These Enrollment Materials (“Materials”) also serve as a Summary of Material Modifications (“SMM”) and describe updates that affect the Associated Builders and Contractors (ABC) Group Benefit Plan (the “Plan’s”) summary plan descriptions. Please read these Materials carefully and keep them with your summary plan descriptions for future reference. If there is any discrepancy between these Materials, the summary plan descriptions and the Plan document, the Plan document will control. ABC reserves the right to end, suspend, or amend the Plan or the benefits provided thereunder, at any time, for any reason, in whole or in part.
ABC 2025 Benefits At-a-Glance
Associated Builders and Contractors (ABC) is committed to a comprehensive employee benefit program that helps our employees stay healthy, feel secure and maintain a work/life balance. The ABC Benefits Program includes company standard benefits as well as flexible health and welfare benefits for a comprehensive benefits package. These benefits are provided in addition to your regular paycheck. Our benefits represent a hidden value of additional income to our employees. Several are entirely paid for by ABC; others require a contribution from you.
The ABC Benefits Program offers several advantages, including: Flexibility—we let you make decisions about your own benefits. You can choose the coverage that is just right for you. In addition, as your needs and family situation changes, you will be able to update your benefits to keep pace with your changing needs; and Tax Savings—our program takes advantage of current tax laws that allow you to pay for some benefits with pre- tax dollars.
The information in this brochure is designed to provide you with a general overview of the benefits plans that are currently available for the plan year January 1, 2025 – December 31, 2025, as well as information on how to enroll, along with the benefits costs. It is not a legal document. More detailed information is provided in the summary plan descriptions. Refer to the actual plan documents and summary plan descriptions if you have specific questions regarding the benefit plan. Wherever conflicts occur between the contents of this guide and the contracts, rules, regulations, or laws governing the administration of the various programs, the terms set forth in the various program contracts, rules, regulations, or laws shall prevail. Space does not permit listing all limitations and exclusions that apply to each plan. ABC reserves the right to modify its benefits at any time.
If you have any questions regarding these benefits, contact Human Resources.
Important Information About Health Insurance Rates
Over the past several years, ABC’s health insurance costs have consistently risen. Despite this, health insurance premiums for employees have remained unchanged since 2020, reflecting a stable cost increase for ABC. For the 2025 plan year, ABC will share the cost of the medical premium increase with employees. This change will be reflected in the medical insurance rate tables. However, there will be no changes to employee rates for dental and vision coverage in 2025.
Open Enrollment Activities for the 2025 plan year will occur between November 11, 2024, through December 6, 2024. All benefit elections during Open Enrollment are effective on January 1, 2025.
Benefits Eligibility – Who Can Be Covered
Employees
You are eligible to enroll in ABC benefits if you are a regular full-time employee working 30+ hours per week. Medical insurance benefits are effective the first of the month coinciding or following hire. The effective date for other benefits may be dependent upon your hire date or a qualifying waiting period. If you experience a qualified event (e.g., marriage, divorce, birth or adoption of a child, death of a dependent, change in spouse's employment status), you must notify Human Resources in writing by providing supporting documentation within 30 days of the date on which the event occurred in order to make a change to your current elections
Important Note for New Hires: New hires will be provided benefits information during New Hire Orientation including instructions and the time period to enroll. Following your start date, you must enroll electronically and return all required benefits documentation to Human Resources within 30 business days of your hire in order to be enrolled in the plan(s). If you miss the initial enrollment date, you are only able to enroll during the next annual open enrollment period, unless you experience a qualifying event during the plan period.
Dependents
If you’re eligible and enrolled in coverage – your dependents may also be eligible to be on some of your benefit plans too! Please note, dependents will only be eligible to be enrolled in the same coverage options as the employee. Who are eligible dependents?
Eligible Dependents are:
o Your spouse or qualified domestic partner.
o Your (or your spouses) biological children, stepchildren, legal adopted children, or children from whom you have legal guardianship over, up to age 26 (post-age 26 coverage may be available for disabled children) through the last day of the month in which your dependent child reaches age 26.
Note: Disabled children are required to be covered under the employer’s plan (i.e., ABC) prior to reaching age 26.
Dependent documentation required:
In order to provide coverage for your newly enrolled dependent(s), you must submit proper legal documentation to Human Resources when requested If applicable, you are also required to provide proof of a child’s handicap status prior to the child’s 26th birthday.
o Spouse/Qualified Domestic Partner: marriage certificate/affidavit
o Dependent child: birth certificate
o Stepchild: birth certificate AND marriage certificate
o Foster child, adopted child or child whom you have legal guardianship: birth certificate AND legal documents from the court
Who is not an eligible dependent:
o Your parents, grandparents, grandchildren, and unmarried dependent children older than 26 unless mandated by law.
o Former spouse or domestic partner after divorce or termination of the domestic partnership.
o Children/stepchildren of a former spouse or domestic partner after divorce of termination of the domestic partnership.
Enroll – How to Select Benefits
ABC will hold Open Enrollment activities beginning November 11, 2024, through December 6, 2024. Employees are required to make benefit elections in Paylocity between November 19, 2024, through December 6, 2024. All benefit elections will be effective on January 1, 2025. Benefits will term on December 31, 2024, for employee who do not make employee benefit elections for 2025 by the required due date. FSA elections are required to be made every year.
If you are…. You must:
(a) …currently enrolled and do not wish to make any changes to your current elections:
(b) …currently enrolled and wish to make changes to your current elections (i.e., enroll or un-enroll from PPO, add/drop dependents, etc.)
(c) … not currently enrolled in a particular benefit plan and wish to enroll:
(d) …currently enrolled and wish to drop coverage; or not enrolled and do not wish to enroll:
Log in to Paylocity and re-elect your benefits by December 6, 2024.
Log in to Paylocity, re-elect your benefits including any changes your elections by December 6, 2024.
Log in to Paylocity and make your benefit elections by December 6, 2024.
Log in to Paylocity and modify your benefit elections by December 6, 2024.
Changing Your Benefits Coverage
You can make changes to your 2025 benefits options any time during the open enrollment period until December 6, 2024
According to the Internal Revenue Service (IRS) regulations that govern flexible benefit plans, the optional Benefits you elect during enrollment must remain in effect throughout the calendar year, unless you experience a qualifying (i.e., change of life) event
If you decide to change your elections as the result of one of the events listed, you must do so within 30 days after the qualifying (i.e., change of life) event with the exception of Medicaid/CHIP which is 60 days. Authorized election change(s) begin first of the month following the date of the elected change.
If you do NOT notify the Human Resources Office within 30 days after the event, you cannot change your elections until the next annual open enrollment. You must provide Human Resources with verification of all change of life events.
What is a qualifying or change of life event:
For all of us, life is a continuing process of change marriage, birth, adoption, a new job, divorce, and death. Should one of these events occur in your life, you may need to rethink, and more than likely, make changes to your enrollment in certain ABC benefit programs, such as: medical, dental, vision and FSA.
Eligible qualifying events include:
• marriage, qualified domestic partnership
• legal separation, divorce, dissolution of domestic partnership
• loss or gain of other coverage by you or covered dependent (e.g., employment status and eligibility for Medicare)
• covered dependent turns age 26 (i.e., over-age children who no longer qualify as dependents)
• death of spouse, qualified domestic partner or dependent
Should any of these events occur, you can make a change to your current benefit elections without waiting for the annual Open Enrollment period. You will be required to provide documentation to support the change.
For changes related to a qualifying event:
1. If you are not currently enrolled, and your qualifying event necessitates enrollment, Human Resources will initiate your ability to change your benefit election(s) You must login to Paylocity and make your election(s) within 30 days of the qualifying event.
2. If you are currently enrolled, and your qualifying event necessitates that you add or drop an eligible dependent, you must login to Paylocity and make changes within 30 days of the qualifying event.
Health Dental and Vision
Medical
Your Medical Insurance is provided by United Healthcare. Assuming timely selection and compliance with the carrier’s eligibility requirements, coverage begins on the 1st of the month following the date in which you are eligible. This plan is contributory meaning the costs are shared by ABC and the employee. Employee premiums are paid through pre-tax, bi-weekly payroll deduction.
PPO Open Access Plus
Your plan gives you the freedom to visit any provider you wish – any time you wish. This means you can receive care from the provider of your choice without ever needing to select a primary care physician (PCP) or obtaining a PCP referral for specialist care. The amount of coverage your PPO Open Access Plus plan offers depends on whether you see a provider in the United Healthcare network (preferred provider). You will always receive a higher level of benefits when you visit a preferred provider. However, the choice is entirely yours. PPO plan also includes discount dental and vision plan.
