Power Group Companies Benefits Guide
PLAN YEAR
| 2013
Our employees are our most valuable asset That’s why at Power Group Companies we are committed to providing a comprehensive employee benefit program that helps our employees stay healthy, feel secure, and maintain a work/life balance. Stay Healthy Medical, Dental, and Vision Care Flexible Spending Accounts Feeling Secure Disability Insurance 401(k) Life and Accidental Death & Dismemberment
Contact Information Refer to this list when you need to contact one of your benefit vendors. ALL BENEFITS Natalie Holtgraves, Human Resources Consultant nholtgraves@pgcompanies.com MEDICAL Meritain Health www.myMERITAIN.com 1-800-925-2272 DENTAL MetLife www.metlife.com 1-800-275-4638 VISION Vision Service Plan www.vsp.com 1-800-216-6248 SHORT-TERM/LONG-TERM DISABILITY UNUM www.unum.com 1-800-858-6843 FLEXIBLE SPENDING ACCOUNT Power Group Administrators www.myflexonline.com 913-754-5946 LIFE & ACCIDENTAL DEATH & DISMEMBERMENT UNUM www.unum.com 1-800-858-6843 RETIREMENT (401K) John Hancock www.jhpensions.com 1-800-395-1113 Kirk Boster 401(k) Wealth Advisor Kirk.boster@marinerwealthadvisors.com
Medical Insurance Power Group Companies offers medical coverage to help protect you and your family from the high cost of medical care and to promote a healthy lifestyle. Employees have the choice of a PPO Base plan or a PPO Buy-Up plan. Power Group contributes towards the cost of your medical premium. Detailed plan summaries are outlined in the following pages. Who is Eligible and When: Full time active employees, their spouse and dependent children are all eligible for coverage. The coverage is effective the first day of the month following date of hire. *Employee Pays: *Rates shown are per pay period employee contributions 2013 Standard Medical Premiums Tier
PPO Base
PPO Buy-up
Employee
$25.00
$71.78
Employee + Spouse
$245.94
$387.51
Employee + Child (ren)
$179.91
$298.29
Family
$327.20
$497.33
2013 Medical Premiums -Wellness Engaged Tier
PPO Base
PPO Buy-up
$0.00
$46.78
Employee + Spouse
$220.94
$362.51
Employee + Child (ren)
$154.91
$273.29
Family
$302.20
$472.33
Employee
A Quick Guide to Your Benefits and Enrollment Power Group Holdings, LLC Group #14132 Enroll with Meritain Health today to take your next step towards a healthier, balanced tomorrow. Meritain Health knows how important it is for healthcare consumers like you to really understand how your plan works. In this way, you can make the changes you want in your health and in your life.
Healthcare benefits provide the support you need to reach your healthy balance. Chances are, you try every day to restore a healthy balance to your life, but time gets away from you, or other details come first. Meritain Health is here to help you focus, to support you every step of the way. Think of the benefits and programs as an important resource in the protection of your body, mind and spirit!
Protecting your healthy balance with preventive care. Question: Which is better: Taking an hour or two out of your busy day to have your annual checkup—or missing hidden symptoms and paying the price in sick days, copays and missed events? Answer: Nothing makes more sense in these busy times than preventing illness before it happens. That’s why your plan offers excellent benefits for preventive services. Early detection, proper nutrition, and routine exercise are the key to living a long and healthy life, and will also help to control long-term healthcare costs. Your employer encourages you to take the necessary steps—available to you right now—to ensure early detection and treatment of diseases.
www.myMERITAIN.com
Benefit Highlights Healthcare for you and your family: When sickness or injury throw you off balance. Knowing that you’re in good hands when you’re sick is one of the most comforting feelings there is. You can be assured that your health plan has everything you’ll need to get the right care if something goes wrong.
Balancing healthcare costs: What you pay and what the plan pays. The Benefits Schedule in this packet shows how much you pay for care, and how much the plan pays. It’s a listing of what is and isn’t included in your benefits plan. For more detailed information, see your summary plan description (SPD). After you pay your annual deductible and any up-front copays, the plan begins to pay a percentage of your provider’s charges, for example 80%. The remaining percentage, for example 20%, is your responsibility—your “out-of-pocket” costs. You’re protected from financial hardship by a maximum out-of-pocket amount each year—the most you’ll have to pay before the plan covers costs at 100%. (Copays do not always apply to the out-of-pocket maximum. This varies by plan).
Know your “numbers.” Are you secretly at risk for serious medical conditions? It’s possible to be at risk for developing serious conditions such as heart disease or diabetes, but not know it because you feel fine. That’s why it’s important to have your vitals checked regularly, such as your cholesterol levels, glucose and blood pressure (as advised by your doctor) and know your “numbers.” It helps to be able to understand what the numeric results of your clinical lab tests could mean and discuss any concerns with your doctor. An ounce of prevention is worth a pound of cure!
Save when you visit network providers. This plan offers a provider network of doctors and other healthcare professionals who have agreed to accept lower amounts than their standard charges, just for members of this plan. These lower amounts are negotiated and predetermined. That means when you see a network provider, your share of costs is based on a lower charge—so your costs are lower, too. Network providers are conveniently located in both urban and rural areas. Lower costs and convenient doctors and clinics are important ways that Meritain Health can support your efforts to stay well and have a healthy lifestyle—or to get care as simply as possible when you’re sick. Remember: If you go outside the network, you may still have benefits, but your share of costs will be higher, and the amount you pay will not be based on a lower rate.
