New Jersey Employee
Eligibility & Making Plan Changes
You have 30 days from your date of hire to enroll in benefits. You will not be able to make changes outside of this time until Open Enrollment or you experience a Qualifying Life Event.
What do I need to do?
Ᏼ Review this Benefits Guide
Ᏼ Think about anything that may affect how you use your benefits
Ᏼ Add your covered dependents if necessary
Ᏼ Add your beneficiary information
Make your benefit elections in ADP no later than 30 days from your date of hire.
Benefits Eligibility
You are considered benefits-eligible if you are a full-time or part-time employee, scheduled to work at least 30 hours per week.
For medical benefits, coverage will take effect on the 1st of the month following the date of hire. For all other benefits, coverage will take effect on the 1st of the month following 30 days after hire.
Under the VNA benefits program, eligible dependents generally include:
• Your legal (same-sex or opposite-sex) spouse or domestic partner.
• Dependent children until the end of the year in which they turn age 26.
NOTE: Dental is available up to the end of the year in which the dependent attains age 19, or age 23 (if a full time student). Child orthodontia is only available up to age 19.
If you separate employment from VNA, your insurance will continue through the end of the month in which the separation occurred.
Making Changes During the Plan Year — Qualifying Life Events
Unless you experience a Qualifying Life Event, you cannot make changes to your benefits until the next Open Enrollment period. Qualifying Life Events include:
• Marriage, divorce or legal separation
• Birth or adoption of a child
• Change in child’s dependent status
• Death of a spouse, child or other qualified dependent
• Change in employment status or a change in coverage under another employer-sponsored plan
You have 30 days to inform ADP MyLife Advisor of the life event and complete all required documentation.
To notify ADP MyLife Advisor of the life event, call 888363-9077 within 30 days of the event. If you do not notify MyLife Advisor within 30 days of the event, you will not be able to make a change and will be required to wait until the next open enrollment or another qualifying event, whichever comes first.
Medical Plan Overview
AdministeredbyUnitedHealthcare/UMR
VNA employees have a choice of three medical plan options through United Healthcare/UMR: the PPO plan, Surest, and the EPO/HRA plan. All three plans utilize the United Healthcare Choice Plus PPO Network.
PPO Plan
The PPO plan is available for employees who are looking for more comprehensive coverage. This plan gives you the option to use both in-network and out-of-network providers, however, you will save money if you choose to use in-network providers. If you choose to go out-ofnetwork, you will be responsible for any balance billing that may occur.
Surest Plan
Surest was designed to give members power over their health experience. Under this plan, you will only pay copays – there is no deductible, no coinsurance, and no costshifting. This plan provides the opportunity to significantly lower your out-of-pocket costs for each service you utilize.
How does this work? Members would use the app or website to see what they’ll owe in advance, compare options within the network, and then decide where to go for care.
EPO/HRA Plan
The EPO/HRA plan offers choice for those who prefer a more traditional type of plan with a set deductible and copays, as long as you stay in-network. This plan includes an HRA where VNA will fund some of your out-of-pocket costs for you.
What is an HRA? An HRA, or Health Reimbursement Account, is an account funded by VNA that employees can access to pay for qualified out-of-pocket expenses. If you enroll in single coverage, VNA will fund $500 in your HRA and if you enroll in family coverage, you’ll receive $1,000. The money funded into the account can only be used during the current plan year and will not roll over each year. If you were to leave VNA, you could not take this money with you.
Note: HRA funds will be prorated based on your date of hire.
Medical Plan Details
VNA offers three medical options so you can choose the plan that most fits the needs of you and your family. Think about the plan features that matter to you most – there is no “best” plan, just the “best plan for you”.
EPO/HRA
In-Network Benefits
Surest
Out-of-Network Benefits
EMBEDDED DEDUCTIBLE: The single deductible is embedded in the family deductible, so no one family member can contribute more than the
amount during the plan year. Once the member meets their single deductible, they will start paying copays and/or coinsurance until the member has reached their out-of-pocket maximum.
About the Health Reimbursement Account (HRA)
• This account is 100% funded by VNA Health Group!
• The money is tax-free.
• You can use these funds for your deductible, copays, and coinsurance.
• The HRA will be administered by CBIZ.
• VNA will fund $500 for single coverage and $1,000 for family coverage.
Prescription Benefits AdministeredbyExpressScripts
If you enroll in one of the medical plans, you are automatically enrolled in corresponding prescription drug coverage. The amount you pay for prescriptions is based on the type of drug, where you purchase your prescription and whether you get your medication filled at a retail pharmacy or through the mail order program, as outlined in the chart below.
1 Prescription deductible does not apply to Generics or Specialty Medications.
2 Eligible specialty medication fills are covered in full when you are enrolled in the SaveOn Copay Program. Medications must be on the SaveOn Drug List in order to be covered at 100%.
3 If a specialty drug is eligible for the SaveOn program and you do not enroll, you will pay 30% coinsurance.
Additional Rx Plan Resources
Mail Order Program
Save money and take advantage of convenient home delivery for medications you take on a regular basis. Order up to a 90-day supply of medications you use for conditions such as asthma, diabetes, heart condition, high cholesterol, hypertension, and birth control.
Register at www.express-scripts.com and download the Express Scripts Mobile App or contact Express Scripts at the number on your ID card to have your prescriptions filled through Mail Order.
In addition to the Mail Order program, we also offer 90day prescriptions to be filled at both Walgreens and CVS.
Specialty Medications
Specialty medications must be filled through Express Scripts and the SaveOn Program.
SaveOn
Members filling Specialty Rx for the first time will be asked to enroll in the SaveOn program. Members that enroll and have eligible specialty medications will receive their medications for a $0 copay. Your medication must be included on the SaveOn Drug List to be eligible for the $0 copay. For more information on eligible specialty drugs, call 800-683-1074
Pharmacy Benefits that Benefit You
Use the Check Coverage Tools on express-scripts.com to find the right pharmacy for you within your covered benefit plan.
Getting Started is Simple:
1. Register on the website or scan the QR code: www.express-scripts.com
2. Download the mobile app
3. Opt into text messages: Text JOIN to 69717
Galileo Telemedicine
What is Galileo?
VNA is excited to provide eligible members Galileo: your personalized digital medical practice at NO ADDITIONAL COST TO YOU!
Galileo is your partner for healthy living. Instantly access the wisdom of expert doctors—all through the convenience of a mobile app.
