Atlanta Center for Reproductive Medicine
BENEFITS GUIDE
June 1, 2023 - May 31, 2024
ACRM Benefit Guide | 2 TABLE OF CONTENTS Eligibility & Enrollment 3 Bernie Portal 4 Anthem Medical Plans 5 Preventive Care 6 Health Savings Account 7 Flexible Spending Accounts 8 Dental 9 Vision 10 Life Insurance 11 Disability and Supplemental Benefits 12 Cost Summary 13 Company Contacts 14 Important Information 15
ELIGIBILITY & ENROLLMENT
Who is Eligible to Join the Benefit Plan?
You and your dependents are eligible to join the health and our company welfare benefit plans if you are a full-time employee regularly scheduled to work 30 hours per week. You must be enrolled in the plan to add dependent coverage.
Who is an Eligible Dependent?
• Your spouse or domestic partner
• Your dependent child under the maximum age specified in the Carriers’ plan documents including:
• Natural child
• Adopted child
• Stepchild
• Child for whom you have been appointed as the legal guardian
*Your child’s spouse and a child for whom you are not the legal guardian are not eligible.
The Dependent Maximum Age Limits is up to age 26 The dependent does not need to be a full-time student; does not need to be an eligible dependent on parent’s tax return; is not required to live with you; and may be unmarried or married. Once the dependent reaches age 26, coverage will terminate on the last day of the birth month
A totally disabled child who is physically or mentally disabled prior to age 26 may remain on the if the child is primarily dependent on the enrolled member for support and maintenance
When Do Benefits Become Effective?
Your benefits become effective on the first day of the month following your date of hire as a full-time employee with ACRM.
Annual Open Enrollment?
Each year during the annual Open Enrollment Period, you are given the opportunity to make changes to your current benefit elections . To find out when the annual Open Enrollment Period occurs, contact Human Resources.
Qualifying Event Changes
You are allowed to make changes to your current benefit elections during the plan year if you experience an IRSapproved qualifying change in life status . The change to your benefit elections must be consistent with and on account of the change in life status.
IRS-approved qualifying life status changes include:
• Marriage, divorce or legal separation
• Birth or adoption of a child or placement of a child for adoption
• Death of a dependent
• Change in employment status, including loss or gain of employment, for your spouse or a dependent
• Change in work schedule, including switching between fulltime and part-time status, by you, your spouse or a dependent
• Change in residence or work site for you, your spouse, or a dependent that results in a change of eligibility
• If you or your dependents lose eligibility for Medicaid or the Children’s Health Insurance Program (CHIP) coverage
• If you or your dependents become eligible for a state’s premium assistance subsidy under Medicaid or CHIP
If you have a life status change, you must notify the company within 60 days for changes in life status due to a Medicare or CHIP event and within 31 days of the other events.
If you do not notify the company during that time, you and/or your dependents must wait until the next annual open enrollment period to make a change in your benefit elections.
Please note, loss of coverage due to nonpayment or voluntary termination of other coverage outside a spouse’s or parent’s open enrollment is not an IRS-approved qualifying life event and you do not qualify for a special enrollment period.
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ONLINE ENROLLMENT
For your convenience, ACRM uses the online benefits management system, Bernie Portal.
Through Bernie Portal, you can:
• View all of your benefit information
• Compare plan information – which plan best suits your healthcare needs?
• Make your new-hire benefit elections
• Make your annual Open Enrollment benefit elections
• Make changes throughout the year (address updates, dependent information, etc.)
• Access a full document library, in which you will find complete benefit summaries, claim forms, prescription discount programs, and more!
HOW TO ENROLL
1. Visit Bernie Portal to begin your enrollment process.
2. Your username is your email address. If you have forgotten your password, click “Forgot Password” to recover.
3. Confirm your personal and contact information and add a photo if you would like to. Then click “Save and Continue . ” Note: the address listed is where your new ID cards will be sent. Please ensure this information is correct.
4. Add your Spouse/Dependent information. Start by toggling the on switch for dependents that you wish to cover. Make sure to provide legal names, correct birth dates, and social security numbers These are required to make elections with the carriers
5. Note the benefits menu on the left, which tracks your plan election progress Once you’ve made your election for that benefit type, a check mark will appear. A shopping cart on the right hand side of the page will keep track of your coverage costs.
