35 minute read
Rates and Important Enclosures
Benefit Rates
Employee Assistance Program (EAP) — Overview
Advertisement
Quit for Life — Tobacco Cessation Program
Optum HSA — Overview
Optum HSA — FAQs
OptumRx Mail Order Prescription Form
CHIP Notice
Notice of Privacy Practices
Creditable Coverage Notice
Kao America Inc. Kao USA/Molton Brown-Office/Remote/Oribe/WSI/Collins
2022 Employee Bi-Weekly Contributions: Medical, Dental and Vision Benefits Rates effective January 1, 2022
Benefit Type
UHC PPO Plan
UHC HDHP Plan Coverage Level Bi-Weekly Payroll Deduction
Non‐Tobacco Tobacco
Single 40.00 60.00 Employee +1 170.00 190.00
Family 245.00 265.00
Single Employee +1 15.00 60.00 35.00 80.00
Family 110.00 130.00
MetLife Dental
VSP Vision
Single Employee + 1 Family
Single Employee +1 Family 4.29 9.90 14.53
4.82 8.09 10.30
As part of KAI’s continuing wellness opportunities, KAI offers a Quit For Life® Tobacco Cessation Program. This program is available to all employees, at no cost, who currently use tobacco products. Enrollment and active participation in the program will qualify an employee to receive the discounted (non-tobacco) medical plan rate.
Please contact the KAI Benefits Department at 1-800-650-8180 for more information.
Contact Us... Anytime, Anywhere
No-cost, confidential solutions to life’s challenges.
Confidential Emotional Support
Our highly trained, local clinicians will listen to your concerns and help you or your family with any issues. Up to six counseling sessions are now available for each issue at no cost. Talk to us for: • Anxiety, depression, stress • Grief, loss and life adjustments • Relationship/marital conflicts
Online Support
GuidanceResources® Online is your 24/7 link to vital information, tools and support. Log on for: • Articles, podcasts, videos, slideshows • On-demand trainings • “Ask the Expert” personal responses to your questions Your ComPsych® GuidanceResources® program offers someone to talk to and resources to consult whenever and wherever you need them.
Call: 866.624.2822 TTY: 800.697.0353
Your toll-free number gives you direct, 24/7 access to a GuidanceConsultantSM , who will answer your questions and, if needed, refer you to a counselor or other resources.
Log on today to connect directly with a GuidanceConsultant about your issue or to consult articles, podcasts, videos and other helpful tools.
24/7 Support, Resources & Information
Enhanced EAP:
Up to six counseling sessions are now available to you and your household family members for each issue at no cost.
Contact Your GuidanceResources® Program
Call: 866.624.2822 TTY: 800.697.0353 Online: guidanceresources.com App: GuidanceNowSM Web ID: KAOEAP
It’s time to plan for a healthier future.
When you quit tobacco, good things start to happen. Your lungs begin to heal and you regain your sense of taste and smell. Best of all, your risk for heart disease, stroke and lung cancer may be dramatically reduced, which may lead to an average life expectancy that is 10 years longer than if you had kept smoking.1 Quit For Life® is a clinically proven program that offers a customized quit plan, 24/7 personal support and strategic tools to help you manage cravings.
Choose Quit For Life during open enrollment.
DID YOU KNOW?
Getting started is as simple as downloading the Quit For Life mobile app
Apple, App Store and the Apple logo are registered trademarks of Apple Inc. Google Play and the Google Play logo are trademarks of Google LLC. All other trademarks are the property of their respective owners.
quitnow.net
1-866-QUIT-4-LIFE TTY 711
1American Cancer Society. Benefits of Quitting Smoking Over Time. cancer.org/healthy/stay-away-from-tobacco/benefits-of-quitting-smoking-over-time.html (Updated 11/2018). Accessed March 6, 2019. Provided at no additional cost as part of your benefits plan. The Quit For Life® Program provides information regarding tobacco-cessation methods and related well-being support. Any health information provided by you is kept confidential in accordance with the law. The Quit For Life® Program does not provide clinical treatment or medical services and should not be considered a substitute for your doctor’s care. Participation in this program is voluntary. If you have specific health care needs or questions, consult an appropriate health care professional. This service should not be used for emergency or urgent care needs. In an
emergency, call 911 or go to the nearest emergency room.
Optum is a registered trademark of Optum, Inc. © 2019 Optum, Inc. All rights reserved. WF607673 131345-032019
Introduction to health savings accounts
A health savings account (HSA) allows you to save money for qualified medical expenses that you’re expecting, such as contact lenses or monthly prescriptions, as well as unexpected ones — for this year and the future.
Why have an HSA?
You own it
The money is yours until you spend it — even deposits made by others, such as an employer or family member. You keep it, even if you change jobs, health plans or retire.
Tax savings
HSAs help you plan, save and pay for health care, all while saving on taxes.