File claims quickly and easily. If you visit a provider in your network, you shouldn’t need to submit a claim for services or pay at the time of your service with the exception of a copay, if applicable. Your provider will submit the claim on your behalf and you will later receive a bill for any out-of-pocket or other balances due. If you have visited an out-of-network provider, you may need to file a claim form to ensure that the service is billed properly. Claim forms can be found online at www.myMERITAIN.com or you can obtain one from your Human Resources Department. Submit the claim by fax or by mail to the fax number or mailing address listed on the claim form.
Benefits Design In Network
Out of Network
BUY UP MEDICAL SCHEDULE OF BENEFITS OVERALL LIFETIME MAXIMUM BENEFIT
Unlimited
ANNUAL DEDUCTIBLE (per calendar year) Co-Insurance
Individual Family
OUT-OF-POCKET LIMIT (per calendar year, and includes deductible) Hospital Services Inpatient Hospital Room and Board Intensive Care Unit Nursery Outpatient Surgery Radiology/Lab
Individual Family
Outpatient Services Emergency Services Hospital (copay waived if admitted) Physician Urgent Care (physician services only-lab covered at 100%-other services/procedures are subject to deductible and co-insurance) Physician Office Visit
Home Health Care Precertification Required/ 60 Visits Calendar Year Max. Ambulance Services Durable Medical Equipment/Supplies/Orthotics and Prosthetics Prior authorization is required Mental Disorders/Substance Use Disorders (paid as any other illness) Inpatient Outpatient Outpatient Therapies (Physical, Occupational and Skeletal Manipulations: 40 visit Calendar Year Maximum. Speech and Hearing: 20 visit Calendar Year Maximum) Preventive Services and Routine Care Physical Exams (copays waived) WellChild Care (Including Immunizations ) Mammogram (Testing and Reading) Pap Smears (Testing and Reading) Prostate Blood Test (Testing and Reading) Fecal Occult Screening (Testing and Reading) Organ Transplant Prior authorization is required Vision Care through VSP All Other Eligible Expenses
Unlimited $ $
500.00 Individual 1,500.00 Family
$ $
2,500.00 Individual 7,500.00 Family
80/20
$ $
500.00 1,500.00
$ $
5,000.00 15,000.00
60/40
80% after Deductible 80% after Deductible 80% after Deductible
60% after Deductible 60% after Deductible 60% after Deductible
80% after Deductible 80% after Deductible
60% after Deductible 60% after Deductible
80% after Deductible
60% after Deductible
$100.00 Copay then 80% after Deductible
$100.00 Copay then 80% after Deductible
80% after Deductible
60% after Deductible
$25.00 Copay
60% after Deductible
$25.00 Copay Copay applies to office visit charge only. Other procedures performed in a physician's office are subject to deductible and co-insurance unless otherwise specified in benefit schedule.
60% after Deductible
80% after Deductible
60% after Deductible
80% after Deductible
80% after Deductible
80% after Deductible
60% after Deductible
80% after Deductible 80% after Deductible
60% after Deductible 60% after Deductible
80% after Deductible
60% after Deductible
100% 100% 100% 100% 100% 100% 100%
60% after Deductible 60% after Deductible 60% after Deductible 60% after Deductible 60% after Deductible 60% after Deductible 60% after Deductible
80% after Deductible
60% after Deductible
$20 Copay
$20 copay then up to $45 maximum benefit.
80% after Deductible
60% after Deductible
PRESCRIPTION DRUG BENEFIT Prescription Drug Card
Covered. Not subject to Calendar Year Maximum.
Retail: Tier 1 $12 Copay Tier 2: $45 Copay Tier 3: $70 Copay Mail Order: Tier 1: $30 Copay Tier 2: $112.50 Copay Tier 3: $175 Copay
3
Retail: Tier 1 $12 Copay then 50% Tier 2: $45 Copay then 50% Tier 3: $70 Copay then 50% Mail Order: Tier 1: $30 Copay then 50% Tier 2: $112.50 Copay then 50% Tier 3: $175 Copay then 50%
Benefits Design
In Network
Out of Network
BASE PLAN MEDICAL SCHEDULE OF BENEFITS OVERALL LIFETIME MAXIMUM BENEFIT
Unlimited
Unlimited
ANNUAL DEDUCTIBLE (per calendar year) Co-Insurance
Individual Family
$ $
2,500.00 Individual 7,500.00 Family
OUT-OF-POCKET LIMIT (per calendar year, and includes deductible) Hospital Services Inpatient Hospital Room and Board Intensive Care Unit Nursery Outpatient Surgery Radiology/Lab
Individual Family
$ $
2,500.00 Individual 7,500.00 Family
Outpatient Services Emergency Services Hospital (copay waived if admitted) Physician Urgent Care (physician services only-lab covered at 100%-other services/procedures are subject to deductible and co-insurance) Physician Office Visit
Home Healthcare Precertification Required/ 60 Visits Calendar Year Max. Ambulance Services
$ $
2,500.00 7,500.00
$ $
10,000.00 20,000.00
80/20
Deductible then 100% Deductible then 100% Deductible then 100%
80% after Deductible 80% after Deductible 80% after Deductible
Deductible then 100% Deductible then 100%
80% after Deductible 80% after Deductible
Deductible then 100%
80% after Deductible
Deductible then 100% Deductible then 100%
80% after Deductible 80% after Deductible
$40.00 Copay
80% after Deductible
$40.00 Copay Copay applies to office visit charge only. Other procedures performed in a physician's office are subject to deductible and co-insurance unless otherwise specified in benefit schedule.
