EONE Sample Benefits Guide

2019 Employee Benefits Summary Overview Plan Year: April 1, 2019 – March 31, 2020

2019 Employee Benefits

1

All About Enrollment Employer-Provided Benefits

As an eligible employee, Company automatically provides you with several benefits. Company pays the full cost of life insurance, short and long term disability coverage, and an employee assistance plan. You are not required to make any contributions for these benefits.

Optional Benefits

In addition to the employer-provided benefits, eligible employees may enroll in optional benefits including medical, dental, vision, voluntary life insurance for self, spouse and dependents and retirement plans. You contribute toward the cost of the optional benefits that you elect.

When Coverage Begins

For all Company benefits, coverage begins the first of the month following your date of hire.

•

New hires/transfers: You must enroll during your first 31 days of employment with Company. If you do not, your coverage will be waived and your next opportunity to enroll in benefits without a qualifying event will be during next year’s annual open enrollment period, typically held in February of each year for the upcoming plan year.

•

Current employees: Each year you have an opportunity to review your benefit elections during the annual open enrollment period, typically in February, and make changes for the upcoming plan year.

When Coverage Ends

For most benefits, coverage will end on the last day of the month in which: •

Your regular work schedule is reduced to fewer than 30 hours per week;

•

Your employment with Company ends due to resignation, termination, or death;

•

Or you stop paying your share of the coverage.

Your dependent coverage ends: •

When your coverage ends;

•

Or the last day of the month in which the dependent is no longer eligible:

•

For dependent children up to age 26: end of the month in which they turn 26.

How to Change your Coverage Mid-Year

The IRS provides strict regulations about changes to pre-tax elections during the plan year. If you experience a qualified IRS family status change mid-year, you are permitted to make a change within 31 days of the event.

If the change request is not completed within 31 days of the event, you will not be able to change your elections until the annual open enrollment period. Below are some of the more commonly known qualified family status changes: •

Marriage, divorce, annulment, or permanent separation from a domestic partner

•

Birth of a child

•

Placement of a foster child or child for adoption with you

•

Obtaining legal guardianship of a child

•

Change in employment status that affects benefits eligibility

•

Return from an unpaid leave of absence

•

Gain or loss of coverage

The change you request must be consistent with the qualifying event. All mid-year changes require documentation, which must also be provided within 31 days of the event. Please contact the EONE BAT Team if you have questions.

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Company 2019 Employee Benefits

All About Enrollment Who Can Enroll You are eligible for benefits if you are a regular, full-time employee. If you elect coverage, your dependents are also eligible for medical, dental, vision, and life insurance coverage.

Eligible dependents include: •

Your Spouse and legal child(ren)

•

Natural children, adopted children, foster children, step children, your domestic partner’s children, or any child for whom you have legal custody

•

Children up to age 26

•

Regardless of age, if fully disabled and unmarried, provided s/he became fully disabled either prior to age 19 or between the ages of 19-26 if the child was covered by the plan when the disability occurred

How to Enroll Self Registration for First Time Users

If this is your first time using ADP services, follow the self-registration process below. Otherwise, use your existing credentials.  Go to https://my.adp.com.  Click Register Now.  Enter the registration code and click Go.  Enter your name and other requested information and click Confirm.

-If the prompt indicates that your record was found, click Register Now. -If the prompt indicates your record could not be found, contact your administrator or ADP help desk.  On Register for Services page, enter your contact information.  View or create (if permitted) a user ID.  Create a password.  Select and answer security questions.  If prompted, read the terms and conditions and select the I Agree check box.  Click Register (or Register Now).  Activate your contact devices by following the instructions in the two emails you will receive.  You can now log in to your ADP service.

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Company 2019 Employee Benefits

Signing In •

Go to https://my.adp.com

•

Enter your User Name.

•

Your user name is the user ID you received when you completed selfregistration.

•

Enter your Password.

•

Your password is the one you created during self-registration.