• The money you deposit is tax advantaged. • Savings grow income tax-free. • Withdrawals for qualified medical expenses are also income tax-free.
It’s not just for doctor visits
Once you’ve contributed to your account, you can use the funds in your HSA to pay for qualified medical expenses such as: • Dental care, including extractions and braces • Vision care, including contact lenses, prescription sunglasses and
LASIK surgery • Prescription medications • Certain over-the-counter drugs and medications • Chiropractic services • Acupuncture
Contribution limits
There are contribution limits, set by the Internal Revenue Service (IRS) and adjusted annually.
These limits are: • $3,600 for individual coverage in 2021; $3,650 in 2022 • $7,200 for family coverage in 2021; $7,300 in 2022 • $1,000 extra if you’re 55 or older, also known as catchup contributions
Save for the future
Your HSA rolls over from year to year, so you can continue to grow your savings and use it in the future — even into retirement.
Who can open an HSA?
To be an eligible individual and qualify for an HSA, you must have a qualifying high-deductible health plan (HDHP) that meets IRS guidelines for the annual deductible and out-of-pocket maximum.
In addition, you must: • Be covered under a qualifying HDHP on the first day of a given month. • Not be covered by any other health plan except what is permitted (dental, vision, disability and some other types of additional coverage are permissible). • Not be enrolled in Medicare, TRICARE or TRICARE for Life. • Have not received Department of Veterans Affairs (VA) benefits within the past three months, except for preventive care. If you are a veteran with a disability rating from the VA, this exclusion does not apply. • Not be claimed as a dependent on someone else’s tax return. • Not have a health care flexible spending account (FSA) or health reimbursement account (HRA). Alternative plan designs, such as a limited-purpose FSA or HRA, might be permitted. Other restrictions and exceptions also apply. Consult a tax, legal or financial advisor to discuss your personal circumstances.
Open your account
Check with your employer or benefits specialist to learn about your company’s application process. You may be able to sign up through your employer or enroll at optumbank.com. You cannot use your HSA to pay for medical expenses you had before you opened your account — so be sure to open your HSA as soon as you are eligible. And be sure to save your receipts! For a full list of qualified medical expenses, visit optumbank.com/qualifiedexpenses.
Have questions?
Visit optumbank.com or download the mobile app.
optumbank.com
Contributions add up quickly
When Marcus started his new job, he decided to open an HSA and contribute $100 per month. Because he hasn’t had many medical expenses, he decided not to touch the balance during his first year. Here’s how his contributions added up:
Monthly contribution: $100 Annual contribution: $1,200 Annual income tax savings1:
$440
Use the HSA Calculator on optumbank.com to help determine your contributions and see how much you can save on taxes. Open your HSA today.
Download the Optum Bank app
Enjoy an easier way to manage your health savings account. You can pay bills, view transactions, upload receipts and more. Download today on your Apple or Android device.
1 Assuming a 24% federal income tax, 5% state tax and 7.65% FICA. Results and amount will vary depending on your particular circumstances.
Health savings accounts (HSAs) are individual accounts offered or administered by Optum Bank® Member FDIC, a subsidiary of Optum Financial, Inc., and are subject to eligibility requirements and restrictions on deposits and withdrawals to avoid IRS penalties. State taxes may apply. Fees may reduce earnings on account. This communication is not intended as legal or tax advice. Federal and state laws and regulations are subject to change.
Apple, the Apple logo, Apple Pay, Apple Watch, iPad, iPhone, iTunes, Mac, Safari, and Touch ID are trademarks of Apple Inc., registered in the U.S. and other countries. iPad Pro is a trademark of Apple Inc. Android, Google Play and the Google Play logo are trademarks of Google LLC. Data rates may apply.
Frequently asked questions: HSAs
What are the benefits of a health savings account (HSA)?
HSAs are tax-advantaged accounts that help people save and pay for qualified medical expenses. Benefits include: • Contributions are pre-tax or tax deductible. • Earnings are income tax-free. • You can make income tax-free withdrawals for qualified medical expenses. • You can carry over unused available funds from year to year. • The HSA is yours to keep even if you change jobs, change health plans or retire.
Note: Contributions are tax deductible on your federal tax return. Some states do not recognize HSA contributions as a deduction, and some states tax interest earned on your HSA. Your own HSA contributions are either tax deductible or pre-tax (if made by payroll deduction). See IRS Publication 969, or consult a qualified tax advisor to see how your state treats HSA contributions.
Who qualifies for an HSA?
To open an HSA, you must have a qualifying highdeductible health plan (HDHP) and meet other IRS eligibility requirements, unless an exception applies. • You cannot be covered by any other health plan that is not an HDHP. • You cannot be currently enrolled in Medicare or TRICARE. • You cannot be claimed as a dependent on another individual’s tax return.
What is a qualifying HDHP?
This is a health plan that satisfies certain IRS requirements with respect to deductibles and out-of-pocket expenses.
