2024 - 2025 BENEFIT GUIDE
June 1, 2024 - May 31, 2025
At Arris Manufacturing we know that our employees are crucial to our success. That’s why we provide you with an excellent, diverse benefits package that helps protect you and your family now and into the future.
This Benefits Guide outlines the health and welfare plans offered to you and your family. It contains general information and is meant to provide a brief overview. For complete details regarding each benefit plan offered, please refer to the individual plan documents as the information contained herein is for illustrative purposes. Details can be found in the plan specific Summary Plan Description(s) and/or Summary of Coverage. In the case of a discrepancy the plan specific documents will prevail.
TABLE OF CONTENTS
Page 2 Smarter Way to Better Health
Page 3 Eligibility & Enrolling
Pages 4-6 Medical Plans
Pages 7-8 HSA
Pages 9 MyHealthToolkit
Page 10 Dental
Page 11 Vision
Page 12 Guardian Anytime
Page 13 Life, Disability, & EAP
Page 14 EAP
Page 15 Voluntary Life
Page 16 Worksite Products
Page 17 Contributions
Page 18 Key Contacts
Page 19-27 Important Information
Page 28 Health Insurance Terms
Page 29
Notes
Arris Manufacturing Benefit Guide | 1
A SMARTER WAY TO BETTER HEALTH
It’s Your Health.
Get Involved
Preventive Health Care Services
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 pleased to offer programs that will support your efforts and help you reach goals.
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
Understanding What’s Covered
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
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% in-network, 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.
Arris Manufacturing Benefit Guide | 2
ELIGIBILITY & ENROLLING
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 fulltime 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 to whom you are legally married
• 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 60 days as a full-time employee with Arris Manufacturing.
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 IRS-approved 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 full-time 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 non-payment or voluntary termination of other coverage outside a spouse’s or parent’s open enrollment is not an IRSapproved qualifying life event and you do not qualify for a special enrollment period
! Arris Manufacturing Benefit Guide | 3
Arris Manufacturing offers two different medical plan options through Blue Cross Blue Shield of South Carolina. The following charts provide an overview of the plan designs. To search for an in-network provider, visit www.southcarolinablues.com, click “Find Care”, and select the Preferred Blue network.
BASE PLAN – $4500 DEDUCTIBLE/30% BCBS of SC- $4500 Deductible Preferred 17 Plan Highlights In Network – You Pay Out-of-Network – You Pay Deductible $4,500 Individual | $7,500 Family $7,500 Individual | $22,500 Family Coinsurance 20% after deductible 40% after deductible Annual Out-of-Pocket Maximum $9,450 Individual | $18,900 Family $14,700 Individual | $29,400 Family Primary Care Physician Office Visit $40 copay Deductible, then 40% Specialist Office Visit $60 copay Deductible, then 40% Preventive Care Services Plan pays 100% Deductible, then 40% Laboratory Diagnostics & X-Ray Deductible, then 20% Deductible, then 40% Complex Imaging Services (CT Scans, PET Scans & MRI’s) Deductible, then 20% Deductible, then 40% Hospital Inpatient Care Deductible, then 20% Deductible, then 40% Outpatient Surgery Deductible, then 20% Deductible, then 40% Emergency Room Deductible, then 20% Paid as In-network Urgent Care $60 copay Deductible, then 40% Prescription Drugs Quantity Limits: Retail = 30-day supply Mail-Order = 90-day supply Tier 1 Generic Drugs Retail: $15 copay Retail: $15 copay, then 40% Tier 2 Preferred Brand-Name Retail: $70 copay Retail: $70 copay, then 40% Tier 3 Non-Preferred Brand-Name Retail: $120 copay Retail: $120 copay, then 40% Tier 4 - Specialty Drugs Retail: 20% to $500 Not Available Arris Manufacturing Benefit Guide | 4 ! *You
by providers and/or facilities when using an out-of-network facility.”