•

Click Sign In.

Medical Insurance Company gives you the option of choosing one of three UMR/United Healthcare plans to best meet your needs. All three plans: •

Use the United Healthcare Choice Plus network,

•

Use Optum Rx as the administrator for all Pharmacy claims

•

Cover preventive care at 100%,

•

Provide the same type of coverage.

Glossary Copay

a fixed fee amounts that you pay at the time you receive services

Deductible

the set amount you must typically pay before coinsurance starts

Coinsurance

the portion of expense you must pay for care, in most cases, after meeting your deductible

Out-of-Pocket Maximum

the maximum amount you could pay for care within a calendar year, including copays and deductibles

Preventive Services

routine health care that includes screenings, check-ups, and patient counseling to prevent illnesses, disease, or other health problems

Premiums

your payroll deductions, which are the amounts you pay to belong to a health plan

In-Network

the doctor or health care facility has a partnership with the insurance carrier to bring you lower costs

Providers

a doctor or health care facility

Our Plans Traditional PPO is our richest plan design, which maximizes coverage at the point of service, so if you and your family would like to pay the least out of pocket at the doctor’s office, then this plan is the right one for you.

PPO HSA #1 offers the same rich benefit design as the Traditional PPO, but requires a little more out of pocket at the time of service. It comes with lower premiums than the Traditional PPO. This plan can be paired with a Health Savings Account.

PPO HSA #2 requires the most at the time of service, but comes with the lowest premiums. This plan can be paired with a Health Savings Account.

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Company 2019 Employee Benefits

Medical Insurance United Healthcare Choice Plus PPO

The PPO network allows you to choose any provider you want each time you need care. There are no requirements to choose a primary care physician (PCP) to coordinate your care. When you use in-network provers, your out-of-pocket expenses are kept to a minimum.

HSA Plan #1 Medical Coverage

HSA Plan #2

PPO Plan #3

In-Network

Out-of-Network

In-Network

Out-of-Network

In-Network

Out-of-Network

Deductible (Ded) Individual / Family

$1,800 / $3,600

$4,000 / $8,000

$3,500 / $7,000

$5,000 / $10,000

$1,000 / $2,000

$4,000 / $8,000

Out-of-Pocket Maximum Individual / Family

$2,300 / $4,600

$6,250 / $12,500

$4,000 / $8,000

$6,250 / $12,500

$2,500 / $5,000

$6,250 / $12,500

100%

80%

100%

70%

80%

70%

Coinsurance Preventive Care

No Charge

20% Coinsurance

No Charge

30% Coinsurance

No Charge

30% Coinsurance

PCP Office Visit (No PCP selection required)

Ded

Ded, then 20%

Ded

Ded, then 30%

$30 Copay

Ded, then 30%

Specialist Office Visit (No referral required)

Ded

Ded, then 20%

Ded

Ded, then 30%

$30 Copay

Ded, then 30%

Mental Health Outpatient Office Visits

Ded

Ded, then 20%

Ded

Ded, then 30%

Ded, then 20%

Ded, then 30%

Inpatient Hospital Stays

Ded

Ded, then 20%

Ded

Ded, then 30%

Ded, then 20%

Ded, then 30%

Short Term Rehab (PT, OT, Skilled Nursing Facility)

Ded

Ded, then 20%

Ded

Ded, then 30%

$30 Copay, then 20%

Ded, then 30%

Diagnostic, Lab and X-Ray

Ded

Ded, then 20%

Ded

Ded, then 30%

No Charge

Ded, then 30%

Imaging (CT, PET scan, MRIs, Nuclear Scans)

Ded

Ded, then 20%

Ded

Ded, then 30%

No Charge

Ded, then 30%

Urgent Care Facility

Ded

Ded, then 20%

Ded

Ded, then 30%

Ded

Ded, then 30%

Hospital Emergency Room (copay waived if admitted)