80% after Deductible
Deductible then 100%
80% after Deductible
Deductible then 100%
Deductible then 100%
Deductible then 100%
80% after Deductible
Deductible then 100% Deductible then 100%
80% after Deductible 80% after Deductible
Deductible then 100%
80% after Deductible
100% 100% 100% 100% 100% 100% 100%
80% after Deductible 80% after Deductible 80% after Deductible 80% after Deductible 80% after Deductible 80% after Deductible 80% after Deductible
Durable Medical Equipment/Supplies/Orthotics and Prosthetics Prior authorization is required Mental Disorders/Substance Use Disorders (paid as any other illness) Inpatient Outpatient Outpatient Therapies (Physical, Occupational and Skeletal Manipulations: 40 visit Calendar Year Maximum. Speech and Hearing: 20 visit Calendar Year Maximum) Preventive Services and Routine Care Physical Exams (copays waived) WellChild Care (Including Immunizations ) Mammogram (Testing and Reading) Pap Smears (Testing and Reading) Prostate Blood Test (Testing and Reading) Fecal Occult Screening (Testing and Reading) Organ Transplant Prior authorization is required Vision Care through VSP All Other Eligible Expenses
Deductible then 100%
80% after Deductible
$20 Copay
$20 copay then up to $45 maximum benefit.
Deductible then 100%
80% after Deductible
PRESCRIPTION DRUG BENEFIT Prescription Drug Card
Covered. Not subject to Calendar Year Maximum.
Retail: Tier 1 $12 Copay Tier 2: $45 Copay Tier 3: $70 Copay Mail Order: Tier 1: $30 Copay Tier 2: $112.50 Copay Tier 3: $175 Copay
Retail: Tier 1 $12 Copay then 50% Tier 2: $45 Copay then 50% Tier 3: $70 Copay then 50% Mail Order: Tier 1: $30 Copay then 50% Tier 2: $112.50 Copay then 50% Tier 3: $175 Copay then 50%
Complete your enrollment, and you’re on your way! All eligible employees must complete the enrollment form (included in this packet), whether you’re choosing this plan or declining benefits. Complete, sign and return your enrollment form to your employer within 31 days of your eligibility date whether you’re enrolling or declining benefits. n Write clearly! If your form is unreadable, your enrollment may be delayed, or incorrect. n Don’t forget the back side of the enrollment form! Missing or incomplete information will delay your enrollment. n Remember to sign and date the form, even if you’re declining benefits. n If you need to prove you’ve had prior healthcare benefits to satisfy the pre-existing condition limitation period, be sure to request a Certificate of Creditable Coverage from your previous health plan. Give one copy to your employer and keep a copy for your files.
The final step toward better balance and better living. After you’ve completed enrollment, your employer has approved it and after any waiting period has passed, your benefits will be effective. Your Meritain Health ID Card will be on its way to you soon. The card shows Meritain Health as your health plan administrator. Keep it in your wallet and carry it with you.
Sample ID Card: Card front ■ Your healthcare plan includes a network of providers you can visit for healthcare services. When you visit providers in this network, you will receive the best service rate. Call the provider information number for participating providers. Name: John Smith ID #: 123456789 Effective Date: 00-00-00 Group #: 12345 Group Name: ABC Company Coverage: Medical EMP/FAM
Copay: Office Visit: Emergency Room: Urgent Care Facility:
RxGrp: 9999 RxPCN: 99 RxBin: 999999 Patient Customer Service: 1-999-999-9999 Pharmacist Use Only: 1-999-999-9999
$xx $xx $xx
Generic Copay: $xx Preferred Copay: $xx Non-Preferred Copay: $xx
■ Your name, identification number, medical group number and your group name, are used to identify you and your covered dependents’ benefits. ■ Your medical copays are conveniently listed for you and your providers. ■ Your pharmacy coverage information is listed on the front of your card, and includes the Scrip World customer service number and prescription copays.
Card back For Pre-Certification call: 999.999.9999 Failure to comply with your plan's pre-certification requirements may result in a reduction of benefits. For a PPO provider: 999.999.9999 PPO Link: www.xyzppo.com
SUBMIT ALL CLAIMS TO: Meritain Health P.O. Box 99999 City, State, zip Benefit/Claim Customer Service: 999.999.9999
■ Please ensure that you precertify with Meritain Health Medical Management, if required.
■ All claims should be submitted to Meritain Health at this address. ■ You or your provider can call Meritain Health to verify eligibility of benefits or check on your claims status.
EDI: WebMD - #99999 24-Hour Automated Customer Service: 999.999.999 or www.myMERITAIN.com
■ You can call for information on a doctor or specialist who is close to you and serves your specific needs.
Access convenient online tools and resources. Visit your personalized member website, www.myMERITAIN.com, to find the benefits information you need. Once enrolled as a Meritain Health member, you will have access to www.myMERITAIN.com. When you log in, you’ll find everything you need to know about your benefits—from eligibility, to enrollment, to what’s covered. It’s another way we’re working with you to help you get the most from your benefits—so you can live a life that’s balanced and informed.
Registration is easy! If you’re already registered to access your online account, simply enter www.myMERITAIN.com into your browser and login from the homepage. If you’re not yet registered, it’s OK. Registration is an easy 4-step process. 1. Go to www.myMERITAIN.com. 2. Click on ‘Create a new user account’ and follow the instructions. You will need to fill in: n Your group ID (you can find this on your ID Card). n Your member ID (you can find this on your ID Card, as well. Enter with no spaces or dashes). n Date of birth. n Name. n Zip code. n Email address. 3. The system will display your username, which is your member ID. You will be asked to change your password. Enter and re-enter your new password, which you will need to create. 4. You will automatically be logged into your myMERITAIN account. The next time you login, use the same username and password from Step 3.
Important Contact Information: Questions about...
You may call...
