At Asher’s Chocolates, we are committed to providing you and your eligible family members with an affordable benefits package that is comprehensive, while also being flexible enough to suit your needs.
Open Enrollment is your annual opportunity to make changes to your benefits. This guide is intended to provide you with the information you need to choose your 2025 benefits, including details about your benefits options and the actions you need to take during this Enrollment period. It also outlines additional sources of information to help you make your enrollment choices.
Please read all the open enrollment communications, study your options, and take advantage of the resources available to you. Elections you make during open enrollment will become effective on June 1, 2025. All elections you submit will be final and cannot be changed unless you experience a qualifying life event, as explained on page 3.
If you have questions about your 2025 benefits or the enrollment process, contact Amy Prior in Human Resources.
2025 OPEN ENROLLMENT INFORMATION
OPEN ENROLLMENT IS:
May 5 – 16, 2025
IMPORTANT:
Passive Open Enrollment
This year’s Open Enrollment will be PASSIVE. Passive enrollment means your current coverage will remain in place and roll-over into the new plan year, unless you want to make changes to your elections and/or covered dependents.
Benefit elections are effective beginning June 1, 2025.
Who is eligible to enroll?
If you’re a full-time employee at Asher’s Chocolates, you’re eligible to enroll in the benefits outlined in this guide. Full-time employees are those who work 30 or more hours per week. In addition, the following family members are eligible for medical, dental and vision coverage:
Legally-married spouse
Your same- or opposite-sex domestic partner
Your child(ren) up to age 26
Making plan changes
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
NOTE: You must notify Human Resources within 30 days of experiencing a Qualifying Life Event.
New for 2025:
All employees will be receiving new ID cards. Current ID cards will no longer work after May 31, 2025.
TIP: During this open enrollment period, review your covered dependents and make sure your beneficiary information is up-to-date!
About your New IBX ID CARDS
Important: Use your new member ID Card
Asher’s Independence Blue Cross (IBX) coverage is entering a new plan year, so you will receive a new member ID card. And this year, your member ID number is new, too!
New member ID numbers for you and your family members
When you receive your card, it will display your new member ID number. If you have covered family members, you will see that their cards each have new — and different — numbers, as well. The numbers all have the same first 8 digits, then the last two are based on their relation to you, as shown here:
Self/Subscriber: 1234567800
Spouse: 1234567801
Dependent: 1234567802
You must present the new card(s) when you visit providers or when filling prescriptions
You will need to present the new card(s) the first time you visit any and all doctors and specialists, or fill a prescription; basically, whenever you use it for the first time in any of these situations. If you don’t, the claim will not be processed, and you will be required to file an appeal to have the service covered.
Accessing your ID Cards DIGITALLY
DID YOU KNOW you have two ways to access your Independence Blue Cross (IBX) member ID card(s) digitally? This may be helpful if you don’t have your physical card on hand — for example if you left it at home, lost it, or need to fax or email it to a health care provider.
1. Online at ibx.com
When you log in at ibx.com, you’ll see your personalized Quick Actions page, where you can access a direct link to your ID Card (orange box). You may also skip to the Dashboard page and click on View ID Cards. Click on the image of your ID card to view a digital version of your card.
Select Print to print the card.
Select Download Images to save a PDF of your card.
Select Email to email a copy of the card or Fax to fax a copy of the card.
Select Order by Mail to order a replacement card.
Want to better understand what is on your ID card? Click on How to Read My ID Card to see what information is on your card.
2. On your Smartphone
Download the IBX mobile app on your smartphone. When you log in, use the same login information as you use for ibx.com so you can access a direct link to your member ID card (orange box).
Use the drop-down menu to view the ID cards of any dependents on your plan.
Select Order by Mail to order a replacement.
Select Share to see options such as Print, Download Images, Email, and Text.
If you have an iPhone, select Add to Apple Wallet to make your card easily accessible.
Having your ID card handy is important
You may need your member ID card at any time for doctor visits, at the pharmacy, and to contact our Customer Service team. So, it’s good to know you have options to access it wherever you are!
Independence Blue Cross MEDICAL BENEFITS
Asher’s Chocolates offers the following medical plan option, administered by Independence Blue Cross. The medical plan includes prescription drug benefits, outlined on page 6. To locate participating providers, visit www.ibx.com.