Year Annual deductible Out-of-pocket expenses
2021 At least $1,400 for individual coverage and $2,800 for family coverage Not exceeding $7,000 for individual coverage and $14,000 for family coverage
At least $1,400 for individual coverage and $2,800 for family coverage Not exceeding $7,050 for individual coverage and $14,100 for family coverage
What happens to my remaining account balance at the end of the year?
Any remaining balance automatically rolls over year after year.
What can I use my HSA for?
You can use the funds in your HSA: • To pay for qualified medical, dental, vision and prescription drug expenses, including certain overthe-counter drugs and medications, as defined in IRS
Publications 502 and 969. • As supplemental income after age 65. Once you are 65, you can withdraw funds for any reason without paying a penalty, but they will be subject to ordinary income tax. If you are under age 65 and use your HSA funds for nonqualified expenses, you will need to pay taxes on the money you withdraw, as well as an additional 20% penalty.
Can I use my HSA to pay for qualified medical expenses for a spouse or tax dependent?
Yes, even if your spouse or tax dependent is covered under another health plan. To get personalized details, consult a qualified tax advisor.
Are health insurance premiums considered qualified medical expenses?
In general, no, but exceptions include qualified long-termcare insurance, COBRA health care continuation coverage, any health plan maintained while receiving unemployment compensation under federal or state law and, for those 65 and over (whether or not they are entitled to Medicare), any employer-sponsored retiree medical coverage premiums for Medicare Part A or B or Medicare HMO. Conversely, premiums for Medigap policies are not qualified medical expenses.
Can I invest my HSA dollars?
Yes, you can choose to invest your HSA dollars once you reach your investment threshold. Visit optumbank.com for more details.
What happens to my HSA if I no longer am covered by a qualifying high-deductible plan (HDHP).
While you can no longer contribute to your HSA, you can still use the remaining funds to pay or be reimbursed for future qualified medical expenses.
How much can I contribute to an HSA?
The IRS sets annual contribution limits each year.
Year Individual coverage Family coverage
2021 $3,600 $7,200
2022 $3,650 $7,300
Note that any contributions made to your HSA by family members, your employer or others count toward this limit. If you are 55 or older, you can contribute an additional $1,000 each year. Note: The primary account holder must be 55 or older (even if the spouse is of that age).
How can I make contributions?
There are three ways to make a deposit: • Payroll deductions through your employer, if available. • Online at optumbank.com using your personal checking account. • Mail in a personal check along with the HSA
Contribution Form. You can find this form after signing in at optumbank.com.
When can contributions be made?
Contributions for a taxable year can be made any time within that year and up until the tax filing deadline for the following year, which is typically April 15.
If I change employers, what happens to my HSA?
Since you are the owner of the HSA, you may continue to maintain the account if you change employers. The funds are yours to keep.
Can I reimburse myself with HSA funds for qualified medical expenses incurred prior to my enrollment in an HSA?
No. Qualified medical expenses may be reimbursed only if the expenses are incurred after the date your HSA was established.
Is there a time limit for reimbursing myself?
You can reimburse yourself at any time for expenses you paid for out of pocket. There is no time limit, but the expenses must have been incurred since you opened your HSA.
How can I use my HSA to pay for medical services?
You can use your Optum Financial debit Mastercard®, use online bill pay; or pay out-of-pocket and then distribute funds from your HSA to reimburse yourself.
Yes. However, any amount of a distribution not used exclusively to pay for qualified medical expenses for you, your spouse or your eligible tax dependents is then included in your gross income. These distributions could be subject to taxes and an additional 20% IRS tax penalty, except in the case of distributions made after your death, disability or reaching age 65.
What happens if my HSA contributions exceed the annual contribution limit?
If you contribute more than the IRS annual contribution limit, you have until the tax-filing deadline to withdraw excess contributions. If excess contributions are not withdrawn by the tax-filing deadline, an annually assessed excise tax of 6% will be imposed on any excess contributions.
Is tax reporting required for an HSA?
Yes. You must complete IRS form 8889 each year with your tax return to report total deposits and withdrawals from your account. You do not need to itemize. For more information about tax rules including distribution information, visit optumbank.com and consult a qualified tax advisor.
What happens to my HSA when I die?
If you are married, your spouse will become the owner of the account and assume it as their own HSA. If you are unmarried, your account will cease to be an HSA. The money in your account will pass to your beneficiaries or become a part of your estate, and it will be subject to applicable taxes.
Investments are not FDIC insured, are not guaranteed by Optum Bank®, and may lose value.
optumbank.com
We are now Optum Financial, which includes Optum Bank.
