan will reimburse you for covered services according to a set fee schedule. A knowledgeable client service rep will help you locate an attorney in your area. You also have access to their online resources for help with court appearances, real estate matters and document review and preparation.
Identity theft protection (Allstate) Services from Allstate Identity Protection assess your risk, deter theft attempts, detect fraud and manage the restoration process in the event of theft. Your identity will be monitored to uncover fraud as it’s happening. You also get an annual credit report, monthly credit scores and monitoring of your TransUnion credit file. A privacy advocate, certified and trained in identity restoration, will serve as your dedicated case manager.
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Supporting the whole you Programs to help make life a little less stressful
Employee assistance program (EAP) For all team members, the EAP is here to help you find the work-life balance you need—because the challenges you face every day can be overwhelming at times. Whether you’re struggling with work stress, looking for financial or legal advice, or coping with a death in the family, the EAP can support you. 5 free counseling sessions for you and each family member
At no cost to you, a licensed counselor will help with any situation. Need more than five visits? The EAP will refer you to a licensed local counselor.
Your EAP is ready to help • Emotional wellness—stress, depression, anxiety and other emotional concerns • Substance use and addiction—helpful recovery and resilience resources • Workplace success—career goals, team conflict and job pressures • Personal and family goals—relationships, aging, children, family conflicts and more
More than mental health counseling Work-life balance often involves more than counseling for mental health. You have access to services that can help reduce stress in many other areas of your life. • Financial resources—college savings, debt relief, estate planning, etc. • Legal consultation—free 30-minute attorney consultation, 25% discount on services, plus self-help tools for wills, living wills, etc. • Find a resource—child or elder care, financial planning, education, home repair, etc. Who to contact (24/7): ComPsych GuidanceResources guidanceresources.com 800-311-4327 Company ID: GEN311
Paid time off (PTO) Work is part of life, but we want you to enjoy the other parts, too. You receive PTO hours based on how long you’ve worked with us, and the hours you work. PTO does not carry over year to year, unless your state’s laws require. Make sure you’re taking time for you.
Holidays Holidays for 2022 include: New Year’s Day, Memorial Day, Independence Day, Labor Day, Thanksgiving Day and Christmas Day (may vary by individual locations).
Other leaves Life happens, and there are times when you may need to be away from work. You may be eligible to take time off for situations like: • Family medical leave (FMLA) • Military obligations • Jury duty • Medical issues • Personal concerns
Continuing education Explore and take advantage of our multimedia training library dedicated to your professional development. Earn interactive CE credits when you sign up for live webinars or follow a self-study course. All CE credits are provided by an approved ADA CERP provider. Visit aspendentallearning.com to learn more.
Aspen Strong Relief Fund—New for 2022! The Aspen Strong Relief Fund helps team members facing financial hardships—whether after a natural disaster or an unforeseen difficulty. Anyone can donate to the fund, including those outside our company. Donate online anytime, by texting “ASPEN” to 71777, or from your biweekly pay (sign up during Open Enrollment). If you’re experiencing a hardship, please visit the website to apply for a grant. Learn more at eafaspendentalurl.azurewebsites.net. Benefits Guide 2022
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Financial programs and perks Supporting your future goals and current needs
401(k) retirement plan
Student loan refinancing
You’re never too early—or too late—to start planning for your retirement. Making contributions to The Aspen Dental 401(k) Plan administered by T. Rowe Price is the first step toward achieving financial security later in life.
Program through Laurel Road offering low interest rates. You could save thousands on your student loan debt. Visit Laurel Road at laurelroad.com/aspen for details.
Contributing to the plan
Employee discounts
You can start contributing on the first of the month following 30 days of employment. You can defer up to 90% of pre-tax or post-tax earnings, up to IRS limits. The IRS limits for 2022 are: • $20,500 for regular contributions • $6,500 catch-up contribution for those age 50+ in 2022
Company matching contributions After one year of service (working at least 1,000 hours), we’ll match 100% on the first 3% you contribute, and then 50% on the next 2% you contribute. To receive the full company match, contribute at least 5% through the entire calendar year.
Changing or stopping your contributions You may change or stop your contributions at any time. If you stop contributions, you may start again at any time.
Investing in the plan You decide how to invest the assets in your account. T. Rowe Price offers a selection of investment options for you to choose from. You may change your investment choices anytime.