About your Independence Blue Cross MEDICAL PLAN
About the PPO plan
The Personal Choice Preferred Provider Organization (PPO) plans give you freedom of choice by allowing you to select your own doctors and hospitals.
You maximize your coverage by accessing care through Personal Choice's network of hospitals, doctors, and specialists, or by accessing care through preferred providers who participate in the BlueCard PPO program. If you access care from a provider who does not participate in our network, you will have higher out-of-pocket costs and may have to submit your claim for reimbursement.
Calendar Year Benefits
The medical plan is a calendar year benefit — meaning that the deductible and out-of-pocket maximum are tracked on a calendar year basis. The calendar year begins on January 1st and end on December 31st. Deductible and out-of-pocket maximum amounts reset every January 1st.
Independence Blue Cross PRESCRIPTION BENEFITS
If you enroll in the Independence Blue Cross medical plan, you are automatically enrolled in the prescription plan outlined below.
GoodRX Discount Program
GoodRx is a prescription drug price comparison tool which allows you to simply and easily search for retail pharmacies that offer the lowest price for specific medications.
Use GoodRx to compare drug prices at local and mail-order pharmacies and discover free coupons and savings tips. Find huge savings on drugs not covered by your insurance plan –you may even find savings versus your typical copayment!
Start saving today by downloading the GoodRx mobile app or visiting www.goodrx.com
Telemedicine
When you’re not feeling well, you don’t want to wait to get care. Good news — with virtual care from Teladoc Health (Teladoc), you don’t have to!
Teladoc General Medical
Teladoc is a leader in whole-person virtual care. With Teladoc General Medical, you get 24/7 access to low-cost, high-quality virtual health care for common health concerns like cough, sore throat, fever, rashes, allergies, asthma, ear infections, pink eye, nausea, and more. Using Teladoc General Medical is quick and convenient.
Features include:
Access to one of the largest virtual care networks in the country, with board-certified doctors who are available by phone, web, or the Teladoc award-winning mobile app
Interpreters who know your language, including American Sign Language (ASL)
Prescription requests sent to your pharmacy of choice
A caregiving option, which allows a babysitter to schedule a visit on your behalf if your child gets sick while in their care
Teladoc Telebehavioral Health
Teladoc Mental Health Care provides convenient, confidential access to trusted professionals who can help you manage stress, anxiety, grief, depression, and more. Using Teladoc Mental Health Care is easy. You can:
Find a board-certified psychiatrist, psychologist, or therapist that meets your needs
Schedule a virtual visit by phone or video at a time that’s best for you to connect
Get ongoing support from your mental health care provider
Why wait for the care you need? Contact Teladoc and feel better now!
Why wait for the care you need? Contact MDLIVE and feel better now!
Visit: www.teladochealth.com
Visit: www.mdlive.com/ibx
Call: 800.835.2362
Call: 877.764.6605
Download the Teladoc mobile app
Download the MDLIVE mobile app
United Concordia DENTAL BENEFITS
Asher’s Chocolates offers the following dental plan option to Lewistown employees, administered by United Concordia. The plan includes 100% coverage for preventive services such as routine dental exams, cleanings and X-rays.
Class I: Preventive & Diagnostic Services
Exams, Cleanings & Fluoride Treatments, Bitewing X-rays, All other X-rays, Sealants, Palliative Treatment
Class II: Basic Services
Space Maintainers, Basic Restorative Fillings, Simple Extractions, Repairs of Crowns, Inlays, Onlays, Bridges, & Dentures, Endodontics, Non Surgical Periodontics, Surgical Periodontics, Complex Oral Surgery, General Anesthesia
* Does not apply to Class1: Preventive & Diagnostic Services & Orthodontics
** UCCI creates out-of-network charges utilizing FAIR HEALTH data supplemented with our charge data as appropriate. We then calculate the out-of-network charge at the 80th Percentile of such data. Non-network dentists may bill the member the difference between the allowance and their fee.
About the PPO Plan
The preferred provider (PPO) plan offers the convenience and flexibility of visiting any licensed dentist, anywhere. Covered services are paid based on UCCI’s Maximum Allowable Charges (MAC)— if, for example, fillings are covered at 80%, you pay the remaining 20%. Get the most plan value by choosing a United Concordia PPO dentist. PPO network dentists complete claim forms and will submit pre-determinations for you. New for 2025, the PPO plan covers 3 cleanings per year.