6. Scroll through benefit types and explore each plan option by using the “Select a Plan” dropdown. If you wish to waive coverage, use the “Waive” option to save and continue.
7. Cost per pay period and coverage tiers will generate based on the plan you have selected and will show based on the dependents added If you were previously enrolled in coverage your current election will appear under each benefit type for your reference
8. Provide the requested beneficiary information for your basic life insurance coverage Adjust the percentage that each beneficiary should receive by sliding the distribution button to the desired percentage.
9. Review your election sheet and complete any outstanding fields. Finally, move your mouse to sign the signature box and click “I Agree” to complete your enrollment.
FOR ANY SUPPORT ISSUES, PLEASE CONTACT STEVEN KATCOFF – stevenk@sspins com
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ANTHEM MEDICAL PLAN OPTIONS
20% after deductible
Order (90 Day): 20% after deductible
20%
Retail (30 Day): $60 copay
Mail Order (90 Day): $180 copay
Retail & Mail Order: 25% up to
*When you visit an ER for non-emergency medical care, services are subject to the deductible, then coinsurance
Retail (30 Day): $60 copay
Mail Order (90 Day): $180 copay
Retail & Mail Order: 25% up to $350
This brochure summarizes the health care and income protection benefits that are available to ACRM employees and their eligible dependents. Official plan documents, policies and certificates of insurance contain the details, conditions, maximum benefit levels and restrictions on benefits. These documents govern your benefits program. If there is any conflict, the official documents prevail. These documents are available upon request through your Human Resources department. Information provided in this brochure is not a guarantee of benefits.
Plan Highlights – Blue Open Access POS Network HSA $5000 80% Core $3500 80% Buy-Up $2000 100% Deductible: Individual | Family $5,000 | $10,000 $3,500 | $10,500 $2,000 | $6,000 Member Coinsurance 20% 20% 0% Annual Out-of-Pocket Maximum Individual | Family $6,900 | $13,800 $7,900 | $15,800 $7,900 | $15,800 Primary Care Physician Office Visit 20% after Deductible $30 copay $30 copay Specialist Office Visit 20% after Deductible $60 copay $60 copay Telemedicine (LiveHealthOnline) 0% after Deductible Plan pays 100% Plan pays 100% Preventive Care Services Plan pays 100% Plan pays 100% Plan pays 100% Laboratory Diagnostics & X-Ray 20% after Deductible 20% after Deductible 0% after Deductible Complex Imaging Services (CT Scans, PET Scans & MRI’s) 20% after Deductible 20% after Deductible 0% after Deductible Hospital Inpatient Care 20% after Deductible 20% after Deductible 0% after Deductible Outpatient Surgery 20% after Deductible 20% after Deductible 0% after Deductible Emergency Room* 20% after Deductible $350 copay + 20% $350 copay Urgent Care 20% after Deductible $75 copay $75 copay Prescription Drugs Medical Deductible Applies No Rx Deductible No Rx Deductible Tier 1 Generic Drugs Retail (30 Day): 20% after deductible Mail Order (90 Day): 20% after deductible Retail (30 Day): $15 copay Mail Order (90 Day): $15 copay Retail (30 Day): $15 copay Mail Order (90 Day): $15 copay Tier 2 Preferred Brand-Name Retail (30 Day): 20% after deductible Mail Order (90 Day): 20% after deductible Retail (30 Day): $35 copay
Retail
Non-Preferred
Retail
Mail
Mail Order (90 Day): $70 copay
(30 Day): $35 copay Mail Order (90 Day): $70 copay Tier 3
BrandName
(30 Day):
Specialty
Retail
Tier 4 -
Drugs
& Mail Order:
after deductible
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$350
!
It’s
A SMARTER WAY TO BETTER HEALTH
Your health is a work in progress that needs your consistent attention and support. Each choice you make for yourself and your family is part of an ever-changing picture. Taking steps to improve your health such as going for annual physicals and living a healthy lifestyle can make a positive impact on your well-being
It’s up to you to take responsibility and get involved, and we are please to offer programs that will support your efforts and help you reach goals.
