Employee Benefits Guide | 2011
D
efender Resorts, Inc. is committed to the health and happiness of our employees. As a part of our ongoing commitment to you, we are offering employees the opportunity to enroll in health and voluntary supplemental benefits. A summary of the available benefits and cost for each can be found in this benefits guide. The guide contains important information regarding the offered benefits and requires your immediate and careful attention. We have provided this booklet to communicate our core benefits package and to assist in your enrollment decision. Please return all applications to Human Resources in a timely manner. All information must be returned to the home office by the 60th day of your employment with Defender Resorts, Inc. Failure to do so may result in loss of coverage. If you have specific questions regarding the benefits we offer or need assistance completing the applications, please call the Employee Benefits Hotline @ 1-800-370-4679. We are glad to have you as an employee and appreciate what you do for our company and our customers. We wish you the very best. Sincerely, Defender Resorts
Employee Benefits Hotline: 1-800-370-4679
Defender Resorts is committed to providing employees with a benefits plan that is both comprehensive and competitive. Our program oers a broad range of plan options to meet the needs of our diverse workforce. This plan is designed to assist you in providing for the health, well–being and financial security of you and your covered dependents. Included in this guide are summary explanations of the benefits, cost information and contact information for each provider. answer most of your questions. Please see your Summary Plan Description for complete details. We hope this guide will give you a clear explanation of your benefits and help you be better prepared for the enrollment process.
Employee Benefits Hotline A dedicated customer service team available throughout the year to answer questions and provide assistance regarding your benefits programs, claims, eligibility, and wellness information. Just call 1-800-370-4679.
Who Is Eligible for Benefits? If you are a full-time employee, authorized to work at least 32.0 hours per week, you are eligible for all insurance plans offered.
It is important to remember that only those benefit programs for which you are eligible and have enrolled in apply to you. We encourage you to review each section and to discuss your benefits with your family members. Be sure to pay close attention to applicable co-payments and deductibles, how to file claims, preauthorization requirements, networks and services that may be limited or not covered (exclusions). This guide is not an employee/employer contract. It is not intended to cover all provisions of all plans but rather is a quick reference to help
If you are enrolling as a new employee, benefit coverage will be effective following 90 days. You may also choose to enroll your eligible dependents in many of our benefits. Your eligible dependents include your legal spouse and unmarried dependent children under age 26.
PLAN
EMPLOYEES WORKING FULL TIME
NEW HIRE ELIGIBILITY WAITING PERIOD
Medical/Prescription
X
After 90 days
Dental
X
After 90 days
Vision
X
After 90 days
Basic Life
X
After 90 days
Short & Long-Term Disability
X
After 90 days
Medical BasE Plan - Preferred Blue
BENEFITs
IN-NETWORK
OUT-OF-NETWORK
Deductible
Single Family
$1,000 $3,000
$2,000 $6,000
Out-of-Pocket Maximum
Single Family
$2,000 $4,000
$4,000 $8,000
70%
50%
Co-Insurance Physician Services Charges for services in the office. (excluding surgical services, mental health, materity care, substance abuse, physical therapy, dialysis treatment and second surgical opinion)
$20 – Primary Care Physician $40 - Specialist
Deductible, 50%
Other Physician Services Inpatient/ Outpatient/ Anesthesia Services / Radiology / Pathology / Obstetrical Delivery / Initial New Born / Pediatric Exam / All other Outpatient Services
Deductible, 70%
Deductible, 50%
Preventive Care (In Network coverage only) Mammograms (Must see a provider in Mammography Network and follow age guidelines.)
