2023-2024 Benefits Open Enrollment Guide

If you (and/or your dependents) have Medicare or will become eligible for Medicare in the next 12 months, a Federal law gives you more choices about your prescription drug coverage. Please see page 19 for more details.

IMPORTANT NOTICE: This document is provided to help employers understand the compliance obligations for Health & Welfare benefit plans, but it may not take into account all the circumstances relevant to a particular plan or situation. It is not exhaustive and is not a substitute for legal advice

BENEFIT BASICS

Camden County Board of Commissioners offers a comprehensive suite of benefits to promote health and financial security for you and your family. This Benefit Guide provides you with your benefits choicesreview it carefully so you can choose the coverage that is right for you and your family. Open Enrollment is the time each year that you have the opportunity to review benefits options and select benefits. The Camden County plan year runs from July 1 to June 30 each year.

BENEFIT BASICS

You are eligible for benefits if you work at least 30 hours per week and are a permanent employee. You may enroll your eligible dependents for coverage, including:

Your legal spouse, Your children up to age 26.

You will select your benefits during Open Enrollment in May 2023. Once your benefit elections become effective on July 1st, 2023, they will remain in effect until June 30th, 2024. You may only change coverage during this time if you experience a qualifying life event

QUALIFYING LIFE EVENTS

Once you have made your selections during open enrollment, you can only change them during the year if you experience an event such as:

Marriage

Divorce or legal separation

Birth of your child

Death of your spouse or dependent child

Adoption of or placement for adoption of your child

Change in employment status of employee, spouse or dependent child

Qualification by the Plan Administrator of a child support order for medical coverage

Entitlement to Medicare or Medicaid

You must notify the Benefits Department within 30 days of a qualifying life event. Depending on the type of event, you may need to provide proof of the event, such as a marriage license. If you do not contact the Benefits Department within 30 days of the qualified event, you will have to wait until the next annual enrollment period to make changes (unless you experience another qualifying life event).

Learn More:

For more information or questions about your benefits, contact the Benefit Resource Center by calling 855.874.0835 or email BRCSOUTH@USI.COM.

Dependent Documentation

Camden County requires supporting documentation when you request to add a dependent to your plan. Be prepared to provide proof of eligibility such as your marriage certificate, your child(ren)’s birth certificates, appropriate adoption paperwork or other documents that support your dependent relationship. This paperwork is required not only to support the coverage of eligible dependents, but also to support a mid-year change in status such as marriage or birth of a child.

BENEFIT BASICS

BENEFIT COSTS

The Company pays the full cost of some of your benefits; you share the cost for others. In addition, you pay the full cost for any voluntary benefits you elect. Camden County offers a defined contribution. After making a medical plan election, unused employer funds can be used to purchase any voluntary products offered on the enrollment portal.

BENEFIT BASICS

HOW TO ENROLL

Camden County partners with Optivase where you will be able to shop for benefits. Through the portal you can select a health plan as well as a variety of other valuable benefit options for yourself and any eligible family members.

After enrollment, Optivase is your first stop when you want more information about your benefits, want to track and manage your costs, or need to add a spouse or child to your plans.

You’ll need to enroll yourself and your family members to have benefits this coming year.

To register for the first time:

 Go to https://www.mybensite.com/cocamdenga/

 Create Account: Verify employee last name, date of birth and last 4 digits of Social Security Number.

 Email: An email address is required. If you do not have one, click on the Gmail or Yahoo links to establish a free email account. Your email becomes your username.

 Password: Create and confirm your password to complete registration.

Once you are registered:

 Go to: https://www.mybensite.com/cocamdenga/

 Username: Email Address that you used to register above

 Enter the password created during registration

 Then check the box to agree to website terms and conditions.

Benefit Shopping:

Click Enroll Now to shop and elect benefits:

Step-by-step enrollment guidance

Camden County Human Resources is available for questions regarding the enrollment system. Please call 912-576-5660.

Cost per paycheck is displayed for each benefit elected Add and manage covered dependents

Update beneficiaries

Review and submit final elections

Print your Benefit Confirmation Statement (BCS) for your records.

A few tips for using the Enrollment Portal:

You may want your spouse present while using the portal – remember, your benefit choices impact your whole family.

You’ll need to have the following handy as you enroll, as the system will require them:

 Social Security Numbers (SSNs)

 date(s) of birth

 address(es) (if dependent living elsewhere)

 other medical coverage carrier name(s) and policies number(s) if dependents have other coverage

 Beneficiary information for life insurance –name(s), date(s) of birth, address(es)

HEALTH CARE

YOUR HEALTH CARE COVERAGE

You will have 4 medical plan options available to you through Aetna that include a range of coverage levels and costs, giving you the flexibility to select the plan that is right for you. Each plan features in- and out-of-network coverage, individual and family deductibles, copays, coinsurance and out-of-pocket maximums. Some offer a lower monthly cost, a higher deductible, and lower coinsurance amounts, while others cost more each month but offer a lower deductible and higher levels of coinsurance.

Keep in mind that while you can seek services in and out of the network, you will always pay less if you are treated by an in-network provider because the plan pays a higher percentage of your covered expenses.

NETWORK ACCESS

It is simple to look for doctors who are part of the Aetna network.

1. Go to aetna.com.

2. At the top of the page, click on Find a doctor.

3. Select Plan from an Employer on the Right side of the screen.

4. Search for a provider by zip code, city, state or county

5. The $1,500 HSA High Deductible Health Plan is an HMO Plan. There are no out-of-network benefits, except for emergencies. If you are selecting this plan, please choose the Elect Choice EPO Open Access Network under the Aetna Open Access Plans.

6. All other plans are POS Plans with in and outof-network benefits. If you are selecting one of these plans, please choose the Aetna Choice POS II (Open Access) Network under the Aetna Open Access Plans.

PlanProvision

HSAorFSAEligible

AnnualDeductible

Definitions

Is this plan eligible to be partnered with an HSA or FSA?

The annual amount you and your family must pay each year before the plan pays benefits.

Coinsurance

Out-of-Pocket Maximum (Includes Deductible & Copays)

PreventiveCare

PrimaryCarePhysician OfficeVisit

The percentage of a covered charge paid by the plan after your deductible is met.

The maximum amount you and your family pay for eligible expenses each plan year. Once your expenses reach the out-of-pocket maximum, the plan pays 100% of eligible expenses for the remainder of the year.

Routine health care that includes check-ups, patient counseling and screenings to prevent illness, disease and other health-related problems.

A physician (generally a family practitioner, internist or pediatrician) who provides ongoing medical care, treats a wide variety of healthrelated conditions and refers patients to specialists as necessary.