Consolidating your retirement savings If you have an existing qualified retirement plan with a previous employer, you may transfer or roll over that account into the plan anytime, even if you are not yet eligible to contribute. Who to contact: T. Rowe Price rps.troweprice.com 800-922-9945 20
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Discover exclusive discounts on all the small (or big) things in life. • PlumBenefits: Discounted tickets to entertainment, family attractions, sporting events at plumbenefits.com (use company code AC0329209) • PerkSpot: Exclusive deals at hundreds of national and local merchants at aspendental.perkspot.com
Payroll purchasing The program allows you to pay for products right from your paycheck, over time. It puts your spending power to work when cash or credit are not an option. Our partner, Purchasing Power, is a responsible financing program that offers more than 7,000 brand-name products and services. Through payroll deduction, you can make manageable payments over a 12-month period with no interest, hidden fees or credit check. Learn more at purchasingpower.com.
Employee referral program Your knowledge, experience and commitment are valued and appreciated. You know what it takes to succeed and we’re confident you know others who will, too. Visit the employee referral center at aspendentalERP.com to learn how you can earn rewards ranging from $100 to $10,000.
Who to contact
Use the contacts below for your specific benefit questions. For general help or eligibility questions, call the Benefit Service Center at 844-407-9444. It’s open Monday through Friday, 8 a.m. to 7 p.m. EST. Benefit
Plan administrator
Contact information
Medical and prescription
Excellus BCBS
877-253-4797 excellusbcbs.com
Telemedicine
MDLive
800-400-MDLIVE (6354) mdlive.com/mobileapp
Health savings account (HSA)
WEX Benefits
866-451-3399 benefitslogin.wexhealth.com
Dental
Your local Aspen dental office
866-541-5652 aspendental.com
Level (child dental)
855-400-5705 support@level.com
Vision
Aetna
877-973-3238 aetna.com
Flexible spending accounts (FSAs)
Benefit Strategies
888-401-3539 benstrat.com
Life insurance and AD&D
Prudential
800-524-0542 prudential.com/mybenefits
Universal life
Transamerica
888-763-7474 transamerica.com
Disability
Prudential
800-842-1718
Critical illness Accident insurance Hospital indemnity
MetLife
800-438-6388
Pet discounts
Pet Benefit Solutions
888-913-7387 petbenefits.com
Pet insurance
ASPCA Pet Health Insurance
877-343-5314 aspcapetinsurance.com
Legal assistance
ARAG
800-247-4184 ARAGlegalcenter.com Access code 18339asp
Identity theft protection
Allstate Identity Protection
800-789-2720 myaip.com
Employee assistance program (EAP)
ComPsych GuidanceResources
800-311-4327 guidanceresources.com Company ID: GEN311
401(k) retirement plan
T. Rowe Price
800-922-9945 rps.troweprice.com
Payroll purchasing
Purchasing Power
888-923-6236 purchasingpower.com
Employee discounts
PlumBenefits
plumbenefits.com (code: AC0329209)
PerkSpot
aspendental.perkspot.com
Laurel Road
laurelroad.com/aspen
Student loan refinancing
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Required notices These are provided for informational purposes only.
We are required by law to provide the following notices about your benefits each year. You do not need to take any action.
Availability of Summary of Benefits and Coverage (SBC) As a team member, the health benefits available to you represent a significant component of your compensation package. They also provide important protection for you and your family in the case of illness or injury. Your plan offers a series of health coverage options. Choosing a health coverage option is an important decision. To help you make an informed choice, your plan makes available a Summary of Benefits and Coverage (SBC), which summarizes important information about any health coverage option in a standard format, to help you compare across options. Go to myaspenbenefits.com to view electronic copies of SBCs. To request a copy free of charge, call the Benefit Service Center at 844-407-9444.
Important information about the notice on Health Insurance Marketplace coverage options The Patient Protection and Affordable Care Act (“Affordable Care Act”), also known as health care reform, was enacted in March 2010. One of the provisions of the Affordable Care Act is the new marketplace options.
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The Marketplace Notice provides you with instructions on how to access information about the new marketplace options. We provide the Marketplace Notice to all new hires at the time of hire as well as make it available to all team members on an annual basis. You can request a copy of the Marketplace Notice by calling the Benefit Service Center at 844-407-9444. You are encouraged to visit healthcare.gov to obtain important information that could apply to you regarding the Affordable Care Act and the new marketplace options where consumers can shop for insurance. If you have questions, call 1-800-318-2596 (TTY: 1-855-889-4325) or visit healthcare.gov.