could be balanced billed
BUY - UP PLAN – $2500 DEDUCTIBLE/20% BCBS of SC- $2500 Deductible Preferred 2 Plan Highlights In Network – You Pay Out-of-Network – You Pay Deductible $2,500 Individual | $7,500 Family $4,500 Individual | $13,500 Family Coinsurance 20% after deductible 40% after deductible Annual Out-of-Pocket Maximum $5,000 Individual | $10,000 Family $9,000 Individual | $18,000 Family Primary Care Physician Office Visit $30 copay Deductible, then 40% Specialist Office Visit $50 copay Deductible, then 40% Preventive Care Services Plan pays 100% Deductible, then 40% Laboratory Diagnostics & X-Ray Deductible, then 20% Deductible, then 40% Complex Imaging Services (CT Scans, PET Scans & MRI’s) Deductible, then 20% Deductible, then 40% Hospital Inpatient Care Deductible, then 20% Deductible, then 40% Outpatient Surgery Deductible, then 20% Deductible, then 40% Emergency Room Deductible, then 20% Paid as In-network Urgent Care $50 copay Deductible, then 40% Prescription Drugs Quantity Limits: Retail = 30-day supply Mail-Order = 90-day supply Tier 1 Generic Drugs Retail: $15 copay Retail: $15 copay, then 40% Tier 2 Preferred Brand-Name Retail: $70 copay Retail: $70 copay, then 40% Tier 3 Non-Preferred Brand-Name Retail: $120 copay Retail: $120 copay, then 40% Tier 4 - Specialty Drugs Retail: 20% to $500 Not covered Arris Manufacturing Benefit Guide | 5 ! *You could be balanced billed by providers and/or facilities when using an out-of-network facility.”
HSA PLAN – $4000 DEDUCTIBLE/0% BCBS of SC- $4000 High Deductible Health Plan 3 Plan Highlights In Network – You Pay Out-of-Network – You Pay Deductible $4,000 Individual | $8,000 Family $4,000 Individual | $8,000 Family Coinsurance 0% after deductible 40% after deductible Annual Out-of-Pocket Maximum $4,000 Individual | $8,000 Family $7,000 Individual | $14,000 Family Primary Care Physician Office Visit Deductible, then 0% Deductible, then 40% Specialist Office Visit Deductible, then 0% Deductible, then 40% Preventive Care Services Plan pays 100% Deductible, then 40% Laboratory Diagnostics & X-Ray Deductible, then 0% Deductible, then 40% Complex Imaging Services (CT Scans, PET Scans & MRI’s) Deductible, then 0% Deductible, then 40% Hospital Inpatient Care Deductible, then 0% Deductible, then 40% Outpatient Surgery Deductible, then 0% Deductible, then 40% Emergency Room Deductible, then 0% Paid as In-network Urgent Care Deductible, then 0% Deductible, then 40% Prescription Drugs Quantity Limits: Retail = 30-day supply Mail-Order = 90-day supply Tier 1 Generic Drugs Deductible, then 0% Deductible, then 40% Tier 2 Preferred Brand-Name Deductible, then 0% Deductible, then 40% Tier 3 Non-Preferred Brand-Name Deductible, then 0% Deductible, then 40% Tier 4 - Specialty Drugs Deductible, then 0% Deductible, then 40% Arris Manufacturing Benefit Guide | 6
providers and/or facilities
using an out-of-network facility.”
! *You could be balanced billed by
when
HEALTH SAVINGS ACCOUNT (HSA)
Available only if you enroll in the HSA Plan through Health Equity
With the health care industry changing and premiums increasing, it’s important to understand the options available to you so that you can make informed choices about your coverage.
A Health Savings Account is an individually owned account used to cover current and future medical expenses. HSA’s are available to all individuals who are covered by a qualified high deductible health plan (HDHP), so it’s important to understand HDHP’s first. An HDHP is exactly what its name implies, although there are regulations in place defining its parameters. First, the deductibles are higher than many traditional plans. One of the benefits of contributing to an HSA is the ability to reduce your tax liability. Contributions to your account are made on a pre-tax basis thus reducing your taxable income. The IRS limits the maximum contribution amount to your HSA. Your account is completely portable; it belongs to you. Additionally, you are not required to take distributions. Your money can continue to grow in your account until you need it. Unlike flexible spending accounts which work on a “use it or lose it” principle, HSA’s are use it or keep it! You maintain complete control over how and when to make payments for qualified medical expenses from your account.
