NCIA 2020-2021 Employee Benefits Guide

Employee Benefits Guide

October 1st, 2020 – September 30th, 2021

Provided by:

Your Guide to Benefits Welcome to Your 2020-2021 Benefits!

Contents Eligibility & Enrollment

3

EONE Benefit Advocate Team

4

Medical

5-6

Health Reimbursement Account (HRA)

7

Health Savings Account (HSA)

8

Dental

9

Vision

10

Life Insurance, AD&D, and Disability

11

Employee Assistance Program & Travel Assistance

12

Voluntary Worksite Benefits

13

Flexible Spending Account

14

2020-2021 Employee Contributions

15

Annual Notices Resources

16-18 19

The specific terms of coverage, exclusions and limitations are contained in the Plan Documents and insurance certificates. All coverages and the costs for such coverage for all participants are subject to change at any time in the future. If you have any questions about a specific service or treatment, please contact the appropriate insurer or the People Department.

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2020 Benefits Guide

Eligibility & Enrollment Welcome to Open Enrollment 2020 NCIA strives to provide the best and most flexible plan offerings to its employees and plan members.

Employees are our greatest asset and we consider the investment we make in our benefit offerings as an investment in the health and wellbeing of our employees and their eligible dependents. Please take the time to review this guide in its entirety to see the array of benefits available to you and your dependents.

What’s Changing for 2020-2021? ✓

✓

✓

✓

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NCIA will now offer a Health Savings Account (HSA) with employer funding of $250 for individuals and $500 for families enrolled in the account.

Effective October 1, 2020, NCIA will offer two consolidated dental plans through Dominion National – an Upgraded PPO and an Elite Plus ePPO. NCIA is now offering enhancements to your vision plan – including increased frame and contact lens allowances.

Discovery Benefits will be your administrator for your HRA, HSA, FSA, and COBRA plans.

Learn more about Discovery here: www.discoverybenefits.com

Who is Eligible?

All eligible full-time employees who work at least 30 hours per week, and their eligible dependents as described below, are eligible for the benefits outlined in this benefit guide.

When Coverage Begins For New Employees Your coverage begins the first of the month following sixty (60) days of employment for regular full-time employees. You will need to complete your benefit elections within 60 days of your effective date.

When Coverage Ends If your employment ends, your medical, dental and vision coverage will end on the last day of the month of your separation. Depending upon the circumstances of your termination, you may be able to continue coverage under COBRA. Other circumstances which may result in termination of you or your dependents coverage include: •

Reduction in your regular hours

•

Divorce or legal separation

•

Dependent children who reach age 26

Eligible Dependents •

Your spouse (unless you are legally separated) or Domestic Partner

•

Your unmarried or married dependent children up to age 26 (Medical, Dental, and Vision)

Qualifying Events •

Change in marital status (divorce, marriage, death, legal separation)

•

Change in number of dependents (birth, death, adoption, child support order or eligibility status)

•

Change in employment status (termination, part-time, full-time status)

•

Spouse’s open enrollment

2020 Benefits Guide

EONE BAT Team

You have questions.

We’re here to help! mybenefits@eonebenefits.com 1-877-719-EMP1(3671) Mon – Fri 9:00am – 5:00pm EST

Benefit Advocate Team The EONE Benefit Advocate Team (BAT) provides answers to employee’s day-to-day questions on their group health and welfare benefits. Employees have direct access to our team by emailing mybenefits@eonebenefits.com or calling 1-877-719-EMP1(3671) and we take it from there. BAT has direct access to the systems and insurance carrier contacts needed to resolve issues that can range from minor to complex. Some examples are:

Explaining benefits coverage The EONE BAT Team can explain and help you understand the details of your medical, dental, vision and life and disability plans so you can maximize your benefits.

Explanation of benefits (EOB) Navigating the information on the EOB can be overwhelming. EONE’s BAT Team has direct access to most carrier EOB’s and the knowledge to review with you.

Resolving claims and provider billing issues The EONE BAT Team will research and advocate on your behalf to ensure claims have been accurately processed and the provider bill is accurate to eliminate overpayments to the provider.

Locating participating providers Employees have access to the carrier sites, but we are happy to review providers to ensure in-network participation with your current plan.