ABC Medical Insurance
2025 Bi-Weekly Plan Costs
ABC generally requires the designation of a primary care provider You have the right to designate any primary care provider who participates in our network and who is available to accept you or your family members For children, you may designate a pediatrician as the primary care provider For information on how to select a primary care provider, and for a list of the participating primary care providers, visit www.myuhc.com
This chart provides a summary of the medical plan provisions and services covered. It is not all-inclusive of the full range of services available. Please review the Summary Plan Description for the full list of medical plan provisions and services covered. In case of a discrepancy, the actual plan documents will prevail.
Services Preventive
Care and Urgent Care
Inpatient and Outpatient Facility
Svcs Inpatient and Outpatient Physician Svcs
Mental Health and Substance Abuse Office Visits
Inpatient / Outpatient Facility Svcs
Inpatient / Outpatient Physician
Svcs Partial Hospitalization Facility
Svcs Partial Hospitalization Physician Svcs
Hospital Alternatives
Home Health Care (90 visits/episode)
Hospice (180-day max)
Skilled Nursing Facility (60 days/benefit period)
Dental and Vision
Dental insurance is provided by MetLife You must enroll in the Dental plan to receive this benefit. Assuming timely selection and compliance with the carrier’s eligibility requirements, coverage begins on the 1st of the month following the date in which you are eligible. This plan is a contributory plan – the costs are shared by ABC and the employee. Employee premiums are paid through pre-tax, bi-weekly payroll deduction.
ABC Dental and Vision Insurance
2025 Bi-Weekly Plan
Rates
MetLife Dental & Vision (must enroll in Dental to enroll in Vision)
This chart provides a summary of the dental plan provisions and services covered. It is not all-inclusive of the full range of services available. Please review the Summary Plan Description for full list of dental plan provisions and services covered. In case of a discrepancy, the actual plan documents will prevail.
METLIFE DENTAL CARE SERVICES
General Plan Provisions
Calendar Year Maximum
Choice of Dentists
$10,000
Participating Provider Network (Par) or any licensed Dentist (Non-Par)
PREVENTATIVE CARE YOUR COPAYMENT
Exams Cleaning Topical Fluoride X-rays
ROUTINE CARE
X-rays - Periapical Fillings
Sealants, Space Maintainers, Endodontics, Periodontics
100%, no deductible 2 X’s a year (usual and customary)
YOUR COPAYMENT
80% co-ins., after deductible (usual and customary).
MAJOR CARE YOUR COPAYMENT
Waiting Period – New Members Crowns, Bridges Dentures Orthodontics
50% co-ins., after deductible (usual and customary).
Adult & Child Orthodontics, $2,000 lifetime
Vision insurance is provided by MetLife for those who elect the Dental plan. You must enroll in the Dental plan to receive the Vision benefit.
Some general plan provisions:
• Frames must be chosen from a group selected by the provider. If a member chooses a frame outside of the group, the member will have to pay the difference between MetLife’s allowance and the provider’s charge for the frames. If the member replaces only the lenses of his/her glasses, the allowance for frames cannot be applied to the cost of lenses and contact lenses.
• If the member receives benefits for contact lenses, the member is not eligible for frames in the same year. If benefits for frames have been paid in a calendar year, those benefits will be deducted for any contact lenses furnished in the same calendar year
COBRA
Under certain circumstances, you and your enrolled dependents have the right to continue coverage under the medical, dental and vision plans, beyond the time that coverage would have ordinarily ended. You may elect continuation of coverage for yourself and your dependents if you lose coverage under the plan due to one of the following qualifying events:
• Termination (for reasons other than gross conduct)
• Reduction in employment hours
• Retirement
• You become entitled to Medicare.
In addition, continuation of coverage may be available to your eligible dependents if:
• You die
• You and your spouse divorce or qualifying domestic partner separate
• A covered child ceases to be an eligible dependent
• You become entitled to Medicare
To apply for COBRA coverage, you or a dependent must contact Human Resources within 60 days of a qualifying life event. You and/or your dependents must pay the full cost COBRA coverage (i.e., employee deduction plus employer contribution) plus a 2% administrative fee. Under the law, COBRA must be offered to eligible individuals at group rates. These rates are subject to change annually, based on plan experience.
* Upon both hire and termination of employment, a “Notice of COBRA Continuation Coverage Rights” will be automatically mailed to your home address of record by our COBRA administrator.
Flexible Spending Accounts (FSAs)
Flexible Spending Account plans allow you to set aside pre-tax money to pay for qualified medical and/or dependent care expenses. Money deducted from an employee's pay into an FSA is not subject to payroll taxes, resulting in substantial payroll tax savings. Assuming timely selection and compliance with the carrier’s eligibility requirements, coverage begins on the 1st of the month following the date in which you are eligible. Employee premiums are paid through pre-tax, bi-weekly payroll deduction. Minimum contribution of $100 for both Health Care and Dependent Care FSAs.
ABC Offers you two FSA Options:
• Health Care FSA – For eligible medical, dental and vision care expenses.
• Dependent Care FSA – For eligible expenses for children and adult care services.
Health Care FSA:
You may elect to set aside up to $3,300 per year per household into a Health Care FSA on a tax-free basis and use this money to pay for eligible out-of-pocket health care costs that are not fully covered by medical, dental or vision benefits. Examples of health care expenses include:
• Deductibles
• Copays
• Coinsurance
Dependent Care FSA:
• Orthodontia
• Eyeglasses
• Hearing aids
• Contact lenses
You may contribute up to $5,000 per year, or $2,500 if married and filing separately, tax free, into a Dependent Care FSA and use it to pay for dependent care expenses for eligible dependents while you are at work. Eligible dependent care expenses include:
• Daycare centers and in-home day care providers
• Babysitter, nanny, au pair
• Before or after school programs, including extended care programs for children under age 13
• Summer day camp (but not virtual camps)
• Nursery school and pre-school programs
• Adult day care & elder care for dependents not capable of self-care
• Day care for disabled adult dependents and elderly parents who live with you
INELIGIBLE Dependent Care FSA expenses
include:
• Babysitter on a weekend while parents are out to dinner
• The employee’s child under the age of 19 babysitting for a younger sibling
• Nursing home expenses
• Expenses to attend kindergarten or a higher grade
• Summer school
• Virtual Camps
• Tutoring program
• Childcare while spouse is volunteering
• Daycare bill paid in advance for future dependent care expenses
To be considered eligible for dependent care reimbursement from your Dependent Care FSA, the dependent must be able to be claimed as a dependent on the employee's federal tax return.
The funds CANNOT be used for summer camps (other than "day camps") or for long-term care for parents who live elsewhere (such as in a nursing home). The dependent care FSA is federally capped at $5,000 per year, per household.
IRS FSA Regulations:
The IRS regulates FSAs and has established certain rules for using them:
• You cannot use Health Care FSA to pay for dependent care expenses and vice versa.
• Due to tax favored status of these accounts, the IRS does not allow mid-year changes to your FSA election, unless you have a qualifying event (see page 14).
• You must re-enroll each year. Enrollment does not roll over into the next year. You must elect to participate in an FSA each year during the annual open enrollment period.
Short Term & Long Term Disability
ABC provides several options for disability insurance which provides partial "wage replacement" coverage to eligible employees for non-work-related sickness or injury (including pregnancy). This means that if an employee is unable to work because of an off-the-job sickness or injury and that employee meets the qualifying conditions of the law, the disabled employee will be paid disability benefits to partially replace the wages lost.
Short-term Disability
ABC provides Short-Term Disability (STD) Insurance through MetLife. Assuming timely selection and compliance with the carrier’s eligibility requirements, coverage begins on the 1st of the month following the date in which you are eligible. There is no waiting period (i.e., elimination period for an accident). There is a 7-day waiting period for sickness. Short-term Disability benefits would provide 66 2/3 % of your average weekly salary, up to maximum of $2,500.00 per week for up to 180 days. This coverage is fully paid for by ABC – there is no cost to the employee.
Example:
If your annual salary is $45,000, your average weekly salary is $865.38. Your weekly STD benefit would be $576.86, which is 66-2/3% of your weekly salary.
Long-Term Disability
Long-Term Disability (LTD) Insurance is provided through MetLife. Long term disability insurance can replace a portion of an employee’s income should the employee become unable to work and earn a paycheck for an extended period of time due to an illness or injury. This plan can help protect the employee and their family from the impact of lost income by replacing a portion of it during an extended disability.