How do I get started?
Simply enroll and download the Galileo mobile app for instant access to 24/7 support on a full spectrum of conditions including: Asthma, dermatology, diabetes, behavioral health, birth control, cold & flu, headaches, hypertension and more.
Who is eligible?
All VNA Health Group employees, spouses, and dependents enrolled in the medical plan will be eligible to take advantage of this program.
Get started today with Galileo!
STEP 1: Download the Galileo Health Mobile App
• Scan the QR code provided or visit: Galileo.health/VNANJ
• Use Access Code: vnanj2023
STEP 2: Enroll
Create an account.
STEP 3: Choose a doctor
Download the app.
STEP 4: Visit
• Sign into the app and get care!
• Need Registration Help? Call 888-613-4254
Care Options and When to Use Them
While we recommend that you seek routine medical care from your primary care physician whenever possible, therearealternativesavailable.Servicesmayvary,soit’sagoodideatovisitthecareprovider’swebsite.Be sure to check that the facility is in-network by calling the number on the back of your medical ID card, or by visiting umr.com.
When you’re experiencing cold/flu like symptoms
When you need routine/ preventive care
When you have a sore throat or a sprain
When you have chest pain or difficulty breathing
Galleri Cancer Detection GRAIL
A proactive breakthrough in cancer screening
While doctors today screen individually for five specific cancers, nearly 70% of cancers have no recommended screening tests. The GRAIL multi-cancer early detection test aims to change that.
How does this work?
With one blood draw, the Galleri test screens for a unique “fingerprint” of 50+ cancers, empowering you with the information you need to pursue the appropriate care.
How long does it take?
The Galleri test takes the time of a single blood draw. The results are available in roughly 2 weeks.
Why is this test important?
Adults over age 50 are 13 times more likely to have cancer and there are only five recommended cancer screening tests. About 3 out of 4 new cancer cases and cancer-related deaths are due to cancers with no recommended screening tests. Galleri can help close this gap.
This new benefit is available to employees age 50 or older, and will be available AT NO COST TO YOU.
To learn more, go to www.galleri.com or scan the QR code.
Dental Plan
Horizon Blue Cross Blue Shield of NJ
The Dental plan is a PPO that offers coverage in- and out-of- network. It is to your advantage to utilize a network dentist in order to achieve the greatest cost savings. If you choose to go out-of-network, you will be responsible for any cost exceeding Horizon Blue Cross Blue Shield’s negotiated fees, plus any deductible and coinsurance associated with your procedure.
Services
Orthodontia Services (Dependent children to age 19)
About In- and Out-of-Network Providers
no deductible
• In-Network Providers: Provider is reimbursed based on contracted fees and cannot balance bill you.
• Out-of-Network Providers: Provider is reimbursed based on Reasonable and Customary standards and balance billing is possible.
Vision Plan
Finding a Vision Provider:
The vision plan offers coverage both in-network and out- of-network. It is to your advantage to utilize a network provider in order to achieve the greatest cost savings. If you go out-of-network, your benefit is based on a reimbursement schedule. Also, if you are considering Lasik surgery or other non- covered benefits, there are discounts available with some providers.
Once every 12 months Once every 12 months Once every 12 months Once every 24 months
Legal and ID Theft Benefits
MetLaw and InfoArmor
MetLaw Legal Plan
The MetLife Legal Plans provide you with access to experienced attorneys and reduces effort on your end. It’s a smart and simple way to get the legal help you need.
You’ll have all the help you’re looking for from an experienced service team, network of attorneys and variety of online resources.
Attorneys at MetLife Legal can help with getting married, buying or selling a home, dealing with identity theft, wills and estate planning, reviewing agreements related to nursing homes, and much more.
Voluntary Identity Theft, Financial and Privacy Protection
Enjoy peace of mind, financial reassurance and time saving expertise with InfoArmor’s comprehensive identity protection plan, administered by Allstate.
This plan can help you with:
• Identity and Credit Monitoring
• Credit Scores and Reports
• Threshold & Financial Transaction Monitoring
• Wallet Protection
• And more!
Flexible Spending Accounts (FSA)
FSAs provide you with an important tax advantage that can help you pay health care and dependent care expensesonapre-taxbasis.Byanticipatingyourfamily’shealthcareanddependentcarecostsforthenext plan year, you can lower your taxable income.
Healthcare FSA
The Healthcare FSA allows you to set aside pre-tax dollars via payroll deductions to pay for qualified healthcare expenses for you and your dependents. For 2025, the annual maximum amount you may contribute is $3,300 per calendar year.
VNA Health Group allows up to $660 of unused Healthcare FSA funds to carry over into the next plan year. Amounts over $660 will be forfeited.
The Healthcare FSA can be used for:
• Doctor office copays
• Non-cosmetic dental procedures (crowns, dentures, orthodontics)
• Prescription contact lenses, glasses and sunglasses
• LASIK eye surgery
Commuter Benefits
Commuter Benefits allow you to conveniently pay for eligible work-related transit and parking commuting costs with a debit card loaded with pre-tax and post-tax dollars deducted from your paycheck. Employees can spend $325 for commuter expenses tax-free.
Types of Accounts
There are two different types of accounts –Transit and Parking. You may participate in one or both accounts. The accounts are separate.
Per IRS regulations, you cannot use money in your Transit Account to pay for parking expenses, or vice versa. The IRS requires unused funds to be forfeited by the employee upon termination of employment.
Dependent Care FSA
The Dependent Care FSA lets you use pre-tax dollars toward qualified dependent care expenses. The annual maximum amount you may contribute is $5,000 (or $2,500 if married and filing separately) per calendar year. Any unused portion of your account balance at the end of the plan year is forfeited.
The Dependent Care FSA can be used for:
• The cost of child or adult dependent care
• The cost for an individual to provide care either in or out of your house
• Nursery schools and preschools (excluding kindergarten)
Use-It-or-Lose-It
Flexible Spending Accounts operate under a use-itor-lose-it rule, meaning that money not used by the end of the plan year does not rollover and must be forfeited, per IRS regulations.
Life and AD&D Insurance AdministeredbyUnum
Basic Life and AD&D Insurance
VNA provides all of its eligible employees Basic Life and Accidental Death & Dismemberment (AD&D) insurance at no cost to you.
LifeandDisabilityeligibilityandbenefitsaredependent onclass.Staffmemberswhoarepartofaunionshould refertotheirrespectivecollectivebargainingagreement orplancertificatefordetails.