Health savings accounts (HSAs) are individual accounts offered or administered by Optum Bank®, Member FDIC, a subsidiary of Optum Financial, Inc., and are subject to eligibility requirements and restrictions on deposits and withdrawals to avoid IRS penalties. State taxes may apply. Fees may reduce earnings on account. The content of this communication is not intended as investment, legal or tax advice. Federal and state laws and regulations are subject to change. © 2021 Optum, Inc. All rights reserved. WF4506690 58081G-052021 OHC
New PrescriPtioN Mail-iN order ForM
1
Member and physician information — please use black or blue ink. one form per member.
Member ID Number
(Additional coverage, if applicable) Secondary Member ID Number
Last Name First Name
MI
Delivery Address
City
Phone Number with Area Code State ZIP
Apt. #
Date of Birth (mm/dd/yyyy) Gender M F
Physician Name Email
Physician Phone Number with Area Code
2
Health history
Medication Allergies: Aspirin Erythromycin Quinolones Others: None known Cephalosporins NSAIDs Sulfa Amoxil/Ampicillin Codeine Penicillin Tetracyclines Health Conditions: Asthma Glaucoma High cholesterol Others: None known Cancer Heart condition Osteoporosis Arthritis Diabetes High blood pressure Thyroid Disease
Over-the-counter/herbal medications taken regularly:
3
Payment and shipping information — do not send cash
Standard delivery is included at no charge. Prescriptions from OptumRx should arrive within 5 business days after we receive the complete order. OptumRx will contact you if there will be an extended delay in delivering your medications. Visit the URL listed on the back of your member ID card to check drug pricing before sending payment. Once shipped, medications may not be returned for a refund or adjustment.
Ship overnight. Add $12.50 to order amount (subject to change).
Check enclosed. All checks must be signed and made payable to: OptumRx.
Charge to my credit card on file.
Charge to my NEW credit card. Signature:
New Credit Card Number
Expiration Date (Month/Year) Visa, MasterCard, AMEX and Discover are accepted.
Date:
For new prescription orders and maintenance refills, this credit card will be billed for copay/coinsurance and other such expenses related to prescription orders. By supplying my credit card number, I authorize OptumRx to maintain my credit card on file as payment method for any future charges. To modify payment selection, contact customer service at any time.
4
Mail this completed order form with your new prescription(s) to optumrx, P.o. Box 2975, Mission, Ks 66201. do Not staPle or taPe PrescriPtioNs to tHe order ForM.
If you or your children are eligible for Medicaid or CHIP and you’re eligible for health coverage from your employer, your state may have a premium assistance program that can help pay for coverage, using funds from their Medicaid or CHIP programs. If you or your children aren’t eligible for Medicaid or CHIP, you won’t be eligible for these premium assistance programs but you may be able to buy individual insurance coverage through the Health Insurance Marketplace. For more information, visit www.healthcare.gov.
If you or your dependents are already enrolled in Medicaid or CHIP and you live in a State listed below, contact your State Medicaid or CHIP office to find out if premium assistance is available.
If you or your dependents are NOT currently enrolled in Medicaid or CHIP, and you think you or any of your dependents might be eligible for either of these programs, contact your State Medicaid or CHIP office or dial 1-877KIDS NOW or www.insurekidsnow.gov to find out how to apply. If you qualify, ask your state if it has a program that might help you pay the premiums for an employer-sponsored plan.
If you or your dependents are eligible for premium assistance under Medicaid or CHIP, as well as eligible under your employer plan, your employer must allow you to enroll in your employer plan if you aren’t already enrolled. This is called a “special enrollment” opportunity, and you must request coverage within 60 days of being determined eligible for premium assistance. If you have questions about enrolling in your employer plan, contact the Department of Labor at www.askebsa.dol.gov or call 1-866-444-EBSA (3272).