Assuming timely selection and compliance with the carrier’s eligibility requirements, coverage begins following the elimination period The elimination period is 180 Days or until the end of the STD. Following the waiting period, Long-term Disability benefits would provide 60% of your average monthly salary, up to a maximum of $10,000.00 per month. This is an employee paid benefit – the costs are not shared by ABC and the employee. Employee premiums are paid through post-tax, bi-weekly payroll deduction.
Example:
If your annual salary is $45,000, your average monthly salary is $3,750.00 Your monthly LTD benefit would be $2,250.00, which is 60% of your monthly salary.
Life and Accidental Death & Dismemberment Insurance
Basic Life, Accidental Death & Dismemberment Insurance
Basic Life and Accidental Death & Dismemberment (AD&D) Insurance is provided by MetLife. ABC provides full-time employees with $35,000 life and $35,000 accidental death and dismemberment (AD&D) insurance through MetLife. Assuming timely selection and compliance with the carrier’s eligibility requirements, coverage begins on the 1st of the month following the date in which you are eligible. This is a non-contributory benefit, provided by ABC at no cost to the employee.
Employee Additional Life and AD&D Insurance
Additional Basic Life and AD&D Insurance is provided by MetLife. All full-time ABC employees age 21 and over who have completed one year of full-time employment will be automatically covered under ABC’s staff life insurance plan for two times their basic annual earnings up to a maximum of $300,000. The effective date of coverage begins on the 1st of the month following benefit eligibility. This is a noncontributory benefit, provided by ABC at no cost to the employee.
Special AD&D Insurance
A Special AD&D insurance benefit is provided through National Union. ABC provides full-time employees with additional AD&D coverage. Coverage begins on the 1st of the month following the employee’s hire date or other date in which the employee is eligible. This is a non-contributory benefit, provided by ABC at no cost to the employee.
Employee Supplemental (Term) Life Insurance and AD&D
Supplemental Term Life Insurance and AD&D is provided by MetLife. Employees have the option to purchase additional life insurance (i.e., supplemental life insurance) up to $500,000. Coverage levels below $100,000 do not require a statemen of health (i.e., Evidence of Insurability). This is an employee paid benefit. Supplemental Term Life
$1,000 of Covered Volume)
The Supplemental AD&D rate is $0.014 per $1,000 of covered volume.
Travel Insurance
ABC is now partnering with MetLife to provide emergency medical and personal assistance services while traveling anytime, anywhere. To complement your MetLife insurance coverage, you have access to Travel Assistance services, a unique program where you and covered family members can contact AXA representatives to administer emergency medical, travel and personal assistance services on your behalf wherever you are in the world. This is a non-contributory benefit, provided by ABC at no cost to the employee.
• Emergency Services- Emergency medical evacuation and transportation services; political and natural disaster evacuation; return of remains; pet repatriation.
• Medical Assistance Services- Medical referrals, appointments, and hospital admissions; replacement of prescription medication; replacement of medical devices.
• Personal Assistance Services- Concierge for you; pet concierge; identity theft assistance.
• Other Assistance Services. Local professional referrals; help with lost documents or luggage; emergency cash/bail assistance.
Worldwide Medical Teleconsultations
If you’re traveling and need medical advice for common and minor illnesses, you and covered family members can have virtual consultations with licensed medical professionals, 24/7 via mobile device or phone.
The DOCTOR PLEASE! App is available at App Store or Google Play. Call AXA at (800) 454-3679 to receive the code needed for user registration in a confidential setting, medical staff can:
• Handle non-life-threatening medical conditions, such as minor injuries and illnesses
• Provide medical advice and treatment options
• Refer you to a provider for follow up care as needed
RETIREMENT
Retirement - 401(k)
ABC’s 401(k) Plan is administered by Ameritas.
ABC employees at least age 21 may begin making tax-deferred contributions to the plan on the first day of the month following a 30-day waiting period from your employment start date. ABC employees are eligible for an employer contribution if you are at least 21 years of age and have worked for ABC for the 30-day waiting period.
• The employer match is subject to a 5-year vesting schedule (i.e., Two- to Five-Year Graded Schedule)
• You are always 100% vested in the amount you defer and the discretionary 4% Employer contribution
You can contribute any portion of your eligible compensation between the Minimum Contribution Percentage and the Maximum Contribution Percentage, by making pre-tax salary deferrals through regular payroll deductions.
You can also contribute to your plan on an after-tax basis by making Roth contributions through regular payroll deductions.
The first day of the month following a
ABC VESTING SCHEDULE (for employer match only)
Voluntary Benefits (NEW)
ABC is pleased to introduce its newest benefit offerings for regular employees. Voluntary benefits are additional benefits that employees can choose to participate in, beyond the basic benefits packages offered by ABC. These benefits are typically offered at discounted rates and can include a wide range of options such as dependent life insurance, pet insurance, legal services, and more.
Voluntary benefits are optional, meaning employees can decide whether or not to opt in. Voluntary benefits provide employees with the flexibility to select coverage that meets their individual needs, helping to improve their overall well-being and job satisfaction.
Dependent Term Life Insurance and AD&D
(Spouse and Child(ren)
Supplemental Term Life Insurance and AD&D is provided by MetLife. Employees have the option to purchase dependent life insurance for their spouse and child(ren).
For spouse, the benefit is a minimum of $5,000 and a max of $100,000, not to exceed 50% of the employee amounts. A statement of health (i.e., Evidence of Insurability) is required for any election over $25,000.
For a child(ren) 15-days to 6 months of age, the benefit is $100 For child(ren) 6months to age 26, the dependent life insurance options may be elected in $1,000, $2,000, $4,000, $5,000 or $10,000 increments
The dependent term life insurance for spouse and child(ren) is an employee paid benefit. The employee must be enrolled in the employee supplemental term life insurance benefit (see Page 17) to enroll in the dependent term life insurance and AD&D benefits.
Supplemental Dependent Life (per $1,000 of Covered Volume)
Spouse (Note: Spouse rates are based on the employee’s age)
Child(ren) $0.240
The Supplemental Dependent AD&D rate for spouse is $0.014 and $0.051 for child(ren) per $1,000 of covered volume.
Pet Insurance
MetLife pet insurance is available during open enrollment and to new employees. Similar to health insurance, for you and your family, pet insurance is coverage for dogs and cats that can help you plan and be better prepared for vet costs. Help make sure your furry family members are protected against unplanned vet expenses for covered accidents or illnesses with MetLife Pet Insurance. This is not a payroll deducted benefit. Employees will pay via direct bill with MetLife.
You can visit any licensed veterinarian or emergency clinic in the United States. You and your vet of choice can determine the best treatment plan and medical course of action for your pet. Once you have received and paid your bill, submit it to MetLife. They will process the claim for reimbursement if the claim expense is covered under the policy.
Each pet’s premium will be unique based on the age, breed, and location as well as the coverage options selected. There are additional discounts for multi-pet households and other factors. Employees interested in coverage must contact MetLife directly and be given a specialized quote.
Here’s how it works:
1. Enroll – Select and enroll in the coverage that’s right for you and download our mobile app To enroll, contact, call 866-464-0096 or Click here to get a quote.
2. Care – Take your pet to the vet when needed and pay the bill; manage your pet’s health and wellness using the app
3. Cover – Send the bill and your claim documents to us and receive reimbursement2 check or direct deposit if the claim expense is covered under the policy
This is NOT a payroll deducted benefit. Employees will pay via direct bill with MetLife. You can enroll, make changes, or cancel at any time directly with MetLife. See review rate sheet for employee cost and more information.
Identity & Fraud Protection
We’re doing more online than ever before – making us more vulnerable to fraud and online threats. ABC partners with MetLife and Aura Identity & Fraud Protection to help safeguard the things that matter to you most: your identity, money and assets, family, reputation, and privacy.
Employees can add unlimited minors and up to 10 adults to their Family plan
Additional adults can include anyone the employee chooses, regardless of their relationship, age, address, or financial dependency
Easy to add adults with only their name and email address - the employee does not need to obtain SSN or other sensitive PII, or activate protection on their behalf
Family safety tools to help protect vulnerable loved ones online
3-Bureau Child Credit Freeze Wizard
Shared Password Vault
Parental Controls
Child Cyberbullying Protection
Caregiver Alert Sharing2 And more
Protection Plan includes core protection for your identity, finances, and privacy such as Credit Monitoring & Alerts, Financial Account and Transaction Monitoring, Dark Web Monitoring, SSN & Identity Authentication Alerts, Password Manager and Safe Web Browsing.
