Keswick 2019 Benefits Guide

Your Benefits Medical Dental Vision Life & Disability Spending Accounts And more‌

Benefits Guide

2019

January 1st, 2019 - December 31st, 2019

Introduction Table of Contents Introduction

2

Contacts

3

EONE

4

CoreSource

5

Medical Plans

6-9

Pharmacy

10

Dental

11

Vision

11

FSA

12

Life & Disability

13

Additional Resources

14-16

Annual Notices

17-19

Employee Eligibility All full-time regular status Employees who work 30 or more hours per week are eligible to enroll in the benefits included in this guide. Keswick offers comprehensive, cost effective benefits options. Employees new to Keswick are eligible for coverage on the first of the month following date of hire. You must enroll within 31 days of your eligibility or you forfeit your right to unroll until the following open enrollment.

Part-time regular status Employees who work a minimum of 20 hours are considered eligible for benefits in this guide, excluding life and disability.

Changing Your Elections It is very important to consider your choices carefully before you make your benefit elections. The benefits you choose will be in place from your eligibility date through the end of the plan year, unless you have a qualifying event during the year such as: •

Marriage, Divorce, Legal Separation Birth or adoption of a child

•

Death of a spouse or child

•

You or one of your covered dependents gains or loses other benefits coverage due to a change in employment status Note: For additional information, Qualified Event Definition is determined by www.IRS.gov guidelines.

Dependent Eligibility •

Legal spouse

•

A dependent child under the age of 26 (coverage terminates at the end of the month in which the dependent turns 26)

Note: Under the Patient Protection and Affordable Care Act (PPACA), adult children enrolled under their parent’s medical plan may maintain their coverage until the age of 26, even if they’re a student, married or employed.

2019 Benefits Guide

2

Contacts CoreSource

Medical, Rx, Dental, & Vision

myCoreSource.com (800) 223-3943

Reliance Standard

Life, Disability, & FMLA

Rsli.com (800) 351-7500

Flores & Associates, LLC

Flexible Spending Account (FSA) and COBRA Administration

flores247.com (800) 532-3327

ACI Specialty Benefits – Affinity Online

Employee Assistance Program

Affinity-online.com (800) 532-3327

Principal

401(k) Retirement Plan

(800) 547-7754

Health Advocate

Claims and Procedure Assistance

(866) 695-8622

Keswick Human Resources

Human Resources

Keswick-multicare.org (410) 662-4260

Employee ONE Benefit Solutions

Benefits Advocate Team ID Cards and Eligibility

mybenefits@employee1.net (410) 719-2222 (410) 719-2221 fax

If you have any questions regarding your benefits, please call Heath Advocate at 1-866-695-8622 (8:00 a.m. to 4:00 p.m. EST). Access Health Advocate online 24-hours a day, seven days a week.

Please Note: This booklet provides a summary of the benefits available, but is not your Summary Plan Description (SPD). Keswick reserves the right to modify, amend, suspend, or terminate any plan at any time, for any reason without prior notification. The plans described in this book are governed by insurance contracts and plan documents, which are available for examination upon request. We have attempted to make the explanations of the plans in this booklet as accurate as possible. However, should there be a discrepancy between this booklet and the provisions of the insurance contracts or plan documents, the provisions of the insurance contracts or plan documents will govern.

2019 Benefits Guide

3

EONE Benefit Advocacy Team

Plan Information & Questions Get the answers you’re looking for, and get back to your life.

410-719-2222 or mybenefits@employee1.net

During open enrollment make sure to take advantage of all group communication materials such as: Benefits Guides, Webinars and Open Enrollment Meetings. If you still have questions about your benefits after open enrollment, we’re here to help!

Provider Search If you’re having trouble navigating the carrier-specific Provider Search as indicated in this Benefits Guide, please give us a call! Remember to check your Benefits Guide for network information to help narrow your search.

