Employee Benefits Guide | 2014
Worksite Wellness Medical Consistant Brand Identity Each guide is branded to your company with your company logo and primary brand color.
Dental Vision Life Insurance Disability Insurance Retirement EAP
MY EMPLOYEE BENEFITS GUIDE Our commitment to you We are dedicated to providing employees with a benefits program that is both comprehensive and competitive. Our program offers a broad range of plan options to meet the needs of our diverse workforce. We know that your benefits are important to you and your family. This program is designed to assist you in providing for the health, well–being and financial security of you and covered dependents. Helping you understand the benefitsbenefits we offer iseducation. essential and Promote employee that is why we have created thisand Benefit guides help reduce confusion Employee Benefits Guide. inform employees about making smart healthcare choices.
It is important to us for our employees to understand the value of their benefits and to be better consumers of all benefits. Benefits guide overview This guide provides a general overview of your benefit choices to help you select the coverage that is right for you. Be sure to make choices that work to your best advantage. The benefits provided to employees may range from reimbursement plans to educational programs, but all benefits plans require employees to assume responsibility for the choices they make and to be informed on how to use their benefits effectively. Please take time to read about and understand the benefit, plan thoughtfully, and enroll on time. It is important to remember that only those benefit programs for which you are eligible and have enrolled in apply to you. We encourage you to review each section and to discuss your benefits with your family members. Be sure to pay close attention to applicable co-payments and deductibles, how to file claims, preauthorization requirements, networks and services that may be limited or not covered (exclusions). The benefits and services offered by B3 Solutions may be changed or terminated at any time. These benefits are not a guarantee of your employment with B3 Solutions. This Guide is designed to help you understand your benefits. Review this material carefully before making your enrollment decisions. Your rights are governed by each plan instrument (which may be a plan document, evidence of coverage, certificate of coverage, or contract), and not by the information in this Guide. If there is a conflict between the provisions of the plan you selected and this Guide, the terms of the plan govern. For detailed information about the plans, contact your health advocate at 866-695-8622.
2
B3 Solutions
ENROLLMENT FAQs
CONTENTS
Making informed benefits choices...
3 Benefits Eligibility 4 Worksite Wellness 5 Online Wellness Resources 6 Medical Insurance 8 Dental Insurance 9 Vision Insurance 10 Basic Life Insurance 10 Voluntary Life Insurance 11 Short-term Disability 11 Long-term Disability 12 Retirement Plan (401k) 14 Healthcare Reform Notices 15 EAP 15 Glossary of Terms 16 Benefit Contacts
Do you have immediate benefit needs or should you consider saving toward future needs? Does someone in your family need chronic care or costly medication that can benefit from a health coach or use of generics? Do you have a primary doctor with whom you can establish a preventive check-up to develop a strategy for better health? Do you want to be able to use pre-tax dollars to pay for qualified medical expenses instead of paying out of pocket? Do you want to cover dependents? Do you want to contribute to a Health Care or Dependent Care Flexible Spending Account (FSA)? If yes, how much would you like to contribute? (Note: in 2014, over-the-counter medications cannot be reimbursed by your FSA unless you have a prescription from a physician.) Do you want to apply for more life or AD&D insurance than what the company already provides, or enroll your spouse or dependent(s)? Do you want to apply for more long-term disability insurance than what the company already provides? Do you want to increase your 401(k) contributions to ensure you and your family live comfortably in retirement?
Are you eligible for benefits?
Offer a Health To determine the benefits for which you may be eligible, please refer to the Advocate Service. chart below. You are eligible to participate in these We plansprovide upon meeting employees each plan’s eligibility requirements. You also have the option to enroll direct access to a registered your eligible dependents in some of these plans.health Eligibleadvocate dependentseducated may in include: their benefits package. • Your spouse • Your children to age 26. Certain limitations apply.
? Questions? Call or email your health advocate. We are on your side and can help now.
Benefit Plan
Full-time Employee Eligible?
New Hire Waiting Period
Medical, Dental & Vision
Yes
Yes
Basic Life and AD&D
Yes
Yes
866-695-8622
Long-term Disability
Yes
Yes
answers@HealthAdvocate.com
Retirement Plan
Yes
Yes
If you (and/ or your dependents) have Medicare or will become eligible for Medicare in the next 12 months, a Federal law gives you more choices about your prescription drug coverage. Please see page 14 for more details. Employee Benefits Guide | 2014
3
WORKSITE WELLNESS
Administered by United Healthcare
Your Health Matters. A focus on your health B3 Solutions cares about the health and wellness of each employee. We hope that all employees will participate in our wellness program. Not only does participation provide great wellness rewards, it also offers ideas and knowledge to help you and your family lead healthier lifestyles.