Important notice about your prescription drug coverage and Medicare Please read this notice carefully and keep it where you can find it. This notice has information about your current prescription drug coverage with Excellus and about your options under Medicare’s prescription drug coverage. This information can help you decide whether or not you want to join a Medicare drug plan. If you are considering joining, you should compare your current coverage, including which drugs are covered at what cost, with the coverage and costs of the plans offering Medicare prescription drug coverage in your area. Information about where you can get help to make decisions about your prescription drug coverage is at the end of this notice.
There are two important things you need to know about your current coverage and Medicare’s prescription drug coverage: 1. Medicare prescription drug coverage became available in 2006 to everyone with Medicare. You can get this coverage if you join a Medicare Prescription Drug Plan or join a Medicare Advantage Plan (like an HMO or PPO) that offers prescription drug coverage. All Medicare drug plans provide at least a standard level of coverage set by Medicare. Some plans may also offer more coverage for a higher monthly premium. 2. We have determined that the prescription drug coverage offered by the Excellus plans is, on average for all plan participants, expected to pay out as much as standard Medicare prescription drug coverage pays and is therefore considered Creditable Coverage. Because your existing coverage is Creditable Coverage, you can keep this coverage and not pay a higher premium (a penalty) if you later decide to join a Medicare drug plan. When can you join a Medicare drug plan? You can join a Medicare drug plan when you first become eligible for Medicare and each year from October 15 through December 7. However, if you lose your current creditable prescription drug coverage, through no fault of your own, you will also be eligible for a two (2) month Special Enrollment Period (SEP) to join a Medicare drug plan. What happens to your current coverage if you decide to join a Medicare drug plan? If you decide to join a Medicare drug plan, your current Company coverage will not be affected. For most persons covered under the Plan, the Plan will pay prescription drug benefits first, and Medicare will determine its payments second. For more information about this issue of what program pays first and what program pays second, see the Plan’s summary plan description or contact Medicare at the telephone number or web address listed herein.
If you do decide to join a Medicare drug plan and drop your current Company coverage, be aware that you and your dependents will not be able to get this coverage back. When will you pay a higher premium (penalty) to join a Medicare drug plan? You should also know that if you drop or lose your current Company coverage and don’t join a Medicare drug plan within 63 continuous days after your current coverage ends, you may pay a higher premium (a penalty) to join a Medicare drug plan later. If you go 63 continuous days or longer without creditable prescription drug coverage, your monthly premium may go up by at least 1% of the Medicare base beneficiary premium per month for every month that you did not have that coverage. For example, if you go nineteen months without creditable coverage, your premium may consistently be at least 19% higher than the Medicare base beneficiary premium. You may have to pay this higher premium (a penalty) as long as you have Medicare prescription drug coverage. In addition, you may have to wait until the following October to join. More information about this notice or your current prescription drug coverage Contact the person listed in the next column for further information. NOTE: You’ll get this notice each year. You will also get it before the next period you can join a Medicare drug plan, and if this coverage through Excellus changes. You also may request a copy of this notice at any time. For more information about your options under Medicare prescription drug coverage More detailed information about Medicare plans that offer prescription drug coverage is in the “Medicare & You” handbook. You’ll get a copy of the handbook in the mail every year from Medicare. You may also be contacted directly by Medicare drug plans.
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For more information about Medicare prescription drug coverage: • Visit medicare.gov • Call your State Health Insurance Assistance Program (see the inside back cover of your copy of the “Medicare & You” handbook for their telephone number) for personalized help • Call 1-800-MEDICARE (1-800-633-4227). TTY users should call 1-877-486-2048. If you have limited income and resources, extra help paying for Medicare prescription drug coverage is available. For information about this extra help, visit Social Security on the Web at socialsecurity.gov or call them at 1-800-772-1213 (TTY: 1-800-325-0778). Remember: Keep this Medicare Part D notice. If you decide to join one of the Medicare drug plans, you may be required to provide a copy of this notice when you join to show whether or not you have maintained creditable coverage and, therefore, whether or not you are required to pay a higher premium (a penalty). Date: 1/1/2022 Name of Entity/Sender: Aspen Dental Management, Inc. Contact-Position/Office: Benefits Department Address:
281 Sanders Creek Parkway East Syracuse, NY 13057
Phone Number:
800-965-6470, option 4
Women’s Health and Cancer Rights Act of 1998 (WHCRA) If you have had or are going to have a mastectomy, you may be entitled to certain benefits under the WHCRA. For individuals receiving mastectomy related benefits, coverage will be provided in a manner determined in consultation with the attending physician and the patient for: • All stages of reconstruction of the breast on which the mastectomy was performed; • Surgery and reconstruction of the other breast to produce a symmetrical appearance; • Prostheses, and • Treatment of physical complications of the mastectomy, including lymphedemas.