ID Cards In most cases, you’re able to order and print your ID card (or temporary card) directly from the carrier website. Review your guide for information on how to register online with each carrier – it’s fast and easy!

Note: HIPAA privacy regulations may require the completion of a pre-authorization form prior to releasing information regarding deductible amounts or specific medical conditions (once a HIPAA form is submitted, it may take up to 48 hours before information can be released). Bank account information (including: 401(k), HSA, HRA and FSA) is generally considered classified and we recommend you reach out directly to the account holder.

2019 Benefits Guide

4

CoreSource Administration A Personal Online Gateway to Your Health Plan These days, people do their banking, pay utility bills and shop for just about anything online. It’s secure, fast, easy and convenient. At CoreSource, we believe accessing information about your health plan, and managing your accounts should be no different. That’s why we provide myCoreSource.com, a personal online portal to detailed claims data, out-of-pocket expense tracking, dedicated customer service with speedy responses to your important questions, and much more. Better yet, you can visit the portal to your health plan when it fits your busy schedule – at any time of the day or night.

Take advantage of all that myCoreSource.com has to offer: View claim detail •

Use a variety of filtering and sorting capabilities to help you find specific claims faster, including the ability to sort by patient status, type or service date.

View Custom Content • • •

Site Security and Login • •

Intense security protects members’ information.

Create separate logins for family members, and have the ability to block certain information from other members of the household.

Explanation of Benefits (EOB) • •

Online Message Center • • •

Quick, direct access to Customer Service.

Immediately send questions about a specific claim while viewing it.

Select certain topics so that your important questions are delivered to the appropriate department and answered as quickly as possible.

2019 Benefits Guide

Tailored messages from your employer when needed.

Informational articles on website functions, health and wellness and healthcare consumer advice.

View links and resources personalized to be relevant to your coverage.

•

View information on medical claims and payments made

by CoreSource with secure electronic EOB. Receive a secure e-mail automatically when electronic EOBs become available.

Update the e-mail address receiving secure electronic EOBs at any time.

Receive E-mail Alerts • •

When electronic EOBs are available to view.

Replies to your Message Center questions.

5

Medical Plan Summary Base Plan Summary The CoreSource / Aetna Base Plan allows you to seek care from an in-network participating provider. This plan does not require you to select a Primary Care Physician (PCP) or obtain a referral from your PCP in order to see a specialist.

In-Network Only Annual Deductible

$500 Individual | $1000 Family

Annual Out-of-Pocket Maximum

$3000 Individual | $6000 Family

Physicians Office Visit

$20 Copay

Specialists Office Visit

$30 Copay

Preventive Care Services Well-Child Care (exams & immunizations) Adult Physical Exam (routine GYN) Breast Cancer Screening Pap Test Prostate & Colorectal Cancer Screening

No Charge

Lab and X-ray

Lab $15 Copay | X-ray $30 Copay

Other Diagnostic Testing (Outpatient Facility)

Deductible

Inpatient Hospital Facility Services

20% coinsurance after deductible is met

Outpatient Hospital Facility Services

20% coinsurance after deductible is met

Emergency Room

$300 per visit (waived if admitted)

Urgent Care

$20 per visit

Rehabilitations Services (Physical, Occupational, Speech)

$20 PCP | $30 SPC

Outpatient Spinal Manipulation

$20 PCP | $30 SPC

Mental Health/Substance Abuse

• • •

Inpatient Hospitalization: 20% coinsurance after deductible is met Office Visits: $20 Copay Outpatient Facility: 20% coinsurance after deductible is met

Prescription Drugs Rx Deductible Rx Out-of-pocket Maximum Tier I – Generic Tier II – Preferred Brand Tier III – Non-Preferred Brand Tier IV – Specialty 90 Maintenance Supply

Members have access to the Aetna network of providers

2019 Benefits Guide

$0 ($0 family) $1000 Individual/ $2000 Family $10 copay per script $20 copay per script $50 copay per script 50% to maximum of $100 2x Retail

Note: The information provided is only a partial, general description of plan benefits and does not constitute a contract. In case of a conflict between your plan documents and this information, the plan documents will govern.