2014 Wellness Activities
Wellness Reward
Online Wellness Credits
$300 toward HRA
Online Wellness Assessment
$100 toward HRA
Physical Exam
$50 toward HRA
Tobacco Free Affidavit
$25 toward HRA
Colonoscopy, Pap Smear, Mammogram, PSA
$20 toward HRA
United Healthcare Healthy Living programs
$25 to $100 toward HRA
Age and gender eligible
Health Management, Weight Management, Smoking Cessation, Healthy Baby
4
B3 Solutions
ONLINE WELLNESS RESOURCES Health Management Making the lifestyle changes necessary to manage chronic conditions can be difficult. Studies show that by improving your self-management skills and by following your doctor’s plan of care, you can help control your symptoms. Most importantly, you can delay or even prevent many of the complications of common health conditions by taking care of yourself today. Health Management is designed to help members with diabetes, heart disease or chronic respiratory conditions live healthier lives. Family members covered by your health plan can also participate.
The Program BlueCross identifies participants from health care information we receive from medical, pharmacy and laboratory claims. If you are identified as someone who could benefit from the program, you are automatically enrolled. As a participant in the Health Management program, you will receive personalized information and tools tailored to help you learn more about your condition and ways to improve your health.
Once you have completed the survey, you’ll get your Personal Health Assessment right away. It will include information on areas that you need to address. You’ll get tips for lowering risk factors and links to organizations that can provide further support. You will be able to print your report or refer back to it online at any time. You also will be given a wellness score. The score will let you know if you are on the right track to good health. The wellness score and tips provided in your report can help you work with your doctor or other health care professional to develop a strategy that’s right for you!
Take the First Step Taking the Personal Health Assessment is voluntary. We hope you will log on and take advantage of this valuable tool. Our goal is to help you achieve and maintain a healthier lifestyle. Personal Health Assessment is your first step. Personal Health Assessment does not replace the medical care you receive from your doctor. Always check with your doctor before following any medical advice.
Participants are also assigned a personal health coach — a health care professional who will help you learn more about your condition and ways to manage it. You will receive your health coach’s contact information in the mail.
Personal Health Assessment Personal Health Assessment is an online survey that can help you identify your personal risk factors while guiding you toward a healthier lifestyle. It’s Easy to Use! 1. Just go to www.uhc.com/health_and_wellness 2. Click: My Health Toolkit. • New member? Click Register and follow the instructions. You will need your Member ID card. • Already have a profile? Enter your Username and Password and click Login. 3. After you’ve logged into My Health Toolkit, click on the Personal Health Assessment link located on the left. (Be sure to first select your name from the drop-down menu.) 4. A new window will appear. Click on Take Personal Health Assessment to begin. 5. Read the Privacy Statement and agree by clicking Continue. 6. To complete the Personal Health Assessment, answer the questions on each page and click Continue. After answering the last series of questions, click on the Download/View link to view your results. If you are not able to finish the assessment, click Save and Exit. When you are ready to return, repeat the instructions above to begin where you left off.
Employee wellness advocacy. Provide health & wellness resources and initiate a worksite wellness program.