Pap Smear/Prostate Screening Well Child to Age 6 Physicals (Maximum of $200 per year)
100% N/A
100% $20 Copay, then 100% $20 Copay, then 100%
Hospital / Skilled Nursing Facility Charges
$100 Copay, 70%
$300 Copay, 50%
Outpatient Facility Charges
Deductible, 70%
Deductible, 50%
Ambulance
Deductible, 70%
Deductible, 70%
$50 Copay, Deductible, 70%
$50 copay, Deductible, 50%
Outpatient Facility Home Health Physical Therapy ($1,000 Maximum) Mental Health
Deductible, 70% Deductible, 70% Deductible, 70% Deductible, 70%
Deductible, 50% Deductible, 50% Deductible, 50% Deductible, 50%
Spinal Subluxation ($750 Max)
Deductible, 70%
Deductible, 50%
Emergency Room (copay waived if admitted) Other Services
Prescriptions Retail (31 day supply) Mail Order Prescriptions (90 day supply) Specialty Pharmacy Rx
IN NETWORK ONLY --Mandatory Generic** $10 (Generic) / $35 (Preferred) / $55 (Non-Preferred) $20 (Generic) / $80 (Preferred) / $140 (Non-Preferred) $100 co-payment for 31 day supply
Mail Claims to: Blue Cross Blue Shield of SC, Columbia Service Center, PO Box 100300, Columbia, SC 29202 Customer Service: 1-800-760-9290 (Medical) / 1-888-963-7290 (Prescription Drugs)
Medical BUy-UP Plan - Preferred Blue
BENEFITs
IN-NETWORK
OUT-OF-NETWORK
Deductible
Single Family
$500 $1,000
$1,000 $2,000
Out-of-Pocket Maximum
Single Family
$1,500 $3,000
$3,000 $6,000
80%
50%
Co-Insurance Physician Services Charges for services in the office. (excluding surgical services, mental health, materity care, substance abuse, physical therapy, dialysis treatment and second surgical opinion)
$20 – Primary Care Physician $40 - Specialist
Deductible, 50%
Other Physician Services Inpatient/ Outpatient/ Anesthesia Services / Radiology / Pathology / Obstetrical Delivery / Initial New Born / Pediatric Exam / All other Outpatient Services
Deductible, 80%
Deductible, 50%
Preventive Care (In Network coverage only) Mammograms (Must see a provider in Mammography Network and follow age guidelines.)
Pap Smear/Prostate Screening Well Child to Age 6 Physicals (Maximum of $200 per year)
100% N/A
100% $20 Copay, then 100% $20 Copay, then 100%
Hospital / Skilled Nursing Facility Charges
$100 Copay, 80%
$300 Copay, 50%
Outpatient Facility Charges
Deductible, 80%
Deductible, 50%
Ambulance
Deductible, 80%
Deductible, 80%
$50 Copay, Deductible, 80%
$50 copay, Deductible, 50%
Outpatient Facility Home Health Physical Therapy ($1,000 Maximum) Mental Health
Deductible, 80% Deductible, 80% Deductible, 80% Deductible, 80%
Deductible, 50% Deductible, 50% Deductible, 50% Deductible, 50%
Spinal Subluxation ($750 Max)
Deductible, 80%
Deductible, 50%
Emergency Room Other Services
Prescriptions Retail (31 day supply) Mail Order Prescriptions (90 day supply) Specialty Pharmacy Rx
IN NETWORK ONLY --Mandatory Generic** $10 (Generic) / $35 (Preferred) / $55 (Non-Preferred) $20 (Generic) / $80 (Preferred) / $140 (Non-Preferred) $100 co-payment for 31 day supply
Mail Claims to: Blue Cross Blue Shield of SC, Columbia Service Center, PO Box 100300, Columbia, SC 29202 Customer Service: 1-800-760-9290 (Medical) / 1-888-963-7290 (Prescription Drugs)
BlueCrossBlueshield - Value-added Programs
The BlueCard® Program Through the BlueCard Program, you have access to a full network of doctors, health professionals and hospitals throughout the United States and worldwide. The BlueCard Program allows you to enjoy in-network discounts from health professionals when you are traveling or living out of your Blue plan’s service area. When traveling within the United States, members can enjoy the savings each local Blue plan has negotiated with physicians, health professionals and hospitals in their area. Participating U.S. physicians and facilities should file the claims on your behalf just as if you were seeing a doctor at home. The local Blue plan will forward the claim to the home plan for processing, so there is no extra paperwork for you. Pre-certification or prior authorization may be required for certain services. Call the Member Services number on your ID card for information. To find a BlueCard physician or hospital anywhere in the United States, you can call 1-800-810-BLUE (2583) or use the Find a Doctor feature available online.
