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Town of

Summerville s o u t h

c a r o l i n a

Benefits Employee Benefits Guide | 2011

Eligibility Medical Plan Dental Plan Basic Life Insurance Flexible Spending Account


Town of

Summerville s o u t h

c a r o l i n a

Welcome to your 2011 Employee Benefits Guide We are committed to providing employees with a benefits program that is both comprehensive and competitive. Our program offers a range of plan options to meet the needs of our diverse workforce. We know that your benefits are important to you and your family. This program is designed to assist you in providing for the health, well–being and financial security of you and covered dependents. Helping you understand the benefits the Town of Summerville offers is important to us. That is why we have created this Employee Benefits Guide.

Benefits Guide Overview

welcome

This guide provides a general overview of your benefit choices to help you select the coverage that is right for you. Be sure to make choices that work to your best advantage. Of course with choice, comes responsibility and planning. Please take time to read about and understand the benefit, plan thoughtfully, and enroll on time. Included in this guide are summary explanations of the benefits and costs as well as contact information for each provider. 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 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.

Contents

At Your Service........................................................................................................................................................... 3 Benefit Contacts.........................................................................................................................................................4 Eligibility Details........................................................................................................................................................ 5

Medical Insurance...................................................................................................................................................... 6 Your Contributions.................................................................................................................................................... 8 Dental Insurance......................................................................................................................................................... 9 Vision Insurance........................................................................................................................................................ 10 Basic Life Insurance..................................................................................................................................................11 Flexible Spending Account (FSA)................................................................................................................... 12

Important Coverage Notices............................................................................................................................. 14 Chip Program Notice ............................................................................................................................................15

2 Employee Benefits Guide


At Your Service...

Employee Call Center Town of Summerville employees have access to a dedicated employee benefit hotline to answer questions about enrollment, coverage, claims and all other concerns regarding their employee benefit package. Our call center is staffed with trained professionals who understand your benefits plan and are dedicated to providing solutions to your problems. Its easy and its free, just call: 1-888-408-9142 (toll-free) Monday - Friday 9am - 5pm EST Online Benefits Website Access to your benefits is available 24/7 via our online employee benefits portal. Visit: http://summerville.bluewaterclick.com username: tosemployee / password: benefits

Employee Service Hotline: 1-888-408-9142 3


Benefit Contacts

Medical Plan

Basic Life Insurance

BlueChoice HealthPlan 1-800-868-2528 www.bluechoicesc.com Group#: BA 736

Companion Life 1-800-753-0404 www.companionlife.com Group#: 602-14-47688-000

Dental Plan

Flexible Spending Account (FSA)

Companion Life 1-800-753-0404 www.companionlife.com Group#: 602-14-47688-000

Blue Water Administrators 1-888-408-9142 fsa-hracustomerservice@bwadministrators.com

4 Employee Benefits Guide


Eligibility Details

Are you eligible for benefits? To determine the benefits for which you may be eligible, please refer to the chart below. You are eligible to participate in these plans upon meeting each plan’s eligibility requirements. You also have the option to enroll your eligible dependents in some of these plans. Eligible dependents may include: • •

Your spouse Your children (dependent age limit to 26*) or when applicable, your unmarried children of any age who are incapable of self-support due to a mental or physical disability and who are totally dependent on you.

*Certain limitations apply. Please call the Employee Service Hotline for additional information, 1-888-408-9142

Benefit Plan

Eligibility

New Hire Waiting Period

Medical/Prescription

Full time Employee

First of the month following 30 days

Dental

Full time Employee

First of the month following 30 days

Basic Life

Full time Employee

First of the month following 30 days

FSA

Full time Employee

First of the month following date of hire

Employee Service Hotline: 1-888-408-9142 5


Medical Plan Benefits

Administered by BlueChoice HealthPlan

In-Network MEMBER PAYS

Out-of-Network MEMBER PAYS

$350 $700

$700 per individual

$2,000 $4,000

$4,000 $8,000

$20 per visit $0

Deductible, then 40% Not Covered

$40 per visit Deductible, then 20% Deductible, then 20%

Deductible, then 40% Deductible, then 40% Deductible, then 20%

$20 per visit $0 $0

Not Covered Not Covered Not Covered

$40 first visit, then 20%

Deductible, then 40%

Deductible, then 20% Deductible, then 20% Deductible, then 20%

Deductible, then 40% Deductible, then 40% Deductible, then 40%

Deductible, then 20% $150 per visit, then 20% $20 per visit

Deductible, then 40% $150 per visit, then 20% Deductible, then 40%

$8 $35 $55

Covered only at a Participating Pharmacy

$16 $70 $110

Covered only at a Participating Pharmacy

$125 or $80 for select drugs $125

Not Covered

Deductible per Benefit Period Per Member Per Family (All family Members can contribute with no one Member contributing more than the individual deductible amount.)