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These benefits will be provided subject to the same deductibles and coinsurance applicable to other medical and surgical benefits provided under the Plan. If you would like more information on WHCRA benefits, refer to your summary plan description or call the Benefits Department at 800-965-6470, option 4.
Special enrollment rights If you are declining enrollment for yourself or your dependents (including your spouse) because of other health insurance or group health plan coverage, you may be able to enroll yourself and your dependents in this Plan if you or your dependents lose eligibility for that other coverage (or if the employer stops contributing toward your or your dependents’ other coverage). Loss of eligibility includes but is not limited to: • Loss of eligibility for coverage as a result of ceasing to meet the plan’s eligibility requirements (i.e., legal separation, divorce, cessation of dependent status, death of an employee, termination of employment, reduction in the number of hours of employment) • Loss of HMO coverage because the person no longer resides or works in the HMO service area and no other coverage option is available through the HMO plan sponsor • Elimination of the coverage option a person was enrolled in, and another option is not offered in its place; • Failing to return from an FMLA leave of absence • Loss of coverage under Medicaid or the Children’s Health Insurance Program (CHIP) Unless the event giving rise to your special enrollment right is a loss of coverage under Medicaid or CHIP, you must request enrollment within 30 days after your or your dependent’s(s’) other coverage ends (or after the employer that sponsors that coverage stops contributing toward the coverage).
If the event giving rise to your special enrollment right is a loss of coverage under Medicaid or CHIP, you may request enrollment under this plan within 60 days of the date you or your dependent(s) lose such coverage under Medicaid or CHIP. Similarly, if you or your dependent(s) become eligible for a state-granted premium subsidy toward this plan, you may request enrollment under this plan within 60 days after the date Medicaid or CHIP determine that you or the dependent(s) qualify for the subsidy. In addition, if you have a new dependent as a result of marriage, birth, adoption or placement for adoption, you may be able to enroll yourself and your dependents. However, you must request enrollment within 30 days after the marriage, birth, adoption or placement for adoption. To request special enrollment or obtain more information, contact the Benefit Service Center at 844-407-9444.
HIPAA privacy and security The Health Insurance Portability and Accountability Act of 1996 deals with how an employer can enforce eligibility and enrollment for health care benefits, as well as ensuring that protected health information which identifies you is kept private. You have the right to inspect and copy protected health information that is maintained by and for the plan for enrollment, payment, claims and case management. If you feel that protected health information about you is incorrect or incomplete, you may ask your benefits administrator to amend the information. For a full copy of the Notice of Privacy Practices, describing how protected health information about you may be used and disclosed and how you can get access to the information, contact the Benefits Department at 800-965-6470, option 4.
Premium assistance under Medicaid and the Children’s Health Insurance Program (CHIP) If you or your children are eligible for Medicaid or CHIP and you’re eligible for health coverage from your employer, your state may have a premium assistance program that can help pay for coverage, using funds from their Medicaid or CHIP programs. If you or your children aren’t eligible for Medicaid or CHIP, you won’t be eligible for these premium assistance programs, but you may be able to buy individual insurance coverage through the Health Insurance Marketplace. For more information, visit healthcare.gov. If you or your dependents are already enrolled in Medicaid or CHIP and you live in a state listed on the next page, contact your state Medicaid or CHIP office to find out if premium assistance is available. If you or your dependents are NOT currently enrolled in Medicaid or CHIP, and you think you or any of your dependents might be eligible for either of these programs, contact your state Medicaid or CHIP office or dial 1-877-KIDS NOW or insurekidsnow.gov to find out how to apply. If you qualify, ask your state if it has a program that might help you pay the premiums for an employersponsored plan. If you or your dependents are eligible for premium assistance under Medicaid or CHIP, as well as eligible under your employer plan, your employer must allow you to enroll in your employer plan if you aren’t already enrolled. This is called a “special enrollment” opportunity, and you must request coverage within 60 days of being determined eligible for premium assistance. If you have questions about enrolling in your employer plan, contact the Department of Labor at askebsa.dol.gov or call 1-866-444-EBSA (3272). If you live in one of the following states, you may be eligible for assistance paying your employer health plan premiums. The following list of states is current as of July 31, 2021. Contact your state for more information on eligibility.