6

Medical Plan Summary Buy-Up Plan Summary The CoreSource / Aetna Buy-Up Plan has in-network or out-of-network coverage. If you seek care from an out-of-network provider, you are subject to higher out-of-pocket expenses and balance billing by that provider. This plan does not require you to select a Primary Care Physician (PCP) or obtain a referral from your PCP in order to see a specialist.

In-Network

Out-of-Network

$500 Individual | $1000 Family

$1,000 Individual | $2,000 Family

$3,000 Individual | $6,000 Family

$6,000 Individual | $12,000 Family

Physicians Office Visit

$20 Copay

40% of allowed benefit after deductible

Specialists Office Visit

$30 Copay

40% of allowed benefit after deductible

Preventive Care Services Well-Child Care (exams & immunizations) Adult Physical Exam (routine GYN) Breast Cancer Screening Pap Test Prostate & Colorectal Cancer Screening

No Charge

40% of allowed benefit after deductible

Lab: $15 Copay | X-ray: $30 Copay

40% of allowed benefit after deductible

Other Diagnostic Tests (OP Facility)

20% coinsurance after deductible is met

40% of allowed benefit after deductible

Inpatient Hospital Facility Services

20% coinsurance after deductible is met

40% of allowed benefit after deductible

Outpatient Hospital Facility Services

20% coinsurance after deductible is met

40% of allowed benefit after deductible

Annual Deductible Annual Out-of-Pocket Maximum

Lab and X-ray

Emergency Room

$300 per visit (waived if admitted)

Urgent Care

$30 per visit

Rehabilitations Services (Physical, Occupational, Speech)

$20 PCP | $30 SPC

40% of allowed benefit after deductible

Outpatient Spinal Manipulation

$20 PCP | $30 SPC

40% of allowed benefit after deductible

• Mental Health/Substance Abuse

• •

Inpatient Hospitalization: 20% coinsurance after deductible is met Office Visits: $20 Copay Outpatient Facility: 20% coinsurance after deductible is met

40% of allowed benefit after deductible

Prescription Drugs Rx Deductible Rx Out-of-pocket Maximum Tier I – Generic Tier II – Preferred Brand Tier III – Non-Preferred Brand Tier IV – Specialty 90 Maintenance Supply Members have access to the Aetna network of providers

2019 Benefits Guide

$50 ($100 family) Combined with medical $10 copay per script $20 copay per script $50 copay per script 50% to maximum of $100 2x Retail Note: The information provided is only a partial, general description of plan benefits and does not constitute a contract. In case of a conflict between your plan documents and this information, the plan documents will govern.

7

Medical Plan Comparison Availability of Summary Health Information As an employee, the health benefits available to you represent a significant component of your compensation package. They also provide important protection for you and your family in the case of illness or injury.

Choosing a health coverage option is an important decision. To help you make an informed choice, your plan makes available a Summary of Benefits and Coverage (SBC), which summarizes important information about any health coverage option in a standard format, to help you compare across options. A paper copy is available, free of charge, by contacting your Human Resources Department.

Base Plan

Buy-Up Plan

In-Network

In-Network

Out-of-Network

$500

$500

$1,000

$1,000

$1,000

$2,000

Individual

$3,000

$3,000

$6,000

Family

$6,000

$6,000

$12,000

Preventive Care

No Charge

No Charge

40% of allowed benefit after deductible

PCP Office Visit

$20 Copay

$20 Copay

40% of allowed benefit after deductible

Specialist Office Visit

$30 Copay

$30 Copay

40% of allowed benefit after deductible

No

No

No

Lab: $15 Copay X-ray: $30 Copay

Lab: $15 Copay X-ray: $30 Copay

40% of allowed benefit after deductible

Urgent Care Facility

$20 Copay

$20 Copay

$20 Copay

Hospital Emergency Room (copay waived if admitted)

$300 Copay

$300 Copay

$300 Copay

20% coinsurance after deductible is met

20% coinsurance after deductible is met

40% of allowed benefit after deductible

Deductible Individual Family Out-of-Pocket Maximum

Referral required?