Maximum Coinsurance per Benefit Period Per Member Per Family

Primary Care Office services Mandated Preventive Care

Specialty Care Office services Hospital services (includes inpatient, outpatient & ambulatory care services) Emergency room care

Other Routine Care GYN Exam Routine Screening Mammogram Routine Screening Colonoscopy

Maternity Care Routine Maternity Physician Services

Inpatient Hospital/Facility Services (Authorization required) Admission (including maternity) Skilled Nursing Facility Long-term Acute Care Facility

Outpatient/Ambulatory Care Facilities All services (including maternity) Emergency room services Urgent care

Prescription Medicine - Retail (up to a 31-day supply) Generic drug and designated over-the-counter drug Preferred brand-name drug Non-preferred brand-name drug No max per Benefit Period, you may have to pay more if you select a brand-name drug instead of a generic drug.

Prescription Medicine - Mail Order (up to a 90-day supply) Generic drug and designated over-the-counter drug Preferred brand-name drug Non-preferred brand-name drug No max per Benefit Period, you may have to pay more if you select a brand-name drug instead of a generic drug.

Specialty Pharmaceuticals Injectable medication (per administration) Oral medication (up to a 31-day supply)

6 Employee Benefits Guide


Medical Plan

Administered by BlueChoice HealthPlan

Benefits

In-Network MEMBER PAYS

Out-of-Network MEMBER PAYS

Deductible, then 20% Deductible, then 20% Deductible, then 20% Deductible, then 20% Deductible, then 20% Deductible, then 20% Deductible, then 20% Deductible, then 20% Deductible, then 20% Deductible, then 20% Deductible, then 20% Deductible, then 20% $40 per visit

Deductible, then 40% Not Covered Not Covered Not Covered Deductible, then 40% Deductible, then 40% Deductible, then 40% Deductible, then 40% Not Covered Deductible, then 40% Not Covered Not Covered Not Covered

Other Services Ambulance Behavioral Therapy (ABA) for Autism Spectrum Disorder Dental Services due to accidental injury Durable Medical Equipment (DME) Home Health Hospice Initial Prosthetic Appliances Medical Supplies Occupational Therapy OP Private Duty Nursing Physical Therapy Speech Therapy Chiropractic Services

Covered transplants will be treated the same as any other medical condition. Services must be provided at a BlueChoice HealthPlan participating facility or a Blues Distinction for Transplant designated facility.

Mental Health & Substance Use Disorders (The following services must be authorized in advance by Companion Benefit Alternatives at 1-800-868-1032) Deductible, then 20% Deductible, then 20% Deductible, then 20% Deductible, then 20% $20 per visit

Inpatient Hospital Facility Services Inpatient Physician Services Outpatient Facility Institutional Services Outpatient Facility Professional Services Office Professional Services

Deductible, Deductible, Deductible, Deductible, Deductible,

then then then then then

40% 40% 40% 40% 40%

In order to receive In-Network benefits, all services must be provided by a BlueChoice HealthPlan Participating Provider. This applies to each individual service unless otherwise noted. All admissions must be authorized by BlueChoice HealthPlan in order to be covered. Benefits are subject to all terms, conditions, limitations, and exclusions outlined in the Contract.

Maximums Annual Benefit Maximum Behavioral Therapy (ABA) Occupational Therapy OP Private Duty Nursing Physical Therapy Skilled Nursing Facility Speech Therapy Chiropractic Care Benefit Period

$2,000,000 $50,000 per Benefit Period 20 visits per Benefit Period 60 visits per Benefit Period 20 visits per Benefit Period 120 days per Benefit Period 20 visits per Benefit Period $1,000 per Benefit Period

Calendar Year

In order to receive In-Network benefits, all services must be provided by a BlueChoice HealthPlan Participating Provider. This applies to each individual service unless otherwise noted. All admissions must be authorized by BlueChoice HealthPlan in order to be covered. Benefits are subject to all terms, conditions, limitations, and exclusions outlined in the Contract.