PPO (Flex Plan)
United Concordia Dental ONLINE TOOLS
MyDentalBenefits: the hub for all your dental insurance info
With MyDentalBenefits, you can find all your coverage info in one place online. You’ll see a quick overview right when you log in. Then just click to get details on everything from covered services to claims.
MyDentalBenefits makes it easy to:
See what your plan covers and what it pays
Estimate your costs before getting dental care
Check the status of dental claims
Find in-network dentists near you
Chat live or upgrade to a phone call with customer service
Print extra ID cards
Take an online oral health assessment
Opt-in to get paperless statements
Chat live with customer service
To create an account:
1. Go to www.unitedconcordia.com/getMDB
2. Enter your Member ID number and Birthdate (You can also use the policyholder’s SSN instead of the ID number)
3. Create a username and password to log in
Once your account is created, you can also download the United Concordia Dental app and sign in with your username and password.
College Tuition Benefit
Your UCCI coverage also includes access to the College Tuition Benefit –College Savings Program. With this program, you will receive:
Earn Tuition Rewards points redeemable for tuition discounts
2,000 points at sign up, then 2,000 points per year
Each child enrolled receives a onetime bonus of 500 Tuition Rewards points
Using your Tuition Rewards
One Tuition Rewards point = $1 reduction in full tuition. Use Tuition Rewards points at participating private colleges and universities. Use Tuition Rewards points at participating private colleges and universities.
United Concordia SMILE FOR HEALTH PROGRAM
This program provides additional coverage for treatment of gum disease for members with certain chronic health conditions. Gum disease is a health risk for everyone, but if you have it in combination with one of these conditions, they can be harder to control
You are eligible for enhanced dental benefits to treat gum disease if UCCI has record that you have been diagnosed with diabetes, heart disease, lupus, oral cancer, or rheumatoid arthritis. You are also eligible if we have record you have gum disease and have had a stroke or organ transplant.
Professional dental care is necessary to treat and stop gum disease from worsening. Smile for Health–Wellness can make it more affordable to get proper gum disease care, which in turn may help improve your overall health. You may also be eligible to get your gum disease treated at no cost by an in-network dentist. But remember, if you go to an out-of-network dentist, you may owe a balance and be billed for that amount.
How to Register
Visit www.UnitedConcordia.com/GetMDB from your desktop or mobile device. Then: Sign into MyDentalBenefits (or create an account).
Click the Wellness tab at the top menu.
Click the +Add a new condition and complete the fields as prompted.
Your condition status will show as ACTIVE to confirm your activation.
* Your standard plan’s frequency limitations (how often services are covered), annual maximum (the maximum amount your plan will pay toward services during the plan year), and other details still apply.
Balance billing may apply.
Talk to your dentist about any additional service you may need to keep your mouth healthy!
NVA VISION BENEFITS
Take care of your vision and overall health while saving on your eye care and eyewear needs. Vision insurance can help you maintain your vision as well as detect various health problems. Health conditions such as diabetes and high blood pressure can be detected early through a comprehensive eye exam. Our vision plan is administered by National Vision Administrators (NVA) and provides coverage for a range of vision care including exams, frames, lenses and contact lenses.
Base Plan
Buy-Up Plan
Bifocal
Trifocal
Progressives
Lenticular
Polycarbonate
Scratch coat (1 year)
Contact Lenses (in lieu of glasses)
Contact Lenses (medically necessary)
Vision Benefits On the Go!*
Download the NVA member mobile app to:
Search for network providers by location or number of frames available to you at $0 out-of-pocket)
Gain quick access to eligibility and plan coverage information
Access your ID card
Use the NVA Smart Buyer to help you make smarter buying decisions on eye care and eyewear
* Only NVA main cardholders can access the app; dependents cannot make their own accounts
Basic and Voluntary Life and AD&D
PRINCIPAL & COLONIAL
LIFE
Life and Accidental Death & Dismemberment (AD&D) insurance provides protection to those who depend on you financially, in the event of your death or an accident that results in death or serious injury.
Basic Life and AD&D
Life insurance can help provide for your loved ones if something were to happen to you. Asher’s Chocolates provides full-time employees with $10,000 in group life and AD&D insurance.