Diagnostic, Lab and X-Ray

Hospital Facility Services Prescription Coverage Rx Deductible

$0 Individual ($0 Family)

$0 Individual ($0 Family)

$1000 Individual/$3000 Family

Combined with Medical

Tier I

$10 copay

$10 copay

Tier II

$20 copay

$20 copay

Tier III

$50 copay

$50 copay

Tier IV

50% to max of $100

50% to max of $100

2 X Retail Copay

2 X Retail Copay

Rx OOP Maximum

90-Day Maintenance

Members have access to the Aetna network of providers

2019 Benefits Guide

Note: The information provided is only a partial, general description of plan benefits and does not constitute a contract. In case of a conflict between your plan documents and this information, the plan documents will govern.

8

How it Works You must meet the plan deductible before the plan will pay for most services.

The steps below highlight how your plan works

Base Plan

Buy-Up Plan

In-Network

In-Network

Out-of-Network

$500 Individual $1,000 Family

$500 Individual $1,000 Family

$1,000 Individual $2,000 Family

Plan pays 100% You pay nothing

Plan pays 100% You pay nothing

(with some exceptions)

(with some exceptions)

Step 1 Meet your deductible You’re responsible for the entire cost of services up to the amount of your deductible. Once your deductible is satisfied, your coverage will become available to you. Some services, such as preventative services, don’t require you to meet a deductible first.

If more than one person is covered on your plan (once the deductible is satisfied) the plan will start to make payments for everyone covered. Any individual will not be required to pay more than $500.

Step 2 Your plan will start to pay for services Calendar Year Deductible. After each eligible family member meets their individual deductible, covered expenses for that member will be paid based on the coinsurance level specified by the plan. Or, after the family deductible has been met, covered expenses for each member will be paid based on the coinsurance level specified by the plan.

Plan pays 60% You pay 40%

Step 3 Your out-of-pocket maximum Your out-of-pocket maximum is the max amount you pay during your benefit period. Your plan deductible, all copays and benefit deductibles contribute towards your out-of-pocket max. After each eligible family member meets his or her individual out of-pocket max, the plan will pay 100% of their covered expenses. Or, after the family out-of-pocket max has been met, the plan will pay 100% of each member’s covered expenses.

$3,000 Individual $6,000 Family

$3,000 Individual $6,000 Individual $6,000 Family $12,000 Family

Track your deductible and out-of-pocket maximums at:

myCoreSource.com

If you have any questions regarding your benefits, contact Health Advocate at:

1-866-695-8622

Members have access to the Aetna network of providers. Find a Doctor at:

Aetna.com

2019 Benefits Guide

9

Pharmacy Benefits ProAct Pharmacy Benefit Manager Retail Pharmacy: • Once you receive a script from your doctor, bring it to the pharmacy to be filled or your doctor may e-scribe to the pharmacy of your choice • Present NEW ID card at the pharmacy • Your prescription will be filled and you will be charged the appropriate copay.

Mail Order Pharmacy • You will need a new prescription from your doctor to begin using the mail order services. They can e-scribe, call-in, or fax it to ProAct pharmacy services.

• Call a Helpdesk rep at 877-635-9545 to set up your home delivery profile and method of payment.

• Script will be filled and you will be charged the appropriate copay. The medication will be mailed directly to your door.

Online Services: • Claims summary • Drug Cost comparison • Pharmacy Finder • Account Info • Formulary Look-up • Mail order status and refill requests

90 day supply for 2x the 30-day supply copay via mail order.