Ded

Treated as In Network

Ded

Treated as In Network

$100 Copay, then 20%

Treated as In Network

Inpatient Hospital Facility Services

Ded

Ded, then 20%

Ded

Ded, then 30%

Ded, then 20%

Ded, then 30%

Outpatient Hospital Facility Services

Ded

Ded, then 20%

Ded

Ded, then 30%

Ded, then 20%

Ded, then 30%

Durable Medical Equipment

Ded

Ded, then 20%

Ded

Ded, then 30%

Ded, then 20%

Ded, then 30%

Prescription Coverage Rx Deductible Rx OOP Maximum Tier I

Shared with Medical

Shared with Medical

None

Shared with Medical

Shared with Medical

$4,100 Individual / $8,200 Family

$10 Copay ($20 Copay)

$10 Copay ($20 Copay)

$10 Copay ($20 Copay)

Tier II

$30 Copay ($60 Copay)

$30 Copay ($60 Copay)

$35 Copay ($70 Copay)

Tier III

$50 Copay ($100 Copay)

$50 Copay ($100 Copay)

$60 Copay ($120 Copay)

2 x Retail

2 x Retail

2 x Retail

90-Day Maintenance

Company Contributes to you HSA Account!

Company makes HSA Contributions to all employees enrolled in an HSA-qualified plan. If you are enrolled as “Employee Only” you may receive $600 per year and those enrolled as “Employee & Dependents” may receive $1,200 per year. Contribution are made based on your tenure of service with Company. Company’s contribution amounts into your HSA Account accumulate to the total of the IRS Annual Contribution Maximum Limit. Please be advised HSA Contribution Amounts are based on calendar year and do not follow our medical plan year. Please remember to set up your Sandy Spring HSA so you can begin to receive Employer contributions. Contributions cannot begin until you establish an account.

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Company 2019 Employee Benefits

Health Savings Account (HSA) Reasons to Love an HSA: Triple Tax Savings •

You can contribute to your HSA using tax-free dollars

•

You can use the money in your HSA to pay for health care expenses with tax-free money

•

Whatever you don’t use in a year rolls over to the next year, and earns interest that is also tax-free!

You decide how and when to use the funds in your account - you can use the funds to pay for your health care expenses or save them for future health care costs.

The account may be used to build funds for retirement. Once you reach age 65, you can continue to use while in retirement.

Standard Deductible HSA Plan #1

High Deductible HSA Plan #2

Plan Deductible and Maximums

Plan Deductible and Maximums

Individual

Non-Individual

Individual

Non-Individual

In Network Deductible

$1,800.00

$3,600.00

In Network Deductible

$3,500.00

$7,000.00

In Network OOP Max

$2,300.00

$4,600.00

In Network OOP Max

$4,000.00

$8,000.00

2019 IRS HSA Contribution Limit

$3,500.00

$7,000.00

2019 IRS HSA Contribution Limit

$3,500.00

$7,000.00

Contributions

Contributions

Individual

Non-Individual

Individual

Non-Individual

Company Contribution

$600.00

$1,200.00

Company Contribution

$600.00

$1,200.00

Employee Deductible Responsibility

$1,200.00

$2,400.00

Employee Deductible Responsibility

$2,900.00

$5,800.00

Employee OOP Responsibility

$1,700.00

$3,400.00

Employee OOP Responsibility

(capped at IRS Maximum)

$2,900.00

$5,800.00

Remaining IRS Limit

$2,900.00

$5,800.00

Remaining IRS Limit

$2,900.00

$5,800.00

Additional Savings Per Pay Required to fund: Individual

Non-Individual

Remaining deductible

$50.00

$92.31

Remaining deductible & OOP Max

$70.83 $120.83

Max IRS contribution for 2019

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Account Savings Per Pay Required to fund: Individual

Non-Individual

Remaining deductible

$120.83

$223.08

$130.77

Remaining deductible & OOP Max

$120.83

$223.08

$223.08

Max IRS contribution for 2019

$120.83

$223.08

Company 2019 Employee Benefits

Dental & Vision Insurance Dental Insurance Company offers you a generous dental plan that allows you to see any dentist you choose. You are encouraged to verify that the dentist accepts United Healthcare dental pricing. Please refer to the chart below for an overview of benefits.