Employee Service Hotline: 1-888-408-9142 7


Your Contributions

Dental Medical

Medical Plan Employee Only

Deduction per pay period $0

Employee + Spouse

$62.25

Employee + Children

$58.22

Employee + Family

$62.25

dental plan Employee Only

Employee + Family

8 Employee Benefits Guide

Deduction per pay period $0

$10.41


Dental Plan

Administered by Companion Life

Coverage type

In-Network

Calendar Year Deductible: Individual

$50

Calendar Year Deductible: Family limit

3 per family

Deductible Waived for

Type I - Preventive

Type I - Preventive Services

100%

Type II - Basic Services (no benefit waiting period)

80%

Type III - Major Services (12 month benefit waiting period)

50%

Calendar Year Maximum

$1,000

Increasing Maximum - After a member’s coverage has been in effect for at least 12 consecutive months, the calendar year maximum payable by Companion for each covered person increases $250 on the first day of the policy holder’s next calendar year benefit period. Calendar year maximums shall increase each calendar year to a maximum of three increases.

$1000 / $1250 / $1500 / $1750

Type IV - Orthodontia (Children only to age 19)

50%

Orthodontia Lifetime Maximum

$1,000

Orthodontia Deductible

none

Orthodontia Benefit Waiting Period

12 months

selected covered services and frequency limitations Type A - Preventive Services Oral Exams Cleanings (2 per 12 months) Bitewing X-rays (1 per 12 months)

Type B - Basic Services Space Maintainers Fillings Pain Treatment Sealants Full Mouth X-rays

Type C - Major Services Anesthesia

Inlays

Endodontics

Onlays

Simple & Surgical Extractions

Dentures

Oral Surgery

Bridges

Periodontics

Implants

Crowns This is only a partial list of dental services. Your certificate of benefits will show exactly what is covered and excluded.

Employee Service Hotline: 1-888-408-9142 9


Vision Plan

Administered by BlueChoice HealthPlan

This is a basic vision benefit included with your medical coverage

MEMBER PAYS

Routine Vision Care - Physicians EyeCare Network (PEN) Providers Only (Refer to Provider Directory)

One routine eye exam or one exam for contact lenses per Benefit Period

$0

One standard contact lens fitting per Benefit Period

$45

One pair of eyewear from a designated selection every other Benefit Period

$0

Please consult your PEN Provider for information on discounts for which you may be eligible if you elect to receive eyewear/contact lenses outside the standard designated selection.

(For Members outside of the South Carolina service area, $71 will be allowed toward the routine eye exam and a $120 credit will apply to the purchase of eyewear. Claims must be filed by the Member.)

10 Employee Benefits Guide


Basic Life Insurance

Basic Term Life Benefit Amount

Empl

Paid

Administered by Companion Life

Basic Accidental Death & Dismemberment

$10,000

Percent Reduction 35% Reduction Schedule 50% 75%

100oy%er

Benefit Amount At Age 65 70 75

Benefits terminate at retirement unless provided for in the Schedule of Benefits.

$10,000

Percent Reduction 35% Reduction Schedule 50% 75%

At Age 65 70 75

Benefits terminate at retirement unless provided for in the Schedule of Benefits.

Basic Life insurance includes waiver of premium

AD&D benefits are equal to the amount of Life benefits. The full AD&D benefit is payable for the following losses if such loss is the result of an accident: loss of life, loss of both hands or both feet, loss of sight in both eyes, loss of a hand and a foot, loss of a hand or a foot and the sight of one eye. Half of the AD&D benefits is payable for the following losses if such loss is the result of an accident: loss of a hand, loss of a foot, loss of the sight in one eye. The loss must occur within 90 days of the date of the accident. Total payment arising out of one accident may not exceed the amount for which the employee is insured. Waiver of Premium - If an employee is totally and permanently disabled prior to age 60, Life coverage will be continued without payments of premium subject to any scheduled reductions and terminations. The employee may apply for this benefit after 12 months of total and continuous disability. Coverage continues for eligible employees whether or not the master policy remains in force but terminates at the earlier of retirement or age 65. Conversion Privilege - Employees may convert to an individual life policy within 31 days of leaving active employment. No evidence of insurability will be required. Accelerated Benefit - For Basic Group Life policies with employee coverage amounts of $10,000 or more, an eligible employee as of the policy effective date who becomes terminally ill while covered by Companion Life can immediately access 50% of their benefit (maximum $50,000) without administrative or interest charges. Employees enrolled after the initial policy effective date become eligible for this benefit after one year of continuous coverage.

Employee Service Hotline: 1-888-408-9142 11


FSA Your Flexible Spending Account (FSA) What is a FSA? There are two types of Flexible Spending Accounts: Health Care and Dependent Care Flexible Spending Accounts (FSA) help you save money by providing a way to pay for certain types of health care and dependent care on a pre-tax basis.

