2022 - 2023
BENEFITS GUIDE
October 1, 2022 September 30,, 2023
Dependent children
*Elections for medical benefits will take place in October for a January 1st effective date. No medical changes can be made at this time.*
Spouse
Legally adopted children
• Change in dependent status (i.e. Dependent child reaches age 26 limit)
• Employment changes from Part-time to Full-time
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Welcome!
OPEN ENROLLMENT
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• Marriage Divorce Birth or adoption
QUALIFYING EVENTS
Stepchildren
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Once you elect your benefits, the elections remain in effect for the plan year, October 1, 2022September 30th, 2023. You may only change coverage due to an IRS qualified “life event” and must do so within 30 days of the event. A qualifying event is a significant change in a person’s life that creates the need to add, cancel, increase, or change coverage. We encourage you to review all your benefits and make selections wisely.
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New hires are eligible for benefits on the first of the month following date of hire. You may enroll yourself and eligible dependents for coverage. You must enroll yourself in benefits in order to enroll your dependents. Dependent children are eligible for the group health plan until their 26th birthday regardless of whether they are a full-time
This year we will be using Employee Navigator again to make our benefits elections. You must elect or decline coverage through the Employee Navigator.
Eligiblestudent. dependents include:
ELIGIBILITY
Open Enrollment is your opportunity to add, cancel, or make changes to your benefits. This year, open enrollment for your Guardian plan; Dental, Vision, Hospital Confinement, Short Term Disability and Accident, will be Monday, September 19th – Thursday, September 29th.
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Our employees are our greatest resource, and so we are proud to offer a robust benefits package. Please take the time to carefully review the information, carrier changes and all the benefits offered to you. We hope the benefits offered will inspire you and your dependents to take charge of your health and continue making wellness a priority.
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Once you have made your elections, you are NOT eligible to change or drop coverage until the next Open Enrollment period unless you have a qualifying event. If you experience a qualifying life event, contact the Human Resources Department within 30 days of your qualifying event. If you fail to do so, you will have to wait until the next open enrollment period to make any changes to your coverage. Qualifying life events include, but are not limited to:
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• Company identifier – Atl.Inv.Co.
If this is your first time logging in to Employee Navigator, you will need to register. To begin, visit www.employeenavigator.com and use the steps below to login.
• The last 4 digits of your SSN.
• Your date of birth.
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HOW TO ENROLL
• Your first and last name as they appear in payroll.
1. Click "Login" at the top right-hand corner of the page.
3. Create your account by entering:
If you encounter a login error, please reach out to Marie Volk at Sterling Seacrest Pritchard – mvolk@sspins.com.
2. Click on Register as a new user. For the 2022-2023 Open Enrollment, all employees will need to register as a NEW USER. Prior Employee Navigator logins will not be active.
Out-of-Network Claims Payments
Type III - Major Services
Type II - Basic Service
COST PER PAYCHECK (52) - Weekly Employee
100% - Cleanings, Exams, X-Rays, Fluoride, Sealants, Space Maintainers
100% - Cleanings, Exams, X-Rays, Fluoride, Sealants, Space Maintainers
Family
Orthodontia Services (lifetime limit) N/A
80% - Fillings, Simple Oral Surgery, Emergency Palliative Treamtment, General Anesthesia, Endo, Perio
DENTAL Benefit Guide | 4 Dental benefits are available through Guardian. To find dental providers visit Guardian.com Click Find a Dentist. The network is the DentalGuard Pref - Atlanta network. VISION Vision benefits are available through Guardian. To find vision providers visit Guardian.com Choose from a large network of retailersoptometristsophthalmologists,andopticians,fromprivatepracticestolikeCostco®Optical,Walmart,Sam’sClubandVisionworks. In-Network VSP Exam (once per 12 months) $10 copay Lenses (once per 12 months) $20 copay Frames (once per 24 months) $130 allowance Contacts (in lieu of glasses) $130 allowance COST PER PAYCHECK (52) - Weekly Employee $1.50 Employee + Spouse $3.02 Employee + Child(ren) $2.55 Family $4.21 Low Plan High Plan Annual Maximum (Per Person) $1,000 $1,500 Deductible - Employee/Family (Waived for Preventive) $50/$150 $50/$150 Type I - Preventive
50% - Inlays, Onlays, Crowns, Dentures, Bridges 50% up to $1,000 90th UCR 90th UCR $7.03 $8.85 $13.82 $17.52 Child(ren) $16.36 $20.98 $25.23 $32.24
Employee +
Employee + Spouse
80% - Fillings, Simple Oral Surgery, Emergency Palliative Treamtment, General Anesthesia, Endo , Perio
50% - Inlays, Onlays, Crowns, Dentures, Bridges
Hospital Admission
Hospital Confinement provides hospital benefits to help cover out of pocket costs created by co pays and deductibles.
See plan summary for additional benefits
$1,000 per day to a max of 1 day per year per insured, max of 3 days per covered family.
Employee $1.34 $2.89
Accidental Death & Dismemberment
Low Plan
Employee - $25,000 Spouse - $12,500 Child - $5,000
Employee + Spouse $2.32 $5.05
Wellness $50 $50
Benefits are provided through Guardian
Voluntary Short Term Disability – Employees have the option to purchase short term disability. Rates are based on age and Benefitsalary.Amount: 60% of weekly salary up to a maximum of $1,000 for non-work related accidents or Waitingsicknesses.Period: Benefits begin on day 15 Benefit Period: up to 11 weeks
Accident coverage provides benefits for common on/off job accidental injuries and related treatments. Benefits are payable for covered injures such as dislocations, fractures and burns; and treatments including ER visits, x rays and surgery.