Asher’s Chocolates pays for the full cost of this benefit, which is administered by Principal.
Voluntary Life and AD&D
While Asher’s Chocolates offers basic life insurance, some employees may be interested in additional coverage based off their personal circumstances. Depending on your needs, you may want to consider buying supplemental coverage. With voluntary life insurance, you are responsible for paying the full cost of coverage through payroll deductions.
Voluntary term life and whole life insurance is available through Colonial Life. You can purchase coverage for yourself, spouse, and/or dependent child(ren).
For more information
For more detailed info about your voluntary life and AD&D benefit options, visit BenePortal at www.asherschocolatesbenefits.com
Ovia Health
MATERNITY & FAMILY PLANNING
NOTE: This service is available at no additional cost to those who enroll in one of the Independence Blue Cross medical plans.
Ovia Health provides you and your family with 24/7 support throughout your parenthood journey.
Download Ovia and launch your account today!
Ovia has three different apps for specialized support to suit your needs: Ovia Fertility, Ovia Pregnancy, and Ovia Parenting.
To sign up within the app, enter your email and select I have Ovia Health as a benefit before clicking Sign Up.
Already have the Ovia app on your phone? Open your app and tap Health to take the Ovia Health Assessment. Click Update my healthcare information and enter your health plan.
Ovia Tools and Resources
Daily, personalized family health support
Articles and tips based on your unique cycle
Track you and your baby’s development for a healthy, happy pregnancy
Newborn health tracking, milestone checklists, and expert parenting articles
Tools and support for balancing work and life as a parent
Caregiver access to share milestones and family photos/videos
More than 60 clinical programs
Predictive and proactive coaching Care and medical benefits navigation
Unlimited one-on-one coaching access
Return-to-work and career advice programs
Case Management integration with Independence Health Coaches
Wondr Health
WEIGHT LOSS SUPPORT
NOTE: This service is available at no additional cost to those who enroll in one of the Independence Blue Cross medical plans.
Wondr Health (Wondr) is a digital behavioral counseling program for weight management, diabetes prevention, and metabolic syndrome (MetS) reversal. This service is available to you and your family at no additional cost and offers a solution that can positively affect your whole health.
How Wondr works
Wondr meets you where you are and helps you develop a healthier relationship with food and build skills to make smarter decisions. The tools you will learn will allow you to enjoy your favorite foods while still helping you lose weight, sleep better, gain energy, and reduce and reverse chronic disease.
Three stages of Wondr
This 52-week program is 100-percent digital and accommodates any schedule, whether at home or on-the-go. Experience Wondr in three stages:
WONDRSKILLS: Learn simple, repeatable skills through weekly master classes.
WONDRUP: Reinforce and practice skills through the weekly personalized master classes.
WONDRLAST: Maintain progress with customizable master classes that keep the weight off and many other benefits.
Wondr participants see results!
84% Lost weight
50% Reversed high blood pressure
10.6 pounds of average weight loss
Additional features include:
Welcome kit includes tools and encouragement
Mobile app and 24/7 support
Weekly on-demand master classes from our expert team of instructors
Communication through tailored emails, text messages, and daily nudges
On-call health coaches to connect with live a
Social support through an online community
Take control of your health
Visit www.wondrhealth.com to register for Wondr and begin your journey today!
Teladoc DIABETES MANAGEMENT
Diabetes management, your way
Get an advanced blood glucose meter, strips and lancets, and support — all at no cost to you! If you have diabetes, you know how important it is to regularly monitor your blood sugar. Sometimes, it can be helpful to have extra support.
Teladoc Health offers real-time tools and guidance that can make it easier to stay on track, such as:
Personalized tips with each blood sugar check
Real-time, one-on-one live support when you’re out of range
Strip re-ordering right from your meter
Optional alters to notify emergency contacts
Health Summary Reports that can be sent from your meter to anyone you choose
Automatic uploads instead of paper logbooks
Get started
To enroll, visit www.teladochealth.com/register/ INDEPENDENCE or call 1-800-835-2362 and use registration code INDEPENDENCE.
Health Advocate
EMPLOYEE ASSISTANCE PROGRAM
There are times when you cannot go it alone. With Health Advocate, you don’t have to.
Life can be unpredictable, and it’s not always easy. So it’s a big deal to know there’s help available when you need it.