Protection Plus Plan includes all the core protection of the Protection plan plus Experian Credit Lock, Payday/Specialty Loans Block, Credit Score Simulator, Social Media Account Monitoring & Takeover Alerts, Gamertag Monitoring, AI-Powered Call & Text Screening.
*The family plan covers the employee, unlimited minors (under 18) and up to 10 additional adults. There are zero restrictions around who can be defined as an adult “family member” – no matter their age, relationship or whether they live at the same address as the employee.
Critical Illness
Even with medical insurance, a serious illness can be expensive. Plan deductibles, copays, and out-ofnetwork costs can add up fast, not to mention costs outside of medical needs, like your mortgage, childcare expenses, transportation and more Critical illness insurance coverage can help with costs while you recover. With this supplemental plan from MetLife there is:
• There is no waiting period for services you can begin using them immediately after coverage begins.
• The ability to take your coverage with you if you change jobs or retire.
• A simple and quick enrollment process that only takes a few minutes and with no health questions.
Reasons to consider adding this plan to your insurance coverage lineup:
• You have a personal or family history of serious illness or medical condition such as cancer, heart attack, or stroke.
• You need dependent coverage for your spouse or children.
• You're looking for additional financial reassurance and support.
IMPORTANT:
This is a fixed indemnity policy, NOT health insurance
This fixed indemnity policy may pay you a limited dollar amount if you're sick or hospitalized. You're still responsible for paying the cost of your care.
• The payment you get isn't based on the size of your medical bill.
• There might be a limit on how much this policy will pay each year.
• This policy isn't a substitute for comprehensive health insurance.
• Since this policy isn't health insurance, it doesn't have to include most Federal consumer protections that apply to health insurance.
Looking for comprehensive health insurance?
• Visit HealthCare.gov or call 1-800-318-2596 (TTY: 1-855-889-4325) to find health coverage options.
• To find out if you can get health insurance through your job, or a family member's job, contact the employer.
Questions about this policy?
• For questions or complaints about this policy, contact your State Department of Insurance. Find their number on the National Association of Insurance Commissioners' website (naic.org) under "Insurance Departments."
• If you have this policy through your job, or a family member's job, contact the employer.
Hospital Indemnity
Even with medical insurance, a hospital stay can be costly. Plan deductibles, copays, and out-of-network costs can add up fast, not to mention costs outside of medical needs, like your mortgage, childcare expenses, transportation and more.
Hospital indemnity insurance can help with out-of-pocket costs while you’re in the hospital and recovering to help reduce the financial impact while you heal. With this supplemental plan from MetLife, you:
• Get competitive rates by enrolling through work.
• Can take your coverage with you if you leave your job or retire.
• Reasons to consider adding this supplemental plan to your insurance coverage lineup:
o You’re pregnant or planning for a baby. Hospital indemnity insurance may provide coverage for extra days spent in the hospital after giving birth.
o You or a family member have a chronic illness. For those with chronic medical conditions like cancer, diabetes, or heart disease hospital indemnity insurance can help cover your frequent hospital visits.
o You have an upcoming surgery or procedure. You may want hospital indemnity insurance for a scheduled hospital visit, overnight stay, or outpatient surgery.
ABC Hospital Indemnity Plan Rates
Accident Insurance
After experiencing an accident, you don’t need any more surprises – like finding out that your medical insurance plan may not cover some of your expenses. With MetLife Accident Insurance, you can receive a lump-sum payment, paid directly to you, to use at your discretion. It can help with:
• Injuries: such as fractures, dislocations, concussions, lacerations, eye injuries, torn knee cartilage, ruptured discs, and severe burns.
• Medical Services and Treatments: Includes ambulance, emergency care, therapy services, medical testing (including X-rays, MRIs, CT scans), medical appliances, and certain types of surgeries.
• Hospitalization: Hospital admission, confinement, and inpatient rehab after an accident.
ABC Accident Insurance Plan Rates
Holidays and Leave Benefits
ABC Holidays
ABC recognizes the following paid holidays:
• New Year’s Day
• Martin Luther King, Jr. Day
• Memorial Day
• Juneteenth National Independence Day
• Independence Day
• Labor Day
• Thanksgiving Day
• Day after Thanksgiving
• Christmas Day
• New Year’s Eve
Holidays which fall on Saturdays are observed on the preceding Friday; holidays which fall on Sundays are observed on the following Monday. Regular budgeted employees are eligible for paid holidays. Interns, seasonal and temporary employees are not eligible for holiday pay unless required or mandated by law ABC National and ABC Trust reserve the right to adjust the holiday schedule at their discretion.
Paid Time Off
ABC believes that in order to maintain a fun and productive workforce, it is important to allow employees to determine when they need time off. ABC provides Paid Time Off (PTO) for full-time, benefit eligible employees to be used for vacation, illness, and personal business or other reasons that you are away from work that are not covered by another company paid policy (such as holidays, jury duty, parental, military and bereavement leave). PTO combines traditional vacation and sick leave plans into one flexible, paid time off program. Employees are accountable and responsible for managing their own PTO hours to allow for adequate reserves if there is a need that requires time off from work. Managers should monitor their staff’s PTO and encourage its use accordingly throughout the year. Employees can rollover a maximum of 5 days of unused PTO from year to year.
All full‐time, benefit eligible employees will be front loaded their eligible annual PTO allotment, or pro-rated based upon hire, according to the following schedule:
PAID TIME OFF ALLOTMENT
(Allocated Annually)
0 – up to 1 year 25 days
1 year – up to 3 years
3 years – up to 5 years
5 years – up to 8 years
8 years – up to 10 years
days
days
days 10 years + 35 days
All hours over 5 (five) PTO days will be forfeited at the end of the year. ABC does not provide cash payment in lieu of PTO accrual.
Employees accrue PTO based on the date they begin employment as a full-time, benefit eligible employee. Time served in temporary or part-time positions is not counted in calculating a staff member's Paid Time Off accrual rate. New employees may not take paid leave during their first ninety (90) days of employment with ABC without prior approval. PTO is not earned (annual leave accrual adjusted) if an employee is out on leave without pay for a full pay period.
Parental Leave
To give parents additional flexibility and time to bond with their new child, adjust to their new family situation, and balance their professional obligations, ABC provides paid Parental Leave to eligible employees with at least one (1) year of service, following childbirth, adoption or placement of a foster child under the age of eighteen (18) in their home. This policy is designed to provide a reasonable and fair period of paid leave to such employees and runs concurrently with Short Term Disability, DC Paid Family and Medical Leave (DCPFL), and the Family Medical Leave Act (FMLA), in cases where an employee is eligible for STD, DC PFL, applicable state mandated benefits, and/or FMLA.
ABC provides six (6) weeks (equivalent of two hundred and twenty-five (225) hours) of paid Parental Leave to the employee parent (as defined above) to care for and bond with a newborn, newly adopted, or newly placed foster child, within ninety (90) days of the birth, the adoption or placement of a child under the age of eighteen (18).
In addition, ABC reimburses nursing mothers for the cost to ship their breast milk in cases where the employee is on travel for ABC events and functions. Employees can contact Human Resources for details and to plan ahead of time.
Family and Medical Leave (FMLA)
ABC complies with the Federal (12 weeks) and District of Columbia (16 weeks) Family and Medical Leave Act (FMLA) and grants eligible full-time employees with up to 16 weeks job-protected unpaid leave during any 12-month period for any of the following non-work-related medical reasons:
• For the birth or adoption of a child (during the 12-month period immediately following the birth or adoption).
• Provide care to a parent, spouse, or child (“covered relations”) with a serious medical condition.
• To enable the employee to treat his or her own serious medical condition.
• Time needed to care for a spouse, son, daughter, parent, or next of kin who is a service member recovering from serious illness or injury sustained in the line of active duty (the leave time is expanded to 26 weeks)
• A qualifying exigency arising out of the fact that the spouse, child, or parent of the employee is on active duty or has been notified of an impending call to order to active duty in the Armed Forces in support of a contingency operation (the leave time is expanded to 26 weeks)
If an employee requests FMLA leave because of his or her own or a covered relative’s illness, the attending health care provider must supply the association with certification of the need for leave. Employees on FMLA leave may continue to participate in ABC’s sponsored health insurance plans. However, any contributions the employee makes through payroll deductions must be paid.