Preferred Blue® PPO Network You have the freedom to see any doctor you choose. But the cost of are received from BlueCross’ network of physicians, health professionals and hospitals is at a discount rate. And we pass these savings on to you. Plus, you will receive a higher level of benefits when you use a network provider. The Preferred Blue PPO network is the largest and most complete network in South Carolina. It includes 90 percent of the state’s doctors and hospitals.
For more information and to locate a participating provider, call 1-866-656-6070. To order discounted nutritional supplements, call 1-800-931-1709. For information on all services, visit www.SouthCarolinaBlues.com.
Weight Loss Through the Jenny Craig discount program, losing weight just got easier. Members receive discounts on memberships and the cost of food. Together with your consultant, you’ll develop a comprehensive program designed to fit your lifestyle. Just present your special member coupon or member ID card to enjoy the discounts at any participating Jenny Craig Centre. To find a location near you, call 1-800-JENNY-20 or visit www.SouthCarolinaBlues.com.
Hearing Aid Discounts Save up to 50 percent on hearing aids. Other benefits of the program include: - Free hearing screenings by professional audiologists and specialists - Complete follow-up care for one year - Testing by trained specialists or audiologists Visit www.SouthCarolinaBlues.com to find a participating location.
Vision ONE You can receive vision care discounts on designer frames, bifocals and more through the Vision ONE Eyecare Program. It’s easy. Just present your ID card to receive the discount at a participating optical center. There are no claims to file.
To find a Preferred Blue network doctor or hospital near you, use the Find a Doctor feature on our Web site. By paying attention to health care costs today, you can help control health care premiums tomorrow.
Call 1-866-559-5252 or visit www.SouthCarolinaBlues.com to find a Vision ONE center near you.
Natural BlueSM
Explore the possibility of life without glasses or contact lenses. Laser vision correction can help correct nearsightedness and astigmatism. We’ve teamed up with eye care professionals nationwide to bring you this service at one of the most reasonable prices available. LASIK services include:
BlueCross members have access to the Natural Blue discount network of complementary and alternative medicine professionals. You’ll have access to acupuncturists, massage therapists, chiropractors, exercise and movement specialists, and diet and supplemental advisors throughout the country. Through Natural Blue, you can also get information and discounts on magazines, day spas, fitness centers and products like nutritional supplements.
LASIK Services and Contact Lenses
- Vision exam - Pre-operative care
- Corrective surgery - Post-operative care for 1 yr.
BlueCrossBlueshield - Value-added Programs
Value-added programs and services help you take charge of your health and save money.These bonus programs complement your health plan benefits and are available to you at no extra cost. They include discounts, information and access to a variety of health related products and services. Now that’s added value beyond just health insurance. It’s innovative health care designed around you.
Cosmetic Surgery
Hair Restoration If you have thinning hair, take advantage of our hair restoration discount program. Receive a discount off the cost of a hair restoration procedure that restores your own hair. Once your hair is restored, it will continue to grow naturally. Call 1-800-510-5357 or visit www.SouthCarolinaBlues.com to find a participating location or center for this special discount program and service.
Allergy Relief Save up to 10 percent off typical retail costs for allergy relief products designed to reduce exposure to indoor allergens such as dust, pet dander and mold. Enjoy savings on the following products:
Members can get cosmetic surgery at special rates for the most popular procedures. If you visit one of the participating cosmetic surgery providers, your rates on average will be 20 percent less than typical costs. Visit the Discounts & Added Values section of www.SouthCarolinaBlues.com for more details about our cosmetic surgery discount program.
Cosmetic Dentistry For the most popular cosmetic dentistry procedures — like whitening, veneers and bridges — simply visit one of our cosmetic dentistry partners and enjoy cost savings. After paying a one-time $50 evaluation fee to the dentist, you’ll receive 20 percent savings. Visit our Web site for a complete list of procedures and to find a partner near you.
Global Health and Dental Care
- Air filters - Air cleaners - Pillow and mattress encasings - Laundry and carpet products - Hypoallergenic bedding
These programs provide members the option of receiving medical and dental services at participating, accredited, overseas facilities at a fraction of the cost for receiving those services within the United States. Members traveling abroad receive assistance with surgical and dental services as well as travel arrangements.
Call 1-877-362-6283 or visit www.SouthCarolinaBlues.com to purchase allergy relief products at discounted prices.