Group Pension Life
In addition to Basic Life and AD&D insurance, VNA provides eligible employees with group pension life insurance in the amount of 1x annual earnings up to $200,000.
To be eligible for this, you must participate in the company’s 401(a) pension plan and work 15 or more hours per week.
Voluntary Whole Life with Long-Term Care Insurance
You can purchase Whole Life Insurance with a LongTerm Care Rider. This benefit offers protection beyond an individual’s working years, potentially for your lifetime. The Long-Term Care component may provide benefits if you are chronically ill and receiving qualified long term care services.
Voluntary Life and AD&D Insurance
You can purchase additional life coverage beyond what VNA provides.
• Voluntary Employee Life: Choose from $10,000 to $500,000 in $10,000 increments up to 5 times your earnings. Employee must be enrolled to enroll dependents.
The guaranteed issue limit is $250,000 with no evidence of insurability required.
• Optional Dependent Life for spouse: Get up to $250,000 of coverage in $5,000 increments, if eligible. Spouse coverage cannot exceed 100% of the coverage amount you purchase for yourself.
• Optional Dependent Life for children: Get up to $10,000 of coverage in $2,000 increments, if eligible. One policy covers all of your children until their 26th birthday. The maximum benefit for children live birth to 6 months is $250.
Reminders:
• Coverage requests over amounts not already approved by Unum must complete Evidence of Insurability (EOI).
• Once approved by Unum, payroll deductions will be updated accordingly.
• You must be enrolled in voluntary life coverage in order for your spouse, and/or eligible dependent children to enroll.
Spouse
Increments of $10,000, up to $200,000
Increments of $5,000, up to $50,000
Ages 15-50: $130,000
Ages 51-80: $60,000
Ages 15-50: $30,000 *
Ages 51-80: $15,000 *
Child Increments of $5,000, up to $25,000 $25,000
* Spouses are considered to have Conditional Guaranteed Issue because one qualifying question is always required
To enroll in the Voluntary Whole Life benefit, you must enroll on Employee Navigator at www.employeenavigator.com. When asked for a Company Identifier, use VNAHG. For enrollment support, call 877-700-8136, Monday thorugh Friday 8am – 8pm ET.
Disability, Leaves, & Paid Time Off
NJ Temporary Disability
NJ Temporary Disability is available through the state fund.
NJ Temporary Disability Insurance provides cash benefits to employees in New Jersey who are unable to work due to a physical or mental health condition or other disability unrelated to their work, including pregnancy/childbirth recovery and COVID-19.
NJ Temporary Disability Benefits
Eligibility
Elimination Period
Benefit
Maximum Benefit Period
As defined by the state of NJ
7 days
85% of your average weekly wage, up to a maximum weekly benefit of $1,081 in 2025
26 weeks
Employees must file claims directly with the State of New Jersey at www.myleavebenefits.nj.gov.
Long-Term Disability
Long-Term Disability insurance is offered to employees working 21 hours per week or more through Unum at no cost to you. The plan benefit is 60% of basic monthly earnings up to a maximum of $10,000 per month.
Basic earnings is the average of your gross monthly income for the year immediately prior to the onset of disability and excludes commissions, bonuses, overtime pay, shift differential pay, or any other earnings. The benefits begin after a 180-day waiting period.
You may not be eligible for benefits if you have received treatment for a condition within three months prior to your effective date under this policy until you have been covered under the policy for twelve months.
Leave/Paid Time Off
Eligible employees will be offered paid time off (vacation, sick time, paid holidays, etc.).
For details on what is available to you, please refer to VNA’s leave/paid time off policy or, for Union Employees, the Collective Bargaining Agreement.
Employee Assistance Program (EAP)
AdministeredbyUnum
VNA employees have access to the Employee Assistance Program (EAP) through Unum. This program gives employees access to Licensed Professional Counselors for help with personal, family, or work issues. Our EAP program is designed to help employees lead happier and more productive lives at home and at work.
You can receive assistance with personal, family, and work issues such as:
• Stress, depression, anxiety
• Relationship issues, divorce
• Anger, grief and loss
• Job stress, work conflicts
• Family and parenting problems
• Addiction, eating disorders, mental illness
The Licensed Professional Counselor will either address concerns during a few initial sessions, or refer employees to other appropriate counselors for long-term help.
Who is covered?
Unum’s EAP services are available to all eligible employees, their spouses or domestic partners, dependent children, parents and parents-in-law.
Employees can also reach out to Work/Life Specialists for help with balancing the demands of home, family and work. These specialists can answer questions and help find resources for various needs such as childcare services, eldercare services, financial services, and legal services.
Voluntary Benefits AdministeredbyUnum
Critical Illness Insurance
We know that everyone has different needs when coping with a critical illness. With Critical Illness insurance, you get a benefit paid directly to the covered person, unless otherwise assigned, if they are diagnosed with a covered critical illness, such as cancer, heart attack, or stroke.
This plan can help ease some of your financial worries so you can stay focused on your health. You choose how to spend or save your benefit. It can be used for expenses, such as:
• Paying for child care or help around the house
• Travel costs to see a specialist
• Medical treatment and doctor visits
• Copays and deductibles
• Prescription drug costs
Plan Features:
• Benefits are paid directly to you, unless you choose otherwise
• Coverage is available for you, your spouse, and dependent children
• You can take your coverage with you if you change jobs or retire (with certain stipulations)
• Fast claims payment (most claims are processed in about four days)
Accident Insurance
Accidents happen and they can affect more than just your physical health. With Accident Insurance, you get a benefit to help pay for costs associated with a covered accident or injury. You may utilize the payments as you best see fit. Accident Insurance covers:
• Initial & emergency care
• Hospitalization
Plan Features:
• Fractures & Dislocation
• Follow-up care
• Coverage is guaranteed-issue (which means you qualify for coverage without having to answer health questions)
• Benefits are paid directly to you (unless you choose otherwise)
• Coverage is available for you, your spouse, and your dependent children
• Coverage is portable (with certain stipulations). That means you can take it with you if you change jobs or retire
• Fast claims payment; most claims are processed in about four business days
Hospital Indemnity Insurance
A hospital stay can happen at any time, and it can be costly. Hospital Indemnity insurance helps you and your loved ones have additional financial protection.
With hospital indemnity insurance, a benefit is paid directly to the covered person, unless otherwise assigned, after a covered hospitalization resulting from a covered injury or illness.