That’s what the Employee Assistance Program (EAP), provided by Health Advocate is all about.
With an EAP, you and your family household members have access to free, confidential resources to help handle life’s everyday - and not so every daychallenges.
How the EAP works
The Health Advocate provides eligible employees and their families assistance with behavioral healthcare services that can help begin the process of resolving emotional or substance abuse issues. You and the members of your household can have face-to-face or telephonic meetings per year. The encounter with the counselor through the EAP is completely confidential.
Health Advocate can help you through uncertain times, by acting as your advocate whenever you or your dependents need treatment of the following:
Emotional Difficulties/Depression
Family/Relationship Problems
Stress/Anxiety Issues
Grief and Loss Issues
Alcohol/Drug Abuse or Addiction
Anger/Rage Issues
Eating Disorders
Life Transition Problems
Gambling Problems
Other Behavioral Addictions
Contact the EAP today!
For personal and confidential assistance, contact Health Advocate via:
Phone: 866.799.2728
Email: answers@healthadvocate.com
Web: www.healthadvocate.com/members
Health Advocate BENEFITS ADVOCACY
Do you need help resolving a benefits issue?
Contact Health Advocate to speak to a speciallytrained member advocate who can help you get the most out of your benefits.
You can contact Health Advocate for assistance if:
You believe your claim was not paid properly
Need clarification on information from the insurance company
Have a question regarding a medical bill
Are unclear on how your benefits work
Need information about adding or removing a dependent
Need help resolving a benefits problem you’ve been working on
To contact Health Advocate
Call 1.866.799.2728, Monday through Friday, 8:30 am to 5:00 pm
Visit: www.healthadvocate.com/members
Email: answers@HealthAdvocate.com
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.
Additional Voluntary Benefits
COLONIAL LIFE / AFLAC
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. Two plan options are offered through Colonial Life: a Premier and Preferred plan.
Accident Insurance covers:
Initial & emergency care
Hospitalization
Fractures & Dislocation
Follow-up care
And more!
Cancer Insurance
Cancer insurance helps provide financial protection through a variety of benefits. These benefits are not only for you but also for your covered family members.
Cancer Insurance covers:
Transportation and home health care
Hospice
Stem cell/bone marrow transplants
Transfusions
Radiation/chemotherapy
And much more!
For more information
Additional Voluntary Benefits COLONIAL LIFE / AFLAC
Specified 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, and 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
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
For more information
For more detailed information about your voluntary benefits, visit BenePortal at www.asherschocolatesbenefits.com
Countrywide PREPAID LEGAL & ID THEFT
Personal Legal Plan
The Personal Legal Plan provides you and your family with affordable access to a number of valuable legal services from network attorneys. Whether you are closing on a house, filing for divorce, facing a traffic violation, need a will, or filing a consumer complaint, receiving legal advice is important. Participating members will receive a 25% discount on attorney hourly rates and a 10% discount on contingency fee matters.
The Personal Legal Plan includes:
Unlimited phone consultations
Face-to-face consultations
Review of legal documents
Identity theft prevention and assistance
And more!
Getting started
This plan is available to benefit-eligible employees, spouses, and dependents (up to age 23) at a payroll deduction of $3.40 per week. Enroll by completing the Countrywide enrollment form and returning it to Human Resources.
Credit Monitoring and ID Theft
The Countrywide Credit Monitoring and ID Theft plans provide identity theft insurance as well as credit monitoring, credit scores and credit reports. In addition to coverage for the employee, you can choose to cover your spouse, dependents, parents, and in-laws.
The Credit Monitoring and ID Theft Plans include: Bureau credit reports
Fraud alerts and fraud assistance
24/7 daily credit monitoring and email alerts
Access to ID fraud restoration specialists
Credit dispute assistance and advocates
And more!
Getting started
Three plans are offered: the Premier/Protect Pro plan, the Platinum/Protect Max plan, and the Bitdefender Total Security Secure Pro+ plan. Details of each plan and costs for coverage are outlined on BenePortal.
For more information
For more detailed information about these benefits, visit BenePortal at www.asherschocolatesbenefits.com and navigate to Benefits > Legal and ID Theft.