Benefit the Plan Pays Plan Year Deductible (Class B and C, waived Class A)

$50 Individual / $150 Family

Annual Plan Year Maximum Benefit

$2,000 per person per year

Class A - Preventive Care (such as cleaning, exams, and X-rays)

100% of UCR

Class B - Regular Restorative Care (such as fillings & root canals)

80%

Class C - Major Restorative Care (such as dentures, bridgework, crowns)

50%

Class D - Orthodontia (covered to age of 19) (such as braces & retainers)

Not Covered

Vision Insurance With our vision plan, you’ll get a great value on your eye care and eye wear.

Using your vision benefit is easy as well. Members will be required to pay for services rendered at the time of service and then submit for reimbursement.

There is no ID card needed!

Maximum Benefit the Plan Pays Eye Exam (once every 12 months)

Covered at 100%

Lenses (one pair every 12 months)

$75 Single Vision $100 Bifocal $175 Trifocal $200 for Progressive

Frames (one pair every 24 months)

$100 allowance

Contact Lenses in lieu of glasses Medically Necessary* (every plan year)

$250

Elective (every plan year)

$150

*Medically Necessary contact lenses are non-elective contact lenses prescribed when certain medical conditions hinder vision correction through regular eyeglasses. Contact lenses are considered a medical necessity when they are the generally accepted standard of treatment for the condition and not elective in lieu of glasses.

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Company 2019 Employee Benefits

Employee Contributions Plan Year - April 1, 2019 to March 31, 2020 Employee Weekly (52) Premiums HSA #1

HSA #2

PPO #3

Bundled Medical, Dental & Vision

Dental Only

Vision Only

Unbundled

Unbundled

Payroll Deductions

Employee Only

$29.36

$15.67

$82.68

$1.03

$0.60

Employee + Children

$74.86

$51.07

$179.59

$3.86

$1.18

Employee + Spouse

$88.79

$54.64

$191.54

$3.86

$1.18

Family

$109.75

$67.55

$211.07

$9.02

$1.79

Dental Only

Vision Only

Unbundled

Unbundled

Employee Semi-Monthly (24) Premiums HSA #1

HSA #2

PPO #3

Bundled Medical, Dental & Vision Payroll Deductions

Employee Only

$63.61

$33.95

$179.14

$2.23

$1.31

Employee + Children

$162.20

$110.65

$389.12

$8.37

$0.26

Employee + Spouse

$192.38

$118.39

$415.01

$8.37

$2.56

Family

$237.79

$146.35

$457.32

$19.55

$3.87

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Company 2019 Employee Benefits

Basic Life & AD&D Basic Group Term Life & Accidental Death & Dismemberment Company provides full-time permanent employees with Life and AD&D coverage and pays the full cost of the coverage.

Coverage eligibility for new employees will become effective the first of the month following the date of employment.

The benefit provided for reach eligible employee is 2X their basic annual earning up to a maximum of $250,000.

Additional Voluntary Life & Accidental Death & Dismemberment All full-time permanent employees of Company are eligible to purchase Additional Voluntary Life/AD&D coverage.

Coverage eligibility for new employees will become effective after the first of the month following the date of employment. The maximum benefit available for each eligible employee is 100% of Employee Amount with a maximum of $500,000 or 5 times annual earnings, whichever is less, 100% of the employee election up to $250,000 for a Spouse and 100% of employee election up to $10,000 for each dependent child. The Flat Guarantee Issue Amount for each is as follows: •

Employee (Under Age 65) $100,000; Spouse (Under Age 65) $50,000; Children $10,000

Short-Term & Long-Term Disability Company also provides full-time permanent employees with short-term and long-term disability income benefits, and pays the full cost of this coverage. Coverage eligibility for new employees will become effective the first of the month after active employment. In the event you become disabled from a non-work-related injury or sickness, disability income benefits are provided as a source of income.