At this number:
n
Medical benefits
Meritain Health Customer Service
1.800.925.2272
n
Prescription drug benefits
Scrip World
1.866.475.7589
n
Participating providers
Aetna
1.800.343.3140
n
Precertification
Meritain Health Medical Management
1.800.242.1199
n
Enrollment or benefit questions
Power Group Holdings, LLC Human Resources Representative
1.913.312.5968
Dental Insurance
Power Group Companies offers dental coverage so you and your family can receive the care needed to maintain good dental health. There is a detailed plan summary outlining coverages in the following pages. Who is Eligible and When: Full time active employees, their spouse and dependent children are all eligible for coverage. The coverage is effective the first day of the month following date of hire. *Employee Pays: *Rates shown are per pay period employee contributions Tier
MetLife PPO
Employee
$0.00
Employee + Spouse
$13.35
Employee + Child (ren)
$15.66
Family
$31.90
There is a $1,000 annual max per participant and a $1,000 lifetime maximum on orthodontia per dependent child.
www.metlife.com/mybenefits
Online Service Solutions Quick. Easy. Powerful.
MyBenefits Registration Overview MyBenefits provides you with a personalized, integrated and secure view of your MetLife-delivered benefits. You can take advantage of a number of self-service capabilities as well as a wealth of easy to access information including planning tools and oral health awareness material.* MetLife is able to deliver services to you that empower you to manage your benefits and not have to rely on your employer. As a first time user, you will need to register on MyBenefits. This will require you to follow the steps outlined below. Registration Process for MyBenefits Provide Your Company Name
Step 2: Enter Personal Information
Step 4: Security Verification Questions
Enter your first and last name, Social Security or Employee ID number, date of birth, and e-mail address.
Lastly, you will need to choose and answer three identity verification questions, to be utilized in the event you forget your password.
Access MyBenefits at www.metlife.com/mybenefits and enter your company name and click ‘Submit.’
Finally, you will be asked to read and agree to the Web site’s Terms of Use. Step 5: Process Complete
Now you will be brought to the “Thank You” page. Lastly, a confirmation of your registration will be sent to the e-mail address you provided during registration.
Step 3: Create a User Name and Password Step 1: The Login Screen
On the Home Page, you can access general information. To begin accessing personal plan information, click on ‘Register Now’ and perform the one-time registration process. Going forward, you will be able to log-in directly.
Then you will need to create a unique user name and password for future access to MyBenefits. The User Name must be a minimum of 8 characters and include at least one letter and one number (i.e. johnsmith1 or 1234567b). The Password must be a minimum of 6 characters and include at least one letter and one number (i.e. jsmith2 or 23451a).
* Available only to dental benefits participants.
19-29650 © 2010 METLIFE, INC. L0910132864(exp0911)(All States) © 2010 Peanuts Worldwide LLC
Metropolitan Life Insurance Company 200 Park Avenue New York, NY 10166 www.metlife.com
Vision Power Group Companies offers voluntary vision coverage so you and your family can receive proper vision care. A detailed plan summary is outlined in the following pages. Who is Eligible and When: Full time active employees, their spouse and dependent children are all eligible for coverage. The coverage is effective the first day of the month following date of hire
*Employee Pays: *Rates shown are per pay period employee contributions Tier
VSP Vision Care
Employee
$3.73
Employee + Spouse
$5.97
Employee + Child (ren)
$6.09
Family
$9.81
Power Group Company LLC and VSP provide you an affordable eyecare plan. Doctor Network……………………………VSP Choice
Your Coverage with a VSP Doctor WellVision Exam® focuses on your eye health and overall wellness • $10.00 copay............................... every 12 months Prescription Glasses • $25.00 copay Lenses................................................... every 12 months • Single vision, lined bifocal, and lined trifocal lenses • Polycarbonate lenses for dependent children Frame.................................................... every 24 months • $130.00 allowance for a wide selection of frames • 20% off the amount over your allowance ~OR~ Contacts (instead of glasses)............ every 12 months • Up to $60.00 copay for your contact lens exam (fitting and evaluation) • $140.00 allowance for contacts If you choose contact lenses you will be eligible for a frame 12 months from the date the contact lenses were obtained.
Extra Discounts and Savings Glasses and Sunglasses • Average 20-25% savings on all non-covered lens options • 20% off additional glasses and sunglasses, including lens options, from any VSP doctor within 12 months of your last WellVision Exam Contacts • 15% off cost of contact lens exam (fitting and evaluation) Laser Vision Correction • Average 15% off the regular price or 5% off the promotional price. Discounts only available from contracted facilities.
Your Coverage with Other Providers Visit vsp.com for details, if you plan to see a provider other than a VSP doctor. Exam .............................................................Up to $45.00 Single vision lenses ......................................Up to $30.00 Lined bifocal lenses ......................................Up to $50.00 Lined trifocal lenses ......................................Up to $65.00 Frame............................................................Up to $70.00 Contacts ......................................................Up to $105.00 VSP guarantees service from VSP doctors only. In the event of a conflict between this information and your organization's contract with VSP, the terms of the contract will prevail.