HealthyLearn HEALTH & WELLNESS RESOURCE
HelthyLearn covers over a thousand health and wellness topics in a simple, straightforward manner. The data and information is laid out in an easy-tofollow format. HealthyLearn includes the following interactive features and services:
Ask the Coach
Health Tip-of-the-Day & Monthly Newsletter
Symptom Checker
A to Z Encyclopedia
Health News
Medical Self-Care Guides
Pain Management Guide
Mental Health Guide
Home Safety Guide
Wellness and Disease Management
Tobacco Cessation
Stress Management
Nutrition and Weight Loss
Health Trackers
And much more!
Download the HealthyLife Mobile App for access on-the-go!
Search your app store for “healthylife mobile”
Download and open the app
Enter the Conner Strong & Buckelew special access code: CSB (all caps)
PLEASE NOTE: You must use the special access code above each time you open the app.
Getting started
Learn more and get started on your path to wellness today by visiting HealthyLearn at www.healthylearn.com/connerstrong.
ONLINE BENEFITS RESOURCE
Your benefits information –all in one place!
At Asher’s Chocolates, you have access to a full-range 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 mobile-optimized, making it easy to view your benefits on-the-go. 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 – with NO login required!
Direct links to benefits enrollment sites
Plan summaries
Wellness resources
Carrier contacts
Downloadable forms
GoodRx
And more!
Simply go to www.asherschocolatesbenefits.com to access your benefits information today!
Your Benefits CARRIER CONTACTS
www.coloniallife.com
Glossary of Benefit 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.
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 (copay)
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
Individuals who meet eligibility requirements under a health plan and are enrolled to receive benefits from the plan as a qualified dependent.
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.
Health Management Organization (HMO)
A type of health insurance plan that usually limits coverage to care from doctors who work for or contract within a specified network. Premiums are paid monthly, and a small copay is due for each office visit and hospital stay. HMOs require that you select a primary care physician who is responsible for managing and coordinating all of your health care.
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.
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.
Glossary of Benefit Terms
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. Out-of-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 Ma ximum (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.
Premium
The amount you pay for a health plan in exchange for coverage. Health plans with higher deductibles typically have lower premiums.
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.
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
WOMEN’S HEALTH AND CANCER RIGHTS ACT NOTICE
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; and
• treatment of physical complications of the mastectomy, including lymphedema.
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, contact Human Resources.
SPECIAL ENROLLMENT NOTICE
Loss of other coverage (excluding Medicaid or a State Children’s Health Insurance Program). If you decline enrollment for yourself or for an eligible dependent (including your spouse) while other health insurance or group health plan coverage (including COBRA coverage) is in effect, 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 Company 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). If you request a change within the applicable timeframe, coverage will be effective the first of the month following your request for enrollment. When the loss of other coverage is COBRA coverage, then the entire COBRA period must be exhausted in order for the individual to have another special enrollment right under the Plan. Generally, exhaustion means that COBRA coverage ends for a reason other than the failure to pay COBRA premiums or for cause (that is, submission of a fraudulent claim). This means that the entire 18-, 29-, or 36-month COBRA period usually must be completed in order to trigger a special enrollment for loss of other coverage.
Loss of eligibility for Medicaid or a State Children’s Health Insurance Program. If you decline enrollment for yourself or for an eligible dependent (including your spouse) while Medicaid coverage or coverage under a state children’s health insurance program (CHIP) is in effect, you may be able to enroll yourself and your dependents in this plan if you or your dependents lose eligibility for that other coverage. However, you must request enrollment within 60 days after your or your
dependents’ coverage ends under Medicaid or CHIP. If you request a change within the applicable timeframe, coverage will be effective the first of the month following your request for enrollment.
New dependent by marriage, birth, adoption, or placement for adoption. 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 new dependents. However, you must request enrollment within 30 days after the marriage, birth, adoption, or placement for adoption. 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.
Eligibility for Medicaid or a State Children’s Health Insurance Program. If you or your dependents (including your spouse) become eligible for a state premium assistance subsidy from Medicaid or through a state children’s health insurance program (CHIP) with respect to coverage under this plan, you may be able to enroll yourself and your dependents in this plan. However, you must request enrollment within 60 days after your or your dependents’ determination of eligibility for such assistance. If you request a change within the applicable timeframe, 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.
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 1-877KIDS 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 employersponsored plan.