Bereavement Leave
ABC provides up to 5 days of paid leave to eligible full-time employees who must take time off due to a death in your immediate family. A part-time employee may receive a pro-rated amount. Under this policy, “immediate family” is defined as:
• Spouse
• Children and stepchildren
• Foster children who live with you
• Parents, stepparents, or legal guardian
• Grandparents and grand children
• Step-grandparents and step-grandchildren
Jury or Witness Duty
• Brothers, sisters, stepbrothers, and stepsisters
• Mother- and father-in-law
• Son- or daughter-in-law
• Brothers- and sisters-in-laws
• Grandparents-in-law
ABC recognizes your obligation as a citizen to appear for court-ordered jury duty. Employees called for jury duty are excused under a jury duty absence. Full-time employees are paid their normal salary or hourly rate, less the amount paid by the court for attendance and travel time (not to include mileage reimbursement expense or food and lodging expense) spent for jury duty. To request a jury leave of absence, submit your jury summons to your manager. An employee who is called for jury duty but is not required to serve on a jury may be expected to return to work.
ABC supports employees in fulfilling their obligations to appear in court as a witness whenever they are subpoenaed to do so. Employees will be granted unpaid time off for their absence or may take Annual Leave if they choose to do so. If you are asked or subpoenaed to testify on the Company’s behalf because of a job-related incident, you will receive paid time off for the period of your appearance. If you require time off to serve as a witness; you should present the subpoena and advise your manager immediately so that operating requirements can be adjusted accordingly.
Please review the Jury Duty and Witness Duty Time Off Policies and contact Human Resources with any questions.
Military Leave
ABC complies with the Uniformed Services Employment and Reemployment Rights Act (USERRA), which prohibits discrimination against persons because of their service in the Armed Forces Reserve, the National Guard, or other uniformed services. USERRA prohibits an employer from denying any benefit of employment based on an individual’s membership, application for membership, performance of service, application for service, or obligation for service in the uniformed services. USERRA also protects the right of veterans, reservists, National Guard members, and certain other members of the uniformed services to reclaim their civilian employment after being absent due to military service or training. If an employee is absent from work to perform military duty, he/she will be excused for those periods of service. Employees will be treated as though they were continually employed for the purposes of determining benefits based on length of service.
Please review the Military Leave Time Off Policy and contact Human Resources with any questions.
Healthy Workplace Benefits
Employee Assistance Program (EAP)
The EAP is a professional service which provides confidential assessment, referral and short-term counseling or support services to employees for problems such as:
• Anxiety
• ADHD/ADD
• Depression
• Eating Disorders
• Financial/Legal
• Grief and Loss
• Marital/Family
• Relationship Issues
• Stress Issues
• Substance Abuse
Coverage is effective from the 1st of the month after hire for all full-time employees. This benefit is fully paid for by ABC – there is no cost to the employee.
ABC has partnered with Lifeworks to offer a comprehensive EAP benefit for employees and family members living in your home Accessing the program is simple:
• Phone Call: 1-888-319-7819
• On the Web: metlifeeap.lifeworks.com user name: metlifeeap / password: eap)
• Mobile App: user name: metlifeeap / and password: eap
For those employees participating in UHC, UHC also provides EAP services through Care 24.
• To access – call the number on the back of your ID card
• Call or web chat with a registered nurse, master’s-level counselor, or legal or financial professional 24/7
ABC’s Work/Life Balance Benefits include various leave policies, the Employee Assistance Program, as well as Professional Development assistance, and are available to all eligible full-time employees.
Wellness Programs
ABC partners with internal and external wellness partners throughout the year to offer employee health and wellness programs. The program offers seminars, classes, training sessions, wellness activities and more throughout the year. Various topics are presented with a quarterly focus.
UHC Provider and Plan Option
Your enrollment in the United Healthcare medical plan gives you access to a variety of wellness resources for you and your family. Many of these resources are provided free of charge, while others are provided at discounted rates. Resources include:
• Health Assessment
• Weight management
• Smoking cessation
• Stress management
• Physical activity
• Chronic Condition Management program for asthma, diabetes, heart failure, COPD
• Options Discount Program: fitness centers, acupuncture, nutritional counseling, laser vision correction, chiropractic care, etc.
Smoke- and Tobacco-Free Workplace
ABC is committed to providing a safe and healthy environment for our employees and visitors. In keeping with this philosophy, ABC maintains a tobacco-free environment which prohibits the use of tobacco including cigarettes, cigars, pipes, and other tobacco products anywhere on Company property. ABC property includes all property, buildings, structures, and parking lots. This prohibition applies to personal cars while located on ABC property (except where state law would conflict). While on client’s premises, employees are required to follow clients’ policies on tobacco use in the workplace.
Drug-Free Workplace
ABC is committed to maintaining a safe and productive work environment for our employees consistent with meeting our professional and legal responsibilities to our clients. Employees who abuse drugs or alcohol at work or who come to work under the influence of alcohol or illegal drugs, harm themselves and ABC’s and/or our client’s work environment. The manufacture, distribution, dispensation, possession, or use of illegal and unauthorized substances by any employee is strictly prohibited. An employee’s use of a controlled substance on ABC premises, or the premises of ABC’s clients, or while performing ABC duties must be pursuant to a physician’s prescription, must not unduly interfere with job performance, and must not cause a risk of injury to employees or others.
Workplace Safety
Every employee should understand the importance of safety in the workplace. By remaining safety conscious, employees can protect their own interests as well as those of their co-workers. Accordingly, ABC emphasizes “safety first” and expects all employees to take steps to promote safety in the workplace. Employees are also required to adhere to the safety guidelines of our clients when working at the client site. All ABC employees are encouraged to utilize hands-free devices when operating a vehicle while utilizing their cell phones. Any work-related accidents and hazards should be reported to your immediate supervisor and Human Resources.
Workers’ Compensation
Your safety and well-being on the job are important to ABC. However, accidents and illnesses can arise from work and when they do, you are covered under workers' compensation law. The purpose of the workers' compensation law is to provide an employee who suffers an industrial injury or illness with medical care, wage loss replacement, and permanent disability benefits. If you are injured on the job, or become ill as a result of your work, you may be eligible to receive insurance benefits as provided under the state Workers’ Compensation Act. You must immediately report the injury to your immediate supervisor or Human Resources (you can do this orally or in writing and obtain appropriate treatment for the injury If you are unable to provide a written report at the time of injury, you must do so when and if you are able
If your claim is accepted, workers’ compensation should pay for the following:
1. Treatments for the injury and hospital charges.
2. Prescription drugs ordered by your doctor.
3. X-rays as prescribed.
4. Physical therapy as ordered by your doctor.
5. Reasonable transportation expense incidental to treatment. (Keep track of your expenses and mileage.)
ABC will provide all employees with a brochure to help explain your benefits and responsibilities under the workers' compensation law. This is a non-contributory benefit, provided by ABC at no cost to the employee.
Social Security & Medicare
All employees are covered under the provisions of the Federal Insurance Contribution Act (FICA) FICA deductions consist of both Social Security and Medicare tax. These benefits are often a significant influence for you and your family in preparing for the future. The amount of deduction from your wages is matched by ABC and credited toward your Social Security benefits. If you have questions, contact either Human Resources or your local Social Security office for further details.
Unemployment Insurance
Every employee at ABC is covered by state and federal unemployment insurance A contribution toward this benefit is provided by ABC and does not require a payroll deduction on your part. You may be entitled to this benefit if you become unemployed through no fault of your own.
ADDITIONAL BENEFITS INFORMATION AND RESOURCES
Pre-Paid Legal (New)
Help protect yourself from the unknown with MetLife Legal Plans. With MetLife Pre-Paid Legal, you get unlimited access to a network of experienced attorneys who can help you with a wide range of issues. If you’re considering adding to your family, buying, or selling a home, or creating a will or estate, our network of attorneys and easy-to-use online tools can help simplify the process. For legal matters that come without warning – like identity theft, tax issues, or even traffic violations – you’ll get the information and guidance you need to be prepared This benefit is fully paid for by ABC – there is no cost to the employee.
• Network of 18,000 attorneys
• Assistance with Money Matters, Home and Real Estate, Estate Planning, Family & Personal, Civil Lawsuits, Elder Care Issues and Traffic Matters
Employee, spouse, and dependent child(ren) would be covered under the plan. Dependent for purposes of a pre-paid legal plan is typically defined as never-married dependent children of the employee who are under 26 and living at home or children under age 18 for whom the employee is the legal guardian.
Inclement Weather
Unless notified by Human Resources or Management of a closing, you should always consider the office open and operating. All employees are capable of working remotely and should exercise this option to ensure their safety.
If requested and approved by your supervisor, you can take unscheduled PTO, if they are unable to work remotely due to childcare or other obligations. In the case of a catastrophic weather event where conditions render an employee’s workplace unsafe or unavailable, employees should immediately contact their supervisor for further direction.