SpecialistOfficeVisit A physician who has specialized training in a particular branch of medicine (e.g., a surgeon, gastroenterologist or neurologist).

X-Ray,Lab,Inpatient& OutpatientHospital Services

UrgentCare

EmergencyRoomCare

RetailPrescriptionDrugs

X-rays, lab work and services provided to an individual at a hospital facility.

An alternative to ER for non-life-threatening illnesses or injuries.

Immediate treatment for life threatening illnesses or injuries.

Generic drugs are less expensive versions of brand name drugs that have the same intended use, dosage, effects, risks, safety and strength.

MailOrderPrescription

Mail order pharmacies provide a 90-day supply of a prescription medication and the convenience of shipping directly to your door.

CamdenCountypaysthefollowingtowardsyourmedicalcoverage. Anyremainingdollarscanbeusedtopurchasevoluntaryproducts. Ifyouwaive themedicalcoverage,youwillreceiveacreditintheamountof$44.21/monththatcanbeusedtopurchasevoluntaryproducts.

MEDICAL PLANS

WELLNESS INITIATIVES

It is Camden County’s desire to promote strategies for wellness by empowering employees and their families to achieve and maintain a healthy lifestyle. We understand that adapting healthy changes can be challenging and we desire to see each person succeed in living a healthy lifestyle. This is why we believe in offering a significant incentive to those employees who are willing to make the investment in their health.

Your participation in the wellness program is voluntary.

PROGRAM ELIGIBILITY

All full-time employees enrolled on the Aetna Medical Plan and their covered spouses are eligible to participate in the optional wellness program via the Camden Health Incentive Program (CHIP) via the WellRight electronic platform. Employees, spouses and dependents not covered by participating insurance plans are encouraged to participate and are eligible to receive other rewards. Nicotine users must successfully complete all of the Healthy U courses for Tobacco in addition to wellness program requirements to remain eligible.

INCENTIVES

Incentives earned during this wellness year will be applied July 2024 through June 2025. Employees and Spouses on the company health plan are BOTH required to participate. Employees must complete the baseline activities below and earn at least 4,000 points. Covered spouses must complete the baseline activities below to earn the premium incentive.

REQUIRED CHALLENGES

All baseline activities must be completed by you and your covered spouse prior to April 30, 2024 to remain eligible for incentives:

1. Say Aah (annual physical) – 600 points

2. Age Gage (health risk assessment) – 400 points

3. No Butts Tobacco affidavit (all courses to be completed by nicotine users by April 30, 2024) - 500 points

Additional ways to earn points are available on the WellRight electronic platform. Visit chips.wellright.com to begin your wellness journey! Contact Heather Farrell with additional questions on this wellness program @ shfarrell@co.camden.ga.us or (912) 576- 0271.

ONSITE CLINIC

Camden County’s goal is to help you achieve your optimal health. Camden County offers an onsite clinic to all full-time employees to diagnose, treat and prescribe for a wide variety of common illnesses and injuries. In addition to sick care, you have access to primary care including a variety of preventive services, adult immunizations, and much more. Dependents that are covered under the Camden County Medical Plans are also encouraged to use the facility. This clinic is located at 701 Charles Gilman Jr. Ave, Suite B, Kingsland, GA 31548.

Note: Members enrolled in a County-Funded Health Savings Account are charged $35.64 per month ($17.82 per pay period) to access the onsite clinic for compliance purposes

FLEXIBLE SPENDING ACCOUNTS

If you are enrolling in the $1,500 Deductible Co-Pay Health Plan or $5,000 Deductible Co-Pay Health Plan, you may want to consider opening a Flexible Spending Account (FSA) through Payflex. FSAs are designed to help you save money on taxes. They work in a similar way to a savings account. Each pay period, funds are deducted from your pay on a pretax basis and credited to a Health Care and/or Dependent Care FSA. You then use your funds to pay for eligible health care or dependent care expenses. Participants in an FSA may not participate in a HSA per IRS guidelines.

IMPORTANT INFORMATION ABOUT FSAs

Your FSA elections are effective from July 1, 2023 through June 30, 2024. Claims for reimbursement must be submitted by September 15th. Please plan your contributions carefully. Any money that is remaining in your account on September 16th, 2024 will be forfeited. This is known as the “use it or lose it” rule and it is governed by Internal Revenue Service regulations. FSA elections do not automatically continue from year to year; you must actively enroll each year.

ANNUAL CONTRIBUTION LIMITS BENEFIT

Most medical, dental and vision care expenses that are not covered by your health plan (such as copayments, coinsurance, deductibles, eyeglasses, prescriptions and over the counter medications)

Dependent care expenses (such as day care, after school programs or elder care programs) so you and your spouse can work or attend school full-time.

WHAT ARE THE ADVANTAGES OF AN FSA?

Maximum 2023 contribution is $3,050 per year (this maximum includes any other FSA contributions you have made in the 2023 calendar year)

Maximum 2023 Calendar Year contribution is $5,000 per year ($2,500 if married and filing separate tax returns)

Saves on eligible expenses not covered by insurance; reduces your taxable income

Reduces your taxable income

Your contributions are not taxed, nor are you taxed when you receive reimbursements from the account. And you are not taxed when you file your income tax returns at the end of the year. Also, your Health FSA dollars are available immediately on a debit card.

EXAMPLE

Here’s a look at how much you can save when you use an FSA to pay for your health care and dependent care expenses.

Health Care FSA

Dependent Care FSA

ACCOUNT TYPE WITH FSA WITHOUT FSA

HEALTH SAVINGS ACCOUNTS

What is a Health Savings Account?

A Health Savings Account (HSA) is an account that can be funded with your tax-exempt dollars to help pay for eligible medical expenses not covered by an insurance plan. The HSA Account is administered by Payflex.

Who is Eligible for an HSA?

Anyone who is:

Covered by a High Deductible Health Plan (HDHP); Not covered under another medical plan (unless that plan is also HSA-qualified), Not entitled to Medicare benefits; or Not eligible to be claimed on another person’s tax return.

What is a High Deductible Health Plan (HDHP)?

A High Deductible Health Plan is a plan with a minimum annual deductible and a maximum out-of-pocket limit that is determined annually by the Internal Revenue Service (IRS). There are two plans that meet these requirements: $1,500 HSA High Deductible Health Plan and the $3,000 HSA High Deductible Health Plan.

When do I use my HSA?

After visiting a physician, facility, or pharmacy your medical claim will be submitted to your HDHP for payment. Your HSA dollars can be used to pay your outof-pocket expenses (deductibles and coinsurance) billed by the physician, facility, or pharmacy or you can choose to save your HSA dollars for a future medical expense. HSA dollars can only be used to purchase over-the-counter drugs for which you have a prescription. Be sure to keep your receipts in the event that substantiation is requested.