Flexible Spending Accounts (FSA) FSAs provide you with an important tax advantage that can help you pay health care and dependent care expenses on a pre-tax basis. By anticipating your family’s health care and dependent care costs for the next year, you can actually lower your taxable income. If you do not use the money contributed it will not be refunded to you or carried forward. Who is Eligible and When: Full time active employees are all eligible for coverage. The coverage is effective the first day of the month following date of hire. Health Care Reimbursement FSA This program lets employees pay for certain IRS-approved medical care expenses not covered by their insurance plan with pre-tax dollars. The annual maximum you can contribute for 2013 is $2,500.Some examples include: Office visit copays Vision services, including contact lenses, contact lens solution, eye examinations, and eyeglasses Dental services and orthodontia Chiropractic services Prescription drugs Dependent Care FSA The Dependent Care FSA lets employees use pre-tax dollars towards qualified dependent care such as caring for children under the age 13 or caring for elders. The annual maximum amount you may contribute to the Dependent Care FSA for 2013 is $5,000 (or $2,500 if married and filing separately). Examples include: The cost of child or adult dependent care The cost for an individual to provide care either in or out of your house Nursery schools and preschools (excluding kindergarten)
Power Group Administrators (PGA) Contact Information Flexible Spending Account Representatives Letha Jones – Manager, FSA Administration and Operations ljones@pgcompanies.com Direct Line – 913-754-5946 Carlton Logan – PGA-Client Services Liaison clogan@pgcompanies.com Direct Line: 913-754-5915 Felicia Pickarell-PGA-Client Services Liaison fpickarell@pgcompanies.com Direct Line: 913-754-5945
Claims Filing: Claims E-mail address: PGAClaimsFaxes@pgcompanies.com Address: Power Group Companies P.O. Box 11290 Overland Park, KS 66207 Fax: 1-866-578-1673 Local Fax: 913-491-6379 Tools to Check Flexible Spending Account Status www.myflexonline.com Flex Account Hot Line (automated System) 913-789-4600 Power Group Companies Contact Information Power Group Companies Main Line
913-491-3280 800-847-0038
P.O. Box 11290 • Overland Park, KS 66207 • phone 913.491.3280 • fax 913.491.6379 • www.pgcompanies.com Power Group Benefits • Power Group Risk Services • Power Group Administrators • Power Group Financial
Dependent Care Expenses Cafeteria Plan: Flexible Spending Account Dependent Care Expenses Are Those That Are Necessary for You and Your Spouse to Be Gainfully Employed
Dependent Care Expenses That Do Qualify □ Nanny expenses, for services provided inside your home, are eligible to the extent they are attributable to dependent care expenses and expenses of incidental household services.
□ Dependent care expenses incurred for services outside your home, providing they are incurred for the care of □ □ □ □ □ □
a qualifying dependent that regularly spends at least 8 hours per day in your home. Registration fees to a daycare facility are eligible as long as the fees are allocable to actual care and not described as materials or other fees. Nursery school expenses are eligible, even if the school also furnishes lunch and educational services. Food and incidental expenses (diapers, activities, etc.) may be eligible if part of dependent care charge. Expenses paid to a relative (e.g. child, parent, or grandparent of participant) are eligible. However, the relative cannot be under age 19 or a tax dependent of the participant. FICA and FUTA payroll taxes of the daycare provider are eligible. Dependent care expenses incurred to enable the employee to find work are eligible.
Dependent Care Reimbursement Limitations
Dependent Care reimbursement may not exceed the smaller of the following limits: □ The maximum allowed under the plan □ $5,000 (if you are married and filing a joint tax return or are filing as single, head of household) and $2,500 if you are married and separate returns are filed □ Your taxable compensation (after all compensation reduction elections) □ If you are married, your spouse's actual or deemed earned income
Dependent Care Expenses That Do Not Qualify □ Kindergarten fees are almost always an education expense and should never be reimbursed under a dependent care plan
□ Elementary school expenses for a child in first grade or higher are not eligible □ Food, transportation, and incidental expenses (diapers, activities, etc.) are not eligible if charged separately from dependent care expenses
□ Expenses paid to a housekeeper, maid, cook, etc. are not eligible, except where incidental to child or
dependent adult care □ Mass transit and parking □ Mother’s Day Out programs □ Pre-school for the purpose of education/socialization when a parent is not gainfully employed, seeking employment or a full-time student. August 23, 2012
My Flex Online
What you should know about the take care card. ©
Your take care© Flex Benefits Visa® Debit Card can only be used at qualified locations including doctors’
Important Reminder
offices, pharmacies, online drug
Why we require you to send in receipts:
stores, online stores for contacts,
The IRS requires us to capture specific information in order
dentist offices, optical shops,
for us to verify a purchase made with the take care© Flex
hospitals,and day care facilities.
Benefits Visa® Debit Card. Requests for receipts may include a payment for a co-pay that does not match the co-
Make sure to save all receipts for items purchased with your card. Occasionally you will be asked to provide
pay amount linked to your take care© account.
documentation of charges made with our card. Please
What type of receipt is acceptable?
save itemized merchant receipts as well as take care©
Acceptable proof of service for expenses paid for with your
card receipts. This is an IRS requirement.
Take care© Card include: •
itemized bill (a medical provider or retailer’s detailed receipt)
•
explanation of benefits (EOB)
•
other documentation from your health
NOTE: As a result of the 2010 Affordable Care Act effective January 1, 2011, there are new requirements for purchasing over-the-counter (OTC) medicines. With the exception of insulin, the card can only be used to pay for OTC drugs when they are prescribed. To learn more about using your card to purchase OTC medicines, go to MyFlexOnline.com
Learn more at MyFlexOnline.com •
get tips for using your take care© card
•
view your account balance(s)
•
look up qualified plan expenses
•
view card transactions
•
verify your plan elections(s)
•
use online claim entry to get reimbursed
provider or health plan
These documents must show: 1. Provider name or where item was purchased 2. Service or purchase date 3. Detailed description of item purchased or service provided 4. Amount paid and/or the portion not reimbursed through your insurance carrier 5. Person who received the service or who the item is for (may be excluded for retail purchases)
when you don’t use the card to pay
www.myflexonline.com The take care© Flex Benefits Card is issued by the Bancorp Bank pursuant to a license from Visa U.S.A. lnc. The Bancorp Bank, Member FDIC. | 815161008 | Copyright 2011 take care© plans | PSP_4640_ICC (Apr. 2011)
Disability Insurance
Power Group provides full-time employees with short and long-term disability income benefits. In the event you become disabled from a non work-related injury or sickness, disability income benefits are provided as a source of income. You are not eligible to receive short-term disability benefits if you are receiving workers’ compensation benefits. A detailed plan summary is outlined in the following pages. Who is Eligible and When: Full time active employees are all eligible for coverage. The coverage is effective the first day of the month following date of hire. Short Term and Long term disability are employer paid benefits and are covered at 100% by Power Group Companies. Benefits You Receive: Short-term Disability Benefits Begin Benefits Duration Percentage of Income Replaced Maximum Benefit