In the event of inclement weather or another type of situation, please follow the Federal Office of Personnel Management (OPM)Schedule at: https://www.opm.gov/policy-data-oversight/snowdismissal-procedures/
Employee Ethics Hotline
If you have questions or concerns about compliance with ABC’s core values, mission, vision, and core purpose, or any of ABC’s policies, or if you are unsure about what is the “right thing” to do, we strongly encourage you to contact your manager, your Vice President, Human Resources, or the CEO. However, if an employee feels uncomfortable reporting suspected improper, unethical or illegal conduct or activities in such a manner, the employee may report the conduct or activity directly, and anonymously, through ABC’s Ethics Hotline telephone number (1-855-612-7059) or Ethics Hotline website (www.abcethicshotline.ethicspoint.com).
Professional Development
ABC strongly supports and invests in employee development because we believe it is critical to maintaining a high performing team. As such, ABC partners with world class global leaders in training to provide you with a wealth of resources and tools for becoming effective in areas that provide mutual benefit to you and ABC. Some of these areas include Leadership, Productivity, Accountability, Strategic Thinking, and Time Management.
While Franklin Covey resources should first be considered, training and development outside of Franklin Covey holding a strong mutual benefit to ABC and the employee may also be considered, and eligible for financial assistance.
Please review the Professional Development Policy and contact Human Resources with any questions or to obtain the requisite form(s).
ABC highly encourages you to create, maintain, and share an Individual Development Plan, developed annually, that highlights training your needs and developmental goals with your supervisor. This will foster an understanding of the strategic objectives of the organization and how you may develop your individual skills which ultimately contribute to ABC’s achievement of the Strategic Plan and deliver the Value Proposition to our Members.
Employees will not be approved for reimbursement of outside professional development activities unless they have maintained an acceptable standard of performance.
Tuition Assistance
In order to assist employees with their Individual Development Plan and to develop ABC staff strategically, ABC may refund relevant educational tuition fees up to a designated amount per year, subject to availability of funds, paid by any regular full-time employee who has been employed by ABC for at least one (1) year.
Please review the Tuition Assistance Policy for additional detail and contact Human Resources with any questions or to obtain the requisite form(s).
Professional Certifications
ABC may provide assistance in obtaining approved credentials in support of targeted certifications or licenses relevant to the employee’s job. Professional Certification reimbursement applies to regular fulltime employees with manager approval. Reimbursement for each certification and/or licensure may be given for a preparatory program, the certification exam, and/or learning materials related to obtaining or retaining a professional certification or license.
Workshops, Seminars, and On -line Training
To further develop employees and ensure their skills and knowledge are current, ABC supports attendance at and/or participation in job- related workshops, seminars, or on-line training sessions.
SmartBenefits® Program
ABC participates in the SmartBenefits® program administered by the Washington Metropolitan Area Transit Authority (WMATA) and entities authorized by WMATA. SmartBenefits® is a convenient program that lets employers assign the dollar value of employees' monthly commuting benefit directly to the employees' SmarTrip® cards.
To enroll or make any changes:
1. Login to WMATA here: https://smartrip.wmata.com/Account/Login
2. Ensure your card is registered, will see your current card or option to register an existing card.
3. Once registered, select the “Smart Benefits” option.
4. Enter in the organization code: ua18dBKS
5. Walk through the steps to update your elections.
Please contact Human Resources for additional information or with any questions.
Employee Parking
For certain nearby garages, parking costs can be deducted from your paycheck on a pre-tax basis. Employees may elect parking or discontinue parking on a monthly basis.
Employee Discounts
For information regarding employee discount opportunities, please visit the Employee Discounts page (https://www.abc.org/Membership/Employee-Discounts)
IMPORTANT REGULATORY NOTICES
WOMEN’S HEALTH AND CANCER RIGHTS ACT (WHCRA)
If you have had or are going to have a mastectomy, you may be entitled to certain benefits under the Women’s Health and Cancer Rights Act of 1998 (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.
• Treatment of physical complications of the mastectomy, including lymphedema.
Our medical plan complies with these requirements. Benefits for these items generally are comparable to those provided under our plan for similar types of medical services and supplies. Coverage for these items may be subject to annual deductibles and coinsurance provisions as may be deemed appropriate and are consistent with those established for other benefits under the plan or coverage. Our plan neither imposes penalties (for example, reducing or limiting reimbursement) nor provides incentives to induce providers to provide care inconsistent with these requirements.
THE NEWBORNS’ AND MOTHERS’ HEALTH PROTECTION ACT (NMHPA)
Group health plans and health insurance issuers offering group insurance coverage generally may not, under federal law, restrict benefits for any hospital length of stay in connection with childbirth, for the mother of newborn child
These rights include:
• for a hospital stay of up to 48 hours for a vaginal birth and 96 hours for a cesarean section delivery without previous authorization.
• A plan cannot provide incentives to a mother or provider to encourage a shorter stay.
• A plan cannot penalize a mother or provider to encourage a shorter stay.
• A plan must provide notice of these rights with respect to the hospital lengths of stay in connection with childbirth.
Our group health plan complies with these requirements.
GENETIC INFORMATION NONDISCRIMINATION ACT OF 2008
The Genetic Information Nondiscrimination Act of 2008 (GINA) prohibits employers and other entities covered by GINA Title II from requesting or requiring genetic information of an individual or family member of the individual except as specifically allowed by this law. To comply with this law, we are asking that you not provide any genetic information when responding to any request for medical information. “Genetic information,” as defined by GINA, includes an individual’s family medical history, the results of an individual’s or family member’s genetic tests, the fact that an individual or an individual’s family member sought or received genetic services, and genetic information of a fetus carried by an individual or an individual’s family member or an embryo lawfully held by an individual or family member receiving assistive reproductive services.
IMPORTANT REGULATORY NOTICES
PROTECTING PREGNANT WORKERS FAIRNESS ACT
The Protecting Pregnant Workers Fairness Act of 2014 (PPWFA) requires District of Columbia employers to provide reasonable workplace accommodations for employees whose ability to perform job duties is limited because of pregnancy, childbirth, breastfeeding, or a related medical condition. Typical reasonable accommodations can include but are not limited to more frequent breaks; time off to recover from childbirth; exemption from heavy lifting; providing of private (non-bathroom) space for expressing breast milk; temporary restructuring of the employee’s position to provide light duty or a modified work schedule. For questions or to request a reasonable accommodation, please contact Human Resources at (202) 595-1329 or thomas@abc.org.
CHILDREN’S HEALTH INSURANCE PROGRAM (CHIP)
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 www.healthcare.gov.
If you or your dependents are already enrolled in Medicaid or CHIP and you live in a State listed below, 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 www.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 employer-sponsored 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 www.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 January 31, 2024. Contact your State for more information on eligibility –
To see if any other states have added a premium assistance program since January 31, 2024, or for more information on special enrollment rights, contact either:
U.S. Department of Labor Employee Benefits Security Administration www.dol.gov/agencies/ebsa 1-866-444-EBSA (3272)
Paperwork Reduction Act Statement
U.S. Department of Health and Human Services Centers for Medicare & Medicaid Services www.cms.hhs.gov 1-877-267-2323, Menu Option 4, Ext. 61565
According to the Paperwork Reduction Act of 1995 (Pub. L. 104-13) (PRA), no persons are required to respond to a collection of information unless such collection displays a valid Office of Management and Budget (OMB) control number. The Department notes that a Federal agency cannot conduct or sponsor a collection of information unless it is approved by OMB under the PRA, and displays a currently valid OMB control number, and the public is not required to respond to a collection of
information unless it displays a currently valid OMB control number. See 44 U.S.C. 3507. Also, notwithstanding any other provisions of law, no person shall be subject to penalty for failing to comply with a collection of information if the collection of information does not display a currently valid OMB control number. See 44 U.S.C. 3512.
The public reporting burden for this collection of information is estimated to average approximately seven minutes per respondent. Interested parties are encouraged to send comments regarding the burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden, to the U.S. Department of Labor, Employee Benefits Security Administration, Office of Policy and Research, Attention: PRA Clearance Officer, 200 Constitution Avenue, N.W., Room N-5718, Washington, DC 20210 or email ebsa.opr@dol.gov and reference the OMB Control Number 1210-0137.
OMB Control Number 1210-0137 (expires 1/31/2026)
IMPORTANT REGULATORY NOTICES
Health Insurance Portability and Accountability Act
THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION. PLEASE REVIEW IT CAREFULLY. THE PRIVACY OF YOUR MEDICAL INFORMATION IS IMPORTANT TO US.