Short-Term Disability

Long-Term Disability

Benefits Payable

• 8th day of disability due to injury • 8th day of disability due to illness

After 90 days of disability

Benefit Percentage

60% of basic weekly salary

60% of basic monthly salary

Maximum Benefit Amount

$1,000 per week

$7,500 per month

Maximum Benefit Period

12 weeks

Social Security Normal Retirement Age

9

Company 2019 Employee Benefits

Employee Assistance Program Mutual of Omaha Employee Assistance Program (EAP) Life’s not always easy. Sometimes a personal or professional issue can affect your work, health and general well-being.

When facing life’s challenges, you often turn to family or friends for support. But sometimes that’s not enough.

Sometimes you need an experienced professional to talk with to know you’re not alone. The EAP through Mutual of Omaha provides useful tools and resources that can guide you through a difficult time. Best of all it is confidential and at no additional cost to you.

What can they help with?

•

Overcoming stress

•

Crisis at home or work

•

Addiction, depression, & other emotional issues

•

Career goals

•

Management support

•

Work-life balance

•

Stress, relaxation, and personal well-being

•

Personal & family goals

Financial or Legal Questions?

Mutual of Omaha can help with those as well!

•

Online will preparation

•

Online legal forms library

•

Telephonic financial consultation

•

Online library of legal and financial tools & resources

Your program includes 3 face to face counseling sessions!

To use your EAP Benefit, call toll free 800-316-2796 or go online to www.mutualofomaha.com/eap

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Company 2019 Employee Benefits

Telemedicine

Download the app today, it’s quick and easy!

Visit Teladoc.com/mobile or visit your app store. Then follow these 3 easy steps: 1. Create an Account – it only takes a few minutes. After downloading the app you will provide a brief medical history so the doctors have the information they need to provide you with quality medical care. You can also add family members so they have access to around the clock care.

2. Talk with a Doctor Now – you have the option to speak with the first available Teladoc doctor, or schedule and appointment. Within minutes a doctor will call ready to listen, diagnose and prescribe medication, if needed.

Afterwards you can choose to share the results with your PCP. 3. Pick Up Your Rx – if an Rx is needed, the Teladoc doctor can send it right to your local pharmacy for pickup!

Support services provided for Company members and their dependents.

The EONE Benefit Advocate Team (BAT) is not affiliated with, nor.

11 Company 2019 Employee Benefits

EMPLOYEE ONE Benefit Solutions 921 E. Fort Ave., Ste. 325 Baltimore, MD 21230

Contacts & Resources Contact information for all of your vendors is included below. For claims and benefit information please contact your Payroll and Benefits Department or the Employee One Benefit Advocate Team.

UMR

Medical, Dental, Vision, Find a Provider

www.umr.com/members | (800) 826-9781

UMR

Rx and Pharmacy

www.umr.com/member | (800) 826-9781

OptumRx

Rx and Pharmacy

www.optumrx.com | (877) 559-2955

Mutual of Omaha

Life, AD&D, and Voluntary Life

Mutual of Omaha

Short-Term and Long-Term Disability

Mutual of Omaha

Employee Assistance Program (EAP)

www.MutualofOmaha.com/eap | (800) 316-2796

Teladoc

Telemedicine

www.Teladoc.com | (800) 835-2326 (TELADOC)

Sandy Spring

Health Savings Account (HSA)

www.sandyspringbank.com/personal/banking/heal th-savings-accounts/form

PNC

Retirement Account – 401k

Company

First LastName, PHR

Medical Administrator

Human Resources

Payroll & Benefits Manager

www.MutualofOmaha.com | (800) 877-5176 Claims fax: (402) 351-8565 gps.east@mutualofomaha.com

www.MutualofOmaha.com | (800) 877-5176 claims fax: (402) 997-1865 disability.management@mutualofomaha.com