If you live in one of the following states, you may be eligible for assistance paying your employer health plan premiums. The following list of states is current as of July 31, 2021. Contact your State for more information on eligibility –
ALABAMA – Medicaid
Website: http://myalhipp.com/ Phone: 1-855-692-5447
ALASKA – Medicaid COLORADO – Health First Colorado (Colorado’s Medicaid Program) & Child Health Plan Plus (CHP+)
The AK Health Insurance Premium Payment Program Website: http://myakhipp.com/ Phone: 1-866-251-4861 Email: CustomerService@MyAKHIPP.com Medicaid Eligibility: http://dhss.alaska.gov/dpa/Pages/medicaid/default.aspx Health First Colorado Website: https://www.healthfirstcolorado.com/ Health First Colorado Member Contact Center: 1-800-221-3943/ State Relay 711 CHP+: https://www.colorado.gov/pacific/hcpf/child-health-plan-plus CHP+ Customer Service: 1-800-359-1991/ State Relay 711 Health Insurance Buy-In Program (HIBI): https://www.colorado.gov/pacific/hcpf/health-insurance-buyprogram HIBI Customer Service: 1-855-692-6442
ARKANSAS – Medicaid
Website: http://myarhipp.com/ Phone: 1-855-MyARHIPP (855-692-7447)
CALIFORNIA – Medicaid
Website: Health Insurance Premium Payment (HIPP) Program http://dhcs.ca.gov/hipp Phone: 916-445-8322 Email: hipp@dhcs.ca.gov
FLORIDA – Medicaid
Website: https://www.flmedicaidtplrecovery.com/flmedicaidtplrecovery.com/ hipp/index.html Phone: 1-877-357-3268
Website: https://medicaid.georgia.gov/health-insurance- Website: https://www.mass.gov/info-details/masshealthpremium-payment-program-hipp premium-assistance-pa Phone: 678-564-1162 ext 2131
Phone: 1-800-862-4840
INDIANA – Medicaid MINNESOTA – Medicaid
Healthy Indiana Plan for low-income adults 19-64 Website: Website: http://www.in.gov/fssa/hip/ https://mn.gov/dhs/people-we-serve/children-andPhone: 1-877-438-4479 All other Medicaid Website: https://www.in.gov/medicaid/ families/health-care/health-care-programs/programs-andservices/other-insurance.jsp Phone: 1-800-657-3739
Phone 1-800-457-4584
– IOWA Medicaid and CHIP (Hawki)
Medicaid Website: https://dhs.iowa.gov/ime/members Medicaid Phone: 1-800-338-8366 Hawki Website: http://dhs.iowa.gov/Hawki Hawki Phone: 1-800-257-8563 HIPP Website: https://dhs.iowa.gov/ime/members/medicaid-ato-z/hipp HIPP Phone: 1-888-346-9562
KANSAS – Medicaid
Website: https://www.kancare.ks.gov/ Phone: 1-800-792-4884 Website: http://dphhs.mt.gov/MontanaHealthcarePrograms/HIPP Phone: 1-800-694-3084
MISSOURI – Medicaid
Website: http://www.dss.mo.gov/mhd/participants/pages/hipp.htm Phone: 573-751-2005
MONTANA – Medicaid
KE –NTUCKY Medicaid
Kentucky Integrated Health Insurance Premium Payment Program (KI-HIPP) Website: https://chfs.ky.gov/agencies/dms/member/Pages/kihipp.aspx Phone: 1-855-459-6328 Email: KIHIPP.PROGRAM@ky.gov
–NEBRASKA Medicaid
KCHIP Website: https://kidshealth.ky.gov/Pages/index.aspx Phone: 1-877-524-4718
Kentucky Medicaid Website: https://chfs.ky.gov Website: http://www.ACCESSNebraska.ne.gov Phone: 1-855-632-7633 Lincoln: 402-473-7000 Omaha: 402-595-1178
–LOUISIANA Medicaid
Website: www.medicaid.la.gov or www.ldh.la.gov/lahipp Phone: 1-888-342-6207 (Medicaid hotline) or 1-855-618-5488 (LaHIPP) Medicaid Website: http://dhcfp.nv.gov Medicaid Phone: 1-800-992-0900
NEVADA – Medicaid
MAINE – Medicaid NEW HAMPSHIRE – Medicaid
Enrollment Website: Website: https://www.dhhs.nh.gov/oii/hipp.htm https://www.maine.gov/dhhs/ofi/applications-forms Phone: 603-271-5218 Phone: 1-800-442-6003 Toll free number for the HIPP program: 1-800-852-3345, ext TTY: Maine relay 711 5218
Private Health Insurance Premium Webpage: https://www.maine.gov/dhhs/ofi/applications-forms Phone: -800-977-6740. TTY: Maine relay 711
Medicaid Website: http://www.state.nj.us/humanservices/ dmahs/clients/medicaid/ Medicaid Phone: 609-631-2392 CHIP Website: http://www.njfamilycare.org/index.html CHIP Phone: 1-800-701-0710
–NEW YORK Medicaid
Website: https://www.health.ny.gov/health_care/medicaid/ Phone: 1-800-541-2831 Website: http://gethipptexas.com/ Phone: 1-800-440-0493
–NORTH CAROLINA Medicaid
Website: https://medicaid.ncdhhs.gov/ Phone: 919-855-4100 Medicaid Website: https://medicaid.utah.gov/ CHIP Website: http://health.utah.gov/chip Phone: 1-877-543-7669
–NORTH DAKOTA Medicaid
Website: http://www.nd.gov/dhs/services/medicalserv/medicaid/ Phone: 1-844-854-4825 Website: http://www.greenmountaincare.org/ Phone: 1-800-250-8427
–OKLAHOMA Medicaid and CHIP
Website: http://www.insureoklahoma.org Phone: 1-888-365-3742 Website: https://www.coverva.org/en/famis-select https://www.coverva.org/en/hipp Medicaid Phone: 1-800-432-5924 CHIP Phone: 1-800-432-5924
OREGON – Medicaid
Website: http://healthcare.oregon.gov/Pages/index.aspx http://www.oregonhealthcare.gov/index-es.html Phone: 1-800-699-9075 Website: https://www.hca.wa.gov/ Phone: 1-800-562-3022
TEXAS – Medicaid
UTAH – Medicaid and CHIP
–VERMONT Medicaid
–VIRGINIA Medicaid and CHIP
–WASHINGTON Medicaid
–PENNSYLVANIA Medicaid
Website: https://www.dhs.pa.gov/providers/Providers/Pages/Medical/HI PP-Program.aspx Phone: 1-800-692-7462 Website: http://mywvhipp.com/ Toll-free phone: 1-855-MyWVHIPP (1-855-699-8447)
–WEST VIRGINIA Medicaid