Long-term Disability
7 days after disability
90 days after disability
12 weeks
Retirement
60%
60%
$2,000 weekly
$10,000 monthly
**STD and LTD benefits will not be taxed when paid out.
Life and AD&D Insurance Basic Life & AD&D Insurance Power Group Companies provides full-time employees group life and accidental death and dismemberment (AD&D) insurance at one times your earnings to a maximum of $50,000 and pays the full cost of this benefit. A detailed plan summary is outlined in the following pages. Voluntary Life Insurance Employees who want to supplement their group life insurance benefits may purchase additional coverage. When you enroll yourself and/or your dependents in this benefit, you pay the full cost through semi-monthly payroll deductions. For Yourself Choose coverage in $10,000 increments. The maximum Voluntary Life Insurance Benefit is $500,000. For Your Spouse Supplemental coverage is also available for your spouse. Coverage must be purchased in $10,000 increments and cannot exceed $250,000 or 50% of your basic and voluntary life benefit combined, whichever is less. For your Children Additional coverage is available for children in $2,000 increments to a maximum of $10,000 Who is Eligible and When: Full time active employees are all eligible for coverage. The coverage is effective the first day of the month following date of hire. Cost Per Pay Period for $10,000 Increments for Employee & $5,000 for Spouse Coverage
Age
25-29 30-34
35-39 40-44
45-49
50-54
55-59 60-64
Employee
.35
.45
.65
1.05
Spouse
.18
.23
.33
.53
AD&D Rates
.15 per pay period per $10,000 AD&D coverage
65-69
1.75
3.00
4.80
6.40
10.15
.88
1.50
2.40
3.20
5.08
.12 per pay period per $2,000 coverage (one premium regardless of Dependent number of children) Children .03 AD&D per pay period per $2,000 coverage
Group Plan Overview – Power Group Companies Short Term Disability 60% of weekly earnings to $2,000 Maximum Weekly Benefit Minimum Weekly Benefit: $25 Elimination Period: 7 Days Injury / 7 Days Sickness 100% Employer Funded Definition of Disability: Residual Benefit Duration: 12 Weeks
Long Term Disability 60% to $10,000 Maximum Monthly Benefit 90 Day Elimination Period Benefit Duration: SSNRA (SS ADEA) 3/12 Pre-Existing Condition Exclusion 100% Employer Funded (Gross Up) Definition of Disability: 3 Year Regular Occupation. Zero-Day Residual Additional Benefit Features: Rehab and Return to Work Assistance Program Work Life Balance Worldwide Travel Assist HR/Benefits Answers Now
Group Life/ AD&D Life/AD&D: 1 x Annual Salary rounded to next higher $1,000. Minimum benefit of $10,000. Overall Maximum: $50,000 Non-Medical Maximum: equal to the overall maximum Benefit Reduction:
65% at age 70; and 55% at age 75; and 30% at age 80;
Accelerated Benefit: 50% of the Life amount to a Maximum of $750,000 100% Employer Funded
This plan highlight is a summary provided to help you understand your insurance coverage from Unum. Some provisions may vary or not be available in all states. Please refer to your certificate booklet for your complete plan description. If the terms of this plan highlight summary or your certificate differ from your policy, the policy will govern.
Term Life Insurance and AD&D Coverage Highlights
Power Group Companies - Policy # 143287
Please read carefully the following description of your Unum Term Life and AD&D insurance plan.
Your Plan Eligibility
All employees working at least 30 hours each week in active employment in the U.S. with the employer, and their eligible spouses and children (up to age 19, or to 26 if they are full-time students).
Coverage Amounts
Your Term Life coverage options are: Employee: Up to 5 times salary in increments of $10,000. Not to exceed $500,000. Spouse:
Up to 50% of employee amount in increments of $5,000. Not to exceed $250,000. Benefits will be paid to the employee.
Child:
Up to 50% of employee coverage amount in increments of $2,000. Not to exceed $10,000. The maximum death benefit for a child between the ages of live birth and 6 months is $1,000. Benefits will be paid to the employee. In order to purchase Life coverage for your spouse and/or child, you must purchase Life coverage for yourself.
Your AD&D coverage options are: Employee: Up to 5 times salary in increments of $10,000. Not to exceed $500,000. You may purchase AD&D coverage for yourself regardless of whether you purchase Life coverage. Spouse:
Up to 50% of employee amount in increments of $5,000. Not to exceed $250,000. Benefits will be paid to the employee.
Child:
Up to 50% of employee coverage amount in increments of $2,000. Not to exceed $10,000. The maximum death benefit for a child between the ages of live birth and 6 months is $1,000. Benefits will be paid to the employee. In order to purchase AD&D coverage for your spouse and/or child, you must purchase AD&D coverage for yourself.
AD&D Benefit Schedule: The full benefit amount is paid for loss of: • • • • • •
Life Both hands or both feet or sight of both eyes One hand and one foot One hand and the sight of one eye One foot and the sight of one eye Speech and hearing
Other losses may be covered as well. Please see your Plan Administrator.