Specialty Pharmacy As part of you healthcare program, you are required to use ProAct’s Specialty pharmacy, Noble Health Services for all specialty medications. Noble Health Service is used to dispense medications used to treat complex and chronic conditions • You will need a new script from your doctor then you may mail, fax, call or e-scribe to Noble Health Services • Upon Enrollment, you will be provided with your own Care Team, who will provide you information and guidance throughout your health and therapy management process.

• Your script will be filled and you be charged the appropriate copay.

1-866-893-6337 $0 Copay for prescriptions shipped to your home Monday to Friday 8:30am - 6:30pm Eastern Time Saturday 9:00am - 5:30pm Eastern Time

Over 300 Brand Name medications, including specialty drugs, are available.

CanaRx International Benefits •

Drugs are sourced from Tier I countries like: UK | Australia | New Zealand | Canada

•

2019 Benefits Guide

You will receive all drugs in the original manufacturer packaging

10

Dental PPO Regular dental care is essential to good health. Keswick provides preferred (PPO) dental coverage through CoreSource with access to the Guardian Dental Guard network of dental providers.

Plan Highlights

• • •

You can visit in-Network and out-of-network dentists Out-of-network providers can balance bill up to full charges National PPO network In-Network

Plan Year Deductible

Out-of-Network $25 Individual / $75 Family

Annual Plan Year Maximum Benefit Preventive Care (such as cleanings, exams, and x-rays) Regular Restorative Care (such as fillings, oral surgery, and root canals)

Major Restorative Care (such as dentures, bridgework and crowns)

$2,000 No Charge

No Charge

20% after deductible

20% after deductible

50% after deductible

50% after deductible

EyeMed Vision Vision coverage through CoreSource provides access to the VSP network of vision care providers.

There are no ID cards for VSP plans, coverage is verified with your SS#..

Base Vision Plan Routine Eye Exam

In-Network

Out-of-Network

$10 Copay

$45 allowance

In-Network Benefits Include: • One vision & eye health evaluation including but not limited to, eye health examination, dilation, refraction, and prescription for glasses.

•

Minimum 20% savings on additional purchases of frames and/or lenses, including lens options, with a valid prescription; offered savings does not apply to contact lens materials. Check with your EyeMed Vision Network Provider for details.

Buy-Up Vision Plan

In-Network

Out-of-Network

Eye Exams (every 12 months)

$10 copay

Up to $45 Reimbursement

$120 Allowance

Up to $96 Reimbursement

No Copay

Up to $52 Reimbursement

$120 Allowance

Up to $96 Reimbursement

Collection Frames (every 24 months) Lenses (every 12 months) Contact Lenses

Minimum 20% savings on additional purchases of frames and/or lenses, including lens options, with a valid prescriptions; offered savings does not apply to contact lens materials. Check with your EyeMed Vision Network Provider for details.

Note: The information provided is only a partial, general description of plan benefits and does not constitute a contract. In case of a conflict between your plan documents and this information, the plan documents will govern.

2019 Benefits Guide

11

Flexible Spending Account Flexible Spending Accounts (FSAs) allow you to be reimbursed for medical and dependent care expenses on a tax-free basis. If you can anticipate your family’s health care and dependent care costs for the next plan year, you may lower your taxable income. Here is how it works. You agree to set aside a portion of your pre-tax salary in the account.

The money comes out of your paycheck over the course of the year. The amount you contribute to the FSA is not subject to Social Security (FICA), federal, state, or local income taxes—effectively adjusting your annual taxable salary. Depending on your tax bracket, you may realize significant savings.

Your dedicated FSA account manager can be reached at 800-532-3327 or online at flores247.com. Log in to your account for real time access to account balance information, pending claim status, reimbursement forms, email your account manager, calculator “what if” scenarios, and more

How it works Use It or Lose It Consider your expenses carefully before you decide how much to contribute to each FSA account. If your eligible expenses for the calendar year turn out to be less than the amount you contributed to your FSA account, federal law requires that the unused balance be forfeited (the “Use it or Lose it” rule). So do not contribute more than you are reasonably certain you will use.