Employee Benefits Guide | 2014
5
MEDICAL BASE PLAN
Administered by United Healthcare
In-Network
Out-of-Network
$2,000 / $6,000
$4,000 per individual
$3,000 / $6,000
$6,000 / $12,000
$20 copay per visit
Deductible, then 50%
$0
Deductible, then 50%
$35 copay per visit
Deductible, then 50%
Deductible, then 20%
Deductible, then 50%
$20 copay per visit
Deductible , then 50%
Routine Screening Mammogram
$0
Deductible , then 50%
Routine Screening Colonoscopy
$0
Deductible , then 50%
$35 first visit, then 20%
Deductible , then 50%
Deductible, then 20%
Deductible, then 50%
$150 per visit, then 20%
$150 per visit, then 20%
Urgent Care
$20 copay per visit
Deductible, then 50%
Prescription Drugs (no max per benefit period)
Retail - 31 day supply
Mail - 90 day supply
Annual Deductible Individual / Family Maximum Coinsurance per Benefit Period Individual / Family Physician Office Visits Primary Care (Routine & Preventive) Primary Care Hospital Services Specialist Emergency Room Care Other Routine Care GYN Exam
Maternity Care Routine Maternity Physician Services Outpatient/Ambulatory Care Facilities All Services (including maternity) Emergency Room Services
6
Generic drug and designated over-the-counter drug
$8 copay
$16 copay
Preferred Brand
$35 copay
$70 copay
Non-Preferred Brand
$55 copay
$110 copay
B3 Solutions
Coverage Tier - Base Plan
Employee Premium
Employee Only
$80.00
Employee + Spouse
$375.50
Employee + Child(ren)
$297.00
Employee + Family
$474.00
MEDICAL BUY-UP PLAN
Administered by United Healthcare
In-Network
Out-of-Network
$500 / $1,500
$1,000 per individual
$3,000 / $6,000
$6,000 / $12,000
$10 copay per visit
Deductible, then 40%
$0
Deductible, then 40%
$20 copay per visit
Deductible, then 40%
Deductible, then 20%
Deductible, then 40%
$20 copay per visit
Deductible , then 40%
Routine Screening Mammogram
$0
Deductible , then 40%
Routine Screening Colonoscopy
$0
Deductible , then 40%
$20 first visit, then 20%
Deductible , then 40%
Deductible, then 20%
Deductible, then 40%
$150 per visit, then 20%
$150 per visit, then 20%
Urgent Care
$20 copay per visit
Deductible, then 40%
Prescription Drugs (no max per benefit period)
Retail - 31 day supply
Mail - 90 day supply
Annual Deductible Individual / Family Maximum Coinsurance per Benefit Period Individual / Family Physician Office Visits Primary Care (Routine & Preventive) Primary Care Hospital Services Specialist
Clear communication. Accurately and concisely illustrate the summary of benefits and the employee’s cost contribution.
Emergency Room Care Other Routine Care GYN Exam
Maternity Care Routine Maternity Physician Services Outpatient/Ambulatory Care Facilities All Services (including maternity) Emergency Room Services
Generic drug and designated over-the-counter drug
$8 copay
$16 copay
Preferred Brand
$35 copay
$70 copay
Non-Preferred Brand
$55 copay
$110 copay
Coverage Tier - Buy-up Plan
Employee Premium
Employee Only
$110.00
Employee + Spouse
$475.50
Employee + Child(ren)
$397.00
Employee + Family
$624.00 Employee Benefits Guide | 2014
7
DENTAL PLAN Plan benefits coverage detail
Administered by Guardian
Percent paid
Program Maximums/Deductibles Deductible $50 $1,500 annual maximum for Preventive, Basic and Major services combined, subject to Maximum Rollover. Diagnostic/Preventative Services (No Deductible) Emergency Palliative Treatment Fluoride Treatments - every 6 months Oral Examination - every 6 months Periodontal Maintenance Procedure - every 3 months Space Maintainers for Children - under age 16 Teeth Cleaning - every 6 months Topical Sealants for unrestored molar teeth (one treatment per child under 16 in a 3 year period) X-Rays - four bitewings every 12 months X-Rays - full mouth series every five years
100%
Basic Service (After Deductible) Crowns: Stainless Steel Diagnostic Consultation- one per year Fillings: Amalgam & Anterior Composites General Anesthesia- surgical procedures only Injectable Antibiotics- for treatment of a dental condition only Laboratory Test Oral Surgery- Uncomplicated extractions/Complex extractions
80%
Major Service (After Deductible) Bridges Installation-fixed and removable Crowns: Resin, Metal Endodontic Services/Root Canal Therapy Repairs of dentures, bridgework, crowns, etc. Dental Implants Scaling & Root Planning Dentures- Full and Partial Inlays, Onlays, & Veneers Periodontal Services (other than Periodontal Maintenance Procedure)
50%
Orthodontics $1,000 lifetime maximum for child(ren) under age 19 The deductible does not apply to Orthodontic services Orthodontic services are not subject to Maximum Rollover
8
B3 Solutions
50%
Coverage Tier
Employee Premium
Employee Only
$7.00
Employee + Spouse
$15.00
Employee + Child(ren)
$18.00
Employee + Family
$22.00
VISION PLAN
Administered by VSP Vision Care
Plan benefits coverage detail WellVision Exam¨ focuses on your eye health and wellness • $10 copay...............................................................................................every 12 months Prescription Glasses • $25 copay Lenses..........................................................................................................every 12 months • Single vision, lined bifocal and lined trifocal lenses. • Polycarbonate lenses for dependent children. Frame...........................................................................................................every 24 months • $130 allowance for frame of your choice. • 20% off amount over your allowance ~OR~ Contact Lens Care • NO copay.....................................................every 12 months $130.00 allowance for contacts and the contact lens exam (fitting and evaluation). This additional exam ensures proper fit of contacts. If you choose contact lenses you will be eligible for a frame 12 months from the date the contact lenses were obtained. Current soft contact lens wearers may qualify for a special program that includes a contact lens evaluation and initial supply of replacement lenses. Extra Discounts and Savings Glasses and Sunglasses • Average 30% savings on lens options like progressives and scratch-resistant and anti-reflective coatings • 20% off additional glasses and sunglasses, including lens options Contacts* • 15% off cost of contact lens exam (fitting and evaluation) *Available from any VSP doctor within 12 months of your last eye exam
Keep your eyes healthy & your vision clear Welcome to VSP Vision Care. We’ll help keep you and your eyes healthy through personal care from a doctor you can trust. Your eyes say a lot about you and can even tell your doctors about you. During your WellVision Exam, your doctor will look for vision problems and signs of health conditions too. FIND a doctor that’s right for you. You will have plenty to choose from by visiting www.vsp.com or calling 1-800-877-7195. ALREADY have a VSP doctor? Make an appointment today and tell them you are a VSP member. CHECK out your coverage savings. Visit www.vsp.com to see your benefits anytime or to view how much money you have saved with VSP after your appointment.
Laser Vision Correction • Average 15% off the regular price or 5% off the promotional price from contracted facilities • After surgery, use your frame allowance (if eligible) for sunglasses from any VSP doctor.