For more information or a listing of participating facilities, call 1-877-232-0765 or visit www.SouthCarolinaBlues.com.
Medical Plan - Employee Contributions
Eligible Employees: Full-time employees working at least 32 hours per week are eligible 90 days following the date of hire. Eligible Dependents: Spouse, dependent children up to age 26. Employee Contribution per pay period: Two options are available, the BASE PLAN and the BUY UP. The rates include MEDICAL, DENTAL, STD, LIFE and AD&D. If dependents are covered, they also receive life and dental coverage for each covered dependent.
DEDUCTIONs PER Pay PERIOD
BasE PLaN
BUy-UP PLaN
$33.21
$55.71
Employee + Spouse
$196.83
$235.71
Employee + Child(ren)
$186.26
$224.30
Employee + Family
$345.75
$404.89
DEDUCTIONs PER Pay PERIOD
PaRTIaL BENEFIT
Employee Only
alternative Partial Benefits Plan available You have the option of waiving the health coverage and enrolling in partial benefits. This package coverage cannot be separated. Please review the following pages of the partial benefit options. PARTIAL BENEFITS INCLuDE: • DENTAL • SHORT-TERM DISABILITY • LIFE and AD&D only. Please remember that these benefits can not be separated.
Employee Only
$2.41
Employee + Spouse
$14.66
Employee + Child(ren)
$14.66
Employee + Family
$27.19
Dental Plan - Preferred Blue
BENEFIT CaTEGORy
PLaN Pays
Deductible per person / per family Unit 1 Preventive Procedures include, but are not limited to: • Routine exams and cleaning (prophylaxis) – four per 12 months • X-rays: Full mouth survey (one every 60 months) Bitewing (one set every 12 months) • Fluoride – each 12 months (covered only for dependent children under age 14) Unit 2 Basic Procedures include, but are not limited to: • Fillings and stainless steel crowns • Emergency exams – subject to Routine exam frequency limit • Sealants – on first and second permanent molars for dependent children under age 14 each 36 mo. • Space maintainers (covered only for dependent children under age 14; repairs not covered) • Periodontal prophylaxis – if three months have elapsed after active surgical periodontal treatment. Subject to Routine cleaning frequency limit. Unit 3 Major Procedures include, but are not limited to: • Simple Oral Surgery • Non-surgical Periodontics, including scaling and root planing - once each quadrant each 24 months (For expectant mothers, diabetics and those with heart disease, this procedure is provided with no deductible and 100% coinsurance.) • Endodontics (Root canal therapy) • Complex Oral Surgical Procedures • General Anesthesia • Non-surgical Periodontics, including scaling and root planing – once each quadrant each 24 mo. • Periodontal Surgical Procedures – one each quadrant each 36 months • Crowns – each 120 months per tooth if tooth cannot be restored by a filling • Inlays and onlays – each 120 months per tooth if tooth cannot be restored by a filling • Bridges, which includes: Initial placement / Replacement of bridges over 120 months old • Dentures, which includes: Initial placement of complete or partial dentures Replacement of complete or partial dentures over 60 months old • Other coverages include: recementing, repairs, relines, rebasing, tissue conditioning and adjustment to bridges/dentures, within policy limitations. Unit 4 Orthodontic procedures include, but are not limited to: • Orthodontic procedures, including x-rays and other diagnostic procedures, fixed and removable appliances • The unit 4 maximum is a lifetime maximum • Orthodontia (children only) Program Maximum Annual Program Maximum (per covered person) Lifetime Orthodontic Maximum
$50/$150 100% No Deductible
100% after deductible
50% after deductible
50%
$1,000 $1,000
Predetermination of Benefits: When charges for a period of dental treatment (other than emergency treatment) are expected to exceed $300 for you or any one of your dependents, you may file a dental treatment plan with Principal Life Insurance Company before treatment begins. Principal Life will provide a written response indicating benefits that may be payable for the proposed treatment.