Over-the-Counter (OTC) Drugs The IRS requires a doctor’s note or prescription for reimbursement of OTC products under the Health Care FSA. This requirement applies to items such as cough medicines and pain relievers. Submit a doctor’s prescription when you submit your claim.

Status Change Federal regulation prohibits you from changing your enrollment or the amount of your election during the plan year. You are only eligible to change your elections during the year if you have a status change. Only benefit changes consistent with the change in status are permitted. Status Changes that may warrant a change in benefit elections are described elsewhere in this benefit guide.

If You Leave the Company Your participation in the Flexible Spending Accounts will end on the date of your termination of employment. This means that you may submit for reimbursement any qualified expenses incurred on or before the date of your termination.

You have 90 days after the end of your plan year to file a claim for reimbursement of these expenses. Please refer to your Human Resource Representative for more details.

2019 Benefits Guide

Health Care Account You may pay for certain IRS approved medical care expenses not covered by your insurance plan with pre-tax dollars e.g. co-pays, deductibles, and other out-of-pocket expenses. Under this FSA, the maximum you may contribute each plan year is $2,500.

Dependent Care Account The Dependent Care FSA lets you use pre-tax dollars toward qualified dependent care. The annual maximum amount you may contribute to the Dependent Care FSA per calendar year is $5,000 or $2,500 if married and filing separate tax returns.

The IRS defines an eligible dependent as: •

A child under the age of 13

•

A dependent over the age of 13 who is physically or mentally incapable of self-care, claimed as a dependent on your income tax return

Only the portion of expenses which enable you to remain employed are eligible. Educational expenses are not eligible.

Note: In order for your FSA contributions to be eligible for reimbursement, you must obtain a tax identification or social security number from your provider which will be reported on your federal income tax return.

12

Life & Disability Insurance Available for Full-time Employees Only

Employer Paid Life and AD&D Insurance Keswick provides Basic Life and Accidental Death and Dismemberment (AD&D) at no cost to you.

• Available to eligible full-time employees.

• Benefits are 2x basic annual earnings (rounded up to the next higher $1000) • Maximum of $100,000

Voluntary Life and AD&D Insurance Keswick sponsors a supplemental Life and AD&D plan which allows Employees the opportunity to purchase additional Life and AD&D for yourself, spouse and children at a discounted group rate.

Additional Life and AD&D Insurance for you: • Maximum benefit of 5x your salary up to $500,000 (available in $10,000 increments) • Initial guarantee issue amount of 5x salary up to $150,000 • Cost varies due to age • Evidence of Insurability may be required for late entrants Additional Life and AD&D Insurance for your spouse and children: • Max benefit of $250,000 ($10,000 increments not to exceed 50% of the Employee amount) • Evidence of Insurability may be required for late entrants • Benefits for your child(ren) aged 14 days to 6 months are available up to $250 • Child benefits available from 6 months to 19 (25 if full-time student) are available up to $10,000.

Employer Paid Short Term Disability Keswick provides Short Term Disability Insurance at no cost to you.

• This benefit replaces up to 60% of your weekly earnings should you become disabled • Available after 1 year of employment • Benefits would begin after 8 days for Accidents and Sickness • Benefits may continue for up to 13 weeks • Pre-existing conditions may apply

Employer Paid Long Term Disability Keswick provides Long Term Disability Insurance at no cost to you.

• This benefit replaces up to 60% of your monthly earnings should you become disabled • Available after 1 year of employment • The maximum monthly benefit you may receive is $4,000 • Benefits would begin after you have been disabled for 90 days • Benefits may continue until your normal Social Security retirement age • Contains a pre-existing condition limitation for the first 12 months of coverage

2019 Benefits Guide

13

Additional Benefits Employee Assistance Program Employees and family plan have access to an Employee Assistance Program (EAP) through ACI Specialty Benefits and Affinity Online. Members can call Toll-Free 24/7 help line staffed

by Master's and PhD level counselors and can receive up to 3 face-to-face sessions per incident with a counselor and unlimited telephone and web access. 24/7 Online portal access available through Affinity Online. Services Include: • Emotional and Work/Life concern • Legal Issues • Financial Planning • Personal Coaching

MTA Bus Pass Keswick offers employees the option to purchase a monthly pass with pre-tax dollars. The pass is available in the Human Resources Department.