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2020 Benefits Guide

Medical

HDHP Signature Plan 4

Flex Choice Signature Plan 20

Kaiser Centers

Kaiser Centers

$1,500 $3,000

$1,500 $3,000

$3,000 $6,000

$4,000 $8,000

$3,500 $7,000

$3,000 $6,000

$3,650 $7,300

$8,000 $16,000

100%

90%

80%

60%

Preventive Care

0%

0%

0%

Ded. then 20%

PCP Office Visit

Ded. then 0%

Ded. then 10%

Ded. then 20%

Ded. then 40%

Specialist Office Visit

Ded. then 0%

Ded. then 10%

Ded. then 20%

Ded. then 40%

Diagnostic, Lab and X-Ray

Ded. then 0%

Ded. then 10%

Ded. then 20%

Ded. then 40%

Imaging: CT, PET scan, MRIs

Ded. then 0%

Ded. then 10%

Ded. then 20%

Ded. then 40%

Ded. then 50%; $100,000 lifetime

Ded. then 20%; $100,000 lifetime

Ded. then 40%; $100,000 lifetime

max; 3 procedures / live birth

max; 3 procedures/ live birth

max; 3 procedures/ live birth

max; 3 procedures/ live birth

$100 copay

Ded. then 10%

Ded. then 20%

Ded. then 40%

Ded. then 0%

$100 copay

Covered in Option 1

Covered in Option 1

Outpatient Surgery

Ded. then 20%

Ded. then 10%

Ded. then 20%

Ded. then 40%

Inpatient Hospital Services

Ded. then 0%

Ded. then 10%

Ded. then 20%

Ded. then 40%

KP

PHCS Network

Out-of-Network

PHCS Network

Out-of-Network

Deductible Individual Family (emb) Out-of-Pocket Maximum Individual Family (emb/non-emb) Coinsurance (what the plan pays)

Infertility Assistive Reproductive Technology

Ded. then 50%; $100,000 lifetime

Urgent Care Facility Hospital Emergency Room (copay waived if admitted)

Prescription Coverage KP

Community Pharmacy

Generic 30-day

$25

$35

$5

$15

$25

Preferred Brand 30-day

$35

$55

$20

$35

$55

Non-Preferred Brand 30-day

$50

$70

$55

$75

$75

Medical Deductible Applies

Retail 90-day

2x KP copay

2x KP copay

Mail Order 30-day

1x KP copay

1x KP copay

Mail Order 90-day

2x KP copay

2x KP copay

This booklet is intended to provide an overview of the benefits plans offered.. All specific plan provisions are described in the legal documents governing the plans. If there are any discrepancies between this booklet and the plan’s legal documents, the legal documents will govern.

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2020 Benefits Guide

Medical

NCIA offers an Out-of-Area (OOA) plan to employees located in North Carolina. To find out if you fit NCIA’s OOA benefit profile, please contact HR.

Out-of-Area (OOA) Kaiser Centers

Out-of-Network

$500 $1,000

$1,000 $2,000

$4,000 $8,000

$8,000 $16,000

Coinsurance (what the plan pays)

80%

60%

Preventive Care

0%

Ded. then 20%

PCP Office Visit

$20 copay

Ded. then 40%

Specialist Office Visit

$30 copay

Ded. then 40%

Diagnostic, Lab and X-Ray

$20 copay

Ded. then 40%

Ded. then 20%

Ded. then 40%

Urgent Care Facility

$30 copay

Ded. then 40%

Hospital Emergency Room (copay waived if admitted)

$100 copay

$100 copay

Outpatient Surgery

Ded. then 20%

Ded. then 40%

Inpatient Hospital Services

Ded. then 20%

Ded. then 40%

Deductible Individual Family (emb)

Out-of-Pocket Maximum Individual Family (emb/non-emb)

Imaging: CT, PET scan, MRIs

Prescription Coverage KP Generic 30-day

$15

$25

Preferred Brand 30-day

$35

$50

Non-Preferred Brand 30-day

$60

$80

Retail 90-day

2x KP copay

2x KP copay

Mail Order 30-day

1x KP copay

1x KP copay

Mail Order 90-day

2x KP copay

2x KP copay

This booklet is intended to provide an overview of the benefits plans offered.. All specific plan provisions are described in the legal documents governing the plans. If there are any discrepancies between this booklet and the plan’s legal documents, the legal documents will govern.