Principal Financial Group: 1-800-247-4695
Vision Plan - Voluntary Benefits
VIsION COVERaGE OVERVIEW Vision Plan Eligibility: All full time employees and their dependents Benefits: Your benefit covers a routine eye exam every 12 months and one of the following: • A set of frames per 24 months and two lenses (one pair) per 12 months • Two contact lenses (one pair). The maximum payment for a pair of contact lenses will be equal to the maximum payment for single vision lenses plus frames. For example: Single vision lenses ($50) plus frames ($150) would equal a contact lenses benefit of $200 for the first 12 months. The contact lenses benefit for the next 12 months would equal $50. This is because the frame benefit is only payable once per 24 months. Exams (a)
Frames & Lenses (B) Frames: $150 One set per 24 months
Exams: $75 One exam per 12 months
Lenses: $50 for single vision $75 for bifocal $100 for trifocal $150 for lenticular Two lenses (one pair) per 12 months
Contact Lenses (C)
Contact Lenses: $200 The maximum payment for two contact lenses (one pair) will be equal to the maximum payment for single vision lenses plus frames.
The following maximum benefits are paid for your Vision Coverage. There is no co-insurance or a deductible to satisfy for your Vision Care Insurance.
Bi-Weekly Deductions Employee Only
VIsION $5.29
Employee + Spouse
$10.67
Employee + Child(ren)
$10.04
Employee + Family
$15.43
VISION CARE INSuRANCE HELPS YOu PAY FOR EYE EXAMS AND PRESCRIBED VISION AIDS
Principal Financial Group: 1-800-247-4695
short-term Disability, Term Life and aD&D
YOu MuST HAVE EITHER ELECTED MEDICAL COVERAGE OR PARTIAL BENEFIT OPTION GROUP sHORT TERM DIsaBILITy
GROUP TERM LIFE aND aD&D
Eligibility: All full time employees
Eligibility: All full time employees
Benefits Begins: 1st day of accident, 8th day of sickness
Benefit Amount: $15,000 for employee $5,000 for dependent spouse $5,000 for dependent child age 6 months to 24 years $1,000 for dependent child under the age of 6 months
Benefit Amount: $200 per week Maximum Payment Period: 26 weeks
Maximum Payment Period: Reduces 35% at the age of 65 Reduces additional 15% at the age of 70 * You must have elected dependent coverage under medical of partial benefit option to have dependent life.
Principal Financial Group: 1-800-247-4695
Voluntary Term Life and aD&D - Voluntary Benefits
LIFE aND aD&D COVERaGE OVERVIEW Employee:
Increments of $10,000. Not to exceed $300,000. Guarantee Issue for employee under 70 is $100,000. Over 70 is $10,000.
spouse:
up to 100% of employee amount in increments of $5,000. Not to exceed $100,000. Guarantee Issue for Spouse under 70 is $30,000. Over 70 is $10,000.
Child:
Children 14 days or older may be covered in the amounts of $5,000, $10,000. The maximum benefit for a child between live birth and 14 days is $1,000. Child coverage cannot exceed 100% of employee coverage.
Coverage amount(s) will reduce according to the following schedule: Age 65 Insurance Amount Reduces to 35% of original amount Age 70 Insurance Amount Reduces to 50% of original amount RaTEs Term Life Coverage Employee per $10,000 Bi-weekly Rate
Term Life Coverage Spouse per $5,000 Bi-weekly Rate
age
Employee
age
spouse
<30
.434
<30
.217
30-34
.512
30-34
.256
35-39
.678
35-39
.339
40-44
.973
40-44
.468
45-49
1.427
45-49
.713
50-54
2.229
50-54
1.115
55-59
3.692
55-59
1.846
60-64
5.663
60-64
2.832
65-69
10.385
65-69
5.192
70+
20.783
70+
10.392
Term Life Coverage Child Bi-weekly Rate Coverage amount $5,000 = $0.46 $10,000 = $0.92 Bi-weekly Rate per Family
Actual payroll deduction amount may be slightly different due to rounding. The employee and spouse are charged separately based upon their individual ages. Your group’s rates include Accidental Death and Dismemberment and are guaranteed for 2 years. Your rate or your spouse’s rate may change because of moving to a different age category.