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State
Phone
Website
Alabama — Medicaid
1-855-692-5447
http://myalhipp.com/
Alaska — Medicaid
1-866-251-4861 Email: CustomerService@ MyAKHIPP.com
The AK Health Insurance Premium Payment Program: http://myakhipp.com/ Medicaid Eligibility: http://dhss.alaska.gov/dpa/Pages/medicaid/default.aspx
Arkansas — Medicaid
1-855-MyARHIPP (1-855-692-7447)
http://myarhipp.com/
California — Medicaid
916-445-8322 Email: hipp@dhcs.ca.gov
http://dhcs.ca.gov/hipp
Colorado — Health First Colorado (Colorado’s Medicaid Program) & Child Health Plan Plus (CHP+)
Medicaid: Health First Colorado Member Contact Center: 1-800-221-3943/State Relay 711 CHP+: CHP+ Customer Service: 1-800-359-1991/State Relay 711 HIBI Customer Service: 1-855-692-6442
Medicaid: Health First Colorado: https://www.healthfirstcolorado.com/
Florida — Medicaid
1-877-357-3268
https://www.flmedicaidtplrecovery.com/flmedicaidtplrecovery. com/hipp/index.html
Georgia — Medicaid
678-564-1162, ext. 2131
https://medicaid.georgia.gov/health-insurance-premiumpayment-program-hipp
Indiana — Medicaid
Healthy Indiana Plan for low-income adults 19-64: 1-877-438-4479 All other Medicaid: 1-800-457-4584
Healthy Indiana Plan for low-income adults 19-64: http://www.in.gov/fssa/hip/
Iowa — Medicaid and CHIP (Hawki)
Medicaid: 1-800-338-8366 Hawki: 1-800-257-8563 HIPP: 1-888-346-9562
Medicaid: https://dhs.iowa.gov/ime/members Hawki: http://dhs.iowa.gov/Hawki HIPP: https://dhs.iowa.gov/ime/members/medicaid-a-to-z/hipp
Kansas — Medicaid
1-800-792-4884
https://www.kancare.ks.gov/
Kentucky — Medicaid
KI-HIPP: 1-855-459-6328 Email: KIHIPP.PROGRAM@ ky.gov KCHIP: 1-877-524-4718
Kentucky Integrated Health Insurance Premium Payment Program (KI-HIPP): https://chfs.ky.gov/agencies/dms/member/Pages/kihipp.aspx
Louisiana — Medicaid
1-888-342-6207 (Medicaid hotline) or 1-855-618-5488 (LaHIPP)
www.medicaid.la.gov or www.ldh.la.gov/lahipp
Maine — Medicaid
Enrollment: 1-800-442-6003 TTY: Maine relay 711 Private Health Insurance Premium: 1-800-977-6740 TTY: Maine relay 711
Enrollment: https://www.maine.gov/dhhs/ofi/applications-forms
Massachusetts — Medicaid and CHIP
1-800-862-4840
https://www.mass.gov/info-details/masshealth-premiumassistance-pa
Minnesota — Medicaid
1-800-657-3739
https://mn.gov/dhs/people-we-serve/children-and-families/ health-care/health-care-programs/programs-and-services/ other-insurance.jsp
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CHP+: https://www.colorado.gov/pacific/hcpf/child-health-plan-plus Health Insurance Buy-In Program (HIBI): https://www.colorado.gov/pacific/hcpf/health-insurancebuy-program
All other Medicaid: https://www.in.gov/medicaid/
KCHIP: https://kidshealth.ky.gov/Pages/index.asp Medicaid: https://chfs.ky.gov
Private Health Insurance Premium: https://www.maine.gov/dhhs/ofi/applications-forms
State
Phone
Website
Missouri — Medicaid
573-751-2005
http://www.dss.mo.gov/mhd/participants/pages/hipp.htm
Montana — Medicaid
1-800-694-3084
http://dphhs.mt.gov/MontanaHealthcarePrograms/HIPP
Nebraska — Medicaid
1-855-632-7633 Lincoln: 402-473-7000 Omaha: 402-595-1178
http://www.ACCESSNebraska.ne.gov
Nevada — Medicaid
1-800-992-0900
http://dhcfp.nv.gov
New Hampshire — Medicaid
603-271-5218 Toll free number for the HIPP program: 1-800-852-3345, ext. 5218
https://www.dhhs.nh.gov/oii/hipp.htm
New Jersey — Medicaid and CHIP
Medicaid: 609-631-2392 CHIP: 1-800-701-0710