Why should you consider the HDHP with HSA?
→ Lower monthly payroll contributions to participate.
→ Ability to open HSA and save funds for qualified expenses.
→ Ability to pay for qualified expenses with pretax payroll dollars.
→ Funds withdrawn for qualified expenses are not taxable.
→ Unspent HSA funds “roll over” year to year (“use it or lose it” does not apply).
→ Use of debit card at HSA approved locations.
→ You own the bank account and keep the HSA if you change jobs or health plans.
The following rules apply when opening an HSA:
An HSA is a bank account opened and controlled by the plan participant (employee). To contribute to the HSA:
→ You must be covered under a Qualified High Deductible Health Plan (HDHP).
→ You may not be covered by any other Non-HDHP insurance.
→ You may not be enrolled in Medicare, TRICARE or TRICARE for Life.
→ You cannot be eligible to be claimed as a dependent on another person’s tax return.
What are qualified expenses?
→ Your health plan deductible
→ Your health plan coinsurance
→ Your prescription copays (after your deductible is met)
→ Vision care (glasses, contact lenses)
Loss of Other Coverage
→ Dental (including periodontics and orthodontia)
→ Long Term Care insurance
→ COBRA premiums
→ Medicare premiums
For more information on Health Savings Accounts, visit www.irs.gov
Arris Manufacturing Benefit Guide | 7
HEALTH SAVINGS ACCOUNT (HSA)
Available only if you enroll in the HSA Plan.
The Health Savings Account (HSA) is a tax-advantaged, interest-bearing bank account used to pay for eligible health care expenses. You can make contributions to the HSA and all money in the account is yours to keep even if you leave Arris . You can withdraw your funds to pay for current health care expenses, or you can keep your money in the HSA to pay for future expenses. At the end of the year, any money in the HSA rolls over to the next year. You never lose it.
IMPORTANT NOTE: Your HSA account is a personal bank account that you would pay into directly. Staying within the IRS Annual limits is your responsibility, not Arris Manufacturing. In order to qualify for the family Maximum you and your dependents must be on a qualified High Deductible Health Plan.
Arris Manufacturing Benefit Guide | 8
Coverage Level IRS Maximum Allowable Calendar Year Contribution for 2024 Individual $4,150 (Company and Employee contribution combined) Family (Individual plus any dependent or dependents) $8,300 (Company and Employee contribution combined) Additional Amount if 55 or Older $1,000
Arris Manufacturing Benefit Guide | 9
DENTAL
Staying healthy includes obtaining quality dental care for you and your family. Arris Manufacturing sponsors a Dental Plan through Guardian. To locate nearby providers in your network go to www.guardiananytime.com and click on Find a Provider.
/
Calendar Year Maximum
Applies to preventive, basic, and major services
Preventive & Diagnostic Services
Exams, Cleanings & Bitewing X-Rays, Fluoride, Sealants
Basic Services
Filings, Extractions, Endodontics (root canal), Periodontics (gum surgery), Oral Surgery
Major Services
Crowns, Bridgework, Full & Partial Dentures, Implants, Repair of Dentures
Claims Reimbursement Method
and Out-ofNetwork
Negotiated Fee Schedule 90th percentile of usual & customary
Maximum Rollover Feature: If you visit the dentist at least once a year and use less than $600 in claims, $300 is placed in a rollover account the next year. The rollover account can continue to grow up to $1,250.
Arris Manufacturing Benefit Guide | 10 Dental
In-Network Out of Network
$50 individual
$150 Family $50 individual
$150 Family
Plan Highlights
Your Deductible
/
$1,250
network
$1,250 combined Innetwork
combined In-
and Out-ofNetwork
100% (Deductible waived) 100% (Deductible waived)
80% After deductible 80% After deductible
50%
deductible 50%
After
After deductible
VISION
Arris Manufacturing offers a voluntary vision plan through Guardian. The plan uses the VSP Vision Network. Please see the Plan Summary Description for more information.