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2020 Benefits Guide

Health Reimbursement Account (HRA) The HRA is designed to help members reduce their out-of-pocket costs for eligible medical expenses that apply to your annual deductible if you elect coverage in the Kaiser HDHP Signature 4 and the Flex Choice Signature Plan 20.

NCIA will fund $500 for Individuals and $1,000 for Families under the Health Reimbursement Arrangement.

Discovery Benefits will administer these accounts. Once claims are processed, any HRA claims are then processed by Discovery and paid directly to your medical providers or to the Pharmacies.

Members are responsible for covering any difference between the HRA account and their deductible.

Please note: the HRA will no longer be the default pre-tax account because NCIA now offers the Health Savings Account (HSA) as the default. Employees are able to select either the HSA or the HRA. For additional details on the HSA, see next page.

Basic HRA Concept Part I: High deductible health plan Health Insurance plan which pays benefits once the initial deductible is met.

Part II: Health Reimbursement Account (HRA) Funded by NCIA: $500 for Individual / $1,000 for Family

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2020 Benefits Guide

Health Savings Account (HSA) NCIA offers a default Health Savings Account (HSA) via payroll deduction to enrolled employees who elect the HSA instead of the HRA. By selecting the HSA, employees will save on payroll taxes.

NCIA will also contribute $250 to Individuals and $500 to Families with the HSA.

NEW THIS YEAR

Deposit, Grow, Save and Pay. Deposit your health care dollars • •

Deposits — Deposit forms, website and online transfers from your bank.

Contribution limits — The IRS sets guidelines for how much you can contribute to an HSA each year. In addition to NCIA’s contribution to your account, you are able to voluntarily contribute up to the individual, family, and catch-up amounts that you can find in the table below.

Grow your savings • •

Earnings — Deposits to your HSA could earn income tax-free interest.

Carry-over — There is no “use it or lose it.” Unspent funds remain in your account.

Save on taxes • • •

Contributions — Contributions to your HSA are tax-deductible up to the annual limit.

Distributions — HSA funds used to pay for qualified medical expenses are tax-free.

Earnings — Interest you may earn on your HSA grows income tax free.

Pay for health care, now or later • • •

Qualified medical expenses — Pay for current and future medical expenses for you, your spouse and your eligible dependents. You can continue to use the funds in your account even if you stop participating in a high-deductible health plan (although you cannot contribute more to it).

Payment methods — Use your debit card to pay pharmacies, doctors, clinics and other health care providers on the spot.

Or, withdraw funds to reimburse yourself for out-of-pocket expenses.

Tax implications — It’s up to you to maintain records to verify that funds were used for qualified medical expenses. Funds used for nonqualified expenses will be taxed as income and subject to a 20% penalty. If you are 65 and older, the 20% penalty does not apply.

Annual HSA Contribution Limits The IRS sets HSA contribution limits for each calendar year. These limits include employer contributions as well as any contributions you make through payroll deductions.

When you are age 55 or older, you’re also eligible to make “catch-up” contributions which allow employees closer to retirement to save more for post-retirement medical expenses. The HSA catch-up contribution limit is $1,000.

Calendar Year 2020 / 2021 HSA Contribution Limits* If you…

Have employee only coverage Cover dependents Are age 55+ and have employee-only coverage* Are age 55+ and cover dependents*

You may contribute up to… $3,550 / $3,600 $7,100 / $7,200 $4,550 / $4,600 $8,100 / $8,200

* If you do not contribute the max in your base HSA, the catch-up contribution won't be as meaningful because it is meant to allow you to contribute more than the annual limit *Not everyone is eligible to participate in an HSA. If you are enrolled in TRICARE, Medicare Part A, or another plan that is not a high deductible health plan, you are not eligible to enroll in an HSA.