How much can I contribute to an HSA?

As noted by federal law for the 2023 calendar year, the annual contribution limits are: $3,850 for individual coverage or $7,750 for family coverage.

Individuals age 55 or older may be eligible to make a catch-up contribution of $1,000.

Camden County will continue to contribute $950 for employee only coverage, $1,200 for employee + spouse or employee + child(ren) coverage, and $1,450 for employee + family coverage annually for all participating members.

What if I enroll in an HSA in the middle of a year?

If you enroll in an HSA in the middle of a year, you are allowed to make a full year’s contribution, provided that you remain covered by the HSA for at least the 12-month period following that year.

Why should I elect an HSA?

1. Cost Savings

 Tax Benefits

o HSA Contributions are excluded from federal income tax

o Interest earnings are tax-deferred

o Withdrawals for eligible expenses are exempt from federal income tax

 Reduction in medical plan contribution

 Unused money is held in an interest-bearing savings or investment account

2. Long-Term Financial Benefits

 Save for future medical expenses

 Funds roll over year to year

 This is your account – you take it with you

3. Choice

 You control and manage your health care expenses.

 You choose when to use your HSA dollars to pay your health care expenses.

 You choose when to save your HSA dollars and pay health care expenses out of pocket.

DENTAL PLANS

YOUR DENTAL COVERAGE

Regular dental exams can help you and your dentist detect problems in the early stages when treatment is more basic, and costs are much lower. Keeping your teeth and gums clean and healthy will help prevent most tooth decay and periodontal disease and is an important part of maintaining your medical health.

Camden County offers you a choice of three dental plans. This year dental coverage is moving to Guardian with the same great plans and lower costs! You can create an online account and find an in-network dentist by visiting www.guardiananytime.com.

Your Dental Coverage has Calendar Year Deductibles & Maximums. This means that all Deductibles and Maximums, excluding the lifetime orthodontia maximum, will start over each year on January 1st. There are no late entrant waiting periods if you choose to elect Dental coverage during open enrollment.

VISION PLANS

YOUR VISION COVERAGE

Camden County offers you a choice of vision plans. This year vision coverage will be moving to Guardian, and we will be offering two plans instead of four. The vision plan provides coverage for routine eye exams and also pays for all or a portion of the cost of glasses or contact lenses if you need them. You can see in- or out-of-network providers, however, keep in mind that out-of-network providers require you to pay up front and be reimbursed at a lower benefit level than in-network providers.

VSP VISION NETWORK

Guardian uses the VSP network which offers you one of the largest vision care networks in the industry, with a wide selection of experienced ophthalmologists, optometrists, and opticians. The VSP network also includes convenient retail locations, including MyEyeDr, Pearle Vision, Visionworks, Walmart, Sam’s Club, and Costco. Visit www.vsp.com/eyedoctor to create an account and find a provider near you.

Note: This is a summary of your in-network coverage only. Please refer to your certificate or benefits summary for the full scope of coverage and details on out-ofnetwork coverage.

LIFE INSURANCE

LIFE AND ACCIDENTAL DEATH & DISMEMBERMENT (AD&D) INSURANCE COVERAGE

Life insurance is an important part of your financial security, especially if others depend on you for support. Accidental Death & Dismemberment (AD&D) insurance is designed to provide a benefit in the event of accidental death or dismemberment.

Camden County provides Basic Life and AD&D Insurance in the amount of One times your Salary to a maximum of $200,000 to all Full Time Employees at no cost through The Hartford.

EMPLOYEE-PAID TERM LIFE INSURANCE

To supplement the life insurance provided by Camden County, you can purchase additional term life insurance through The Hartford for yourself, your spouse and your child(ren).

As a new hire, you can purchase up to the Guarantee Issue Amount without answering medical questions. Evidence of insurability is required for any amounts over the Guarantee Issue Amount. If you did not elect additional life insurance when you were first eligible and want to elect it now, evidence of insurability is required for any amounts of life insurance. If you are increasing current coverage amounts, evidence of insurability will also be required.

During Open Enrollment, Hartford allows you to increase your current coverage for you and/or your spouse by one increment (25,000 for employee or $5,000 for spouse) without answering medical questions as long as your total amount is not above the guarantee issue amounts listed above. Any amounts of life insurance above this amount will require Evidence of Insurability.

If you (the employee) are age 70 or older: The life insurance benefit amount elected are subject to benefit reductions due to your age. At age 70, the benefit elected decreases to 50% of the original amount.

DISABILITY INSURANCE

Disability insurance helps replace a major portion of your income when you are sick or injured and unable to work. Some people think of it as “paycheck protection.” Others view it as a way to protect their home since a mortgage payment is often a family’s most significant monthly expense.

Having disability insurance can provide a sense of security, knowing that if the unexpected should happen, you’ll still receive a monthly income.

If you think about it, everything you have today - your home, car, groceries, savingsbasically your lifestyle, depends on your ability to earn an income. Most people are quick to insure their possessions, such as their home and car. And they generally have life insurance that would provide for their family. But the one thing that makes all this possible is – your income. It’s your most important asset. So, protecting it with disability insurance isn’t just a good decision – it’s essential.

Camden County provides you with the opportunity to purchase Short Term Disability insurance through payroll deduction through The Hartford. This covers you for any sickness or injury that is off of the job. Below is a summary of the benefits. Please refer to your certificate of coverage for full details.

SHORT TERM DISABILITY

You may elect a flat weekly benefit amount from $100 to $2,000 in increments of $50. The elected incremental benefit amount cannot exceed 60% of your weekly earnings. Because there are no offsets with The Hartford, the benefit amount you elect will not be reduced for any reason if you go out on claim. Benefits begin on the 8th day of injury or illness and continues to the earlier of recovery or 26 weeks.

LONG TERM DISABILITY

Camden County offers Long Term Disability insurance coverage through The Hartford to all full-time employees at no cost to you. It Covers 60% of your monthly pre-disability earnings, up to a $8,000 monthly maximum. Benefits begin after 90 days of disability or illness and continues to the earlier of recovery or your Social Security Normal Retirement Age (2-year own occupation is included).

PRE-EXISTING CONDITIONS

The Voluntary Short-Term Disability includes an annual open enrollment with Guaranteed Issue Coverage. No Medical questions are required at the time of enrollment. A Pre-existing condition limitation may apply.

A pre-existing condition is an illness, injury or pregnancy-related condition for which, during the 6 months before your coverage became effective:

You were diagnosed or treated; or

You received diagnostic or treatment services; or

You took drugs which were prescribed or recommended by a physician.