Services In Network Out Of Network Eye Exam: Routine Exam with Dilation $10 Copay $39 allowance Frames: Frames $130 frame allowance 20% off balance over allowance $46 allowance Standard Plastic Lenses: Single $25 Copay $23 allowance Bifocal $25 Copay $37 allowance Trifocal $25 Copay $49 allowance Contact Lenses: (Material Only) Conventional $130 allowance $100 allowance Frequency: Examination 12 months Frames 24 months Eyeglass Lenses 12 months Contact Lenses 12 months Arris Manufacturing Benefit Guide | 11
Arris Manufacturing Benefit Guide | 12
GROUP LIFE AND AD&D
Life Insurance is a key element of proper financial planning and helps provide financial stability and protection for families in case of an untimely death. If you are an eligible full-time employee, Arris Manufacturing provides $25,000 of basic group term life insurance and an additional matching amount of accident death and dismemberment (AD&D) insurance through Guardian.
Choose Your Beneficiary
• Make sure your life and accident death benefits will be paid as you intend.
• Be sure you name a beneficiary when you enroll in Life and AD&D benefits during open enrollment.
• Then, continue to review your beneficiary designations as you experience life changes.
SHORT - TERM DISABILITY
Arris Manufacturing provides all full-time employees with Short-Term Disability insurance through Guardian. This coverage pays a weekly benefit of 60% of your pre-disability income (up to a maximum of $1,000 per week) during periods of disability resulting from injury, sickness, or pregnancy. STD benefits begin on the 15th day after an accident, sickness, or pregnancy. STD benefits pay weekly for a duration of up to 12 weeks. If you receive a salary increase, your benefit amount will be adjusted.
EMPLOYEE ASSISTANCE
WorkLife Matters, Guardian’s comprehensive Employee Assistance Program (EAP), is complimentary and confidential. Receive expert support services to assist you and your family with a variety of life issues, from family care, stress, depression or addiction. In today’s environment, we acknowledge that addressing work-life balance issues is more important than ever.
Arris Manufacturing Benefit Guide | 13
Arris Manufacturing Benefit Guide | 14
VOLUNTARY LIFE AND AD&D
Supplemental Life/AD&D Insurance
Employees have the option of purchasing Supplemental Life/AD&D Insurance, on top of their employer-paid insurance through Guardian. Supplemental Life/AD&D is are intended to provide additional protection to full-time employees. AD&D provides additional protection in the event of accidental death. It also covers loss of limb or eye due to accident. Those interested can elect the amount that suits their needs at an affordable rate.
Employee: Coverage is available in increments of $10,000 up to a maximum of $250,000.
The guarantee issue amount is $150,000. Employees wishing to apply for coverage above $150,000 will need to seek approval for this coverage by completing an Evidence of Insurability form, where they will answer a series of simple health questions for Guardian underwriting to review. There is no age reduction in the benefit.
If electing for yourself, you can also elect for your spouse and/or children
Spouse: Increments of $5,000 to the lesser of $250,000 or 100% of the employee’s supplemental life amount. The guarantee issue amount is $25,000.
Child: $1,000 increments between $5,000 and $10,000. All child life is guarantee issue and all children are covered at one rate.
Cost is based on age and can be found in ADP
Choose Your Beneficiary
Make sure your life and accident death benefits will be paid as you intend.
Be sure you name a beneficiary when you enroll in Life and AD&D benefits during open enrollment.
Then, continue to review your beneficiary designations as you experience life changes.
Arris Manufacturing Benefit Guide | 15
WORKSITE PRODUCTS
Arris offers a Voluntary Accident plan through Guardian. Benefits are paid directly to you based on a flat schedule when an accident occurs. Group Accident insurance is designed to help covered employees meet the out-of-pocket expenses and extra bills that can follow an accidental injury, whether minor or catastrophic.
Accident Insurance
Some examples of covered accidents: fracture, dislocation, burn, concussion, coma, torn cartilage in knee, laceration, broken tooth, eye injury, ambulance, paralysis, dismemberment, etc. There is also a benefit for accidental death. This plan is portable at your set premium amount and does not have any preexisting condition limitations or waiting periods.