It can be used for expenses such as:
• Copays
• Deductibles
• Coinsurance
• Unexpected costs
• Child care
• Follow-up services
• Help for the home
Retirement Plans
AdministeredbyEmpower
403(b) Plan
The VNA 403(b) plan, also called the Tax Deferred Annuity plan, is a retirement savings investment plan, where employees can make contributions from their paycheck. Employees are eligible from their date of hire, and participation is voluntary.
Employees can contribute up to $23,500 per year in 2025 (with an additional catch-up contribution of $7,500 if the employee is age 50 or older).
401(a) Plan
The VNA 401(a) plan, also called the Defined Contribution Pension Plan, is a retirement savings and investment plan where the VNA contributes for eligible employees.
Employees are eligible for this plan after accumulating two years in which they worked at least 1,000 hours in each of two years from date of hire. Once eligible, employees are automatically enrolled in the plan and receive a contribution equal to 4% of their pay. This contribution is 100% vested to the employee.
Employees can change and control how this money is invested.
Tips to Save Smart for Retirement
• Start NOW. Don’t wait. Time is critical.
• Start small, if necessary. Even small contributions can make a big difference given enough time and the right kind of investments.
• Use automatic deductions from your payroll or your checking account for deposit into mutual funds, your IRA or other investment vehicles.
• Save regularly. Make saving for retirement a habit.
• Be realistic about investment returns. Never assume that a year or two of high market returns (or market declines) will continue indefinitely.
• Roll over retirement account money if you change jobs.
• Don’t dip into retirement savings.
For investment advice and additional information on the VNA Retirement Plans, contact Conor Egan of Egan Lynch Financial Group at 732-223-4555. This is a free service to VNA Employees.
BenePortal Your online benefits resource
Your Benefits Information — All in One Place!
At VNA Health Group, employees have access to a fullrange of valuable employee benefit programs. With BenePortal, you and your dependents can review your current employee benefit plan options online, 24/7!
Use BenePortal to access benefit plan documents, insurance carrier contacts, forms, guides, links and other applicable benefit materials. BenePortal is mobileoptimized, making it easy to view your benefits on-thego. Simply bookmark the site in your phone’s browser or save it to your home screen for quick access.
BenePortal features include:
• Secure online access
• Direct links to benefits enrollment sites
• Plan summaries
• Wellness resources
• Carrier contacts
• Downloadable forms
• GoodRx
• Benefit Perks Discount Program
• And more! Go to www.myvnabenefits.org to access your benefits information today!
Benefits Member Advocacy Center
Your benefits advocates
Don’t get lost in a sea of benefits confusion! With just one call or click, the Benefits MAC can help guide the way!
The Benefits Member Advocacy Center (“Benefits MAC’), provided by Conner Strong & Buckelew, can help you and your covered family members navigate your benefits.
Contact the Benefits MAC to:
• Find answers to your benefits questions
• Search for participating network providers
• Clarify information received from a provider or your insurance company, such as a bill, claim, or explanation of benefits (EOB)
• Guide you through the enrollment process or how you can add or delete coverage for a dependent
• Rescue you from a benefits problem you’ve been working on
• Discover all that your benefits have to offer!
You can contact Benefits MAC in any of the following ways:
• Via phone: 888-363-9077, Monday through Friday, 8:30 am to 5:00 pm
• Via the web: www.connerstrong.com/memberadvocacy
• Via e-mail: cssteam@connerstrong.com
• Via fax: 856-685-2253
Member Advocates are available Monday through Friday, 8:30 am to 5:00 pm (Eastern Time). After hours, you will be able to leave a message with a live representative and receive a response by phone or email during business hours within 24 to 48 hours of your inquiry.
Glossary of Medical Terms
Balance Billing:
Balance billing, sometimes called surprised billing, is a medical bill from a healthcare provider billing a patient for the difference between the total cost of services being charged and the amount the insurance pays.
Brand/Preferred:
A drug that is sold by a drug company under a specific trademark/name; more costly than a generic drug.
Coinsurance:
The amount or percentage that you pay for certain covered health care services under your health plan. This is typically the amount paid after a deductible is met, and can vary based on the plan design.
Copayment:
A flat fee that you pay toward the cost of covered medical services.
Covered Expenses:
Health care expenses that are covered under your health plan.
Deductible:
A specific dollar amount you pay out of pocket before benefits are available through a health plan. Under some plans, the deductible is waived for certain services.
Dependent:
Your legal (same-sex or opposite-sex) spouse or domestic partner, or dependent children until the end of the year in which they turn age 26.
Embedded Deductible:
The single deductible is embedded in the family deductible, so no one family member can contribute more than the individual deductible during the plan year. Once the member meets their single deductible, they will start paying copays and/or coinsurance until they have reached their out-of-pocket maximum.
Exclusive Provider Organization (EPO):
A managed care plan where services are covered only if you go to doctors, specialists, or hospitals in the plan’s network (except in an emergency).
Flexible Spending Account (FSA):
An account that allows you to save tax-free dollars for qualified medical and/or dependent care expenses that are not reimbursed. You determine how much you want to contribute to the FSA at the beginning of the plan year. Most funds must be used by the end of the year, as there is only a limited carryover amount.
Generic:
A pharmaceutical drug that contains the same chemical substance as a brand name equivalent; more cost effective than brand drugs.
Health Reimbursement Arrangement (HRA):
An employer-owned medical savings account in which the company deposits pre-tax dollars for each of its covered employees. Employees can then use this account as reimbursement for qualified health care expenses.
In-network:
Health care received from your primary care physician or from a specialist within an outlined list of health care practitioners.
Inpatient:
A person who is treated as a registered patient in a hospital or other health care facility.
Glossary of Medical Terms
Maintenance Drug :
Prescription medications that are taken on a continuing basis; used to treat chronic or long-term health conditions such as high blood pressure, heart disease, asthma, and diabetes.
Medically Necessary (or medical necessity):
Services or supplies provided by a hospital, health care facility or physician that meet the following criteria: (1) are appropriate for the symptoms and diagnosis and/ or treatment of the condition, illness, disease or injury; (2) serve to provide diagnosis or direct care and/or treatment of the condition, illness, disease or injury; (3) are in accordance with standards of good medical practice; (4) are not primarily serving as convenience; and (5) are considered the most appropriate care available.
Medicare:
An insurance program administered by the federal government to provide health coverage to individuals aged 65 and older, or who have certain disabilities or illnesses.