(800) 399-5919 HSA@sandyspringbank.com

www.retirementdirections.com | (800) 374-4631

participantservices@pncadvisors.com

(410) 888-8888 | flastname@Company.com

Benefit Advocate Team mybenefits@employee1.net Your EONE Benefit Advocate Team (BAT) is available Monday through Friday during normal business hours to provide concierge level support with matters relating to your group health and welfare benefits.

Sometimes health insurance can be confusing and stressful if you feel you’re not getting the help you need.

The EONE BAT team is familiar with your benefits and can help explain how your plan works.

If you’re experiencing a billing issue, need assistance resolving a claim, or just have general questions about your benefits, email: mybenefits@employee1.net, or give us a call us at: 1-877-719-EMP1(3671).

> Concierge-Level Support > Billing Issues > Claims Resolution > Important Dates > Qualifying Events > General Benefits Information > Contacts, and more…

Support services provided for Company members and their dependents.

Benefit Advocate Team (BAT) is not affiliated with, nor represents, the, Company 2019 Employee Benefits a 12

EMPLOYEE ONE Benefit Solutions 921 E. Fort Ave., Ste. 325 Baltimore, MD 21230

Continuation of Health Coverage Consolidated Omnibus Budget Reconciliation Act (COBRA) You must notify Human Resources within 30 days of the following COBRA events: •

divorce or legal separation

•

death of an employee

•

dependent child’s loss of dependent status

Individual election rights to continuation of coverage Loss of Coverage due to:

Voluntary or Involuntary loss of employment Max Continuation for covered individuals: You 18 Months Spouse 18 Months Child 18 Months When any covered member loses health insurance coverage based on a termination of employment or the occurrence of other qualifying events, the member will be eligible to elect continuation of coverage under the Consolidated Omnibus Budget Reconciliation Act (COBRA). Once your termination of health insurance coverage is processed you will receive a COBRA packet in mail from CoreSource. You will have 60 days to elect COBRA. Once COBRA is elected your coverage is retroactive to the date you lost coverage. There will be no lapse in coverage. Please contact a Company insurance representative for additional information on pricing regarding COBRA coverage.

Each individual who is covered by the health plan immediately preceding the member’s COBRA event has independent election rights to continue his or her medical or vision coverage. The right to continuation of coverage ends at the earliest of when: •

you, your spouse or dependents become covered under another group health plan: or,

•

you become entitled to Medicare: or,

•

you fail to pay the cost of coverage: or,

•

your COBRA Continuation Period expires.

For more information visit: www.dol.gov/ebsa/cobra.html

Loss of Coverage due to:

Disability (at the time of event)

Max Continuation for covered individuals: You 29 Months Spouse 29 Months Child 29 Months Loss of Coverage due to:

Your Death

Max Continuation for covered individuals: You n/a Spouse 36 Months Child 36 Months Loss of Coverage due to:

Your Divorce or Legal Separation

Max Continuation for covered individuals: You n/a Spouse 36 Months Child 36 Months Loss of Coverage due to:

You become entitled to Medicare

Max Continuation for covered individuals: You n/a Spouse 36 Months Child 36 Months

Support services provided for Company members and their dependents.

The EONE Benefit Advocate Team (BAT) is not affiliated with, nor 13 Company 2019 Employee Benefits

EMPLOYEE ONE Benefit Solutions 921 E. Fort Ave., Ste. 325 Baltimore, MD 21230

Annual Notices Right to Rescind Coverage PPACA requires group health plans to provide notice 30 days prior of group health plan termination. The rules prohibit rescissions except in very limited situations such as employees who commit fraud or make intentional misrepresentations. For example, if plan documents require employees enrolling family members to assert that these individuals meet plan eligibility requirements and to immediately notify the employer if their status changes, rescission might be possible for an employee who intentionally misrepresented marital status to obtain coverage for a friend. Prospective terminations of coverage and retroactive terminations for failure to pay premiums or contributions are not rescissions.