Includes a $50 per year wellness benefit for completing certain routine wellness screenings or procedures.
Critical Illness Hospital Indemnity
Arris offers a Voluntary Critical Illness plan through Guardian. Critical Illness insurance is designed to help employees offset the financial effects of a catastrophic illness with a lump sum benefit if an insured is diagnosed with a covered critical illness.
You will be offered coverage in $5,000 increments up to a $20,000 maximum, $2,500 increments up to $10,000 for spouse, and 25% of the employee coverage for children. All volumes are guaranteed issue.
Some examples of covered Illnesses: Cancer, Heart Attack, Stroke, End Stage Renal (Kidney) Failure, Major Organ Failure, Coma as the result of Severe Traumatic Brain Injury, Blindness, Benign Brain Tumor, Occupational HIV.
Arris offers a Voluntary Group Hospital Indemnity plan though Guardian. Group Hospital Indemnity insurance is designed to help provide financial protection for covered individuals by paying a benefit due to a hospitalization and in some cases, for treatment received for an accident or sickness, even if that treatment occurs outside the hospital.
Employees can use the benefit to meet the out-of-pocket expenses and extra bills that can occur. Indemnity lump sum benefits are paid directly to the employee based on the amount of coverage listed, regardless of the actual cost of treatment.
The Sports Package increases the total benefit payment by 25%
Arris Manufacturing Benefit Guide | 16
Payroll Deductions
Semi-Monthly Payroll Deductions Semi-Monthly Employee Contributions Employee Only Employee & Spouse Employee & Child(ren) Family Medical Base Plan Preferred 17 $4,500 Deductible $93.14 $306.85 $221.59 $432.14 Medical Buy-Up Plan Preferred 2 $2,500 Deductible $149.72 $449.86 $322.98 $611.15 Medical HSA Plan HDHP 3 $4,000 Deductible $107.22 $345.39 $254.87 $483.81 Dental Plan $4.10 $12.17 $14.11 $21.53 Vision Plan $4.27 $7.18 $7.33 $11.59 Accident $4.65 $7.85 $8.44 $11.65 Hospital Indemnity $5.02 $12.52 $9.32 $16.82 Arris Manufacturing Benefit Guide | 17 ** Spousal Surcharge: $50 per month If you have a spouse that is eligible for health insurance coverage with their own employer, but you choose to enroll them in your coverage through Arris Manufacturing, you will be charged a $50 spousal surcharge per month. Weekly Employee Contributions Employee Only Employee & Spouse Employee & Child(ren) Family Medical Base Plan Preferred 17 $4,500 Deductible $42.99 $141.62 $102.27 $199.45 Medical Buy-Up Plan Preferred 2 $2,500 Deductible $69.10 $207.63 $149.07 $282.07 Medical HSA Plan HDHP 3 $4,000 Deductible $49.49 $159.41 $117.63 $223.29 Dental Plan $1.89 $5.62 $6.51 $9.94 Vision Plan $1.97 $3.31 $3.38 $5.35 Accident $2.14 $3.62 $3.90 $5.37 Hospital Indemnity $2.32 $5.78 $4.30 $7.76
CONTRIBUTIONS
Weekly
KEY CONTACTS & RESOURCES
Questions on your benefits or need assistance with Claims? Contact Sterling Seacrest Pritchard.