Preventative Health Care Services
Preventive care includes services like checkups, screenings and immunizations that can help you stay healthy and may help you avoid or delay health problems Many serious conditions such as heart disease, cancer, and diabetes are preventable and treatable if caught early It’s important for everyone to get the preventive care they need. Some examples of preventive care services are:
o Blood pressure, diabetes, and cholesterol tests
o Certain cancer screenings, such as mammograms, colonoscopies
o Counseling, screenings and vaccines to help ensure healthy pregnancies
o Regular well-baby and well-child visits
Immunizations
Some immunizations and vaccinations are also considered preventive care services Standard immunizations recommended by the Centers for Disease Control (CDC) Include: hepatitis A and B, diphtheria, polio, pneumonia, measles, mumps, rubella, tetanus and influenza although these may be subject to age and/or frequency restrictions.
Understanding
What’s Covered
Generally speaking, if a service is considered preventive care, it will be covered at 100%. If it’s not, it may still be covered subject to a copay, deductible or coinsurance. The Affordable Care Act (ACA) requires that services considered preventive care be covered by your health plan at 100% innetwork, without a copay, deductible or coinsurance . To get specifics about your plan’s preventive care coverage, call the customer service number on your member ID card You may want to ask your doctor if the services you’re receiving at a preventive care visit (such as an annual checkup) are all considered standard preventive care.
If any service performed at an annual checkup is as a result of a prior diagnosed condition, the office visit may not be processed as preventive and you may be responsible for a copay, coinsurance or deductible To learn more about the ACA or preventive care and coverage, visit www.healthcare.gov
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Your Health. Get Involved
HEALTH SAVINGS ACCOUNT (HSA)
Available only if you enrolled in the HSA Medical Plan through Anthem. Our HSA banking partner is Admin America.
What is a Health Savings Account?
A Health Savings Account (HSA) is an account permitted under the federal tax law that allows you to save money for healthcare expenses on a tax-favored basis It is an individual account that belongs to you and is not part of ACRM’s medical plan. The account is portable, which means it is not tied to your employment at ACRM. Your HSA stays with you if you retire or leave the company. Because the HSA has special tax status under the law, it is governed by numerous mandatory tax rules and regulations
Who is Eligible for an HSA?
Generally, to be eligible to set up and contribute to an HSA, you:
▪ Must be covered by a Consumer Directed Health Plan (CDHP) – the HSA medical plan
▪ Cannot be claimed as a dependent on anyone else’s tax return
▪ Are not enrolled in Medicare (due to age or disability) or Tricare
▪ Cannot be enrolled in a general purpose FSA, nor can your spouse
You may find information about these rules on the IRS website (www.irs.gov), including IRS Publication 969 and 502. You may also want to consult a tax-advisor.
How Does an HSA Work?
What Type of Expenses Can Be Paid From an HSA?
You can receive tax-free distributions from your HSA to pay for or to be reimbursed for qualified medical expenses that are incurred after you establish your HSA. These include:
▪ Any medical expenses that apply toward your deductible,
▪ Any healthcare expenses that are qualified expenses for tax purposes under Section 213 of the Internal Revenue Code. Some of these expenses are described in IRS Publication 502,
▪ Once your reach age 65, Medicare premiums or other health insurance, other than a Medicare supplemental policy.
When can I Begin Contributions to My HSA Account?
You may begin funding your HSA account as soon as your account is established.
Can I Invest My HSA Funds?
Yes, investment options are available once your account has accumulated certain thresholds.
Can I Use The Money in My HSA for Anything Other Than Eligible Medical Expenses?
You can withdraw your HSA at anytime and use it for any purpose; however, you will pay income taxes on the amount withdrawn, plus a 20% penalty. After age 65, the 20% penalty no longer applies.
How Much Can I Contribute to An HSA?
As noted by federal law, the annual contribution limits are:
▪ The amount is $3,850 for individual coverage and $7,750 for family coverage.