Tuition Assistance Educational reimbursement to regular full-time and regular part-time employees who meet eligibility requirements and who attend an accredited community or state college institution in Maryland

Vacation Days Vacation days for regular full-time and regular part-time employees are based on their position classification and employment service time

Holidays (Fixed) Fixed holidays throughout the year for regular full-time and regular part-time employees are based on their classification and employment service time

Sick Days Sick days for regular full-time and regular part-time employees are based on their classification and employment service time

Bereavement Leave Up to twenty-four (24) hours of paid leave between the day of death in the employee’s immediate family and the day following the funeral for regular full-time employees. Regular part-time employees bereavement time off is based on their number of scheduled hours

Floating Holidays Up to two (2) floating holidays per year for regular full-time and regular part-time employees based on their classification and employment service.

2019 Benefits Guide

14

Health and Benefits Resources

Available 24/7/365 Talk to a doctor anytime | $40 Copay 1-800-Teladoc | Teladoc.com

Getting Started with Teladoc Teladoc’s U.S. board-certified doctors are available 24/7/365 to resolve many of your medical issues through phone or video consults. Set up your account today so when you need care now, a Teladoc doctor is just a call or click away.

Set Up Your Account It’s quick and easy online. Visit the Teladoc website at Teladoc.com, click “Set up account” and provide the required information. You can also call Teladoc for assistance over the phone.

Request A Consult Once your account is set up, request a consult anytime you need care.

Provide Medical History Your medical history provides Teladoc doctors with the information they need to make an accurate diagnosis.

Health Advocate Keswick participants have access to Health Advocate’s comprehensive Health Advocacy service at no cost. Health Advocate is designed to help you and your family navigate healthcare and insurance-related issues, resolving problems that you may encounter.

During your first call, you will be assigned a Personal Health Advocate who will begin helping you right away.

Personal Health Advocates are registered nurses, supported by medical directors and benefits and claims specialists. They'll help cut through the red tape and assist with complex conditions, find specialists, address eldercare issues, clarify insurance coverage, work on claim denials, help negotiate fees for non-covered services and get to the heart of your issue.

2019 Benefits Guide

15

Commonly Used Terms Allowable charge – sometimes known as the "allowed

Medicare — the federal health insurance program that

amount," or "usual, customary, and reasonable (UCR)" charge, this is the dollar amount considered by a health insurance company to be a reasonable charge for services or supplies based on the rates in your area.

to a plan member for medical costs.

provides health benefits to Americans age 65 and older.

Signed into law on July 30, 1965, the program was first available to beneficiaries on July 1, 1966 and later expanded to include disabled people under 65 and people with certain medical conditions. Medicare has two parts; Part A, which covers hospital services, and Part B, which covers doctor services.

Coinsurance — the amount you pay to share the cost of

Network — the group of doctors, hospitals, and other

covered services after your deductible has been paid. The coinsurance rate is usually a percentage. For example, if the insurance company pays 80% of the claim, you pay 20%.

health care providers that insurance companies contract with to provide services at discounted rates. You will generally pay less for services received from providers in your network.

Benefit — the amount payable by the insurance company

Coordination of benefits — a system used in group health plans to eliminate duplication of benefits when you are covered under more than one group plan. Benefits under the two plans usually are limited to no more than 100% of the claim.