Family $3.73 $8.14
COST PER PAYCHECK (52) - Weekly
Employee + Spouse $2.32 $5.05
COST PER PAYCHECK (52) - Weekly
Admission - $1,000 Confinement - $250/day
Hospital Admission - $500 Confinement - $100/day
Employee - $50,000 Spouse - $25,000 Child - $10,000
Employee + Child(ren) $2.75 $5.98
Voluntary Benefits
Fractures up to $3,000 up to $6,000
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$500 per day to a max of 1 day per year per insured, max of 3 days per covered family.
Dislocations up to $2,000 up to $5,000
See plan summary for additional benefits
High Plan
Family $3.73 $8.14
Hospital Confinement $100 per day to max of 15 days $200 per day to max of 15 days
Benefit Basic Advantage
$1.34 $2.89
Employee
Employee + Child(ren) $2.75 $5.98
Questions on your benefits or need assistance with Claims, contact Sterling Seacrest Pritchard: Benefit Guide | 6
Your Employee Support Contact
KEY CONTACTS & RESOURCES
Benefit Questions? Marie jblazevich@sspins.com704.996.6517Jebmvolk@sspins.com770.635.0451VolkBlazevich Claims Questions? Darlene CopyNameNameDateSubscriberINFORMATIONBEdmoorman@sspins.com770.635.0439MoormanSURETOHAVETHEFOLLOWINGWHENCALLING:ID#ofServiceofPatientofDoctor,FacilityorHospitalofBillorExplanationofBenefits (EOB)
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:
• Surgery and reconstruction of the other breast to produce a symmetrical appearance;
The continuation required by Federal Law does not apply to any benefits for loss of life, dismemberment or loss of income . Federal law enables you or your dependent to continue health insurance if coverage would cease due to a reduction of your work hours or your termination of employment (other than gross misconduct) Federal law also enables your dependents to continue health insurance if their coverage ceases due to your health, divorce, or legal separation, or with respect to a dependent child, failure to continue to qualify as a dependent. Continuation must be elected in accordance with the rules of your Employer's group health plan(s) and is subject to federal law, regulations and interpretations
NEWBORNS' & MOTHERS' HEALTH PROTECTION ACT
Federal law prohibits the plan from limiting a mother's or newborn's length of hospital stay to less than 48 hours for a normal delivery or 96 hours for a Cesarean delivery or from requiring the provider to obtain pre authorization for a stay of 48 or 96 hours, as appropriate. However, federal law generally does not prohibit the attending provider, after consultation with the mother, from discharging the mother or her newborn earlier than 48 hours for normal delivery or 96 hours for Cesarean delivery
If you decline enrollment in your employer's health plan for you or your dependents (including your spouse) because of other health insurance or group health plan coverage, you or your dependents may be able to enroll in your employer's plan without waiting for the next open enrollment period if you:
• Prostheses; and
HEALTH INSURANCE PORTABILITY AND ACCOUNTABILITY ACT (HIPAA)
• Lose other health insurance or group health plan coverage You must request enrollment within 30 days after the loss of other coverage.
THIS GUIDE This brochure summarizes the health care and income protection benefits that are available to Atlantic Investment Company 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.
LEGAL NOTICES
SPECIAL ENROLLMENT NOTICES
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WOMEN'S HEALTH ACT
• Treatment of physical complications of the mastectomy, including lymphedema. These benefits will be provided subject to the same deductibles and coinsurance applicable to other medical and surgical benefits provided under this plan If you have any questions about your coverage, please contact your Human Resources department.
• Gain a new dependent as a result of marriage, birth, adoption or placement for adoption. You must request (medical plan OR health plan) enrollment within 30 days after the marriage, birth, adoption or placement for adoption
The continuation required by Federal Law does not apply to any benefits for loss of life, dismemberment or loss of income . Federal law enables you or your dependent to continue health insurance if coverage would cease due to a reduction of your work hours or your termination of employment (other than gross misconduct) Federal law also enables your dependents to continue health insurance if their coverage ceases due to your health, divorce, or legal separation, or with respect to a dependent child, failure to continue to qualify as a dependent. Continuation must be elected in accordance with the rules of your Employer's group health plan(s) and is subject to federal law, regulations and interpretations
Atlantic Investment Company, in accordance with HIPAA, protects your Protected Health Information (PHI) . We will only discuss your PHI with medical providers and third party administrators when necessary to administer the plan that provides you your medical, dental and vision benefits or as mandated by law A copy of the Notice of Privacy is available upon request through your Human Resources department.
• All stages of reconstruction of the breast on which the mastectomy was performed;
CONTINUATION REQUIRED BY FEDERAL LAW FOR YOU & YOUR DEPENDENTS (COBRA)
• Lose Medicaid, or Children's Health Insurance Program (CHIP) coverage because you are no longer eligible. You must request medical plan enrollment within 60 days after the loss of such coverage.
MEDICAID AND THE CHILDREN'S HEALTH INSURANCE PROGRAM (CHIP)