THE FOLLOWING ENTITIES AFFILIATED WITH ABC ARE COVERED BY THIS NOTICE:
This notice applies to the privacy practices of the health plans listed below. As affiliated (related) entities, we might share your protected health information and the protected health information of others on your insurance policy as needed for payment or health care operations.
This Notice describes our privacy practices, which include how we might use, disclose (share or give out), collect, handle, and protect our members’ protected health information. We are required by certain federal and state laws to maintain the privacy of your protected health information. We are also required to give you this notice about our privacy practices, our legal duties, and your rights concerning your protected health information. We must follow the privacy practices that are described in this notice while it is in effect. This notice takes effect November 27, 2023, and is an amendment of any prior ABC notice of privacy practices. We reserve the right to change our privacy practices and the terms of this notice at any time, as long as the law permits the changes. We reserve the right to make the changes in our privacy practices and the new terms of our notice effective for all protected health information that we maintain, including protected health information we created or received before we made the changes. If we make a significant change in our privacy practices, we will change this notice and send the new notice to our health plan subscribers within sixty days of the effective date of the change. You may request a copy of our notice at any time. For more information about our privacy practices, or for additional copies of this notice, please contact us using the information listed at the end of this notice.
USES AND DISCLOSURES OF MEDICAL INFORMATION
Primary Uses and Disclosures of Protected Health Information
We use and disclose protected health information about you for payment and health care operations. The federal health care Privacy Regulations generally do not “preempt” (or take precedence over) state privacy or other applicable laws that provide individuals greater privacy protections. As a result, to the extent state law applies, the privacy laws of a particular state, or other federal laws, rather than the HIPAA Privacy Regulations, might impose a privacy standard under which we will be required to operate. For example, where such laws have been enacted, we will follow more stringent state privacy laws that relate to uses and disclosures of the protected health information concerning HIV or AIDS, mental health, substance abuse/chemical dependency, genetic testing, and reproductive rights. In addition to these state law requirements, we also may use or disclose protected health information in the following situations:
Payment: We might use and disclose your protected health information for all activities that are included within the definition of “payment” as written in the Federal Privacy Regulations. For example, we might use and disclose your protected health information to pay claims for services provided to you by doctors, hospitals, pharmacies, and others for services delivered to you that are covered by your health plan. We might also use
your information to determine your eligibility for benefits, to coordinate benefits, to examine medical necessity, to obtain premiums, and to issue explanations of benefits to the person who subscribes to the health plan in which you participate.
Health Care Operations: We might use and disclose your protected health information for all activities that are included within the definition of “health care operations “as defined in the Federal Privacy Regulations. For example, we might use and disclose your protected health information to determine our premiums for your health plan, to conduct quality assessment and improvement activities, to engage in care coordination or case management, and to manage our business.
Business Associates: In connection with our payment and health care operations activities, we contract with individuals and entities (called “business associates”) to perform various functions on our behalf or to provide certain types of services (such as member service support, utilization management, subrogation, or pharmacy benefit management). To perform these functions or to provide the services, our business associates will receive, create, maintain, use, or disclose protected health information, but only after we require the business associates to agree in writing to contract terms designed to appropriately safeguard your information.
Other Covered Entities: In addition, we might use or disclose your protected health information to assist health care providers in connection with their treatment or payment activities, or to assist other covered entities in connection with certain of their health care operations. For example, we might disclose your protected health information to a health care provider when needed by the provider to render treatment to you, and we might disclose protected health information to another covered entity to conduct health care operations in the areas of quality assurance and improvement activities, or accreditation, certification, licensing or credentialing.
Other Possible Uses and Disclosures of Protected Health Information: The following is a description of other possible ways in which we might (and are permitted to) use and/or disclose your protected health information. To You or with Your Authorization: We must disclose your protected health information to you, as described in the Individual Rights section of this notice. You may give us written authorization to use your protected health information or to disclose it to anyone for any purpose not listed on this notice. If you give us an authorization, you may revoke it in writing at any time. Your revocation will not affect any use or disclosures that we made as permitted by your authorization while it was in effect. Without your written authorization, we might not use or disclose your protected health information for any reason except those described in this notice.
Disclosures to the Secretary of the U.S. Department of Health and Human Services: We are required to disclose your protected health information to the Secretary of the U.S. Department of Health and Human Services when the Secretary is investigating or determining our compliance with the federal Privacy Regulations.
To Plan Sponsors: Where permitted by law, we may disclose your protected health information to the plan sponsor of your group health plan to permit the plan sponsor to perform plan administration functions. For example, a plan sponsor may contact us seeking information to evaluate future changes to your benefit plan. We may also disclose summary health information (this type of information is defined in the Federal Privacy Regulations) about the enrollees in your group health plan to the plan sponsor to obtain premium bids for the health insurance coverage offered through your group health plan or to decide whether to modify, amend or terminate your group health plan.
To Family and Friends: If you agree (or, if you are unavailable to agree), such as in a medical emergency situation we might disclose your protected health information to a family member, friend or other person to the extent necessary to help with your health care or with payment for your health care.
Underwriting: We might receive your protected health information for underwriting, premium rating or other activities relating to the creation, renewal, or replacement of a contract of health insurance or health benefits. We will not use or further disclose this protected health information received under these circumstances for any other purpose, except as required by law, unless and until you enter into a contract of health insurance or health benefits with us. In addition, we will not use your genetic information for underwriting purposes.
Health Oversight Activities: We might disclose your protected health information to a health oversight agency for activities authorized by law, such as: audits; investigations; inspections; licensure or disciplinary actions; or civil, administrative, or criminal proceedings or actions. Over- sight agencies seeking this information include government agencies that oversee:
I. the health care system;
II. government benefit programs;
III. other government regulatory programs; and
IV. compliance with civil rights laws.
Abuse or Neglect: We might disclose your protected health in- formation to appropriate authorities if we reasonably believe that you might be a possible victim of abuse, neglect, domestic violence, or other crimes.
To Prevent a Serious Threat to Health or Safety: Consistent with certain federal and state laws, we might disclose your protected health information if we believe that the disclosure is necessary to prevent or lessen a serious and imminent threat to the health or safety of a person or the public.
Coroners, Medical Examiners, Funeral Directors, and Organ Donation: We might disclose protected health information to a coroner or medical examiner for purposes of identifying you after you die, determining your cause of death or for the coroner or medical examiner to perform other duties authorized by law. We also might disclose, as authorized by law, information to funeral directors so that they may carry out their duties on your behalf. Further, we might disclose protected health information to organizations that handle organ, eye, or tissue donation and transplantation.
Research: We might disclose your protected health information to researchers when an institutional review board or privacy board has: (1) reviewed the research proposal and established protocols to ensure the privacy of the information; and (2) approved the research.
Inmates: If you are an inmate of a correctional institution, we might disclose your protected health information to the correctional institution or to a law enforcement official for: (1) the institution to provide health care to you; (2) your health and safety and the health and safety of others; or (3) the safety and security of the correctional institution.
Workers’ Compensation: We might disclose your protected health information to comply with workers’ compensation laws and other similar programs that provide benefits for work-related injuries or illnesses.
Public Health and Safety: We might disclose your protected health information to the extent necessary to avert a serious and imminent threat to your health or safety or the health or safety of others.
Required by Law: We might use or disclose your protected health information when we are required to do so by law. For ex- ample, we must disclose your protected health information to the U.S. Department of Health and Human Services upon their request for purposes of determining whether we are incompliance with federal privacy laws.
Legal Process and Proceedings: We might disclose your protected health information in response to a court or administrative order, subpoena, discovery request, or other lawful process, under certain circumstances. Under limited circumstances, such as a court order, warrant, or grand jury subpoena, we might disclose your protected health information to law enforcement officials.
Law Enforcement: We might disclose to law enforcement officials limited protected health information of a suspect, fugitive, material witness, crime victim, or missing person. We might dis- close protected health information where necessary to assist law enforcement officials to capture an individual who has admitted to participation in a crime or has escaped from lawful custody.
Military and National Security: We might disclose to military authorities the protected health information of Armed Forces personnel under certain circumstances. We might disclose to federal officials protected health information required for lawful intelligence, counterintelligence, and other national security activities.