–RHODE ISLAND Medicaid and CHIP –WISCONSIN Medicaid and CHIP
Website: http://www.eohhs.ri.gov/ Phone: 1-855-697-4347, or 401-462-0311 (Direct RIte Share Line) Website: https://www.dhs.wisconsin.gov/badgercareplus/p-10095.htm Phone: 1-800-362-3002
–SOUTH CAROLINA Medicaid
Website: https://www.scdhhs.gov Phone: 1-888-549-0820 Website: https://health.wyo.gov/healthcarefin/medicaid/programs-andeligibility/ Phone: 1-800-251-1269
–WYOMING Medicaid
To see if any other states have added a premium assistance program since July 31, 2021, or for more information on special enrollment rights, contact either:
U.S. Department of Labor U.S. Department of Health and Human Services Employee Benefits Security Administration Centers for Medicare & Medicaid Services
www.dol.gov/agencies/ebsa www.cms.hhs.gov
1-866-444-EBSA (3272) 1-877-267-2323, Menu Option 4, Ext. 61565
According to the Paperwork Reduction Act of 1995 (Pub. L. 104-13) (PRA), no persons are required to respond to a collection of information unless such collection displays a valid Office of Management and Budget (OMB) control number. The Department notes that a Federal agency cannot conduct or sponsor a collection of information unless it is approved by OMB under the PRA, and displays a currently valid OMB control number, and the public is not required to respond to a collection of information unless it displays a currently valid OMB control number. See 44 U.S.C. 3507. Also, notwithstanding any other provisions of law, no person shall be subject to penalty for failing to comply with a collection of information if the collection of information does not display a currently valid OMB control number. See 44 U.S.C. 3512.
The public reporting burden for this collection of information is estimated to average approximately seven minutes per respondent. Interested parties are encouraged to send comments regarding the burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden, to the U.S. Department of Labor, Employee Benefits Security Administration, Office of Policy and Research, Attention: PRA Clearance Officer, 200 Constitution Avenue, N.W., Room N-5718, Washington, DC 20210 or email ebsa.opr@dol.gov and reference the OMB Control Number 1210-0137.
OMB Control Number 1210-0137 (expires 1/31/2023)
NOTICE OF PRIVACY PRACTICES
KAO America Inc.
Effective September 23, 2013
THIS NOTICE DESCRIBES HOW PERSONAL HEALTH INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION.
PLEASE READ CAREFULLY.
We understand that health information about you is personal. We are committed to protecting the personal health information that we maintain as part of the group health care insurance coverage that we sponsor. We have set up policies and procedures to make sure that this health coverage information that identifies you is kept private.
This notice applies to all personal health information that Kao America Inc. maintains. It will tell you about the ways that we may use and share personal health information about you. It describes our responsibilities for personal health information that we use. Also, this notice tells you about your rights in relation to your personal health information.
Kao America Inc. is required by law to make sure that we protect and safeguard your personal health information that we maintain. We must give you this notice that describes our legal duties and our privacy practices concerning your personal health information. We must make reasonable efforts to release only the minimum personal health information necessary to accomplish the use, disclosure or request. By law, we must follow the terms of our privacy notice that is currently in effect.
Use and Disclosure of Personal Health Information by Kao America Inc.
This notice describes the personal health information practices of Kao America Inc. in its role of employer sponsor of group health insurance coverage for you. It also describes the responsibilities and obligations that Kao America Inc. has placed on its third party providers and insurance carriers that provide or assist in the administration of the health care insurance coverage that you have through Kao America Inc.
To provide you with group health care insurance coverage, it is necessary for Kao America Inc. to collect, store, use and share with others, personal health information about those who have our health care insurance coverage.
Ordinary Business Practice It is our ordinary business practice to maintain personal health information about individuals who have health care insurance coverage that Kao America Inc. sponsors. Kao America Inc. will use and disseminate personal health information obtained from covered individuals and health care providers to pay for care received by those covered under the plan and to administer the operations of the health care coverage plan. By formal arrangement, Kao America Inc. has delegated some responsibility for administration of benefits coverage to third parties. Kao America Inc. has delegated administration of the health care coverage plans to United HealthCare Insurance Company, administration of dental coverage to Metlife and adminstration of the Health Care Flexible Spending Account to ADP.
