January 1, 2026 – December 31, 2026
A SMARTER WAY TO BETTER HEALTH
It’s Your 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 pleased 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
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.
ELIGIBILITY & ENROLLMENT
Whether you are a new employee enrolling in your benefits for the first time or considering your benefits during open enrollment, this guide is designed to help you through the process.
Open Enrollment refers to our opportunity to:
• Change Plans
• Enroll in benefits
• Cancel benefits
• Change coverage for your dependents
Eligible dependents are defined as:
• Your spouse
• Children under the age of 26
• Children of any age who are mentally or physically incapable of living independently
Eligibility
All full-time employees working more than 30 hours a week are eligible to participate in our benefit plans. Spouses and dependent children of the employee are also eligible. Dependent children include your natural children, legally adopted children, step-children and children for whom you have been appointed guardian up to the age of 26.
Enrollment Period
Employees are eligible to enroll in benefits effective following 30 days as a full-time employee or during the annual open enrollment period.
Mid-Year Benefit Changes
Outside of your annual Open Enrollment period, you may be eligible to make certain benefits changes during the middle of the year. Examples of when you might be able to make mid-year changes are:
• Marriage or divorce
• Birth, death, or adoption
• Gaining/loss of other coverage
• Change in eligibility status
MEDICAL & PRESCRIPTION
HEALTH SAVINGS ACCOUNT (HSA)
The Health Savings Account (HSA) is a tax-advantaged, interest-bearing account used to pay for eligible health care expenses. You can open and contribute to an HSA with Medcom only if you are enrolled in the Meritain High Deductible HSA $5,500 Plan (Option 3). 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, HSAs are use it or keep it! You maintain complete control over how and when to make payments for qualified medical expenses from your account. You can make contributions to the HSA and all money in the account is yours to keep even if you leave CL Burks. You can withdraw your funds to pay for current qualified medical, dental and vision 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.
The IRS Maximum contribution did increase from 2025 to 2026, please note the new amounts listed below.
CL Burks will contribute to your HSA for those newly enrolling into the Meritain HDHP Option #3 for the first time.
$500 prefunded for Employee Only and/or Employee Spouse; and $1000 toward those enrolled as Employee+Child(ren) or Family.
Earn a $100 gift card from CL Burks if you utilize the KISx card through Valenz Health for an upcoming procedure or major imaging service!
CONNECT PROGRAM
SPECIALTY DRUG PROGRAM
What is SmithRx Connect?
SmithRx Connect is a Specialty Drug Cost Management & Member Advocacy Company who partners with Self-Funded Health Plans to reduce the financial burden of high-cost specialty drugs for the employer and their members, by securing alternate funding through the manufacturer’s assistance programs.
Is my medication still covered?
The plan will still pay for your medication with no increase in co-pay or cost share to you However, the method of obtaining these medications have changed Instead of funneling through our Pharmacy Benefits Manager, this will now funnel through SmithRx Connect If SmithRx Connect is unable to obtain secure alternative funding then coverage will revert to our traditional PBM coverage
What if my income is too high to qualify? Do I still have to work with SmithRx Connect and go through the program? SmithRx Connect is now the interface for all specialty medication The coverage under the medical benefit’s plan is the same for all employees regardless of pay grade Therefore, all employees seeking benefits must go through the same process
Who do I contact with additional questions?
Please contact our Benefits Advisor (678) 488-6838 or SmithRx Connect’s Customer Service at (844) 454-5201
$0 MAIL ORDER PROGRAM
SmithRx Connect specializes in finding better pricing for high-cost medications. Delivered to your doorstep!
Who is Eligible?
Fouts Bros is making this program available to members enrolled in the health plan If you are currently on any eligible maintenance medications, you will want to follow the steps below for potential cost savings to you!
Which drugs are available through Connect?
These would include: Enbrel, Otezla, Ozempic, Humalog, Baqsimi, Restasis, Janumet, Eliquis, Pradaxa, Xarelto, Breo Ellipta, and MANY MANY More!
What are the Costs?
There are no costs to participate in the Connect program Your employer has paid 100% of the cost of this service for you and your family as long as you are enrolled in your employer’s health plan Prescriptions obtained through this service are NO COST TO YOU!
DENTAL & VISION
Dental benefits are administered by Unum. Benefits provide access to coverage for dental care ranging from routine cleanings to crowns and bridges Dental insurance can cover a wide range of services to keep your mouth and gums healthy including routine exams to root canals and braces To find InNetwork dentist providers follow these steps:
1. Go to www unumdentalcare com and click ‘Find a Dental Provider’
2. Choose the Search by location and enter the zip code in which you are looking for a provider. You may enter a provider name or practice if you wish to confirm they are in the network Otherwise, leave the Dentist or Practice Name blank to find results near you
3. Select Find and results will appear
Vision benefits are administered by Unum To find In-Network vision providers follow these steps:
1. Log onto www.UnumVisionCare.com and select “Find a Vision Provider”
2. You can then enter the zip code you are looking for a provider in. You may also enter a provider name or practice if you wish to confirm they are in the network.