Member:
You and those covered become members when you enroll in a health plan. This includes eligible employees, their dependents, COBRA beneficiaries and surviving spouses.
Out-of-network:
Health care you receive without a physician referral, or services received by a non-network service provider. Outof-network health care and plan payments are subject to deductibles and coinsurance.
Out-of-pocket Expense:
Amount that you must pay toward the cost of health care services. This includes deductibles, copayments and coinsurance.
Out-of-pocket Maximum (OOPM):
The highest out-of-pocket amount that you can be required to pay for covered services during a benefit period.
Preferred Provider Organization (PPO):
A health plan that offers both in-network and out-ofnetwork benefits. Members must choose one of the innetwork providers or facilities to receive the highest level of benefits.
Primary Care Physician (PCP):
A doctor that is selected to coordinate treatment under your health plan. This generally includes family practice physicians, general practitioners, internists, pediatricians, etc.
Specialty Drug:
High-cost prescription medications used to treat complex, chronic conditions such as cancer, rheumatoid arthritis, and multiple sclerosis.
Surest:
Surest is an employer-sponsored health plan offered by UnitedHealthcare. Surest has no deductibles or coinsurance, and members can see prices for services in advance.
Usual, Customary and Reasonable (UCR) Allowance:
The fee paid for covered services that is: (1) a similar amount to the fee charged from a health care provider to the majority of patients for the same procedure; (2) the customary fee paid to providers with similar training and expertise in a similar geographic area, and (3) reasonable in light of any unusual clinical circumstances
Legal Notices
Important Notice from VNA Health Group About Your Prescription Drug Coverage and Medicare
Please read this notice carefully and keep it where you can find it. This notice has information about your current prescription drug coverage with VNA and about your options under Medicare’s prescription drug coverage. This information can help you decide whether or not you want to join a Medicare drug plan. If you are considering joining, you should compare your current coverage, including which drugs are covered at what cost, with the coverage and costs of the plans offering Medicare prescription drug coverage in your area. Information about where you can get help to make decisions about your prescription drug coverage is at the end of this notice.
There are two important things you need to know about your current coverage and Medicare’s prescription drug coverage:
1. Medicare prescription drug coverage became available in 2006 to everyone with Medicare. You can get this coverage if you join a Medicare Prescription Drug Plan or join a Medicare Advantage Plan (like an HMO or PPO) that offers prescription drug coverage. All Medicare drug plans provide at least a standard level of coverage set by Medicare. Some plans may also offer more coverage for a higher monthly premium.
2. VNA has determined that the prescription drug coverage offered by the PPO, Surest, and HDHP plans are, on average for all plan participants, expected to pay out as much as standard Medicare prescription drug coverage pays and is therefore considered Creditable Coverage. Because your existing coverage is Creditable Coverage, you can keep this coverage and not pay a higher premium (a penalty) if you later decide to join a Medicare drug plan.
WHEN CAN YOU JOIN A MEDICARE
DRUG PLAN?
You can join a Medicare drug plan when you first become eligible for Medicare and each year from October 15th 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 VNA coverage will not be affected.
If you do decide to join a Medicare drug plan and drop your current VNA coverage, be aware that you and your dependents will not be able to get this coverage back without a qualifying life event.
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 VNA and don’t join a Medicare drug plan within 63 continuous days after your current coverage ends, you may pay a higher premium (a penalty) to join a Medicare drug plan later.
If you go 63 continuous days or longer without creditable prescription drug coverage, your monthly premium may go up by at least 1% of the Medicare base beneficiary premium per month for every month that you did not have that coverage. For example, if you go nineteen months without creditable coverage, your premium may consistently be at least 19% higher than the Medicare base beneficiary premium. You may have to pay this higher premium (a penalty) as long as you have Medicare prescription drug coverage. In addition, you may have to wait until the following October to join.
FOR MORE INFORMATION ABOUT THIS NOTICE OR YOUR CURRENT PRESCRIPTION DRUG COVERAGE…
Contact the person listed below 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 VNA changes. You also may request a copy of this notice at any time.
FOR MORE INFORMATION ABOUT YOUR OPTIONS UNDER MEDICARE PRESCRIPTION DRUG COVERAGE…
More detailed information about Medicare plans that offer prescription drug coverage is in the “Medicare & You” handbook. You’ll get a copy of the handbook in the mail every year from Medicare. You may also be contacted directly by Medicare drug plans.
For more information about Medicare prescription drug coverage:
• Visit www.medicare.gov
• Call your State Health Insurance Assistance Program (see the inside back cover of your copy of the “Medicare & You” handbook for their telephone number) for personalized help
• Call 1-800-MEDICARE (1-800-633-4227). TTY users should call 1-877-486-2048.
If you have limited income and resources, extra help paying for Medicare prescription drug coverage is available. For information about this extra help, visit Social Security on the web at www.socialsecurity.gov, or call them at 1-800-772-1213 (TTY 1-800-325-0778).
Remember: Keep this Creditable Coverage notice. If you decide to join one of the Medicare drug plans, you may be required to provide a copy of this notice when you join to show whether or not you have maintained creditable coverage and, therefore, whether or not you are required to pay a higher premium (a penalty).