Coverage amount(s) will reduce according to the following schedule: Age: 70 75 80
Insurance Amount Reduces to: 65% of original amount 55% of original amount 30% of original amount
Coverage may not be increased after a reduction. Guarantee Issue
If you enroll within 31 days of your eligibility date, you may apply for any amount of Life insurance coverage up to $100,000 for yourself and any amount of coverage up t o $50,000 f or your s pouse. Any Life i nsurance c overage ov er t he Guarantee Issue amount(s) will be subject to evidence of insurability. If you and your eligible dependents do not enroll within 31 days of your eligibility date, you can apply for coverage onl y during an a nnual enrollment pe riod and will be r equired t o f urnish evidence of insurability for the entire amount of coverage. If you a nd your e ligible dependents e nroll w ithin 31 da ys of your eligibility da te, and l ater, w ish t o increase y our cov erage, you may i ncrease y our c overage, with evidence of insurability, at anytime during the year. H owever, you may wait until the next annual enrollment and only coverage over the Guarantee Issue amount(s) will be subject to evidence of insurability. AD&D coverage does not require evidence of insurability.
Insurance Age
Your rate is based on your insurance age, which is your age immediately prior to and including the anniversary/effective date.
Additional Benefits Life Planning Financial & Legal Resources
This personalized financial counseling service provides expert, objective financial counseling to survivors and terminally ill employees at no cost to you. This service is also extended to you upon the death or terminal illness of your covered spouse. The financial consultants are master level consultants. They will help develop strategies needed to protect resources, preserve current lifestyles, and build future security. At no time will the consultants offer or sell any product or service.
Portability/Conversion
If you retire, reduce your hours or leave your employer, you can take this coverage with you according to the terms outlined in the contract. However, if you have a medical condition which has a material effect on life expectancy, you will be ineligible to port your coverage. You may also have the option to convert your Term life coverage to an individual life insurance policy.
Accelerated Benefit
If you become terminally ill and are not expected to live beyond a certain time period as stated in your certificate booklet, you may request up to 50% of your life insurance amount up to $750,000, without fees or present value adjustments. A doctor must certify your condition in order to qualify for this benefit. Upon your death, the remaining benefit will be paid to your designated beneficiary(ies). This feature also applies to your covered dependents.
Waiver of Premium
If you become disabled (as defined by your plan) and are no longer able to work, your premium payments will be waived during the period of disability.
Retained Asset Account
Benefits of $10,000 or more are paid through the Unum Retained Asset Account. This interest bearing account will be established in the beneficiary's name. He or she can then write a check for the full amount or for $250 or more, as needed.
Education Benefit: If you or your insured spouse die within 365 days of an accident, an additional benefit is paid to your dependent child(ren). Your child(ren) must be a full-time student beyond grade 12. (Not available in Illinois or New York.) Seat Belt/Air Bag Benefit: If you or your insured dependent(s) die in a car accident and are wearing a properly fastened seat belt and/or are in a seat with an air bag, an amount will be paid in addition to the AD&D benefit.
Additional AD&D Benefits
Limitations/Exclusions/ Termination of Coverage Life benefits will not be paid for deaths caused by suicide in the first twenty-four months after your effective date of coverage.
Suicide Exclusion
No increased or additional benefits will be payable for deaths caused by suicide occurring within 24 months after the day such increased or additional insurance is effective. AD&D benefits will not be paid for losses caused by, contributed to by, or resulting from:
AD&D Benefit Exclusions
Termination of Coverage
•
Disease of the body or diagnostic, medical or surgical treatment or mental disorder as set forth in the latest edition of the Diagnostic and Statistical Manual of Mental Disorders;
•
Suicide, self-destruction while sane, intentionally self-inflicted injury while sane, or self-inflicted injury while insane;
•
War, declared or undeclared, or any act of war;
•
Active participation in a riot;
•
Attempt to commit or commission of a crime;
•
The voluntary use of any prescription or non-prescription drug, poison, fume, or other chemical substance unless used according to the prescription or direction of your or your dependent’s doctor. This exclusion does not apply to you or your dependent if the chemical substance is ethanol;
•
Intoxication. (“Intoxicated” means that the individual’s blood alcohol level equals or exceeds the legal limit for operating a motor vehicle in the state or jurisdiction where the accident occurred.)
Your coverage and your dependents’ coverage under the Summary of Benefits ends on the earliest of: •
The date the policy or plan is cancelled;
•
The date you no longer are in an eligible group;
•
The date your eligible group is no longer covered;
•
The last day of the period for which you made any required contributions;
•
The last day you are in active employment unless continued due to a covered layoff or leave of absence or due to an injury or sickness, as described in the certificate of coverage;
•
For dependent’s coverage, the date of your death.
In addition, coverage for any one dependent will end on the earliest of: •
The date your coverage under a plan ends;
•
The date your dependent ceases to be an eligible dependent;
•
For a spouse, the date of divorce or annulment.
Unum will provide coverage for a payable claim which occurs while you and your dependents are covered under the policy or plan.
Next Steps How to Apply
If you apply for coverage after your effective date, or if you choose coverage over the guarantee issue amount, you will need to complete a medical questionnaire which you can get from your Plan Administrator. You may also be required to take certain medical tests at Unum’s expense.
Effective Date of Coverage
Please see your Plan Administrator for your effective date.
Delayed Effective Date of Coverage
Employee: Insurance coverage will be delayed if you are not in active employment because of an injury, sickness, temporary layoff, or leave of absence on the date that insurance would otherwise become effective. Dependent: Insurance coverage will be delayed if that dependent is totally disabled on the date that insurance would otherwise be effective. Exception: infants are insured from live birth. “Totally disabled” means that, as a result of an injury, a sickness or a disorder, your dependent is confined in a hospital or similar institution; is unable to perform two or more activities of daily living (ADLs) because of a physical or mental incapacity resulting from an injury or a sickness; is cognitively impaired; or has a life threatening condition.