Company Group Health Plan the privacy rules under the Health Insurance Portability and Accountability Act (HIPAA) require the Group Health Plan (the “Plan”) to periodically send a reminder to participants about the availability of the Plan’s Privacy Notice and how to obtain a copy of this notice.

The Privacy Notice explains participants’ rights and the Plan’s legal duties with respect to protected health information (PHI) and how the plan may use and disclose PHI. Mothers’ and Newborns’ Act Group health plans and health insurance issuers generally may not, under federal law, restrict benefits for any hospital length of stay in connection with childbirth for the mother or newborn child to less than 48 hours following a vaginal delivery, or less than 96 hours following a cesarean section. However, federal law generally does not prohibit the mother’s or newborn’s attending provider, after consulting with the mother, from discharging the mother or her newborn earlier than 48 hours (or 96 hours as applicable). In any case, plans and insurers may not, under federal law, require that a provider obtain authorization from the plan or issuer for prescribing a length of stay not in excess of 48 hours (or 96 hours).

Medicare Information Attention Members who are Medicare eligible or who have Medicare eligible dependents—(or those who will soon be eligible). Coordination of benefits between the group plan and Medicare Parts A & B depends on specific criteria and reason for election of Medicare. Please contact the Company Insurance Team for more information in regards to these criteria and how the coordination of benefits would be determined.

Uniformed Services Employment and Reemployment Rights Act (USERRA) Health Insurance Protection if you leave your job to perform military service, you have the right to elect to continue your existing employer-based health plan coverage for you and your dependents for up to 24 months while in the military. Even if you don't elect to continue coverage during your military service, you have the right to be reinstated in your employer’s health plan when you are reemployed, generally without any waiting periods or exclusions except for service-connected illnesses or injuries.

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 or 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 lymphedemas.

These benefits will be provided subject to the same deductibles and coinsurance applicable to other medical and surgical benefits provided under the plan.

COBRA Under the Consolidated Omnibus Budget Reconciliation Act (COBRA) of 1985, COBRA qualified beneficiaries generally are eligible for group coverage during a maximum of 18 months for qualifying events due to award 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. COBRA coverage is not extended for those terminated for gross misconduct. Upon termination, or other COBRA qualifying event, the former fellows and any other beneficiary will receive COBRA enrollment information.

Support services provided for Company members and their dependents.

The EONE Benefit Advocate Team (BAT) is not affiliated with, nor 14 Company 2019 Employee Benefits

EMPLOYEE ONE Benefit Solutions 921 E. Fort Ave., Ste. 325 Baltimore, MD 21230

Medicare Part D Notice Important Notice from the employer 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 and 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: 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. The employer has determined that the prescription drug coverage offered by the plan 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. If you lose your current creditable prescription drug coverage, through no fault of your own, you will also be eligible for a two 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 group coverage will not be affected. You and your dependents can keep this coverage if part D is elected and the plan will coordinate with Part D. See pages 7- 9 of the CMS Disclosure of Creditable Coverage To Medicare Part D Eligible Individuals Guidance (available at http://www.cms.hhs.gov/CreditableCoverage/), which outlines the prescription drug plan provisions/options that Medicare eligible individuals may have available to them when they become eligible for Medicare Part D. If you do decide to join a Medicare drug plan and drop your current coverage, be aware that you and your dependents will be able to get this coverage back but you/they may have to wait until the next open enrollment plan.

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 group coverage 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 your HR Manager for further information. It is always best to discuss your personal situation with a Medicare expert when you are considering your options.

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 group coverage changes. You also may request a copy of this notice at any time. 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 or 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).

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