Loss of Other Coverage
You fund the HSA with your dollars up to a certain limit each year by making a deposit directly into your HSA account. The account must be funded prior to any withdrawals. Then, as you have eligible qualified expenses, you may withdraw money from your HSA to pay expenses that are not otherwise paid by the health, dental or vision plans, e g your deductible or coinsurance It’s up to you whether to use your HSA funds You are not required to use the money, you may save it for the future and let it continue to accumulate. It’s important to understand that the HSA, unlike a Healthcare Flexible Spending Account (FSA), will not pay for qualified expenses that exceed the balance in the HSA When filing your taxes each year, you will provide your tax advisor a report showing the amount you contributed to the HSA account, and you will receive a tax deduction for that amount.
▪ Individuals age 55 or older may be eligible to make a catch-up contribution of $1,000.
Health Savings Account (HSA)
▪ Use money in your account to pay for qualified health care expenses
▪ Reduce the amount of your federal taxes
▪ Earn tax-free interest on money in your HSA
▪ Funds in your account roll over every year
▪ The money is yours, so the account stays with you if you leave your employer
▪ Once you have a certain amount in your account, you may invest your funds
▪ Investment gains grow, tax-free
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FLEXIBLE SPENDING ACCOUNTS ( FSA)
Provided by Admin America
ACRM offers employees the opportunity to participate in the Healthcare Flexible Spending Account (FSA) & Dependent Care FSA. These programs may provide you with significant tax advantages as they allow you to pay for eligible out-of-pocket expenses with pre-tax dollars through payroll deductions . It is very important that you estimate your annual expenses as accurately as possible because the Healthcare FSA plan only allows for a $610 carryover maximum annually.
Participants will receive an Admin America debit card which can give you access to the funds for all of your FSA accounts
Additionally, you can administer the FSA benefits using the Admin America smartphone app to upload your receipts and eliminate the need for paperwork.
Healthcare Flexible Spending Account
You may defer up to $3,050 to your Healthcare FSA to fund eligible out-of-pocket healthcare expenses. The Healthcare FSA will be front-loaded for the entire benefit year on 6/1 (or your new hire start date) The following list provides examples of expenses eligible for reimbursement under the IRS guidelines:
• Non-covered medical expenses that quality under Section 217 of the IRS code
• Deductibles
• Office visit copays
• Prescription medication
• Over-the-counter medications
• Hearing and dental expenses not covered by insurance
Examples of non-eligible expenses include: cosmetic surgery, electrolysis, toiletries, vitamins, health club dues.
Dependent Care FSA
You may defer up to $5,000 to your Dependent Care FSA to fund eligible out-of-pocket expenses for childcare and eldercare. To be eligible for reimbursement, expenses must meet the following criteria established by the IRS:
▪ The person cared for must be under age 13, or if older, physically or mentally incapable of self-care.
▪ Day care must be necessary in order for you and your spouse to work.
▪ The person cared for must be claimed as a dependent on your federal tax return and must reside in your home at least eight hours per day
▪ Payment for care cannot be made to anyone you claim as a dependent on your income tax return, to your spouse or to a child under age 19.
▪ If care is provided by a center that cares for more than six individuals, it must be licensed.
For a complete list of eligible medical and dependent care expenses, you may access publications #502 (healthcare), #503 (dependent care) on the web at www.irs.gov.
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Our PPO Dental plan will be administered by Anthem. This plan has an extensive list of in- network providers . We would recommend seeing in-network dentists in order to maximize benefits and minimize out of pocket costs . Dental maximums reset on January 1st every year
To find a dentist, log on to www.anthem.com
DENTAL ACRM Benefit Guide | 9 Anthem PPO Dental Plan Highlights In-Network (Plan Pays) Out-of-Network (Plan Pays) Your Deductible (Waived for Preventive) $50 individual / $150 Family $50 individual / $150 Family Calendar Year Maximum Applies to preventive, basic, and major services $1,000 combined In-network and Out-of-Network $1,000 combined In-network and Out-of-Network Preventive & Diagnostic Services Exams, Cleanings & Bitewing X-Rays, Fluoride, Sealants 100% (Deductible waived) 100% (Deductible waived) Basic Services Filings, Extractions, Endodontics, Periodontics, Oral Surgery, Extractions 80% After deductible 80% After deductible Major Services Crowns, Bridgework, Full & Partial Dentures, Implants 50% Coinsurance 50% Coinsurance Orthodontics (Children under age 19) 50% to $1,000 50% to $1,000 Plan Reimbursement Levels Based on Contracted Fees Based on 90th Percentile of Usual & Customary
VISION
Our Vision plan will be administered by Anthem, utilizing the Blue View Vision network. This plan has an extensive list of in- network providers. We would recommend seeing in-network eye doctors in order to maximize benefits and minimize out of pocket costs.