How a FSA works During Open Enrollment you decide how much money you want to contribute for the year (there are limits). You have only one opportunity a year to enroll, unless you have a qualified “life change”. The amount you designate for the year is taken out of your paycheck in equal installments each pay period and placed in a FSA account. As you incur medical expenses that are not fully covered by your insurance, you may submit your expenses for claims transactions using one of the following options: 1) Explanation of Benefits form from your insurance carrier after a claim has been paid; 2) Detail claim from the provider of services (ex: physician/ dentist) on the provider of services form with all information related to the service and expenses; 3) A Prescription form that you receive from the Pharmacy with the information on each prescription you are submitting; 4) A computer form from a Pharmacy for prescriptions filled at that Pharmacy with all detail information related to the prescriptions/date/costs You may submit any one of the above to evidence claim payment to Blue Water Administrators.

A way to save taxes Enrolling in a FSA can save you money by reducing your taxable income. Your total savings will depend upon your family income, tax status, and expected amount of health and dependent care costs. The contributions you make to a Flexible Spending Account are deducted from your pay BEFORE your Federal, State, or Social Security Taxes are calculated and are never reported to the IRS. The end result is that you decrease your taxable income and increase your spendable income. You can save hundreds or even thousands of dollars a year.

Estimate expenses carefully To receive the greatest savings, you must carefully estimate the amount of eligible out-of-pocket expenses you will have for the year. Once you have estimated the total annual amount, divide it by 26. That amount is what you may

12 Employee Benefits Guide

Administered by Blue Water Administrators

want to have deducted from your gross pay (before taxes) each pay period to be used to fund your Flexible Spending Account. If you terminate before the end of the plan year and have an account balance you may be eligible to elect Cobra for this benefit. If you do not elect Cobra, any unclaimed contributions will be forfeited. You have 60 days from date of termination to file claims for expenses incurred prior to termination. Please see SPD for complete plan details.

Do not over estimate Be conservative in your calculations. If you do not incur eligible expenses for the full amount you elected to put in your FSA, the remaining balance in your account will be forfeited according to IRS regulations. Use it or lose it!

Changing your enrollment You should also remember that once you have made an election for the plan year, you cannot change it until the next annual Open Enrollment period unless you have a qualifying life event. If you do have a qualifying life event and you want to change an FSA, it is your responsibility to do so within 31 days of the life event.

Eligibility If you are a full-time employee, you may enroll in a Flexible Spending Account. NOTE: Starting January 1, 2011

A closer look at Health Care FSA’s Health Care Flexible Spending Accounts allow employees to set aside pre-tax dollars taken through a payroll deduction to pay for expenses not covered by any medical or dental plan in which you may be enrolled. These pre-tax dollars are set aside in a personal flexible spending account until needed. The most you may set aside for this account is $3,500 per year.

Eligible expenses According to IRS regulations, the following expenses are eligible to be claimed against a Health Care FSA. These expenses must be incurred during the plan year and must not be eligible for reimbursement from insurance policies or any other source. Also, expenses can only be incurred by you, your spouse, or any dependent (if you furnished over one half of the dependent’s support during the plan year). Please use the list on the next page to estimate the amount you wish to put in your Health Care FSA. We encourage you to refer to this list during the year to be sure you are taking full advantage of your FSA.


FSA

Administered by Blue Water Administrators

Eligible expenses examples

What’s best for you?

• artificial limbs, eyes, etc.

Your total savings will depend upon your family income, tax status, and total expenses. If you have Dependent Care expenses, you may choose to claim a tax credit when you file your Federal taxes rather than contribute to a Dependent Care FSA. Your own circumstances will determine whether using a Dependent Care FSA or the Federal income tax credit will be better for you.

• chiropractic care, licensed services/practitioner • deductibles/co-insurance (if not reimbursed from another source) • dental fees, including braces, treatments, etc. • drugs, prescription • durable medical equipment, wheelchairs, etc. • eyeglasses (if for medical reasons), contact lenses, solutions, enzymes • hearing aids and batteries • maternity (delivery) expenses, midwife • nursing home, if for medical reasons • ophthalmologist, optometrist services • orthodontic expenses • orthopedic shoes and corrective devices • physical examinations

Contributions limits The Dependent Care FSA allows employees to set aside pre-tax dollars taken through a payroll deduction to pay for workrelated child care expenses (daycare must have a valid Tax ID) or adult dependent care. Up to $5,000 can be set aside for this purpose.