Coverage Tier
Employee Premium
Employee Only
$4.10
Employee + Spouse
$6.50
Employee + Child(ren)
$6.65
Employee + Family
$10.50 Employee Benefits Guide | 2014
9
LIFE INSURANCE
Administered by Prudential
Basic Life Insurance primary benefits Employee Benefit Amount................................................................................................................................................................................................................ $20,000 AD&D...................................................................................................................................................................................................................................... $20,000 Benefit Reductions....................................................................................................................................................................................................35% at age 65 50% at age 70 Plan Maximum........................................................................................................................................................................................................................ $20,000 Termination.................................................................................................................................................................................................................. At Retirement Accelerated Death Benefit............................................................................................................................................................................... 90% to $20,000 Guarantee Issue....................................................................................................................................................................................................................... $20,000
Voluntary Life Insurance primary benefits Benefit Plan Type ...........................................................................................................................................................................................................Incremental Coverage in Increments of............................................................................................................................................................................................... $10,000 Minimum Amount Available........................................................................................................................................................................................... $10,000 Maximum Coverage Available.............................................................................................................................. Lesser of 5x Earnings or $500,000 Guaranteed Issue Amount............................................................................................................................................................................................ $100,000 Age Reduction Schedule..................................................................................................................................................................................... 35% @ age 65, 50% @ age 70 Waiver of Premium Provision.................................................................................................................................................................. Applies, to Age 65 Termination.................................................................................................................................................................................................................. At Retirement Accelerated Benefit Option........................................................................................................................................................................... 90% to $500,000 Accelerated Benefit Option Type......................................................................................................................................... 12 Month life expectancy Portability...................................................................................................................................................................................................................................... Applies Actively At Work Provision................................................................................................................................................................................................. Applies Annual Increase w/out medical evidence max.......................................... lesser 4 increments/salary multiples flat dollar amount Maximum Dollar Amount................................................................................................................................................................................................. $40,000
How much does this insurance cost? Employee & Spouse Monthly Rates Age Bracket Per $1,000 Under age 20 ..................................................................................$0.070 20 - 24.................................................................................................. $0.070 25 - 29.................................................................................................. $0.070 30 - 34.................................................................................................. $0.084 35 - 39.................................................................................................. $0.126 40 - 44.................................................................................................. $0.140
Age Bracket Per $1,000 45 - 49.................................................................................................. $0.210 50 - 54.................................................................................................. $0.322 55 - 59.................................................................................................. $0.602 60 - 64.................................................................................................. $.0924 65 - 69.................................................................................................. $1.778 70+........................................................................................................ $2.884
Child Rates 14 days - 19 years of age up to 25 for full time students........................................................................................................... $.070 Per $1,000
10
B3 Solutions
DISABILITY INSURANCE
Administered by Prudential
Short-term Disability primary benefits Coverage Begins
After completing 90 days of continuous full time active employment 8th day non-occupational accidental injury
Benefit Begins
8th day non-occupational sickness 60% of weekly earnings, to a maximum of $1,000 per week Benefit paid biweekly Your STD benefits may be reduced by the amount of other income replacement benefits you receive for the same disability, such as benefits from state-mandated disability plans or Worker’s Compensation, etc. However, the minimum weekly benefit is $25.