To find a provider, log on to www.anthem.com
ANTHEM VISION Services In Network Out Of Network Eye Exam: Routine Exam with Dilation $10 Copay $42 allowance Frames: Any available frame at provider location $130 frame allowance 20% off balance over allowance $45 allowance Standard Plastic Lenses: Single $25 Copay $40 Bifocal $25 Copay $60 Trifocal $25 Copay $80 Lens Options: Factory Scratch Coating Covered in
Transitions Lenses
Covered
Standard Polycarbonate
Covered in
Transitions Lenses (Adults) $75 Standard UV Coating You pay up to $15 Standard Progressive (Add-on to Bifocal) $55 Other Add-Ons and Services 20% off retail Contact Lenses: Conventional $130 allowance $105 allowance Disposable $130 allowance $105 allowance Medically Necessary Paid in full $210 allowance Standard contact lens fitting Up to $55 Premium contact lens fitting 10% off retail price Frequency: Examination 12 months Frames 24 months Eyeglass Lenses 12 months Contact Lenses 12 months
Full
(Children under age 19)
in Full
(Children under age 19)
Full
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ACRM provides all Full-Time employees a $30,000 basic life and Accidental Death & Dismemberment (AD&D) benefit. Life insurance pays your named beneficiary in the event of your death. AD&D insurance will provide a benefit to your beneficiary if your death is the result of an accident AD&D insurance will provide a benefit to you if you suffer certain accidental injuries, such as the loss of limb (arm/leg), loss of eyesight or permanent paralysis This coverage is provided through Mutual of Omaha and is paid for by the company The benefit reduces by 35% at age 65 and 50% at age 70 Please make sure beneficiary information is updated in the Bernie Portal
SUPPLEMENTAL LIFE AND AD&D
Employees may elect a minimum of $10,000 up to a maximum of 5x earnings or $300,000, in $10,000 increments subject to guaranteed issue schedule. Spouses may elect increments of $5,000 up to a maximum of $150,000, subject to guaranteed issue schedule. The spouse's Voluntary Life benefit cannot exceed 50% of the employee's Voluntary Life amount. Dependent Child(ren) coverage is available up to a maximum benefit of $10,000. Pricing is based on Employee age and amount of coverage. See Bernie Portal for further details.
Guaranteed Issue Schedule
• Employee: $100,000
• Spouse: $20,000
• Child: All coverage is guaranteed issue
EMPLOYER
LIFE AND AD&D
PAID
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DISABILITY INSURANCE
Disability coverage provides the financial security of knowing that you will continue to receive income if you are unable to work due to illness or injury.
Voluntary Short-Term Disability
Even a few weeks away from work can make it difficult to manage household expenses Short-Term Disability is a voluntary benefit through Mutual of Omaha This coverage will pay up to 60% of your weekly salary up to a maximum of $1,000 for non work-related accidents or illnesses, so you can focus on getting better, and worry less about keeping up with your bills . Benefits begin on the 15th day of disability for accident and sickness . Benefits are payable up to a maximum of 11 weeks
Pre-existing conditions exclusion: 3 month lookback; Excluded for the first 6 months of coverage.
Voluntary Long-Term Disability
Serious illnesses or accidents can come out of nowhere They can interrupt your life and your ability to work for months or even years. Voluntary Long-Term Disability coverage is available to you through Mutual of Omaha. This benefit pays 60% of your monthly earnings in the event of a disability after 90 days for non workrelated accidents or illnesses up to a maximum monthly benefit of $6,000. The Long-Term Disability benefit pays up to the Social Security Normal Retirement Age (SSNRA).