This plan limits the maximum benefit to 4 weeks for a disability that is caused, or contributed to, by a pre-existing condition, until the employee has been covered for 6 consecutive months with no medical care for the condition, or until the employee has been covered for 12 consecutive months.

The same limitations apply to Long Term Disability with a 3-month look-back and 3 month treatment-free period.

LEGAL NOTICES

Dear Plan ParScipant:

As a parScipant in any of The Camden County Board of County Commissioners (Company’s) health and welfare benefits, you can request any or all of the following documents at any Sme. You can contact Human Resources and you will receive a copy of the documents as soon as possible. In addiSon, you can access these documents 24/7/365 by logging into the Employees Only secSon of the Camden County Website. They will be posted under the Insurance InformaSon Tab. These documents are updated periodically. If you are unable to obtain these documents at this specified locaSon or would prefer a paper copy, please contact Human Resources at (912) 576-5660 to request a copy.

1. The Camden County Board of County Commissioners SecSon 125 Summary Plan DescripSon (SPD). The SPDs are a summary of all the material provisions of the health and welfare benefits offered by the Company.

2. CerSficates of Coverage. The explanaSon of benefits is a benefit booklet prepared by the insurance carrier which explains the details of how and which benefits are covered and which are not.

3. Summary of Material ModificaSons. If any of the benefits offered by the Company are changed in a substanSal way, the Company will amend the corresponding documents about the benefits. This is someSmes contained in this document.

4. Annual and other Required Disclosures. All are contained in our Open Enrollment materials. If you have any quesSons about these noSces, please let us know.

5. IniSal COBRA NoSce. This noSce explains your rights under COBRA should you have a qualifying event, including a terminaSon of employment or a reducSon in hours.

6. Summary of Benefits & Coverage. This is a document that was required under the Affordable Care Act (Obamacare). It is a four-page document prepared for each medical plan offering of the Company and enables you to compare each plan side by side.

7. Marketplace NoSce. This NoSce gives you informaSon about the health insurance marketplace which was created as part of Obamacare. The Marketplace NoSce is included in this enrollment guide.

8. Medicare Part D NoSce. This NoSce informs you about the credibility of the Company’s prescripSon drug coverage so that you can elect Medicare in a Smely manner to avoid potenSal penalSes. This noSce is included in this enrollment guide.

9. Wellness Program InformaSon and Disclosures. This informaSon will explain how the Company’s wellness program works, and what is required to receive an incenSve. This disclosure is included in this enrollment guide.

Thank you, and please let us know if you have any quesSons.

Human Resources

LEGAL NOTICES

Notice of Special Enrollment Rights

If you are declining enrollment for yourself or your dependents (including your spouse) because of other health insurance or group health plan coverage, you may be able to enroll yourself and your dependents in this plan if you or your dependents lose eligibility for that other coverage (or if the employer stops contributing toward your or your dependents’ other coverage). However, you must request enrollment within 30 days after your or your dependents’ other coverage ends (or after the employer stops contributing toward the other coverage).

In addition, if you have a new dependent as a result of marriage, birth, adoption, or placement for adoption, you may be able to enroll yourself and your dependents. However, you must request enrollment within 30 days after the marriage, birth, adoption, or placement for adoption.

Further, if you decline enrollment for yourself or eligible dependents (including your spouse) while Medicaid coverage or coverage under a State CHIP program is in effect, you may be able to enroll yourself and your dependents in this plan if: coverage is lost under Medicaid or a State CHIP program; or you or your dependents become eligible for a premium assistance subsidy from the State. In either case, you must request enrollment within 30 days from the loss of coverage or the date you become eligible for premium assistance.

To request special enrollment or obtain more information, contact person listed at the end of this summary.

The

Newborns’ and Mothers’

Health

Protection Act of 1996

Group health plans and health insurance issuers generally may not, under Federal law, restrict benefits for any hospital length of stay in connection with childbirth for the mother or newborn child to less than 48 hours following a vaginal delivery, or less than 96 hours following a cesarean section. However, Federal law generally does not prohibit the mother’s or newborn’s attending provider, after consulting with the mother, from discharging the mother or her newborn earlier than 48 hours (or 96 hours as applicable). In any case, plans and issuers may not, under Federal law, require that a provider obtain authorization from the plan or the insurance issuer for prescribing a length of stay not in excess of 48 hours (or 96 hours).

Women’s Health and Cancer Rights Act of 1998

The Women’s Health and Cancer Rights Act of 1998 requires Camden County to notify you, as a participant or beneficiary of the Camden County Health and Welfare Plan, of your rights related to benefits provided through the plan in connection with a mastectomy. You, as a participant or beneficiary, have rights to coverage to be provided in a manner determined in consultation with your attending physician for:

1. All stages of reconstruction of the breast on which the mastectomy was performed;

2. Surgery and reconstruction of the other breast to produce a symmetrical appearance; and

3. Prostheses and treatment of physical compilations of the mastectomy, including lymphedema.

These benefits are subject to the plan’s regular deductible and co-pay. For further details, refer to your Summary Plan Description. Keep this notice for your records and call Human Resources for more information.

LEGAL NOTICES

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, 2023. Contact your State for more information on eligibility –

ALABAMA–Medicaid CALIFORNIA-Medicaid

Website: http://myalhipp.com/

Phone: 1-855-692-5447

ALASKA–Medicaid

The AK Health Insurance Premium Payment Program

Website: http://myakhipp.com/

Phone: 1-866-251-4861

Email: CustomerService@MyAKHIPP.com

Medicaid Eligibility: http://dhss.alaska.gov/dpa/Pages/medicaid/default.aspx

ARKANSAS–Medicaid

Website: http://myarhipp.com/ Phone: 1-855-MyARHIPP (855-692-7447)

GEORGIA-Medicaid

GA HIPP Website: https://medicaid.georgia.gov/healthinsurance-premium-payment-program-hipp

Phone: 678-564-1162, Press 1

GA CHIPRA Website: https://medicaid.georgia.gov/programs/third-partyliability/childrens-health-insurance-programreauthorization-act-2009-chipra

Phone: (678) 564-1162, Press 2

Website:

Health Insurance Premium Payment (HIPP) Program http://dhcs.ca.gov/hipp

Phone: 916-445-8322 Fax: 916-440-5676

Email: hipp@dhcs.ca.gov

COLORADO-HealthFirstColorado(Colorado’sMedicaidProgram)&Child HealthPlanPlus(CHP+)

Health First Colorado Website: https://www.healthfirstcolorado.com/ Health First Colorado Member Contact Center: 1-800-221-3943/ State Relay 711

CHP+: https://www.colorado.gov/pacific/hcpf/child-health-plan-plus

CHP+ Customer Service: 1-800-359-1991/ State Relay 711

Health Insurance Buy-In Program (HIBI): https://www.colorado.gov/pacific/hcpf/health- insurance-buy-program

HIBI Customer Service: 1-855-692-6442

FLORIDA-Medicaid

Website: https://www.flmedicaidtplrecovery.com/flmedicaidtplrecovery. com/hipp/index.html

Phone: 1-877-357-3268

MAINE-Medicaid

Enrollment Website: https://www.maine.gov/dhhs/ofi/applications-forms

Phone: 1-800-442-6003

TTY: Maine relay 711

Private Health Insurance Premium Webpage: https://www.maine.gov/dhhs/ofi/applications-forms

Phone: -800-977-6740.