Changes to Coverage
Each year you and your spouse will be given the opportunity to change your Life coverage and AD&D coverage. You and your spouse may purchase additional Life coverage up to the Guarantee Issue amounts without evidence of insurability if you are already enrolled in the plan. Life coverage over the Guarantee Issue amounts will be medically underwritten and will require evidence of insurability and approval by Unum’s Medical Underwriters. The suicide exclusion will apply to any increase in coverage. AD&D coverage does not require evidence of insurability for increase amounts.
This plan highlight is a summary provided to help you understand your insurance coverage from Unum. Some provisions may vary or not be available in all states. Please refer to your certificate booklet for your complete plan description. If the terms of this plan highlight summary or your certificate differ from your policy, the policy will govern. For complete details of coverage, please refer to policy form number C.FP-1, et al. Life Planning is provided by Ceridian Incorporated. The services are subject to availability and may be withdrawn by Unum without prior notice. Underwritten by: Unum Life Insurance Company of America, 2211 Congress Street, Portland, Maine 04122, www.unum.com Unum is a registered trademark and marketing brand of Unum Group and its insuring subsidiaries. ©2007 Unum Group. All rights reserved.
Supplemental Insurance
Benefits You Receive: These supplemental insurance plans are offered through UNUM at an additional cost to employees. We offer two programs at this time including Accident and Critical Illness. Benefits are paid directly to you. These are individual policies so you can elect to continue your coverage if you retire or change jobs. The rates will vary based on the coverage that you chose. These will be offered through UNUM. A detailed plan summary is outlined on the following pages. Who is Eligible and When: Full time active employees are all eligible for coverage. The coverage is effective the first day of the month following date of hire.
Power Group Companies Group Critical Illness Issue Age Rates Annual Rate per $1000 Without Cancer NonIssue Age Tobacco Tobacco 15 5.76 3.96 25 6.48 3.96 30 9.12 5.04 35 12.96 6.60 40 19.20 9.36 45 25.44 12.24 50 32.40 15.96 55 40.32 20.88 60 50.04 26.88 65 52.92 31.68 70 92.40 61.08
Annual Wellness Rate per $25 Employee and Dependent Children Spouse
GREF Rates
With Cancer NonTobacco Tobacco 10.08 6.60 12.00 7.32 17.04 9.48 24.96 12.96 36.60 18.36 50.52 25.20 67.44 33.24 85.92 43.80 102.96 56.16 107.28 63.12 172.92 113.16
9.60 9.60
Voluntary Workplace Benefits - Accident Insurance Off-Job Plan
Monthly Premiums
Off-Job Plan
These rates are not for use in California or New York Individual $14.30
Family Coverage Options Individual and Spouse One Parent Family $20.41 $29.12
Two Parent Family $35.23
Individual $3.51
Sickness Hospital Confinement Rider Individual and Spouse One Parent Family $7.02 $5.98
Two Parent Family $9.49
May not be available in all states.
This Plan Type is not available in PA.
Version 1.00
Provident Life and Accident Insurance Company 1 Fountain Square, Chattanooga, TN 37402
12/05/2012
Employee Assistance Program The Employee Assistance Program is confidential information, support, and referral service designed to help you cope with everyday problems that have added stress to your life. You and your immediate family members can use these services. Caring, Experienced, Professional… With UNUM Work-Life Balance EAP, you will find caring professionals ready to listen and prepared to help you find ways to solve the problem. Services are free and confidential. The call center is answered live 24 hours a day, 7 days a week for your convenience. We help with:
Childcare and/or eldercare referrals Personal relationship information Health information and online tools Legal consultations with licensed attorneys Financial planning assistance Stress management Career development www.lifebalance.net
The user ID and password are both “lifebalance.” Several resources are available, including balanced life, dependent care, stress, financial, legal, health & wellness, mental health, personal growth and solution centers. You can also call 1-800-8541446.
401k
To help you prepare for the future, Power Group Companies sponsors a 401(k) plan as part of its benefits package. Through payroll deduction, you can make contributions up to 100% of your taxable income not to exceed $17,500 for 2013. If you are over age 50, you can make catch up contributions to the plan. The maximum for 2013 is $5,500. Power Group Companies will make matching contributions, for non-highly compensated employees. They will contribute 50% of the employee’s contribution, up to 6% of eligible compensation. Who is Eligible and When: Full time active employees are eligible for coverage. You must also be 21 years of age and work 1,000 hours annually. The coverage is effective the first day of the month following date of hire. By saving on a before-tax basis, you reduce the taxes you pay today and delay paying taxes on the money you save, as well as your account earnings, until you withdraw the money from the plan. Automatic Enrollment The 401(k) plan includes an automatic salary deferral feature for all new hires. Unless you make an alternative salary deferral election, Power Group will automatically withhold 3% of your compensation from your pay each payroll period and contribute that amount to the Plan as a Pre-Tax 401(k) deferral. You may complete a salary deferral agreement to select an alternative deferral amount or to elect not to defer under the Plan in accordance with the deferral procedures of the Plan. While you are a participant, the automatic deferral amount will increase by 1% per year up to a maximum of 6% of your compensation as of the beginning of each subsequent calendar year.
401k
Company Matching Contributions/Vesting In addition to your contributions, Power Group Companies helps you save by matching the money that you saved based on your years of service. You vest, or gain ownership, in the matching contributions from Power Group Companies based on the schedule below.
Years of Service
Total Amount Vested
1
20%
2
40%
3
60%
4
80%
5
100%