Pre-existing conditions exclusion: 12 month lookback; Excluded for the first 12 months of coverage.
If you decline the LTD benefit when you are first eligible as a new-hire and apply as a late-entrant, evidence of insurability will be required for you to be approved for coverage
SUPPLEMENTAL BENEFITS
Aflac will be offering 4 supplemental benefit plans to compliment the core benefits through ACRM.
Accident Critical Care Cancer
Hospital Indemnity
Pays you specific dollar amounts for accidents/injuries requiring medical attention Dollar amounts will vary based on the type and severity of the claim The accident plan has a wellness benefit offering along with organized sport even injuries which have a 25% additional benefit.
Pays a lump sum of $7,500 if you experience a major life event, such as a heart attack, stroke, cancer, coma, etc.
Pays an initial diagnosis benefit prior to the beginning of treatment Treatment of specific types of cancer have no maximum amount. The cancer plan includes skin cancer and hospital confinement benefits. The plan has a $75 wellness benefit for each insured and children are covered free up to age 26.
Pays set dollar amounts of $500, $1,000, $1,500 or $2,000 for initial hospital confinement of 23 hours or more, days spent in the hospital, physician visits and intensive care treatment.
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COST OF COVERAGE
ACRM contributes to the cost of medical coverage for all eligible employees. Please refer to the chart below for your pre-tax payroll deductions.
Semi-Monthly Payroll Deductions Anthem Medical Plans Employee Only Employee & Spouse Employee & Child(ren) Family HSA $5000 80% $59.34 $217.05 $196.73 $347.45 Core $3500 80% $104.12 $294.60 $268.56 $470.54 Buy-Up $2000 100% $136.20 $381.22 $347.73 $607.25 Dental Employee Only Employee & Spouse Employee & Child(ren) Family Anthem Dental Plan $9.16 $26.81 $28.86 $50.15 Vision Employee Only Employee & Spouse Employee & Child(ren) Family Anthem Vision Plan $2.95 $5.90 $6.63 $10.44 Basic Life / AD&D 100% Company Paid Voluntary Life & Disability See Bernie Portal for Personalized Pricing Information ACRM Benefit Guide | 13
Benefit Company Phone Website Medical, Dental Vision Coverage Anthem 855-397-9267 www.anthem.com Life and Disability Mutual of Omaha 800-877-5176 www.mutualofomaha.com FSA HSA Admin America 770-992-5959 www.adminamerica.com Voluntary Benefits Aflac (Shirley Lloyd) 815-600-0721 Email: Shirley_Lloyd@us.Aflac.com KEY CONTACTS & RESOURCES Questions on your benefits or need assistance with Claims, contact Sterling Seacrest Pritchard: ACRM Benefit Guide | 14 Your Employee Support Contacts Claims Questions? Darlene Moorman 770.635.0439 dmoorman@sspins.com BE SURE TO HAVE THE FOLLOWING INFORMATION WHEN CALLING: Subscriber ID # Date of Service Name of Patient Name of Doctor, Facility or Hospital Copy of Bill or Explanation of Benefits (EOB) Benefit Questions? Steven Katcoff 678.426.1572 stevenk@sspins.com
IMPORTA NT NOTICE ABOUT YOUR PRESCRIPTION DRUG COVERAGE & MEDICARE
CREDITABLE
Please read this notice carefully and keep it where you can find it This notice has information about your current prescription drug coverage with ACRM 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:
• 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
• ACRM has determined that the prescription drug coverage offered by the three Anthem plans are, on average for all plan participants, expected to pay out as much as standard Medicare prescription drug coverage pays and is therefore considered Creditable Coverage Because your existing coverage is Creditable Coverage, you can keep this coverage and not pay a higher premium (a penalty) if you later decide to join a Medicare drug plan
When Can You Join a Medicare Drug Plan?
You can join a Medicare drug plan when you first become eligible for Medicare and each year from October 15th to December 7th However, if you lose your current creditable prescription drug coverage, through no fault of your own, you will also be eligible for a two (2) month Special Enrollment Period (SEP) to join a Medicare drug plan.