The following categories give details about the times when we could have access to your personal health information. Not every use or disclosure in a category will be listed, but all of the uses and disclosures permitted by law fall within the categories.
To Obtain and Manage Health Care Insurance Coverage The collection, use and sharing of personal health information is necessary to get health care insurance coverage for our employees and eligible dependents. For instance, we may use personal health information to: get premium quotes from insurance carriers or third party administrators or obtain premium underwriting; submit claims for stop-loss or excess loss coverage; obtain legal, accounting, and audit services; manage costs; document each employee’s enrollment in or declination of coverage under Kao America Inc. for himself / herself and eligible spouse and dependents; conduct business management and administrative activities related to the health care insurance coverage. Plans (other than a long-term care plan) are prohibited from using protected health information (PHI) that is genetic information for underwriting purposes.
To Help With Treatment Kao America Inc. does not directly provide any health care treatment. However, we may use or share your personal health care information to help health care providers serve or treat you. For example, we may share information about allergies to a hospital emergency department if needed to render appropriate emergency care.
To Pay Claims Kao America Inc. may use and share your personal health information to make payment possible for covered health care that you receive. This includes determining eligibility for coverage benefits and coordinating coverage with other health care plans. For instance, Kao America Inc. may tell a health care provider about your medical history to help decide if particular treatment is covered under our group health plan. We may disclose personal health information related to a request from an employee for assistance with eligibility, coverage or claims issues or otherwise authorized by the individual covered by the plan. Also, we may share personal health information with another carrier or third party payor to determine payment responsibility. Kao America Inc. may also disclose health information related to a worker’s compensation program or a work related illness or injury.
To Comply with Laws and Government Authorities Kao America Inc. will disclose your personal health information when required by federal, state or local law, regulation, or court or government agency order. For example, as permitted or required by law, we must reveal personal health information when: required to work with public officials to prevent or manage a serious threat to public health or safety; required for government monitoring of health care, civil rights laws, or other government oversight activities; ordered to do so by a court or other lawful process relating to a civil lawsuit or criminal matter; and directed by law enforcement officials, coroners, medical examiners, or national security officials in the lawful pursuit of their duties. If ordered by a court or other legal process to provide personal health information about you, Kao America Inc. will make an effort to tell you about the request.
Other Uses and Disclosures Uses and disclosures of personal health information other than those listed above will be made only with an individual's written authorization and the individual may revoke such authorization. Covered health plans are required to obtain your authorization to use or disclose psychotherapy notes, to use PHI for marketing purposes, to sell PHI, or to use or disclose PHI for any purpose not described in this notice.
You, or a personal representative that you designate, have the following rights regarding any of your personal health information that we may maintain.
Right to Authorize Other Uses and Disclosures Other uses or disclosures of your personal health information not covered by this notice will be made only with your written and signed permission or authorization.
If you give written permission or authorization to disclose your personal health information, you may revoke the authorization or remove the permission at any time. To revoke the authorization or remove the permission, you must tell us in writing by sending a written notice to the Privacy Officer and address that is designated at the end of this notice in the section entitled “Exercising Your Rights”. If we have released information before receiving your request to revoke the authorization or remove permission, we will not be able to take that information back.
Right to Request Restriction on Certain Uses/Disclosures You have the right to ask for a limitation or restriction on the personal health care information that we use and maintain for treatment, payment or health care operations. You also have the right to request a restriction or limitation on the information that we disclose to someone involved in your care or payment for your care. For example, you could ask that we not disclose a surgery that you had to a family member or a friend. The law says that we are not required to agree to your request.
In your written request, you must tell us: What information you want us to limit; Do you want us to limit our use, disclosure or both use and disclosure; To whom you want the limits to apply, for example, your spouse.
Right to Receive Confidential Communications You have the right to ask us that we communicate with you about personal health care matters in a certain way. For instance, you can ask that we only contact you about personal health care matters at work, or only by mail.
Do not tell us the reason for your request. You must tell us in the request how or where you wish to receive a communication that has personal health information. We will comply with any reasonable request.
Right to Inspect and Copy Personal Health Information You have the right to inspect and copy any of your personal health information that Kao America Inc. maintains in relation to our group health coverage that is used for making health care decisions or claims payment. If you request a copy of this personal health information, we can charge a fee for the costs of copying, mailing or other supplies associated with your request.
We may deny your request to inspect and copy in certain very limited circumstances, as permitted by law. If we deny access to your personal health information, you may request that the denial be reviewed.
Right to Amend Personal Health Information You have the right to ask Kao America Inc. to amend or change your personal health information that we have if you believe that the information is incomplete or inaccurate.
We may deny your request for any of the following reasons: It is not in writing; It does not contain a reason to support why you think that the information is incomplete or inaccurate; The information is not kept by Kao America Inc.; The information was not created by Kao America Inc., unless the person or entity that created the information is no longer available to make the change; The information is not part of the personal health information that you have a right to inspect or copy; The information is accurate and complete.