Benefit Amount
MAXIMUM PAYMENT PERIOD: 12 WEEKS (90 days)
Long-term Disability primary benefits Benefit Begins
Integrated following 90 days of STD coverage 60% of monthly earnings, to a maximum of $12,500 per month Benefit paid monthly
Benefit Amount
Your LTD benefits may be reduced by the amount of other income replacement benefits you receive for the same disability, such as benefits from state-mandated disability plans or Worker’s Compensation, etc. However, the minimum weekly benefit is $25. MAXIMUM PAYMENT PERIOD: To age 70 (extended benefits past age 70 for at least 1 year)
When am I considered disabled?
Long term disability is employer paid
You are disabled when The Plan determines that due to your sickness or injury you are unable to perform the material and substantial duties of your regular occupation and you are not working in any occupation.
This benefit is fully paid by B3 Solutions. This benefit will be taxable to the employee when the employee receives benefits.
What is an elimination period? The Elimination Period is the length of time of continuous disability which must be satisfied before you are eligible to receive benefits. For Short term Disability, if your disability is the result of an injury that occurs while you are covered under the plan, your Elimination Period is 7 days. If your disability is due to a sickness, your Elimination Period is also 7 days. Your Long term Disability benefit begins following 90 days of Short term Disability and will take over where your Short term Disability benefit left off.
Partial disability The Plan will allow an employee to work in a part-time capacity (i.e. as long as there is at least a 20% earnings loss) and still receive LTD benefits. Your LTD benefit would be offset by your part-time earnings after one year of partial disability.
Termination of benefits Long Term Disability benefits will terminate on your last day of full-time employment.
Employee Benefits Guide | 2014
11
RETIREMENT PLAN
Administered by Lincoln Financial
Eligibility
Employer
You will be eligible to make Elective Deferrals when you complete one month of service. You will be eligible for any Safe Harbor employer contributions when you have completed 12 consecutive months of Service without a Break In Service.
Each year at the discretion of the employer, a safe harbor matching contribution of 100% of your elective deferrals up to 3% of your compensation, and 50% of elective deferrals between 3% and 5% of your compensation may be made.
For more information, please refer to the Summary Plan Description and the Plan Document.
The employer may make an additional profit sharing or matching contribution. Additional eligibility requirements may apply to these contributions. These contribution amounts are subject to change upon notice from the Employer.
Entry Dates January 1st, April 1st, July 1st and October 1st
Employee For the 2014 Plan Year, you may Contribution contribute up to $16,500 ($22,000 if Amounts you will attain age 50 during the plan year) of your gross compensation. The amounts you defer cannot be forfeited or taken away from you under any circumstances.
Vesting You will become vested in your non-Safe Harbor employer contribution accounts according to the following schedule: Years of Service
Vesting %
1 .............................................................................................................. 0% 2 ............................................................................................................ 20%
Rollover
3 ............................................................................................................ 40%
If you participated in another qualified retirement plan (401(k), profit sharing and/or money purchase), 403(b) plan, or 457 plan before you were employed by us, or if you have an Individual Retirement Account (IRA), you can roll distributions made to you from that plan into this Plan, excluding any after-tax contributions, provided that you have met all legal requirements for a rollover. Please contact your plan administrator for more information on rollover contributions. You will always be 100% vested in any rollovers.
4 ............................................................................................................ 60% 5 ............................................................................................................ 80% 6 ......................................................................................................... 100% Credit for vesting will be given for Years of Service with the company based on your original date of hire.
Beneficiary You may change your beneficiary designation at any time by completing a new Beneficiary Designation Form and sending it to your company. If you are married, your spouse will be named as your beneficiary unless, with your spouse’s consent, you designate another on your Beneficiary Designation Form.
Designation Contributions: Hardship The Plan allows for a distribution of your Vested Account balance for hardship reasons, which are defined in the Plan document as unreimbursed medical expenses; post-secondary education for yourself, your spouse and/or your children; the financing of a primary residence; funeral expenses for a member of your family; substantial rehabilitation and repair to a primary residence; and prevention of eviction or foreclosure.