What Happens To Your Current Coverage If You Decide to Join A Medicare Drug Plan?
If you decide to join a Medicare drug plan, your current ACRM cover- age will not be affected Please review prescription drug coverage plan provisions/options under the certificate booklet provided by Cigna. See pages 7- 9 of the CMS Disclosure of Creditable Coverage To Medicare Part D Eligible Individuals Guidance 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 ACRM coverage, be aware that you and your dependents may 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 ACRM 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 carrier.
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 ACRM 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- 800325-0778).
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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IMPORTANT INFORMATION
COBRA Continuation of Coverage
The right to COBRA continuation coverage was created by a federal law, the Consolidated Omnibus Budget Reconciliation Act of 1985 (COBRA). COBRA continuation coverage can become available to you and other members of your family when group health coverage would otherwise end. For more information about your rights and obligations under the Plan and under federal law, you should review the Plan’s Summary Plan Description or contact the Plan Administrator. For additional information regarding COBRA qualifying events, how coverage is provided and actions required to participate in COBRA coverage, please see your Human Resources department
Newborns’ and Mothers’ Health Protection Act
The group health coverage provided complies with the Newborns’ and Mothers’ Health Protection Act of 1996. Under this law 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 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 issuers may not, under federal law, require that a provider obtain authorization from the plan or the insurance issuer for prescribing a length of stay not in excess of 48 hours (or 96 hours).
Premium Assistance under Medical and CHIP
If you or your children are eligible for Medicaid or CHIP (Children’s Health Insurance Program) and you are eligible for health coverage from your employer, your State may have a premium assistance program that can help you pay for coverage These States use funds from their Medicaid or CHIP programs to help people who are eligible for employer-sponsored health coverage but need assistance in paying their health premiums . If you or your dependents are already enrolled in Medicaid or CHIP you can 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, you can contact your State Medicaid or CHIP office or dial 1-877-KIDS NOW or www.insurekidsnow.gov to find out how to apply. If you qualify, you can ask the State if it has a program that might help you pay the premiums for an employer-sponsored plan. Please see Human Resources for a list of state Medicaid or CHIP offices to find out more about premium assistance
Special Enrollment Events
An Eligible Person and/or Dependent may also be able to enroll during a special enrollment period. A special enrollment period is not available to an Eligible Person and his or her dependents if coverage under the prior plan was terminated for cause, or because premiums were not paid on a timely basis
An Eligible Person and/or Dependent does not need to elect COBRA continuation coverage to preserve special enrollment rights Special enrollment is available to an Eligible Person and/or Dependent even if COBRA is elected. Please be aware that most special enrollment events require action within 30 days of the event. Please see Human Resources for a list of special enrollment opportunities and procedures.
Women’s Health and Cancer Rights Act
If you have had or are going to have a mastectomy , you may be entitled to certain benefits under the Women’s Health and Cancer Rights Act of 1998 (WHCRA) For individuals receiving mastectomy-related benefits, coverage will be provided in a manner determined in consultation with the attending physician and the patient, for: All stages of reconstruction of the breast on which the mastectomy has been performed; Surgery and reconstruction of the other breast to produce a symmetrical appearance; and Prostheses and treatment of physical complications of the mastectomy, including lymphedemas. These benefits will be provided subject to deductibles and coinsurance applicable to other medical and surgical benefits provided under this plan. If you would like more information on WHCRA benefits, call your plan administrator.
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IMPORTANT INFORMATION
The Genetic Information Nondiscrimination Act (GINA) prohibits health benefit plans from discriminating on the basis of genetic information in regards to eligibility, premium and contributions. This generally also means that private employers with more than 15 employees, its health plan or “business associate” of the employer, cannot collect or use genetic information, (including family medical history information) The once exception would be that a minimum amount of genetic testing results make be used to make a determination regarding a claim.
You should know that GINA is treated as protected health information (PHI) under HIPAA. The plan must provide that an employer cannot request or require that you reveal whether or not you have had genetic testing; nor can your employer require that you participate in a genetic test. An employer cannot use any genetic information to set contribution rates or premiums.