TTY: Maine relay 711

LEGAL NOTICES

INDIANA-Medicaid

Healthy Indiana Plan for low-income adults 19-64

Website: http://www.in.gov/fssa/hip/

Phone: 1-877-438-4479

All other Medicaid

Website: https://www.in.gov/medicaid/ Phone 1-800-457-4584

IOWA-MedicaidandCHIP(Hawki)

Medicaid Website: https://dhs.iowa.gov/ime/members

Medicaid Phone: 1-800-338-8366

Hawki Website: Http://dhs.iowa.gov/Hawki

Hawki Phone: 1-800-257-8563

HIPP Website: https://dhs.iowa.gov/ime/members/medicaid- a-toz/hipp

HIPP Phone: 1-888-346-9562

KANSAS-Medicaid

Website: https://www.kancare.ks.gov/

Phone: 1-800-792-4884

KENTUCKY-Medicaid

Kentucky Integrated Health Insurance Premium Payment Program (KI-HIPP) Website: Https://chfs.ky.gov/agencies/dms/member/Pages/kihipp.aspx

Phone: 1-855-459-6328

Email: KIHIPP.PROGRAM@ky.gov

KCHIP Website: https://kidshealth.ky.gov/Pages/index.aspx Phone: 1-877-524-4718

Kentucky Medicaid Website: https://chfs.ky.gov

LOUISIANA-Medicaid

Website: www.medicaid.la.gov or www.ldh.la.gov/lahipp

Phone: 1-888-342-6207 (Medicaid hotline) or 1-855-618-5488 (LaHIPP)

NEVADA-Medicaid

Medicaid Website: http://dhcfp.nv.gov

Medicaid Phone: 1-800-992-0900

NEWHAMPSHIRE-Medicaid

Website: https://www.dhhs.nh.gov/programsservices/medicaid/health-insurance-premium-program

Phone: 603-271-5218

Toll free number for the HIPP program: 1-800-852-3345, ext 5218

NEWJERSEY-MedicaidandCHIP

Medicaid Website: http://www.state.nj.us/humanservices/ dmahs/clients/medicaid/

Medicaid Phone: 609-631-2392

CHIP Website: http://www.njfamilycare.org/index.html CHIP

Phone: 1-800-701-0710

NEWYORK-Medicaid

Website: https://www.health.ny.gov/health_care/medicaid/

Phone: 1-800-541-2831

NORTHCAROLINA-Medicaid

Website: https://medicaid.ncdhhs.gov/

Phone: 919-855-4100

NORTHDAKOTA-Medicaid

Website: http://www.nd.gov/dhs/services/medicalserv/medicaid/

Phone: 1-844-854-4825

OKLAHOMA-MedicaidandCHIP

Website: http://www.insureoklahoma.org

Phone: 1-888-365-3742

MASSACHUSETTS-MedicaidandCHIP

Website: https://www.mass.gov/masshealth/pa

Phone: 1-800-862-4840

TTY: (617) 886-8102

MINNESOTA-Medicaid

Website: https://mn.gov/dhs/people-we-serve/children-andfamilies/health-care/health-care-programs/programs-andservices/other-insurance.jsp

Phone: 1-800-657-3739

MISSOURI-Medicaid

Website: http://www.dss.mo.gov/mhd/participants/pages/hipp.htm

Phone: 573-751-2005

MONTANA-Medicaid

Website: http://dphhs.mt.gov/MontanaHealthcarePrograms/ HIPP Phone: 1-800-694-3084

Email: HHSHIPPProgram@mt.gov

NEBRASKA-Medicaid

Website: http://www.ACCESSNebraska.ne.gov

Phone: 1-855-632-7633

Lincoln: 402-473-7000 Omaha: 402-595-1178

SOUTHCAROLINA-Medicaid

Website: https://www.scdhhs.gov

Phone: 1-888-549-0820

SOUTHDAKOTA-Medicaid

Website: http://dss.sd.gov

Phone: 1-888-828-0059

TEXAS-Medicaid

Website: http://gethipptexas.com/

Phone: 1-800-440-0493

UTAH–MedicaidandCHIP

Medicaid Website: https://medicaid.utah.gov/

CHIP Website: http://health.utah.gov/chip

Phone: 1-877-543-7669

VERMONT–Medicaid

Website: http://www.greenmountaincare.org/

Phone: 1-800-250-8427

VIRGINIA–MedicaidandCHIP

Website: https://www.coverva.org/en/famis-select

https://www.coverva.org/en/hipp

Medicaid/CHIP Phone: 1-800-432-5924

WASHINGTON–Medicaid

Website: https://www.hca.wa.gov/

Phone: 1-800-562-3022

LEGAL NOTICES

OREGON-Medicaid

Website: http://healthcare.oregon.gov/Pages/index.aspx

http://www.oregonhealthcare.gov/index-es.html

Phone: 1-800-699-9075

PENNSYLVANIA-Medicaid

Website:https://www.dhs.pa.gov/Services/Assistance/Pages/HIPP Program.aspx

Phone: 1-800-692-7462

WESTVIRGINIA–MedicaidandCHIP

Website: https://dhhr.wv.gov/bms/ http://mywvhipp.com/

Medicaid Phone: 304-558-1700

CHIP Toll-free phone: 1-855-MyWVHIPP (1-855-699- 8447)

WISCONSIN-MedicaidandCHIP

Website: https://www.dhs.wisconsin.gov/badgercareplus/p10095.htm

Phone: 1-800-362-3002

RHODEISLAND-MedicaidandCHIP WYOMING-Medicaid

Website: http://www.eohhs.ri.gov/

Phone: 1-855-697-4347, or 401-462-0311 (Direct Rite Share Line)

Website: https://health.wyo.gov/healthcarefin/medicaid/programsand-eligibility/

Phone: 1-800-251-1269

To see if any other states have added a premium assistance program since January 31, 2023 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 Notice from Camden County About Your Prescription Drug Coverage & Medicare

Please read this notice carefully and keep it where you can find it. This notice has information about your current prescription drug coverage with Camden County and about your options under Medicare’s prescription 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 through Medicare prescription drug plans and Medicare Advantage Plan (like an HMO or PPO) that offer prescription drug coverage. All Medicare prescription 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.