If you or your dependents are eligible for premium assistance under Medicaid or CHIP, as well as eligible under your employer plan, your employer must allow you to enroll in your employer plan if you aren’t already enrolled. This is called a “special enrollment” opportunity, and you must request coverage within 60 days of being determined eligible for premium assistance. If you have questions about enrolling in your employer plan, contact the Department of Labor at www.askebsa.dol.gov or call 1-866 -444-EBSA (3272).
If you live in one of the following states, you may be eligible for assistance paying your employer health plan premiums. The following list of states is current as of January 31, 2024. Contact your State for more information on eligibility –
To see if any other states have added a premium assistance program since January 31, 2024, or for more information on special enrollment rights, contact either:
U.S. Department of Labor
Employee Benefits Security Administration
www.dol.gov/agencies/ebsa
1-866-444-EBSA (3272)
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
HIPAA INFORMATION NOTICE OF PRIVACY PRACTICES
In compliance with the Health Insurance Portability and Accountability Act of 1996 (HIPAA). Asher’s recognizes your right to privacy in certain matters related to the disclosure of health-related information. The Notice of Privacy Practices (provided to you upon your enrollment in the health plan) details steps that Asher’s has taken to assure your privacy are protected. The Notice also explains your rights under HIPAA. A copy of this Notice is available to you at any time, free of charge by contacting Asher’s HR department in writing.
IMPORTANT NOTICE FROM ASHER’S CHOCOLATES 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 Asher’s Chocolates 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. Asher’s Chocolates has determined that the prescription drug coverage offered by Independence Blue Cross is, on average for all plan participants, expected to pay out as much as standard Medicare prescription drug coverage pays and is therefore considered Creditable Coverage. Because your existing coverage is Creditable Coverage, you can keep this coverage and not pay a higher premium (a penalty) if you later decide to join a Medicare drug plan.
When Can You Join A Medicare Drug Plan?
You can join a Medicare drug plan when you first become eligible for Medicare and each year from October 15th 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 Asher’s Chocolates coverage will not be affected
If you do decide to join a Medicare drug plan and drop your current Asher’s Chocolates coverage, be aware that you and your dependents will not 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 [Insert Name of Entity] 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 Asher’ 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 1-800772-1213 (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).
Name of Entity/Sender: Asher’s Chocolates
Contact--Position/Office: Amy Prior, Human Resources
Address: 19 East Susquehanna Ave, Lewistown, PA 17044
Phone Number: 717-447-2441
Legal Notices
COBRA CONTINUATION COVERAGE RIGHTS
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.
What
is COBRA continuation coverage?
COBRA continuation coverage is a continuation of Plan coverage when it would otherwise end because of a life event. This is also called a “qualifying event.” Specific qualifying events are listed later in this notice. After a qualifying event, COBRA continuation coverage must be offered to each person who is a “qualified beneficiary.” You, your spouse, and your dependent children could become qualified beneficiaries if coverage under the Plan is lost because of the qualifying event. Under the Plan, qualified beneficiaries who elect COBRA continuation: must pay for COBRA continuation coverage.
If you’re an employee, you’ll become a qualified beneficiary if you lose your coverage under the Plan because of the following qualifying events:
• Your hours of employment are reduced, or
• Your employment ends for any reason other than your gross misconduct.
If you’re the spouse of an employee, you’ll become a qualified beneficiary if you lose your coverage under the
Plan because of the following qualifying events:
• Your spouse dies;
• Your spouse’s hours of employment are reduced;
• Your spouse’s employment ends for any reason other than his or her gross misconduct;
• Your spouse becomes entitled to Medicare benefits (under Part A, Part B, or both); or
• You become divorced or legally separated from your spouse.
Your dependent children will become qualified beneficiaries if they lose coverage under the Plan because of the following qualifying events:
• The parent-employee dies;
• The parent-employee’s hours of employment are reduced;
• The parent-employee’s employment ends for any reason other than his or her gross misconduct;
• The parent-employee becomes entitled to Medicare benefits (Part A, Part B, or both);
• The parents become divorced or legally separated; or
• The child stops being eligible for coverage under the Plan as a “dependent child.”
When is COBRA continuation coverage available?