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2020 Benefits Guide

Dental

NEW THIS YEAR Effective October 1, 2020, NCIA will offer two National dental plans – an Elite Plus ePPO and an Upgraded PPO

Dominion National Dental Elite Plus ePPO

Upgraded PPO

In-Network

In-Network

Out-of-Network

$25 / $75

$50 / $100

$50 / $100

$2,000

$2,000

$2,000

Preventive & Diagnostic

Fee Schedule

0%

20%

Basic Restorative

Fee Schedule

20%

20%

Major Restorative

Fee Schedule

50%

50%

Orthodontia (Adult and Child)

Not Covered

50%

50%

Orthodontia Lifetime Max

Not Covered

$2,000

$2,000

Plan Year Deductible (Individual / Family) Annual Plan Year Maximum Benefit

This booklet is intended to provide an overview of the benefits plans offered.. All specific plan provisions are described in the legal documents governing the plans. If there are any discrepancies between this booklet and the plan’s legal documents, the legal documents will govern.

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2020 Benefits Guide

Vision

NEW ENHANCED BENEFITS EyeMed Vision Insight Network In-Network

Out-of-Network

$10 Copay

Up to $45

Single

$25 copay

Up to $40

Bifocal

$25 copay

Up to $60

Trifocal

$25 copay

Up to $80

Lenticular

$25 copay

Up to $80

$150 allowance; 20% savings on the amount over your allowance

Up to $104

$150 allowance; 15% savings on the amount over your allowance. Contact lens exam (fitting and evaluation) – Up to $40

Up to $130

Eye Exam (once every 12 months) Lenses (once every 12 months)

Frames (one pair every 12 months) Contact Lenses (once every 12 months)

This booklet is intended to provide an overview of the benefits plans offered.. All specific plan provisions are described in the legal documents governing the plans. If there are any discrepancies between this booklet and the plan’s legal documents, the legal documents will govern.

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2020 Benefits Guide

Life Insurance, AD&D, and Disability

Benefit

Details

Basic Life Insurance and AD&D

NCIA offers Basic Life and AD&D at no cost to active employees who regularly work at least 30 hours each week.

Your Basic Life benefit amount is equal to your annual base salary up to $50,000. AD&D pays a benefit that is 100% of annual earnings up to $100,000.

Supplemental Life Insurance and AD&D

Active employees working at least 30 hours per week can purchase additional Life and AD&D coverage beyond what NCIA provides. Employees can elect coverage in increments of $10,000 to a maximum of $300,000. Rates are based on age and amount of coverage – please contact The Standard for further information.

Spouse Supplemental Life and AD&D Insurance

Active employees can purchase optional dependent life and AD&D for their spouse. The elected benefit can be purchased in increments of $5,000 to a maximum of $150,000. Rates are based on age and amount of coverage – please contact The Standard for further information.

Dependent Supplemental Life and AD&D Insurance

Active employees can purchase optional dependent life and AD&D for their children. The elected benefit can be purchased as $10,000 for children aged 14 days to age 19 or 26 if they are a full-time student. Rates are based on age and amount of coverage – please contact The Standard for further information.

Short-Term Disability

NCIA offers Short-Term Disability at no cost to active employees who regularly work at least 30 hours each week.

Your STD benefit begins after a 14-day unpaid waiting period and has a maximum duration of 24 weeks.

Long-Term Disability

NCIA offers Long-Term Disability at no cost to active employees who regularly work at least 30 hours each week.

The benefits begin after 180 days of disability and the maximum benefit duration is 5 years.

This booklet is intended to provide an overview of the benefits plans offered.. All specific plan provisions are described in the legal documents governing the plans. If there are any discrepancies between this booklet and the plan’s legal documents, the legal documents will govern.

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2020 Benefits Guide

Employee Assistance Program There are times in life when you might need a little help coping or figuring out what to do. Take advantage of the Employee Assistance Program, which includes WorkLife Services and is available to you and your family in connection with your group insurance from The Standard. It’s confidential; information will be released only with your permission or as required by law.