PPACA Compliant Plan Notice
Since key parts of the health care law took effect in 2014, there is a new way to buy health insurance: the Health Insurance Marketplace . To assist you as you evaluate options for you and your family, this notice provides some basic information about the new Marketplace and employment based health coverage offered by your employer.
If your employer offers health coverage that meets the “minimum value” plan standard, you will not be eligible for a tax credit through the Marketplace and may wish to enroll in your employer’s health plan The “minimum value” plan standard is set by the Affordable Care Act Your health plans offered by [Company] are ACA compliant plans (surpassing the “minimum value” standard), thus you would not be eligible for the tax credit offered to those who do not have access to such a plan.
NOTE: If you purchase a health plan through the marketplace instead of accepting health coverage offered by your employer, then you will lose the employer contribution to the employer offered coverage. Also, this employer contribution, as well as your employee contribution to employer offered coverage, is excluded from income for Federal and State income tax purposed.
USERRA Notice
The Uniformed Services Employment and Reemployment Rights Act of 1994 (USERRA) established requirements that employers must meet for certain employees who are involved in the uniformed services In addition to the rights that you have under COBRA, you (the employee) are entitled under USERRA lo continue the coverage that you (and your covered dependents, if any) had under the [Company] plan.
You Have Rights Under Both COBRA and USERRA. Your rights under COBRA and USERRA are similar but not identical. Any election that you make pursuant to COBRA will also be an election under USERRA, and COBRA and USERRA will both apply with respect to the continuation coverage elected. If COBRA and USERRA give you different rights or protections, the law that provides the greater benefit will apply The administrative policies and procedures described in the attached COBRA Election Notice also apply to USERRA coverage, unless compliance with the procedures is precluded by military necessity or is otherwise impossible or unreasonable under the circumstances
Definitions
"Uniformed services" means the Armed Forces, the Army National Guard, and the Air National Guard when an individual is engaged in active duty for training, inactive duty training, or full-time National Guard duty (i e , pursuant to orders issued under federal law), the commissioned corps of the Public Health Service, and any other category of persons designated by the President in time of war or national emergency.
"Service in the uniformed services" or "service" means the performance of duty on a voluntary or involuntary basis in the uniformed services under competent authority, including active duty, active and inactive duty for training, National Guard duty under federal statute, a period for which a person is absent from employment for an examination to determine his or her fitness to perform any of these duties, and a period for which a person is absent from employment to perform certain funeral honors duty It also includes certain service by intermittent disaster response appointees of the National Disaster Medical System.
GINA
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IMPORTANT INFORMATION
Duration of USERRA Coverage
General Rule: 24- Month Maximum. When a covered employee takes a leave for service in the uniformed services, USERRA coverage for the employee (and covered dependents for whom coverage is elected) can continue until up to 24 months from the date on which the employee's leave for uniformed service began However, USERRA coverage will end earlier if one of the following events takes place:
A premium payment is not made within the required time; You fail to return to work or to apply for reemployment within the time required under USERRA (see below) following the completion of your service in the uniformed services; You lose your rights under USERRA as a result of a dishonorable discharge or other conduct specified in USERRA.
Notice of Privacy Provision
This Notice of Privacy Practices (the "Notice") describes the legal obligations of [Company] (the "Plan") and your legal rights regarding your protected health information held by the Plan under the Health Insurance Portability and Accountability Act of 1996 (HIPAA) and the Health Information Technology for Economic and Clinical Health Act (HITECH Act) . Among other things, this Notice describes how your protected health information may be used or disclosed to carry out treatment, payment, or health care operations, or for any other purposes that are permitted or required by law We are required to provide this Notice of Privacy Practices to you pursuant to HIPAA.
The HIPAA Privacy Rule protects only certain medical information known as "protected health information." Generally, protected health information is health information, including demographic information, collected from you or created or received by a health care provider, a health care clearinghouse, a health plan, or your employer on behalf of a group health plan, from which it is possible to individually identify you and that relates to:
• Your past, present, or future physical or mental health or condition;
• The provision of health care to you; or
• The past, present, or future payment for the provision of health care to you.
If you have any questions about this Notice or about our privacy practices, please contact your Human Resources department. The full privacy notice is available with your Human Resources Department.
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