678-538-2111 shatcher@sspins.com MARIANNE
843-544-5490 mchavis@arrisholdings.com
Copy of Bill or Explanation of Benefits (EOB) Your Employee Support Contacts
NEED HELP WITH A CLAIM? BE SURE TO HAVE THE FOLLOWING INFORMATION WHEN CALLING:
Subscriber ID #
Date of Service
Name of Patient
Name of Doctor, Facility or Hospital
Benefit Company Phone Website Medical Coverage BCBS of SC 888-410-2227 www.southcarolinablues.com Dental, Vision, Life, Vol Life, Disability, and Worksite Products Guardian 800-627-4200 www.guardiananytime.com Employee Assistance Program (EAP) WorkLifeMatters 800-386-7055 www.ibhworklife.com Username: Matters Password: wlm70101
CLIENT SERVICE ASSOCIATE
SARAH HATCHER SSP
RESOURCES
CHAVI S ARRIS HUMAN
Arris Manufacturing Benefit Guide | 18
IMPORTANT INFORMATION
This guide provides a summary of you employee benefits rights and regulations as determined by Federal and State Laws. Information included in this guide includes the following:
Special Open Enrollment Rights
Children’s Health Insurance Program (CHIP) Premium Assistance
General Notice of the Cobra Continuations Rights
Affordable Care Act (ACA) – Insurance Mandate
Health Insurance Marketplace Coverage Options and Your Group Health Coverage
Affordable Care Act (ACA) – Preventive Services for Non-grandfathered Plans Newborns’ and Mothers’ Health Protection Act of 1996
Break Time for Nursing Mothers Under the Fair Labor Standards Acts (FLSA) Women’s Health & Cancer Rights Act
The Generic Information Nondiscrimination Act of 2008 (GINA)
HIPAA Privacy Rules
SPECIAL OPEN ENROLLMENT RIGHTS
This notice is being provided to ensure that you understand your right to apply for group health insurance coverage A special enrollment period is a time outside of the annual open enrollment period during which you and your family have a right to sign up for health coverage In the Marketplace, you qualify for a special enrollment period 60 days following certain life events that involve a change in family status (for example, marriage or birth of a child) or loss of other health coverage. Job-based plans must provide a special enrollment period of 30 days. Some events will require additional documentation to be submitted with the application at the time of enrollment You should read this notice even if you plan to waive coverage at this time
If you have a new dependent as a result of a marriage, birth, adoption, or placement for adoption, you may be able to enroll yourself and your dependents However, you must request enrollment within 30 days after the marriage, birth, or placement for adoption
If you or your dependents lose eligibility for coverage under Medicaid or the Children’s Health Insurance Program (CHIP) or become eligible for a premium assistance subsidy under Medicaid or CHIP, you may be able to enroll yourself and your dependents You must request enrollment within 60 days of the loss of Medicaid or CHIP coverage or the determination of eligibility for a premium assistance subsidy Marriage, Birth, or Adoption
If you are declining coverage for yourself or your dependents (including your spouse) because of other health insurance or group health plan coverage, you may be able to enroll yourself and your dependents in this plan if you or your dependents lose eligibility for that other coverage (or if the employer stops contributing toward your or your dependents’ other coverage) However, you must request enrollment within 30 days after your or your dependents’ other coverage ends (or after the employer stops contributing toward the other coverage).
To request special enrollment or obtain more information, please contact HR.
Arris Manufacturing Benefit Guide | 19
Loss of Other Coverage Medicaid or CHIP
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 employersponsored 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 1877-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
Arris Manufacturing Benefit Guide | 20
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
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 PPACA
Arris Manufacturing Benefit Guide | 21
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.
Arris Manufacturing Benefit Guide | 22
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 Arris Manufacturing 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
• Arris Manufacturing has determined that the prescription drug coverage offered by the BCBS of SC 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 Arris Manufacturing coverage will not be affected Please review prescription drug coverage plan provisions/options under the certificate booklet provided by BCBS of SC 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 Arris Manufacturing 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 Arris Manufacturing 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 Arris Manufacturing 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 (1-800-6334227) 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)
Arris Manufacturing Benefit Guide | 23
IMPORTA NT NOTICE ABOUT YOUR PRESCRIPTION DRUG COVERAGE & MEDICARE
NON - 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 Arris Manufacturing 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.
• Arris Manufacturing has determined that the prescription drug coverage offered by the BCBS of SC HSA Plans are, on average for all plan participants, NOT expected to pay out as much as standard Medicare prescription drug coverage pays. Therefore, your coverage is considered Non-Creditable Coverage. This is important because, most likely, you will get more help with your drug costs if you join a Medicare drug plan, than if you only have prescription drug coverage from the BCBS of SC HSA Plans This also is important because it may mean that you may pay a higher premium (a penalty) if you do not join a Medicare drug plan when you first become eligible.