The Plan will offer COBRA continuation coverage to qualified beneficiaries only after the Plan Administrator has been notified that a qualifying event has occurred. The employer must notify the Plan Administrator of the following qualifying events:
• The end of employment or reduction of hours of employment;
• Death of the employee;
• Commencement of a proceeding in bankruptcy with respect to the employer; or
• The employee’s becoming entitled to Medicare benefits (under Part A, Part B, or both).
For all other qualifying events (divorce or legal separation of the employee and spouse or a dependent child’s losing eligibility for coverage as a dependent child), you must notify the Plan Administrator within 60 days after the qualifying event occurs. You must provide this notice to: Amy Prior
How is COBRA continuation coverage provided?
Once the Plan Administrator receives notice that a qualifying event has occurred, COBRA continuation coverage will be offered to each of the qualified beneficiaries. Each qualified beneficiary will have an independent right to elect COBRA continuation coverage. Covered employees may elect COBRA continuation coverage on behalf of their spouses, and parents may elect COBRA continuation coverage on behalf of their children.
COBRA continuation coverage is a temporary continuation
of coverage that generally lasts for 18 months due to employment termination or reduction of hours of work. Certain qualifying events, or a second qualifying event during the initial period of coverage, may permit a beneficiary to receive a maximum of 36 months of coverage.
There are also ways in which this 18-month period of COBRA continuation coverage can be extended:
If you or anyone in your family covered under the Plan is determined by Social Security to be disabled and you notify the Plan Administrator in a timely fashion, you and your entire family may be entitled to get up to an additional 11 months of COBRA continuation coverage, for a maximum of 29 months. The disability would have to have started at some time before the 60th day of COBRA continuation coverage and must last at least until the end of the 18month period of COBRA 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, Medicare, Medicaid, Children’s Health Insurance Program (CHIP), 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.
Can I enroll in Medicare instead of COBRA continuation coverage after my group health plan coverage ends?
In general, if you don’t enroll in Medicare Part A or B when you are first eligible because you are still employed, after
Legal Notices
the Medicare initial enrollment period, you have an 8-month special enrollment period to sign up for Medicare Part A or B, beginning on the earlier of
• The month after your employment ends; or
• The month after group health plan coverage based on current employment ends.
If you don’t enroll in Medicare and elect COBRA continuation coverage instead, you may have to pay a Part B late enrollment penalty and you may have a gap in coverage if you decide you want Part B later. If you elect COBRA continuation coverage and later enroll in Medicare Part A or B before the COBRA continuation coverage ends, the Plan may terminate your continuation coverage. However, if Medicare Part A or B is effective on or before the date of the COBRA election, COBRA coverage may not be discontinued on account of Medicare entitlement, even if you enroll in the other part of Medicare after the date of the election of COBRA coverage.
If you are enrolled in both COBRA continuation coverage and Medicare, Medicare will generally pay first (primary payer) and COBRA continuation coverage will pay second. Certain plans may pay as if secondary to Medicare, even if you are not enrolled in Medicare.
For more information visit https://www.medicare.gov/medicare-and-you.
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.
Plan contact information: Amy Prior, Human Resources Manager.
PATIENT PROTECTION MODEL DISCLOSURE
Independence Blue Cross generally allows the designation of a primary care provider. You have the right to designate any primary care provider who participates in our network and who is available to accept you or your family members. For information on how to select a primary care provider, and for a list of the participating primary care providers, contact Independence Blue Cross, www.ibx.com.
For children, you may designate a pediatrician as the primary care provider.
You do not need prior authorization from Independence Blue Cross or from any other person (including a primary care provider) in order to obtain access to obstetrical or gynecological care from a health care professional in our network who specializes in obstetrics or gynecology. The health care professional, however, may be required to comply with certain procedures, including obtaining prior authorization for certain services, following a preapproved treatment plan, or procedures for making referrals. For a list of participating health care professionals who specialize in obstetrics or gynecology, contact Independence Blue Cross, www.ibx.com.
The information presented in this Guide is not intended to be construed to create a contract between Asher's Chocolates and any one of Asher's Chocolates employees or former employees. In the event that the content of this Guide or any oral representations made by any person regarding the plan conflict with or are inconsistent with the provisions of the plan document, the provisions of the plan document are controlling. Asher's Chocolates reserves the right to amend, modify, suspend, replace or terminate any of its plans, policies or programs, in whole or in part, including any level or form of coverage by appropriate company action, without your consent or concurrence.