Other uses and Disclosures of your Protected Health Information: Other uses and disclosures of your protected health information that are not described above will be made only with your written authorization. For example, in general and subject to specific conditions, we will not use or disclose your psychiatric notes; we will not use or disclose your protected health information for marketing; and we will not sell your protected health information, unless you give us a written authorization. If you provide us with such an authorization, you may revoke the authorization in writing, and this revocation will be effective for future uses and disclosures of protected health information. However, the revocation will not be effective for information that we already have used or disclosed in reliance on your authorization.
Breach of Unsecured Protected Health Information: You must be notified in the event of a breach of unsecured protected health information. A “breach” is the acquisition, access, use, or disclosure of protected health information in a manner that compromises the security or privacy of the protected health information. Protected health information is considered compromised when the breach poses a significant risk of financial harm, damage to your
reputation, or other harm to you. This does not include good faith or inadvertent disclosures or when there is no reasonable way to retain the information. You must receive notice of the breach as soon as possible and no later than 60 days after the discovery of the breach.
INDIVIDUAL RIGHTS
Access: You have the right to look at or get copies of the protected health information contained in a designated record set, with limited exceptions, including your protected health information maintained in an electronic format. You may request that we provide copies in a format other than photocopies. We will use the format you request unless we cannot reasonably do so. For example, if your protected health information is available in an electronic format, you may request access electronically and that this be transmitted directly to someone you designate. You must make a request in writing to obtain access to your protected health information. You may obtain a form to request access by using the contact information listed at the end of this notice. You may also request access by sending a letter to the address at the end of this notice. If you request copies, we might charge you a reasonable fee for each page, and postage if you want the copies mailed to you. If you request an alternative format; we might charge a cost-based fee for providing your protected health information in that format. But any fee must be limited to the cost of labor involved in responding to your request if you requested access to an electronic health record. If you prefer, we will prepare a summary or an explanation of your protected health information, but we might charge a fee to do so. We might deny your request to inspect and copy your protected health information in certain limited circumstances. Under certain conditions, our denial will not be reviewable.
If this event occurs, we will inform you in our denial that the decision is not reviewable. If you are denied access to your information and the denial is subject to review, you may request that the denial be licensed health care professional chosen by us will review your request and the denial.
The person performing this review will not be the same person who denied your initial request.
Disclosure Accounting: You have the right to receive a list of instances in which we or our business associates disclosed your protected health information, including a disclosure involving an electronic health record, for purposes other than treatment, payment, health care operations and certain other activities (Note: this exemption does not apply to electronic health records).We will provide you with the date on which we made the disclosure, the name of the person or entity to which we disclosed your protected health information, a description of the protected health information we disclosed, the reason for the dis- closure, and certain other information. If you request this list more than once in a 12-month period, we might charge you a reasonable, cost- based fee for responding to these additional requests. You may request an accounting by submitting your request in writing using the information listed at the end of this notice. Your request may be for disclosures made up to 6 years before the date of your request (three years in the case of a disclosure involving an electronic health record).
Restriction Requests: You have the right to request that we place additional restrictions on our use or disclosure of your protected health information. We are not required to agree to these additional restrictions, but if we do, we will abide by our agreement (except in an emergency). Any agreement that we might make to a request for additional restrictions must be in writing and signed by a person authorized to make such an agreement on our behalf. We will not be liable for uses and disclosures made outside of the requested restriction unless our agreement to restrict is in writing. We are permitted to end our agreement to the requested restriction by notifying you in writing. You may request a restriction by writing to us using the information listed at the end of this notice. In your request tell us: (1) the information of which you want to limit our use and disclosure; and (2) how you want to limit our use and/or disclosure of the information.
Confidential Communication: If you believe that a disclosure of all or part of your protected health information may endanger you, you have the right to request that we communicate with you in confidence about your protected health information. This means that you may request that we send you information by alternative means, or to an alternate location. We must accommodate your request if: it is reasonable, specifies the alternative means or alternate location, and specifies how payment issues (premiums and claims) will be handled.
You may request a Confidential Communication by writing to us using the information listed at the end of this notice. Amendment: You have the right to request that we amend your protected health information. Your request must be in writing, and it must explain why the information should be amended. We may deny your request if we did not create the information, you want amended or for certain other reasons. If we deny your request, we will provide you with a written explanation. You may respond with a statement of disagreement to be appended to the information you wanted amended. If we accept your request to amend the information, we will
make reasonable efforts to inform others, including people you name, of the amendment and to include the changes in any future disclosures of that information.
QUESTIONS AND COMPLAINTS
Information ABC’s Privacy Practices: If you want more information about our privacy practices or have questions or concerns, please contact the member services number on the back of your card.
Filing a Complaint: If you are concerned that we might have violated your privacy rights, or you disagree with a decision we made about your individual rights, you may use the contact information listed at the end of this notice to complain to us. You also may submit a written complaint to the U.S. Department of Health and Human Services (DHHS). We will provide you with the contact information for DHHS upon request. We support your right to protect the privacy of your protected health and financial information. We will not retaliate in any way if you choose to file a complaint with us or with the U.S. Department of Health and Human Services.
HIPAA website: http://www.hhs.gov/ocr/privacy/
ABC Privacy Official:
Vice President of Human Resources
440 First Street NW, Suite 200 Washington, DC 20001
Phone: 202-595-1329
Email: thomas@abc.org
Important Notice from Associated Builders and Contractors 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 under the Associated Builders and Contractors Sponsored Health Plan and about your options under Medicare’s prescription drug coverage. This information can help you decide whether 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. Associated Builders and Contractors has determined that the prescription drug coverage offered 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 15th through December 7th.
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 while you are covered under the Associated Builders and Contractors Sponsored Health Plan, your Associated Builders and Contractors Sponsored Health Plan may be affected. Your employer sponsored coverage cannot be cancelled due to your Medicare enrollment (See the COBRA Note below.). Medicare and your employer sponsored coverage will coordinate benefits so that you will not receive duplicate benefits.
The Medicare, Who Pays First handbook available from your Medicare representative or on line https://www.medicare.gov/Pubs/pdf/02179-Medicare-Coordination-Benefits-Payer.pdf, has detail on how Medicare coordinates benefits.
Typically, your employer sponsored coverage will pay its benefits without regard to payments that may be made by Medicare. In these cases, your employer sponsored coverage is considered ‘primary’ and Medicare is ‘secondary’ coverage. Medicare will only pay after the primary employer sponsored coverage has paid its benefits. Your Medicare coverage will have no effect on your employer sponsored coverage cost sharing such as copayments, deductibles, exclusions, or other plan limits.
HOWEVER, there are three instances where Medicare is primary, and your employer sponsored coverage is secondary. In these cases, Medicare will pay its benefits without regard to payments that may be made under the employer sponsored coverage. The employer sponsored coverage will coordinate benefits so that it does not duplicate benefits paid by Medicare. This will reduce the benefits paid by your employer sponsored coverage. These three instances are when:
• Your employer employs less than 20 employees.
• Your coverage is from a former employer, a retiree plan or COBRA coverage
• You are disabled and the employer sponsored coverage is due to another person working for the employer (examples when allowed – the coverage is under your spouse, your domestic partner, your dependent or grandchild), and the employer has less than 100 employees. When the employer has 100 or more employees then Medicare is secondary.
Notes:
1. If you have end stage renal disease, then the employer sponsored coverage is primary for the first 30 months and Medicare is primary after that 30-month period has expired.)
2. If you are enrolled in Medicare prior to electing COBRA, then your Medicare enrollment cannot be used to limit or deny COBRA. If you enroll in Medicare after you elect COBRA, then the Medicare enrollment is a terminating event for your COBRA coverage.
If you do decide to join a Medicare drug plan and drop your current Associated Builders and Contractors Sponsored Health Plan, be aware that you and your dependents will have to wait for the next Open Enrollment period, if any are offered by your Employer, or HIPAA Special Enrollment Right 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 coverage with Associated Builders and Contractors 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.
For More Information about This Notice or Your Current Prescription Drug Coverage
Contact the person listed below at the bottom of this Notice for further information or to receive the contact information for someone at the insurance company, third party administrator or service provider who administers the prescription drug program for the Associated Builders and Contractors Sponsored Health Plan.
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 Associated Builders and Contractors 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.
For more information about Medicare prescription drug coverage: • Visit www.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 www.socialsecurity.gov, or call them at 1800-772-1213 (TTY 1-800-325-0778).
Remember: Keep this Creditable Coverage 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: October 15, 2024
Contact: DeAnna Thomas
Position/Office: Vice President of Human Resources
Address: 440 1st Street, NW, #200, Washington, DC 20001
Phone Number: 202-595- 1329
Associated Builders and Contractors
Contact Human Resources if you have questions or need additional details regarding any of the benefits listed in this Guide.