• You can keep your current coverage from the BCBS of SC HSA plans However, because your coverage is non-creditable, you have decisions to make about Medicare prescription drug coverage that may affect how much you pay for that coverage, depending on if and when you join a drug plan When you make your decision, you should compare your current coverage, including what drugs are covered, with the coverage and cost of the plans offering Medicare prescription drug coverage in your area. Read this notice carefully - it explains your options.
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
EMPLOYER GROUP PLAN
If you decide to drop your current coverage with Arris Manufacturing, you will be eligible for a two (2) month Special Enrollment Period (SEP) to join a Medicare drug plan. However you also may pay a higher premium (a penalty) because you did not have creditable coverage under HDHP.
When Will You Pay A Higher Premium (Penalty) To Join A Medicare Drug Plan?
Since the coverage under BCBS of SC plan, is not creditable, depending on how long you go without creditable prescription drug coverage you may pay a penalty to join a Medicare drug plan. Starting with the end of the last month that you were first eligible to join a Medicare drug plan but didn’t join, if you go 63 continuous days or longer without prescription drug coverage that’s creditable, 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 (penalty) as long as you have Medicare prescription drug coverage. In addition, you may have to wait until the following October to join.
Arris Manufacturing Benefit Guide | 24
IMPORTA NT NOTICE ABOUT YOUR PRESCRIPTION DRUG COVERAGE & MEDICARE
NON - CREDITABLE (CONT.)
When Will You Pay A Higher Premium (Penalty) To Join A Medicare Drug Plan?
If you decide to join a Medicare drug plan, your current Arris Manufacturing coverage may be affected. Please review prescription drug coverage plan provisions/options under the certificate booklet provided by BCBS of SC.
See pages 7- 9 of the CMS Disclosure of Creditable Coverage To Medicare Part D Eligible Individuals Guidance (available at http:// www cms hhs gov/CreditableCoverage/), which outlines the prescription drug plan provisions/options that Medicare eligible individuals may have available to them when they become eligible for Medicare Part D
If you do decide to join a Medicare drug plan and drop your current Arris Manufacturing coverage, be aware that you and your dependents may not be able to get this coverage back. drug plan. When you make your decision, you should compare your current coverage, including what drugs are covered, with the coverage and cost of the plans offering Medicare prescription drug coverage in your area. Read this notice carefully - it ex- plains your options.
For more information about this notice or your current prescription drug coverage contact human resources.
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 Arris Manufacturing 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 (1-800633-4227) 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)
Arris Manufacturing Benefit Guide | 25
HEALTH INSURANCE MARKETPLACE
PART A: GENERAL INFORMATION
To assist you as you evaluate options for you and your family, this notice provides some basic information about the Marketplace and employment-based health coverage offered by your employer.
What is the Health Insurance Marketplace?
The Marketplace is designed to help you find health insurance that meets your needs and fits your budget. The Marketplace offers “one-stop shopping” to find and compare private health insurance options You may also be eligible for a new kind of tax credit that lowers your monthly premium right away Open enrollment for health insurance coverage through the Marketplace runs from November 1, 2024 through December 15, 2024 for coverage starting as early as January 1, 2025.
Can I Save Money on my Health Insurance Premiums in the Marketplace?
You may quality to save money and lower your monthly premium, but only if our employer does not offer coverage, or offers coverage that doesn’t meet certain standards The savings on your premium that you’re eligible for depends on your household income
Does Employer Health Coverage Affect Eligibility for Premium Savings Through the Marketplace?
Yes If you have an offer of health coverage from your employer that meets certain standards, you will not be eligible for a tax credit through the Marketplace and may wish to enroll in your employer’s health plan However, you may be eligible for a tax credit that lowers your monthly premium, or a reduction in certain cost-sharing if your employer does not offer coverage to you at all or does not offer coverage that meets certain standards If the cost of a plan from your employer that would cover you (and not any other members of your family) is more than 9.5% of your household income for the year, or if the coverage your employer provides does not meet the “minimum value” standard set by the Affordable Care Act, you may be eligible for a tax credit.