Principal Financial Group: 1-800-247-4695
Long-term Disability - Voluntary BeneďŹ ts
Eligibility: All full time employees Elimination Period: 180 Days Benefit Amount: 60% of salary, Not to exceed $6,000 per Month for employees Maximum Payment Period: Normal Retirement Age Definition of Disability: Cannot perform majority of substantial and material duties of occupation. LONG TERM DIsaBILITy BI-WEEKLy PREMIUM GRID
Employee assistance Program
HELP WHEN yOU NEED IT The Employee Assistance Program (EAP) offers assistance with day-to-day issues so you can be at your best - at work and at home. Confidential assistance is available for concerns such as: Family, relationship or parenting issues Child and elder care needs Emotional and stress related issues Conflicts at home or at work Alcohol and drug dependencies Health and wellness issues
Everyone needs help dealing with life’s challenges from time to time. Through the EAP service provided by Megellan Health Service, you and your family can get help that is easy, convenient and confidential. Counselors are available 24 hours a day seven days a week anywhere in the united States. Best of all, EAP services are at NO COsT to you or your family. If you need assistance beyond the scope of the EAP, counselors will help you find an affordable solution. Services Include: • Telephonic costulation, 24/7, with licensed mental health professional • Referrals to local child and elder care service and resources • Online information and services at www.megellanhealth.com • Referrals to local community resources if you need additional assistance • Private Megellan Self Screening Service 1-866-272-4084
Help is just a click or a phone call away www.megellan.com Toll free : 1-800-450-1327 TTY for earing impaired: 1-800-456-4006 Self Screening: 1-866-272-4084
Important notices regarding your plan
Medicaid and the Children’s Health Insurance Program (CHIP) Offer Free Or Low-Cost Health Coverage To Children And Families If you are eligible for health coverage from your employer, but are unable to afford the premiums, some States have premium assistance programs that can help pay for coverage. These States use funds from their Medicaid or CHIP programs to help people who are eligible for employer-sponsored health coverage, but need assistance in paying their health premiums. If you or your dependents are already enrolled in Medicaid or CHIP, you can 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, you can 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, you can ask the State if it has a program that might help you pay the premiums for an employer-sponsored plan.
Once it is determined that you or your dependents are eligible for premium assistance under Medicaid or CHIP, your employer’s health plan is required to permit you and your dependents to enroll in the plan – as long as you and your dependents are eligible, but not already enrolled in the employer’s plan. This is called a “special enrollment” opportunity, and you must request coverage within 60 days of being determined eligible for premium assistance.
You should contact your State for further information on eligibility SOUTH CAROLINA – Medicaid Website: http://www.scdhhs.gov Phone: 1-888-549-0820 For more information on special enrollment rights, you can contact either: U.S. Department of Labor U.S. Employee Benefits Security Administration www.dol.gov/ebsa 1-866-444-EBSA (3272)
Department of Health and Human Services Centers for Medicare & Medicaid Services www.cms.hhs.gov 1-877-267-2323, Ext. 61565
GRaNDFaTHERED sTaTUs NOTICE This plan is a "grandfathered health plan" under the Patient Protection and Affordable Care Act (the Affordable Care Act). As permitted by the Affordable Care Act, a grandfathered health plan can preserve certain basic health coverage that was already in effect when the law was enacted. Being a grandfathered health plan means that your plan may not include certain consumer projections of the Affordable Care Act that apply to other plans, for example, the requirement for the provision of preventive health services without any cost sharing. However, grandfathered health plans must comply with certain other consumer protections in the Affordable Care Act, for example the elimination of lifetime limits on benefits. Questions regarding which protections apply and which protections do not apply to a grandfathered health plan and what might cause a plan to change from grandfathered health plan status can be directed to the benefits hotline: 1-800-370-4679.