Withdrawals Contributions: Your hardship distribution will be taxable as ordinary income in the year you receive it. If you have not attained age 59, the distribution may also be assessed a 10% penalty tax.
12
B3 Solutions
EMPLOYEE ASSISTANCE PROGRAM First Sun counselors are available to assist you and all family members who are eligible for company health care benefit issues, addiction, family issues, or life transition issues, assistance is just a phone call away. In addition to these services, each eligible person may also use up to three (3) of the following life management services. • Telephonic Legal Consultation • Family Financial Counseling • Adult care Consultation • Childcare Services • School Assistance • College Assistance • Adoption Assistance First Sun EAP offers web-based information, articles, selfassessments, and streaming videos that focus on a wide range of behavioral health topics. Information about financial
GLOSSARY OF TERMS Coinsurance - a percentage of an eligible expense that you are required to pay for a covered service. Deductible - the amount you must pay before the Plan begins to pay benefits. Explanation of Benefits (EOB) - after you or your provider submit a claim, an explanation will be sent to you that will give you claims payment information, including the amount paid to the provider and any amount you may owe. If a deductible and/or coinsurance applies, the amount applied to your deductible and out-of-pocket maximum will also be shown. Network - The providers and facilities contracted with to render health care to members. Members receiving innetwork care generally obtain a higher level of benefits. Out-of-Pocket Expense - the annual maximum limit you may pay for covered expenses. After your share of eligible expenses (deductible and coinsurance) reaches a certain limit, the Plan will pay 100 percent (unless balance billing applies) of most covered medical expenses for a covered plan member for the remainder of the calendar year. Out-of-pocket maximum - the most you pay in coinsurance during a benefit plan year. After you reach your out-of-pocket maximum, your medical plan option pays 100% of eligible expenses for the remainder of the benefit plan year.
Administered by First Sun EAP
Benefits
In-Network
Individual & Family Counseling Visits 1-3
$0
Life Management Services 3 Visits
$0
planning and financial calculators are also available online. Use your company name as your password and login name to access the website. These services are confidential to the fullest extent of the law.
Please call: 1-800-968-8143 If you have any questions or need additional materials.
Provide employee education resources. A glossary of healthcare terms is a handy tool for any employee in need of defining common healthcare jargon. Primary care physician (PCP) - a family practitioner, general practitioner, internist or pediatrician who provides care and coordinates your medical treatment. Network PCPs meet qualification standards and are subject to periodic review. In-network Provider - A physician, hospital or other health care provider that joins a managed care plan and provides services based on negotiated fees. Generally, using an in-network provider will save you money in the form of copayments, lower deductibles and a higher reimbursement level, and the provider will file claims for you. Out-of-network Provider - An out-of-network provider does not participate in the plan and therefore charges a nondiscounted fee. Payments for out-of-network services are based on your benefit plan and maximum allowable charges. Also your portion of the coinsurance and your deductible will be higher when you go out of network for services. When you visit an out-of-network provider, in most cases, you may need to file a claim for reimbursement. Many providers who are not members of the network will file claims for you, but not all out-of-network providers perform this service. If you use an out-of-network provider, be sure to talk with the provider’s staff about whether you or the provider will file your claim.
Employee Benefits Guide | 2014
13
IMPORTANT LEGAL NOTICES IMPORTANT NOTICE FROM B3 SOLUTIONS ABOUT YOUR PRESCRIPTION DRUG COVERAGE AND MEDICARE Please read this notice carefully and keep it where you can find it. This notice has information about your current prescription drug coverage with B3 Solutions 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: 1. 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. 2. B3 Solutions has determined that the prescription drug coverage offered by the BlueChoice Health Plan is, 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 B3 Solutions coverage will not be affected. If you do decide to join a Medicare drug plan and drop your current B3 Solutions coverage, be aware that your dependents will not be able to get this coverage back until the next enrollment period unless you experience a qualified life event. Note that your current coverage pays for other health expenses, in addition to prescription drugs, and you will still be eligible to receive all of your current health and prescription drug benefits if you choose to enroll in a Medicare prescription drug plan and
14
B3 Solutions
keep your coverage under the B3 Solutions Plan. 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 B3 Solutions 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. Summary of Options for Medicare Eligible Employees (and/ or Dependents) Medical and prescription drug coverage are offered as a package under the B3 Solutions plan (you cannot elect medical coverage without prescription drug coverage). 1. Continue medical and prescription drug coverage under the B3 Solutions Plan and do not elect Medicare D coverage. Impact – your claims continue to be paid by the B3 Solutions plan. 2. Continue medical and prescription drug coverage under the B3 Solutions plan and elect Medicare D coverage. Impact - As an active employee (or dependent of an active employee) the B3 Solutions plan continues to pay primary on your claims (pays before Medicare D). 3. Drop the B3 Solutions plan coverage and elect Medicare Part D coverage. Impact – Medicare is your primary coverage. You will not be able to rejoin the B3 Solutions plan until the next open enrollment period unless you experience a qualified life event. For More Information About This Notice Or Your Current Prescription Drug Coverage… Contact the person listed below for further information. 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 B3 Solutions changes. You also may request a copy of this notice at any time. For More Information About Your Options Under Medicare Prescription Drug Coverage… 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 (1800-633-4227). TTY users should call 1-877486-2048. 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).