Out-of-network provider — a health care professional,

Copayment — one of the ways you share in your medical

Out-of-pocket maximum — the most money you will

costs. You pay a flat fee for certain medical expenses (e.g., $10 for every visit to the doctor), while your insurance company pays the rest.

pay during a year for coverage. It includes deductibles, copayments, and coinsurance, but is in addition to your regular premiums. Beyond this amount, the insurance company will pay all expenses for the remainder of the year.

hospital, or pharmacy that is not part of a health plan's network of preferred providers. You will generally pay more for services received from out-of-network providers.

Deductible — the amount of money you must pay each year to cover eligible medical expenses before your insurance policy starts paying.

Preferred provider organization (PPO) — a health

Exclusion or limitation — any specific situation,

insurance plan that offers greater freedom of choice than HMO (health maintenance organization) plans. Members of PPOs are free to receive care from both in-network or outof-network (non-preferred) providers, but will receive the highest level of benefits when they use providers inside the network.

condition, or treatment that a health insurance plan does not cover.

Provider — any person (i.e., doctor, nurse, dentist) or

Dependent — any individual, spouse or child, which is covered by the primary insured member’s plan.

institution (i.e., hospital or clinic) that provides medical care.

Exclusive Provider Organization (EPO) — a type of health insurance plan that usually limits coverage to care from doctors who work for or contract with the EPO. It generally won't cover out-of-network care except in an emergency. An EPO may require you to live or work in its service area to be eligible for coverage. EPOs often provide integrated care and focus on prevention and wellness.

Waiting period — the period of time that an employer makes a new Employee wait before he or she becomes eligible for coverage under the company's health plan. Also, the period of time beginning with a policy's effective date during which a health plan may not pay benefits for certain pre-existing conditions

In-network provider — a health care professional, hospital, or pharmacy that is part of a health plan’s network of preferred providers. You will generally pay less for services received from in-network providers due to negotiated discounts for services in exchange for the insurance company sending more patients their way.

For a complete glossary of healthcare terms visit

www.healthcare.gov/glossary

2019 Benefits Guide

16

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.

Keswick 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 Keswick Insurance Team for more information in regards to these criteria and how the coordination of benefits would be determined.

2019 Benefits Guide

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.

17

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).

2019 Benefits Guide

18

New Health Insurance Marketplace Coverage Options PART A: General Information 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 “onestop shopping” to find and compare private health insurance options. You may also be eligible for a new kind of tax credit that lowers your monthly premium right away. Open enrollment for health insurance coverage through the Marketplace begins in October 2015 for coverage starting as early as January 1, 2016.

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

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

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

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

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

How Can I Get More Information?

For more information about your coverage offered by your employer, please check your summary plan description or contact your HR department. The Marketplace can help you evaluate your coverage options, including your eligibility for coverage through the Marketplace and its cost. Please visit HealthCare.gov for more information, including an online application for health insurance coverage and contact information for a Health Insurance Marketplace in your area.

Part B: Information about Health Coverage Offered by Your Employer This section contains information about any health coverage offered by your employer. If you decide to complete an application for coverage in the Marketplace, you will be asked to provide this information. This information is numbered to correspond to the Marketplace application.

Employer Name

Employer Identification Number (EIN)

Employer Address

Employer Phone Number

City

State

Zip Code

Who can we contact about employee health coverage at this job?

Phone number (if different from above)

Email Address

▪ Eligible members regularly scheduled to work more than 30 hours each week.

▪ Dependent coverage - eligible dependents are spouses/domestic partners and children (biological, adopted and step-children) ▪ Coverage meets minimum value standards, and the cost of this coverage to you is intended to be affordable, based on employee wages. ** Even if your employer intends your coverage to be affordable, you may still be eligible for a premium discount through the Marketplace. The Marketplace will use your household income, along with other factors, to determine whether you may be eligible for a premium discount. If, for example, your wages vary from week to week (perhaps you are an hourly employee or you work on a commission basis), if you are newly employed mid-year, or if you have other income losses, you may still qualify for a premium discount. ***

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

2019 Benefits Guide

19