We’re here to help The Standard’s EAP assists employees and their eligible dependents with personal or job-related concerns including: ➢ Depression, grief, loss and emotional wellbeing ➢ Family, marital and other relationship issues ➢ Life improvement and goal-setting ➢ Addictions such as alcohol and drug abuse ➢ Stress or anxiety with work or family ➢ Financial and legal concerns ➢ Identity theft and fraud resolution ➢ Online will preparation

EAP Benefits ➢ Unlimited telephone access to EAP professionals 24 hours a day, seven days a week by phone, online, live chat, email and text. There’s even a mobile EAP app. ➢ Telephone assistance and referral ➢ Service for employees and eligible dependents ➢ Legal assistance ➢ Resources for: ➢ Reducing your Medical/ Dental Bills ➢ Substance abuse and other addictions ➢ Dependent and elder care assistance & referral services To access these resources simply go to workhealthlife.com/Standard3 or call 888-293-6948.

Travel Assistance Program Things can happen on the road. Passports get stolen or lost.

Unforeseen events or circumstances derail travel plans.

Medical problems surface at the most inconvenient times.

Travel Assistance can help you navigate these issues and more at any time of the day or night.

You and your spouse are covered with Travel Assistance – and so are your kids through age 25 – with your group insurance from The Standard.

Don’t Forget this Travel Essential: ➢ 800-872-1414 United States, Canada, Puerto Rico, U.S. Virgin Islands and Bermuda ➢ +1-609-986-1234 Everywhere else ➢ Text: +1-609-334-0807 ➢ Email: medservices@assistamerica.com ➢ Reference number: 01-AA-STD-5201

What to expect You can trust your EAP professional to assess your needs and handle your concerns in a confidential, respectful manner. Our goal is to collaborate and find solutions that are responsive to your needs.

If additional services are needed, your EAP will help locate appropriate resources in your area.

Don’t delay if you need help. Visit workhealthlife.com/Standard3 or call 888-293-6948 for confidential consultation and resource services.

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2020 Benefits Guide

Voluntary Worksite Benefits NCIA provides employees with the option to enroll in voluntary Group Accident Insurance, Critical Illness Insurance, Hospital Indemnity Insurance, and Whole Life Insurance through Unum. The cost of these benefits depends on the type and coverage selected. Employees pay 100% of the cost through payroll deduction. Please contact UNUM with any questions at unum.com or call 866-679-3054.

Benefit Group Accident Insurance

Critical Illness Insurance

Details Unum’s coverage provides a lump sum benefit based on the type of injury (or covered incident) you sustain or the type of treatment you need. Accident Insurance can provide benefits for covered accidents that occur on and off the job. It is offered to all eligible employees who are actively at work. You decide if it’s right for you and your family.

How can Critical Illness insurance help?

Critical Illness insurance can pay a lump sum benefit at the diagnosis of a critical illness. You can choose to purchase $5,000 to $50,000 of coverage in increments of $1,000 – and you can use the money any way you see fit.

Covered Conditions Include: Heart attack, Major organ failure, Occupational HIV, Benign brain tumor, Blindness, End-stage renal (kidney) failure, and Coronary artery bypass surgery (pays 25% of lump sum benefit).

Covered Conditions with Time Limitations: Stroke, Coma, and Permanent paralysis.

Cancer Conditions: Carcinoma in situ, pays 25% of lump sum benefit.

Hospital Indemnity Insurance pays a benefit when you are admitted to the hospital for a covered hospital stay. This coverage can complement your health insurance to help you pay for the costs associated with a hospital stay. It can also provide funds that can be used to help pay the out-ofpocket expenses your medical plan may not cover, such as coinsurance, copays, and deductibles.

Hospital Indemnity Insurance

Group hospital indemnity provides a benefit for hospital admission and can be tailored to include benefits for events like ER visits, hospital confinement, intensive care stays, and ambulance transportation. Benefits are payable directly to employees; you can use the money for co-pays, coinsurance and deductibles - or however else you choose.

It’s also affordable! You get lower rates because this is purchased through the workplace and the premiums are paid with convenient payroll deduction.

Whole Life Insurance

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Whole Life Insurance provides much more than a death benefit – it also offers valuable “living benefits” that you can use during times of need. You can keep your Whole Life coverage after you retire, making it an essential complement to Term Life.