Date: 9/9/2024
Name of Entity/Sender: VNA
Contact--Position/Office: Robert Liotto, Human Resources
Address: 3600 Route 66, Neptune, NJ 07753
Phone Number: 800-862-3330
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 July 31, 2024. Contact your State for more information on eligibility –
ALABAMA – 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: https://health.alaska.gov/dpa/Pages/default.aspx
ARKANSAS – Medicaid
Website: http://myarhipp.com/ Phone: 1-855-MyARHIPP (855-692-7447)
CALIFORNIA - MEDICAID
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 - Health First Colorado (Colorado’s Medicaid Program) & Child Health Plan Plus (CHP+) Health First Colorado Website: https://www.healthfirstcolorado.com/ Health First Colorado Member Contact Center: 1-800-221-3943/State Relay 711
CHP+: https://hcpf.colorado.gov/child-health-plan-plus CHP+ Customer Service: 1-800-359-1991/State Relay 711 Health Insurance Buy-In Program (HIBI): https://www.mycohibi.com/ HIBI Customer Service: 1-855-692-6442
FLORIDA – Medicaid
Website: https://www.flmedicaidtplrecovery.com/flmedicaidtplrecovery.com/hipp/index.html Phone: 1-877-357-3268
GEORGIA – Medicaid
GA HIPP Website: https://medicaid.georgia.gov/health-insurance-premium-payment-program-hipp Phone: 678-564-1162, Press 1
GA CHIPRA Website: https://medicaid.georgia.gov/programs/third-party-liability/childrens-health-insurance-program-reauthorization-act-2009-chipra Phone: 678-564-1162, Press 2
INDIANA – Medicaid
Health Insurance Premium Payment Program
All other Medicaid Website: https://www.in.gov/medicaid/ http://www.in.gov/fss/dfr/ Family and Social Services Administration Phone: 1-800-403-0864
Member Services Phone: 1-800-457-4584
IOWA – Medicaid and CHIP (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-to-z/hipp HIPP Phone: 1-888-346-9562
Legal Notices
KANSAS – Medicaid
Website: https://www.kancare.ks.gov/
Phone: 1-800-792-4884
HIPP Phone: 1-800-967-4660
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://kynect.ky.gov
Phone: 1-877-524-4718
Kentucky Medicaid Website: https://chfs.ky.gov/agencies/dms
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)
MAINE – Medicaid
Enrollment Website: www.mymaineconnection.gob/benefits/s/?language=en_US
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
MASSACHUSETTS – Medicaid and CHIP
Website: https://www.mass.gov/masshealth/pa Phone: 1-800-862-4840 TTY: 711
Email: masspremassistance@accenture.com
MINNESOTA – Medicaid
Website: https://mn.gov/dhs/health-care-coverage/ Phone: 1-800-657-3672
MISSOURI – Medicaid
Website: http://www.dss.mo.gov/mhd/participants/pages/hipp.htm Phone: 1-573-751-2005
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: 855-632-7633
Lincoln: 402-473-7000 Omaha: 402-495-1178
NEVADA – Medicaid
Medicaid Website: http://dhcfp.nv.gov Medicaid Phone: 1-800-992-0900
NEW HAMPSHIRE – Medicaid
Website: https://www.dhhs.nh.gov/programs-services/medicaid/health-insurance-premium-program Phone: 603-271-5218
Toll free number for the HIPP program: 1-800-852-3345, ext 15218
Email: DHHS.ThirdPartyLiabi@dhhs.nh.gov
NEW JERSEY – Medicaid and CHIP Medicaid Website: http://www.state.nj.us/humanservices/ dmahs/clients/medicaid/ Phone: 800-356-1561
CHIP Premium Assistance Phone: 609-631-2392
CHIP Website: http://www.njfamilycare.org/index.html CHIP Phone: 1-800-701-0710 (TTY: 711)
NEW YORK – Medicaid
Website: https://www.health.ny.gov/health_care/medicaid/ Phone: 1-800-541-2831
NORTH CAROLINA – Medicaid
Website: https://medicaid.ncdhhs.gov/ Phone: 919-855-4100
NORTH DAKOTA – Medicaid
Website: https://www.hhs.nd.gov/healthcare Phone: 1-844-854-4825
Legal Notices
OKLAHOMA – Medicaid and CHIP
Website: http://www.insureoklahoma.org
Phone: 1-888-365-3742
OREGON – Medicaid and CHIP
Website: http://healthcare.oregon.gov/Pages/index.aspx Phone: 1-800-699-9075
PENNSYLVANIA – Medicaid and CHIP
Website: https://www.pa.gov/en/services/dhs/apply-for-medicaid-health-insurance-premium-payment-program-hipp.html Phone: 1-800-692-7462
CHIP Website: https://www.pa.gov/en/agencies/dhs/resources/chip.html
CHIP Phone: 1-800-986-KIDS (5437)
RHODE ISLAND – Medicaid and CHIP
Website: http://www.eohhs.ri.gov/ Phone: 1-855-697-4347, or 401-462-0311 (Direct RIte Share Line)
SOUTH CAROLINA - Medicaid
Website: https://www.scdhhs.gov Phone: 1-888-549-0820
SOUTH DAKOTA - Medicaid Website: http://dss.sd.gov Phone: 1-888-828-0059
TEXAS - Medicaid Website: https://www.hhs.texas.gov/services/financial/health-insurance-premium-payment-hipp-program Phone: 1-800-440-0493
UTAH – Medicaid and CHIP Utah’s Premium Partnership for Health Insurance (UPP)
Website: https://medicaid.utah.gov/upp/ Email: upp@utah.gov Phone: 1-888-222-2542
Adult Expansion Website: https://medicaid.utah.gov/expansion/ Utah Medicaid Buyout Program Website: https://medicaid.utah.gov/buyout-program/ CHIP Website: https://chip.utah.gov/
VERMONT– Medicaid
Website: https://dvha.vermont.gov/members/medicaid/hipp-program Phone: 1-800-562-3022
VIRGINIA – Medicaid and CHIP
Website: https://coverva.dmas.virginia.gov/learn/premium-assistance/famis-select https://coverva.dmas.virginia.gov/learn/premium-assistance/health-insurance-premium-payment-hipp-programs Phone: 1-800-432-5924
WASHINGTON – Medicaid
Website: https://www.hca.wa.gov/ Phone: 1-800-562-3022
WEST VIRGINIA – Medicaid and CHIP
Website: http://mywvhipp.com/ and https://dhhr.wv.gov/bms/ Medicaid Phone: 304-558-1700 CHIP Toll-free phone: 1-855-MyWVHIPP (1-855-699-8447)
WISCONSIN – Medicaid and CHIP
Website: https://www.dhs.wisconsin.gov/badgercareplus/p-10095.htm Phone: 1-800-362-3002
WYOMING – Medicaid
Website: https://health.wyo.gov/healthcarefin/medicaid/programs-and-eligibility/ Phone: 800-251-1269
To see if any other states have added a premium assistance program since July 31, 2024, or for more information on special enrollment rights, contact either:
U.S. Department of Labor
Employee Benefits Security Administration
www.dol.gov/agencies/ebsa 1-866-444-EBSA (3272)
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
Legal Notices
Initial COBRA Notice
Introduction
You’re getting this notice because you recently gained coverage under a group health plan (the Plan). This notice has important information about your right to COBRA continuation coverage, which is a temporary extension of coverage under the Plan. This notice explains COBRA continuation coverage, when it may become available to you and your family, and what you need to do to protect your right to get it. When you become eligible for COBRA, you may also become eligible for other coverage options that may cost less than COBRA continuation coverage.