• physician fees

Checking your FSA balance

• radial keratotomy (PRK, LASIK) • smoking cessation programs and prescription medication • transportation, tolls or parking expense for medical care • vaccinations, immunizations

For more information on eligible and ineligible expenses, visit www.irs.gov and refer to Publication 502.

Changes to the Over the Counter Eligibility for Reimbursement - January 1, 2011 Healthcare Reform has changed the allowable FSA over the counter drugs. The list below has been provided in categories of items that will be removed from the *IIAS list. Please note this is not the complete listing of items. This list may assist you in determining the amount that you allow for your Flexible Spending Account election, and if you have a Health Reimbursement Account that allows all IRS 213 expenses. These items require a prescription from a medical doctor to be filled by a pharmacy: • Acid Controllers • Antibiotic Products • Anti-Gas • Anti-Parasitic Treatments • Cold Sore Remedies • Digestive Aids • Hemorrhoid Preps • Motion Sickness • Respiratory Treatments • Stomach Remedies

• Allergy & Sinus • Anti-Diarrheal • Anti-Itch - Insect Bites • Baby Rash Ointments/Creams • Cough, Cold, Flu Remedies • Feminine Anti-Fungal/Anti-Itch • Laxatives • Pain Relief • Sleep Aids & Sedatives

A closer look at Dependent Care FSA’s Dependent Care Flexible Spending Accounts may be used to pay for expenses you incur for the care of dependent children under age 13 or any disabled dependent who lives with you and who you claim on your taxes. If you use Dependent Care services for a child, you know how much you need to budget for this expense every month. With an FSA, you set aside money to pay this expense with pre-tax dollars.

To check your balance on the FSA visit the website: https://employeebwa.lh1ondemand.com The first time you log onto this site use these credentials: username: your social security # no dashes password: changeme1 Once you have logged on for the first time you will be prompted to create a new unique password for future login. Upon login you will be able to check your FSA account balance. Click on the My Account button and choose to view your account balance. You may also check your FSA account balance by contacting the Customer Service Hotline at 1-888-408-9142.

How to file an online claim File your claims by logging onto the website: https://employeebwa.lh1ondemand.com Click on the FILE CLAIMS link and select the file claim button next to the appropriate account. Fill out the form and click submit. Print your confirmation page and send a copy of it along with your claim (detail claim from provider, explanation of benefits form from insurance carrier or copy of prescription) to: Blue Water Administrators FAX#: 843-375-0157

How to file a paper claim File your paper claims by logging onto the website https://employeebwa.lh1ondemand.com Click on the FORMS link and print. Fill out the form and send a copy of it along with your claim (detail claim from provider, explanation of benefits form from insurance carrier or copy of prescription) to: Blue Water Administrators | Attn: Flex 1024 eWall Street, Ste 101 | Mt. Pleasant, SC 29464 FAX: 843.375.0157 fsa-hracustomerservice@bwadministrators.com

Employee Service Hotline: 1-888-408-9142 13


Medicare Notice PLEASE READ THESE Important Notices About Your PLAN AND COVERAGE Medicare Part D Credible Coverage Notice Prior to 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 2010 or 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 The Town of Summerville, 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. • The Town of Summerville has determined that the prescription drug benefit offered through the Town of Summerville 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 The Town of Summerville prescription drug coverage you will have to drop all of your healthcare coverage with The Town of Summerville since prescription drug coverage is a part of your The Town of Summerville healthcare plan. Please be aware that you may not be able to get this coverage back should you decide to drop it.

You should also know that if you drop or lose your coverage with The Town of Summerville 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 customer service team for further information at 1-888408-9142. 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

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.

The lifetime limit on the dollar value of benefits under The Town of Summerville 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 Blue Water Benefits at 1-888-408-9142.

dependent children coverage Notice

• Married; • Living with you; • In school; • Financially dependent on you; • Eligible to enroll in their employer’s plan, with one temporary exception: Until 2014 “grandfathered” group plans do not have to offer dependent coverage up to age 26 if a young adult is eligible for group coverage outside their parents’ plan.

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 Town of Summerville health plan. For more information contact the Benefits Hotline at 1-888-408-9142. Your adult children can join or remain on your plan whether or not they are:

14 Employee Benefits Guide


Chip Notice 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 and you live in a State listed below, 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 employersponsored 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

12/1/2010

Employee Service Hotline: 1-888-408-9142 15


Town of Summerville Employee Benefits Guide  

A resource for the Town of Summerville employees to access their employee benefits in a concise, convenient booklet overview.

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