Important Notice From Defender Resorts About Your Prescription Drug Coverage and Medicare
MEDICaRE PaRT D CREDIBLE COVERaGE NOTICE Since November 15, 2007, all employers who offer a medical plan that provides pharmacy coverage are required to send a notice to all plan participants who are eligible for Medicare. Because we do not track which of our employees are eligible for Medicare, we are meeting this obligation by providing this notice to all employees who are eligible for our benefits program. This notice does not apply to you if you or your dependents are not Medicare eligible. If you or a covered dependent are Medicare eligible or will become Medicare eligible in 2010or 2011, this notice is important to you and contains important, time sensitive information. Please read it carefully and act accordingly to protect your interests. Please read this notice carefully and keep it where you can find it. This notice has information about your current prescription drug coverage with Defender Resorts , and prescription drug coverage available for people with Medicare. It also tells you where to find more information to help you make decisions about your prescription drug coverage. • Medicare prescription drug coverage became available in 2006 to everyone with Medicare through Medicare prescription drug plans and Medicare Advantage Plans that offer prescription drug coverage. All Medicare prescription drug plans provide at least a standard of coverage set by Medicare. Some plans may also offer more coverage for a higher monthly premium. • Defender Resorts has determined that the prescription drug benefit offered through the Defender Resorts medical plan is, on average for all plan participants, expected to pay as much as the standard Medicare prescription drug coverage and is considered creditable coverage. Individuals can enroll in a Medicare prescription drug plan when they first become eligible for Medicare and each year from November 15th through December 31st. However, because you have existing prescription drug coverage that, on average, is as good as Medicare coverage, you can choose to join a Medicare prescription drug plan later. Each year after that, you will have the opportunity to enroll in a Medicare prescription drug plan between November 15th through December 31st. If you do decide to enroll in a Medicare prescription drug plan and want to drop your Defender Resorts prescription drug coverage you will have to drop all of your healthcare coverage with Defender Resorts since prescription drug coverage is a part of your Defender Resorts healthcare plan. Please be aware that you may not be able to get this coverage back should you decide to drop it. You should compare your current coverage, including which drugs are covered, with the coverage and cost of the plans offering Medicare prescription drug coverage in your area. Your current coverage pays for other health expenses in addition to prescription drugs. You will be eligible to receive all of your current health and prescription drug benefits even if you choose to enroll in a Medicare prescription drug plan. You should also know that if you drop or lose your coverage with Defender Resorts and don’t enroll in Medicare prescription drug coverage after your current coverage ends, you may pay more to enroll in Medicare prescription drug coverage later. If you go 63 days or longer without prescription drug coverage that’s at least as good as Medicare’s prescription drug coverage, your monthly premium will go up at least 1% per month for every month that you did not have that coverage. For example, if you go nineteen months without coverage, your premium will always be at least 19% higher than what most other people pay. You’ll have to pay this higher premium as long as you have Medicare coverage. In addition, you may have to wait until the following November to enroll.
For more information about this notice or your current prescription drug coverage, contact our office for further information. NOTE: You may receive this notice at other times in the future such as before the next period you can enroll in Medicare prescription drug coverage, and if this coverage changes. You also may request a copy at any time. More detailed information about Medicare plans that offer prescription drug coverage is available in the ’Medicare & You’ handbook. You will get a copy of the handbook in the mail every year from Medicare. You may also be contacted directly by Medicare prescription drug plans. You can also get more information about Medicare prescription drug plans from these places: • Visit www.medicare.gov. • Call your State Health Insurance Assistance Program (see 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 For people with limited income and resources, extra help paying for a Medicare prescription drug plan is available. Information about this extra help is available from the Social Security Administration (SSA). For more information about this extra help, visit SSA online at www.ssa.gov, or call them at 1–800–772–1213 (TTY1–800–325–0778). Remember: Keep this notice. If you enroll in one of the Medicare approved plans offering prescription drug coverage, you may need to provide a copy of this notice when applying for the coverage to show that you are not required to pay a higher premium amount. LIFETIME LIMIT CHaNGE NOTICE The lifetime limit on the dollar value of benefits under Defender Resorts no longer applies. Individuals whose coverage ended by reason of reaching a lifetime limit under the plan are eligible to enroll in the plan. For more information contact the benefits hotline: 1-800-370-4679. DEPENDENT CHILDREN COVERaGE NOTICE Individuals whose coverage ended, or who were denied coverage (or were not eligible for coverage), because the availability of dependent coverage of children ended before attainment of age 26 are eligible to enroll in the Defender Resorts health plan. Individuals may request enrollment for such children during open enrollment. Enrollment will be effective January 1, 2011. For more information contact the benefits hotline: 1-800-370-4679. Your adult children can join or remain on your plan whether or not they are: • Married; • Living with you; • In school; • Financially dependent on you
Employee Benefits Hotline: 1-800-370-4679