LEGAL NOTICES

2. Camden County has determined that the prescription drug coverage offered by the Welfare Plan for Employees of Camden County under the Aetna options are, on average for all plan participants, expected to pay out as much as the 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 to 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, your current Camden County coverage will not be affected. You can keep this coverage if you elect part D and this plan will coordinate with Part D coverage.

If you decide to join a Medicare drug plan and drop your current Camden County coverage, be aware that you and your dependents will 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 Camden County 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 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 for further information. NOTE: You’ll get this notice each year. You will also get it before the next period you can join a Medicare drug plan, and if this coverage through Aetna 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 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 1-800-7721213 (TTY 1-800-325-0778).

Remember: Keep this notice. If you enroll in one of the new plans approved by Medicare which offer prescription drug coverage, you may be required to provide a copy of this notice when you join to show that you are not required to pay a higher premium (a penalty).

LEGAL NOTICES

Name of Entity/Sender: Camden County Board of Commissioners, Human Resources

Address: 200 East 4th Street, Woodbine, GA 31569

Phone Number:(912) 576-5660

Wellness Program Notification

The Camden County Wellness Plan is a voluntary wellness program available to all employees. The program is administered according to federal rules permitting employer-sponsored wellness programs that seek to improve employee health or prevent disease, including the Americans with Disabilities Act of 1990, the Genetic Information Nondiscrimination Act of 2008, and the Health Insurance Portability and Accountability Act, as applicable, among others. If you choose to participate in the wellness program you will be asked to complete a voluntary health risk assessment or "HRA" that asks a series of questions about your health-related activities and behaviors and whether you have or had certain medical conditions (e.g., cancer, diabetes, or heart disease). You will also be asked to complete a biometric screening, which will include a blood test for Total Cholesterol, HDL Cholesterol, and LDL Cholesterol, Triglycerides, calculated risk ratio and glucose. You are not required to complete the HRA or to participate in the blood test or other medical examinations. However, employees who choose to participate in the wellness program will receive a wellness discount on 2023 medical premiums for completing the wellness plan requirements. Although you are not required to complete the HRA or participate in the biometric screening, only employees who do so will receive wellness discount on 2023 medical premiums.

The information from your HRA and the results from your biometric screening will be used to provide you with information to help you understand your current health and potential risks, and may also be used to offer you services through the wellness program, such as the employee onsite clinic. You also are encouraged to share your results or concerns with your own doctor.

Protections from Disclosure of Medical Information

We are required by law to maintain the privacy and security of your personally identifiable health information. Although the wellness program and Camden County may use aggregate information it collects to design a program based on identified health risks in the workplace, the Camden County Wellness Program will never disclose any of your personal information either publicly or to the employer, except as necessary to respond to a request from you for a reasonable accommodation needed to participate in the wellness program, or as expressly permitted by law. Medical information that personally identifies you that is provided in connection with the wellness program will not be provided to your supervisors or managers and may never be used to make decisions regarding your employment.

Your health information will not be sold, exchanged, transferred, or otherwise disclosed except to the extent permitted by law to carry out specific activities related to the wellness program, and you will not be asked or required to waive the confidentiality of your health information as a condition of participating in the wellness program or receiving an incentive. Anyone who receives your information for purposes of providing you services as part of the wellness program will abide by the same confidentiality requirements. The only individual(s) who will receive your personally identifiable health information are the nurses at the onsite health clinic in order to provide you with services under the wellness program.

In addition, all medical information obtained through the wellness program will be maintained separate from your personnel records, information stored electronically will be encrypted, and no information you provide as part of the wellness program will be used in making any employment decision. Appropriate precautions will be taken to avoid any data breach, and in the event a data breach occurs involving information you provide in connection with the wellness program, we will notify you immediately.

LEGAL NOTICES

You may not be discriminated against in employment because of the medical information you provide as part of participating in the wellness program, nor may you be subjected to retaliation if you choose not to participate.

If you have questions or concerns regarding this notice, or about protections against discrimination and retaliation, please contact Human Resources at (912) 576-5660.

Wellness Program Disclosure

Your health plan is committed to helping you achieve your best health. Rewards for participating in a wellness program are available to all employees. If you think you might be unable to meet a standard for a reward under this wellness program, you might qualify for an opportunity to earn the same reward by different means.

Contact us at Human Resources at (912) 576-5660 and we will work with you (and, if you wish, with your doctor) to find a wellness program with the same reward that is right for you in light of your health status.

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.

Your Information. Your Rights. Our Responsibilities. Recipients of the notice are encouraged to read the entire notice. Contact information for questions or complaints is available at the end of the notice.

Your Rights

You have the right to:

 Get a copy of your health and claims records

 Correct your health and claims records

 Request confidential communication

 Ask us to limit the information we share

 Get a list of those with whom we’ve shared your information

 Get a copy of this privacy notice

 Choose someone to act for you

 File a complaint if you believe your privacy rights have been violated

Your Choices

You have some choices in the way that we use and share information as we:

 Answer coverage questions from your family and friends

 Provide disaster relief

 Market our services and sell your information

Our Uses and Disclosures

We may use and share your information as we:

 Help manage the health care treatment you receive

 Run our organization

 Pay for your health services

 Administer your health plan

 Help with public health and safety issues

 Do research

 Comply with the law

 Respond to organ and tissue donation requests and work with a medical examiner or funeral director

LEGAL NOTICES

 Address workers’ compensation, law enforcement, and other government requests

 Respond to lawsuits and legal actions

Your Rights

When it comes to your health information, you have certain rights. This section explains your rights and some of our responsibilities to help you.

Get a copy of health and claims records

 You can ask to see or get a copy of your health and claims records and other health information we have about you. Ask us how to do this.

 We will provide a copy or a summary of your health and claims records, usually within 30 days of your request. We may charge a reasonable, cost-based fee.

Ask us to correct health and claims records

 You can ask us to correct your health and claims records if you think they are incorrect or incomplete. Ask us how to do this.

 We may say “no” to your request, but we’ll tell you why in writing, usually within 60 days.

Request confidential communications

 You can ask us to contact you in a specific way (for example, home or office phone) or to send mail to a different address.

 We will consider all reasonable requests, and must say “yes” if you tell us you would be in danger if we do not.