If you purchase a health plan through the Marketplace instead of accepting health coverage by your employer, then you may lose the employer contribution (if any) to the employer-offered coverage Also, this employer contribution – as well as your employee contribution to employer-offered coverage – is often excluded from income for Federal and State income tax purposes Your payments for coverage through the Marketplace are made on an alter-tax basis.
How Can I Get More Information?
For more information about your coverage offered by your employer, please check your summary plan description or contact Human Resources.
The Marketplace can help you evaluate your coverage options, including your eligibility for coverage through the Marketplace and its cost. Please visit www.healthcare.gov for more information, including an online application for health insurance coverage and contact information for a Health Insurance Marketplace in your area.
Arris Manufacturing Benefit Guide | 26
!
HEALTH INSURANCE MARKETPLACE
PART B: INFORMATION ABOUT HEALTH COVERAGE OFFERED BY YOUR EMPLOYER
This section contains information about any health coverage offered by your employer. If you decide to complete an application for coverage in the Marketplace, you will be asked to provide this information. This information is numbered to correspond to the Marketplace application
3. Employer Name Arris Manufacturing
5. Employer Address 2660 Highway 9
7. City East Clio
4. Employer Identification Number (EIN) 83-2643858
6. Employer Phone Number 843-823-6350
8. State SC
10. Who can we contact about health coverage at this job? Andrew Miller
11. Phone Number (if different from above)
12. Email Address amiller@arrisholdings.com
Here is some basic information about health coverage offered by this employer:
As your employer, we offer a health plan to:
All employees. Eligible employees are:
Active full-time employees working 30 or more hours a week
Some employees. Eligible employees are:
With respect to dependents:
We do offer coverage. Eligible dependents are:
Spouses and children up to age 26
We do not offer coverage
9. Zip Code 29525
If checked, this coverage meets the minimum value standard and the cost of this coverage to you is intended to be affordable, based on employee wages.
** Even if your employer intends your coverage to be affordable, you may still be eligible for a premium discount through Marketplace The Marketplace will use your household income, along with other factors, to determine whether you may be eligible for a premium discount If for example, your wages vary from week to week (perhaps you are an hourly employee or you work on a commission basis), if you are newly employed mid-year, or if you have other income losses, you may still qualify for a premium discount
If you decide to shop for coverage in the Marketplace, Healthcare.gov will guide you through the process Here’s the employer information you’ll enter when you visit to find out if you can get a tax credit to lower your monthly premiums
Arris Manufacturing Benefit Guide | 27
HEALTH INSURANCE TERMINOLOGY
Health insurance terminology can be confusing As a result, understanding your benefits and what you may owe out of pocket can be difficult. In order to make sure you are using your coverage effectively, it is important to understand some key insurance terms.
You can purchase either group or individual health insurance Group health insurance is typically acquired through your employer and covers many people
Individual insurance, on the other hand, is usually purchased by an individual or a family and is not tied to a job.
To better understand your health insurance, be aware of the following terms:
Participant
There are a few different participants involved in health insurance One is the “provider”, or a clinic, hospital, doctor lab, health care practitioner or pharmacy The ”insurer” or the “carrier” is the insurance company providing coverage The “policyholder” is the individual or entity who purchased the coverage, and the “insured” is the person with the coverage”.
Premium
The amount of money charged by an insurance company for coverage. Rates are typically paid annually or in smaller payments over the course of the year (for example monthly)
Deductible
The amount you owe for health care services each year before your insurance company begins to pay Your deductible may not apply to all services, such as preventive care.
Copayment
The fixed amount that you pay for a covered health care service That amount can vary by the type of covered health care service (for example, a doctor’s office visit or a specialist, urgent care or emergency room visit)
Coisurance
The percentage of a medial bill that you pay (for example, 20 percent) and the percentage that the health plan pays (for example, 80 percent) You pay coinsurance plus any deductible you owe for a covered health service
You Pay Health Plan Pays
Out-of-pocket maximum (OOPM)
The most you should have to pay for health care during a year, excluding the monthly premium After you reach the annual OOPM, your plan begins to pay 100 percent of the allowed amount for covered health services
Arris Manufacturing Benefit Guide | 28
20% 80%
NOTES:
Arris Manufacturing Benefit Guide | 29