What features are available? ➢ Cash value: This policy accumulates cash value. You can borrow funds from this value as needed. ➢ Living benefit option rider: If you are diagnosed with a terminal illness, you can require up to 100% of your policy’s benefit amount and use it for any purpose. ➢ Long term care benefits: Your policy may include a long-term care rider - see your plan administrator. ➢ Coverage for dependents: You may elect individual coverage, or a term life benefits for your spouse and/or dependent child(ren).

2020 Benefits Guide

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.

Log in to your account for real time access to account balance information, pending claim status, reimbursement forms, calculate “what if” scenarios, and more.

How it works Use It or Lose It

Health Care Account

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.

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 $1,000.

Over-the-Counter (OTC) Drugs

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 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.

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Dependent Care Account

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.

Limited Purpose Account The Limited Purpose FSA lets employees enrolled in the HSA use pre-tax dollars toward qualified vision, dental, and preventative care expenses before meeting the insurance deductible. The annual maximum you may contribute to the Limited Purpose FSA per calendar year is $1,000.

2020 Benefits Guide

2020-21 Employee Contributions Total Monthly Premium

Employee Contribution

NCIA Contribution

Employee Only

$379.93

$98.78

$281.15

Employee and Spouse

$874.30

$349.72

$524.58

Employee and Child(ren)

$703.45

$281.38

$422.07

$1,028.33

$411.33

$617.00

$840.53

$647.21

$193.32

Employee and Spouse

$1,934.31

$1,605.48

$328.83

Employee and Child(ren)

$1,556.33

$1,291.75

$264.58

Employee and Family

$2,356.43

$1,955.84

$400.59

$739.06

$98.78

$640.28

Employee and Spouse

$1,700.79

$349.72

$1,351.07

Employee and Child(ren)

$1,368.43

$281.38

$1,087.05

Employee and Family

$2,071.94

$411.33

$1,660.61

Total Monthly Premium

Employee Contribution

NCIA Contribution

Employee Only

$14.22

$7.04

$7.18

Employee and Spouse

$27.72

$20.41

$7.31

Employee and Child(ren)

$28.86

$21.54

$7.32

Employee and Family

$41.52

$34.06

$7.46

Employee Only

$24.58

$14.75

$9.83

Employee and Spouse

$45.56

$32.80

$12.76

Employee and Child(ren)

$51.90

$37.37

$14.53

Employee and Family

$73.32

$60.12

$13.20

Total Monthly Premium

Employee Contribution

NCIA Contribution

$5.90

$2.95

$2.95

Employee and Spouse

$11.21

$8.25

$2.96

Employee and Child(ren)

$11.80

$8.85

$2.95

Employee and Family

$17.34

$14.40

$2.94

Medical Kaiser HDHP 4 Signature

Employee and Family

Kaiser Flex Choice V Employee Only

Kaiser OOA PPO Employee Only

Dental Dominion Elite Plus ePPO

Dominion Upgraded PPO

Vision EyeMed Vision Insight Employee Only

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2020 Benefits Guide

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.

NCIA 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 NCIA Human Resources department for more information in regards to these criteria and how the coordination of benefits would be determined.

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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.

2020 Benefits Guide

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 Department 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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2020 Benefits Guide

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 November 2018 for coverage starting as early as January 1, 2020.

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 9.86% 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 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.

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2020 Benefits Guide

Resources Benefit

Phone

Website

Kaiser Permanente Medical, Dental, and HSA

800-777-7902

www.kp.org

Dominion National Dental Dental

888-518-5338

www.dominionnational.com

EyeMed Vision

866-939-3633

www.eyemedvisioncare.com

The Standard Life, AD&D, Disability

800-428-2938

www.standard.com

Discovery Benefits Flexible Spending Accounts Health Reimbursement Account (HRA) Health Savings Account (HSA)

866-451-3399

www.discoverybenefits.com

The Standard Employee Assistance Program (EAP)

888-293-6948

www.workhealthlife.com

Unum Voluntary Worksite Benefits

800-635-5597

www.unum.com

Human Resources - Benefits Team

443-780-1300

ncianet.org/company-culture/contact/

Toll free: 877-719-EMP1

myBenefits@eonebenefits.com

Employee One Benefit Solutions Benefit Advocate Team (BAT) Claims Resolution General Plan Information

Have a Happy, Healthy Plan Year!

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2020 Benefits Guide