The right to COBRA continuation coverage was created by a federal law, the Consolidated Omnibus Budget Reconciliation Act of 1985 (COBRA). COBRA continuation coverage can become available to you and other members of your family when group health coverage would otherwise end. For more information about your rights and obligations under the Plan and under federal law, you should review the Plan’s Summary Plan Description or contact the Plan Administrator.
You may have other options available to you when you lose group health coverage. For example, you may be eligible to buy an individual plan through the Health Insurance Marketplace. By enrolling in coverage through the Marketplace, you may qualify for lower costs on your monthly premiums and lower out-of- pocket costs. Additionally, you may qualify for a 30-day special enrollment period for another group health plan for which you are eligible (such as a spouse’s plan), even if that plan generally doesn’t accept late enrollees.
Second qualifying event extension of 18-month period of continuation coverage.
If your family experiences another qualifying event during the 18 months of COBRA continuation coverage, the spouse and dependent children in your family can get up to 18 additional months of COBRA continuation coverage, for a maximum of 36 months, if the Plan is properly notified about the second qualifying event. This extension may be available to the spouse and any dependent children getting COBRA continuation coverage if the employee or former employee dies; becomes entitled to Medicare benefits (under Part A, Part B, or both); gets divorced or legally separated; or if the dependent child stops being eligible under the Plan as a dependent child. This extension is only available if the second qualifying event would have caused the spouse or dependent child to lose coverage under the Plan had the first qualifying event not occurred.
Are there other coverage options besides COBRA Continuation Coverage?
Yes. Instead of enrolling in COBRA continuation coverage, there may be other coverage options for you and your family through the Health Insurance Marketplace, Medicaid, or other group health plan coverage options (such as a spouse’s plan) through what is called a “special enrollment period.” Some of these options may cost less than COBRA continuation coverage. You can learn more about many of these options at www.healthcare.gov.
If you have questions
Questions concerning your Plan or your COBRA continuation coverage rights should be addressed to the contact or contacts identified below. For more information about your rights under the Employee Retirement Income Security Act (ERISA), including COBRA, the Patient Protection and Affordable Care Act, and other laws affecting group health plans, contact the nearest Regional or District Office of the
U.S. Department of Labor’s Employee Benefits Security Administration (EBSA) in your area or visit www.dol.gov/ ebsa. (Addresses and phone numbers of Regional and District EBSA Offices are available through EBSA’s website.) For more information about the Marketplace, visit www.healthcare.gov.
Keep your plan informed of address changes
To protect your family’s rights, let the Plan Administrator know about any changes in the addresses of family members. You should also keep a copy, for your records, of any notices you send to the Plan Administrator.
Paperwork Reduction Act Statement
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 num- ber. The Department notes that a Federal agency cannot conduct or sponsor a collection of information unless it is ap- proved 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. Al- so, notwithstanding any other provisions of law, no person shall be subject to penalty for failing to comply with a collec- tion 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, Employ- ee 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)
Legal Notices
Women’s Health And Cancer Rights Act Of 1998
If you have had, or are going to have, a mastectomy, you may be entitled to certain benefits under the Women’s Health and Cancer Rights Act of 1998 (WHCRA). For individuals receiving mastectomy-related benefits, coverage will be provided in a manner determined in consultation with the attending physician and the patient, for:
• All stages of reconstruction of the breast on which the mastectomy was performed.
• Surgery and reconstruction of the other breast to produce a symmetrical appearance.
• Prostheses.
• Treatment of physical complications at all stages of the mastectomy, including lymphedemas.
These benefits will be provided subject to the same deductibles and coinsurance applicable to other medical and surgical benefits provided under this plan. If you would like more information on WHCRA benefits, call your Plan Administrator at (732) 747-1204.
Special Enrollment Notice
During the open enrollment period, eligible employees are given the opportunity to enroll themselves and dependents into our group health plans.
If you elect to decline coverage because you are covered under an individual health plan or a group health plan through your parent’s or spouse’s employer, you may be able to enroll yourself and your dependents in this plan if you and/or your dependents lose eligibility for that other coverage. You must request enrollment within 30 days after the other coverage ends. In addition, if you have a new dependent as a result of marriage, birth, adoption or placement for adoption, you may enroll any new dependent within 30 days of the event.
If you or your dependents become ineligible for Medicaid or CHIP, you may be able to enroll yourself and your dependents in the plan. You must request enrollment within 60 days.
If you or your dependents become eligible for premium assistance from Medicaid or CHIP, you may be able to enroll yourself and your dependents in the plan. You must request enrollment within 60 days.
If you request a change within the applicable timeframe, coverage will be effective the date of birth, adoption or placement for adoption. For a new dependent as a result of marriage, coverage will be effective the first of the month following your request for enrollment.
To request special enrollment or obtain more information, contact Human Resources.
This notice is a summary. For a full description of all of VNA Health Group’s benefit plans, please refer to the Summary Plan Descriptions.
Protections From Disclosure Of Medical Information
We are required by law to maintain the privacy and security of your personally identifiable health information. Although VNA Health Group may use aggregate information it collects to design a program based on identified health risks in the workplace, the health plan will never disclose any of your personal health 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 ser- vices as part of the wellness program will abide by the same confidentiality requirements. The only individuals who will receive your personally identifiable health information are health professionals 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.
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 Fehmi Malik at 732224-6839 .
Legal Notices
Notice Of Material Change (Also Material Reduction In Benefits)
This open enrollment communication addresses information on changes coming for the new year, and as such this communication constitutes a “Summary of Material Modification” or SMM to the Summary Plan Description (SPD) for the Plan, thereby modifying the information previously presented in the SPD with respect to the Plan. Please keep a copy of this SMM with the SPD previously provided to you.
Fixed Indemnity Insurance Notice
IMPORTANT: This is a fixed indemnity policy, NOT health insurance
This fixed indemnity policy may pay you a limited dollar amount if you’re sick or hospitalized. You’re still responsible for paying the cost of your care.
• The payment you get isn’t based on the size of your medical bill.
• There might be a limit on how much this policy will pay each year.
• This policy isn’t a substitute for comprehensive health insurance.
• Since this policy isn’t health insurance, it doesn’t have to include most federal consumer protections that apply to health insurance.
Looking for comprehensive health insurance?
• Visit HealthCare.gov or call 1-800-318-2596 (TTY: 1-855-889-4325) to find health coverage options.
• To find out if you can get health insurance through your job, or a family member’s job, contact the employer.