Ask us to limit what we use or share

 You can ask us not to use or share certain health information for treatment, payment, or our operations.

 We are not required to agree to your request.

Get a list of those with whom we’ve shared information

 You can ask for a list (accounting) of the times we’ve shared your health information for up to six years prior to the date you ask, who we shared it with, and why.

 We will include all the disclosures except for those about treatment, payment, and health care operations, and certain other disclosures (such as any you asked us to make). We’ll provide one accounting a year for free but will charge a reasonable, cost-based fee if you ask for another one within 12 months.

Get a copy of this privacy notice

You can ask for a paper copy of this notice at any time, even if you have agreed to receive the notice electronically. We will provide you with a paper copy promptly.

Choose someone to act for you

 If you have given someone medical power of attorney or if someone is your legal guardian, that person can exercise your rights and make choices about your health information.

 We will make sure the person has this authority and can act for you before we take any action.

File a complaint if you feel your rights are violated

 You can complain if you feel we have violated your rights by contacting us using the information at the end of this notice.

 You can file a complaint with the U.S. Department of Health and Human Services Office for Civil Rights by sending a letter to 200 Independence Avenue, S.W., Washington, D.C. 20201, calling 1-877-696-6775, or visiting www.hhs.gov/ocr/privacy/hipaa/complaints/.

 We will not retaliate against you for filing a complaint.

LEGAL NOTICES

Your Choices

For certain health information, you can tell us your choices about what we share. If you have a clear preference for how we share your information in the situations described below, talk to us. Tell us what you want us to do, and we will follow your instructions.

In these cases, you have both the right and choice to tell us to:

 Share information with your family, close friends, or others involved in payment for your care

 Share information in a disaster relief situation

If you are not able to tell us your preference, for example if you are unconscious, we may go ahead and share your information if we believe it is in your best interest. We may also share your information when needed to lessen a serious and imminent threat to health or safety.

 In these cases we never share your information unless you give us written permission:

Marketing purposes

Sale of your information

Our Uses and Disclosures

How do we typically use or share your health information?

We typically use or share your health information in the following ways.

Help manage the health care treatment you receive

We can use your health information and share it with professionals who are treating you.

Example: A doctor sends us information about your diagnosis and treatment plan so we can arrange additional services.

Pay for your health services

We can use and disclose your health information as we pay for your health services.

Example: We share information about you with your dental plan to coordinate payment for your dental work.

Administer your plan

We may disclose your health information to your health plan sponsor for plan administration.

Example: Your company contracts with us to provide a health plan, and we provide your company with certain statistics to explain the premiums we charge.

Run our organization

 We can use and disclose your information to run our organization and contact you when necessary.

 We are not allowed to use genetic information to decide whether we will give you coverage and the price of that coverage. This does not apply to long term care plans.

Example: We use health information about you to develop better services for you.

How else can we use or share your health information?

We are allowed or required to share your information in other ways – usually in ways that contribute to the public good, such as public health and research. We have to meet many conditions in the law before we can share your information for these purposes. For more information see: www.hhs.gov/ocr/privacy/hipaa/understanding/consumers/index.html

Help with public health and safety issues

We can share health information about you for certain situations such as:

 Preventing disease

 Helping with product recalls

 Reporting adverse reactions to medications

 Reporting suspected abuse, neglect, or domestic violence

LEGAL NOTICES

 Preventing or reducing a serious threat to anyone’s health or safety

Do research

We can use or share your information for health research.

Comply with the law

We will share information about you if state or federal laws require it, including with the Department of Health and Human Services if it wants to see that we’re complying with federal privacy law.

Respond to organ and tissue donation requests and work with a medical examiner or funeral director

 We can share health information about you with organ procurement organizations.

 We can share health information with a coroner, medical examiner, or funeral director when an individual dies.

Address workers’ compensation, law enforcement, and other government requests

We can use or share health information about you:

 For workers’ compensation claims

 For law enforcement purposes or with a law enforcement official

 With health oversight agencies for activities authorized by law

 For special government functions such as military, national security, and presidential protective services

Respond to lawsuits and legal actions

We can share health information about you in response to a court or administrative order, or in response to a subpoena.

Our Responsibilities

 We are required by law to maintain the privacy and security of your protected health information.

 We will let you know promptly if a breach occurs that may have compromised the privacy or security of your information.

 We must follow the duties and privacy practices described in this notice and give you a copy of it.

 We will not use or share your information other than as described here unless you tell us we can in writing. If you tell us we can, you may change your mind at any time. Let us know in writing if you change your mind. For more information see: www.hhs.gov/ocr/privacy/hipaa/understanding/consumers/noticepp.html.

Changes to the Terms of this Notice

We can change the terms of this notice, and the changes will apply to all information we have about you. The new notice will be available upon request, on our web site (if applicable), and we will mail a copy to you.

Other Instructions for Notice

 May 2023

 Camden County Board of Commissioners, Human Resources, Phone Number: (912) 576-5601

Your Rights and Protections Against Surprise Medical Bills

When you get emergency care or get treated by an out-of-network provider at an in-network hospital or ambulatory surgical center, you are protected from surprise billing or balance billing.

What is “balance billing” (sometimes called “surprise billing”)?

When you see a doctor or other health care provider, you may owe certain out-of-pocket costs, such as a copayment, coinsurance, and/or a deductible. You may have other costs or have to pay the entire bill if you see a provider or visit a health care facility that isn’t in your health plan’s network.

LEGAL NOTICES

“Out-of-network” describes providers and facilities that haven’t signed a contract with your health plan. Out-of-network providers may be permitted to bill you for the difference between what your plan agreed to pay and the full amount charged for a service. This is called “balance billing.” This amount is likely more than in-network costs for the same service and might not count toward your annual out-of-pocket limit.

“Surprise billing” is an unexpected balance bill. This can happen when you can’t control who is involved in your care— like when you have an emergency or when you schedule a visit at an in-network facility but are unexpectedly treated by an out-of-network provider.

You are protected from balance billing for:

Emergency services

If you have an emergency medical condition and get emergency services from an out-of-network provider or facility, the most the provider or facility may bill you is your plan’s in-network cost-sharing amount (such as copayments and coinsurance). You can’t be balance billed for these emergency services. This includes services you may get after you’re in stable condition, unless you give written consent and give up your protections not to be balanced billed for these poststabilization services.

Certain services at an in-network hospital or ambulatory surgical center

When you get services from an in-network hospital or ambulatory surgical center, certain providers there may be out-ofnetwork. In these cases, the most those providers may bill you is your plan’s in-network cost-sharing amount. This applies to emergency medicine, anesthesia, pathology, radiology, laboratory, neonatology, assistant surgeon, hospitalist, or intensivist services. These providers can’t balance bill you and may not ask you to give up your protections not to be balance billed. If you get other services at these in-network facilities, out-of-network providers can’t balance bill you, unless you give written consent and give up your protections.