& Diagnostic Services Exams, Cleanings & Bitewing X-Rays, (Fluoride & Sealants to age 16)
Services Oral Surgery, Fillings, Extractions, Periodontics, Endodontics, Repair of dentures
Services Crowns, Bridgework, Full & Partial Dentures, Implants
(Children to age 19)
of
90th of Usual and Customary
LIFE INSURANCE + AD&D
Employer-Paid Life / AD&D Insurance
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 a full-time salaried employee, CL Burks provides Basic Life / AD&D insurance to you at no cost through Unum
Voluntary Life / AD&D Insurance
Voluntary Life Insurance and Accidental Death and Dismemberment (AD&D) are supplemental employee-paid benefits 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
Increments of $10,000 to a maximum of $500,000 or 5x your annual earnings, whichever comes first
Increments of $5,000 to a maximum of $250,000 or 100% of the Employee election, whichever comes first
Child
Evidence of Insurability
$30,000
Increments of $2,000 to a maximum of $10,000 or 100% of the Employee election, whichever comes first $10,000
If you do not enroll in supplemental employee or spouse life when you are first eligible (within 30 days of your eligibility), there is no guaranteed issue amount and any amounts requested are subject to Evidence of Insurability (EOI) If you already are enrolled in supplemental life, you may increase your coverage up to the guaranteed issue during open enrollment with no health questions.
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
• Then, continue to review your beneficiary designations as you experience life changes.
Portability Provision
If an insured employee's employment terminates for reasons other than sickness or injury, retirement, or plan termination, the employee may elect to continue employee and spouse coverage (not applicable to coverage for dependent children). The amount that may be continued is the amount in effect on the date Voluntary Group Term Life Insurance terminates. Spouse insurance may not be continued if the employee does not elect to continue employee insurance Premiums are due no later than 31 days after the date the insurance would otherwise terminate and are at the same rate applicable under the employer policy This coverage will end if the employer's Master Policy terminates
LONG-TERM 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. CL Burks pays for this benefit on your behalf.
Serious illnesses or accidents can come out of nowhere. They can interrupt your life and your ability to work for months even years. Long-Term Disability coverage is available to you through Unum. This benefit pays 60% of your monthly earnings in the event of a disability after 90 days for accident and illness up to a maximum monthly benefit of $7,500. The Long-Term Disability benefit pays up to the Social Security Normal Retirement Age (SSNRA).
The policy does not provide benefits for a disability caused by some pre-existing conditions. A pre-existing condition is any condition for which you received medical treatment, consultation, care or services including diagnostic measures, or took prescribed drugs or medicines prior to your effective date of coverage. Please refer to the plan certificate for the pre-existing guidelines.
EMPLOYEE ASSISTANCE PROGRAM
Employee Assistance Program (EAP)
Your EAP is designed to help you lead a happier and more productive life at home and at work Call for confidential access to a Licensed Professional Counselor* who can help you. Call 1-800-854-1446 (multi-lingual) or go online to www.unum.com/lifebalance.
A Licensed Professional Counselor can help you with:
• Stress, depression, anxiety
• Relationship issues, divorce
• Job stress, work conflicts
• Family and parenting problems
• Anger, grief and loss
Work/Life Balance
You can also reach out to a specialist for help with balancing and life issues Just call and one of our Work/Life Specialists can answer your questions and help you find resources in your community.
Ask our Work/Life Specialists about:
• Childcare
• Elder care
• Legal questions
• Identify theft
• Financial services, debt management, credit report issues
• Even reducing your medical/dental bills!
VOLUNTARY BENEFITS
Hospital Indemnity Insurance
• Voluntary, 100% Employee Paid
• Pays cash benefits in case of hospital admission
• $1,500 per admission to a max of 1 admission per year, per insured
• $100 per day to a max of 365 days per year, per insured
• Covers sickness and injury
• Treatment of Childbirth. Hospital Admission benefits are not payable for birth within first 9 months after the insured’s coverage effective date
• You can keep coverage if you leave CL Burks
Accident Insurance
No one plans on getting injured…but just in case, we’ve got you covered.
Group Accident Insurance is offered through Unum. This coverage provides a lump sum payment based on the accident/injuries sustained; its paid directly to you, and you decide the best way to spend it Its that simple Whether it’s to pay medical expenses, the mortgage, car payments or even utility bills, you decide The premiums for this insurance would be 100% employee paid
Other advantages of accident insurance are:
• Cash benefits for expenses that may not be covered under your medical insurance
• You can keep coverage if you leave CL Burks
• There is a $50 wellness benefit that offers a cash benefit per calendar year
• You can cover your spouse and children
CONTRIBUTIONS
CL Burks contributes to the cost of medical coverage for all eligible employees For an additional premium employees can add dependent coverage CL Burks pays 100% of the Virtual Mental Health coverage, Group Life/AD&D, and LongTerm Disability coverage Vol Life premiums are based on the amount you selected and your age Those benefit costs will display in Employee Navigator when you enroll Please refer to the chart below for your weekly payroll deductions
Weekly Payroll Deductions
CL Burks will pay out a Wellness Benefit of a $150 gift card to all employees that are enrolled in a CL Burks medical plan and turn in an EOB showing that the employee has had a biometric screening completed for the plan year.
678-538-2111
shatcher@sspins.com
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
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.
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.
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 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).
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.
To request special enrollment or obtain more information, please contact HR.
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, 2023 through December 15, 2023 for coverage starting as early as January 1, 2024.
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.
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 CL Burks Construction
5. Employer Address 1640 Redi Road
7. City Cumming
4. Employer Identification Number (EIN) 27-3203938
6. Employer Phone Number 800-969-2875
8. State GA
10. Who can we contact about health coverage at this job?
Jonathan Kilgore
11. Phone Number (if different from above)
12. Email Address Jonathan.Kilgore@clburks.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 30040
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
IMPORTANT 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 CL Burks 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
• CL Burks has determined that the prescription drug coverage offered by the Meritain’s 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 15 th 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 CL Burks coverage will not be affected Please review prescription drug coverage plan provisions/options under the certificate booklet provided by Meritain. 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 CL Burks 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 CL Burks 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 CL Burks 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)