Right to Receive an Accounting of Disclosures
You have the right to receive a list or an accounting of any non-incidental disclosures of the personal health information we have about you that are not authorized by you, not permitted by law or regulation, or related to treatment, payment or group health plan operations. When we become aware of any disclosure
not authorized by you or not permitted by law or regulation, we will inform you in writing. You have a right to receive a notice when there is a breach of your protected health information.
Right to a Paper Copy of this Notice You have the right to another paper copy of this notice. You may ask Kao America Inc. for it at any time.
Changes to This Notice
Kao America Inc. reserves the right to change this notice and to make new notice provisions effective for all personal health information that it maintains or collects in the future. If we change this notice, we will send you a copy of the changed notice.
Exercising Your Rights
Contacting your Health Plan. If you have any questions about this notice, please contact the Privacy Officer. If you would like to exercise any of your rights, you must put your request in writing and describe your request and mail it to the Privacy Officer whose name is set forth below.
Charges. In some instances, we have the right to charge you for the cost(s) associated with providing you the requested information.
Filing a Complaint. If you believe your privacy rights have been violated, you may file a complaint with us at the following address:
Deb Lawrence Privacy Officer Kao America Inc. 2535 Spring Grove Ave. Cincinnati, Ohio 45214-1773 (513) 455-5528
If you wish to contact us, please do so at the number and address above.
You may also notify the Secretary of the Department of Health and Human Services. We will not take any action against you for filing a complaint.
Important Notice from Kao America Inc. About Your Prescription Drug Coverage and Medicare
Please read this notice carefully and keep it where you can find it. This notice has information about your current prescription drug coverage with Kao America Inc. and about your options under Medicare’s prescription drug coverage. This information can help you decide whether or not you want to join a Medicare drug plan. If you are considering joining, you should compare your current coverage, including which drugs are covered at what cost, with the coverage and costs of the plans offering Medicare prescription drug coverage in your area. Information about where you can get help to make decisions about your prescription drug coverage is at the end of this notice.
There are two important things you need to know about your current coverage and Medicare’s prescription drug coverage:
1. Medicare prescription drug coverage became available in 2006 to everyone with
Medicare. You can get this coverage if you join a Medicare Prescription Drug Plan or join a Medicare Advantage Plan (like an HMO or PPO) that offers prescription drug coverage.
All Medicare drug plans provide at least a standard level of coverage set by Medicare.
Some plans may also offer more coverage for a higher monthly premium.
2. Kao America Inc. has determined that the prescription drug coverage offered by United
Health Care 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
When Can You Join A Medicare Drug Plan?
You can join a Medicare drug plan when you first become eligible for Medicare and each year from October 15th to December 7th. However, if you lose your current creditable prescription drug coverage, through no fault of your own, you will also be eligible for a two (2) month Special Enrollment Period (SEP) to join a Medicare drug plan.
If you decide to join a Medicare drug plan, your current Kao America Inc. coverage will not be affected. See below for more information about what happens to your current coverage if you join a Medicare Drug Plan.
Your current coverage pays for other health expenses in addition to prescription drug. If you enroll in a Medicare prescription drug plan, you and your eligible dependents will still be eligible to receive all of your current health and prescription drug benefits. There are a few prescription drug options under the plan Kao America Inc. offers to those who are Medicare eligible. Please contact your benefits representative for more information on these plans and the impact Medicare Part D may have on the prescription coverage. If you do decide to join a Medicare drug plan and drop your current Kao America Inc. coverage, be aware that you and your dependents will not be able to get this coverage back.
When Will You Pay A Higher Premium (Penalty) To Join A Medicare Drug Plan?
You should also know that if you drop or lose your current coverage with Kao America Inc. 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 our office for further information at 1-800-650-8180. NOTE: You’ll get this notice each year. You will also get it before the next period you can join a Medicare drug plan, and if this coverage through Kao America Inc. 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 • Call your State Health Insurance Assistance Program (see the inside back cover of your copy of the “Medicare & You” handbook for their telephone number) for personalized help • Call 1-800-MEDICARE (1-800-633-4227). TTY users should call 1-877-486-2048.
If you have limited income and resources, extra help paying for Medicare prescription drug coverage is available. For information about this extra help, visit Social Security on the web at www.socialsecurity.gov, or call them at 1-800-772-1213 (TTY 1-800-325-0778).
Remember: Keep this Creditable Coverage notice. If you decide to join one of the Medicare drug plans, you may be required to provide a copy of this notice when you join to show whether or not you have maintained creditable coverage and, therefore, whether or not you are required to pay a higher premium (a penalty).
Date: 10/01/2021 Name of Entity/Sender: Kao America Inc. Contact--Position/Office: Tracey Furnish Deb Lawrence Address: 2535 Spring Grove Ave. Cincinnati, OH 45214 Phone Number: 1-800-650-8180