You’re never required to give up your protections from balance billing. You also aren’t required to get care out-ofnetwork. You can choose a provider or facility in your plan’s network.

When balance billing isn’t allowed, you also have the following protections:

 You are only responsible for paying your share of the cost (like the copayments, coinsurance, and deductibles that you would pay if the provider or facility was in-network). Your health plan will pay out-of-network providers and facilities directly.

 Your health plan generally must:

o Cover emergency services without requiring you to get approval for services in advance (prior authorization).

o Cover emergency services by out-of-network providers.

o Base what you owe the provider or facility (cost-sharing) on what it would pay an in-network provider or facility and show that amount in your explanation of benefits.

o Count any amount you pay for emergency services or out-of-network services toward your deductible and out-of-pocket limit.

If you believe you’ve been wrongly billed, you may contact Camden County. Visit - the Centers for Medicare and Medicaid Services at CMS at www.cms.gov - for more information about your rights under federal law.

Contact Information

Questions regarding any of this information can be directed to:

Human Resources

200 East 4th Street, P.O. Box 99 Woodbine, Georgia United States 31569 (912) 576-5601

LEGAL NOTICES

New Health Insurance Marketplace Coverage Form Approved Options and Your Health Coverage

PART A: General Information

OMB No. 1210-0149

(expires 6-30-2023)

When key parts of the health care law take effect in 2014, there will be a new way to buy health insurance: the Health Insurance Marketplace. To assist you as you evaluate options for you and your family, this notice provides some basic information about the new Marketplace and employment based health coverage offered by your employer

What is the Health Insurance Marketplace?

The Marketplace is designed to help you find health insurance that meets your needs and fits your budget. The Marketplace offers "one-stop shopping" to find and compare private health insurance options. You may also be eligible for a new kind of tax credit that lowers your monthly premium right away. Open enrollment for health insurance coverage through the Marketplace begins in October 2013 for coverage starting as early as January 1, 2014.

Can I Save Money on my Health Insurance Premiums in the Marketplace?

You may qualify to save money and lower your monthly premium, but only if your employer does not offer coverage, or offers coverage that doesn't meet certain standards. The savings on your premium that you're eligible for depends on your household income.

Does Employer Health Coverage Affect Eligibility for Premium Savings through the Marketplace?

Yes. If you have an offer of health coverage from your employer that meets certain standards, you will not be eligible for a tax credit through the Marketplace and may wish to enroll in your employer's health plan. However, you may be eligible for a tax credit that lowers your monthly premium, or a reduction in certain cost-sharing if your employer does not offer coverage to you at all or does not offer coverage that meets certain standards. If the cost of a plan from your employer that would cover you (and not any other members of your family) is more than 9.5% of your household income for the year, or if the coverage your employer provides does not meet the "minimum value" standard set by the Affordable Care Act, you may be eligible for a tax credit.1

Note: If you purchase a health plan through the Marketplace instead of accepting health coverage offered by your employer, then you may lose the employer contribution (if any) to the employer-offered coverage. Also, this employer contribution -as well as your employee contribution to employer-offered coverage- is often excluded from income for Federal and State income tax purposes. Your payments for coverage through the Marketplace are made on an after-tax basis.

How Can I Get More Information?

For more information about your coverage offered by your employer, please check your summary plan description or contact Camden County.

The Marketplace can help you evaluate your coverage options, including your eligibility for coverage through the Marketplace and its cost. Please visit HealthCare.gov for more information, including an online application for health insurance coverage and contact information for a Health Insurance Marketplace in your area.

PART B: Information About Health Coverage Offered by Your Employer

This section contains information about any health coverage offered by your employer. If you decide to complete an application for coverage in the Marketplace, you will be asked to provide this information. This information is numbered to correspond to the Marketplace application.

Here is some basic information about health coverage offered by this employer:

•As your employer, we offer a health plan to:

 All employees. Eligible employees are: active, full-time employees working more than 30 hours per week, refer to SPD

Some employees. Eligible employees are:

•With respect to dependents:

 We do offer coverage. Eligible dependents are: legal spouse and child(ren) as listed in SPD

We do not offer coverage.

 If checked, this coverage meets the minimum value standard, and the cost of this coverage to you is intended to be affordable, based on employee wages.

** Even if your employer intends your coverage to be affordable, you may still be eligible for a premium discount through the Marketplace. The Marketplace will use your household income, along with other factors, to determine whether you may be eligible for a premium discount. If, for example, your wages vary from week to week (perhaps you are an hourly employee or you work on a commission basis), if you are newly employed mid-year, or if you have other income losses, you may still qualify for a premium discount.

If you decide to shop for coverage in the Marketplace, HealthCare.gov will guide you through the process. Here's the employer information you'll enter when you visit HealthCare.gov to find out if you can get a tax credit to lower your monthly premiums.

1 An employer-sponsored health plan meets the "minimum value standard" if the plan's share of the total allowed benefit costs covered by the plan is no less than 60 percent of such costs.

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CONFIDENTIALITY DISCLOSURE

These materials are produced by USI for the sole use of Camden County, prospective Camden County employees, and their representatives. Certain information contained in these materials are considered proprietary information created by USI and/or their licensed and appointed insurance carriers. Such information and any insurance designs furnished by USI are considered “Confidential Material.” Such information shall not be used in any way, directly or indirectly, detrimental to USI and Camden County and/or potential Camden County employees and any of their representatives will keep that information confidential.

IRS Circular 230 Disclosure: USI Insurance Services does not provide tax advice. Accordingly, any discussion of U.S. tax matters contained herein (including any attachments) is not intended or written to be used, and cannot be used, in connection with the promotion, marketing or recommendation by anyone unaffiliated USI Insurance Services of any of the matters addressed herein or for the purpose of avoiding U.S. tax-related penalties. Also, the information contained in this benefit summary should not be construed as medical or legal advice.

ABOUT THIS GUIDE

This benefit summary provides selected highlights of the Camden County employee benefits program. It is not a legal document and shall not be construed as a guarantee of benefits nor of continued employment at the Company. All benefit plans are governed by master policies, contracts and plan documents. Any discrepancies between any information provided through this summary and the actual terms of such policies, contracts and plan documents shall be governed by the terms of such policies, contracts and plan documents. Camden County reserves the right to amend, suspend or terminate any benefit plan, in whole or in part, at any time. The authority to make such changes rests with the Plan Administrator.