NOTICE REGARDING THE WOMEN’S HEALTH AND CANCER RIGHTS ACT On October 21, 1998, Congress passed a bill called the Women’s Health and Cancer Rights Act. This new law requires group health plans that provide coverage for mastectomy to provide coverage for certain reconstructive services. These services include: •Reconstruction of the breast upon which the mastectomy has been performed, •Surgery/reconstruction of the other breast to produce a symmetrical appearance, •Prostheses, and •Treatment of physical complications during all stages of mastectomy, including lymphedemas. In addition, the plan may not: •Interfere with a woman’s rights under the plan to avoid these requirements, or •Offer inducements to the health provider, or assess penalties against the health provider, in an attempt to interfere with the requirements of the law. However, the plan may apply deductibles and copays consistent with other coverage provided by the plan. If you have any questions about the current plan coverage, please contact HR.
REPORT ELIGIBILITY CHANGES IN A TIMELY MANNER It is your responsibility to notify the Benefits Department when a dependent becomes eligible or ceases to be eligible for coverage under our benefit plans. All eligibility changes should be reported within 30 days of the event. Failure to report changes in a timely manner can impact your ability to add newly eligible dependents or discontinue pre-tax premium contributions on ineligible dependents. In addition, failure to report a loss of eligibility due to legal separation or divorce or a dependent that has otherwise ceased to be
IMPORTANT LEGAL NOTICES eligible, such as a child reaching the maximum dependent child age limit, can impact your dependent’s rights for group health plan coverage under the federal law known as COBRA. If you fail to report the loss of eligibility within 60 days of the event, your dependents may be left with no continuation coverage under our plan. Please see your COBRA notice or your group health plan summary plan description for additional information.
NEWBORNS’ AND MOTHERS’ HEALTH PROTECTION ACT (NMHPA) 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 child 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 insurers may not, under Federal law, require that a provider obtain authorization from the plan or the insurer for prescribing a length of stay not more than 48 hours (or 96 hours). B3 Solutions Initial Notice of Group Health Plan’s Pre-existing condition limitation This plan imposes a pre-existing condition exclusion. This means that if you have a medical condition before coming to our plan, you might have to wait a certain period of time before the plan will provide coverage for that condition. this exclusion applies only to conditions for which medical advice, diagnosis, care, or treatment was recommended within a six-month period. Generally this six-month period ends the day before your coverage begins. The pre-existing condition exclusion does not apply to pregnancy nor to an individual under age 19. This exclusion may last up to 12 months (18 months if you are a late enrollee) from your first day of coverage, or, if you were in a waiting period, from the first day of your waiting period. However, you can reduce the length of this exclusion period by the number of days of your prior “creditable coverage.” Most prior health coverage is creditable coverage and can be used to reduce the preexisting condition exclusion if you have not experienced a break in coverage of at least 63 days. To reduce the 12- month (or 18- month) exclusion period by your creditable coverage, you should give us a copy of any certificates of creditable coverage that you have. If you do not have a certificate, but you do have prior health coverage, we will help you obtain one from your prior plan or issuer. There are also other ways that you can show you have creditable coverage. Please contact us if you need help demonstrating creditable coverage. All questions about the pre-existing condition exclusion and creditable coverage should be directed to Human Resources.