Questions about this policy?
• For questions or complaints about this policy, contact your state Department of Insurance. Find their number on the National Association of Insurance Commissioners’ website (naic.org) under “Insurance Departments.”
• If you have this policy through your job, or a family member’s job, contact the employer.
Insurance Marketplace Notice
Even if you are offered health coverage through your employment, you may have other coverage options through the Health Insurance Marketplace (“Marketplace”). To assist you as you evaluate options for you and your family, this notice provides some basic information about the Health Insurance Marketplace and health coverage offered through your employment.
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 in your geographic area.
Can I Save Money on my Health Insurance Premiums in the Marketplace?
You may qualify to save money and lower your monthly premium and other out-of-pocket costs, but only if your employer does not offer coverage, or offers coverage that is not considered affordable for you and doesn’t meet certain minimum value standards (discussed below). The savings that you’re eligible for depends on your household income. You may also be eligible for a tax credit that lowers your costs.
Does Employment-Based Health Coverage Affect Eligibility for Premium Savings through the Marketplace?
Yes. If you have an offer of health coverage from your employer that is considered affordable for you and meets certain minimum value standards, you will not be eligible for a tax credit, or advance payment of the tax credit, for your Marketplace coverage and may wish to enroll in your employment-based health plan. However, you may be eligible for a tax credit, and advance payments of the 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 is considered affordable for you or meet minimum value standards. If your share of the premium cost of all plans offered to you through your employment is more than 9.12% of your annual household income, or if the coverage through your employment does not meet the “minimum value” standard set by the Affordable Care Act, you may be eligible for a tax credit, and advance payment of the credit, if you do not enroll in the employment-based health coverage. For family members of the employee, coverage is considered affordable if the employee’s cost of premiums for the lowest-cost plan that would cover all family members does not exceed 9.12% of the employee’s household income. 1 2
Note: If you purchase a health plan through the Marketplace instead of accepting health coverage offered through your employment, then you may lose access to whatever the employer contributes to the employment-based coverage. Also, this employer contribution -as well as your employee contribution to employment-based coverageis generally excluded from income for federal and state income tax purposes. Your payments for coverage through the Marketplace are made on an after-tax basis. In addition, note that if the health coverage offered through your employment does not meet the affordability or minimum value standards, but you accept that coverage anyway, you will not be eligible for a tax credit. You should consider all of these factors in determining whether to purchase a health plan through the Marketplace.
When Can I Enroll in Health Insurance Coverage through the Marketplace?
You can enroll in a Marketplace health insurance plan during the annual Marketplace Open Enrollment Period. Open Enrollment varies by state but generally starts November 1 and continues through at least December 15.
Outside the annual Open Enrollment Period, you can sign up for health insurance if you qualify for a Special Enrollment Period. In general, you qualify for a Special Enrollment Period if you’ve had certain qualifying life events, such as getting married, having a baby, adopting a child, or losing eligibility for other health coverage. Depending on your Special Enrollment Period type, you may have 60 days before or 60 days following the qualifying life event to enroll in a Marketplace plan.
There is also a Marketplace Special Enrollment Period for individuals and their families who lose eligibility for Medicaid or Children’s Health Insurance Program (CHIP) coverage on or after March 31, 2023, through July 31, 2024. Since the onset of the nationwide COVID-19 public health emergency, state Medicaid and CHIP agencies generally have not terminated the enrollment of any Medicaid or CHIP beneficiary who was enrolled on or after March 18, 2020, through March 31, 2023. As state Medicaid and CHIP agencies resume regular eligibility and enrollment practices, many individuals may no longer be eligible for Medicaid or CHIP coverage starting as early as March 31, 2023. The U.S. Department of Health and Human Services is offering a temporary Marketplace Special Enrollment period to allow these individuals to enroll in Marketplace coverage.
Marketplace-eligible individuals who live in states served by HealthCare.gov and either- submit a new application or update an existing application on HealthCare.gov between March 31, 2023 and July 31, 2024, and attest to a termination date of Medicaid or CHIP coverage within the same time period, are eligible for a 60-day Special Enrollment Period. That means that if you lose Medicaid or CHIP coverage between March 31, 2023, and July 31, 2024, you may be able to enroll in Marketplace coverage within 60 days of when you lost Medicaid or CHIP coverage. In addition, if you or your family members are enrolled in Medicaid or CHIP coverage, it is important to make sure that your contact information is up to date to make sure you get any information about changes to your eligibility. To learn more, visit HealthCare.gov or call the Marketplace Call Center at 1-800-318-2596. TTY users can call 1-855-889-4325.
What about Alternatives to Marketplace Health Insurance Coverage?
If you or your family are eligible for coverage in an employment-based health plan (such as an employer-sponsored health plan), you or your family may also be eligible for a Special Enrollment Period to enroll in that health plan in certain circumstances, including if you or your dependents were enrolled in Medicaid or CHIP coverage and lost that coverage. Generally, you have 60 days after the loss of Medicaid or CHIP coverage to enroll in an employment-based health plan, but if you and your family lost eligibility for Medicaid or CHIP coverage between March 31, 2023 and July 10, 2023, you can request this special enrollment in the employment-based health plan through September 8, 2023. Confirm the deadline with your employer or your employment-based health plan.
Alternatively, you can enroll in Medicaid or CHIP coverage at any time by filling out an application through the Marketplace or applying directly through your state Medicaid agency. Visit https://www.healthcare.gov/medicaid-chip/getting-medicaid-chip/ for more details.
How Can I Get More Information?
For more information about your coverage offered through your employment, please check your health plan’s summary plan description or contact the person listed below.
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.
1 Indexed annually; see https://www.irs.gov/pub/irs-drop/rp-22-34.pdf for 2023.
2 An employer-sponsored or other employment-based 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. For purposes of eligibility for the premium tax credit, to meet the “minimum value standard,” the health plan must also provide substantial coverage of both inpatient hospital services and physician services.
Insurance Marketplace Notice (continued)
3. Employer Name Visiting Nurse Association Health Group, Inc
5. Employer Address 3600 NJ-66
4. Employer Identification Number (EIN) 22-250029
6. Employer Phone Number 732-747-1204
7. City Neptune Township 8. State NJ 9. ZIP Code 07733
10. Who can we contact about employee health coverage at this job? Fehmi Malik
11. Phone Number (if different from above) 732-224-6839
12. Email Address Fehmi.Malik@vnahg.org