Medicaid: http://www.state.nj.us/humanservices/dmahs/clients/ medicaid/ CHIP: http://www.njfamilycare.org/index.html
New York — Medicaid
1-800-541-2831
https://www.health.ny.gov/health_care/medicaid/
North Carolina — Medicaid
919-855-4100
https://medicaid.ncdhhs.gov/
North Dakota — Medicaid
1-844-854-4825
http://www.nd.gov/dhs/services/medicalserv/medicaid/
Oklahoma — Medicaid and CHIP
1-888-365-3742
http://www.insureoklahoma.org
Oregon — Medicaid
1-800-699-9075
http://healthcare.oregon.gov/Pages/index.aspx http://www.oregonhealthcare.gov/index-es.html
Pennsylvania — Medicaid
1-800-692-7462
https://www.dhs.pa.gov/Services/Assistance/Pages/HIPPProgram.aspx
Rhode Island — Medicaid and CHIP
1-855-697-4347 or 401-462-0311 (Direct RIte Share Line)
http://www.eohhs.ri.gov/
South Carolina — Medicaid
1-888-549-0820
https://www.scdhhs.gov
South Dakota — Medicaid
1-888-828-0059
http://dss.sd.gov
Texas — Medicaid
1-800-440-0493
http://gethipptexas.com/
Utah — Medicaid and CHIP
1-877-543-7669
Medicaid: https://medicaid.utah.gov/ CHIP: http://health.utah.gov/chip
Vermont — Medicaid
1-800-250-8427
http://www.greenmountaincare.org/
Virginia — Medicaid and CHIP
1-833-5CALLVA (1-833-522-5582) TDD: 1-888-221-1590
https://www.coverva.org/en/famis-select https://www.coverva.org/en/hipp
Washington — Medicaid
1-800-562-3022
https://www.hca.wa.gov/
West Virginia — Medicaid
1-855-MyWVHIPP (1-855-699-8447)
http://mywvhipp.com/
Wisconsin — Medicaid and CHIP
1-800-362-3002
https://www.dhs.wisconsin.gov/badgercareplus/p-10095.htm
Wyoming — Medicaid
1-800-251-1269
https://health.wyo.gov/healthcarefin/medicaid/programs-andeligibility/
To see if any more states have added a premium assistance program since July 31, 2021, or for more information on special enrollment rights, you can contact either: U.S. Department of Labor Employee Benefits Security Administration dol.gov/agencies/ebsa 1-866-444-EBSA (3272)
U.S. Department of Health and Human Services Centers for Medicare & Medicaid Services cms.hhs.gov 1-877-267-2323, Menu Option 4, ext. 61565
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By enrolling in and confirming your elections, you agree to have premiums for elected benefits deducted from your biweekly pay effective with the paycheck corresponding to the benefits effective date(s). The deduction amounts on your paycheck may vary slightly due to rounding. If you are unable to pay the biweekly premium for any reason due to insufficient pay available, including but not limited to, being on a leave of absence, not working enough hours, etc., premiums owed will accrue in arrears and will be due on the next available paycheck. The company is authorized, without notice, to take a percentage of the arrears balance, in addition to normal deductions, with each biweekly paycheck, until the arrears balance is paid in full. By enrolling in a Dependent Care Flexible Spending Account (DCFSA), you acknowledge that the company is subject to certain testing requirements as outlined under IRS Section 129. These testing requirements may impact your ability to participate in the DCFSA as well as your ability to contribute on a pre-tax basis. You agree that the company can change your elected amount and/or subject some or all of your contributions to normal payroll taxes in order to satisfy testing at any time. While the company will make efforts to notify you of such actions, it is not required in order to take such actions.
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