HIPAA SPECIAL ENROLLMENT RIGHTS Loss of Other Coverage- If you are declining enrollment for yourself and/or your dependents (including your spouse) because of other health insurance coverage or group health plan coverage, you may be able to enroll yourself and/or your dependents in this plan if you or your dependents lose eligibility for that other coverage or if the employer stops contributing towards your or your dependent’s coverage. You will be required to submit a signed statement that this other coverage as the reason for waiving enrollment originally. To be eligible for this special enrollment opportunity you must request enrollment within 30 days after your other coverage ends or after the employer stops contributing towards the other coverage. New Dependent as a Result of Marriage, Birth, Adoption or Placement for Adoption- If you have a new dependent as a result of marriage, birth, adoption or placement for adoption, you may be able to enroll yourself and/or your dependent(s). To be eligible for this special enrollment opportunity you must request enrollment within 30 days after the marriage, birth, adoption or placement for adoption. Medicaid Coverage- The B3 Solutions group health plan will allow an employee or dependent who is eligible, but not enrolled for coverage, to enroll for coverage if either of the following events occur: 1. TERMINATION OF MEDICAID OR CHIP COVERAGE- If the employee or dependent is covered under a Medicaid plan or under a State child health plan (SCHIP) and coverage of the employee or dependent under such a plan is terminated as a result of loss of eligibility. 2. ELIGIBILITY FOR PREMIUM ASSISTANCE UNDER MEDICAID OR CHIP- If the employee or dependent becomes eligible for premium assistance under Medicaid or SCHIP, including under any waiver or demonstration project conducted under or in relation to such a plan. This is usually a program where the state assists employed individuals with premium payment assistance for their employer’s group health plan rather than direct enrollment in a state Medicaid program.
If you or your dependents are already enrolled in Medicaid or CHIP and you live in a State listed below, you can contact your State Medicaid or CHIP office to find out if premium assistance is available. If you or your dependents are NOT currently enrolled in Medicaid or CHIP, and you think you or any of your dependents might be eligible for either of these programs, you can contact your State Medicaid or CHIP office or dial 1-877-KIDS NOW or www.insurekidsnow. gov to find out how to apply. Once it is determined that you or your dependents are eligible for premium assistance under Medicaid or CHIP, you must request coverage within 60 days of being determined eligible for premium assistance. You should contact your State for further information on eligibility. To see if any more States have added a premium assistance program since July 31, 2011, or for more information on special enrollment rights, you can contact either: U.S. Department of Labor U.S. Employee Benefits Security Administration www.dol.gov/ebsa 1-866-444-EBSA (3272) Department of Health and Human Services Centers for Medicare & Medicaid Services www.cms.hhs.gov 1-877-267-2323, Ext. 61565
HIPAA PRIVACY NOTICE Protecting Your Health Information Privacy Rights. The Plan’s policies protecting your privacy rights and your rights under the law are described in the Plan’s Notice of Privacy Practices. Please contact your medical plan carrier to request a copy of the Notice.
To be eligible for this special enrollment opportunity you must request coverage under the group health plan within 60 days after the date the employee or dependent becomes eligible for premium assistance under Medicaid or SCHIP or the date you or your dependent’s Medicaid or state-sponsored CHIP coverage ends. To request special enrollment or obtain more information, please contact the HR Department. PREMIUM ASSISTANCE UNDER MEDICAID AND THE CHILDREN’S HEALTH INSURANCE PROGRAM (CHIP) If you are eligible for health coverage but are unable to afford the premiums, some States have premium assistance programs that can help pay for coverage.
Stay in compliance. Provide the required legal and healthcare reform notices for your employees... Accurate and up-to-date.
B3 SOLUTIONS INITIAL NOTICE OF YOUR
Employee Benefits Guide | 2014
15
BENEFIT CONTACTS
Make it easy. Provide carrier and benefit provider contact information with group #s when available.
Medical Plan
Short Term Disability
United Healthcare 866-633-2446 www.myuhc.com Group#: 1236542
Prudential 1-800-524-0542 www.prudential.com
Dental Plan
Prudential 1-800-524-0542 www.prudential.com
Guardian 1-(800) 529-3268 www.guardiananytime.com Group#: 12691211
Vision Plan VSP Vision Care 1-800-877-7195 www.vsp.com
Basic Life Insurance Prudential 1-800-524-0542 www.prudential.com
Voluntary Life Insurance Prudential 1-800-524-0542 www.prudential.com
Long Term Disability
Retirement Plan Lincoln Financial www.lfg.com
EAP First Sun EAP 1-803-376-2668 1-800-968-8143 www.firstsuneap.com
Benefits Hotline Health Advocate 866-695-8622 answers@HealthAdvocate.com